Rhode Island tobacco cessation efforts are showing results: per the 2013 Youth Risk Behavior Survey (YRBS), only 8% of RI youth smoke, the second lowest rate in the country (Utah owns the top spot). Until that rate is 0%, though, efforts will continue to help smokers quit. As part of this effort, The Rhode Island Department of Health asked JSI to help build a program using a tool that most youth are already very familiar with: text messaging.
When we set out to build a collection of text messages to help teens quit smoking, we knew we needed to find the right balance in tone and content. We needed something that spoke to young people in ways they care about, but we weren’t going to try to pretend we were their cool new best friend (kids see through that; everyone does, really). The messages had to be fun and engaging, but still taken seriously.
We also knew that this program, Text 2 Be An Ex (T2BX), had to be different from others out there. For one thing, it is bidirectional, meaning a teen signed up for the program can text back if they like, and someone will respond. Additionally, while most programs allow for sign up only after a quit date is set, we decided to broaden the reach to anyone, including those just starting to think about quitting. Using Prochaska’s Stages of Change model, we created messages targeting each stage, including early contemplation. Using a series of messages from the National Institutes of Health as a starting reference, we built a library of nearly 400 messages. That list went through a number of iterations, in part due to vetting through focus groups with the target audience.
Because we wanted to customize the messages, send each subscriber relevant texts, and evaluate the overall program, we ask a brief series of questions of new subscribers, and few others as the program is underway. Each response feeds into an algorithm that results in messages appropriate to each individual. For example, we ask subscribers why they use tobacco (is it stress? or social reasons? perhaps to manage weight?), so we can subsequently target messages worded to match these preferences and share appropriate information.
A more fun feature of the program is the inclusion of distractions, which a user can ask for at any time of day by texting a specific keyword. These are short videos that often don’t have much to do with tobacco, but may take your mind off of smoking for long enough that you make it through a craving. I had a lot of fun tracking these links down with the idea that it might help a young person stay strong even when cravings hit.
Overall, I think we hit a note that sounds human while still being professional. There are more than 80 teens signed up for the program less than a month after launch, which is an encouraging sign. We’ll watch to see how our target audience responds over time, and use their feedback and results to make it even better!
Sample texts participants receive, based on their current stage:
You may have just started to think about quitting. That’s the first step! I’m here to help you take the next step. Any interest in giving it a shot?
Setting a quit date helps you to succeed. Within two weeks is best. Yes or no: have you set a date yet?
No? C’mon, I know you can do this! And I am here to help. One idea for setting a quit date: when your next pack is empty. 🙂
You probably don’t want your sister or brother to smoke cigs, right? Quit and be a role model.
Don’t give up! Quitting sometimes takes a few tries, and I know you can do it. If you slip again, text SLIP for a quick shot of support.
If stress is indicated as the reason for smoking, the subscriber might get this message:
I bet those smoking triggers are still around. Try this: Instead of tobacco, try a healthier way to deal. Take a fast walk. Go to the gym. Play a game.
Learn more about the T2BX program: