Sociodemographic Paradoxes and Enrollment Differences in In-Person Versus Online Recruitment to a Mobile Health Smoking Cessation Intervention for Food-Insecure Adults: Secondary Analysis of a Randomized Controlled Trial.

Background: Little is known about (1) sociodemographic, psychosocial, or smoking-related differences among individuals recruited to smoking cessation randomized controlled trials (RCTs) using in-person versus online recruitment methods or (2) the relative speed of recruitment using these 2 approaches. This secondary analysis is the first to examine these comparisons in a smoking cessation RCT for people experiencing food insecurity, a vulnerable special population for whom quitting is especially urgent. Objective: To compare (1) baseline sociodemographic, smoking-related, and psychosocial characteristics; and (2) screening, eligibility, and enrollment rates of in-person versus online recruits to a smoking cessation RCT for people experiencing food insecurity. Methods: Participants completed a brief eligibility questionnaire and a baseline assessment via tablet (in person) or personal electronic device (after clicking an online advertisement). Eligibility required past-30-day food aid use, smoking ≥5 cigarettes per day, and willingness to attempt quitting within 7 days post enrollment. Responses were compared using chi-squared and Fisher exact tests (categorical variables) and 2-tailed t tests (continuous variables). Results: Enrollees recruited online endorsed greater food insecurity (mean 4.5, SD 1.9 vs mean 3.0, SD 2.3; P<.001) and were more likely to be educated beyond high school or equivalent (69% vs 49%; P<.001), have household income of US $20,000 or more (46% vs 36%; P=.03), and be non-Hispanic White (77% vs 50%; P<.001). Online recruits indicated lower motivation to quit smoking (Contemplation Ladder; mean 7.2, SD 2.4 vs mean 8.0, SD 2.8; P<.001) and smoking cessation self-efficacy (mean 20.5, SD 8.0 vs mean 23.2, SD 8.6; P<.001). Online recruits also reported lower subjective social status (mean 4.6, SD 2.0 vs mean 5.9, SD 2.2; P<.001), greater financial strain (mean 17.9, SD 6.3 vs mean 16.2, SD 6.6; P=.004), more depressive symptoms (mean 8.6, SD 6.3 vs mean 7.4, SD 6.1; P=.04), greater loneliness (mean 6.0, SD 2.1 vs mean 5.2, SD 2.0; P<.001), less resilience (mean 19.5, SD 5.1 vs mean 20.5, SD 4.3; P=.02), less alcohol misuse (27% vs 37%; P=.02), and more past-30-day cannabis use (25% vs 15%; P=.01). Enrollment rates were higher online (64.8 per month; n=324) than in-person (7.7 per month; n=178). Although screened eligible at similar rates whether recruited online or in person (79% vs 75%; P=.10), eligible online individuals were more likely to enroll (71% vs 49%; P<.001). Conclusions: This study is the first to compare baseline participant characteristics by recruitment method (in person vs online) in a cessation RCT for people experiencing food insecurity and to evaluate the relative pace of recruitment via those methods. Online and in-person recruits were demographically and psychosocially distinct, and online recruitment was associated with faster accrual than in-person recruitment. These findings inform recruitment strategies for cessation interventions, especially those targeting food-insecure individuals.