Users can receive additional messages on demand by texting specific keywords that signify their needs (eg, MOOD if they are experiencing a negative mood, CRAVE if they have a craving, or SLIP if they have smoked a cigarette).
Throughout the program, users receive messages that assess their smoking status (eg, “Did you smoke today? Reply YES or NO” ), craving level (eg, “What’s your craving level? Reply with: HI, MED, or LOW”), and mood status (eg, “How is your mood? Reply GOOD, OK, or BAD”). Messages also contain links to relevant pages on the Smokefree website and promote social support through Smokefree social media pages (eg, Facebook). Starting on the quit date, the 6-week intervention comprises 1 to 5 SMS text messages each day, including behavioral intervention and social support messages that target smoking cessation goals. Depending on when users set their quit date, they can receive up to 2 weeks of preparation messages leading up to that date. At the time of enrollment, users are prompted to set a quit date within 2 weeks of enrollment.
SMOKEFREE TEXT MESSAGING PROGRAM CODE
Individuals can enroll in SmokefreeTXT through the Smokefree website or by texting a keyword to a short code (QUIT to 47848). SmokefreeTXT also refers program users to Smokefree web resources for more detailed smoking cessation information, as well as to the National Network of Tobacco Cessation Quitlines and the NCI Cancer Information Service. SmokefreeTXT comprises 6 to 8 weeks of SMS text messages that provide cessation motivation, tips on preparing to quit, advice on managing cravings, quit smoking facts, and recognition of cessation milestones. In 2020, a total of 32,633 new users were enrolled in the SmokefreeTXT program designed for general adult smokers. The program was developed by a team of mobile technology specialists and clinical psychologists with expertise in tobacco cessation. SmokefreeTXT is a free, publicly available, fully automated SMS text message–based smoking cessation program introduced in 2011 by the NCI. We also investigate potential differences in program experience between users who completed the SmokefreeTXT program and those who opted out of the program before completion. Specifically, we conducted qualitative interviews with real-world users (ie, who were not part of an existing research study) of the National Cancer Institute’s (NCI) publicly available SmokefreeTXT program to understand perceptions about program structure and content, engagement with specific program features, and perceived utility of the program for smoking cessation. To address these gaps, we explore the experiences of real-world users of a publicly available smoking cessation program (SmokefreeTXT).
Moreover, prior studies have been conducted with participants who remained in the cessation SMS text messaging program under study for the entirety of the program, and the experiences of users who opted out of the program before completion were not investigated. However, these studies have primarily been conducted as part of existing cessation trials or with specific populations such as women with pregnancies. The few qualitative studies that exist on this topic have found high levels of acceptability toward SMS text message–based cessation programs, and participants have reported that they appreciate the convenience and emotional support that these programs offer.
Given the popularity of these programs, pervasive ownership and use of mobile phones in the United States (97% of US adults report owning a mobile phone), and opportunities to reach underserved populations with mHealth smoking cessation programs, it is important to continually optimize these programs.ĭespite the demonstrated efficacy of SMS text message–based smoking cessation programs in quantitative evaluations, qualitative studies of user experiences with SMS text message cessation programs are scarce. A type of mHealth intervention with demonstrated efficacy for smoking cessation is an SMS text messaging–based cessation program. mHealth interventions also provide anonymity and real-time support, reaching users from the convenience of their mobile devices at any place or time of day. Mobile health (mHealth) smoking cessation platforms (eg, mobile phones, smartphones, and tablets) can be beneficial to the cessation process, as they can reduce barriers (eg, time commitment and access limitations) associated with traditional modalities and have been found to facilitate smoking abstinence. Although evidence-based approaches, such as smoking cessation counseling and pharmacological cessation aids, can support cessation, they are underused. In 2019, the prevalence of cigarette smoking among US adults was 13.7%. Although cigarette smoking rates have declined over time, smoking remains the leading preventable cause of death in the United States.