MobileCoach Tobacco A text messaging based smoking cessation intervention for young people Funded by the Swiss Tobacco Prevention Fund Severin Haug, Raquel Paz, Tobias Kowatsch, Michael Schaub
BACKGROUND Tobacco smoking prevalence in adolescents and young adults Gmel G et al. (2014). Addiction Monitoring Switzerland, Data 2013. 2
BACKGROUND Smoking prevalence and educational degree Gmel G et al. (2014). Addiction Monitoring Switzerland, Data 2013. 3
BACKGROUND Smoking cessation interventions in young people Lack of well designed trials (Stanton & Grimshaw, 2013) No evidence for nicotine replacement therapy Promising: Complex approaches incorporating elements sensitive to stage of change, motivational enhancement and CBT 4
BACKGROUND Intention to stop smoking in young people Gmel G et al. (2014). Addiction Monitoring Switzerland, Data 2013. 5
BACKGROUND Text messaging based smoking cessation interventions Nearly all adolescents and young adults own a mobile phone 16 19 years: 98% of which 97% were smartphones (Willemse et al., 2014) Text messaging provides opportunity for individualized and interactive information delivery Text messaging based programs are effective for smoking cessation in adults with intention to stop smoking (z.b. Free et al. 2011, Whittaker et al. 2012) 6
METHODS SMS COACH Study SMS COACH (2010 2013) Objective: Acceptance and efficacy of a fully automated text messaging program for smoking cessation Target group: Vocational school students in the German speaking part of Switzerland, daily and occasional smokers Duration of intervention: 12 weeks Theoretical background: Health Action Process Approach (Schwarzer 2008) Test of efficacy : Cluster randomised controlled trial Follow up assessment: 6 months 7
METHODS SMS COACH Theoretical background Health Action Process Approach (HAPA, Schwarzer 2008) 8
METHODS SMS COACH Study procedure Computer based screening of students in vocational school classes (demographics, smoking status, ownership of a mobile phone) Daily or occasional smoking & ownership of a mobile phone Study information and invitation Informed consent and assessment of smoking related variables Cluster Randomisation SMS COACH Control group Telephone interviews at 6 month follow up 9
METHODS SMS COACH Overview SMS COACH Weekly SMS assessment One text message per week to assess (1)HAPA stage or (2) number of cigarettes smoked per day or (3) whether individually chosen strategy to cope with craving was applied SMS Feedbacks 2 weekly text messages tailored to (1)the data of the online assessment and (2)the weekly SMS assessments SMS COACH Extra Integrated program for quit day preparation and relapse prevention providing up to 2 daily text messages after entering a scheduled quit date Invitation only for intenders and actors 10
METHODS SMS COACH Text messaging based assessments Number of cigarettes smoked per day SMS COACH Hi Mike, how many cigarettes do you smoke on a typical day? Please type the number of cigarettes and reply HAPA stage SMS COACH Hey Peter Have you recently smoked cigarettes? (1) Yes, and I do not intend to quit (2) Yes, but I am considering quitting (3) Yes, but I seriously intend to quit (4) No, I quit smoking Please type 1,2,3 or 4 and reply Individually chosen strategy to cope with craving SMS COACH Hi Beetle Did you apply the following strategy recently? When I am on a party, I distract myself from smoking by dancing? Please type Y for yes or N for no and reply 11
METHODS SMS COACH SMS COACH: Exemplary SMS Feedbacks HAPA stage Content category SMS Feedback Preintender Social norms Hey Mika. Did you know, not smoking is in! A survey from the University of Zurich found that among 16 to 17 year old female adolescents, only 11% still smoke cigarettes daily. Intender Actor Social support for smoking cessation Coping with craving situations There are forums online in which smokers and ex smokers exchange their experiences on smoking cessation. Have a look at www.stoptabac.ch Great job, Vince: journals or a book can help you to bridge time when waiting. If there is a moment in which you have nothing readily to hand, you can also distract yourself by using your cell phone for calling somebody or sending a text message to someone. 12
RESULTS SMS COACH Study participation Assessment of eligibility in 2638 students in 178 vocational school classes Study information and invitation for participation n=1012 (38% of 2638) Study registration n=755 (75% of 1012) Randomization Smoking & own mobile phone Study participation Control group n=383 SMS COACH n=372 6 months follow up n=559 (74% of 755) 13
RESULTS SMS COACH Program use Intervention group participants (n=372) Received entire intervention for 3 months, n (%) 362 (97%) Mean number of replies to weekly text message assessments (SD) 6.5 (3.7) Participants with invitation to use SMS COACH Extra (n=151) Registration for the SMS COACH Extra 58 (38%) 14
RESULTS SMS COACH Efficacy concerning smoking abstinence Control Intervention p 7 day point prevalence abstinence 9.6% 12.5% >.05 Mean number of cigarettes smoked per day at 6 months follow up 10.0 7.5 <.05 Quit attempt within 6 months preceding follow up 36.3% 43.7% >.05 15
MOBILE COACH MobileCoach Tobacco 2014 2017 Aims Technical optimization Optimized for tablet computers Integration of suitable video clips and web ressources Higher interactivity Content optimization Increased tailoring of messages Increased consideration of alcohol consumption 16
BACKGROUND MOBILE COACH TOBACCO Hazardous drinking in vocational school students Haug et al. (2013). Predictors of hazardous drinking, tobacco smoking and physical inactivity in vocational school students. BMC Public Health 2013, 13:475. 17
BACKGROUND MOBILE COACH TOBACCO Associations of smoking and drinking in young people Drinking alcohol increases cigarette craving (Kahler et al., 2010) Relapses after successful smoking cessation are often associated with alcohol consumption (Sayette et al. 2005, Van Zundert et al., 2012) Integrated smoking cessation and binge drinking intervention for young adult smokers with regular binge drinking revealed higher tobacco abstinence rates than smoking cessation treatment only (Ames et al., 2010 & 2014) 18
METHODS MOBILE COACH TOBACCO Comparision of standard and integrated program Computer assessment of demographics, alcohol consumption and tobacco related characteristics Web based feedback on drinking behavior Text messages to support smoking cessation Text messages stimulating drinking within lowrisk limits Mobile Coach Tobacco Mobile Coach Tobacco+ 19
METHODS MOBILE COACH TOBACCO Baseline assessment demographics Age Sex Education Immigrant background 20
METHODS MOBILE COACH TOBACCO Baseline assessment health behaviour Stress Cigarette smoking status Physical activity Body weight Alcohol consumption 21
METHODS MOBILE COACH TOBACCO Baseline assessment study participation Ownership of mobile phone Study information Consent Username Mobile phone number 22
METHODS MOBILE COACH TOBACCO Baseline assessment smoking related characteristics Intention to quit Cigarette consumption Quit attempts Proportion of smoking friends Pros and cons of cessation Craving situations Strategies to cope with cravings Costs per package 23
METHODS MOBILE COACH TOBACCO Text messages to support smoking cessation Monitoring Assessment of cigarette consumption, intention to quit, individual chosen strategies to cope with cravings Quiz questions Health benefits of smoking cessation, money spent for cigarettes per year, percentage of smokers in age and gender specific reference group Message Contest Invitation to create a text message to motivate other participants to quit smoking or to provide ways to help quitting Tailored smoking cessation messages 2 messages per week tailored according to baseline data data from text message monitoring MobileCoach Extra Up to 2 daily text messages for quit day preparation and relapse prevention 24
METHODS MOBILE COACH TOBACCO Sample text messages to support smoking cessation < SMS/MMS Tue 19:03 You can be really proud of yourself! Since the last assessment, you ve smoked about 4 cigarettes less per day. That means you re on the right path towards an active and healthy lifestyle. < SMS/MMS Tue 19:03 Hey Can19 In this video, Marco tells you about what helped him most to quit smoking. It may be interesting for you, too? < SMS/MMS Tue 18:07 Thinking about several alternatives to smoking may help you stay smoke free longer. Try it right now with Julia, to see how it works: www.juliarauchfrei.at Non-Intender Intender Actor 25
METHODS MOBILE COACH TOBACCO Quiz questions < SMS/MMS Tue 18:07 MobileCoach Quiz Hey Berti, what do you think? How much money do you spend on smoking yearly? Please answer by sending the estimated amount in francs (e.g. 100). < SMS/MMS Tue 22:09 yearly? Please answer by sending the estimated amount in francs (e.g. 100). 1100 < SMS/MMS Tue 22:11 If you save the money you spend on cigarettes yearly, assuming that a pack costs CHF 7.80, you will have saved CHF 1708! That s more than you had estimated. 26
METHODS MOBILE COACH TOBACCO Message contest < SMS/MMS Tue 18:07 Hey, what could motivate you or others to quit smoking? Write down a sentence. We ll send the best messages around to all MobileCoach users anonymously. < SMS/MMS Tue 22:09 down a sentence. We ll send the best messages around to all MobileCoach users anonymously. Stop smoking if you want more endurance. < SMS/MMS Thu 18:11 MobileCoach Top Message of the week: Kissing a nonsmoker is a lot more pleasant. So away with the cigarette, and come and give me a kiss! 27
METHODS MOBILE COACH TOBACCO+ Feedback on drinking behaviour introduction 28
METHODS MOBILE COACH TOBACCO+ Feedback on drinking behaviour drinks per week 29
METHODS MOBILE COACH TOBACCO+ Feedback on drinking behaviour calories consumed by alcoholic drinks 30
METHODS MOBILE COACH TOBACCO+ Text messages stimulating drinking within low risk limits Only for participants with binge drinking in the previous month Sent on individual s typical drinking day and time < SMS/MMS Sa 20:03 Hi Fab. Don t drink alcohol when you re not feeling well. Why? A lot of alcohol intensifies negative feelings. A clear head will help you deal with problems better. < SMS/MMS Fr 22:03 Hey Mik. Try taking less money with you when you go out in the evenings. Then it will be easier to control you alcohol use and at the same time to smoke less. < SMS/MMS Su19:07 Hi Molly, drinking alcohol increases the need to smoke cigarettes considerably. Therefore, avoid parties during the first two nonsmoking weeks and drink less or no alcohol at all. Non-Intender Intender Actor 31
REFERENCES Technical platform www.mobile-coach.eu 32
REFERENCES Literature and contact www.isgf.ch severin.haug@isgf.uzh.ch 33