Randomised Controlled Trial

Twitter users will be familiar with non-using friends questioning the point of the social network.

Well now you have an evidence-based answer: Twitter is proven to help you quit smoking.

A Californian randomised controlled trial evaluation compared two groups of people who wanted to quite smoking. The first group received 56 days of nicotine patches, emails with links to the smokefree.gov cessation website, and instructions to set a quit date within 7 days. The second, Tweet2Quit,  group were enrolled in 20-person, 100-day Twitter groups, and received daily discussion topics via Twitter, and daily engagement feedback via text.

The evaluation found that the Tweet2Quite group doubled the rate of sustained abstinence from smoking.

The model

Cornelia Pechmann, Kevin Delucchi, Cynthia M Lakon and  Judith J Prochaska developed a novel intervention for smoking cessation called Tweet2Quit which sends twice-daily automated communications to encourage frequent and concurrent check-in, and forms small intimate groups that start immediately and are closed to new members, and are deliberately of limited duration.

Tweet2Quit builds on promising past work in buddy interventions, in which smokers were assigned real world quit buddies. The difference with Tweet2Quit smokers is that they meet numerous potential quit buddies in a virtual online forum. Unique to the intervention condition was enrolment in a Tweet2Quit 20-person, 100-day, virtual peer support group.

The groups were closed in that each member followed and was followed exclusively by other members, and no new members were added. The groups were private, because only the group members and the study staff could see the tweets. Twenty smokers were included per group, because, based on marketing research, the average social network has about 17–20 active participants.

Tweet2Quit also builds on promising research on health interventions that employ autocommunications, that is, text or email messages from health experts that are sent automatically to participants to encourage healthy behaviours.

So, Tweet2Quit is, in effect, a hybrid intervention that involves both: social network-based, peer-to-peer participant exchanges and daily auto-communications sent by the study website posing treatment-relevant questions from experts for participants to discuss.

Study sample and recruitment

A national sample of US smokers was recruited using the Google search engine and a US$10,000/month advertisement budget on Google AdWords. If smokers were interested in participating, they completed a brief online interest form requesting their email. Then about one month before a projected cohort start date, they were emailed a link to a screening survey to assess their eligibility and obtain
informed consent.

Inclusion criteria were: resident of the continental USA, English speaking, aged 18–59 years, smoked 100+ cigarettes in lifetime, currently smoking ≥5 cigarettes daily, intention to quit smoking in the next month, active email account, mobile phone with internet access and unlimited texting, weekly texting, and daily Facebook use. The age range was 18–59 years to be as inclusive as possible, while excluding two age groups that were likely to have different lifestyles and cessation motivations: minors for whom cigarette use is illegal and retired older adults.

Results

There were a total of 160 smokers in the trial. Analysis of complete cases indicated sustained abstinence out to 60 days post-quit date of 40.00% (26/65) in the Tweet2Quit condition versus 20.00% (14/70) in the control condition. In an analysis with incomplete cases, imputing participants lost to follow-up as smoking, sustained abstinence was 32.50% (26/80) for Tweet2Quit versus 17.50% (14/80) for control.

In both analyses, there was a consistent effect for Tweet2Quit versus control across cohorts.

The researchers also analysed the tweeting behaviour of those in the Tweet2Quit groups and found that three quarters tweeted at least once, sending an average of 59 tweets each.

Conclusion

The authors acknowledge that this was quite a small scale study and that the follow-up period was short (60 days post stopping smoking). Nonetheless, the findings are encouraging.

Tweet2Quit, doubled the odds of self-reported sustained smoking abstinence to 60 days follow-up, when added to the usual care of nicotine patches and a quit-smoking website. Moreover, engagement in Tweet2Quit was high with most participants tweeting for an extended duration; and engagement related to abstinence.

Because smokers were randomly assigned to Tweet2Quit versus control, the evidence suggests a causal effect for Tweet2Quit on abstinence.

Tweet2Quit did not affect nicotine patch use or use of the quit-smoking website, so the effective component seems to be tweeting and social network support from the groups.