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. 2025 May 20;25(1):1852.
doi: 10.1186/s12889-025-22995-8.

Smoking cessation message testing to inform app-based interventions for young adults - an online experiment

Josef Hamoud  1 , Janardan Devkota  2 , Timothy Regan  3 , Amanda Luken  2 , Joseph Waring  2 , Jasmin Jiuying Han  2 , Felix Naughton  4 , Roger Vilardaga  5 , Jonathan Bricker  6   7 , Carl Latkin  8 , Meghan Moran  8 , Johannes Thrul  9   10   11
Affiliations

Smoking cessation message testing to inform app-based interventions for young adults - an online experiment

Josef Hamoud et al. BMC Public Health. .

Abstract

Background: To improve the efficacy of digital smoking cessation interventions for young adults, intervention messages need to be acceptable and appropriate for this population. The current study compared ratings of smoking cessation and urge reduction messages based on Cognitive Behavioral Therapy (distraction themed) and Acceptance and Commitment Therapy (acceptance themed) in young adults who smoke.

Methods: A total of 124 intervention messages were rated by an online Qualtrics panel of N = 301 diverse young adults who currently smoked tobacco cigarettes (Age M = 26.6 years; 54.8% male; 51.5% racial/ethnic minority; 16.9% sexual or gender minority (SGM); 62.5% daily smoking). Each participant rated 10 randomly selected messages (3,010 total message ratings; 24.3 ratings per message) on 5-point scales (higher scores representing more favorable ratings) evaluating quality of content, quality of design, perceived support for coping with smoking urges, and perceived support for quitting smoking. Mixed models examined associations between message category (distraction vs. acceptance), participant level predictors (sociodemographic variables, readiness and motivation to quit, daily smoking, psychological flexibility), and message ratings.

Results: Overall ratings ranged from M = 3.61 (SD = 1.25) on support for coping with urges to M = 3.90 (SD = 1.03) on content, with no differences between distraction and acceptance messages. Male participants gave more favorable ratings on the dimensions of support for coping (p < 0.01) and support for quitting (p < 0.01). Participants identifying as SGM gave lower ratings for message design (p < 0.05). Participants with a graduate degree gave higher ratings on support for coping with urges and support for quitting (both p < 0.05). Higher motivation to quit was associated with more favorable scores across all dimensions (all p < 0.01). Those smoking daily rated messages as less helpful for coping with urges (p < 0.01) and quitting smoking (p < 0.05) compared to those smoking non-daily. Few interactions were found between message category distraction vs. acceptance and participant characteristics.

Conclusions: Distraction and acceptance messages received similar ratings among young adults who smoke cigarettes. Message revisions may be needed to increase appeal to women, SGM, those with lower education, and those less motivated to quit. Messages will be refined and used in an ongoing micro-randomized trial to investigate their real-time impact on smoking urges and behaviors.

Keywords: Communication; Evaluation; Messages; Mobile health; Smoking cessation.

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Conflict of interest statement

Decalarations. Ethics approval and consent to participate: This study adhered to the Declaration of Helsinki and was approved by the Institutional Review Board of the Johns Hopkins Bloomberg School of Public Health. Digital informed consent was obtained before participants completed the survey. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Intervention message examples for distraction and acceptance messages, including image and text content
Fig. 2
Fig. 2
Acceptance and distraction messages and mean rating scores for each message on dimensions content, design, support for coping with smoking urges, and support for quitting smoking (median; interquartile range (IQR) Q1 to Q3; whiskers are lower and upper adjacent values, respectively)
See this image and copyright information in PMC

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