Prochaska, Meet Text Messaging: How Utilization of Text Messaging Can Aid Smokers through the Stages of Change

Theoretical Background and research questions/hypothesis: Text messaging is rapidly becoming a preferred method of engagement for many marketers because of their attachment to people. Most people carry their cell phone with them, making messaging to people easier and timelier than traditional advertising. By utilizing cell phones for smoking cessation interventions, studies to date have shown an increase in short-term quit rates. This study shows text messaging can be an effective way to move people through the stages of change. As “Mobile phone-based smoking cessation is an innovative means of delivering smoking cessation support, which doubles the self-reported quit rate in the short term” (Free, C. 2009) it is important to recognize how developing technologies can be integrated into existing marketing plans to increase overall effectiveness of mass media interventions. According to the CDC, 25.5% of Utah households are cell phone only, with 23.9% of adults having only a cell phone. Internal Utah Department of Health (UDOH) surveys show an average smoking rate of 9.1% for landline surveys. In a cell phone only sampling, the rate of smoking increased nearly 50% to ~14% for cell phone only recipients. Clearly, the cell phone only population is a disparate population in need of increased attention for smoking cessation interventions. African Americans and Hispanics text more often than their Caucasian counterparts (Pew Internet Study, 2009), so text messaging campaigns can be cost efficient way to reach many disparate populations. Finally, as people text for information a database of assumed smokers is created, allowing for future interventions to drive an already interested and needy population toward existing services for smoking cessation. This study seeks to determine if confidence levels are impacted by a 21 day text messaging intervention.

Methods: Recognizing that higher quit rates can be encouraged with motivation enhancement components (Sussman, 2006), and to address the aforementioned concerns, the UDOH Tobacco Prevention and Control Program (TPCP) created a 21 day, twice daily text messaging based intervention. The text messaging campaign included capacity building text messages designed to encourage motivation and confidence in the ability of the smoker to quit and/or remain quit. With a three question survey gleaned from motivational interviewing questions before and after the 21 day intervention, the text messaging campaign results suggest that text messaging can be a useful intervention for capacity building within individuals who seek to increase their self sufficiency in smoking cessation.

Results: The text messaging campaign increased the quit confidence of those receiving messages.

Conclusions: Text messaging can be a cost effective way to increase the capacity of smokers on their way through Prochaska's stages of change toward becoming smoke-free. Confidence in quitting can increase cessation success rates in the short term. and

Implications for research and/or practice: Further studies can add to this research by clinically placing participants in a study into one of the stages of change, then evaluate how long messages need to be delivered before progression through the stages begins. Additionally, incorporating a text messaging component into an existing marketing mix can be a useful addition for reaching the disparate community of cell phone only users.