# Pilot study examining the effect of rurality on engagement and abstinence for adult users of a text-message cessation intervention

## TL;DR

This study explores how a text-message smoking cessation program works for people in rural versus non-rural areas, finding that rural users may benefit more from real-time support.

## Contribution

The study is the first to examine how rurality affects engagement and outcomes in a publicly available text-message cessation program.

## Key findings

- Rural participants had higher seven-day abstinence rates at three and six months compared to non-rural participants.
- Rural participants used real-time support more and found it more useful for managing mood and cravings.
- mHealth interventions may be especially effective for rural populations with limited access to traditional cessation services.

## Abstract

Mobile health (mHealth) interventions have the potential to expand the reach of smoking cessation interventions. However, it is unknown if people using the same cessation mHealth intervention but living in different places have similar program engagement, satisfaction, and outcomes. The objective of this study was to explore the potential need to enhance existing interventions for rural populations by examining program engagement, satisfaction, and outcomes by rurality for the publicly available cessation text messaging intervention, SmokefreeTXT.

Participants were adults interested in quitting smoking from Virginia (N = 49), with recruitment stratified by county-level rurality (n = 23 rural, n = 26 non-rural). Participants completed a 7-week version of SmokefreeTXT and completed assessments at baseline, immediately post-intervention, and three- and six-months from enrollment. Descriptive statistics compared program engagement, satisfaction, and seven-day point prevalence abstinence at all time points by rurality. Multivariable logistic regression models assessed the association between rurality and cessation at all time points.

Overall, seven-day abstinence rates were 32.6%, 28.6%, and 36.7%, and among participants from rural counties rates were 39.1%, 30.4%, and 43.5% at post-intervention, three-, and six-months, respectively. Participants from rural counties had higher use of real-time support for mood and cravings and reported this support to be more useful than participants from non-rural counties (Ps < 0.05).

mHealth cessation interventions may work well for people living in rural counties, potentially providing good support for adults attempting to quit smoking but lacking easy access to traditional cessation support services. Modifications to enhance support for craving and mood may be particularly relevant for people living in rural areas.

ClinicialTrials.gov: NCT05055778, Registration date: 9/14/2021.

The online version contains supplementary material available at 10.1186/s12889-025-25284-6.