Feasibility and Acceptability of a Culturally- and Linguistically-Adapted Smoking Cessation Text Messaging Intervention for Latino Smokers

Kick Vaping: Feasibility, acceptability, and preliminary impact of a vaping cessation text messaging intervention for Latino young adults

OBJECTIVE

To assess the feasibility, acceptability, and preliminary impact of Kick Vaping among Latino young adults.

METHODS

Forty Latino young adults (ages 18 to 25) who were currently vaping received Kick Vaping, a vaping cessation text messaging intervention available in English and Spanish. Feasibility was measured by the eligibility, enrollment, and follow-up rates. Acceptability was measured by overall satisfaction with the intervention. Preliminary impact was measured by self-reported 7-day point prevalence abstinence and changes in self-efficacy.

RESULTS

Two hundred three individuals were identified, 61 were assessed for eligibility, and 55 were eligible. Forty individuals consented to participate and were enrolled in Kick Vaping. At baseline, most participants used disposable devices (70%), vaped daily (97.5%), had low (37.5%) or medium (35.0%) e-cigarette dependence, and had attempted to quit in the past year (72.5%). At Month 3, the follow-up rate was 90% (36/40). Treating those lost to follow-up as participants who continued vaping, 75% (30/40) of participants self-reported 7-day point prevalence abstinence. Self-efficacy mean scores significantly increased from 30.65 (SD 8.07) at baseline to 50.11 (SD 10.57) at follow-up (p < 0.01). Most participants (88.9%, 32/36) reported being satisfied/extremely satisfied with Kick Vaping.

CONCLUSION

It is feasible to recruit and retain Latino young adults in a vaping cessation text messaging intervention. Kick Vaping generated high satisfaction among Latino young adults, significantly increased self-efficacy, and resulted in a notable vaping cessation rate at Month 3. Additional testing in a randomized controlled trial is warranted to assess the efficacy of the intervention.

Decídetexto: Mobile Cessation Support for Latino Adults Who Smoke: A Randomized Clinical Trial

BACKGROUND

Latino adults experience multiple barriers to health care access and treatment that result in tobacco-related disparities. Mobile interventions have the potential to deliver smoking cessation treatment among Latino adults, who show the highest use rates of mobile technologies.

RESEARCH QUESTION

Is Decídetexto, a culturally accommodated mobile health intervention, more effective for smoking cessation compared with standard care among Latinx adults who smoke?

STUDY DESIGN AND METHODS

A two-arm parallel group randomized clinical trial was conducted in Kansas, New Jersey, and New York between October 2018 and September 2021. Eligible Latino adults who smoke (n = 457) were randomly assigned to Decídetexto or a standard care group. The primary outcome was biochemically verified 7-day smoking abstinence at week 24. Secondary outcomes included self-reported 7-day smoking abstinence at weeks 12 and 24 and uptake and adherence of nicotine replacement therapy (NRT).

RESULTS

Participants' mean age was 48.7 (SD, 11.1) years, 45.2% were female, and 50.3% smoked ≥ 10 cigarettes per day. Two hundred twenty-nine participants were assigned to Decídetexto and 228 to standard care. Treating those lost to follow-up as participants who continued smoking, 14.4% of participants in the Decídetexto group were biochemically verified abstinent at week 24 compared with 9.2% in the standard care group (OR, 1.66; 95% CI, 0.93-2.97; P = .09). Treating those lost to follow-up as participants who continued smoking, 34.1% of the participants in the Decídetexto group self-reported smoking abstinence at week 24 compared with 20.6% of participants in the standard care group (OR, 1.99; 95% CI, 1.31-3.03; P < .001). Analyzing only participants who completed the assessment at week 24, 90.6% (174/192) of participants in the Decídetexto group self-reported using NRT for at least 1 day compared with 70.2% (139/198) of participants in standard care (OR, 4.10; 95% CI, 2.31-7.28; P < .01).

INTERPRETATION

Among Latino adults who smoke, the Decídetexto intervention was not associated with a statistically significant increase in biochemically verified abstinence at week 24. However, the Decídetexto intervention was associated with a statistically significant increase in self-reported 7-day smoking abstinence at weeks 12 and 24 and uptake of NRT. This randomized clinical trial provides encouragement for the use of Decídetexto for smoking cessation among Latino adults.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03586596.

Analysis of the intensity of engagement with CuidaTEXT, a text message intervention for dementia caregiver support among Latinos/as

OBJECTIVES

To examine the associations between participant intensity of engagement with a text message intervention, CuidaTEXT, and socio-demographic factors, acceptability measures, and clinical outcomes among Latino/a caregivers of individuals with dementia.

METHODS

CuidaTEXT is a six-month, bilingual, and bidirectional intervention. We enrolled 24 Latino/a caregivers in a one-arm feasibility trial. Participants received approximately one automatic daily text message and could engage with the intervention by texting specific keywords (e.g. STRESS to receive messages about stress-coping), and by chat-texting with a live coach. We used metrics and psychometric scales to quantify variables.

RESULTS

Participants sent a total of 1847 messages to CuidaTEXT. Higher intensity of engagement was associated with higher intervention satisfaction (r = 0.6, p = 0.007), as were several other acceptability outcomes. We found no associations between intensity of engagement with CuidaTEXT and sociodemographic or clinical outcomes (p > 0.05).

CONCLUSION

Encouraging more intense engagement with CuidaTEXT might lead to higher levels of satisfaction with the intervention. However, it is possible that those who are highly satisfied, engage more intensely with CuidaTEXT. Future research should determine the directionality of these associations to optimize text message interventions.

CLINICAL IMPLICATIONS

Creating more opportunities to increase the intensity of text message engagement with caregiver support interventions may improve caregiver satisfaction with them.

Linking genetic counseling communication skills to patient outcomes and experiences using a community-engagement and provider-engagement approach: research protocol for the GC-PRO mixed methods sequential explanatory study

INTRODUCTION

In over 50 years since the genetic counseling (GC) profession began, a systematic study of GC communication skills and patient-reported outcomes in actual sessions across multiple clinical specialties has never been conducted. To optimize GC quality and improve efficiency of care, the field must first be able to comprehensively measure GC skills and determine which skills are most critical to achieving positive patient experiences and outcomes. This study aims to characterise GC communication skills using a novel and pragmatic measure and link variations in communication skills to patient-reported outcomes, across clinical specialties and with patients from diverse backgrounds in the USA. Our community-engagement and provider-engagement approach is crucial to develop recommendations for quality, culturally informed GC care, which are greatly needed to improve GC practice.

METHODS AND ANALYSIS

A mixed methods, sequential explanatory design will be used to collect and analyze: audio-recorded GC sessions in cancer, cardiac, and prenatal/reproductive genetic indications; pre-visit and post-visit quantitative surveys capturing patient experiences and outcomes and post-visit qualitative interview data. A novel, practical checklist will measure GC communication skills. Coincidence analysis will identify patterns of GC skills that are consistent with high scores on patient-reported measures. Two-level, multilevel models will be used to evaluate how GC communication skills and other session/patient characteristics predict patient-reported outcomes. Four community advisory boards (CABs) and a genetic counselor advisory board will inform the study design and analysis.

ETHICS AND DISSEMINATION

This study has been approved by the single Institutional Review Board of the University of Minnesota. This research poses no greater than minimal risk to participants. Results from this study will be shared through national and international conferences and through community-based dissemination as guided by the study's CABs. A lay summary will also be disseminated to all participants.

Recruiting Latino young adults into a vaping cessation study via social media: Feasibility and cost analysis

INTRODUCTION

This study aims to assess the feasibility and cost of recruiting young Latino adults (aged 18-25 years) to participate in a vaping cessation study via social media and to describe the baseline characteristics of participants enrolled via social media.

METHODS

Paid advertisements were launched using the Meta Ads platform, which serves ads to users on Facebook and Instagram. Key measures of audience targeting included ages 18-25 years, all genders, and the following interests: 'electronic cigarettes', 'vape', 'Latin pop', and 'Latin music'. The advertisements invited young Latino adults to join a text messaging vaping cessation study. By clicking on the advertisements, interested individuals were directed to a website to fill in a contact form. The study team contacted individuals who filled in the form, assessed them for study eligibility, and, if eligible, enrolled them in the study.

RESULTS

A total of 164 individuals completed the contact form, and 26 were successfully enrolled in the study. The enrollment efficiency ratio was 15.9% (26/164). The cost per enrollment was US$94.14. The participants' mean age was 22.7 years (SD=1.6). Half of the participants (50%) were male, 38.5% were female, and 11.5% were gender non-conforming/non-binary. Two-thirds of the participants (69.2%) were born in the US, 23.1% in Puerto Rico, and 7.7% in Mexico. Eight participants (30.7%) selected Spanish as their language of preference. In terms of the type of vaping device, 16 participants (61.5%) indicated using disposables, 6 (23.1%) cartridges/pods, and 4 (15.4%) tanks/refillable. Sixteen participants (61.5%) reported using marijuana in e-cigarettes. Six participants (23.1%) had high e-cigarette dependence. Twenty participants (76.9%) had attempted to quit e-cigarettes in the past year.

CONCLUSIONS

It is feasible to recruit young Latino adults for a vaping cessation study via social media. Social media offers a relatively low-cost approach to recruiting a diverse sample of Latino young adults who vape.

Actívatexto: Feasibility and Acceptability of a Mobile Intervention That Promotes Smoking Cessation and Physical Activity among Latinos

The purpose of this study was to assess the feasibility and acceptability of a mobile intervention that promotes smoking cessation and physical activity among Latinos living in the United States. Twenty Latino adults who smoked and did not meet recommended levels of physical activity were recruited using community-based recruitment strategies. Participants received Actívatexto, a theory-based, culturally accommodated, 12-week text messaging intervention (available in English and Spanish) that promotes smoking cessation and physical activity. Actívatexto integrates four components: (i) a text messaging program, (ii) a wearable device, (iii) an online dashboard where the research team manages participants' incoming and outgoing data from both the text messaging program and wearable device, and (iv) nicotine replacement therapies (NRT). We assessed self-reported 7-day point prevalence smoking abstinence at month 3, weekly minutes of moderate to vigorous physical activity (MVPA), pharmacotherapy adherence, and satisfaction. At baseline, participants' mean age was 47.3 years old (SD 16.0), 55% of participants were female, and 60% indicated that Spanish was their language of preference. Seventy-five percent of participants smoked 1-10 cigarettes daily and 35% smoked their first cigarette within 5 minutes after waking up. At month 3, 14 participants (70%) self-reported 7-day point prevalence smoking abstinence (90% follow-up rate). Fitbit-assessed mean minutes of MVPA per week increased from 113 (SD 127; range: 0-399) at week 1 to 177 (SD 163; range: 0-513) at month 3 (P = 0.15). Sixteen participants (88.9%, 16/18) reported NRT use in the past 90 days. Most participants reported being extremely satisfied or satisfied with the intervention (88.9%, 16/18).

SIGNIFICANCE

Actívatexto resulted in a noteworthy cessation rate at month 3 (70%), increased mean weekly minutes of MVPA, produced high use of NRT, and was well received by participants. Additional testing in a randomized clinical trial is warranted to assess the efficacy of the intervention.

Evaluating the psychometric properties of the Hispanic Stress Inventory-2 Simplified version among a diverse sample of Latinos who smoke

OBJECTIVE

Acculturation stress can negatively impact Latinos immigrant mental and physical health related behaviors such as smoking. It is essential to have validated and updated instruments that allow the evaluation of acculturation stress on this population. This study aims to evaluate the psychometric properties of an abbreviated version of the Hispanic Stress Inventory Version 2 (HSI2) immigration scale among Latinos who smoke.

METHODS

The study consisted of a secondary data analysis from a baseline assessment of Decídetexto, a mobile health (mHealth) smoking cessation randomized clinical trial. Of 457 Latinos included in the parent study, 352 immigrants who smoke were included. Construct validity was analyzed by completing a Pearson correlation coefficient matrix. Structural validity was analyzed using an Exploratory Factor Analysis (EFA). Cronbach alpha analysis was used to estimate the internal consistency of the items constituting a factor.

RESULTS

The results included an abbreviated version of the HSI2 including 52 items. From the Pearson correlation coefficient matrix with a cutoff point of 0.4, 22 of the 52 items were excluded. From the Pearson correlation coefficient matrix with a cutoff point of 0.4, 22 items were excluded. Exploratory Factor Analysis (EFA) results in six factors extracted, explaining 69.1% of the variance. According to the EFA, two items were relocated in different factors from the original scale. The HSI2 30 items scale reflected excellent reliability with a Cronbach's alpha coefficient of 0.93. The six factors reflect acceptable to excellent reliability, ranging from 0.77-0.93 across factors. The median for the HSI2 total score was 34.00 (25-45) out of a possible total score of 150.

CONCLUSION

Results confirmed acceptable psychometric properties of the HSI2 simplified 30-item version and provided a reliable and shorter measure of acculturation stress for Latinos groups. Having a valid and reduced measure of acculturation stress is the first step in understanding diverse ethnic groups of Latinos that are at higher risk of presenting health risk behaviors such as smoking. The present results provided the possibility of assessing the impact of acculturation stress among adults who smoke.

Understanding the perceived benefits, barriers, and cues to action for lung cancer screening among Latinos: A qualitative study

Introduction

Rates of lung cancer screening among Latinos remain low. The purpose of the study was to understand the perceived benefits, barriers, and cues to action for lung cancer screening among Latinos.

Methods

Participants (N=20) were recruited using community-based recruitment strategies. Eligibility criteria included: 1) self-identified as Hispanic/Latino, 2) spoke English and/or Spanish, and 3) met the USA Preventive Services Task Force eligibility criteria for lung cancer screening. Interviews were conducted in Spanish and English, audio recorded, and transcribed verbatim. Using the health belief model, a qualitative theoretical analysis was used to analyze the interviews.

Results

Participants' mean age was 58.3 years old (SD=5.8), half of the participants were female, 55% had completed high school or lower educational level, and 55% reported speaking more Spanish than English. All participants were currently smoking. Fourteen participants (70%) were unaware of lung cancer screening, and eighteen (90%) did not know they were eligible for lung cancer screening. Regarding lung cancer screening, participants reported multiple perceived benefits (e.g., smoking cessation, early detection of lung cancer, increased survivorship) and barriers (e.g., fear of outcomes, cost, lung cancer screening not being recommended by their clinician). Lastly, multiple cues to actions for lung cancer screening were identified (e.g., family as a cue to action for getting screened).

Conclusions

Most Latinos who were eligible for lung cancer screening were unaware of it and, when informed, they reported multiple perceived benefits, barriers, and cues to action. These factors provide concrete operational strategies to address lung cancer screening among Latinos.

Development of a Vaping Cessation Text Messaging Intervention for Latino Young Adults: A Participatory Research Approach

OBJECTIVE

Describe the participatory research procedures of developing Kick Vaping, a vaping cessation text messaging intervention for Latino young adults, available in English and Spanish.

METHODS

Using community-based recruitment strategies, we convened a Community Advisory Board (CAB) of eight Latino young adults (ages 18-25) with different vaping experiences (never users, ex-users, and current users of e-cigarettes). Members held a series of working meetings to adapt Decídetexto, a smoking cessation text messaging intervention, for vaping cessation. Members provided iterative feedback on the text messages until reaching a consensus on content. Messages were translated from English to Spanish following a committee approach. Readability assessments were used to evaluate the legibility of the text messages.

RESULTS

At baseline, members' mean age was 22.6 years old (SD 3.1), 75% were female, and 50% used both English and Spanish equally. Three members (37.5%) were ex-users and one member (12.5%) was a current user of e-cigarettes. 18 meetings provided sufficient opportunities for iterative feedback on the text messages for developing the intervention. The Kick Vaping intervention consists of 208 text messages. Readability scores of the text messages in English were equivalent to fourth and fifth grade, and in Spanish were equivalent to easy and somewhat easy.

CONCLUSION

It is feasible and practical to build participatory research among Latino young adults focused on vaping cessation. Members of the CAB added innovation and creativity to the development of the vaping cessation text messaging intervention. Future research is needed to evaluate the impact of the intervention on vaping cessation.

A text message intervention to support latino dementia family caregivers (CuidaTEXT): feasibility study

OBJECTIVES

To test the feasibility, acceptability, and preliminary efficacy of CuidaTEXT: a bidirectional text message intervention to support Latino dementia family caregivers.

METHODS

CuidaTEXT is a six-month, bilingual intervention tailored to caregiver needs (e.g., education, problem-solving, resources). We used convenience sampling and reached 31 potential participants via clinics, registries, community promotion, and online advertising. We enrolled 24 Latino caregivers in a one-arm trial and assessed feasibility, acceptability, and preliminary efficacy within six months.

RESULTS

None of the participants unsubscribed from CuidaTEXT and 83.3% completed the follow up survey. Most participants (85.7%) reported reading most text messages thoroughly. All participants reported being very or extremely satisfied with the intervention. Participants reported that CuidaTEXT helped a lot (vs not at all, a little, or somehow) in caring for their care recipient (71.4%; n = 15), for themselves (66.7%; n = 14), and understanding more about dementia (85.7%; n = 18). Compared to baseline, at six months caregiver behavioral symptom distress (0-60) decreased from 19.8 to 12.0 and depression (0-30) from 8.8 to 5.4 (p < .05).

CONCLUSIONS

CuidaTEXT demonstrated high levels of feasibility, acceptability, and preliminary efficacy among Latino caregivers.

CLINICAL IMPLICATIONS

CuidaTEXT's feasibility and potential for widespread implementation holds promise in supporting Latino caregivers of people with dementia.

Acculturation level and change in cigarette consumption behaviors among diverse Hispanics/Latinos: the Hispanic Community Health Study/Study of Latinos

PURPOSE

To study associations between language acculturation level and changes in cigarette consumption among the diverse and growing U.S.-based Hispanic/Latino population and inform culturally tailored smoking prevention and cessation strategies.

METHODS

In the Hispanic Community Health Survey/Study of Latinos cohort, we used cigarette consumption behaviors at baseline (2008-2011) and follow-up (2014-2017) and a modified Short Acculturation Scale for Hispanics (SASH) language subscale to measure associations of language acculturation (unidimensional) with changes in cigarette consumption and quitting rates. Weighted multivariable linear and logistic regressions were stratified by daily (n = 1397) and nondaily (n = 633) smoking, and either sex, educational attainment, or migration status.

RESULTS

Smokers at baseline (n = 2030) on average were aged 42 years old (SE = 0.5) with a mean SASH-language score of 2.3 (SE = 0.1; range = 1-5), indicating more Spanish language use. Among male daily smokers, we observed increases in smoked cigarettes-per-day (CPD) with unit increases in SASH-language score (1.08, 95% CI: 0.24-1.92). Associations with acculturation trended toward greater increases in CPD and lower odds of quitting as educational attainment increased.

CONCLUSIONS

Language acculturation level is an important determinant for increased smoking behaviors, particularly among men. Our findings are significant in informing smoking reduction programs for the Hispanic/Latino population.

Understanding the Perspectives of Latino Adults Who Smoke on Physical Activity: A Qualitative Study

Smoking and sedentary lifestyle frequently co-occur among Latinos. Evidence suggests that moderate to vigorous physical activity (MVPA) may enhance smoking cessation rates. However, this synergistic phenomenon has not been studied among Latinos, the largest minority group in the United States. This qualitative study consisted of semi-structured interviews in English or Spanish with Latino adults who smoke (n = 20) to understand their perspectives on physical activity. Participants were recruited using community-based recruitment strategies. The Health Belief Model was used as a framework for qualitative theoretical analysis. Multiple perceived benefits (e.g., mood management, strategy to quit smoking), susceptibility (e.g., risk of cardiovascular diseases, physical impairment), and barriers (e.g., lack of social support, low financial resources) of being physically active were identified. Moreover, multiple cues to action to do physical activity (e.g., being a role model, spending time with family and friends) were identified. These factors provide concrete operational strategies to address smoking cessation and physical activity among Latinos. Further research is needed on how best to integrate these perspectives into smoking cessation interventions.

"I'm a transgender man… I have to quit smoking for treatment and surgery": Describing the experience of a Latino transgender man during his attempt to quit smoking

OBJECTIVE

To describe the experience of a Latino transgender man during his attempt to quit smoking using a text messaging intervention.

METHODS

A Latino transgender man enrolled in a smoking cessation randomized controlled trial for Latino smokers. The participant was randomized to Decídetexto, a smoking cessation mobile intervention. The participant received a 24-week text messaging intervention. We assessed text messaging interactivity with the program, satisfaction, and self-reported abstinence at Week 12 and Month 6.

RESULTS

During the 24-week intervention period, the participant sent a total of 287 text messages to the program. When analyzing the content of the text messages sent by the participants, four important themes were identified: 1) gender identity, 2) low social support, 3) stressors (e.g., gender dysphoria), and 4) gender affirmation surgery as a reason to quit smoking. At both Week 12 and Month 6, the participant reported being extremely satisfied with the intervention and self-reported cigarette use.

CONCLUSION

A smoking cessation mobile intervention generated high satisfaction and frequent interactivity among a Latino transgender man. This case report provides important insights into the experience of one Latino transgender man during his attempt to quit smoking. There is an urgent need to develop or adapt existing smoking cessation interventions to better meet the needs of transgender people.

Design and Implementation of a Culturally-Tailored Randomized Pilot Trial: Puerto Rican Optimized Mediterranean-Like Diet

Background

Adhering to a Mediterranean Diet (MedDiet) is associated with a healthier cardiometabolic profile. However, there are limited studies on the MedDiet benefits for non-Mediterranean racial/ethnic minorities, for whom this diet may be unfamiliar and inaccessible and who have a high risk of chronic diseases.

Objectives

To describe the study design of a pilot trial testing the efficacy of a MedDiet-like tailored to adults in Puerto Rico (PR).

Methods

The Puerto Rican Optimized Mediterranean-like Diet (PROMED) was a single-site 4-mo parallel two-arm randomized pilot trial among a projected 50 free-living adults (25-65 y) living in PR with at least two cardiometabolic risk factors (clinicaltrials.gov registration #NCT03975556). The intervention group received 1 individual nutritional counseling session on a portion-control culturally-tailored MedDiet. Daily text messages reinforced the counseling content for 2 mo, and we supplied legumes and vegetable oils. Participants in the control group received cooking utensils and one standard portion-control nutritional counseling session that was reinforced with daily texts for 2 mo. Text messages for each group were repeated for two more months. Outcome measures were assessed at baseline, 2 and 4 m. The primary outcome was a composite cardiometabolic improvement score; secondary outcomes included individual cardiometabolic factors; dietary intake, behaviors, and satisfaction; psychosocial factors; and the gut microbiome.

Results

PROMED was designed to be culturally appropriate, acceptable, accessible, and feasible for adults in PR. Strengths of the study include applying deep-structure cultural components, easing structural barriers, and representing a real-life setting. Limitations include difficulty with blinding and with monitoring adherence, and reduced timing and sample size. The COVID-19 pandemic influenced implementation, warranting replication.

Conclusions

If PROMED is proven efficacious in improving cardiometabolic health and diet quality, the findings would strengthen the evidence on the healthfulness of a culturally-appropriate MedDiet and support its wider implementation in clinical and population-wide disease-prevention programs.

Intervention targeting and retention, engagement and abstinence outcomes among Latino and White users of Smokefree.gov text messaging programmes: a cross-sectional study

Background

We examined retention, engagement, and abstinence among Latino users of SmokefreeTXT en Español (SFTXTesp), a Latino-targeted text messaging smoking cessation intervention, and Latino and White users of SmokefreeTXT (SFTXT), a non-targeted intervention.

Methods

Data came from 12281 users (1562 Latino SFTXTesp users and 2301 Latino and 8418 White SFTXT users). We conducted time-to-dropout analyses by race/ethnicity. Using logistic regression, we examined associations between intervention targeting, race/ethnicity, and responses to smoking status prompts, an engagement metric, and self-reported abstinence on quit day, intervention end, and one-month follow-up. Age, gender, census region, smoking frequency, cigarettes smoked per day, prequit time, and number of quit attempts were covariates.

Results

Latinos in SFTXTesp (aOR 0.63) and SFTXT (0.88) were less likely to drop out of the intervention than Whites. SFTXTesp Latino users had higher response rates to smoking prompts than SFTXT Latinos users (aORs 1.35, quit day; 1.84, intervention end; 1.82, one-month follow-up). However, SFTXTesp and SFTXT Latino users had lower response rates than Whites (aORs 0.68, 0.45, quit day; 0.60, 0.30, intervention end; 0.64, 0.33, one-month follow-up). Abstinence was equivalent among Latinos in SFTXTesp and SFTXT interventions, but Latinos using SFTXTesp and SFTXT were less likely to be abstinent than Whites (aORs 0.42, 0.41, quit day; 0.45, 0.37, intervention end; and 0.53, 0.35, one-month follow-up).

Conclusion

Linguistic intervention targeting improved retention and engagement among Latinos, but not abstinence. Latinos had higher retention but lower engagement and abstinence rates than Whites. Cultural targeting may engage Latinos in smoking cessation interventions and improve abstinence.

Targeting Smoking Triggers: A Nurse-led Intervention for Tobacco Smoking Cessation

Background: Nursing interventions tailored to the smoking triggers in patients with non-communicable chronic diseases are essential. However, these interventions are scant due to the nature of factors associated with smoking cessation and the poor understanding of the effect of nurse-led intervention in Iraq.Purpose: This study aimed to determine the dominant smoking triggers and examine the effects of a tailored nursing intervention on smoking behavior in patients with non-communicable chronic diseases.Methods: Convenience samples of 128 patients with non-communicable chronic diseases, male and female patients, who were 18-70 years old, were recruited in this quasi-experimental, randomized comparative trial in the outpatient clinic in one major teaching hospital in Baghdad City, Iraq. The intervention included simple yet specific instructions that were given both orally and in written form to the study samples to enable them to manage their craving to smoke for 6 weeks. The smoking triggers were assessed using Why Do You Smoke questionnaire. Participants were randomly allocated to receive either the nurse-led intervention or standard care. Data were analyzed using descriptive statistics, independent sample t-tests, logistic regression, and two-sided tests.Results: Stress reduction was the dominant smoking trigger among subjects. The percentage of participants who were either able to completely quit smoking or reduce the number of smoked cigarettes per day (n=19, 29.7%; n=28, 43.8%, respectively) was greater in the study group than those in the control group (n=5, 5.8%; n=5, 5.8%, respectively). Study findings demonstrated significant differences in the inability to improve readiness to quit smoking between the intervention group and control group (p=0.000) at the sixth-week follow-up.Conclusion: The tailored nursing intervention was effective for a successful achievement of smoking reduction and cessation among patients with non-communicable chronic diseases, and a potential to equip nurses in clinical settings to support patients to achieve this is recommended.  

Telehealth interventions for substance use disorders in low- and- middle income countries: A scoping review

The increasing prevalence and magnitude of harmful effects of substance use disorders (SUDs) in low- and middle-income countries (LMICs) make it imperative to embrace interventions which are acceptable, feasible, and effective in reducing this burden. Globally, the use of telehealth interventions is increasingly being explored as possible effective approaches in the management of SUDs. Using a scoping review of literature, this article summarizes and evaluates evidence for the acceptability, feasibility, and effectiveness of telehealth interventions for SUDs in LMICs. Searches were conducted in five bibliographic databases: PubMed, Psych INFO, Web of Science, Cumulative Index of Nursing and Allied Professionals and the Cochrane database of systematic review. Studies from LMICs which described a telehealth modality, identified at least one psychoactive substance use among participants, and methods that either compared outcomes using pre- and post-intervention data, treatment versus comparison groups, post-intervention data, behavioral or health outcome, and outcome of either acceptability, feasibility, and/or effectiveness were included. Data is presented in a narrative summary using charts, graphs, and tables. The search produced 39 articles across 14 countries which fulfilled our eligibility criteria over a period of 10 years (2010 to 2020). Research on this topic increased remarkably in the latter five years with the highest number of studies in 2019. The identified studies were heterogeneous in their methods and various telecommunication modalities were used to evaluate substance use disorder, with cigarette smoking as the most assessed. Most studies used quantitative methods. The highest number of included studies were from China and Brazil, and only two studies from Africa assessed telehealth interventions for SUDs. There has been an increasingly significant body of literature which evaluates telehealth interventions for SUDs in LMICs. Overall, telehealth interventions showed promising acceptability, feasibility, and effectiveness for SUDs. This article identifies gaps and strengths and suggests directions for future research.

Ask-Advise-Connect: Differential Enrollment and Smoking Cessation Outcomes Between Primary Care Patients Who Received Quitline-Delivered Treatment in Spanish vs English

PURPOSE

This study examined differences in Quitline treatment enrollment, engagement, and smoking cessation outcomes among primary care patients preferring Spanish and English using the evidence-based tobacco treatment Ask-Advise-Connect.

METHODS

Ask-Advise-Connect was implemented April 2013 through February 2016 in a large safety-net health system to connect smokers with treatment via a link in the electronic health record. Rates of treatment enrollment, engagement, acceptance of nicotine replacement therapy, and smoking abstinence (self-reported and biochemically confirmed) were compared at 6 months among patients who received treatment in Spanish and English using χ 2 tests. Logistic regression examined language and nicotine replacement therapy and their interaction as predictors of abstinence.

RESULTS

The smoking status of 218,915 patients was assessed and recorded in the electronic health record. Smoking prevalence was 8.4% among patients preferring Spanish and 27.0% among those preferring English. Spanish-preferring patients were less likely to enroll in treatment (10.7% vs 12.0%, χ 2 = 12.06, P = .001) yet completed more counseling calls when enrolled (median = 2 vs 1, P <.001). Patients who received treatment in Spanish (vs English) were twice as likely to be abstinent at 6 months (self-reported: 25.1% vs 14.5%, odds ratio [OR] = 1.98, 95% CI, 1.62-2.40; biochemically confirmed: 7.6% vs 3.7%, OR = 2.13, 95% CI, 1.52-2.97). Receipt of nicotine replacement therapy increased abstinence for all patients and language did not interact with nicotine replacement therapy to predict abstinence.

CONCLUSIONS

Automated point-of-care approaches such as Ask-Advise-Connect have great potential to reach Spanish-preferring smokers. Those who received tobacco treatment in Spanish (vs English) demonstrated better engagement and cessation outcomes.

Web-delivered Acceptance and Commitment Therapy (ACT) for smoking cessation: Is it engaging and efficacious for US Hispanic/Latinx adult smokers?

Hispanic/Latinx adult smokers in the United States (US) face barriers to receiving and utilizing evidenced-based cessation treatments compared with other racial/ethnic groups. The lack of efficacious and accessible smoking cessation treatments for this population further contributes to such smoking disparities. In a secondary analysis, we explored the efficacy of an Acceptance and Commitment Therapy (ACT)-based website (WebQuit.org) versus a US Clinical Practice Guidelines (USCPG)-based website (Smokefree.gov) for smoking cessation in a subset of Hispanic/Latinx adult participants enrolled in the WebQuit trial. Of the 2,637 participants who were randomized in the parent trial, 222 were Hispanic/Latinx (n = 101 in WebQuit, n = 121 in Smokefree). Smoking cessation outcomes were measured at 3, 6, and 12-months. The primary outcome was self-reported complete-case 30-day point prevalence abstinence (PPA) at 12-months. Treatment engagement and satisfaction, change in acceptance of urges to smoke, and commitment to quitting smoking were compared across conditions. Retention rate was 88% at 12-months. WebQuit participants had higher odds of smoking cessation compared to Smokefree participants at 12-months (40% vs. 25%; OR = 1.93 95% CI: 1.04, 3.59). Findings were similar using multiple imputation. WebQuit participants engaged more with the website than Smokefree participants through multiple indicators of engagement, including spending more time using the website (IRR = 2.32; 95% CI: 1.68, 3.20). Although WebQuit participants engaged more with the website than Smokefree participants, there was no evidence that differences in quit rates were mediated by engagement level. This study provides initial empirical evidence that digital interventions may be efficacious for helping Hispanic/Latinx adults quit smoking.

Can a smartphone application help Hispanic/Latinx adults quit smoking? A randomized trial secondary analysis

Introduction

There are no known efficacious digital smoking cessation interventions for Hispanic/Latinx adults who smoke. This study is a secondary analysis using data from a randomized trial to evaluate whether Acceptance and Commitment Therapy (ACT) delivered via a smartphone app (iCanQuit) would be more efficacious for smoking cessation than the US Clinical Practice (USCPG)-based app (QuitGuide) in a sample of Hispanic/Latinx participants.

Methods

A total of 210 Hispanic/Latinx adults who smoke were randomized to receive the iCanQuit or QuitGuide app for 12-months. Participants self-reported on 30-day abstinence from cigarette smoking at the 3-month, 6-month, and 12-month follow-ups; 7-day abstinence at all follow-ups; abstinence from other nicotine/tobacco products at 12-months; and continuous prolonged abstinence from 3 to 12-months. Participants also reported on their willingness to accept cues to smoke without smoking and satisfaction with their apps.

Results

A total of 176 (84%) participants reported on study outcomes at the 12-month follow-up. Compared to QuitGuide participants, iCanQuit participants were significantly more likely to report 30-day abstinence from cigarette smoking at 12-months (34% iCanQuit, 20% QuitGuide; p=0.026). iCanQuit participants utilized their app more frequently and reported greater satisfaction with their assigned app than those who received the QuitGuide app. Increases in participants' willingness to accept cues to smoke mediated the intervention effect on abstinence from cigarette smoking at 12-months.

Conclusions

Acceptance and Commitment Therapy-delivered via a smartphone app may be efficacious for helping Hispanic/Latinx adults abstain from cigarette smoking. Replication in a fully powered randomized trial that focuses on an independent sample of Hispanic/Latinx adults is now needed.

Evaluating the Immediate Impact of Graphic Messages for Vaping Prevention among Black and Latino Adolescents: A Randomized Controlled Trial

The purpose of this pilot study was to assess the immediate impact of vaping prevention graphic messages on the susceptibility to future vaping among Black and Latino adolescents (ages 12 to 17). Graphic messages (available in English and Spanish) were developed using participatory research procedures with Black and Latino adolescents. Recruitment was conducted by a team of diverse, bilingual (English and Spanish), trained recruiters. Participants (n = 362) were randomized in a 1:1:1:1 schema to receive one of four graphic messages (health rewards, financial rewards, autonomy, and social norms). Overall, all graphic messages but one showed a slight decrease in the number of participants susceptible to future vaping, though none of these differences was statistically significant. The graphic message on health rewards decreased the number of participants susceptible to future vaping the most (55.7% vs. 50%, at pre- vs. post-viewing, p = 0.125), followed by the graphic messages on social norms and autonomy (55.1% vs. 52.8%, p = 0.687; 55.4% vs. 52.2%, p = 0.435; respectively). The graphic message on financial rewards increased the number of participants susceptible to future vaping slightly (52.7% vs. 53.8%, p = 1.00). Future research is needed to evaluate susceptibility to future vaping before and after exposure to different and/or repeated vaping prevention graphic messages.

Proactive and Reactive Recruitment of Black and Latino Adolescents in a Vaping Prevention Randomized Controlled Trial

The purpose of this study was to assesses the effectiveness of proactive and reactive methods in the recruitment of Black and Latino adolescents into a vaping-prevention randomized controlled trial (RCT). This study also assessed the characteristics of study participants by recruitment method. Proactive recruitment strategies included study presentations at community-based events (e.g., festivals, health fairs), school-based events (e.g., back-to-school events, after-school programs), and recreational centers (e.g., fitness centers, malls). Reactive recruitment strategies included study advertisements via social media (e.g., Facebook posts shared by local community-based organizations), word of mouth, and an academic-based research hub. Using proactive and reactive methods, in a 4-month period, 362 Black and Latino adolescents were successfully enrolled into the RCT. Compared to the proactive method, adolescents screened reactively were equally likely to be eligible but significantly more likely to enroll in the study. However, both proactive and reactive strategies made notable contributions to the overall recruitment effort. Moreover, proactive and reactive methods attracted adolescents with different characteristics (e.g., age, gender, sexual orientation, etc.). These findings suggest that both proactive and reactive recruitment strategies should be implemented for studies interested in recruiting a diverse sample of Black and Latino adolescents.

A Text Messaging Intervention to Support Latinx Family Caregivers of Individuals With Dementia (CuidaTEXT): Development and Usability Study

BACKGROUND

Latinx family caregivers of individuals with dementia face many barriers to caregiver support access. Interventions to alleviate these barriers are urgently needed.

OBJECTIVE

This study aimed to describe the development of CuidaTEXT, a tailored SMS text messaging intervention to support Latinx family caregivers of individuals with dementia.

METHODS

CuidaTEXT is informed by the stress process framework and social cognitive theory. We developed and refined CuidaTEXT using a mixed methods approach that included thematic analysis and descriptive statistics. We followed 6 user-centered design stages, namely, the selection of design principles, software vendor collaboration, evidence-based foundation, caregiver and research and clinical advisory board guidance, sketching and prototyping, and usability testing of the prototype of CuidaTEXT among 5 Latinx caregivers.

RESULTS

CuidaTEXT is a bilingual 6-month-long SMS text messaging-based intervention tailored to caregiver needs that includes 1-3 daily automatic messages (n=244) about logistics, dementia education, self-care, social support, end of life, care of the person with dementia, behavioral symptoms, and problem-solving strategies; 783 keyword-driven text messages for further help with the aforementioned topics; live chat interaction with a coach for further help; and a 19-page reference booklet summarizing the purpose and functions of the intervention. The 5 Latinx caregivers who used the prototype of CuidaTEXT scored an average of 97 out of 100 on the System Usability Scale.

CONCLUSIONS

CuidaTEXT's prototype demonstrated high usability among Latinx caregivers. CuidaTEXT's feasibility is ready to be tested.

Feasibility and Effectiveness of Recruiting Latinos in Decídetexto-A Smoking Cessation Clinical Trial from an Emergency Department Patient Registry

There is an underrepresentation of Latinos in smoking cessation clinical trials. This study describes the feasibility and effectiveness of recruiting Latino smokers in the U.S. from an emergency department (ED) patient registry into a randomized smoking cessation clinical trial. Recruitment occurred from the Hackensack University Medical Center ED. Potential participants were contacted from a patient registry. The primary outcome was whether the participant responded to a call or text. Secondary outcomes included the best day of the week, week of the month, and time of day to obtain a response. Of the 1680 potential participants, 1132 were called (67.5%), while 548 (32.5%) were texted. For calls, response rate was higher compared to text (26.4% vs 6.4%; p < 0.001). More participants were interested in the study when contacted by calls compared to text (11.4% vs. 1.8%) and more participants were enrolled in the study when contacted by calls compared to text (1.1% vs. 0.2%). Regression models showed that ethnicity, age, time of day, and week of the month were not significantly associated with response rates. Recruitment of Latinos from an ED patient registry into a smoking cessation clinical trial is feasible using call and text, although enrollment may be low.

Translation and Examination of the Reliability and Validity of the Spanish Version of the Smoking Self-Efficacy Questionnaire Among Latino Smokers

The 12-item Smoking Self-Efficacy Questionnaire (SEQ-12) is a valid and reliable instrument to assess confidence in one’s ability to refrain from smoking in a variety of different situations. This study evaluated the psychometric properties of the Spanish version of the 12-item Smoking Self-Efficacy Questionnaire (SEQ-12) among a sample of Spanish-speaking Latino smokers engaged in a smoking cessation research study. A forward-backward translation procedure guided the translation of the SEQ-12 into Spanish. The Spanish version of the SEQ-12 showed promising internal consistency reliability and construct validity among Latino smokers, with potential applications in both research and clinical settings.

Barriers and Facilitators of Smoking Cessation among Latinos Living with HIV: Perspectives from Key Leaders of Community-Based Organizations and Clinics

The purpose of this study was to identify the perspectives from key leaders of community-based organizations (CBOs) and clinics serving people living with HIV on barriers and facilitators of smoking cessation among Latino smokers living with HIV. Semi-structured interviews were conducted in English and Spanish with 10 key leaders. Using a social ecological model, qualitative theoretical analysis was used to analyze the results. Participants identified barriers at the individual (e.g., low education level, HIV, and financial stress), interpersonal (e.g., language barriers, low social support), organizational (e.g., lack of smoking cessation resources and targeted interventions), community (e.g., HIV and mental health stigma), and policy (e.g., paperwork for insurance) level. Participants identified facilitators at the individual (e.g., high participation in trials, good medication adherence), interpersonal (e.g., no smoking in social circles), organizational (e.g., bilingual staff, culturally competent care), community (e.g., providing transportation, the coronavirus disease 2019 as an opportunity for smoking cessation), and policy level (e.g., existence of funding, comprehensive insurance programs). These results provide operational strategies to address smoking disparities among Latino smokers living with HIV. Further research is needed on how to integrate these perspectives into effective smoking cessation interventions.

Decídetexto: Feasibility and Acceptability of a Mobile Smoking Cessation Intervention in Puerto Rico

The purpose of this pilot study was to assess the feasibility and acceptability of a mobile smoking cessation intervention in Puerto Rico. This was a single-arm pilot study with 26 smokers in Puerto Rico who were enrolled in Decídetexto, a mobile smoking cessation intervention. Decídetexto incorporates three integrated components: (1) a tablet-based software that collects smoking-related information to develop an individualized quit plan, (2) a 24-week text messaging counseling program with interactive capabilities, and (3) pharmacotherapy support. Outcome measures included self-reported 7-day point prevalence abstinence at Months 3 and 6, pharmacotherapy adherence, satisfaction with the intervention, and changes in self-efficacy. The average age of the participants was 46.8 years (SD 12.7), half of them (53.8%) were female. Most participants (92.3%) smoked daily and half of them (53.8%) used menthol cigarettes. All participants requested nicotine patches at baseline. However, only 13.0% of participants used the patch >75% of days. At Month 3, 10 participants (38.4%) self-reported 7-day point prevalence abstinence (88.5% follow-up rate). At Month 6, 16 participants (61.5%) self-reported 7-day point prevalence abstinence (76.9% follow-up rate). Most participants (90%, 18/20) reported being satisfied/extremely satisfied with the intervention at Month 6. Self-efficacy mean scores significantly increased from 40.4 (SD 12.1) at baseline to 57.9 (SD 11.3) at Month 3 (p < 0.01). The study suggests that Decídetexto holds promise for further testing among Puerto Rican smokers.