Adolescents’ Response to a Text Message-Delivered Tobacco Use Intervention by Depressive Symptoms and Sex

Abstract Introduction Adolescent female tobacco users are more likely to have a depression disorder relative to tobacco using adolescent males. Less is known about how sex interacts with depression within the context of text-messaged delivered randomized controlled trials addressing tobacco use. Understanding the variation of treatment response based on sex and depression symptomatology would inform targeted, personalized adolescent tobacco use treatments. Methods To address this issue, a secondary data analysis was conducted from a text message-delivered clinical trial targeting 198 tobacco-using adolescents. The sample was 53% female and 91% African American with a mean age of 16.2. A three-way moderation analysis was used to determine if the treatment’s effect on tobacco use was moderated by depressive symptoms, which in turn, was moderated by sex. Results The analyses demonstrated that female adolescents were significantly more sensitive to the effects of depressive symptoms compared to male adolescents, such that those with elevated depressive symptoms did no better than controls on past 30-day tobacco use. However, for those females with fewer depressive symptoms, the treatment was effective in significantly reducing tobacco use. For males, treatment effects were not dependent on depressive symptoms. Conclusions These findings contribute to the clinical science on treatment response to text-delivered adolescent tobacco use interventions. Results support the need to provided targeted, individualized tobacco treatment that concurrently addresses depression for female adolescents.