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

I. WHY INTEGRATE NEW TECHNOLOGY INTO QUITLINE SERVICES

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

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

Where people search for health information

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

II. HOW MAKE USE OF TECHNOLOGY OPPORTUNITIES: EXISTING TECHNOLOGY FOR SMOKING CESSATION

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

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

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

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

III. HOW MAKE USE OF TECHNOLOGY OPPORTUNITIES AT QUITLINES: EXAMPLES FROM MY RESEARCH

Example 1:

Efficacy study of & Phone Counseling at the ACS Quitline

Aims 1. To develop a computer generated, tailored 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)

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. 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, a quit smoking counselor your question Talk to a quit smoking counselor at QUIT-NOW Send an e-card to get support from someone you know Visit the Great American Smokeout Quit Smoking E-Messenger

Hypotheses Phone counseling enhanced with 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)

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

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

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  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.

TEXT MESSAGING Example 2:

Formative evaluation of text messaging and at Smokefree.gov

Figure 3. Study Design Enrollment Assessment Randomization Phone Counseling (N=250) Phone Counseling + Mobile (N=250) Follow-Up at 3,7 & 12 months

SMARTPHONES Example 3:

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

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

Results Most used a calendar approach followed by 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

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:  2. Mobile  3. Social networking

Questions? Contact: Lorien Abroms, ScD