Mobile Phone Text Messaging for Tobacco Risk Communication among Young Adult Community College Students: Protocol and Baseline Overview for a Randomized Trial (Preprint)

BACKGROUND Young adults in community college represent an underserved population susceptible to tobacco use. The use of mobile health (mHealth) text messaging may be an effective strategy for tobacco risk communication with diverse young adults. However, the message structure that is most capable of increasing perceived tobacco risk is still not known. OBJECTIVE The current research protocol outlines the rationale and design of Project Debunk, a randomized trial comparing the effects of different structures of text messages. METHODS The study is being conducted as a 6-month long randomized trial comparing eight arms, based on the combination of the three message structures delivered to young adults in a 2x2x2 study design: framing (gain-framed or loss-framed), depth (simple or complex), and appeal (emotional or rational). Participants were invited to participate from three community colleges in Houston from September 2016 through July 2017. Participants are randomized to one arm, and receive text messages in two separate campaigns. Each campaign consists of two text messages per day for 30 days (i.e., 60 messages). In addition to baseline assessment, perceived risk is assessed two months after the first campaign, and two months after the second campaign. We assessed perceived risk of using conventional products (e.g., combustible cigarettes) and new and emerging products (e.g., electronic cigarettes). RESULTS We completed data collection for the baseline survey on a rolling basis during this time, and assessed validity of the message structure after one week of messages. For the entire sample (n=636), the average age was 20.92 years (SD=2.52); about two-thirds were female, and most were black/African American (n=266/636; 41.2%) or white/Caucasian (n=239/636; 37.0%). After one week of receiving messages: (1) loss-framed messages were more likely to be perceived as presenting a loss than gain-framed messages (F=13.21, P<0.001), (2) complex messages were perceived to be more complex than simple messages (F=2.03, P=0.049), and (3) emotional messages were perceived to be more emotionally involving than rational messages (F=6.35, P<0.001). CONCLUSIONS This study confirms that the recruitment, randomization methods, and message structures, have been successfully implemented for this randomized trial. The findings will be able to identify specific types of message combinations that are more effective than others in increasing perceived risk of tobacco use. If our results suggest that any of the eight specific text message structures is more effective for helping young adults understand tobacco risk, this would provide evidence to include such messages as part of larger technology-based campaigns such as smartphone applications, entertainment-based campaigns, and social media. CLINICALTRIAL This trial was registered at the Clinical Trials registry, NCT03457480; https://clinicaltrials.gov/ct2/show/NCT03457480?term=NCT03457480&rank=1 (Archived by WebCite at http://www.webcitation.org/6ykd4IIap).