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Grand Rounds March 27, 2026: Text Messaging and Video Stories to Support Hypertension Self-Management in Black Veterans: A Randomized Clinical Trial (Sarah L. Cutrona, MD, MPH)

Posted on by Sophia Ramirez

Speaker

Sarah L. Cutrona, MD, MPH
Acting Director, Center for Health Optimization and Implementation Research (CHOIR)
VA Bedford Healthcare System
Professor, Division of Health Informatics and Implementation Science
Department of Population and Quantitative Health Sciences
UMass Chan Medical School

Keywords

Blood Pressure; Hypertension; Self-Management; Video; Texting; Black Americans; Veterans

Key Points

  • Black Americans experience disproportionate morbidity and mortality due to hypertension (HTN). Simultaneously, self-management is made more difficult by differential rates of diagnosis and treatment titration; decreased access to, trust in, and engagement with the healthcare system; and cost, access, and environmental barriers. This study sought to improve HTN control and self-management among about 600 Black Veterans by supplementing a preexisting video story intervention with longitudinal texting support.
  • Those in the intervention arm watched 5 video stories featuring other Black Veterans, chose their preferred storyteller, and received educational and interactive messages aligned with that storyteller. Those in the control arm received only interactive messages. The researchers hypothesized that peer stories would promote participants’ emotional engagement with the messages via a parasocial relationship with the storyteller, enhancing self-efficacy, influencing health behaviors and ultimately improving HTN control.
  • While participants in both arms saw marginal improvements in systolic and diastolic blood pressure (BP), there was no significant difference in the BP change between the arms. The intervention saw high treatment fidelity (92%) and sustained engagement, with over 55% of participants responding to texts through the end of the 6-month period. The researchers concluded that the interactive text messages, which were present in both arms, were an effective way to maintain engagement in a multi-month study and may serve as a useful strategy for future longitudinal interventions supporting Black Veterans.

Discussion Themes

The control group was intentionally kept active – i.e., received educational texts – to isolate the specific impact of storytelling rather than just the impact of receiving text messages.

The intervention was shaped by direct feedback from veteran consultants, who provided guidance on tone, word choice, and structure to ensure the messages felt authentic.

Attendees noted that negative studies are vital for informing future research and that the intervention provided valuable moments of outreach to a population facing socioeconomic vulnerabilities and isolation.

Grand Rounds August 8, 2025: Youth Nicotine Vaping Cessation: RCT of Varenicline Added to Remote Young Adult Lay Counselor Delivered Behavioral Cessation Support Vs. Texting Support (A. Eden Evins, MD, MPH)

Posted on by Sophia Ramirez

Speaker

A. Eden Evins, MD, MPH
Cox Family Professor of Psychiatry, Harvard Medical School
Founding Director, MGH Center for Addiction Medicine
Director for Faculty Development, Mass General Hospital Department of Psychiatry

Keywords

Vaping; Nicotine; Cessation; Behavioral Support; Texting

Key Points

  • Vaping, though technically a less harmful alternative to cigarette smoking, is the primary route to nicotine addiction in youth. Initially promoted to help with smoking cessation, vaping devices are increasingly marketed towards young people and have transformed teen nicotine and cannabis use.
  • Few treatments for vaping cessation have been tested. The research team hypothesized that the pharmacotherapy varenicline could help young adults abstain from nicotine vaping.
  • They conducted a randomized clinical trial with 2 aims: evaluate the efficacy of varenicline in addition to behavioral support for cessation of vaped nicotine and assess the safety and tolerability of varenicline. The target population was adolescents attempting vaping cessation.
  • According to the original design, participants would be randomized to 1 of 2 arms: varenicline + behavioral therapy and placebo + behavioral therapy. The possibility arose that the behavioral intervention would be particularly effective, they wouldn’t be able to differentiate between the arms, and the trial would fail. So they added a third arm: a referral to a widely-available messaging app supporting youth vaping cessation.
  • The research team made a few additional modifications to cut costs and enhance adherence. These included fully remote intervention and assessment; non-clinical personnel delivering the behavioral interventions; and video documentation of adherence, with compensation of $1 per video.
  • Over half of participants offered varenicline + counseling quit vaping and were abstinent for the last 4 weeks of treatment. The 4-week abstinence rate was 14% in the placebo + counseling group and 6% in the group that received texting support.
  • The study had a 97% completion rate using remote methods for intervention delivery and data collection. The research team received video evidence for 52% of varenicline doses and 42% of placebo doses. Behavioral counseling attendance was higher in the varenicline group (84%) than in the placebo group (66%).
  • Nausea, vivid dreams, and insomnia were more common in the group that received varenicline.

Discussion Themes

There’s interest in testing the effectiveness of varenicline without the addition of behavioral support. It’s an important question, Dr. Evins noted, given that behavioral support can be hard to come by.

Varenicline has been associated with exacerbation of psychiatric symptoms, including suicidal ideation. However, this has not been replicated in large clinical trials or epidemiologic trials. Explanations for the association include the effects of nicotine withdrawal symptom or the manifestation of comorbid psychiatric illnesses.