Can't quit smoking? Maybe you haven't gotten the right message

What motivates us the most? Rewards? Threats? Being part of a positive trend? These questions are central to a modern approach to help people kick the habit.

A Wilmot Cancer Institute team is launching a two-year research project to develop different types of text messages for smoking cessation—and then study them in clinical trials to find out what works best.

Plans call for recruiting about 2,600 smokers from a 27-county area that includes Rochester and extends up to Oswego and down to the Southern Tier, said Paula Cupertino, Ph.D., Wilmot's associate director of Community Outreach & Engagement (COE), who joined the University of Rochester a year ago.

Researchers will pay special attention to the Latino population because it has not been as successful at quitting smoking. Through partnerships with co-investigators, the study goal is to enroll and engage 1,300 Latino people from upstate New York and in California.

Examples of the types of messages that researchers will evaluate include:

• "Many people have already quit with our free text message stop-smoking program. Now is your turn. Reply YES to enroll!"
• "Only 100 places left! Enroll today in the free text message stop-smoking program. Reply YES to enroll!"
• "Half a million smokers die every year in the U.S. because of tobacco. Quitting is possible with help. Reply YES to enroll in our free text message quitting program!"

Cupertino and Wilmot's assistant director for the COE program, Francisco Cartujano, M.D., received a $1 million federal Small Business Technology Transfer (STTR) grant to conduct this work. STTR funding requires a partnership between a research institution and a small business, with the goal of developing new consumer products that can improve population health. In this case, the Wilmot team is collaborating with Agile Health, Inc., a digital engagement company that leverages text messages to help people make healthy decisions.

"It's highly unusual for a Cancer Center to receive this type of grant," said Jonathan Friedberg, M.D., M.M.Sc., Wilmot's director. "It's a testament to Dr. Cupertino's expertise, and it validates the high impact of her work and our ongoing commitment to overcoming cancer disparities."

Mobile text messaging for health improvement is being studied in other areas: for weight loss, diabetes self-management, and exercise, for example. With billions of mobile phone users worldwide, however, researchers are trying to scientifically validate the correct approaches before rolling out programs more broadly.

"The future of medicine will rely on tools like this, and here we are in Rochester, doing it," Cupertino said, adding that she will compile a "library" of text messages geared to helping people quit smoking.

Latinos are the largest and fastest growing segment of the U.S. racial and minority population, and their rates of cancer, heart disease and stroke—which are often linked to smoking—are among the top four leading causes of death among Latinos, according to Cupertino's pilot data and the STTR grant report submitted to the Small Business Administration.

Rochester also has a high concentration of Puerto Ricans, the group most like to smoke cigarettes among Latinos, Cartujano said. Lung cancer prevention is another priority for the research team; it is among the largest cancer burdens in the Finger Lakes region.

The pilot phase of the project was completed earlier, when Cupertino and Cartujano worked at the University of Kansas Cancer Center in Kansas. In phase one, they developed a culturally relevant version of a smoking cessation program, available in English and Spanish, called Latino Kick Butts. The next phase, which begins immediately in the Rochester area, will compare the impact of four different types of text messaging, what times of the day and days of the week seem to elicit the best responses, and evaluate the retention rates and whether the mobile system has commercial potential.

"As researchers, we develop a lot of innovations that end up on the shelf, that never make it into consumers' hands, so this is a big deal," Cupertino said. "And not only will we help people to quit smoking, but in the process, we will prevent cancer."