Twitter-enabled Mobile Messaging for Smoking Relapse Prevention

In Phase I (first 12 months), consistent with Aim 1, we have developed a treatment protocol for smoking cessation and relapse prevention that uses virtual quit-smoking Twitter groups and Twitter-enabled interactive peer messaging. We are in the process of testing and refining this protocol using 40 participants in 2 quit-smoking Twitter groups. In Phase II (24 months), consistent with Aim 2, we will conduct a two-condition (test vs. control) randomized controlled trial of the treatment protocol created in Phase I. This research will provide crucial pilot data about the viability and methodology of 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 examines whether providing virtual (web-based) social support to smokers, through Twitter-enabled interactive peer texting, can 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 is the only service that 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 will start July 1, 2012, we will conduct a two-condition randomized controlled trial (Aim 2). All participants (N=240) 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. In this Phase II trial, participants will also be randomly assigned at the individual level to one of two conditions: (1) a virtual quit-smoking Twitter group condition where the group members are 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 are not given this instruction or a Twitter group. There will be 6 Twitter groups and 6 control groups with 20 smokers randomly assigned to each group (i.e., N=120 test, N=120 control). The primary outcomes will be self-reported 7-day point prevalence abstinence at 7, 30 and 60 days after the quit date. Participants' tweets, their virtual and face-to-face social networks, and several other mediating and moderating variables will also be analyzed.

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 unless it is adjusted
• use drugs or marijuana regularly