ASHES, Vol. 17(13) – Path2Quit, a culturally-specific tobacco cessation text-messaging intervention

African Americans face greater barriers to tobacco cessation and higher levels of tobacco-related diseases. Culturally-specific interventions are evidence-based interventions adapted to incorporate cultural context to more effectively aid participants who have been historically marginalized in the medical community. This week, ASHES reviews a study by Monica Webb Hooper and colleagues that examined the effectiveness of a culturally-specific tobacco cessation text-messaging intervention for African American adult smokers facing economic disadvantages.

What was the research question?
Is a culturally-specific tobacco cessation intervention more effective than a general program for African American adult smokers facing economic disadvantages?

What did the researchers do?
This randomized controlled study involved 119 African American adults seeking to quit smoking who were recruited from an urban Midwestern U.S. city. The researchers separated participants into either the culturally-specific intervention Path2Quit or the National Cancer Institute’s SmokefreeTXT (a general intervention) group. Both groups also attended a behavioral counseling meeting and received two weeks of nicotine replacement therapy. Path2Quit sends out texts with videos including general tobacco information, tobacco use among African Americans, testimonials from African Americans who quit smoking, cognitive behavioral techniques for cessation, culturally-based empowerment messages, etc. The researchers used analysis of covariance to analyze nicotine replacement therapy use and bivariate analyses and logistic regressions to analyze the end-of-intervention data on (1) quit attempts, (2) biochemically verified point prevalence smoking abstinence (using carbon monoxide), and (3) self-reported 7-day point prevalence smoking abstinence (for the prior 7 days).

What did they find?
There were no differences between Path2Quit and SmokefreeTXT in terms of intervention evaluations; participants viewed both interventions positively. The two groups were also similar in terms of intervention use, quit attempts, and 7-day point prevalence abstinence. However, Path2Quit promoted greater nicotine replacement therapy use, and participants exposed to this culturally-tailored intervention were more likely to have stopped smoking at the end of the 6 weeks, as confirmed by carbon monoxide measurement (see Figure).

Figure. Days of nicotine replacement therapy use and carbon monoxide-verified point prevalence abstinence at the end of the intervention by study condition. Click image to enlarge.

Why do these findings matter?
This study provides an initial indication that a culturally-specific tobacco intervention has a positive impact on cessation efforts in comparison to a more general tobacco cessation intervention, suggesting that culturally-specific tobacco cessation interventions are both possible and necessary. Furthermore, this study highlights the need for research into health literacy and methods of delivery for specific target populations due to digital inequity (i.e. unequal access to Wifi).

Every study has limitations. What are the limitations of this study?
While this study was able to provide preliminary data on short-term effectiveness, the participants were not checked after 6 weeks and thus long-term conclusions cannot be drawn. Additionally, the sample only came from a single Midwestern U.S. city and it is unclear whether these findings can be generalized to a different population. Future research needs to be done to confirm these findings in larger sample groups and/or in various geographic locations.

For more information:
SmokeFree offers tools and tips for quitting and maintaining abstinence from smoking tobacco. The Talk With Your Teen About E-cigarettes tip sheet provides tips for parents to explain why e-cigarettes are harmful. The Centers for Disease Control and Prevention also provides research and tips about cigarettes and how to quit. For more details about addiction, visit our Addiction Resources page.

— Taylor Lee

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