University of Massachusetts Medical School Faculty Publications

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Department of Population and Quantitative Health Sciences; Department of Medicine; Meyers Primary Care Institute; Department of Psychiatry; Graduate School of Biomedical Sciences

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Health Communication | Health Information Technology | Psychiatry and Psychology | Race and Ethnicity | Substance Abuse and Addiction


BACKGROUND: Although African Americans have the lowest rates of smoking onset and progression to daily smoking, they are less likely to achieve long-term cessation. Interventions tailored to promote use of cessation resources in African American individuals who smoke are needed. In our past work, we demonstrated the effectiveness of a technology-assisted peer-written message intervention for increasing smoking cessation in non-Hispanic White smokers. In this formative study, we have adapted this intervention to be specific for African American smokers.

OBJECTIVE: We aimed to report on the qualitative analysis of messages written by African American current and former smokers for their peers in response to hypothetical scenarios of smokers facing cessation challenges.

METHODS: We recruited African American adult current and former smokers (n=41) via ResearchMatch between April 2017 and November 2017. We asked participants to write motivational messages for their peers in response to smoking-related hypothetical scenarios. We also collected data on sociodemographic factors and smoking characteristics. Thematic analysis was conducted to identify cessation strategies suggested by the study participants.

RESULTS: Among the study participants, 60% (25/41) were female. Additionally, more than half (23/41, 56%) were thinking about quitting, 29% (12/41) had set a quit date, and 27% (11/41) had used electronic cigarettes in the past 30 days. Themes derived from the qualitative analysis of peer-written messages were (1) behavioral strategies, (2) seeking help, (3) improvements in quality of life, (4) attitudes and expectations, and (5) mindfulness/religious or spiritual practices. Under the behavioral strategies theme, distraction strategies were the most frequently suggested strategies (referenced 84 times in the 318 messages), followed by use of evidence-based treatments/cessation strategies. Within the seeking help theme, subthemes included seeking help or support from family/friends or close social networks (referenced 56 times) and health care professionals (referenced 22 times). The most frequent subthemes that emerged from improvements in the quality of life theme included improving one's health (referenced 22 times) and quality of life (referenced 21 times). Subthemes that emerged from the attitude and expectations theme included practicing positive self-talk (referenced 27 times), autonomy/independence from the smoking habit (referenced six times), and financial cost of smoking (referenced five times). The two subthemes that emerged from the mindfulness/religious or spiritual practices theme were use of self-awareness techniques (referenced 36 times) and religious or spiritual practices to cope (referenced 13 times).

CONCLUSIONS: Our approach to adapt a prior peer-message intervention to African American smokers yielded a set of evidence-based messages that may be suitable for smokers at all phases of motivation to quit (ready to quit or not ready to quit). In future research, we plan to assess the impact of texting these messages to African American smokers in a smoking cessation trial. H Williams, Dalton Mourao, Oluwabunmi M Emidio, Maryann Davis, Lori Pbert, Sarah L Cutrona, Thomas K Houston, Rajani S Sadasivam. Originally published in JMIR Formative Research (, 30.04.2021.


African American, cessation, communication, intervention, peer-to-peer, smoking, thematic analysis, tobacco disparities

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Copyright © Catherine S Nagawa, Jamie M Faro, Anitha J Menon, Mayuko Ito Fukunaga, Jessica H Williams, Dalton Mourao, Oluwabunmi M Emidio, Maryann Davis, Lori Pbert, Sarah L Cutrona, Thomas K Houston, Rajani S Sadasivam. Originally published in JMIR Formative Research (, 30.04.2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.

DOI of Published Version



Nagawa CS, Faro JM, Menon AJ, Ito Fukunaga M, Williams JH, Mourao D, Emidio OM, Davis M, Pbert L, Cutrona SL, Houston TK, Sadasivam RS. Written Advice Given by African American Smokers to Their Peers: Qualitative Study of Motivational Messages. JMIR Form Res. 2021 Apr 30;5(4):e21481. doi: 10.2196/21481. PMID: 33929332; PMCID: PMC8128361. Link to article on publisher's site

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Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.