Twitter-enabled Mobile Messaging for Smoking Relapse Prevention

We conducted a two-arm (test vs. control, N=160) randomized controlled trial of small, private, online support groups for quitting smoking with 20 people per group who were seeking to quit smoking. A novel feature was a bot (auto-messenger) that posted a daily cessation-related discussion topic in each group, timed to the group's quit date.

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. From June 2012 through 2014, we conducted a two-condition randomized controlled trial. 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 or online quit-smoking group on Twitter where the group members were instructed to use 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). In the Twitter groups, a bot (auto-messenger) posted a daily cessation-related discussion topic in each group, timed to the group's quit date. 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' posts, their virtual and face-to-face social networks, and several other possible mediating and moderating variables were also analyzed.

Eligibility Criteria:
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