Pragmatic Trial of Text Messages to Recruit Unassisted Tobacco Users Into Quitline Service

Texting to Recruit Unassisted Tobacco Users at a Large Safety Net Health System Into Quitline Service for a Medicaid Value-based Care Program: Pragmatic Randomized Controlled Trial

The goal of this pragmatic trial is to compare the effects of text messages on quitline enrollment by patients identified in electronic health records as unassisted tobacco users. The main question it aims to answer is:

Do messages offering free counseling or free nicotine patches by text increase quitline enrollment?

Researchers will compare if people receiving texts about free nicotine patches will have higher quitline enrollment than texts about free counseling.

Participants will receive a text message stratified by quitline language and click on the toll-free number to access quitline services.

Participants were patients of Los Angeles County Department of Health Services (LADHS). Through the LADHS population health team, eligible patients were identified through data extraction from the electronic health record for quality metric reporting.

Participants were stratified by language (English, Spanish) by LADHS, then randomly assigned to one of two groups. The randomization assignment was generated by a statistician from Kick It California, and text messages were assigned to groups and delivered by LADHS.

Group 1 received a text message offering free quitline coaching. Group 2 received a text message offering free nicotine patches. The texts were sent April-May 2022 and were in English or Spanish according to patient preference. All messages contained a toll-free number to access services, which could be called directly from the text message link, but for tracking purposes different numbers were used.

The quitline, Kick It California, offered coaching to all enrolled participants. The quitline also mailed a 2-week supply of nicotine patches to all enrolled participants unless contraindicated, regardless of which text offer they received. To ensure equitable access, a second text was sent to all participants in June 2022 offering free NRT.

Inclusion Criteria:

• Patient of Los Angeles County Department of Health Services with clinical encounter in past 12 months
• 18 years or older
• English or Spanish language
• Had cell phone
• Permission to text
• Patient identified as tobacco user with no documented assistance (e.g., smoking cessation medication, quitline referral, brief counseling by provider) in the prior 24 months

Exclusion Criteria:

- Languages other than English or Spanish