Could these students be nudged to make healthier choices?

Source: Kelly Campbell et al./Wikimedia Commons

Colleges nationwide are using text messaging to communicate with and motivate their students in all sorts of ways. Going beyond alerts about campus closures, colleges are reminding students via text about unpaid bills, upcoming appointments, and approaching deadlines. Some colleges are taking even greater advantage of texting, using it to increase matriculation, boost retention, and provide needed mental health support to underserved students in crisis.

But colleges have yet to incorporate a burgeoning area of research on health behavior into their communication strategies. The medical community has been leveraging texting for years now to motivate patients to adhere to schedules and modify behaviors that can reduce morbidity and mortality. Scientists have only recently begun translating these lessons to improve the health of college students, which could help students to not only complete college but also establish enduring habits that lead to a healthier adulthood. I have identified three recent studies that changed college students’ , eating, and drinking behaviors, and describe below how they leveraged texting to get their message across.

Quitting Smoking

While rates of tobacco use continue to decline in the U.S., the 2014 National College Health Assessment indicated that over 3% of college students still smoked daily, and about 12% had smoked in the past month. That’s over 2 million college smokers! Although texting seems like a perfect method for supporting quit attempts, which can be and require multiple stops and restarts, few trials have examined whether text messages can lead to successful smoking cessation. A 2015 meta-analysis on this topic included only nine studies, but did find that smokers who received supportive texts were over 50% more likely to quit compared to controls.

A more recent study from Sweden, where rates of young adult smoking are similar to our own, sought to apply these lessons to help college students quit. Over 800 students were recruited through the health centers at 25 Swedish colleges and universities. Participants had to be smoking at least weekly and indicate a desire to quit in the next month. Students received texts for 12 weeks, starting at 4 to 5 messages per day but gradually decreasing over time. The study found that students receiving these text messages were over twice as likely as controls to remain abstinent (i.e., fewer than 5 smoked) over the 8 weeks observed in the study (26% vs. 15%). Moreover, students in the intervention were 50% more likely to not smoke at all in the 4 weeks following the program’s end compared to control students (21% vs. 14%).

Healthy Eating

The “Freshman 15,” the idea that college students gain 15 pounds in their first year, is hyperbole wrapped around some truth. Multiple studies have shown that students, on average, do gain weight when they get to college, although these gains are not universal and usually much less than the infamous 15 pounds. Various explanations for this weight gain has been put forward, such as an increase in use, reduction in exercise, change in eating habits (e.g., eating more; eating less healthy options; eating late at night; more snacking), and normal metabolic processes that begin around age 18. Regardless of the root cause, many college students could benefit from an intervention to help them eat healthier.

Researchers at Illinois State University adapted principles of Intuitive Eating into a text message intervention. Intuitive Eating encourages unconditional permission to eat when you want, but with a focus on eating for energy—as opposed to emotional reasons—and in tune with your body’s hunger and signals. 150 college students received 10 text messages over 5 weeks teaching them principles of Intuitive Eating; another 150 students in the control group received an email upfront containing all 10 messages. The students who received texts were better able to read their hunger and satiety cues, but no other effects emerged. Unfortunately, about two-thirds of the experimental group and only one-third of the control group completed all follow-up measures, so the power of this study was limited. Still, future research could employ text messaging with a larger group of students to test its efficacy for improving and weight loss.

Reducing Binge Drinking

SEC football.

Source: Getawaypaul27/Wikipedia

In late 2017, I wrote about ways in which researchers were using text messaging to curb college students’ drinking. In the past 2 years, this approach has exploded and I thought it would be useful to update the discussion with a recent study built upon this earlier research. In my prior post, I described an intervention from New Zealand that targeted drinking during student orientation week, and I advocated for more interventions that take place during high-risk drinking events. A group of researchers at the University of Missouri did just that by intervening with students participating in football tailgates.

Tailgating is extremely popular in college, and reports estimate that 75% of students who tailgate consume alcohol while doing so. Tailgating is especially big in the SEC, where games are generally played under great weather and draw tens of thousands of fans. For this study, the researchers recruited 133 students who had a) Tailgated in the past month; b) Binge drank (≥5 drinks for men; ≥4 drinks for women) at a tailgate in the past year; and c) Intended to tailgate that season. These students were surveyed about their drinking habits at tailgating and in general, and then randomly assigned to one arm of the intervention.

Every Saturday morning of a home football game, all 133 students were texted and asked if they were going to tailgate that day. If they answered yes, students in the experimental group received a type of alcohol-reduction intervention known as Personalized Feedback. Based on their earlier survey responses, students received texts about how much they drank at tailgates compared to other students, their estimated Blood Alcohol Content (BAC) at tailgates, and how many alcohol-related problems they reported from tailgating. Students in the control group received text messages with basic information about issues caused by excessive drinking. During that day’s tailgate, students who received Personalized Feedback drank less (7.0 vs. 5.5 drinks) and had a lower estimated BAC (.09 vs. .13) than students who were texted just information. Moreover, in the 30 days following the intervention, those students reported fewer alcohol problems (e.g., hangovers, passing out, doing embarrassing things while drunk) and a lower peak BAC (.12 vs. .16).

Applying Lessons to College Student Health

As colleges refine their communication strategies and incorporate text messaging as a key technology, they should consider where and how it makes sense to leverage texting to improve student health. If your campus has an initiative to change a student health behavior (e.g, reducing binge drinking), discuss how an intervention deployed through text messaging could support your other efforts. Because of students’ ease with texting and the interactivity that texting elicits, also consider using it as a means of understanding student health issues that you might only suspect are prevalent. Whatever you decide, be sure to strategize using published research like the studies described above; this guidance will save you lots of time and be pivotal in designing an effective text messaging campaign.