Texting Program Promotes Healthier Living Among Neglected Children

For Jasmin Alvarado, going to college full-time and holding down a part-time job, was constantly tired and would often get sick.

“It was my diet,” she says. “I was eating poorly and that was weakening my immune system.”

How did she know her diet was the culprit? A text message told her.

It had been sent by medical personnel from the Children’s Health Fund, who work with young people who are hard to reach: neglected kids often living in the street.

Alvarado, 22, had agreed to take part in a pilot program to receive several messages a week —quizzes, to make them interesting — providing factual information about sexually transmitted diseases, birth control, asthma, diabetes, depression, eating disorders, bullying, nutrition.

One of those messages got Alvarado thinking that her poor health was caused by her diet, an easy-to-grab fuel of snacks and coffee to keep her going during long, busy days at school and on her job.

She decided to see a nutritionist, also from the Children’s Health Fund, who told her to substitute fruit, peanut butter and cranberry juice for the snack food, and to drink water instead of all that coffee.

“It’s been helping,” she says, six months later.

This is just the sort of outcome that Dr. Seth Ammerman was hoping for.

Dr. Ammerman, a pediatrician and adolescent-medicine specialist at Packard Children’s Hospital, in Palo Alto, Calif., started the non-profit Teen Health Van in 1996 to reach uninsured, underserved and homeless youth, aged 10 to 25, from San Francisco to San Jose.

The van now sees 400 individuals a year for medical visits .The program’s dietitians, social workers and fitness instructor see another 200 or 300. All the services are free.

“What I’m proudest of,” Dr. Ammerman says, “is that the return-visit rate is over 70 percent. That’s remarkable. It shows they’re engaged with the program.”

The van is actually a recreational vehicle, 36 feet long and eight feet wide, remodeled to contain exam room and waiting room on wheels. It rolls two days a week to a half-dozen rotating sites around the Peninsula.

Many of the the patients are kids from juvenile homes and shelters, who age out of those institutions yet are unprepared for the adult world. Many are minorities, at the low end of the socio-economic scale. Some are gay youth, cast out of the house by their parents. Although many are children of the working poor, all lack health insurance.

Dr. Ammerman has learned a lot about this population in 18 years: their need for education on safe sex and healthy diets; access to condoms and birth control; and counseling for bullying and depression.

A couple of years ago, he noticed something striking about the kids on the street.

“Virtually every homeless kid that we work with,” he says, “they all have cell phones.”

And almost all have unlimited texting.

With financial help from the Verizon Foundation, he and his team put together a novel project: a program of text messages geared to homeless kids that would deliver facts about living healthily to the phones they held in their hands.

“I work with teens so much, and this is what they do,” Dr. Ammerman says. “I just thought it was a really good idea.”

After sounding out some of the kids, they decided to use a quiz format “to make it more interactive.” Thirty signed up for it, and 80 percent, spurred partly by the incentive of free movie tickets, responded regularly, “which was cool,” the doctor says.

The project ran for 14 weeks from September through December, three messages a week.

Sample questions:

1. True or False: Skipping breakfast can negatively affect your weight, energy, focus and your appetite the rest of the day.

2. How effective are condoms in preventing an unintended pregnancy: a) 60%, b) 70%, c) 80%, d) 90%.

3. Your friend just told you he or she wants to hurt or kill himself, what should you do? a) Listen without judgment or fear, b) Call the suicide hotline, c) If at school, immediately tell teacher/principal/counselor or contact an adult they trust, d) Leave them alone.

4. You may be suffering from depression if you: a) Have trouble sleeping, concentrating, b) Lack energy, c) Are not enjoying activities you used to enjoy, d) All of the above

(Answers below)

The Verizon Foundation’s grant paid for the team’s time to develop the project and the telecommunications platform to protect patients’ health information. “We wouldn’t have been able to do it without that help,” Dr. Ammerman says.

Now he wants to expand it to all his more than 400 patients. This fall, if grant money permits, the team will make the questions more like interactive games, with levels and points. Groups will specific problems, like asthma or diabetes, will get targeted questions. The team will chart the kids’ increases in knowledge and, hopefully, changes in behavior.

Some published studies have shown that texting can be successful for smoking cessation and diabetes care — with adults, Dr. Ammerman says. For adolescents, “we are on the front line, so to speak, in doing this sort of thing.”

Jasmin Alvarado will always credit the texts with helping her feel better. Beforehand, she used to visit the Teen Health Van, but never felt she could open up to the nutritionist or therapist on board.

“But then, I would mention a text message and we’d talk about the question and the answer — and I’d feel comfortable talking with them,” she says.

Soon she was talking about her problems. And the staff were offering solutions.

“It’s a great way,” Alvarado says, “to make a connection.”

Answers: 1. true; 2. d; 3. a, b and c; 4. d.