Taming the Tobacco Beast with Teen Support
HiTOPS is a one-stop health shop for adolescents and young adults in Princeton, New Jersey. For twenty years, young people have come to this innovative clinic for healthcare advice ranging from reproductive issues to substance abuse. Over the years, HiTOPS has developed a reputation for creating peer education programs that address the real needs of the community. "Teens teaching teens" can be an effective model for education across a range of healthcare concerns.
Sandra Friedman, Director of the Health Center, and Ivy Pearlstein, HiTOPS' Tobacco Education Coordinator, decided to apply this peer education approach to tobacco use among the young people of Mercer County. They wanted to take their teen teaching tools into an online and interactive format, and a Small Innovative Grant from the American Legacy Foundation made that possible.
"We address a lot of reproductive health issues here, and our age group tends not to seek out routine preventive care, but they do seek out birth control and HIV testing," said Friedman. "This is how they are entering our program, but while they're here we can address their other issues like tobacco use with the nurse practitioner model."
HiTOPS' population is tech-savvy and mobile, so Friedman and Pearlstein launched iQuit, a web-based tobacco education program designed by Ivy with input from the HiTOPS educators, for young people. HiTOPS had no experience with online programming, but Friedman and Pearlstein jumped right into the digital world.
"I have a Macintosh computer at home with a little button that says you can make your own podcasts," said Pearlstein. "But I found out that there is a little more to it than that. It kind of felt like putting on a Broadway show. I'm not a scriptwriter, I'm a nurse!"
Pearlstein and Freidman found a few adolescent healthcare podcasts, mostly long audio files of experts droning on and on. They aimed instead to replicate an online audio version of the informal, but very informative, skits that had become a staple in HiTOPS' education program. They quickly realized that they would need technical help assembling iQuit, and they called on HG Media, a marketing communications firm.
The learning curve was steep. The first round of recordings sounded like long scripted paragraphs, not pieces of conversation. Pearlstein realized that allowing her young "actors" to improvise and ad lib improved the quality of each podcast. The complete collection of seven podcasts covers the entire range of cessation education, from setting a quit date to preventing relapse. Pearlstein found an alarming prevalence rate of hookah use in the population and added a targeted podcast to debunk common hookah myths as well. Each podcast lasts roughly two minutes and tells the story of Andre, a young man struggling to quit, and his two very patient friends who are leading him through a plan "to tame the beast."
In addition to the podcasts, iQuit incorporates a tailored one-month text messaging campaign to help young people stay quit. Each message has an element of encouragement and a fact about tobacco use. About 60 of the 200 smokers that frequent HiTOPS have signed up for the Short Message Service (SMS) support. HiTOPS sends out the daily message around lunchtime, a time of temptation. These messages are simple, but don't strive to mimic the voice of a young person. "It just does not work when an adult woman tries to speak like an eighteen year old," said Pearlstein. "They'll look at me like I'm nuts. I speak to them with respect, and they respond to that." She also is available to her young clients for confidential email counseling through an "ask the expert" function.
HiTOPS further broadened the podcasts and SMS support by producing an entire version in Spanish. With the help of Diana Miranda, HiTOPS' Latino outreach coordinator, this tool is now accessible to native Spanish speakers, a growing high school-age population in the area. "They could not get this information in Spanish," said Miranda. "With the SMS, email, and the podcasts, it is complete support, the whole circle."
The next challenge is to spread the word. iQuit has its own Facebook group and a fan page. HiTOPS is strategizing to drive more young people to their iQuit support system. They launched the site with a rock concert, which drew in a couple hundred young people to a community room at the local library. "By the end of the night they were waving their hands in the air, shouting 'I Quit! I Quit!'," said Freidman. HiTOPS has also created a 15-second commercial for the local multi-screen movie theater (insert: video commercial?). It has already run for nine weeks and will run again during the teen-friendly summer blockbuster season.
Incentives are also handy to get teens into the iQuit crew, said Pearlstein. Young people who complete the entire program are eligible to win an iPod, complete with a familiar set of podcasts installed, just in case they need a little more support down the line. "Many of them have tried to stop, but it's a part of their social scene, and at that age they don't really see the negative health effects from smoking," said Pearlstein. "A lot of them have never even had a conversation about this." iQuit is sparking that conversation in Central New Jersey.