A Web-Based Text Messaging for Tobacco Cessation in Rural Mississippi

A Randomized Trial of a Web-Based Text Messaging for Tobacco Cessation in Rural Mississippi

Cigarette smoking prevalence has decreased to ~12% in 2022; however, over 40 million U.S. adults were current cigarette smokers in the same year. Rural-urban disparities in tobacco use are persistent, with higher tobacco use and lower cessation in rural areas. Less research has been dedicated to addressing rural-urban tobacco use disparities, perhaps due to logistics, difficulty recruiting and following participants from rural areas, and challenges with conducting clinic-based interventions. Mississippi is one of the states with higher rurality, as 79% of Mississippi counties are classified as rural. Additionally, Mississippi has a higher prevalence of tobacco use and lower cessation rates compared with the national average. Moreover, Mississippi is one of the few states that did not expand Medicaid, which covers comprehensive tobacco cessation services. This may add to the persistent disparity in tobacco use and cessation between rural and urban Mississippians. To overcome these challenges, the investigators propose a randomized clinical trial to test the effectiveness of theory-driven text messaging for tobacco cessation in rural Mississippi among users of cigarettes, smokeless tobacco (SLT), and dual users of cigarettes and SLT. Specifically, this proposal has the following specific aims: (1) To conduct a two-arm, randomized, clinical trial (RCT) of a web-based, text messaging approach for tobacco cessation among cigarette smokers, SLT users and dual users from rural Mississippi; (2) To assess the effectiveness of a web-based, text messaging intervention on tobacco cessation among cigarette smokers, SLT users and dual users; and (3) To identify barriers to and facilitators of tobacco cessation using ecological momentary assessment (EMA). To achieve these aims, a sample of 150 tobacco users (50 cigarette smokers, 50 SLT users, 50 dual users) who intend to quit and have made ≥1 quit attempt in the past 6 months will be recruited via a web-based, crowdsourcing platform (ResearchMatch.org). ResearchMatch.org is a large crowdsourcing platform that facilitates recruitment of a desired research sample from an online panel. Eligible participants will be randomized to intervention and control arms and will be asked to set up a quit date within the first 4 weeks post-intervention. Participants in the intervention arm will receive up to 3 motivational text messages daily during the first 4 weeks, and up to 2 daily during the last 2 weeks. The same frequency will be followed for the control group, but they will receive non-specific text messages. Participants will also receive a daily, midday text message during weeks 1-10 post-intervention to document the barriers and facilitators of tobacco cessation using EMA approach. After week 10 and to the end of 6 months post-intervention, the frequency of EMA texts will be reduced to once per week. Two-way text messaging will be facilitated via a web-based service called Mosio. The investigators will assess prolonged and 7-day point prevalence abstinence at 6 weeks, 3 months, and 6 months post-intervention. This project represents an attempt to test a simple and innovative approach to reducing rural-urban tobacco use disparities and overall tobacco-related morbidity and mortality. The findings can facilitate applying for extramural funding for a larger trial.

Study Overview

• Status: Not yet recruiting
• Conditions: Tobacco Cessation
• Intervention / Treatment: Behavioral: Motivational text messaging for tobacco cessation; Behavioral: Non-specific text messaging

• Study Type: Interventional
• Enrollment (Estimated): 150
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Raed A Bahelah, PhD; Phone Number: 601-815-9523; Email: rbahelah@umc.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• ≥18 years-old
• resident of rural Mississippi (verified by a ZIP code)
• not planning to move out of Mississippi during the next 6 months
• own a personal cellphone with an unlimited texting plan
• having the intention to quit tobacco and having made at least 1 quit attempt in the past 6 months
• smokes ≥5 cigarettes per day during the past 6 months (for the cigarette smoking condition)
• uses SLT ≥3 times per day during the past 6 months (for the SLT condition)
• concurrent use of cigarettes and SLT on ≥15 days monthly during the past 6 months (for the dual use condition).

Exclusion Criteria:

• a self-report of being diagnosed with or taking medications for severe mental illness
• refusal to provide informed consent
• having no intention to quit tobacco
• currently using electronic cigarettes or pharmacological medications for tobacco cessation
• currently participating in another RCT.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Motivational text messaging; Participants will receive motivational text messaging for tobacco cessation	Behavioral: Motivational text messaging for tobacco cessation; Participants will receive motivational text messaging for tobacco cessation.
Placebo Comparator: Non-specific text messaging; Participants will receive non-specific text messaging	Behavioral: Non-specific text messaging; Non-specific text messaging

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Prolonged abstinence	Prolonged abstinence is defined as self-report of not using cigarettes (among cigarette smokers), SLT (among SLT users), and both SLT and cigarettes (among dual users) between baseline and 6 months post-randomization. This outcome will be measured at three time points: 6 weeks, 3 months, and 6 months post-randomization.	Baseline to 6 months post-randomization
7-day point prevalence abstinence	At each time point (6 weeks, 3 months, and 6 months), participants will complete a survey and self-report their tobacco use during the past 7 days prior to the survey. 7-day point prevalence abstinence is defined as not using cigarettes (among cigarette smokers), SLT (among SLT users), and both SLT and cigarettes (among dual users) during the 7 days prior to the survey.	Past 7 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Prolonged abstinence of all tobacco products	Prolonged abstinence of all tobacco products, defined as a self-report of complete abstinence from using all tobacco products, including cigarettes, since the quit date at 6 weeks, 3 months, and 6 months post-intervention.	Baseline to 6 months

Collaborators and Investigators

• Sponsor: University of Mississippi Medical Center

Publications and helpful links

Helpful Links

• ResearchMatch.org for recruting participants
• A web-based, two-way text messaging will be facilitated through Mosio, a two-way texting platform that allows participants send texts to the study coordinator.

Study record dates

Study Major Dates

• Study Start (Estimated): December 1, 2026
• Primary Completion (Estimated): June 30, 2027
• Study Completion (Estimated): November 30, 2027

Study Registration Dates

• First Submitted: September 22, 2025
• First Submitted That Met QC Criteria: February 18, 2026
• First Posted (Actual): February 24, 2026

Study Record Updates

• Last Update Posted (Actual): February 24, 2026
• Last Update Submitted That Met QC Criteria: February 18, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Rural; Smokeless tobacco; Text messaging
• Additional Relevant MeSH Terms: Behavior; Health Behavior; Tobacco Use; Tobacco Use Cessation
• Other Study ID Numbers: UMMC-IRB-2024-453

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: The dataset will be used as pilot data to apply for larger grants. It is uncertain when the team will be able to obtain external funding based on this pilot dataset, and therefore, sharing IDP is not appropriate.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No