The document discusses the potential for using mobile health (mHealth) technologies like text messaging for tobacco dependence treatment interventions. It provides an overview of the Smokefree.gov project's text messaging program SmokefreeTXT, which has engaged over 22,000 subscribers in the U.S. and is being adapted for projects in China and other countries. Metrics show SmokefreeTXT is engaging users and initial studies suggest it may help increase quit rates.

1. 1
www.globalbridges.org

2. Erik Augustson, PhD, MPH
Behavioral Scientist
Tobacco Control Research Branch
Behavioral Research Program
National Cancer Institute
Going Mobile: The Potential of
mHealth for Tobacco
Dependence Treatment
Global Bridges, April 23, 2013

3. Smokefree Development Team
NCI
Erik Augustson
Ami Bahde
Yvonne Hunt
Heather Patrick
MMG
Lewellyn Belber
Jeff Goldfarb
Brian Keefe
Samantha Post
Amy Sanders
Shani Taylor*
Alle Vargo
Additional Support
Lorien Abroms
Rachel Grana
Robin Mermelstein
Nalini Padmanabhan
Alison Pilsner
Allison Rose
Mary Schwarz
Robyn Whittaker
* Funded in part by NCI Contract No. HHSN261200800001E; HHSN261200544018C, NO2-PC-54418; and
HHSN2612007000191

4. Outline
• mHealth Potential for Interventions
• The Smokefree.gov Project
• SmokefreeTXT
• Domestic & International Case Studies

5. Mobile Uptake
• Mobile subscriptions
– U.S. 234 MILLION
– Worldwide 6 BILLION
– 90% of world pop has cell
signal access
– 75% world pop has access to
mobile phone
**Source: ComScore June 2012 Report; Ericsson 2011
• Of U.S. mobile consumers:
– 75% sent messages in early 2012
– 51.4% used apps
– 50.2% used a browser
– 36.9% accessed social media sites or blogs
– Motivation for health behavior change

6. Text Messaging
79%
80%
85%
American Text
Messaging Prevalence
Send/Receive Texts
• Texting for Health
– 9% of Americans
receive
updates/alerts on
health issues
Source: Pew Mobile Report 2012
• More likely to sign
up for health text
messages:
– Women
– 30-64 years old
– African American

7. U.S. Smartphone Ownership
Young adults tend to have higher-than-average levels of smartphone
ownership regardless of income or educational attainment.
**Source: Pew Research Center’s Internet & American Life Project 2012

8. Smartphone Use for Health
27%
15%
35%
19%
38%
25%
2012
2010
Smartphone use to Find
Health Information by
Race Hispanic
African
American
White
Source: Pew Mobile Report 2012
• Owning a
smartphone increases
likelihood of
accessing health
information online
• More likely to look
up health
information on
mobile phone:
– Young adults
– Minorities

9. mHealth Potential
• Reach
– Large audiences
– Underserved audiences
• Engagement with intervention platform
– Increase access to intervention
– Decrease barriers to participation
(scheduling, transportation, etc)
– Decrease space/time gap between treatment &
behavior
– Seamlessly integrate user interaction with treatment
within their daily life
– Interactive functionality  improved “dose”
• Reduces cost burden on healthcare system

10. Smokefree Family History
• 2003 Smokefree.gov
– Focus on cessation resource
– Multiple updates and iterations
• 2009 Smokefree Women
– Expanded interactivity
– Incorporation of social media
• 2011 Smokefree Teen
– Multi-platform intervention
• 2012 Smokefree Español
– Spanish

11. Smokefree Projects
• Smokefree.gov
– Website
– Mobile app
(QuitGuide, QuitPal)
– Social media: Twitter
• Smokefree Women
– Mobile Website (Spring
2013)
– Social media:
Facebook, Twitter, Pinteres
t, YouTube
• Smokefree Teen
– Mobile Website
– Social media:
Facebook, Twitter, Tumblr
– Mobile app (QuitSTART)
• Spanish Smokefree
– Website
– Social media
• Smokefree Pregnancy
– Web content
– Online video
• SmokefreeTXT
– Teen
– Young Adult
– Spanish Language
– QuitNow Library
– Veteran (June 2013)
– Military (coming soon)

12. SmokefreeTXT Program

13. • Text messaging smoking cessation
intervention
• Features versions for teens, young adults
& Spanish speaking audiences
• Users can opt-in and select a quit date up
to 30 days into the future
– Free with unlimited texting plan
– Receive messages 2 weeks before and up to 6
weeks after quit date
– Increased number of messages close to quit date
• Bidirectional: assesses user’s
mood, craving, & smokefree status
– Users can text keywords (i.e. CRAVE, MOOD, SLIP)
SmokefreeTXT Overview

14. SmokefreeTXT Metrics
Total Subscriptions
March 2012- March 2013
22,610
-
5,000
10,000
15,000
20,000
25,000

15. SmokefreeTXT Metrics
Subscriber Breakdown by Sex All
Time Subscribers
Total Males
Total Females
Total Unknown
34%
58%
9%

16. SmokefreeTXT Metrics
Smoking Status Reported at Registration for over
13,000 participants
Every day
Most days
Some days
Less than that
Unknown
81%
2%
5%
1%
11%

17. SmokefreeTXT Metrics
Adult Subscriber Opt Outs over Course of Treatment
September 2011 – October 2012
0
500
1000
1500
2000
2500
3000
3500
4000
4500

18. SmokefreeTXT Metrics
ITT Adult Follow-Up Responses:
Assessment of Active Subscribers, March 2013
• 1-Month: 17%
• 3-month: 13%
• 6-month: 11%

19. International Opportunities
• China: 300,000,000 Smokers
• 1) US HHS-China MOH-Nokia
• 2) Emory University-Suzchou

20. SmokefreeTXT: China
• 1) US HHS-China MOH-Nokia
– Four provinces selected
– Health messages developed specifically for
project
– Cessation messages based on NCI library
– Translated by Chinese public health
professionals
– Focus Group Testing of messages with
Chinese Smokers
• 8 conducted
• 2 in each province
• Urban & rural

21. SmokefreeTXT: China
• 1) US HHS-China MOH-Nokia
– Phase One: 250,000 Smokers
• 10 days smoking health effect messages
• Started 4/15/2013
– Phase Two: 8000 Smokers
• 2-arm RCT
• 1 week count down to quit day
• 6 week treatment
• 1 & 3 month f/u
• Start 4/28/2013
• Finish 9/17/2013

22. SmokefreeTXT: China
• 2) Emory University-Suzchou
– Nonrandomized Demonstration Project
– Part of annual Quit Contest
– NCI Library translated by local health officials
– 4 week treatment w f/u at EOT
– 665 Smokers received text messages
– ~1000 Smokers participated w/o text
• Data available in near future

23. Suzchou Project: Clinical Data
• Baseline Smoking Status
– Daily 60% (49% vs. 70%)
• Time to 1st cigarette
– 30+ minutes 69% (72% vs. 66%)
• Cigarettes per day
– 10 or less 52% (54% vs. 51%)
– 11-20 CPD 36% (40% vs. 33%)
• One Month Quit Rate
– 38% (57% vs. 22%)

24. Suzchou Project: Feedback
• Amount of text messages
– Right Amount 57% (74% vs. 42%)
• Provided Helpful/Useful Information
– Yes 80% (92% vs. 69%)
• Helped to Motivate Quit Attempt
– Yes 78% (90% vs. 69% )

25. Additional International
Activities
• Collaboration with Healthy Caribbean
Coalition
– Launch June 2013
• Technical guidance for WHO project in
Costa Rica
• Collaboration in South Pacific Islands
• Continued development of India project
• Exploring project in Central & South
America

26. Underserved Populations:
Challenges
• Consistency of cell phone access
• Multiple users per device
• Fee structures
• Populations with Low Literacy
• Role of mHealth interventions with in
larger public health infrastructure

27. Questions?
@SmokefreeGov
augustse@mail.nih.gov