A Pilot Study and Ecological Model of Smoking Cues to Inform Mobile Health Strategies for Quitting Among Low-Income Smokers

Shuo Zhou*, Arnold H. Levinson, Xuhong Zhang, Jennifer D. Portz, Susan L. Moore, M. Odette Gore, Kelsey L. Ford, Qing Li, Sheana Bull

*Corresponding author for this work

Research output: Contribution to journalJournal articlepeer-review

3 Citations (Scopus)


One crucial factor that leads to disparities in smoking cessation between groups with higher and lower socioeconomic status is more prevalent socioenvironmental smoking cues in low-income communities. Little is known about how these cues influence socioeconomically disadvantaged smokers in real-world scenarios and how to design interventions, especially mobile phone–based interventions, to counteract the impacts of various types of smoking cues. We interviewed 15 current smokers living in low-income communities and scanned their neighborhoods to explore smoking-related experiences and identify multilevel cues that may trigger them to smoke. Findings suggest four major types of smoking cues influence low-income smokers—internal, habitual, social, and environmental. We propose an ecological model of smoking cues to inform the design of mobile health (mHealth) interventions for smoking cessation. We suggest that user-triggered strategies will be most useful to address internal cues; server-triggered strategies will be most suitable in changing perceived social norms of smoking and routine smoking activities to address social and habitual cues; and context-triggered strategies will be most effective for counteracting environmental cues. The pros and cons of each approach are discussed regarding their cost-effectiveness, the potential to provide personalized assistance, and scale.

Original languageEnglish
Pages (from-to)850-862
Number of pages13
JournalHealth Promotion Practice
Issue number6
Early online date23 Jul 2020
Publication statusPublished - Nov 2021

Scopus Subject Areas

  • Public Health, Environmental and Occupational Health
  • Nursing (miscellaneous)

User-Defined Keywords

  • ecological model
  • just-in-time adaptive intervention
  • low-SES population
  • mHealth
  • smoking cessation
  • smoking cues


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