Going mobile: the potential of mHealth for tobacco dependence treatment


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Erik Augustson, PhD, MPH, is the Program Director of the Tobacco Control Research Branch of the National Cancer Institute. He serves on a number of national committees in the United States to improve population-based tobacco control such as the Department of Health and Human Services eHealth and mHealth Cessation Interventions committee, Smoking Cessation Subcommittee of the DHHS, the National Tobacco Control Strategy Committee and the North American Quitline Consortium. In addition, Dr. Augustson serves as the federal co-lead on the Smokefree.gov Initiative which represents the first web and mobile based cessation resource developed by the United States federal government.

During this webinar, Dr. Augustson discussed the use of mHealth for health behavior interventions, particularly in tobacco dependence. MHealth has been defined as “health related services delivered by mobile communication devices,” which can be in the form of SMS messaging, smartphone applications, or the mobile web. This webinar focused on text-message based interventions such as NCI’s SmokefreeTXT and the opportunity to implement such interventions at an international level. Dr. Augustson has worked on mHealth interventions not only in the United States but also in China and shared preliminary results from program evaluations and discussed the future potential of mobile interventions to treat tobacco dependence on a population level.

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Going mobile: the potential of mHealth for tobacco dependence treatment

  1. 1. 1www.globalbridges.org
  2. 2. Erik Augustson, PhD, MPHBehavioral ScientistTobacco Control Research BranchBehavioral Research ProgramNational Cancer InstituteGoing Mobile: The Potential ofmHealth for TobaccoDependence TreatmentGlobal Bridges, April 23, 2013
  3. 3. Smokefree Development TeamNCIErik AugustsonAmi BahdeYvonne HuntHeather PatrickMMGLewellyn BelberJeff GoldfarbBrian KeefeSamantha PostAmy SandersShani Taylor*Alle VargoAdditional SupportLorien AbromsRachel GranaRobin MermelsteinNalini PadmanabhanAlison PilsnerAllison RoseMary SchwarzRobyn Whittaker* Funded in part by NCI Contract No. HHSN261200800001E; HHSN261200544018C, NO2-PC-54418; andHHSN2612007000191
  4. 4. Outline• mHealth Potential for Interventions• The Smokefree.gov Project• SmokefreeTXT• Domestic & International Case Studies
  5. 5. Mobile Uptake• Mobile subscriptions– U.S. 234 MILLION– Worldwide 6 BILLION– 90% of world pop has cellsignal access– 75% world pop has access tomobile phone**Source: ComScore June 2012 Report; Ericsson 2011• Of U.S. mobile consumers:– 75% sent messages in early 2012– 51.4% used apps– 50.2% used a browser– 36.9% accessed social media sites or blogs– Motivation for health behavior change
  6. 6. Text Messaging79%80%85%American TextMessaging PrevalenceSend/Receive Texts• Texting for Health– 9% of Americansreceiveupdates/alerts onhealth issuesSource: Pew Mobile Report 2012• More likely to signup for health textmessages:– Women– 30-64 years old– African American
  7. 7. U.S. Smartphone OwnershipYoung adults tend to have higher-than-average levels of smartphoneownership regardless of income or educational attainment.**Source: Pew Research Center’s Internet & American Life Project 2012
  8. 8. Smartphone Use for Health27%15%35%19%38%25%20122010Smartphone use to FindHealth Information byRace HispanicAfricanAmericanWhiteSource: Pew Mobile Report 2012• Owning asmartphone increaseslikelihood ofaccessing healthinformation online• More likely to lookup healthinformation onmobile phone:– Young adults– Minorities
  9. 9. mHealth Potential• Reach– Large audiences– Underserved audiences• Engagement with intervention platform– Increase access to intervention– Decrease barriers to participation(scheduling, transportation, etc)– Decrease space/time gap between treatment &behavior– Seamlessly integrate user interaction with treatmentwithin their daily life– Interactive functionality  improved “dose”• Reduces cost burden on healthcare system
  10. 10. Smokefree Family History• 2003 Smokefree.gov– Focus on cessation resource– Multiple updates and iterations• 2009 Smokefree Women– Expanded interactivity– Incorporation of social media• 2011 Smokefree Teen– Multi-platform intervention• 2012 Smokefree Español– Spanish
  11. 11. Smokefree Projects• Smokefree.gov– Website– Mobile app(QuitGuide, QuitPal)– Social media: Twitter• Smokefree Women– Mobile Website (Spring2013)– Social media:Facebook, Twitter, Pinterest, YouTube• Smokefree Teen– Mobile Website– Social media:Facebook, Twitter, Tumblr– Mobile app (QuitSTART)• Spanish Smokefree– Website– Social media• Smokefree Pregnancy– Web content– Online video• SmokefreeTXT– Teen– Young Adult– Spanish Language– QuitNow Library– Veteran (June 2013)– Military (coming soon)
  12. 12. SmokefreeTXT Program
  13. 13. • Text messaging smoking cessationintervention• Features versions for teens, young adults& Spanish speaking audiences• Users can opt-in and select a quit date upto 30 days into the future– Free with unlimited texting plan– Receive messages 2 weeks before and up to 6weeks after quit date– Increased number of messages close to quit date• Bidirectional: assesses user’smood, craving, & smokefree status– Users can text keywords (i.e. CRAVE, MOOD, SLIP)SmokefreeTXT Overview
  14. 14. SmokefreeTXT MetricsTotal SubscriptionsMarch 2012- March 201322,610-5,00010,00015,00020,00025,000
  15. 15. SmokefreeTXT MetricsSubscriber Breakdown by Sex AllTime SubscribersTotal MalesTotal FemalesTotal Unknown34%58%9%
  16. 16. SmokefreeTXT MetricsSmoking Status Reported at Registration for over13,000 participantsEvery dayMost daysSome daysLess than thatUnknown81%2%5%1%11%
  17. 17. SmokefreeTXT MetricsAdult Subscriber Opt Outs over Course of TreatmentSeptember 2011 – October 2012050010001500200025003000350040004500
  18. 18. SmokefreeTXT MetricsITT Adult Follow-Up Responses:Assessment of Active Subscribers, March 2013• 1-Month: 17%• 3-month: 13%• 6-month: 11%
  19. 19. International Opportunities• China: 300,000,000 Smokers• 1) US HHS-China MOH-Nokia• 2) Emory University-Suzchou
  20. 20. SmokefreeTXT: China• 1) US HHS-China MOH-Nokia– Four provinces selected– Health messages developed specifically forproject– Cessation messages based on NCI library– Translated by Chinese public healthprofessionals– Focus Group Testing of messages withChinese Smokers• 8 conducted• 2 in each province• Urban & rural
  21. 21. SmokefreeTXT: China• 1) US HHS-China MOH-Nokia– Phase One: 250,000 Smokers• 10 days smoking health effect messages• Started 4/15/2013– Phase Two: 8000 Smokers• 2-arm RCT• 1 week count down to quit day• 6 week treatment• 1 & 3 month f/u• Start 4/28/2013• Finish 9/17/2013
  22. 22. SmokefreeTXT: China• 2) Emory University-Suzchou– Nonrandomized Demonstration Project– Part of annual Quit Contest– NCI Library translated by local health officials– 4 week treatment w f/u at EOT– 665 Smokers received text messages– ~1000 Smokers participated w/o text• Data available in near future
  23. 23. Suzchou Project: Clinical Data• Baseline Smoking Status– Daily 60% (49% vs. 70%)• Time to 1st cigarette– 30+ minutes 69% (72% vs. 66%)• Cigarettes per day– 10 or less 52% (54% vs. 51%)– 11-20 CPD 36% (40% vs. 33%)• One Month Quit Rate– 38% (57% vs. 22%)
  24. 24. Suzchou Project: Feedback• Amount of text messages– Right Amount 57% (74% vs. 42%)• Provided Helpful/Useful Information– Yes 80% (92% vs. 69%)• Helped to Motivate Quit Attempt– Yes 78% (90% vs. 69% )
  25. 25. Additional InternationalActivities• Collaboration with Healthy CaribbeanCoalition– Launch June 2013• Technical guidance for WHO project inCosta Rica• Collaboration in South Pacific Islands• Continued development of India project• Exploring project in Central & SouthAmerica
  26. 26. Underserved Populations:Challenges• Consistency of cell phone access• Multiple users per device• Fee structures• Populations with Low Literacy• Role of mHealth interventions with inlarger public health infrastructure
  27. 27. Questions?@SmokefreeGovaugustse@mail.nih.gov
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