Feasibility and Acceptability of a Text Message-Based Smoking Cessation Program for Young Adults in Lima, Peru: Pilot Study

Abstract

BackgroundIn Peru’s urban communities, tobacco smoking generally starts during adolescence and smoking prevalence is highest among young adults. Each year, many attempt to quit, but access to smoking cessation programs is limited. Evidence-based text messaging smoking cessation programs are an alternative that has been successfully implemented in high-income countries, but not yet in middle- and low-income countries with limited tobacco control policies.ObjectiveThe objective was to assess the feasibility and acceptability of an short message service (SMS) text message-based cognitive behavioral smoking cessation program for young adults in Lima, Peru.MethodsRecruitment included using flyers and social media ads to direct young adults interested in quitting smoking to a website where interested participants completed a Google Drive survey. Inclusion criteria were being between ages 18 and 25 years, smoking at least four cigarettes per day at least 6 days per week, willing to quit in the next 30 days, owning a mobile phone, using SMS text messaging at least once in past year, and residing in Lima. Participants joined one of three phases: (1) focus groups and in-depth interviews whose feedback was used to develop the SMS text messages, (2) validating the SMS text messages, and (3) a pilot of the SMS text message-based smoking cessation program to test its feasibility and acceptability among young adults in Lima. The outcome measures included adherence to the SMS text message-based program, acceptability of content, and smoking abstinence self-report on days 2, 7, and 30 after quitting.ResultsOf 639 participants who completed initial online surveys, 42 met the inclusion criteria and 35 agreed to participate (focus groups and interviews: n=12; validate SMS text messages: n=8; program pilot: n=15). Common quit practices and beliefs emerged from participants in the focus groups and interviews informed the content, tone, and delivery schedule of the messages used in the SMS text message smoking cessation program. A small randomized controlled pilot trial was performed to test the program’s feasibility and acceptability; nine smokers were assigned to the SMS text message smoking cessation program and six to a SMS text message nutrition program. Participant retention was high: 93% (14/15) remained until day 30 after quit day. In all, 56% of participants (5/9) in the SMS text message smoking cessation program reported remaining smoke-free until day 30 after quit day and 17% of participants (1/6) in the SMS text message nutrition program reported remaining smoke-free during the entire program. The 14 participants who completed the pilot reported that they received valuable health information and approved the delivery schedule of the SMS text messages.ConclusionsThis study provides initial evidence that a SMS text message smoking cessation program is feasible and acceptable for young adults residing in Lima.

The Feasibility of Implementing Text Messaging System to Support Smoking Cessation for Smokers in Hanoi

“…Although the result of quitting is not the main objective in this study, there are still 8 participants who completely quit smoking cigarettes/water-pipe tobacco (20%), 6 participants who quit smoking cigargettes,but still smoked water-pipe tobacco (15%). Our results are similar to those carried out in some other countries in the world [12] and [14]. After 6 weeks of intervention, 65% still smoked.…”

Smoking Cessation Mobile Interventions in Latin America: A Systematic Review

“…In terms of the study population, three studies included the general adult population (Chaves & Oyama, 2008;Cupertino, Cartujano-Barrera, Perales et al, 2019;Cupertino, Cartujano-Barrera, Ramírez et al, 2019), two studies focused on hospitalized adults (Cruvinel et al, 2019;de Azevedo et al, 2010), one study focused on adults with chronic conditions (Cupertino et al, 2020), and another study focused on young adults (Blitchtein-Winicki et al, 2017) Cruvinel et al, 2019;Cupertino, Cartujano-Barrera, Perales et al, 2019;Cupertino, Cartujano-Barrera, Ramírez et al, 2019;Cupertino et al, 2020), and Day 30 (one study; Blitchtein-Winicki et al, 2017) abstinence rates. Six studies used intention-to-treat analysis (Blitchtein-Winicki et al, 2017;Chaves & Oyama, 2008;Cruvinel et al, 2019;Cupertino, Cartujano-Barrera, Perales et al, 2019;Cupertino, Cartujano-Barrera, Ramírez et al, 2019;Cupertino et al, 2020) and one study used complete case analysis ( de Azevedo et al, 2010). Cessation rates varied from 9.4% self-reported 7day point prevalence abstinence at Week 12 (Cupertino et al, 2020) to 55.5% self-reported 30-day point prevalence abstinence at Day 30 (Blitchtein-Winicki et al, 2017).…”

“…The included studies were conducted in different geographic locations and times. Four studies were conducted in Brazil (Chaves & Oyama, 2008; Cruvinel et al, 2019; Cupertino et al, 2020; de Azevedo et al, 2010), two in Mexico (Cupertino, Cartujano-Barrera, Perales et al, 2019; Cupertino, Cartujano-Barrera, Ramírez et al, 2019), and one in Peru (Blitchtein-Winicki et al, 2017). Studies were conducted between 2007 and 2017.…”

“…Overall, the systematic review suggests that smoking cessation mHeath interventions in Latin America are highly acceptable, feasible, and produce promising cessation rates. However, mHealth interventions have only been conducted in Brazil (Chaves & Oyama, 2008;Cruvinel et al, 2019;Cupertino et al, 2020;de Azevedo et al, 2010), Mexico (Cupertino, Cartujano-Barrera, Perales et al, 2019;Cupertino, Cartujano-Barrera, Ramírez et al, 2019), and Peru (Blitchtein-Winicki et al, 2017). Moreover, only one study was an adequately powered RCT ( de Azevedo et al, 2010), limiting the ability to assess the efficacy of mHealth interventions in Latin America.…”

“…. Smoking cessation outcomes included self-reported abstinence in five studies(Blitchtein-Winicki et al, 2017;Chaves & Oyama, 2008;Cupertino, Cartujano-Barrera, Ramírez et al, 2019, 2020 de Azevedo et al, 2010) and biochemically verified abstinence in two studies(Cruvinel et al, 2019;Cupertino, Cartujano-Barrera, Perales et al, 2019). One study biochemically verified abstinence via exhaled carbon monoxide(Cruvinel et al, 2019); another study biochemically verified abstinence via urinary cotinine(Cupertino, Cartujano-Barrera, Perales et al, 2019).Table2lists the outcomes and major limitations in each study.…”