Text‐messaging e‐cigarette cessation intervention for young adults in rural areas: A feasibility randomized trial

Abstract Background Electronic Nicotine Delivery Systems (ENDS) use is disproportionately high among young adults (YAs) in rural US communities, where cessation support is limited. The REVIVE (Rural Vaping Free Intervention for Young Adults via Text Messaging) program was developed to address the unique cessation barriers experienced in these settings. The objectives of this study were to examine the feasibility, acceptability, and preliminary efficacy of the REVIVE. Methods In a pilot randomized controlled trial, 39 YAs (ages 18‐24) who used ENDS in rural areas were assigned to either the REVIVE intervention ( n = 19) or standard care control (SCC; n = 20) over 9 months (June‐August in 2023 and June‐November in 2024). REVIVE participants received an 8‐week targeted, interactive text‐messaging cessation program. SCC participants received weekly links to general ENDS quitting resources. Feasibility (eg, retention rates), acceptability (eg, thought about quitting), and preliminary efficacy (self‐reported 7‐day point prevalence abstinence as the primary outcome and self‐reported nicotine dependence as the secondary outcome) were assessed. Descriptive statistics, bivariate analyses, and logistic and multiple regression analyses were undertaken. Results REVIVE participants showed statistically significantly higher self‐reported abstinence at 1‐month follow‐up compared to SCC (71.4% vs 35.7% 52.6% vs 25.0% by intent‐treat analysis). Nicotine dependence statistically significantly decreased in the REVIVE group (mean reduction = 5.09) versus SCC (mean reduction = 2.92). Retention rates were 73.7% in REVIVE and 70.0% in SCC, and 71.4% of REVIVE participants reported reading all text messages. Acceptability was high, with 92.9% indicating the program made them think about quitting and 85.7% saying they would recommend it to others. Participants confirmed the program's relevance, message timing, tone, and engagement features, while also highlighting areas for improvement, such as technical glitches and limited personalization. Conclusions REVIVE was feasible, acceptable, and effective in reducing nicotine dependence among rural YAs. These findings support further development of targeted, culturally responsive digital interventions for ENDS cessation in underserved populations in rural areas.