Smokefree Teen: teen.smokefree.gov

 

Since 2003, the Tobacco Control Research Branch (TCRB) of the National Cancer Institute has been developing and expanding web-based cessation intervention resources. The parent site, http://smokefree.gov, consistently garners between 70,000 and 100,000 visits to the site per month. Meanwhile, http://women.smokefree.gov, a newer smoking cessation site tailored specifically to the needs of women, has incorporated the use of social media and Web 2.0 features to optimize audience engagement. During the 19 months since the site’s launch, traffic to the site has consistently reached between 8,000 and 11,000 visits per month.

 

To continue its efforts to develop highly tailored and targeted smoking cessation resources for various populations, TCRB is currently developing a teen smoking cessation site. Given teens’ unique usage patterns of emerging technologies, text messaging, mobile device optimization, and downloadable mobile applications will be integral for a teen site. Indeed, the use of text messaging to deliver cessation treatment is seen as a core feature of the teen site.

 

The focus of the new site will be on cessation, but the goal of the site is to expand to other crucial topics including tobacco prevention and other health behaviors. Most smoking-related information targeted toward teens is prevention-based with few cessation resources available. Currently there do not appear to be other federal sites focused on providing teen cessation interventions. The development plan for Smokefree Teen calls for the site and text messaging program to launch in summer 2011. Additional elements of the program (see below) will also launch throughout summer and fall 2011.

Mobile Use: Recent data from the Pew Internet and American Life Project indicate the frequency with which teens interact with mobile devices, specifically the use of SMS text messaging, is extremely high. According to its most recent report on “Teens and Mobile Phones,” 75 percent of teens aged 12–17 own a cell phone, up from 45 percent in 2004 (Lenhart, Ling, Campbell, & Purcell, 2010, available online at: http://www.pewinternet.org/Reports/2010/Teens-and-Mobile-Phones.aspx). Additionally, daily text messaging among teens has increased rapidly. In 2008, 38 percent of teens texted daily; as of 2009 this had increased to 54 percent (Lenhart, Ling, Campbell, & Purcell, 2010). One in three teens sends 3,000 texts a month, and 87 percent of teens text message at least occasionally (Lenhart, Ling, Campbell, & Purcell, 2010).

More recently, a report issued by Flurry, a mobile apps analytics firm, analyzed how daily interactive consumption (on mobile and desktop web) has significantly changed over the past year. According to the report, the average user now spends 9 percent more time using mobile apps that the Internet (mobile or desktop based). Additionally, it was found that of the time spent using mobile apps, 32 percent is spent on social networking apps like Facebook and Twitter and 47 percent was spent on games. (Flurry 2011 report available online at: http://blog.flurry.com/bid/63907/Mobile-Apps-Put-the-Web-in-Their-Rear-view-Mirror.)

 

The core Smokefree Teen website is distinct from many tobacco-oriented and teen-targeted websites because it will encourage smoking cessation rather than focus on tobacco use prevention. The overall tone of the site will be encouraging and understanding—not preachy. The aim is to provide teens with important information and key resources that they can take advantage of if they decide they are ready to quit smoking. A critical message the site intends to deliver is that the decision and choice to quit smoking is theirs.

 

The website will feature three core areas:

1.      Personal Introspection: Information that allows teens to understand and think about the role that smoking plays in their individual lives.

2.      Smoking Facts: Statistics and information on the impact and consequences of smoking, as well as information on the tobacco industry’s manipulation and predatory marketing.

3.      Resources: Tools and support available to teens to help them quit smoking. Such resources will include interactive quizzes, mobile apps, and most importantly, the Smokefree TXT messaging program.

Overview: The Teen SmokefreeTXT text messaging program is designed as a smoking cessation intervention for teens who are ready to quit smoking.

 

Users will be able to opt into the program from the main teen.smokefree.gov website. During the early stages of the program, users will be able to opt in to the program on Smokefree.gov and Women.smokefree.gov. At sign up, a user’s mobile number and demographic information including age, gender, quit date, and smoking frequency (daily or almost every day, most days, only a few days a week, only on weekends, a few times a month or less) will be collected. Once registered, participants will receive an automated response welcoming them to the program and providing key information about the program such as how to opt out and how to receive help and support at any time by texting any of the programmed keywords into the system. To opt out, users must text STOP to the iQUIT short code (47848). In the early stages of the program, a long code will be used (202) 618-4419. At sign up, participants will have the option to choose a quit date up to one month out. Text messages will start up to 14 days before their specified quit date. Users also have the option of changing their quit date at any time if desired. In a future phase of the program, users will have the ability to opt into the program post-quit date and receive only messages that will help them stay quit. To do so, they will need to text STOP to the short code and re-enroll in the program.

Program Design: The program is designed as a 14-day countdown to quit date with subsequent six weeks of daily messages. Each day within the program is identified as either a pre-quit date (Q- # days) or a post-quit date (Q+#). If a user opts into the program fewer than 14 days before their quit date, the system will begin sending messages on that day. For example, if they opt in four days prior to their quit date, the system will send a welcome message and recognize that they are at Q-4 (or four days before their quit date), and they will receive the message that everyone else receives four days before their quit date. As the user progresses throughout the program, they will receive messages outlined in the teen text message library. Throughout the program, users will receive texts that cover a variety of content areas including tips, informational content, motivational messaging, and keyword responses. On the days closest to a user’s quit date (before and after), they will receive an increased number of text messages, with a heavy emphasis on support, efficacy building, and what to expect. Further away from a user’s quit date, the messages will reduce in frequency. If the user says they have started to smoke again, the system will give them the option of continuing the program as planned or starting over and setting a new quit date.

 

The system is also designed to assess the user’s mood, craving level, and smokefree status several times during the program. These assessment messages are characterized as MOOD, CRAVE, and STATUS messages. Whenever the system asks for a response from the user, it will send a programmed response based on the user's answer (i.e., if the user responds with MOOD = SUCKY then they will receive a message customized to that response). These programmed response messages rotate throughout the course of the program. Users can also send the system one of five programmed keywords (WANT, BOOST, and UHOH), and the system will send unique, automated responses based on the texted keyword. Currently, there are 10 messages for each of the programmed keywords which rotate on a random basis; decreasing the likelihood the user will get the same response in a row.

 

There is also a SmokefreeTXT “lite” version that will be especially useful for teens without unlimited text messaging capabilities who would still like to receive support or those who want to be able to control the number of messages they receive. In the lite program, users can text any of the programmed keywords to the code without fully opting in to the program.

After the full six-week program comes to an end, the system will follow up at one, three, and six months to check on the user's smokefree status and offer additional assistance if needed. The user will also be reminded to visit teen.smokefree.gov for FAQs, terms, privacy policy, and information on keyword definitions. During the early phase of the program, all relevant information will be found on smokefree.gov and women.smokefree.gov until the launch of teen.smokefree.gov.

 

Texting STOP to the service discontinues participation in the program, and no further texts will be sent to the user.

Message Types:

Tips – Tips provide users with actionable strategies on how to manage cravings and deal with quitting smoking in general. Example tip messages are below.

 

 

Motivation/encouragement – Motivational messages encourage users to keep going on their smokefree journey despite the difficulty and struggle they may be facing. Example motivational messages are below.

 

Information – Informational messages provide users with facts and other salient points about the impact of smoking relevant to their socio-cultural environment. Example messages are below.

 

 

Assessment – The assessment messages are built into the text messaging program and are designed to collect information about the user’s experience as they are quitting and provide immediate feedback based on the user’s response. Assessment messages fall along three dimensions: mood, craving, and smokefree status. Examples are listed below.

 

 

Reactive (keyword replies): At any point throughout the program, users can text one of five programmed keywords (WANT, BOOST, and UHOH), and the system will send them rotating, automated responses. WANT messages respond to cravings; BOOST messages are for users who are down, or stressed and need some advice and encouragement; UHOH messages are responses to users who have slipped and smoked as cigarette. Examples are below.