Abstract B013: Text messaging for accessible smoking cessation support among underserved adults in rural and urban Georgia

Abstract Background: Tobacco use, a primary behavioral risk factor for cancer, is the leading preventable cause of morbidity and mortality in the U.S. Severe tobacco-related health disparities persist for certain populations including those with low socioeconomic status, people living in rural areas, and racial and ethnic minoritized groups. There is a growing need for accessible, evidence-based smoking cessation interventions tailored to underserved communities. Text messaging could be a cost-effective and user-friendly modality to increase access to smoking cessation treatment. In a pilot study of a mindfulness-based text messaging intervention for smoking cessation (“iQuit Mindfully”) in urban Atlanta and rural Georgia, 34.8% achieved biochemically-confirmed smoking abstinence, which compares to about 7% who successfully quit in the general population. This study examined qualitative data from post-treatment interviews, with a focus on treatment accessibility. Methods: Sixty adults who smoked cigarettes daily were enrolled in Atlanta (n=30) and rural Georgia (n=30). Most were female (61.7%), 41.7% identified as African American, and about half (53.3%) reported total annual household income less than $30,000. Participants were randomly assigned to iQuit Mindfully (intervention text messages, nicotine replacement therapy, at-home breath carbon monoxide monitor, and self-help materials) or usual care (nicotine replacement therapy, at-home breath carbon monoxide monitor, and self-help materials). Following the intervention, participants engaged in individual interviews to provide in-depth feedback. Interviews were analyzed by multiple team members using inductive and deductive methods. Qualitative analyses were completed using NVivo software. Results: Participants described the text messaging intervention as convenient because they did not have to travel to in-person appointments. They described the texts as encouraging, motivational, and inspirational, and they liked receiving personalized reminders about their reasons for quitting smoking. Participants appreciated being able to customize the frequency and timing of the text messages and explained that texting keywords (e.g., CRAVE) for real-time support helped them to manage cravings without smoking. Many enjoyed seeing their progress by using the portable breath carbon monoxide monitor, which they described as highly motivating. A few rural participants described technical issues with using the monitor, but almost all participants, rural or urban, expressed that they found the device helpful for tracking their smoking behavior. Discussion: These results support the feasibility and acceptability of the iQuit Mindfully text messaging intervention for smoking cessation in urban and rural Georgia. Text messaging could provide accessible support for quitting smoking in rural settings. The presentation will include example quotes from participants and discussion of strategies for wider implementation. Citation Format: Larry M. Mason, Hope Derricott, Khandis Brewer, Thandiwe Bobb, Kyan Nguyen, Megha Yeddula, Martha S. Tingen, Claire A. Spears. Text messaging for accessible smoking cessation support among underserved adults in rural and urban Georgia [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr B013.