A Multicomponent Intervention Including Texting to Promote Tobacco Abstinence in Emergency Department Smokers: A Pilot Study

• Published in: Academic emergency medicine Vol. 23; no. 7; pp. 803 - 808
• Main Authors: Bernstein, Steven L., Rosner, June, Toll, Benjamin, Griffey, Richard T.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.07.2016
• Subjects: Adult; Behavior modification; Clinical outcomes; Drug therapy; Emergency medical care; Emergency Service, Hospital; Feasibility Studies; Female; Health Promotion - methods; Humans; Male; Middle Aged; Motivational Interviewing; Pilot Projects; Referral and Consultation; Smoking cessation; Smoking Cessation - methods; Telemedicine; Text Messaging; Transdermal medication; United States > US
• ISSN: 1069-6563; 1553-2712; 1553-2712
• DOI: 10.1111/acem.12990

Background Emergency department (ED) patients commonly smoke. Current treatment approaches use motivational interviewing, which is effective, but resource‐intensive. Mobile health approaches may be more feasible and generalizable. Objective The objective was to assess the feasibility of an ED‐initiated program of tobacco dependence treatment that employs text messaging. Methods Smokers age 18 or older were randomized to intervention or control arms. Control subjects received a brochure describing the state smokers’ quitline. Intervention subjects received the brochure, 4 weeks of nicotine patches and gum (with the initial dose administered in the ED), a referral to the quitline, and enrollment in SmokefreeTXT, a free SMS‐messaging service. SmokefreeTXT delivered 28 days of messages, two to five messages/day. Some messages ask subjects to provide data on mood or craving. Follow‐up was conducted by phone call. Results Sixty subjects were enrolled in May 2014. Of all subjects, 33 (55%) were nonwhite; 78% were insured by Medicaid. All intervention subjects used the texting program, with 24/30 (80%) using the program for all 28 days. At 1 month, 14/30 subjects (47%) in the intervention arm reported abstinence versus 3/30 (10%) in the control arm (p = 0.003). At 3 months, the abstinence rates in the intervention and control arms were, respectively, 9/30 (30%) and 4/30 (13%; p = 0.21). Subjects responding to more assessments of mood or craving were more likely to report abstinence at 1 month. Conclusion A texting program, combined with pharmacotherapy and a quitline referral, is feasible and may promote tobacco abstinence in ED smokers. A larger trial is planned to assess these results.