Using New Communication Technologies to Enhance Services at Smoking Quitlines

1. Using New Communication Technologies to Enhance Services at Smoking Quitlines Lorien Abroms, ScD. Dept. of Prevention & Community Health GW School of Public Health & Health Services Lorien@gwu.edu

2. I . Why integrate new technology into Quitline services

3. Who Uses the Internet & How? 147 million people (73%) on the Internet 91% read email 48% video sharing 39% read blogs 35% have profile on social networking site (2008) Source : Pew 2007/2008

4. Who Uses Cell Phones & How? Over 75 % of adults have cell phones 40% use SMS/text messaging Age: 65 % of 18-29 Ethnicity: Hispanics (54%); Af-Am (42%), Whites (31%) 44% of people use their mobile as their main camera Source : Pew 2005

5. Where people search for health information

7. Quitlines & New Media • Quitlines collect user information in computerized databases at intake

8. II. How make use of technology opportunities: Existing Technology for smoking cessation

9. Following from U.S. Public Health Clinical Practice Guideline, tobacco treatment programs should: • Be intense • Offer social support • Teach problem solving and coping skills • Promote use of pharacotherapy • Combine delivery modes Fiore et al. 2000

10. Technology opportunity 1: Email for smoking cessation • Efficacy of tailored and time emails (Lenert et al. 2004) • Utility of emails for reducing smoking among NRT users (Etter et al. 2003) • Efficacy of email for smoking cessation in a college population (Abroms et al. 2007)

11. Technology opportunity 2: Mobile Phones for smoking cessation • STOMP • Colorado Dept. of Public Health

12. Technology opportunity 3: Social Networking/Web sites for smoking cessation • Quitnet • BecomeAnEx.org • Facebook???

13. III. How make use of technology opportunities at quitlines: Examples from My Research

14. Example 1: Email

15. Efficacy study of email & Phone Counseling at the ACS Quitline

16. Aims 1. To develop a computer generated, tailored email message service, which will be used as an adjunct to phone counseling 2. To pilot test the service 3. To conduct an efficacy study within the context of the ACS Quitline (NE)

17. Quit Smoking E-Messenger Mary’s Quitting Information: Top 2 reasons for quitting: 1. Family or friends 2. To feel more in control of your life Social Support: Your husband QuitDay: January 16, 2007 Email a quit smoking counselor your question Talk to a quit smoking counselor at 1-800-QUIT-NOW Send an e-card to get support from someone you know Visit the Great American Smokeout Hello Mary!  Today is the day! You’ve been preparing for your Quit Day and now it’s here. Remind your friends and family that today’s your Quit Day. You’ll need their support. Here are some tips to help you get through the day: •  Stay busy. It’s important to distract yourself so you won’t have time to think about smoking. If you spend time at the computer, you might like to download the ACS Craving Stopper. • Avoid being in places you associate with smoking. • Recognize your triggers and try to avoid them. Don’t forget: the urge to smoke usually only lasts 3-5 minutes. Distract yourself and you’ll make it through the urge.

18. Hypotheses • Phone counseling enhanced with email messages will result in : • Higher quit rates • Better quitting outcomes (e.g. more quit attempts, more consecutive days quit, and higher levels of quitting than phone counseling alone). • Higher levels of client satisfaction • Additional use of Quitline services (more contact hours)

19. Design and Evaluation • Design Prototype • Pilot—Callers (N=25), • Large trial N=1070

20. Enrollment Assessment Randomization Phone Counseling (N=540) Phone Counseling + Email (N=540) Follow-Up at 6 weeks, 3,6 & 12 months Follow-Up at 6 weeks, 3,6 & 12 months Phases II & III: Develop prototype and test, Figure 3. Study Design

21. Why Innovative? • Makes use of existing technology which is widely used, but which has not been applied for smoking cessation • Makes use of existing quitline data infrastructure • Good potential for improving quit rates • Email can increase the intensity and contact time, enhance problem solving skills, serve as an additional treatment modality • Builds on existing platform, the Quitline--potential for dissemination is high.

22. Example 2: Text messaging

23. Formative evaluation of text messaging and email at Smokefree.gov

24. Enrollment Assessment Randomization Phone Counseling (N=250) Phone Counseling + Mobile (N=250) Follow-Up at 3,7 & 12 months Follow-Up at 3,7 & 12 months Formative evaluation of text messaging and email at Smokefree.gov Figure 3. Study Design

25. Example 3: Smartphones

26. iPhone App called “My Quitline” Rationale: connect users with proven therapy

27. Content Analysis of iPhone Apps for smoking cessation (n=62) • Adherence to best practice guidelines • US Public Health Service 2008 Clinical Practice Guidelines • Approach to smoking cessation • Popularity of use

28. Results • Most used a calendar approach followedby a rationing, hypnosis and calculator approach. • Few apps included the following practices: • communicate the risks of smoking, • provide social support for cessation, • connect a smoker to proven treatments

29. Conclusions • Use of “new” communication technologies is widespread • Quitline callers are using it • Quitlines have computerized intake which can integrate with technology • Technology opportunities abound • 1: Email • 2. Mobile • 3. Social networking

30. Questions? Contact: Lorien Abroms, ScD Lorien@gwu.edu