Factors associated with enrollment, adherence, and retention in a remotely delivered tobacco cessation randomized...

Remote tobacco cessation trials can expand access, yet enrollment, adherence, and retention remain challenging. This study aimed to identify individual- and neighborhood-level factors associated with enrollment, adherence, and retention in a two-arm, remotely delivered tobacco cessation randomized controlled trial (RCT). We conducted a secondary analysis of data from RCT NCT05277831.

Adults who smoke were recruited between October 2022 and July 2024 through quitlines, recruiting firms, and community outreach conducted in Arizona, New York, and West Virginia. Participants were block-randomized to a behavioral cessation intervention or behavioral plus guided imagery intervention. Data were collected using online, self-reported questionnaires. Outcomes included enrollment (Session 1 completion), adherence (≥4/6 sessions), and 3 month retention, using multivariable logistic regression estimated adjusted odds ratios (AORs) for demographic, clinical, and neighborhood disadvantage covariates.

Of 1595 randomized participants, 1209 enrolled (75.8%), 914 (75.6%) were adherent, and 1046(86.5%) were retained at 3 months. The sample (mean age 50 years) was predominantly female (65%) and White (77%); about 35% had high school or lower education. Enrollment was lower among males (AOR=0.76; 95% CI: 0.60-0.97, p=0.03) those with lower education (AOR=0.74; 95% CI: 0.57-0.96, p=0.03), and those from more disadvantaged neighborhoods (AOR=0.99; 95% CI: 0.98-0.99, p=0.02). Adherence was higher with older age (AOR=1.02; 95% CI: 1.01-1.03, p=0.003), but lower with multiple household smokers (AOR=0.90; 95% CI: 0.82-1.00, p=0.05). Non-English primary language (AOR=0.36; 95% CI: 0.14-0.92, p=0.03), having more than one household smoker (AOR=0.88; 95% CI: 0.79-0.98, p=0.02), lack of a high school education (AOR=0.39; 95% CI: 0.23-0.65, p<0.001), and substance use (AOR=0.40; 95% CI: 0.2-0.81, p=0.01) were all associated with lower retention.

Sociodemographic factors influenced enrollment, adherence, and retention, highlighting the importance of continued research to better understand and address engagement challenges in remotely delivered cessation studies.