Very few efforts to reduce cigarette smoking have been carried out among young adult rural or Spanish-speaking smokers in Texas. There are no cessation services, beyond our own, designed and promoted specifically for young Latino adults, or for Latino and non-Latino young adults in underserved rural counties. Cessation service delivery for all age groups is also sparse in rural counties, where smoking rates are relatively higher than in urban areas.

Smoking cessation before age 35 yields a predicted average gain of 10 years in life expectancy. Both telephone counseling and text-messaging (SMS) applications have been shown to roughly double successful quit rates, with even greater im...

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Very few efforts to reduce cigarette smoking have been carried out among young adult rural or Spanish-speaking smokers in Texas. There are no cessation services, beyond our own, designed and promoted specifically for young Latino adults, or for Latino and non-Latino young adults in underserved rural counties. Cessation service delivery for all age groups is also sparse in rural counties, where smoking rates are relatively higher than in urban areas.

Smoking cessation before age 35 yields a predicted average gain of 10 years in life expectancy. Both telephone counseling and text-messaging (SMS) applications have been shown to roughly double successful quit rates, with even greater impact in younger age groups and an enormous potential for adding years to the lives of young adults who smoke.

Young adults are heavy users of mobile devices for texting and access to mobile media. We will overcome barriers to serving rural and Spanish-speaking populations by using tailored mobile communication channels and messages to recruit smokers to an evidence-based, enhanced mobile SMS and social media service designed specifically for the young adults in rural areas, and for rural and urban Spanish speakers. 

Utilizing well-developed promotional plans and the evidence-based, culturally tailored English and Spanish mobile SMS cessation service that we have created and tested in South Texas, we will carry out an intensive social media promotional campaign to recruit 5,000 young adult cigarette smokers to a social-media enhanced version of this service over three years of work, focusing on all young adults and those who speak Spanish in rural counties and Spanish-speaking young adults in low-income zones of five major metropolitan areas—all within the six Texas Public Health Regions we have selected in South, West and Central Texas. Responses to promotion, receipt of services and cessation outcomes will be tracked for process, outcome and impact evaluation.

We aim to: (1) achieve 60 million social media advertising impressions (appearances on social media feeds) to reach close to half or more of all young adult Latino smokers and both Latino and non-Latino young adult smokers in rural counties; (2) generate 600,000 clicks on social media ads by young adults to then see mobile messages promoting self-efficacy and benefits of cessation while encouraging text responses to enroll in the mobile SMS and social media cessation service; and (3) enroll 5,000 young adult smokers (half for English service in rural areas and half for Spanish service in rural and low-income urban areas) and document that approximately 20% of service recipients achieve longer-term (more than 6 months) cessation, yielding 1,000 successful quitters (500 English speakers in rural areas and 500 Spanish speakers in rural and low income urban areas).

This project’s innovative features include attention to a population that has not been served with efforts to promote and assist smoking cessation. We will innovatively combine text messaging with social media (Facebook, Instagram and others) for outreach to young adults who smoke.

We have successfully transformed evidence-based SMS cessation assistance methods that have previously been available only in English or with generic Spanish translation, to fit the language use and cultural milieu of young Latino Spanish and English speakers in rural counties and Spanish-speakers in low-income urban areas in Texas. We will add to this innovation by adding a social media component to the service and by adding mobile content tailored for the populations we serve.

This project will greatly increase accessibility and utilization of evidence-based smoking cessation services among underserved young adults in Texas. By creating a San Antonio-based cessation service specifically for young adult smokers who are Latino and either English or Spanish speaking, and both Latino and non-Latino young adults in rural counties, we are achieving a significant and nonduplicative systems change that will have an impact beyond what is presently being accomplished by Texas DSHS cessation services—which links users to national-level protocols instead of the regionally and culturally tailored service that we will provide.

It will also serve as a model that can be replicated by any organization or network interested in reaching this fast-growing demographic group in all parts of the state, establishing an SMS cessation service that can continue to assist young adult Latino and other racial/ethnic smokers in Spanish and English across Texas. With a total expenditure of less than $1.5 million over three years, we expect to help 1,000 underserved young adult smokers quit—adding approximately 10 years to each of their lives at an estimated net cost of less than $450 per year added.

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