• By Laura Whybra
  • Posted on Monday 21st September, 2015

Stop Me Smoking? Using SMS texting to prevent harmful substance use by youth

strong>Advertisers decided years ago that phone texting provides a cheap and efficient way to find large audiences among young people. A review of research using text messages to combat substance use suggests prevention scientists might usefully follow their example.Despite recent progress in developing effective life-skills training and other programs for preventing substance misuse, there are limits on how many young people an intervention can reach when delivered by a therapist or teacher. Also, there are just not enough evidence-based programs being delivered with high fidelity to satisfy the need to prevent adolescent smoking, drug or alcohol use in the United States or worldwide.Short message services (SMS) have the potential to bridge some of gap by extending access to evidence-based treatments to young people who may be otherwise hard to reach. They can be delivered any time, any place with 100 per cent fidelity to the intended prevention message, and may carry less stigma than face-to-face interventions. They can also be tailored to the individual characteristics of those taking part in a program.Phone ownership “near saturation”On the basis of research studies, mobile phone-based interventions have become a recommended, evidence-based strategy in the US for adults trying to quit smoking and prevent other substance misuse. Yet comparatively little is known about the effect of similar preventive approaches targeting youth This is surprising, given near-saturation ownership cell phones by young people in many countries and extensive use of texting (an astonishing average of 110 messages a day were sent by American 18 to 24-year olds in 2011)Searching for studies to include in an exploratory “meta-analysis” of substance use prevention interventions that use texting to reach 12 to 29-year olds, researchers at Virginia Commonwealth University found only 14 randomized controlled trials that satisfied their requirements. Of these, eleven targeted tobacco use and just three focused on alcohol. The interventions varied in content, including the number of texts sent to participants (from one to 278), and their timescale (from one day to one year) as well as the characteristics of the participants. The sample sizes for the individual studies ranged from 18 to 5,792.Combining the results for a calculation of average effectiveness in reducing substance use compared with non-participating control groups yielded a positive, but “low” effect size of 2.5. Thus, although the effect sizes in individual studies varied, about one third of young people taking part in the text-based prevention programs reduced their substance use.An important qualification to the overall results was that the trials of texting to target tobacco use among young people had the largest samples and produced effect sizes ranging between “small” and “medium”. By contrast, the studies targeting alcohol were small-scale feasibility trials, of which only one achieved a statistically significant effect. “Texting is cheap”Had the interventions been costly, these review findings might be considered disappointing. However, as the authors point out, texting is cheap with the potential to reach very large numbers of young people. Across a large population, even a small effect size would mark it out as a useful, cost-effective contribution to substance use prevention and better public health.It is early days for texting as an intervention method for prevention in its own right or as an ingredient in multi-dimensional programs. The review highlights numerous useful leads that need to be pursued through further research, including an indication that “dosage” – in this case the number of texts sent – is likely to be an important consideration in designing effective approaches, as well as the achievable aims of text-based programs and their specific content. The reviewers make helpful suggestions about ways that those who evaluate texting programs in future could provide more detail about the number and content of texts sent and how they related to face-to-face prevention programs. Better technical information would also make it easier to consider how the intervention might be replicated. Unpacking the theory behind the approach and testing out different methods of using this tool will enhance the development of this genuinely promising avenue. ************Reference:Mason, M., Ola, B., Zaharakis, N., & Zhang, J. (2014). Text Messaging Interventions for Adolescent and Young Adult Substance Use: a Meta-Analysis. Prevention Science, 1-8.

Back to Archives