People with HIV who smoke and live in under-resourced communities expressed strong interest in receiving tobacco treatment through phone calls, text messages, smartphone applications and other digital tools, according to a new study led by a University of Miami Miller School of Medicine doctoral student.

The findings suggest that digital interventions must account for patients’ access to technology, treatment preferences and individual circumstances. Although cell phone ownership was widespread among participants, access to smartphones and the internet was less consistent.

The study, published in Tobacco Use Insights, was led by Olusanya J. Oluwole, M.D., M.P.H., a Ph.D. student in Prevention Science and Community Health in the Department of Public Health Sciences. It marks his first publication as first author.

Motivation to Quit Despite Significant Barriers

Researchers surveyed 205 people with HIV who smoked cigarettes to examine their smoking behaviors, previous attempts to quit, barriers to treatment, access to technology and interest in receiving smoking cessation support through digital platforms.

More than half of the participants identified as non-Hispanic Black, approximately one-third identified as Hispanic and nearly three-quarters reported annual household incomes below $10,000.

Despite the challenges they faced, more than three-quarters of participants had previously attempted to quit smoking. Difficulty managing cravings was the most frequently reported obstacle, followed by treatment costs and limited access to care. Depression, risky alcohol use, insufficient social support and living with someone who smoked also complicated cessation efforts.

The findings underscore the importance of addressing the broader circumstances that can affect a person’s ability to quit rather than focusing exclusively on smoking behavior.

“Accessible treatment has to be designed with the realities of the population in mind,” Dr. Oluwole said.

“It is not enough to develop an effective digital intervention if the people who could benefit most do not have reliable access to the technology, connectivity or support needed to use it. These findings help us understand how to design future smoking-cessation interventions that are flexible, patient-centered and reachable for under-resourced people living with HIV,” he added.

Matching Treatment to Technology Access

Approximately 92% of participants owned a cell phone, while 61% owned a smartphone and approximately 64% reported having internet access.

About 60% expressed interest in receiving tobacco treatment through a combination of digital methods. Phone calls were the most popular individual option, followed by text messages, smartphone applications and video counseling.

Participants also expressed interest in established smoking cessation strategies that could be incorporated into digital programs. Mindfulness-based approaches and nicotine replacement therapy received the strongest interest, followed by brief and individual counseling.

Preferences varied by gender, race, ethnicity and sexual orientation, reinforcing the need to offer multiple treatment formats rather than relying on a single digital platform.

The researchers concluded that digital health could expand access to flexible, patient-centered tobacco treatment. However, technology alone may not overcome persistent barriers involving cost, stigma, mental health, social support and the limited integration of smoking cessation services into HIV care.

Building Toward a Future Smoking-Cessation Intervention

The study complements a broader research program led by Taghrid Asfar, M.D., M.S.P.H., a member of Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine and professor of public health sciences. Her work focuses on understanding and reducing smoking-related disparities among people with HIV.

A nationally representative analysis published by the team in 2021 found that 47% of people with HIV were current smokers, nearly twice the prevalence among adults without HIV. Subsequent research adapted a mindfulness-based smoking-cessation application to the needs of people with HIV and tested the intervention in a proof-of-concept randomized trial.

The trial produced promising smoking-abstinence and antiretroviral-therapy adherence outcomes while identifying barriers involving smartphone access, digital literacy, language and privacy. Those findings are informing efforts to optimize the intervention and develop a future full-scale trial.

The current study contributes information about the technology participants have available and the treatment formats they are willing to use. Those insights can help researchers design digital interventions that reach the populations they are intended to serve without inadvertently widening the digital divide.

A Milestone in Doctoral Training

Dr. Oluwole conceptualized and designed the study with senior author Dr. Asfar. He conducted the statistical analysis and prepared the initial manuscript.

“This achievement is very well deserved and reflects all of his hard work and dedication,” said Dr. Asfar, who is also his doctoral adviser and dissertation committee chair. Through her mentorship, he has developed independent research skills in study design, quantitative analysis, interpretation and scientific writing.

Dr. Oluwole’s additional research examines how health communication, technology and behavioral interventions can reduce tobacco- and alcohol-related harms. One manuscript under peer review evaluates pictorial warning labels among adolescents who use electronic nicotine delivery systems. He is also studying tobacco and marijuana use among cancer survivors who drink alcohol and how pictorial warning labels influence their responses.

Dr. Oluwole worked with Department of Public Health Sciences faculty members Tulay Koru-Sengul, Ph.D., M.H.S., and David J. Lee, Ph.D., who are also members of Sylvester Comprehensive Cancer Center. The research team also included Deborah L. Jones, Ph.D., and Maria L. Alcaide, M.D., of the Miller School, and Adam Carrico, Ph.D., of Florida International University.

The research was supported by the National Cancer Institute of the National Institutes of Health.

Written by Deycha Torres Hernández, published August 24, 2026.