Reaching Latinos Through Social Media and SMS for Smoking Cessation

Transcription

1 Reaching Latinos Through Social Media and SMS for Smoking Cessation Patricia Chalela, DrPH Associate Professor Institute for Health Promotion Research

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3 Program Team Institute for Health Promotion Research Amelie Ramirez, DrPH, Program Director Patricia Chalela, DrPH, Program Coordinator Edgar Muñoz, MS, Biostatistician Andrea Fernandez, MPH, Outreach Specialist Pramod Sukumaran, PhD, Outreach Specialist Cliff Despres, BJ, Communications Director Rick Carrillo, Video Producer UT San Antonio David Akopian, PhD, SMS System Development Sahak Kaghyan, PhD, SMS System Management Rodrigo Escobar, PhD(c), SMS System Development UT School of Public Health - Austin Alfred, L. McAlister, PhD, Program Evaluator

4 Smoking is the leading cause of premature, preventable death 480,000 deaths/year including 41,000 from second hand smoking: 1 in 5 36% of cancer 39% of heart disease 24% of lung disease Source: USDHHS, A Report of the Surgeon General, 2014; NCI 2017; Graphic: CC0 Creative Commons - Pixabay

5 Mortality among smokers is 3 times higher Smokers die 10 years earlier than non-smokers Smoking costs billions of dollars each year $170B in direct medical care More than $156B in lost productivity Source: USDHHS, A Report of the Surgeon General, 2014; Jha et al. New England Journal of Medicine, 2013; Xu et al. American Journal of Preventive Medicine, Graphic: CC0 Creative Commons - Pixabay

6 Smoking kills more than 25,000 people in Texas every year About 3,000 in South Texas Source: Texas Department of State Health Services, 2013 Graphic: CC0 Creative Commons - Pixabay

7 Almost 90% of adult smokers start smoking by age 18 99% of daily tobacco users try their first cigarette by age 26 Source: USDHHS, A Report of the Surgeon General, 2014 Graphic: CC0 Creative Commons - Pixabay

8 Prevalence of smoking among young adults is about 22.3% Rates are lower among older Latinos but notably higher among young Latino men than women Source: SAMHSA, 2018; SMHSA, NSDUH State Data, 2015 Graphic: CC0 Creative Commons - Pixabay

9 Telephone counseling double cessation rates Only reaches 1-2% of smokers annually and 0.9% of Latinos Source: Rabius et al. Tobacco Control, 2007; Bailey, Texas Tobacco Summit, 2014 Graphic: CC0 Creative Commons - Pixabay

10 9 out of 10 Latinos own a smartphone Facebook most frequently used social media Smartphone/social media are innovative, evidence-based interventions to promote healthy behaviors among young people Source: Pew Research, 2017; Wittaker et al. Cochrane Database of Systematic Reviews, 2016 Graphic: CC0 Creative Commons - Pixabay

11 Short message service (SMS or text messaging) can significantly increase odds of successful cessation of smoking (OR 1.7) Counseling protocols used in telephone services based on Social Cognitive Theory, the Transtheoretical Model, and motivational interviewing significantly increase quitting success Source: Whittaker, R., et al. Cochrane Database of Systematic Reviews, 2016; McAlister et al. Health Behavior and Health Education, 2008; Prochaska et al. American Psychologist, 1992; Miller & Rollnick, 1991 Graphic: CC0 Creative Commons - Pixabay

12 A Cessation Service for Young Adults Develop, pretest and implement a bilingual, culturally appropriate, evidence-based mobile text message cessation service for young adults (18-29) in South Texas, a marginalized population with low access to cessation services

13 Service Area 53,000-square-mile area that borders Mexico Contains 4.9 million people Includes the Rio Grande Valley, one of the most medically underserved and impoverished areas in the nation 67% Latinos Median age of 27 years

14 Program Development Formative research Revision of existing evidence-based SMS cessation services Focus groups to pretest message library Creation of new messages to suit young adults Latinos culture and language in South Texas Focus groups Development of tailored texting protocol and SMS system programming Design and pretest of social media ads Betatesting before formal launch

15 A Cessation Service for Young Adults Inclusion criteria Current smoker 18 years or older Willing to set a quit date within 14 days Provision of baseline data

16 A Cessation Service for Young Adults Responds to text codes with a sequence of interactive messages beginning with collection of baseline data: Demographics Cigarette smoking e-cigarette use Binge drinking Text iquit to to turn your phone into a quit-smoking text coach!

17 A Cessation Service for Young Adults Participants are prompted to either choose quit tomorrow or set a quit date within 14 days. Specific sequence of messages for each selection

18 A Cessation Service for Young Adults Program provides motivational messages, tips to manage cravings and difficult situations and support 24/7 Specific code words: Helpnow, crave, stress, badmood, slip, exit Helpnow What s the problem? If you are having a bad craving text CRAVE If you are having a bad mood text MOOD...

19 A Cessation Service for Young Adults Links to 9 mobile web pages, music, videos and other fun, helpful content: Motivation for quitting Obtaining social support Nicotine replacement Avoiding binge drinking Increasing physical activity Breathing exercises for managing stress Things to do instead of smoking (counterconditioning) Avoiding relapse by talking yourself out of smoking Predicting, planning and practicing for difficult situations

20 Program Enrollment Enrollment is promoted using social media (i.e., Facebook, Instagram) Local mass media publicity Outreach at colleges, universities, trade schools and venues attended by young adults Social media ads with different themes (i.e, disgust, confidence in quitting) and styles (cowboy, metro, punk, graphic novel) Participants are prompted to click on the ad or text a code corresponding to the channel of recruitment

21 Social Media Enrollment

22 Social Media Enrollment

23 Social Media Enrollment

24 Social Media Enrollment

25 Social Media Enrollment

26 Program Evaluation Enrollment in Quitxt Continuation of service utilization Self-reported cessation status at 2, 4 and 7 months. 24-hour point prevalence abstinence from smoking: Did you make it through the day without smoking? Text Yes or No Chi square tests and multivariate analyses were used to determine the statistical significance of differences between service user groups Source: Velicer & Prochaska, Addictive Behaviors, 2004; Benowitz et al. Nicotine & Tobacco Research, 2002

27 Group Assessment A total of 798 enrollees are included in the group assessment. The most productive recruitment source was positive Facebook ads Cost of $120 per enrollee Graphic: CC0 Creative Commons - Pixabay

28 Group Assessment Characteristics N (%) Abstinent (%) OR 95% CI Age: Gender: Male Female Ethnicity: Non-Hispanic/L Hispanic/Latino No. of cigarettes per day <10 cigs/day 10 cigs/day e-cigs use: Yes No 398 (55.1) 324 ( (56.5) 308 (43.5) 446 (64.5) 246 (35.5) 308 (46.4) 356 (53.6) 307 (50.4) 302 (49.6) Binge drinking: No 216 (35.9) 37.5 Ref. Ref Ref Ref Ref Ref. 0.34*

29 Group Assessment Cessation rates were higher than the rates reported in previous studies of mobile cessation services, but consistent with research on telephone counseling for young adults Measurement of point prevalence of 24-hour abstinence yields cessation rates estimates that are slightly higher than longer reported intervals of abstinence Smokers in our service were mostly light to moderate smokers (mean 11.5 cigarettes) which may have contributed to the relatively high cessation rate achieved This is not a randomized trial and self-reported cessation cannot be attributed with certainty to Quitxt, however, the cost per enrollment compared favorable with other similar cessation services Source: Whittaker et al. Cochrane Database of Systematic Reviews, 2016; Rabius et al. Health Psychology, 2004; Velicer & Prochaska, Addictive Behaviors, 2004

30 Lessons Learned Simplification is important Pretesting is critical Negative appeal ads generated most clicks but positive appeal ads produced the highest enrollment Ad rotation is essential to avoid ad fatigue Social media is an ever-changing technology

31 Lessons Learned Type of questions asked may affect enrollment Texting and mobile media services for smoking cessation can be effectively delivered to young adults in South Texas Support can be delivered 24/7 wherever the person is located Provides anonymity people like Can be interactive allowing participants to obtain help when it is most needed

32 Conclusion This is a highly scalable service, making mobile personalized smoking cessation advice/support an affordable approach to reach disadvantage population groups, produce a public health impact, reduce health service costs, and reduce smokingrelated health disparities.

33 Future Directions With CPRIT support we will continue and expand the effective mobile/sms service that we created, tested and refined. To reach high-priority populations for cessation services, including all young adult smokers in rural areas and Spanish speaking young adults in urban areas. To carry out a systems change to enhance the integration of tobacco screening and treatment into electronic health record systems and including routine referral to our Quitxt text and social messaging (Chatbot) cessation services for tobaccousing patients receiving services from UT Health San Antonio Primary Care Center (PCC) providers and oncologists at the Mays Cancer Center. Source: Whittaker et al. Cochrane Database of Systematic Reviews, 2016

34 Thank You / Mil Gracias chalela@uthscsa.edu Saludtoday