Rhode Island Spotlight: Text to Be an Ex

Despite the warnings.

Despite the messages.

Despite all of the public education, teenagers are still smoking.


Tobacco texting copyThe good news is that Rhode Island has the second lowest percentage nationwide of teenage smokers — 8%. But how to get the anti-tobacco message to them, especially if they’re trying to quit? If you have a teenager, you know one of the best ways is to text them.

“We know text message is a teen’s primary mode of communication,” said Erica Collins, who helped develop a program for The Rhode Island Department of Health called T2BX — in texting parlance:  Text to Be an Ex.

“I really wanted to do something with text message that would deliver encouragement and education to the remaining 8% of Rhode Island youth who smoke, about quitting.’’ 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.

“This text message program is completely unique,” Collins said. “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.”

welshErica Boles-Welsh is the Tobacco Control Program Manager at the Department of Health and has overseen T2BX since it was launched in January. “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,” she said.

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.

“Who are they hanging out with?” Boles-Welsh said. “Because they have found over 10 years of this research that the social groups 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.”

Collins said the research found something interesting: Among the 13 to 18 crowd, it is the high school smokers who want to quit. “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 noticed that they were sort of the pariah in high school, it sort of separated them from the pack.”

When teenagers text in they are connected with a real person and get a combination of live and automated messages, depending on the situation. The Department of Health’s goal is to reach 10% of youth smokers in the target age of 13 to 18. Through the first five months of the program it met 81% of that goal, which translates to about 260 participants so far.

The Department finished the first phase of the program on June 30. 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.

Boles-Welsh said the preliminary results are encouraging. “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, almost 40% are moving from one stage of change to another.’’

Collins added, “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.”

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