Speaking Their Language
Despite all of the public education and shifting social mores, smoking is still attractive to some teenagers. And while Rhode Island has one of the lowest smoking rates in the country for young people, The Department of Health has launched an initiative aimed at helping 13-18-year-olds stop using tobacco: an interactive texting program that’s the first of its type in the country.
Click here for more information about T2BX.
Despite the warnings.
Despite the messages.
Despite all of the public education, teenagers are still smoking.
The good news is: Rhode Island has the second lowest percentage nationwide of teenage smokers - at 8 percent.
But how to get the anti-tobacco message to them? Especially if they’re trying to quit? Well, if you have a teenager, you know one of the best ways - is to text them.
Collins: ``We know text message is a teen’s primary mode of communication. so I really wanted to do something with text message that would deliver encouragement and education, to the remaining 8 percent of Rhode Island youth who smoke about quitting.’’
Erica Collins helped develop a program for The Rhode Island Department of Health called T2BX - in texting parlance: Text to Be an Ex.
The interactive program is made possible by a grant from CVS Health through The United Way and is the first of its kind in the country.
Collins: ``This text message program is completely unique. There are other text message programs where you can receive help and encouragement for all sorts of things. But the thing that makes this one different is that it’s tailored to the needs of the smoker, and it’s two-way, so they can have a conversation and a dialogue with a trained tobacco-treatment specialist.’’
Boles Welch: ``When you enroll, you immediately will get five back-to-back text messages from the program saying hey, and it’s all to introduce the program.’’
Eric Boles-Welsh is the Tobacco Control Program Manager at the Department of Health and has overseen T2BX since it was launched in January.
Boles Welsh: ``What we found was that youth wanted to know about the program before they start telling us about themselves, so we can develop a relationship with them.’’
The program was 2 1/2 years in the making and the Department engaged Rescue Social Change, national experts on changing high risk behavior. The company did research and focus groups in high schools across Rhode Island.
Boles Welsh: ``Who are they hanging out with because they have found that over 10 years of this research that social the groups that you hang out with says more about behavior and who they are and what they like and what they’re doing, than other standard demographics. Rhode Island’s two highest youth smoking groups are those youth who associate culturally with hip-hop music and with alternative music. They have a much higher smoking rate than the statewide average.’’
So they launched a targeted advertising campaign with online music services like Pandora and Spotify. And they set up a Facebook page that is regularly updated with encouraging messages, articles and videos.
Collins: ``Because we didn’t want to reach all youth, we wanted to reach only the 8 percent that were smoking, so even our media campaign that promoted T2BX is very targeted.’’
The research also found something interesting: among the 13-18 crowd, it is the high school smokers who want to quit.
Collins: ``The middle school kids who were smoking, they still thought it was cool and that’s why they smoked, they thought it made them look older and be cool, but by the time we got to high school kids for our focus groups, the high schoolers already wanted to quit. They had noticed that they were sort of the pariah in high school, it sort of separated them from the pack.’’
Boles Welsh: ``You know we’re not talking about kids who you’ll find most traditionally involved in school activities. Or other types of traditional activities, so T2BX was designed to reach them, where they’re at. It’s designed to speak to them in a way that’s very familiar and casual, and quick texts.’’
When teenagers text in they are connected with a real person and going forward get a combination of live and automated messages, depending on the situation.
Collins: ``That’s a big part of what makes T2BX unique: there is a person there, it’s half and half, there’s an automated system that handles most o the basic communications, but if that youth needs to reach someone and needs talk to someone, they can, there’s someone there.
Boles Welsh: ``When they type in the word crave, they’ll be sent a short, funny, silly video on You Tube to get them through the current distraction.’’
Hummel: ``And that’s all done through texting.’’
Boles Welsh: ``All done through texting.’’
Hummel: ``So even the initial questionnaire and everything else.’’
Boles Welsh: ``Everything.’’
Hummel: ``There’s a little method to that madness, isn’t there?’’
Boles Welsh: ``Yeah, absolutely.’’
Hummel: ``You’re not going to have some kid sit down at a table and fill out of a form, right?’’
Boles Welsh: ``No, we have a short code. It’s the medium they’re most comfortable with.’’
And it’s not just cigarettes teenagers these days.
Collins: ``E-cigarettes, flavored cigars, all sorts of tobacco products have creeped up with nice flavors and enticing candy-like wrappers. And as those things sort of hit the market and become more popular youth start to use those more frequently. So we do have our work cut out for us.’’
The Department of Health’s goal is to reach 10 percent of youth smokers in the target age of 13-18.
Through the first five months of the program it met 81 percent of that goal.
That translates to about 260 participants so far.
The Department finished the first phase of the program June 30th. It will use the summer to analyze data - including all of the text conversations by participants - and tweak the program, with a relaunch date in September.
So what have they found so far?
Boles Welsh: ``There’s about 21 active days that a youth will participate in the program. And very preliminarily we see those youth who are moving through the program in the way we had designed the program to work, meaning that they’re answering back to the texts they received, giving us either a quit date or helping us to understand which stage of change they’re in, for those who are using the program in the way it was designed - that about almost 40 percent are moving from one stage of change to another. Now they’re estimating you know maybe a dozen quit attempts before you can actually quit tobacco; so if we successful in moving someone who has never thought of quitting into someone who wants to start to think about a plan. That’s really how cessation works: you’re slowly moving people through a process that hopefully one day will end in a quit attempt.’’
The CVS grant will also allow the United Way to run anti-tobacco youth trainings programs beginning in the fall. Their goal is to build a statewide network of young people promoting a smoke-free lifestyle.
Hummel: ``Are other states looking at you?’’
Boles Welsh: ``Absolutely, they’re really curious - we have several states who want to hear after we do our first round of evaluation, to hear how this went.’’
And the goal remains the same:
Collins: ``We wanted youth to be able to subscribe, text in, get distractions and get encouragement when they needed it and feel like they had a coach or a buddy who was there and had their back.’’
In Providence, Jim Hummel for The Rhode Island Spotlight.