Karen S. Calabro

Developing mobile phone text messages for tobacco risk communication among college students: a mixed methods study

BackgroundEngaging young adults for the purpose of communicating health risks associated with nicotine and tobacco use can be challenging since they comprise a population heavily targeted with appealing marketing by the evolving tobacco industry. The Food and Drug Administration seeks novel ways to effectively communicate risks to warn about using these products. This paper describes the first step in developing a text messaging program delivered by smartphones that manipulate three messaging characteristics (i.e., depth, framing, and appeal).MethodsPerceptions of community college students were described after previewing text messages designed to inform about risks of using conventional and new tobacco products. Thirty-one tobacco users and nonusers, aged 18–25 participated in five focus discussions held on two community college campuses. Attendees reviewed prototype messages and contributed feedback about text message structure and content. Qualitative data were coded and analyzed using NVivo Version 10.ResultsMost participants were female and two-thirds were ethnic minorities. A variety of conventional and new tobacco products in the past month were used by a third of participants. Three identified domains were derived from the qualitative data. These included perceived risks of using tobacco products, receptivity to message content, and logistical feedback regarding the future message campaign.ConclusionOverall, participants found the messages to be interesting and appropriate. A gap in awareness of the risks of using new tobacco products was revealed. Feedback on the prototype messages was incorporated into message revisions. These findings provided preliminary confirmation that the forthcoming messaging program will be appealing to young adults.

Project SUCCESS: Results from a Randomized Controlled Trial

The present investigation tested whether an enhanced smoking cessation program produced higher cessation rates for participants than for controls. Participants in the enhanced intervention condition received in-person motivational counseling with health feedback, a tailored internet-based program, and nicotine patch. Participants in the control group received a smoking cessation self-help manual and nicotine patch. This randomized controlled trial was conducted at a 4-year university with a student body of 32,000. Five hundred-nine students who smoked ≥1 cigarette daily were individually randomized into the enhanced intervention and control groups. Over a 3-month period, participants in the enhanced intervention condition attended two personal sessions with smoking cessation counselors. Participants in both conditions were reassessed for smoking status 12 months post-baseline. Multivariate logistic regression techniques were used to analyze the data using the intent to treat approach. Results indicated that the odds of smoking cessation were 2 times larger for the enhanced intervention group than controls (odds ratio = 2.3, 95%, confidence interval = 1.3, 3.9, P<.01). This study begins to fill research gaps regarding college students and smoking cessation. Suggestions for future advancements in smoking cessation interventions for college students are provided.

Validation of mobile phone text messages for nicotine andtobacco risk communication among college students:A content analysis

INTRODUCTION In the United States, young adults have the highest prevalence of tobacco use. The dissemination of mobile phone text messages is a growing strategy for tobacco risk communication among young adults. However, little has been done concerning the design and validation of such text messages. The Texas Tobacco Center of Regulatory Science (Texas-TCORS) has developed a library of messages based on framing (gain- or loss-framed), depth (simple or complex) and appeal (emotional or rational). This study validated the library based on depth and appeal, identified text messages that may need improvement, and explored new themes. METHODS The library formed the study sample (N=976 messages). The Linguistic Inquiry and Word Count (LIWC) software of 2015 was used to code for word count, word length and frequency of emotional and cognitive words. Analyses of variance, logistic regression and scatter plots were conducted for validation. RESULTS In all, 874 messages agreed with LIWC-coding. Several messages did not agree with LIWC. Ten messages designed to be complex indicated simplicity, while 51 messages designed to be rational exhibited no cognitive words. New relevant themes were identified, such as health (e.g. ‘diagnosis’, ‘cancer’), death (e.g. ‘dead’, ‘lethal’) and social connotations (e.g. ‘parents’, ‘friends’). CONCLUSIONS Nicotine and tobacco researchers can safely use, for young adults, messages from the Texas-TCORS library to convey information in the intended style. Future work may expand upon the new themes. Findings will be utilized to develop new campaigns, so that risks of nicotine and tobacco products can be widely disseminated.

From the Experience of Interactivity and Entertainment to Lower Intention to Smoke: A Randomized Controlled Trial and Path Analysis of a Web-Based Smoking Prevention Program for Adolescents

Background Web-based programs for smoking prevention are being increasingly used with some success among adolescents. However, little is known about the mechanisms that link the experience of such programs to intended nicotine or tobacco control outcomes. Objective Based on the experiential learning theory and extended elaboration likelihood model, this study aimed to evaluate the impact of a Web-based intervention, A Smoking Prevention Interactive Experience (ASPIRE), on adolescents’ intention to smoke, while considering the experience of interactivity and entertainment as predictors of reduced intention to smoke, under a transitional user experience model. Methods A total of 101 adolescents were recruited from after-school programs, provided consent, screened, and randomized in a single-blinded format to 1 of 2 conditions: the full ASPIRE program as the experimental condition (n=50) or an online , text-based version of ASPIRE as the control condition (n=51). Data were collected at baseline and immediate follow-up. Repeated-measures mixed-effects models and path analyses were conducted. Results A total of 82 participants completed the study and were included in the analysis. Participants in the experimental condition were more likely to show a decrease in their intention to smoke than those in the control condition (beta=−0.18, P=.008). Perceived interactivity (beta=−0.27, P=.004) and entertainment (beta=−0.20, P=.04) were each associated with a decrease in intention to smoke independently. Results of path analyses indicated that perceived interactivity and perceived entertainment mediated the relationship between ASPIRE use and emotional involvement. Furthermore, perceived presence mediated the relationship between perceived interactivity and emotional involvement. There was a direct relationship between perceived entertainment and emotional involvement. Emotional involvement predicted a decrease in intention to smoke (beta=−0.16, P=.04). Conclusions Adolescents’ experience of interactivity and entertainment contributed to the expected outcome of lower intention to smoke. Also, emphasis needs to be placed on the emotional experience during Web-based interventions in order to maximize reductions in smoking intentions. Going beyond mere evaluation of the effectiveness of a Web-based smoking prevention program, this study contributes to the understanding of adolescents’ psychological experience and its effect on their intention to smoke. With the results of this study, researchers can work to (1) enhance the experience of interactivity and entertainment and (2) amplify concepts of media effects (eg, presence and emotional involvement) in order to better reach health behavior outcomes. Trial Registration Clinicaltrials.gov NCT02469779; https://clinicaltrials.gov/ct2/show/NCT02469779 (Archived by WebCite at http://www.webcitation.org/6nxyZVOf0)

Mobile Phone Text Messaging for Tobacco Risk Communication Among Young Adult Community College Students: Protocol and Baseline Overview for a Randomized Controlled Trial

Background Community-college students are at high risk for tobacco use. Because the use of mobile phone text messaging is nearly ubiquitous today, short message service (SMS) may be an effective strategy for tobacco risk communication in this population. Little is known, however, concerning the message structure significantly influencing perceived tobacco risk. Objective We aim to outline the rationale and design of Project Debunk, a randomized trial comparing the effects of different SMS text message structures. Methods We conducted a 6-month randomized trial comparing 8 arms, based on the combination of the 3 message structures delivered to young adults in a 2×2×2 study design: framing (gain-framed or loss-framed), depth (simple or complex), and appeal (emotional or rational). Participants were invited to participate from 3 community colleges in Houston from September 2016 to July 2017. Participants were randomized to 1 arm and received text messages in 2 separate campaigns. Each campaign consisted of 2 text messages per day for 30 days. Perceived tobacco risk was assessed at baseline, 2 months after the first campaign, and 2 months after the second campaign. We assessed the perceived risk of using conventional products (eg, combustible cigarettes) and new and emerging products (eg, electronic cigarettes). The validity of message structures was assessed weekly for each campaign. A 1-week follow-up assessment was also conducted to understand immediate reactions from participants. Results We completed data collection for the baseline survey on a rolling basis during this time and assessed the validity of the message structure after 1 week of SMS text messages. For the entire sample (N=636), the average age was 20.92 years (SD 2.52), about two-thirds were male (430/636, 67.6%), and most were black or African American (259/636, 40.7%) or white (236/636, 37.1%). After 1 week of receiving text messages, the following was noted: (a) loss-framed messages were more likely to be perceived as presenting a loss than gain-framed messages (F7,522=13.13, P<.001), (b) complex messages were perceived to be more complex than simple messages (F7,520=2.04, P=.05), and (c) emotional messages were perceived to be more emotionally involving than rational messages (F7,520=6.46, P<.001). Conclusions This study confirms that the recruitment, randomization, and message composition have been successfully implemented. Further analyses will identify specific types of messages that are more effective than others in increasing the perceived risk of tobacco use. If our results suggest that any of the 8 specific message structures are more effective for helping young adults understand tobacco risk, this would provide evidence to include such messages as part of a larger technology-based campaign such as mobile phone apps, entertainment-based campaigns, and social media. Trial Registration ClinicalTrials.gov NCT03457480; https://clinicaltrials.gov/ct2/show/NCT03457480 (Archived by WebCite at http://www.webcitation.org/6ykd4IIap) Registered Report Identifier RR1-10.2196/10977

Smoke-Free Home and Vehicle Policies Among Community College Smokers

Background. Personal smoke-free policies (home and vehicle) reduce secondhand smoke exposure, improve health, and increase quitting among smokers. Overall, 83.0% and 78.1% of Americans report smoke-free homes and vehicles, respectively. However, little is known about such policies among 2-year community college (CC) students, who represent a large, diverse population with higher smoking rates and less negative attitudes toward smoking than 4-year college students. Methods. Prevalence of, and factors associated with, personal smoke-free policies were examined for 2,475 CC smokers enrolled in a national trial of web-assisted tobacco intervention. Results. Few students had smoke-free home policies (20.7%), smoke-free vehicles (17.0%), both smoke-free home and vehicle policy (4.2%), or any policy (home or vehicle; 31.2%). In logistic regression models, having children was associated with a smoke-free home or any policy but not with a smoke-free vehicle, and among participants who had children, only 20% reported a smoke-free home, and only 15% had a smoke-free vehicle. In addition, not living with other smokers, living with parents or roommates/siblings (vs. alone), smoking later than 30 minutes after awakening, believing that smoking affects the health of others, and confidence in quitting were associated with presence of a smoke-free home or any policy; no variables were significantly associated with presence of a smoke-free vehicle. Conclusions. CC students represent a priority population for intervention regarding smoke-free homes and vehicles. Such intervention can decrease exposure of others, including children, and potentially increase the likelihood of quitting in this high-risk population.

Development and initial testing of the brief adolescent smoking curiosity scale (ASCOS)

BACKGROUND Although the reasons behind tobacco smoking at young age are complex, research has identified curiosity as a potent driver of smoking among adolescents. OBJECTIVE The objective of the current study is to develop and provide initial evidence of reliability and validity of a short scale assessing smoking curiosity among adolescents (first measure of its kind). In particular, we developed and tested the adolescent smoking curiosity scale (ASCOS). METHODS After scale development, 101 adolescents completed a survey on smoking-related measures, including ASCOS (June to August 2014). We conducted exploratory factor analysis and Cronbachs alpha calculation to inspect factor-structure and reliability. We conducted multiple linear regression models to examine the scales capacity to predict antecedents of smoking initiation. RESULTS Factor analysis supported a single-factor structure of smoking curiosity. ASCOS was internally reliable (Cronbachs alpha=0.83). Controlling for demographics, the measure correlated significantly with temptation to try smoking (β=0.41, p<0.01), number of friends who smoke (β=0.27, p<0.01), agreeing with the pros of smoking (β=0.41, p<0.001), sensation seeking (β=0.21, p<0.05), and depression (β=0.23, p<0.01). When controlling for a single-item measure for smoking curiosity, ASCOS significantly predicted susceptibility to smoke cigarettes (OR=3.40, p<0.05) and cigars (OR=6.66, p<0.01). CONCLUSIONS ASCOS presented good psychometric properties and passed initial validity-testing through associations with antecedents of smoking. ASCOS was a better predictor of susceptibility to smoke than did a traditional single-item measure used by previous research. As an implication, ASCOS can be crucial to the development of tailored interventions for smoking prevention that can reduce smoking curiosity.

A Pilot Study for Linking Adolescent Patients to an Interactive Tobacco Prevention Program

Context: The American Academy of Pediatrics and professional guidelines recommend intervening with adolescents about avoiding tobacco use in the health-care setting. Barriers in the clinical setting limit consistent provision of this critical service. Objectives: This pilot study compared 2 approaches for referring adolescents to an evidence-based tobacco prevention and cessation program in the outpatient setting. Secondary aims assessed tobacco use, knowledge, and program evaluation. Design, Setting, and Participants: The study setting was a medical and dental clinic. Participants aged 13 to 18 received tobacco advice and instructions to work through “A Smoking Prevention Interactive Experience.” The program addresses health concerns of adolescents about tobacco use and is founded on behavioral change theories. The link to access it is featured on the website of the National Cancer Institute’s Research-Tested Interventions. Participants (N = 197) were randomized to 1 of 2 approaches (ie, a program link via e-mail or referral by a printed card). Results: The program was accessed by 57% (112 of 197) of participants. Both referral approaches were equally effective. Non-Hispanics were twice as likely to access the program as Hispanics (adjusted odds ratio = 2.1, 95% confidence interval = 1.2-3.8, P < .05). Over 95% of participants identified themselves as nonusers of tobacco and evaluated the program as beneficial in increasing knowledge and motivation to remain tobacco-free. Conclusion: Linking adolescent patients to an evidence-based tobacco prevention/cessation program at a community health clinic was highly promising and feasible. We present conclusions for future research.

Nicotine and Tobacco Use Prevention among Youth and Families

OBJECTIVE To review the importance of and evidence-based strategies to prevent tobacco use and promote tobacco cessation in the pediatric setting. DATA SOURCES Literature review of evidence-based resources on tobacco use and prevention/cessation interventions in the pediatric/adolescent population. CONCLUSION Knowledge of the impact of tobacco use on cancer risk, second- and third-hand smoke carcinogenesis, and newer methods of tobacco delivery is necessary to select appropriate and effective prevention and cessation strategies. IMPLICATIONS FOR NURSING PRACTICE Systematic evaluation of both parents and children for tobacco use can identify patients that will benefit from tobacco cessation interventions. Patients and families need education and support so they can make good decisions and adhere to recommendations for prevention and cessation of tobacco use.

Abstract B36: Respiratory symptoms after smoking cessation among college students

Introduction: Data about respiratory symptoms and lung function are available for middle-aged adults post-cessation. Similar evidence is lacking for those aged 18 to 24 years. This study addresses that gap. Procedures: This report is a secondary analysis of data derived from two randomized controlled smoking cessation trials among a subset of 18- to 24-year-old college students. Data from both studies were combined regardless of treatment condition. Some participants received an active intervention while controls were provided with self-help smoking materials. Self-reported respiratory symptoms were longitudinally analyzed in 273 quitters. The change in respiratory symptoms was calculated by subtracting the final scores from those at baseline. Summary of Data: The respiratory symptoms of continued smokers were compared to the quitters at the final visit using t-tests. Significant improvements in respiratory symptoms were found among quitters for morning cough, (p =.002) daytime cough, (p =.007), and chest pain (p =.007). Statement of Conclusions: Young individuals rarely respond to quit-smoking motivation based on long-term health consequences, such as risk of tobacco-attributable cancers. A more appropriate motivational strategy for young adults appears to be emphasizing the existing respiratory symptoms caused by smoking. Clinicians are encouraged to detect and discuss respiratory symptoms with their young tobacco-using patients as a part of smoking cessation counseling and treatment. Highlighting post-cessation reduction in these symptoms is likely to reinforce continued abstinence. Citation Information: Cancer Prev Res 2011;4(10 Suppl):B36.