Texting to Good Health

Recently the Metro Health Department in Louisville has begun a texting program to assist teens in quitting smoking. Anyone can participate, but the principle target audience is youth, because of the growing dominance of texting as a means of communication in that age group. The texting program is provided by a third party vendor that has done some evaluation of the viability and effectiveness of this approach. Results are still limited but generally positive. Much more evaluation is needed before this can be called a proven cessation tool.

The procedure begins when students enroll in the Butt Out Louisville program. Enrollment is done by cell phone, and shortly after, the user begins to receive text messages several times per day. Messages provide guidance on the cessation process and encouragement not to relapse. An example of a text message is “Withdrawal symptoms are signs that your body is starting to heal. Remember to drink a lot of fluids, especially water.” There is some research and theory to support this program. Certainly the advice has been demonstrated to be helpful, and frequent messages (4-5 times per day) are reinforcing from a motivational perspective. Students don't have to seek out help; messages find them wherever and whenever.  There is enough theory and evidence to say this is an innovation worth testing further. Evaluation for a follow-up period is needed to give more assurance that this will really be effective.

A number of questions come up about the use of texting in this way. A government health department is expected to serve the entire population. However, there will be a disproportionate percentage of low income and minority youth who don’t have cell phones and texting service. This may extend a disparity that already exists: the prevalence of smoking is much greater among low income, poorly educated persons. Will the texting tool leave them even further behind? We will have to see.

Most schools don't permit students to use their phones at school during the school day.  Even though the cessation messages are timed to be evenly spread throughout the day, students will get them all at once when they get out of school.  This may distort the impact of keeping them focused on cessation throughout the day.  We will have to see.

Another question is whether it is realistic to believe that these texts will really break through with sufficient strength to impact motivation and behavior. For example, many teens will send and receive dozens of texts per day, sometimes more than 1,000 in a month. With that huge volume of text traffic, will the cessation texts just get lost in the noise? We will have to see.

Here is yet another question. The cessation texts will be delivered into a text ambiance which will influence the impact. For example, what are the topics of the body of texts students are receiving? Are they sending inappropriate pictures of themselves or others? Are they using texts for plagiarism and cheating? The point is, the texting environment has similarity to TV broadcasts. The TV producer sends out programming into households, with no control over the viewing environment to assure people are watching and thinking about content. Because of this basic characteristic of mass media, the unit effectiveness is likely to be low, offset by the promise to reach a large audience efficiently.  We will have to see.

In spite of the reservations, I'm excited about the potential of this technique.  If we find evidence that phones can be used this way to help students quit smoking, all the other issues are just academic details.  We can also look ahead to a time when the texting can be even further tailored to meet the exact needs of individual smokers.  This could be done with expert computer systems and entry of unique learning and motivational characteristics.  We will have to see.

TAFN  BBN BBT T:)T (If you can't read this, see the teenager nearest you.)