Almost one third of military veterans in the United States who accessed smoking cessation messages on the Internet were able to quit; rates were even higher in veterans who also received text messages, researchers reported here at the American Telemedicine Association 17th Annual International Meeting.
Of the veterans who accessed tailored messages on the Internet, 32.8% were able to quit. The rate rose to 42.9% in veterans who also got text messages about cessation.
This study demonstrated that “the addition of tailored text messages improved quit rates,” said Patricia Jordan, PhD, from the US Veterans Affairs (VA) Pacific Islands Health Care System in Honolulu, Hawaii.
The VA spends more than $6 billion a year to treat tobacco-related diseases, and smoking abstinence rates for military personnel are only about 12% to 19% in most cessation programs, Dr. Jordan said.
To see if cell phones could help address the problem, Dr. Jordan and her colleagues recruited 235 veterans using Facebook ads, direct mailings, community newsletters, and flyers. With the promise of information and a gift card, they attracted some veterans who did not want to quit.
The researchers made a special effort to recruit women, who are underrepresented among veterans but made up 48% of study participants.
All the subjects took part in computerized tailored interventions (CTI), in which they logged onto a Web site and answered questions at 3 time points over a period of 3 months.
On the basis of their answers, they received messages tailored to such conditions as their readiness to quit, their confidence about quitting, and strategies they have used to quit. The program is based on the transtheoretical model of behavior change.
“They get feedback that’s tailored to exactly what they have answered,” Dr. Jordan told Medscape Medical News.
The researchers used focus groups to adapt the questions and messages specifically to the needs of veterans.
CTIs offer the advantage of anonymity and allow smokers to move at their own pace, Dr. Jordan said. In other studies of CTIs, the smoking cessation rates have averaged about 25%, she noted.
The researchers divided subjects into 2 groups. One group only participated in the CTI. Of these, 38 of 116 quit smoking.
The other group received automated text messages reinforcing the tailored messages from the CTIs. The number of text messages ranged from 2 per week for those people who said they were not ready to quit, to 7 per week for those who indicated they needed maximum support to quit. Of those who received text messages, 51 of 119 quit smoking.
Dr. Jordan did not report statistical significance.
The relatively high cessation rates in both groups could be due to a relatively high percentage of participants — more than two thirds — who were at the “contemplation” stage of behavior change, said Dr. Jordan.
In a follow-up study, she and her colleagues plan to track how many relapse. “I think when we dig into the data we will find a high relapse rate,” she said.
But tailoring the messages to the specific needs of veterans could also account for the program’s success, she said.
Session moderator Sunil Hazaray, chief commercial officer of Authentidate Holding Corp., in Berkeley Heights, New Jersey, told Medscape Medical News that knowing the relapse rate will be very important in evaluating the success of the program.
“This is, in fact, a very novel approach,” he said. “It’s one of the first times we’ve seen the benefits of telemedicine, not only in efficacy but in cost effectiveness. You literally don’t spend anything to send a text message.”