Nashville-based Agile Health, a B2B developer of mobile health interventions, announced a major upgrade to its Kick Buts smoking cessation program. Kick Buts is a text-messaging intervention based on software company HSA Global's STOMP platform, which was shown in a 2011 randomized trial in the UK to double successful quit rates over a control group. Agile licenses Kick Buts, along with other mobile-based health interventions, to self-insured employers.

In addition to a primary intervention of two-way text messaging, the original version of Kick Buts offered online and web-enabled phone access to games, quizzes and possibly coupons for nicotine-replacement therapies like gums and patches from GlaxoSmithKline, depending on whether the employer chooses to fund NRT. The new version builds on that by adding social media integration. Participants will be able to enroll via their Facebook accounts and choose a group of Facebook friends to form a support network. Kick Buts will invite the chosen friends and family to write personal notes to the person who's trying to quit smoking.

In the current platform, when a user texts a keyword (like "crave"), the system responds by choosing from a library of encouraging messages. The Facebook integration will allow the system to substitute the personal messages from friends and family, which can include pictures and videos as well.

The other major update in version 2.0 is a Spanish-language version of the whole product, translated by partner Magnus, which, according to CEO Gary Slagle, does "cultural intent translation" as well as literal translation, to maximize engagement with users. The company is planning to use the same partnership for deployments of the product in Malaysia and Indonesia.

Slagle says the key to an engaging two-way text intervention is creating a library of good responses. His six-person team spends a lot of time looking at texts that users send to the system that don't contain any keywords -- what they call "unrecognized text" -- and creating appropriate responses.

"We work on that unrecognized text all the time," said Slagle. "Engagement is proven to beget continuous engagement. Getting people to engage, keeping them engaged is what it's all about."

Text messaging-based smoking cessation interventions have been around long enough to be about as close to a proven model as the mobile health field offers: A recent meta-analysis from the Cochrane Library (which included the 2011 STOMP trial) showed that in general, mobile interventions tended to double quit rates. MobiHealthNews has written about several interventions like the Alere's Text2Quit, created by Voxiva, and a texting intervention from the Rhode Island Department of Health.

The company raised $2 million in equity in September 2012, to expand into a similar intervention for diabetes management, which is still planned for a 2013 release.