O3248: Text Me Maybe: Text Message Outreach Pilot Connecting Adolescents to Nicotine Treatment

Purpose/Objectives: As most adult tobacco use begins during adolescence, treating adolescent tobacco/nicotine use before it continues into persistent and long-term use is a critical public health issue. Most adolescents who use tobacco/nicotine want and attempt to quit, but rates of nicotine use treatment are extremely low for adolescents. Leveraging a combination of clinical informatics and population health approaches, we sought to assess the feasibility, acceptability, and clinical impact of remote nicotine treatment through a health navigator, within a large primary care network.

Design/Methods: This was a 6-week longitudinal quality improvement (QI) pilot study. All adolescents who attended primary care visits across 32 practices completed a confidential electronic adolescent health questionnaire (AHQ) assessing past 30-day nicotine use. Those who screened positive were asked if they were interested in receiving resources for quitting via text-message outreach. Adolescents who responded “yes” and provided their phone number, as well as adolescents connected to the pilot by their pediatrician, received text-message outreach from a health navigator (Figure 1). Initial text-message language was refined iteratively over the trial using QI methodology. Two treatment options were offered: This is Quitting (TIQ), a text-message-based vaping cessation program, and/or nicotine replacement therapy (NRT). Those interested in NRT had a confidential phone visit with the prescribing pediatrician and received an NRT prescription if indicated. Adolescents interested in TIQ were enrolled by the health navigator. Feasibility was measured as any response to text outreach. Acceptability was measured by the number of adolescents who opted to hear about treatment options and were connected to treatment. Clinical impact was measured as self-reported use of either treatment. Secondary outcomes included any engagement with the health navigator for ongoing support with cessation.

Results: From January-March 2024, 329 adolescents screened positive for nicotine use and 39 (12%) opted-in for outreach. A total of 40 adolescents (41% female, median age: 17 years, range 13-21) received text message outreach, either to their phone (n=38) or to their parent’s phone with their consent (n=2) (Figure 2). Most adolescents (70%) responded to initial outreach, demonstrating feasibility for text-message outreach. For acceptability, 18 (45%) opted to learn about treatment options and 7 (18%) were connected to treatment: 5 (13%) were prescribed NRT and 5 (13%) were enrolled in TIQ. Assessing clinical impact, 4 (10%) confirmed using NRT and/or TIQ. For secondary outcomes, 5 (12%) engaged the health navigator for counseling or cessation support.

Conclusion/Discussion: Text-message outreach from a health navigator is feasible, acceptable, and may impact clinical care for adolescents interested in nicotine cessation through pediatric primary care. Most adolescents responded to initial text outreach and nearly half were interested in learning more about cessation resources. Future research should evaluate the impact of this approach on rates of adolescent treatment engagement and e-cigarette cessation.