Twitter-enabled Mobile Messaging for Smoking Relapse Prevention

In Phase I (N=40), we developed a treatment protocol for smoking cessation and relapse prevention that used virtual quit-smoking Twitter groups and Twitter-enabled interactive peer messaging. We tested and refined this protocol using two quit-smoking Twitter groups. In Phase II (N=160), we conducted a two-arm (test vs. control) randomized controlled trial of the treatment protocol created in Phase I. In Phase III (N=80) we ran additional quit-smoking Twitter groups and tested various interventions to increase engagement in the intervention, e.g., peer leaders. This research provided crucial data about the viability and methodology to be used in a larger randomized controlled trial that would directly measure smoking behavior.

Smoking relapse rates remain high, innovative strategies are needed to lower them, and web-based social networking may help like Twitter. This developmental research examined whether providing virtual (web-based) social support to smokers, through Twitter-enabled interactive peer texting, could help smokers quit and avoid relapses. Twitter is a free social networking and micro-blogging service, one of the most advanced and novel technologies available today that can provide social support to smokers, and it provides free texting to groups. It is global and has many features that are associated with treatment success including interactive, multi-way, live messaging and mobile accessibility, because the messages go instantly to mobile phones and to the web. It can provide an innovative way to reach smokers who might otherwise not seek treatment, and it can be extended to other health domains. In Phase II which took place from June 2012 through 2013, we conducted a two-condition randomized controlled trial (Aim 2). All participants in this trial (N=160) received 8 weeks of free nicotine patches, referral to the NCI's online Smokefree.gov Quit Guide, and instruction to set a quit date within 1 week of study start. Participants were also randomly assigned at the individual level to one of two conditions: (1) a virtual quit-smoking Twitter group condition where the group members were instructed to use Twitter-enabled interactive peer messaging to help them quit and stay quit, or (2) a control group condition where the group members were not given this instruction or a Twitter group. In total, there were 4 Twitter groups and 4 control groups with 20 smokers randomly assigned to each group (i.e., N=80 test, N=80 control). The primary outcome was self-reported 7-day point prevalence abstinence that was sustained at 7, 30 and 60 days after the quit date. Participants' tweets, their virtual and face-to-face social networks, and several other possible mediating and moderating variables were also analyzed.

Experimental participants are assigned a 20-person twitter quit-smoking group to interact with, are instructed to use Twitter-enabled interactive peer messaging,and are sent daily messages to encourage interaction. The baseline intervention 'smoking cessation aides' is also provided.

Control participants are not assigned to a twitter group. The baseline intervention 'smoking cessation aides' is also provided.

All participants will receive 8 weeks of free nicotine patches, referral to the NCI's online Smokefree.gov Quit Guide, and instruction to set a quit date within 8 days of study start.

self-reported 7-day point prevalence abstinence from smoking that was sustained at 7, 30 and 60 days after the quit date

Inclusion Criteria: must have smoked 100 cigarettes during their lifetime must currently smoke 5 or more cigarettes a day must be in the preparation stage of quitting smoking ages 18-59 years English speaking have a mobile phone with an unlimited texting plan and internet access use text messaging at least once a week use Facebook daily have an active email account live in the continental USA Exclusion Criteria: a medical condition that is contra-indicated for nicotine replacement therapy: pregnant breast feeding a recent heart attack an irregular heartbeat high blood pressure not controlled with medication skin allergies to adhesive tape or serious skin problems taking a prescription medicine for depression or anxiety use drugs or marijuana regularly live in the same household with another participant

Pechmann C, Delucchi K, Lakon CM, Prochaska JJ. Randomised controlled trial evaluation of Tweet2Quit: a social network quit-smoking intervention. Tob Control. 2017 Mar;26(2):188-194. doi: 10.1136/tobaccocontrol-2015-052768. Epub 2016 Feb 29.

Pechmann C, Pan L, Delucchi K, Lakon CM, Prochaska JJ. Development of a Twitter-based intervention for smoking cessation that encourages high-quality social media interactions via automessages. J Med Internet Res. 2015 Feb 23;17(2):e50. doi: 10.2196/jmir.3772.