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NCI: Reaching the Public via SMS to Change Behaviors

Apr 16, 2015

SMS messages are an excellent way to reach audiences. The National Cancer Institute (NCI) saw SMS messages as an opportunity to reach the public for the implementation of their Mobile Health Behavioral Intervention Programs. NCI has 15 SMS based programs, including HealthyYouTxt, a program designed to help users live a healthier lifestyle, and SmokeFreeTxt, a program designed to help users quit smoking. In this piece, we will talk specifically about the domestic version of the SmokeFreeTxt program, one of their most popular programs.

SMS vs. Mobile App

At the start of the SmokeFreeTxt project, NCI had the choice of implementing the program through either a mobile app or a SMS texting program. NCI decided to use SMS messaging. There are “low psychological costs” associated with SMS messages, according to Erik Augustson, Behavioral Scientist at NCI. “SMS messages don’t require much work, thought or investment,” said Augustson.

For the SmokeFreeTxt Program, the user starts the program by signing up and choosing a quit date. The user receives messages leading up to and following the quit date. As part of the program, the user receives about 130 messages, some of which are bidirectional: they allow the user to submit feedback. The messages that the user receives are separated into three types: clinical content, assessments and user-initiated feedback.


The clinical content messages are scheduled based on the quit date selected by the user. The messages increase in frequency as the user gets closer to their quit date and provide the user with tools and resources to aid in the quitting process.

The messaging via SmokeFreeTXT is completely automated. “The complete automation of the messages was chosen as opposed to contact center agents to make the program scalable and to add to its cost efficiency,” said Augustson.

The assessment messages are used to determine the user’s mood, craving level and smoking status. After an answer is submitted, a message is sent based on the selection made by the user. For example, if the user is having a good day, they are sent a message with positive words of encouragement. If the user is having a bad day, the user is sent a message with an actionable tip.


The user-initiated messages occur when the user submits a keyword based on a problem or symptom that they are experiencing. The user is sent a message with an actionable tip.

User-initiated messages from SmokeFreeTXT app.

SmokefreeTXT Program’s Success

Currently, more than 100,000 people have signed up and used the program, and the program’s data suggests that it doubles the chance of the user quitting smoking when compared to the user quitting on their own.

When Augustson was asked about what makes the SmokefreeTxt program more successful than a person quitting smoking on their own, he pointed to the fact that the SmokefreeTxt program provides the end user with the behavioral skills and strategies needed to help them through the process of quitting smoking.

“When someone attempts to quit smoking on their own, they often experience trouble because they do not have the skills to manage withdrawal symptoms, they have no social support and they do not use any behavioral strategies,” said Augustson.

As shown with this program, SMS text messages are a cost-effective, scalable way to communicate with the public.