Cell phones help Turkish smokers quit

An innovative new smoking cessation program supported by NIH allows researchers and health workers in Turkey to use cell phones to reach smokers who would not normally seek traditional methods of quitting. The program is funded under Fogarty’s International Tobacco and Health Research and Capacity Building program, which addresses the burden of tobacco consumption in low- and middle-income nations.

Smoking and lung cancer are significant public health concerns in Turkey, where more than half the men and about one quarter of the women smoke. Despite these high rates, however, the majority of Turkey’s smokers report a desire to quit and more than 45 percent have attempted to do so in the past year.

Headed by Dr. Michele Ybarra of the nonprofit organization Internet Solutions for Kids, the project is based on an existing text messaging cessation program in New Zealand and will bring together a multinational team of public health, tobacco and health technology experts. The program’s goal is to deliver wide-reaching interventions to adult smokers while building in-country capacity and increasing local expertise in the area of smoking cessation research.

Hand holding burnt down cigarette rests on table, glass in background
Photo by David Snyder

A new program in Turkey will use test messaging
to reach out to smokers who want to quit.

Ybarra and a team of researchers in Ankara are using focus groups and one-on-one interviews to identify common text message vernacular and determine optimal delivery methods to create tailored, culturally relevant messages. “The target population is recruited through flyers, word of mouth and shopping malls,” said Ybarra. “The messages are based upon cognitive behavioral therapy, or altering the individual's way of thinking and acting.” See Examples of SMS Turkey Text Messages.

Pilot studies of the project have already been carried out, with high retention rates demonstrated. Additionally, two medical fellows who have shown promise in smoking cessation research are being trained at Hacettepe University in epidemiology and biostatistics while helping to implement the program.

Cell phones are used by approximately 35 million Turks and are 1.8 times more common than landlines in Turkey. If successful, Ybarra’s team intends to scale up the effort nationally and implement a similar program in the United States.

Examples of SMS Turkey Text Messages

Below find examples of SMS text messages The actual messages are in Turkish and conform to the 160-character SMS limit.

Text Message type Text Message examples
Pre-quit day

SMS TURKEY: Congratulations!! The hardest part – deciding to quit – is already behind you. Write down all of the reasons why you want to quit.

SMS TURKEY: People who quit smoking use coping strategies - things to do instead of smoke. Look 4 cues or triggers 4 your smoking. For each one, write down something U can do instead. e.g. if you're angry, try deep breathing.

Quit day + 1

SMS TURKEY: Congratulations - today is your special day!!!  It is your first day without cigarettes.  Your goal today is to keep yourself busy and without a cigarette. Think NOPE… Not One Puff Ever!

Early quit (4 days) intervention

SMS TURKEY Treat every day like your quit day. Pretend like it is the first day without cigarettes and be prepared for temptation.

SMS TURKEY: Remember… former smokers live longer than people who keep smoking. Fight the urge to smoke today for better health tomorrow.

SMS TURKEY: Keep taking your nicotine replacement therapy or smoking cessation medication unless you are having problems. This will help you to stay quit!

Late quit (21 days, after completion of Early quit)

SMS TURKEY: Think about how much money you've saved since you quit. Put it toward a new hobby or activity.

SMS TURKEY: Now that you don't smoke, you can go places you couldn't because of smoking restrictions. Try something new as a non-smoker.

SMS TURKEY: Whether you smoke or not, life sometimes gets stressful. People who work on the problem instead of hide the problem (by smoking) feel better. What can you do to handle or cope with stress in a healthy way?

Relapse (4 days for those not quit)

SMS TURKEY: A slip is a warning or a learning experience. Warning = you still need to protect yourself in your danger zones (i.e., when you’re most tempted to smoke).

SMS TURKEY: How did you feel just before you smoked? Recommit to complete quitting - cutting down isn't good enough for you!

Encouragement for those no longer wanting to quit (3 days)

SMS TURKEY: Smokers live an average of 7 -12 years less than non-smokers. Consider quitting again!

SMS TURKEY: Whatever you decide about smoking, believe in yourself. You CAN quit smoking if you put your mind to it and have a plan for success.

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