Fourteen-year-old Sophia, an eighth-grader in Miami-Dade County, sends her first text at 7:30 a.m. On school nights, her phone is turned off at 10:30 p.m. But in those 15 hours in between, she sends or receives 152 texts per day. She is a typical teenager.
The average teenager exchanges texts with friends every 15 minutes they are awake—up to 60 texts per day. SMS (Short Message Service) or text messaging is a critical piece of their everyday life. Researchers are hoping to use that dedication to text messaging to try to mitigate teenagers' risky behaviors.
FIU's Community-Based Intervention Research Group (C-BIRG), in collaboration with Miami Children's Hospital, has embarked on a new Ware Foundation-funded research study testing how effective text messaging could be in reducing underage drinking.
Adolescence is a difficult, yet critical, time to try to reach children, note C-BIRG researchers. Teenagers are not worried about drinking and driving because many don't drive. Those teenagers who do drive often underestimate the risk inherent in drinking and driving. Broadly speaking, they are not worried about their own habits. This is why public health advocates are looking for alternate ways of positively influencing teenagers.
"Text messaging is a low-cost intervention that we think might be a very effective way of broadly covering kids at risk for underage drinking, and reducing the likelihood that they and their families and society will suffer harm from their drinking," says Eric Wagner, FIU professor of social work and director of C-BIRG.
"As pediatricians, we deal with teenagers, but substance abuse is the area that we are the least trained in," says Lorena Siqueira, M.D., director of Miami Children's Hospital adolescent medicine division. "I was delighted that I could liaise with the research folks at FIU on this project."
Wagner notes that previous studies have suggested that text messaging can reduce underage drinking. But FIU's project will be sending the texts out in Spanish and English, aiming at a particularly high-risk group—Hispanic adolescents.
"We've taken this whole set of English-language texts that have been published in previous research and we've translated them into Spanish for those kids who might prefer to receive texts in Spanish," says Wagner. "This study is specifically targeting Hispanic kids, who are at particular risk for underage drinking," Wagner explains.
According to a comprehensive 2012 study titled "Monitoring the Future," during early and middle adolescence, Hispanic/Latino teens report more underage drinking that their non-Hispanic White or African-American peers—18% of Hispanic/Latino 8th graders and 32% of Hispanic/Latino 10th graders versus 11.3%/11.6% for White/African-American 8th graders and 30%/21% for White/African-American 10th graders.
Wagner also notes that in Miami-Dade County, girls are more likely than boys to report alcohol use. "Girls' higher rates of alcohol and other drug use during middle school is particularly problematic since adolescents who use substances at earlier ages are more likely to develop substance abuse and dependence problems."
"Hispanic adolescents are underserved and underrepresented in health care services and underrepresented in research, and we are excited to be able to bring this kind of prevention to this population," says Michelle Hospital, assistant professor with C-BIRG. "These kids need our help and we are hoping that this will help."
Conducted in two phases, the first part of the study begins with the messaging itself. Volunteers, identified through the adolescent medicine group, will serve as a focus group for the content and style of the text messages. They will also help determine the timing.
"We're adjusting the text messages to fit best with the kids' experiences," Wagner says. "The kids will give us feedback on what the texts should say and when they should be going out. Once we have that done, then we'll perfect our materials and then conduct clinical trials."
The clinical trial aspect of the project will consist of a random selection of adolescents receiving targeted texts over the course of 14 weeks, with messaging aimed to "reduce their drinking or at least to pay attention to things that would reduce their harm from drinking," says Wagner. The other half would receive texts that would be general content, such as appointment reminders.
C-BIRG believes that ultimately the adolescents assigned to alcohol prevention texts will show greater reductions in alcohol use and other negative behaviors than the adolescents who receive neutral texts. They will also be looking at other aspects of the study, such as whether the texts are more effective in younger or older children and what percentage of the children prefer Spanish language texts versus English.
"One of the exciting things about this project is that if we find a lot of the kids do prefer to receive communications in Spanish, we can start applying this in other countries that are predominantly Spanish speaking," says Hospital.
"Cell phones have become ubiquitous in South and Central America and people use it as their primary form of communication. So if we can get the groundwork on this research, we may be able to extract this to other countries in a culturally sensitive way," she notes.