Each year, roughly 30,000 youth exit the foster care system due to aging out at age 18, losing access to support services while also becoming fully responsible for their own financial, health, employment, and housing needs. Progressing from homes disproportionately high in neglect and maltreatment, these emerging adults face independence with an increased likelihood of heavy tobacco use and, ultimately, the development of tobacco use disorders. Indeed, lifetime tobacco use is nearly ubiquitous among foster youth, while daily use rates are four times that of the general population. Services to curtail such use while young people remain in the foster care system are severely limited, if they are offered at all. Once removed from foster care, these youth have far less access to health services compared to their non-foster care peers. The proposed feasibility study seeks to address these gaps in availability, accessibility, and use of tobacco cessation services for youth aging out of the foster care system. Computer- and mobile phone-based interventions have the capacity to provide evidence-based treatment content while reducing many of the barriers relevant to tobacco cessation service delivery for foster youth. The proposed study will begin a program of research to synthesize the benefits of these approaches in a way that addresses the needs of a vulnerable population who experience tobacco-related health disparities. More specifically, this study seeks to test an adaptation of an existing substance use intervention (iHeLP: Interactive Healthy Lifestyle Preparation) for smoking cessation among youth aging out of foster care. Rooted in motivational interviewing, the transtheoretical model, and social cognitive theory, iHeLP is a one-time computerized screening and brief intervention (SBI), supplemented by six months of tailored text messaging based on participants' SBI results and subsequent fluctuations in their readiness to change. The goal of this pilot study is to obtain data on acceptability and feasibility of a novel intervention, as well as examine direction of effects on both overall motivation to change and actual tobacco use. As such, we will conduct a two-arm feasibility trial, testing iHeLP against a contact-control condition. The use of daily text messaging represents a novel method for delivering intervention boosters. Low-intensity, high-frequency interactions are a marked change from traditional interventions and have high potential for extending initial gains. In addition, tailoring of these messages through dynamic, text-based communication with participants is innovative. Given the potential of wide dissemination to multiple at-risk populations at low cost, the proposed study has high potential public health and clinical significance.
Youth aging out of foster care are at great risk for a host of negative and costly outcomes, including tobacco dependence, other substance abuse, mental illness, homelessness, and unemployment. Addressing smoking cessation across this transition has the potential to alter youths' trajectories toward healthy, rather than problematic, health outcomes. The proposed study will demonstrate the feasibility and preliminary efficacy of a novel intervention for smoking cessation among youth exiting the foster care system.
