Skip to main content
SpringerLink
Log in

Recruiting pregnant smokers from Text4baby for a randomized controlled trial of Quit4baby

  • Original Research
  • Published:
Translational Behavioral Medicine

Abstract

Recruiting pregnant smokers into clinical trials is challenging since this population tends to be disadvantaged, the behavior is stigmatized, and the intervention window is limited. The purpose of this study is to test the feasibility and effectiveness of recruiting pregnant smokers into a smoking cessation trial by sending recruitment text messages to an existing subscriber list. Recruitment messages were sent to subscribers flagged as pregnant in Text4baby, a national text messaging program for pregnant women and mothers. Four recruitment messages were rotated to test the effectiveness of different emotional frames and a financial incentive. Study staff called subscribers who expressed interest to screen for eligibility and enroll eligible women. Between October 6, 2015 and February 2, 2016, 10,194 recruitment messages were sent to Text4baby subscribers flagged as pregnant, and 10.18% (1038) responded indicating interest. No significant increase in cancellation was observed compared to subscribers who received other ad hoc messages. Of respondents, 54.05% (561) were reached by phone for follow-up, and 21.97% (228) were found to be eligible. Among the eligible, 87% (199) pregnant smokers enrolled. The recruitment message with a pride emotional appeal had a significantly higher response (p = 0.02) compared to the recruitment message with no emotional appeal, but enrollment did not significantly differ between recruitment messages with different emotional appeals. The recruitment messages with a reference to financial incentive yielded higher response (p < 0.01) and enrollment (p = 0.03) compared to a recruitment message without. This study demonstrates success recruiting pregnant smokers using text message. Future studies should consider building on this approach for recruiting high-risk populations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig 1

Similar content being viewed by others

References

  1. U.S. Department of Health and Human Services. The Health Consequences Of Smoking—50 Years Of Progress: A Report Of The Surgeon General. Atlanta, GA: National Library of Medicine Cataloging in Publication; 2014.

  2. Tobacco Cessation | Medicaid.gov. Medicaidgov. 2016. Available at: https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Tobacco.html. Accessed June 16, 2016.

  3. U.S. Department of Health and Human Services. Smoking Prevalence and Cessation Before and During Pregnancy: Data from the Birth Certificate, 2014. Hyattsville, MD: National Vital Statistics Reports, Vol. 65, No. 1; 2016.

  4. Centers for Disease Control and Prevention. Pramstat. Atlanta, GA; 2016: Indicator for whether mother smoked during the last three months of pregnancy.

  5. Frew, P. M., Saint-Victor, D. S., Isaacs, M. B., et al. (2014). Recruitment and retention of pregnant women into clinical research trials: an overview of challenges, facilitators, and best practices. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 59(Suppl 7), S400–S407. doi:10.1093/cid/ciu726.

    Article  Google Scholar 

  6. Lopez, E., Simmons, V., Quinn, G., Meade, C., Chirikos, T., & Brandon, T. (2008). Clinical trials and tribulations: lessons learned from recruiting pregnant ex-smokers for relapse prevention. Nicotine & Tobacco Res, 10(1), 87–96. doi:10.1080/14622200701704962.

    Article  Google Scholar 

  7. Cinciripini, K., Sorensen, G., Klar, N., et al. (2000). An evaluation of videotaped vignettes for smoking cessation and relapse prevention during pregnancy: the very important pregnant smokers (VIPS) program. Tob Control, 9(90003), 61iii–61i63. doi:10.1136/tc.9.suppl_3.iii61.

    Article  Google Scholar 

  8. Emmons, K., Sorensen, G., Klar, N., et al. (2000). Healthy baby second-hand smoke study: project brief. Tob Control, 9(90003), 58iii–58i60. doi:10.1136/tc.9.suppl_3.iii58.

    Article  Google Scholar 

  9. Goldenberg R, Klerman L, Windsor R, Whiteside, Jr H. Smoking in pregnancy: final thoughts. Tobacco Control. 2000;9(90003):85iii-86. doi:10.1136/tc.9.suppl_3.iii85.

  10. Pollack, K. I., Oncken, C. A., Lipkus, I. M., Peterson, B. L., Swamy, G. K., Pletch, P. K., Lyna, P., Namenek Brouwer, R. J., Fish, L. J., & Myers, E. R. (2006). Challenges and solutions for recruiting pregnant smokers into a nicotine replacement therapy trial. Nicotine and Tobacco Research, 8(4), 547–554.

    Article  Google Scholar 

  11. Ruggiero, L., Webster, K., Peipert, J. F., & Wood, C. (2003). Identification and recruitment of low-income pregnant smokers who are we missing? Addict Behav, 28(8), 1497–1505.

    Article  PubMed  Google Scholar 

  12. Solomon, L. J., Secker-Walker, R. H., Flynn, B. S., Skelly, J. M., & Capeless, E. L. (2000). Proactive telephone peer support to help pregnant women stop smoking. Tob Control, 9(Suppl III), iii72–iii74.

    PubMed  PubMed Central  Google Scholar 

  13. Strecher, V. J., Bishop, K. R., Bernhardt, J., Thorp, J. M., Cheuvront, B., & Potts, P. (2000). Quit for keeps: tailored smoking cessation guides for pregnancy and beyond. Tob Control, 9(Suppl III), iii78–iii79.

    PubMed  PubMed Central  Google Scholar 

  14. Boucher JKonkle, A. (2016). Understanding inequalities of maternal smoking—bridging the gap with adapted intervention strategies. Int J Environ Res Public Health, 13(3), 282. doi:10.3390/ijerph13030282.

    Article  Google Scholar 

  15. Prenatal Care Utilization, Child Health USA 2013. Mchbhrsagov. 2016. Available at: http://mchb.hrsa.gov/chusa13/health-services-utilization/p/prenatal-care-utilization.html. Accessed June 30, 2016.

  16. Ingall GCropley, M. (2010). Exploring the barriers of quitting smoking during pregnancy: a systematic review of qualitative studies. Women and Birth, 23(2), 45–52. doi:10.1016/j.wombi.2009.09.004.\.

    Article  Google Scholar 

  17. Petersen, Z., Nilsson, M., Everett, K., & Emmelin, M. (2009). Possibilities for transparency and trust in the communication between midwives and pregnant women: the case of smoking. Midwifery, 25(4), 382–391. doi:10.1016/j.midw.2007.07.012.

    Article  PubMed  Google Scholar 

  18. Maxwell, A. E., Bastani, R., Glenn, B. A., Mojica, C. M., & Chang, C. (2009). An experimental test of the effect of incentives on recruitment of ethnically diverse colorectal cancer cases and their first-degree relatives into a research study. Canc Epidemiol Biomarkers Prev, 18(10), 2620–2625. doi:10.1158/1055-9965.EPI-09-0299.

    Article  Google Scholar 

  19. Hatchett, B. F., Holmes, K., Duran, D. A., & Davis, C. (2000). African Americans and research participation: the recruitment process. J Black Stud, 30, 664–674. doi:10.1177/002193470003000502.

    Article  Google Scholar 

  20. Cleland, V., & Ball, K. (2010). Recruiting hard-to-reach populations: lessons from a study of women living in socioeconomically disadvantaged areas of Victoria, Australia. Health Promot J Austr, 21(3), 243–244.

    PubMed  Google Scholar 

  21. Furimsky, I., Cheung, A. H., Dewa, C. S., & Zipursky, R. B. (2008). Strategies to enhance patient recruitment and retention in research involving patients with a first episode of mental illness. Contemp Clin Trials, 29, 862–866. doi:10.1016/j.cct.2008.07.005.

    Article  PubMed  Google Scholar 

  22. Barnett, J., Aguilar, S., Brittner, M., & Bonuck, K. (2012). Recruiting and retaining low-income, multi-ethnic women into randomized controlled trials: successful strategies and staffing. Contemporary Clinical Trials, 33(5), 925–932.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Yancey, A. K., Ortega, A. N., & Kumanyika, S. K. (2006). Effective recruitment and retention of minority research participants. Annu Rev Public Health, 27, 1–28.

    Article  PubMed  Google Scholar 

  24. Galli, L., Knight, R., Robertson, S., Hoile, E., Oladapo, O., Francis, D., & Free, C. (2014). Using marketing theory to inform strategies for recruitment: a recruitment optimisation model and the txt2stop experience. Trials, 15, 182. doi:10.1186/1745-6215-15-182.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Turner, M. M. (2011). Using emotional appeals in health messages. In H. Cho (Ed.), Health Communication Message Design: Theory and Practice (pp. 59–69). Thousand Oaks: SAGE Publications Retrieved from: https://books.google.com/books?id=MACkkuKWEqEC.

    Google Scholar 

  26. Hoek, J., Gifford, H., Maubach, N., & Newcombe, R. (2014). A qualitative analysis of Maori and Pacific smokers’ views on informed choice and smoking. BMJ Open, 4, e006716. doi:10.1136/bmjopen-2014-006716.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Nabi, R. (2003). Exploring the framing effects of emotion: do discrete emotions differentially influence information accessibility, information seeking, and policy preference? Commun Res, 30(2), 224–247. doi:10.1177/0093650202250881.

    Article  Google Scholar 

  28. Witte KAllen, M. (2000). A meta-analysis of fear appeals: implications for effective public health campaigns. Health Educ Behav, 27(5), 591–615. doi:10.1177/109019810002700506.

    Article  Google Scholar 

  29. Anderson M. Technology Device Ownership. Pew Research Center. 2015. Available at: http://www.pewinternet.org/files/2015/10/PI_2015-10-29_device-ownership_FINAL.pdf. Accessed June 16, 2016.

  30. Smith A. Americans and text messaging. Pew Research Center. 2011. Available at: http://www.pewinternet.org/files/old-media//Files/Reports/2011/Americans%20and%20Text%20Messaging.pdf. Accessed June 16, 2016.

  31. U.S. Department of Health and Human Services. Promoting Maternal And Child Health Through Health Text Messaging. Rockville, MD; 2015:17–26.

  32. Messages on Critical Issues. Text4babyorg. 2016. Available at: https://text4baby.org/about/message-content. Accessed June 30, 2016.

  33. Text4baby—Who Involved. Partnerstext4babyorg. 2016. Available at: https://partners.text4baby.org/index.php/about/partners. Accessed June 30, 2016.

  34. Center for Medicare & Medicaid Services, Maternal and Infant Health. Pilot mobile health program: using mobile technology to reach, educate, and connect pregnant and postpartum medicaid enrollees.; 2016. Available at: https://www.medicaid.gov/medicaid-chip-program-information/by-topics/quality-of-care/downloads/pilot-mobile-health-program.pdf. Accessed June 30, 2016.

  35. California State University San Marcos. National Survey of Text4baby Participants.; 2013. Available at: http://www.csusm.edu/anthropology/docsandfiles/Text4baby.pdf. Accessed June 18, 2016.

  36. Abroms, L., Johnson, P., Heminger, C., et al. (2015). Quit4baby: results from a pilot test of a mobile smoking cessation program for pregnant women. JMIR mHealth uHealth, 3(1), e1e0. doi:10.2196/mhealth.3846.

    Article  Google Scholar 

  37. Whittaker, R., Matoff-Stepp, S., Meehan, J., et al. (2012). Text4baby: development and implementation of a national text messaging health information service. Am J Public Health, 102(12), 2207–2213. doi:10.2105/ajph.2012.300736.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Ammerman, A., Smith, T., & Calancie, L. (2014). Practice-based evidence in public health: improving reach, relevance, and results. Annu Rev Public Health, 35, 47–63.

    Article  PubMed  Google Scholar 

  39. Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health, 89, 1322–1327.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform, 42(2), 377–381.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank the George Washington University Research Assistants Dasha Afanaseva MPH, Laura Macherelli MPH, Shelby Fallon MPH, Shawn Chiang, and Nisha Radhakrishnan for following through with the recruitment process over the phone. We would also like to thank Ada Obi, Lalida Thaweethai MPH, Diana Zuskov of Voxiva, and Amy Pirretti of ZERO TO THREE for their contributions to developing and implementing the recruitment plan.

Author information

Authors and Affiliations

  1. Prevention and Community Health, The George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave., 3rd Floor, Washington, DC, 20052, USA

    Leah Leavitt M.P.H, Lorien Abroms Sc.D, M.A, Jennifer Schindler-Ruwisch M.P.H, Sean D. Cleary Ph.D, M.P.H, Whitney McInvale M.P.H & Monique Turner Ph.D, M.A

  2. Voxiva, Inc., 1820 N Fort Myer Dr, Suite 600, Arlington, VA, 22209, USA

    Pamela Johnson Ph.D & Indira Singh M.P.H

  3. ZERO TO THREE, 1255 23rd Street, NW, Suite 350, Washington, DC, 20037, USA

    Jessica Bushar M.P.H

Authors
  1. Leah Leavitt M.P.H
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lorien Abroms Sc.D, M.A
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pamela Johnson Ph.D
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jennifer Schindler-Ruwisch M.P.H
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jessica Bushar M.P.H
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Indira Singh M.P.H
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sean D. Cleary Ph.D, M.P.H
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Whitney McInvale M.P.H
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Monique Turner Ph.D, M.A
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Leah Leavitt M.P.H.

Ethics declarations

The recruitment protocol was approved by the George Washington University Institutional Review Board.

Comments to the editor

The findings reported have not been previously published and this manuscript is not being simultaneously submitted elsewhere. Preliminary findings were presented at the Society of Behavioral Medicine’s 37th Annual Meeting in March 2016. The authors have full control of all primary data and agree to allow the journal to review their data if requested.

Funding

Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number R44DA035017. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Conflicts of interest

Dr. Lorien Abroms has stock options in Voxiva, Inc. and has licensed Quit4Baby and Text2Quit to Voxiva, Inc. Dr. Pamela Johnson and Indira Singh are currently employed by Voxiva, Inc., and Jessica Bushar is employed by ZERO TO THREE, a partner operating the Text4baby service.

Statement of human rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki Declaration and its later amendments or comparable ethical standards. Animal experimental subjects were not used in this research.

Statement on informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Implications

Practice: An outreach recruitment text message sent to an existing text messaging subscriber list is a novel way to recruit pregnant smokers for a clinical trial.

Policy: Government programs such as Medicaid and other health plans may consider using text messages to identify and reach high-risk populations.

Research: Future research should consider building on the use of text message for recruiting at risk populations for future trials and established treatment programs.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Leavitt, L., Abroms, L., Johnson, P. et al. Recruiting pregnant smokers from Text4baby for a randomized controlled trial of Quit4baby. Behav. Med. Pract. Policy Res. 7, 157–165 (2017). https://doi.org/10.1007/s13142-016-0450-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13142-016-0450-4

Keywords

Search

Navigation