Text-Message Outreach to Connect Adolescents and Young Adults to Nicotine Treatment: A Pilot Study in Pediatric Primary Care.

OBJECTIVE

Strategies are needed to increase adolescent and young adult (AYA) engagement in nicotine use treatment. We assessed feasibility, acceptability, and clinical impact of text-message outreach connecting AYA to nicotine use treatment across a large health network.

METHODS

This quality improvement pilot study included 2 phases of text-message outreach following primary care visits. All patients aged 13 to 22 completed an in-visit confidential electronic health questionnaire assessing past 30-day nicotine use. Phase 1: patients selected whether to receive text outreach about quitting resources. Phase 2: all patients reporting nicotine use who provided a phone number on the electronic questionnaire received automatic text outreach. Treatment options included a text-messaging program (This is Quitting) and/or nicotine replacement therapy. Outcome measures included feasibility (phone number provision), acceptability (treatment interest), and clinical impact (treatment connection).

RESULTS

Among 23,411 AYA screened from February to June 2024, 919 (3.9%) reported past 30-day nicotine use. For feasibility, 90% and 91% of AYA who reported nicotine use provided a phone number in each phase, respectively. Acceptability was higher in Phase 1 versus Phase 2 (11% vs 2%), but clinical impact was similar (2% vs 1%). Overall, 824 patients who reported nicotine use provided a phone number (90%), 59 expressed treatment interest (6%), and 16 connected to treatment (2%).

CONCLUSIONS

Text-message outreach was feasible but achieved low acceptability and clinical impact. Barriers included a high rate of messages blocked as spam, limited interventions for AYA with infrequent nicotine use, and barriers to accessing NRT related to cost and confidentiality.