using mobile phones for smoking cessation using mobile phones for smoking cessation lorien abroms,...
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Using mobile phones for smoking cessation
Lorien Abroms, ScD.
Milken Institute School of Public Health
Prevention & Community HealthGeorge Washington University
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Topics I’ll cover
I. Current Research Program
II. Future opportunities
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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
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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
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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
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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
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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
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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
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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
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-Covers 27 States, 675 employers/health plans -Participants receive:1) Phone counseling 2) Web
Coach® 3) Text2QuitSM
-Over 100,000 callers enrolled in Text2Quit
+
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Whittaker et al. Meta-Analysis. Cochrane. 2012
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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
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Quit4Baby
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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
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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
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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
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Automated text messaging programs are easy to develop
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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
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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.
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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