Lorien C. Abroms

iPhone Apps for Smoking Cessation A Content Analysis

BACKGROUND With the proliferation of smartphones such as the iPhone, mobile phones are being used in novel ways to promote smoking cessation. PURPOSE This study set out to examine the content of the 47 iPhone applications (apps) for smoking cessation that were distributed through the online iTunes store, as of June 24, 2009. METHODS Each app was independently coded by two reviewers for its (1) approach to smoking cessation and (2) adherence to the U.S. Public Health Services 2008 Clinical Practice Guidelines for Treating Tobacco Use and Dependence. Each app was also coded for its (3) frequency of downloads. RESULTS Apps identified for smoking cessation were found to have low levels of adherence to key guidelines in the index. Few, if any, apps recommended or linked the user to proven treatments such as pharmacotherapy, counseling, and/or a quitline. CONCLUSIONS iPhone apps for smoking cessation rarely adhere to established guidelines for smoking cessation. It is recommended that current apps be revised and future apps be developed around evidence-based practices for smoking cessation.

The Effectiveness of Mass Communication to Change Public Behavior

This article provides an overview of the ways in which mass communication has been used -- or can be used -- to promote beneficial changes in behavior among members of populations. We use an ecological perspective to examine the ways in which mass media interventions can be used to influence public behavior both directly and indirectly. Mass media interventions that seek to influence people directly -- by directly targeting the people burdened by the public health problem of concern and/or the people who influence them -- have a long basis in public health history, and recent reviews have clarified our expectations about what can be expected from such approaches. Mass media interventions that seek to influence people indirectly -- by creating beneficial changes in the places (or environments) in which people live and work -- have equal if not greater potential to promote beneficial changes in population health behaviors, but these are currently less explored options. To have the greatest possible beneficial influence on public behavior with the public health resources available, we recommend that public health program planners assess their opportunities to use media to target both people and places in a manner that complements and extends other investments being made in population health enhancement.

Weight loss—there is an app for that! But does it adhere to evidence-informed practices?

Little is known about how much smartphone apps for weight control adhere to evidence-informed practices. The aim of this study was to review and summarize the content of available weight control apps. Information on content, user rating, and price was extracted from iTunes on September 25, 2009. Apps (n = 204) were coded for adherence to 13 evidence-informed practices for weight control. Latent class analysis was used to identify subgroups of apps based on endorsement practices. Only a small percentage of apps had five or more of the 13 practices (15%). Latent class analysis revealed three main types of apps: diet, physical activity, and weight journals (19%); dietary advice and journals (34%); and weight trackers (46%). User ratings were not associated with apps from these three classes. Many apps have insufficient evidence-informed content. Research is needed that seeks to develop, improve, and evaluate these apps.

A Content Analysis of Popular Smartphone Apps for Smoking Cessation

BACKGROUND Smartphone applications (apps) are increasingly available for smoking cessation. PURPOSE This study examined the content of popular apps for smoking cessation for both iPhone and Android operating systems in February 2012. METHODS A total of 252 smoking-cessation apps were identified for the iPhone and 148 for the Android. Across both operating systems, the most popular apps were identified (n=47 for the iPhone and n=51 for the Android) and analyzed for their (1) approach to smoking cessation and (2) adherence to an index based on the U.S. Public Health Services Clinical Practice Guidelines for Treating Tobacco Use and Dependence. Where available, apps were coded for frequency of downloads. The analysis took place in 2012. RESULTS Overall, popular apps have low levels of adherence, with an average score of 12.9 of a possible 42 on the Adherence Index. No apps recommended calling a quitline, and only a handful of apps recommended using approved medications (4.1%). Android apps in the sample were downloaded worldwide between 310,800 and 1,248,000 times per month. For both the iPhone and Android, user ratings were positively associated with scores on the Adherence Index. For the iPhone, display order was also positively associated with scores on the Adherence Index. CONCLUSIONS Apps could be improved by better integration with the Clinical Practice Guidelines and other evidence-based practices.

Communication and marketing as tools to cultivate the public's health: a proposed "people and places" framework

BackgroundCommunication and marketing are rapidly becoming recognized as core functions, or core competencies, in the field of public health. Although these disciplines have fostered considerable academic inquiry, a coherent sense of precisely how these disciplines can inform the practice of public health has been slower to emerge.DiscussionIn this article we propose a framework – based on contemporary ecological models of health – to explain how communication and marketing can be used to advance public health objectives. The framework identifies the attributes of people (as individuals, as social networks, and as communities or populations) and places that influence health behaviors and health. Communication, i.e., the provision of information, can be used in a variety of ways to foster beneficial change among both people (e.g., activating social support for smoking cessation among peers) and places (e.g., convincing city officials to ban smoking in public venues). Similarly, marketing, i.e., the development, distribution and promotion of products and services, can be used to foster beneficial change among both people (e.g., by making nicotine replacement therapy more accessible and affordable) and places (e.g., by providing city officials with model anti-tobacco legislation that can be adapted for use in their jurisdiction).SummaryPublic health agencies that use their communication and marketing resources effectively to support people in making healthful decisions and to foster health-promoting environments have considerable opportunity to advance the publics health, even within the constraints of their current resource base.

A randomized trial of Text2Quit: a text messaging program for smoking cessation.

BACKGROUND Text messaging programs on mobile phones have shown some promise in helping people quit smoking. Text2Quit is an automated, personalized, interactive mobile health program that sends text messages to offer advice, support, and reminders about quitting smoking. PURPOSE To evaluate the effect of Text2Quit on biochemically confirmed repeated point prevalence abstinence in the context of an RCT conducted in the U.S. METHODS Participants (n=503) were recruited on the Internet and randomized to receive Text2Quit or self-help material. Between 2011 and 2013, participants were surveyed at baseline and at 1, 3, and 6 months post-enrollment to assess smoking status. Saliva was collected from participants who reported not smoking in the past 7 days at the 6-month follow-up. An intent to treat analysis was used, and those lost to follow-up were categorized as smokers. All analyses were completed in 2013. RESULTS Biochemically confirmed repeated point prevalence abstinence favored the intervention group, with 11.1% abstinent compared to 5.0% of the control group (relative risk=2.22, 95% CI=1.16, 4.26, p<0.05). Similarly, self-reported repeated point prevalence abstinence was higher in the intervention group (19.9%) than in the control group (10.0%) (p<0.01). Effects were found to be uniform across the analyzed demographic subgroups, although suggestive of a larger effect for non-whites than whites. CONCLUSIONS These results provide initial support for the relative efficacy of the Text2Quit program.

Text2Quit: results from a pilot test of a personalized, interactive mobile health smoking cessation program.

Text messaging programs on mobile phones have shown some promise in helping people quit smoking. Text2Quit is an automated, personalized, and interactive mobile health program that sends text messages and e-mails timed around a participants quit date over the course of 3 months. The text messages include pre- and post-quit educational messages, peer ex-smoker messages, medication reminders and relapse messages, and multiple opportunities for interaction. Study participants were university students (N = ;23) enrolled in the Text2Quit program. Participants were surveyed at baseline and at 2 and 4 weeks after enrollment. The majority of participants agreed that they liked the program at 2 and 4 weeks after enrollment (90.5% and 82.3%, respectively). Support for text messages was found to be moderate and higher than that of the e-mail and web components. Of participants, 75% reported reading most or all of the texts. On average, users made 11.8 responses to the texts over a 4-week period, although responses declined after the quit date. The interactive feature for tracking cigarettes was the most used interactive feature, followed by the craving trivia game. This pilot test provides some support for the Text2Quit program. A future iteration of the program will include additional tracking features in both the pre-quit and post-quit protocols and an easier entry into the not-quit protocol. Future studies are recommended that identify the value of the interactive and personalized features that characterize this program.

Mobile health evaluation methods: The Text4baby case study.

Mobile phones have been shown effective in several public health domains. However, there are few evaluations of the effectiveness of mobile health in health promotion. Also, although many studies have referenced behavioral theory, none appears to have explicitly tested theoretical assumptions or demonstrated mechanisms of change. More robust evaluation models that incorporate theory and measurement of behavioral mediators are needed. As in all public health programs, mobile health operates within a social ecological context. For example, organizational- and individual-level programs seek to influence health and health care practices and individual health behaviors. New programs such as Text4baby demonstrate how theory and explicit testing of mediators can be incorporated in evaluations. There are challenges and opportunities facing mHealth evaluations given the nature of the mobile channel. Mobile communication is ubiquitous, available at all times and places, and thus experimental control is often difficult. Natural experiments using variation in dosage of mHealth and place- or location-based designs may increase experimental control. Text4baby is a text messaging program that provides prenatal care messages to pregnant women and new mothers. It uses a partnership model with health care facilities often serving as local implementation partners. The authors review a case example of the evaluation of Text4baby at Madigan Army Medical Center. Participants were randomized to usual prenatal care plus text messaging or usual care alone. The evaluation has a theoretical model of behavior change and measures mediators as well as behavioral outcomes. Results will inform how behavioral theory works within mobile health programs.

Obama's Wired Campaign: Lessons for Public Health Communication

For those who still question the value of new media in public health campaigns, the election of Barack Obama as the 44 th president of the United States can be instructive. Obama’s campaign strategy has been heralded for its impressive ability to reach, engage, and inspire supporters. The high level of public involvement was evident in the record numbers of people who volunteered, donated money, and, most importantly, turned out to vote for Obama (Swanson, 2008). While there are clearly many factors that contributed to Obama’s decisive win, including the demographics of his supporters, one contributing factor was his campaign’s innovative use of new media (Gardner, 2008; Swanson, 2008)—defined as media that are based on the use of digital technologies such as the Internet, digital video, and mobile devices (Abroms, Schiavo, & Lefebvre, 2008). These technologies were used to gain supporters and to mobilize them into action in ways that were unprecedented and untested in political campaigns. The Obama campaign’s use of new media has relevance for how we conduct and build communities around our own public health campaigns. While previous political (Creamer, 2008; Deighton & Kornfeld, 2009; Harnden, 2008) and public health campaigns (Hamilton, Dennings, & Abroms, 2008; Hoff, Mishel, & Rowe, 2008; Huhman, 2008; Taubenheim et al., 2008; Williams, Zraik, Schiavo, & Hatz, 2008) have made use of new media, Obama’s presidential campaign, especially during the general election, took their application to a new level. The Obama campaign’s use of new media was an evolution from prior presidential campaigns such as Governor Dean’s 2004 campaign, which made extensive use of the Internet for grassroots fundraising. It also stemmed from Obama’s own experience in the primary against Hillary Clinton, who also made use of new media in her campaign (Deighton & Kornfeld, 2009). It was during the general election campaign against John McCain, however, that the Obama campaign’s new media ‘‘machine’’ got up and running at full speed and broke new ground for political campaigning (Vargas, 2008). As such, an understanding of how new media was used by Obama in the general election is worthy of reflection. The Obama campaign’s use of new media can be

What Is the Best Approach to Reducing Birth Defects Associated with Isotretinoin

Background to the debate: Isotretinoin is an effective treatment for severe acne, a condition which can be physically, emotionally, and socially disabling. Because the drug is teratogenic, causing severe birth defects, women taking the drug are directed to avoid pregnancy. In the United States, a series of risk reduction programs have been implemented that aim to prevent pregnant women from taking the drug and to prevent women taking it from getting pregnant. The most recent, and most stringent, is an Internet-based, performance-linked system called iPLEDGE, which tries to ensure that the drug is dispensed only when there is documentary proof that the patient is not pregnant and is using two forms of birth control. Is iPLEDGE the best way to reduce isotretinoin birth defects, or is it an unproven and overly burdensome system?