Using WhatsApp and Facebook Online Social Groups for Smoking Relapse Prevention for Recent Quitters: A Pilot Pragmatic Cluster Randomized Controlled Trial

Background Quit attempters often have episodes of smoking relapse before they eventually quit. Interactive text messaging through mobile phones has been shown to increase abstinence. This service can be potentially applied on the platform of a social networking service to help quitters maintain abstinence. Objective Our aim was to determine if the group discussion and reminders via the WhatsApp or Facebook social group were effective to prevent smoking relapse in quitters who had stopped smoking recently. Methods This was a single-blinded, parallel, 3-arm pilot cluster randomized controlled trial allocating recent quitters, who had completed an 8-week treatment and reported abstinence for at least 7 days, to WhatsApp (n=42), Facebook (n=40), and a control group (n=54). The 2 intervention groups participated in a 2-month online group discussion with either WhatsApp or Facebook moderated by a trained smoking cessation counselor and received a self-help booklet on smoking cessation. The control group only received the booklet. The primary outcome was the 2- and 6-month relapse rates, defined as the proportion of participants who smoked at least 5 cigarettes in 3 consecutive days. Results Fewer participants in the WhatsApp group (17%, 7/42) reported relapse than the control group (42.6%, 23/54) at 2-month (OR 0.27, 95% CI 0.10-0.71) and 6-month (40.5%, 17/42 vs 61.1%, 33/54; OR 0.43, 95% CI 0.19-0.99) follow-ups. The Facebook group (30.0%, 12/40) had an insignificantly lower relapse rate than the control group (42.6%, 23/54) at 2-month (OR 0.58, 95% CI 0.24-1.37) and 6-month (52.5%, 13/40 vs 61.1%, 33/54; OR 0.70, 95% CI 0.31-1.61) follow-ups. The WhatsApp social groups had more moderators’ posts (median 60, IQR 25 vs median 32, IQR 7; P=.05) and participants’ posts (median 35, IQR 50 vs median 6, IQR 9; P=.07) than their Facebook counterparts, but the difference was insignificant. Conclusions The intervention via the WhatsApp social group was effective in reducing relapse probably because of enhanced discussion and social support. Inactive discussion in the Facebook social group might have attributed to the lower effectiveness. ClinicalTrial Clinicaltrials.gov NCT02007369; https://clinicaltrials.gov/show/NCT02007369 (Archived by WebCite® at http://www.webcitation.org/6c3RbltQG)

[1]  Robert West,et al.  Relapse prevention interventions for smoking cessation. , 2013, The Cochrane database of systematic reviews.

[2]  Saul Shiffman,et al.  Dynamic self-efficacy and outcome expectancies: prediction of smoking lapse and relapse. , 2005, Journal of abnormal psychology.

[3]  Hayden McRobbie,et al.  Using text messaging to prevent relapse to smoking: intervention development, practicability and client reactions. , 2012, Addiction.

[4]  John P Hatch,et al.  Cut-off levels for breath carbon monoxide as a marker for cigarette smoking. , 2005, Addiction.

[5]  R. West,et al.  Is nicotine replacement therapy for smoking cessation effective in the “real world”? Findings from a prospective multinational cohort study , 2007, Thorax.

[6]  Ben Kirman,et al.  Motivating physical activity at work: using persuasive social media for competitive step counting , 2010, MindTrek.

[7]  K. Cummings,et al.  Adherence to and reasons for premature discontinuation from stop-smoking medications: data from the ITC Four-Country Survey. , 2011, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[8]  Judith J Prochaska,et al.  A Mixed-Methods Study of Young Adults' Receptivity to Using Facebook for Smoking Cessation: If You Build It, Will They Come? , 2015, American journal of health promotion : AJHP.

[9]  D. Streiner,et al.  Intention to treat analysis in clinical trials when there are missing data , 2001, Evidence-based mental health.

[10]  C. Vandelanotte,et al.  Are Health Behavior Change Interventions That Use Online Social Networks Effective? A Systematic Review , 2014, Journal of medical Internet research.

[11]  E. Augustson,et al.  If you build (and moderate) it, they will come: the Smokefree Women Facebook page. , 2013, Journal of the National Cancer Institute. Monographs.

[12]  R. Borland,et al.  The natural history of quitting smoking: findings from the International Tobacco Control (ITC) Four Country Survey. , 2009, Addiction.

[13]  Min Zhao,et al.  Evaluation of the Chinese versions of the Minnesota nicotine withdrawal scale and the questionnaire on smoking urges-brief. , 2010, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[14]  D. Razavi,et al.  Maintaining abstinence from cigarette smoking: effectiveness of group counselling and factors predicting outcome. , 1999, European journal of cancer.

[15]  Timothy B. Baker,et al.  Rates and Predictors of Renewed Quitting After Relapse During a One-Year Follow-Up Among Primary Care Patients , 2015, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[16]  Tobacco Use and Dependence Guideline Panel.  Treating Tobacco Use and Dependence: 2008 Update , 2008 .

[17]  C. Lau,et al.  An evaluation of the psychometric properties of the Smoking Self-Efficacy Questionnaire (SEQ-12) among Chinese cardiac patients who smoke. , 2008, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[18]  L. Struik,et al.  The Role of Facebook in Crush the Crave, a Mobile- and Social Media-Based Smoking Cessation Intervention: Qualitative Framework Analysis of Posts , 2014, Journal of medical Internet research.

[19]  Ulrich John,et al.  Efficacy of a Text Message-Based Smoking Cessation Intervention for Young People: A Cluster Randomized Controlled Trial , 2013, Journal of medical Internet research.

[20]  Michael G Kenward,et al.  Preventing smoking relapse using text messages: analysis of data from the txt2stop trial. , 2013, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[21]  R. Borland,et al.  The challenge of embracing a smoke-free lifestyle: a neglected area in smoking cessation programs. , 2007, Health education research.

[22]  Daniel Parent,et al.  Online Social and Professional Support for Smokers Trying to Quit: An Exploration of First Time Posts From 2562 Members , 2010, Journal of medical Internet research.

[23]  R. Engels,et al.  In the heat of the moment: alcohol consumption and smoking lapse and relapse among adolescents who have quit smoking. , 2012, Drug and alcohol dependence.

[24]  B. Mccann,et al.  The effects of a multiple treatment program and maintenance procedures on smoking cessation. , 1981, Preventive medicine.

[25]  J. Hollis,et al.  Preventing smoking relapse, using an individually tailored skills-training technique. , 1989, Journal of consulting and clinical psychology.

[26]  Peter Dalum,et al.  “After all – It doesn’t kill you to quit smoking”: An explorative analysis of the blog in a smoking cessation intervention , 2013, Scandinavian journal of public health.

[27]  Strike while the iron is hot: can stepped-care treatments resurrect relapsing smokers? , 2001 .

[28]  T. Coleman,et al.  A systematic review of the effectiveness of smoking relapse prevention interventions for abstinent smokers. , 2010, Addiction.

[29]  Ron Borland,et al.  Can transtheoretical model measures predict relapse from the action stage of change among ex-smokers who quit after calling a quitline? , 2006, Addictive behaviors.

[30]  R. Whittaker,et al.  Mobile phone-based interventions for smoking cessation. , 2016, The Cochrane database of systematic reviews.

[31]  R. Whittaker,et al.  Diagnostic accuracy of NicAlert cotinine test strips in saliva for verifying smoking status. , 2008, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.