Using mobile phones for smoking cessation

Lorien Abroms, ScD.

Milken Institute School of Public Health

Prevention & Community HealthGeorge Washington University

Topics I’ll cover

I. Current Research Program

II. Future opportunities

Text2Quit• Automated, interactive, personalized text messages for

quitting smoking• Supporting website and emails

• Messages are timed around quit date• Proactive: Advice on quitting, peer ex-smoker messages,

medication msgs, games, and relapse messages.• On-Demand: need additional motivation, having a

craving, relapse.• 2-3 messages/day following quitdate

Medication msg

Peer ex-smoker msg

On demand games & tips

Check-ins

Text2Quit. Tomorrow’s the big day! Throw out all your cigs & clean out ashtrays. Keep busy & avoid smokers. Text CRAVE to fight cravings.

Advice on Quitting

QuitDate/No Date Reasons for quitting Triggers Gender Use of pharmacotherapy Stats on money saved and

health benefits accrued

Personalization

Personalized Reasons

Text2Quit. Lorien’s reasons to quit are: To improve my health, To save money, So that I can be there for my kids Lailah, David & Maya

Evidence: Cessation programs should follow 5A’s:

Ask for tobacco use statusAdvise every user to quitAssess willingness to quitAssist with a quit planPractical counseling Intra-treatment social supportConnect to a quitline

Arrange for follow-up

Advantages of mobile

1. Help anywhere and anytime2. Proactive messages interrupt you3. Interactive help4. Personalized help5. Increase contact time6. Unobtrusive and confidential 7. (Goes with smoking) Source: Abroms, Padmanabhan, and Evans 2011

Participants (n = 503) were recruited on the Internet with google ad words

Randomized to receive Text2Quit or a self-help material (Smokefree.gov; Clearing the Air).

Surveyed at baseline and at 1, 3, and 6 months post-enrollment to assess smoking status.

Saliva collected from self-reported quitters at 6 months An intent to treat analysis was used, and those lost to

follow up were categorized as smokers.

Abroms LC, Boal AL, Simmens SJ, Mendel JA, Windsor RA. A Randomized Trial of Text2Quit: A Text Messaging Program for Smoking Cessation. American Journal of Preventive Medicine. 2014

Randomized Trial of Text2Quit

Be Free Study (N=503)

1 month 3 months 6 months0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

Tex-t2Quit

No S

mokin

g i

n t

he P

ast

7

days

30.5%

14.5%

33.2%

19.9%

31.7%

20.7%

Abroms LC, Boal AL, Simmens SJ, Mendel JA, Windsor RA. A Randomized Trial of Text2Quit: A Text Messaging Program for Smoking Cessation. American Journal of Preventive Medicine. 2014

-Covers 27 States, 675 employers/health plans -Participants receive:1) Phone counseling 2) Web

Coach® 3) Text2QuitSM 

-Over 100,000 callers enrolled in Text2Quit

+

Whittaker et al. Meta-Analysis. Cochrane. 2012

Text4Baby

Core Partners:

Outreach Partners:

Telecoms industry support:

12

N=900,000+ subscribers since launch (2011)

CMS pays for Quit4baby as add on service in 4 states

300+ enrolled in Quit4baby

Quit4Baby

  Intervention Control  1-month 1-monthMeasure    Abstained from smoking in past 7 daysa,b,c

24% 21%

Abstained from smoking in past 30 daysa,b,c

12% 0%

Number of continuous days quitb

13.0 9.4

Banned smoking from their homeb

66% 58%

Banned smoking from their carb,c

63% 35%

Smoking-Related Outcomes

Program Data: Days Enrolled

0 2 4 6 8 10 12 14 16 18 20 22 24 26 2830

to

8915

0 to

209

270

or m

ore

0

20

40

60

80

100

Days

Fre

qu

en

cy

~30% unsubscribe in first week

N=480 Abroms LC, Leavitt LE, Schindler-Ruwisch JM, Augustson, EM. 2015

Does it work with hard to reach smokers (e.g. pregnant, HIV+)

Does it work in a real world context Enrollment High unsubscribe rates

Next Frontier: Personalized Medicine

Optimize with sensors, apps, social media

Integrate with human help (quitlines)

Other health behaviors (asthma) Does it work in health systems as a

outreach tool

Text Messaging Future Questions

Automated text messaging programs are easy to develop

Thank-you ! Acknowledgements:

Baby & Me/SmokefreeMOM Study Team: Co-I’s: Margaret Montgomery, Sean Cleary & Monique TurnerConsultant: Tom BrandonStudy Manager &Research Assistants: Leah Leavitt, Jennifer Schindler-Ruwisch, MPH, Laura Macherelli, Shawn Chiang , Nisha Radhakrishnan, Whitney McInvale, Shelby Fallon, Indira Singh,Dasha Afanaseva

References & Selected Readings Abroms LC, Ahuja M, Kodl, Y, Thaweethai L, Sims J, Winickoff J, Windsor RA. (2012a) Text2Quit:results from a pilot test of a personalized, interactive mobile health smoking cessation program. Journal of Health Communication (2012).   Abroms LC, Ahuja M, Windsor RA. (2012b). Text2Quit:results from a randomized trial of a personalized, interactive mobile health smoking cessation program. Presented

at SRNT, 2013.   Abroms LC, Padmanabhan N, Evans WD. (2011a). Mobile Phones for Health Communication to Promote Behavior Change. eHealth applications: Promising strategies for behavior change. Noar, S. M., & Harrington, N. G. (Eds.). New York: Routledge, (in-press).   Abroms LC, Padmanabhan N, Thaweethai L, Phillips T. (2011b). A content analysis of iPhone apps for smoking cessation. American Journal of Preventive Medicine. 40(3):279-85.   Brendryen H, Drozd F, Kraft P. A Digital Smoking Cessation Program Delivered Through Internet and Cell Phone Without Nicotine Replacement (Happy Ending): Randomized Controlled Trial. J Med Internet Res. 2008; 10(5):e51.   Cole-Lewis H, Kershaw T. Text messaging as a tool for behavior change in disease prevention and management. Epidemiologic Rev. 2010; 32(1):56-69.   Free C, Knight R, Robertson S, Whittaker R, Edwards P, Zhou W, Rodgers A, Cairns J, Kenward MG, Roberts I. (2011). Smoking cessation support delivered via mobile

phone text messaging (txt2stop): a single-blind, randomised trial. Lancet. 378(9785):49-55.   Free et al. 2013.Review of mHealth. Plos One.   Guide to Community Preventive Services. (2011). Increasing tobacco use cessation: mobile phone-based interventions. Accessed on 2/22/12 at :

http://www.thecommunityguide.org/tobacco/cessation/mobilephone.html   Naughton F, Prevost AT, Gilbert H, Sutton S. (2012). Randomized Controlled Trial Evaluation of a Tailored Leaflet and SMS Text Message Self-help Intervention for

Pregnant Smokers (MiQuit). Nicotine Tob Res. Feb 6.   Rodgers A, Corbett T, Bramley D. Do U Smoke after TXT? Results of a randomized trial of smoking cessation using mobile phone text messaging. Tobacco Control.

2005;14(4): 255-261.   The Quit Group. Evaluation of the first year of the Txt2Quit Services (Online) July 31, 2009: [Cited: March 2011]Available at: http://www.quit.org.nz/file/research/FINAL%202008-09%20Txt2Quit%20evaluation%20report%2020090731.pdf   Whittaker R, Borland R, Bullen C, Lin RB, McRobbie H, Rodgers A. Mobile phone-based interventions for smoking .The Cochrane Library, 2009;(4).   Whittaker R, Maddison R, McRobbie H. A Multimedia Mobile Phone-Based Youth Smoking Cessation Intervention Findings From Content Development and Piloting

Studies, Journal of Medical Internet Research, 2008;10(5): e49.   Whittaker R. et al. The Cochrance Library, 2012.

U.S. 25% of State Quitlines (NAQC 2013)

Text2Quit to over 100,000 callers since April 2012

SmokefreeTXT (smokefree.gov) 100,000+ users since Sept. 2012

New Zealand; UK National Health Service; Australia

WHO initiative to spread to lower income countries: Costa Rica, India, Tunisia…

mCessation Text Messaging Services Spreading

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mCessation Services1. SMS Programs

3. Mobile Web

2. Smartphone Apps

4. Mobile Devices & Sensors