Internet interventions are effective for smoking cessation and a recommended treatment approach. Less studied are ways to further increase their effectiveness. Given the well documented dose-response relationship between treatment intensity and outcomes in traditional cessation interventions [4], it is expected that increasing levels of treatment engagement with digital interventions may yield better outcomes. Optimizing engagement with Internet behavior change interventions has been noted as a research priority.
Text messaging is a promising channel for optimizing engagement. Nine in ten U.S. adults own a mobile phone, and text messaging is a preferred communication modality among mobile phone owners phone without effort from the recipient. Text messages have a 98% open rate, typically within 3 minutes, and a response rate double that of phone, email, or social media. Text messaging has been used successfully to deliver behavior change techniques (e.g., education, prompts and cues, goal setting, support) and is a recommended modality for smoking cessation. It has been used to increase uptake of quitline services [23], but has not been tested as a strategy to increase engagement with an Internet cessation program.