Reducing Teen Tobacco Use Via Text Messaging: Motivational Interviewing Integrated with Social Network Counseling

Introduction

Although tobacco use by adolescents has declined substantially in the last forty years, about one in 10 high school seniors were daily smokers in 2011. Tobacco use is a critical public health problem that requires creative new prevention approaches. The CDC recommends mobile phone-based interventions for tobacco cessation based on sufficient evidence of effectiveness in increasing tobacco use abstinence among people interested in quitting. Motivationally-based text messages are personalized to the individual, and delivered wherever the person is located eliminating the need to come to the researcher. While extensive research supports that peer networks predict tobacco use, the integration of a social network component within interventions is rare, and has yet to be routinely integrated into adolescent smoking cessation models.  Thus we have conducted a clinical trial that tests the effectiveness of a text-based intervention for adolescent smoking that utilizes a motivational interviewing (MI) and social network counseling model.

Methods

We recruited 37 adolescents from a community substance use facility into a clinical trial. The intervention was automated through a computer texting program that delivered individualized messages based on teens’ survey responses. The week long text intervention focused on 1) likes/dislikes about smoking, 2) normative comparisons, 3) network quality, and 4) plans for behavior change. Each group received 30 text messages with booster texts available upon request. All teens were provided a smart phone for the duration of the study.  We compared the treatment group to an attention control group to analyze the tobacco use trajectory of participants.  We used a repeated measures ANOVA examining Condition x Time interactions and we obtained effect sizes using Partial Eta Squared statistic.

Results

The intervention increased teens’ behaviors of Stopping Smoking or Taking Actions to Stop: F (1,35)=5.81, p< .05; eta²=.15; increased teens’ Readiness to Stop Smoking: F (1,35)=4.30, p< .05; eta²=.12; decreased teens’ intentions to Be Smoking in 5 Years:  F (1,35)=5.62, p< .05; eta²=.15; and decreased the number of teens’ Close Friends Who Are Daily Smokers:  F (1,35)=4.43, p< .05; eta²=.12.

Conclusions

The results of this trial indicate that the texting intervention significantly activated behaviors to stop smoking, readiness and intentions to stop smoking, and social network risk composition in the treatment group compared to controls.  The effect sizes are medium and large, which is promising given the very brief dosage of intervention delivered.  Theoretically, the results support the intervention’s MI component (readiness, intentions) as well as the Social Network component (level of risk-smoking peers).  These findings are encouraging for this innovative intervention with hard to reach adolescents.