[Ed. We are proud to welcome Dr. Perry Payne to the iMedicalApps team. Dr. Payne brings a keen clinical and academic perspective to our coverage of mobile health]
by: Perry W. Payne, MD, JD
Teenage smoking is an old, persistent public health problem with about 20% of teens smoking today, but the National Cancer Institute (NCI) thinks that it has a new way to help teens quit: texting.
In an effort to tap into what all parents of teenagers know is the main mode of communication for teenagers these days, NCI recently introduced a new smoking cessation support program called Smokefree TXT. The initiative is viewed as a key component of the US Department of Health and Human Services’ efforts to create mobile health programs that improve the health of Americans.
In addition, this program comes just in time for any New Year’s resolutions by teens and their parents to curb a habit which is well known as a cause of multiple health problems.
What is Smokefree TXT?
Smokefree TXT is a free, twenty four hour service that provides teens who are trying to quit smoking with encouragement, advice, and tips to support their efforts. It is managed by the National Cancer Institute and paid for by American taxpayers. When teens sign up for the service, they are provided a quit date.
Teens receive various useful messages from that point on. On the website for Smokefree TXT, teens are told by the writers of the website that “We’re NOT going to tell you what to do.” The goal appears to be helping teens take control of their health. The text messages they receive are likely to empower them and counter any messages that promote teen smoking. Teens who continue the service until their quit date will continue receiving messages for up to six weeks.
NCI indicates that this cessation support during the first few weeks beyond quitting is important based on existing research. What’s not clear from the information provided by NCI is how teens can stop the messages if they decide not to quit or if the messages are not actually helping them or worse harming them in some way.
How can a teen sign up?
Teens as young as 13 years of age can sign up for the free service in two ways: online at teen.smokefree.gov and by texting QUIT to iQUIT (47848). Along with SmokeFree TXT, teens can also sign up for cessation information using a variety of social networking tools (i.e. Twitter, Facebook, etc.) on the website.
Will it Work?
The potential of Smokefree TXT making a dent in the smoking prevalence for teens is unclear. The NCI cites no research studies to support this service in their press release. In addition, the iMedicalApps Team conducted a quick search of MEDLINE using the terms “cessation support and teen” and found only 1 article from New Zealand focused on teens calling a quit line. By contrast, “cessation support” alone yielded 148 references.
There are numerous questions raised by this service.
- Will it be useful for lower income teens who are less likely to have unlimited texting plans, but much more likely to smoke?
- How should it be marketed to teens?
- Who do they text their questions to?
- Since the teens are minors, what role do their parents play in signing them up for the service and will this inhibit their use of it?
These and other questions could be addressed by a good evaluation of this service. Whether that will occur remains to be seen. Much could be learned by this effort if the NCI evaluates it well. However, without such an evaluation and with virtually no prior studies, the evidentiary basis appears to be weak at best for this type of intervention but it may still be useful given the high level of cell phone use among teens. In 2008, teens texted an average of 2,272 text messages per month according to the NY Times.
Should physicians recommend it?
Whether physicians should recommend this or not seems to be a clinical judgment call. There is no clear evidence to support the intervention, but for teens who need more support than they currently have, the advice is coming from a reputable source that is using the best evidence available to help teens. In addition, the tool costs nothing (beyond the cell phone plan) and given the lack of cheap alternatives to curb smoking, this may be worth a try.