Table 3.

Summary of intervention studies using social media for smoking cessation

Study	Origin	Social Media Platform	Study Design	Study Follow Up	Sample Description	Intervention Description	Key Findings
Bakersville et al (2016)²⁵	Canada	Interactive website, social media including Facebook and YouTube, and smartphone application	Quasi- experimental controlled trial	3 months	238 young adults (range 19–29 years); 43% male	Break-it-Off campaign encourages young adults to end their bad relationship with tobacco. Users can access interactive website, learn about methods for quitting, upload videos, connect to social media, and download free smartphone app to overcome triggers. Compared to Smokers’ Helpline telephone counseling smoking cessation service.	Break-it-Off users had higher 7-day and 30-day quit rates compared to Smoker’s Helpline users. At 3-months, Break-It-Off participants (32.4%) were more likely than SHL participants (14%) to have quit smoking for 30 days (p<0.001) and Break-it-Off participants (91%) were more likely than SHL participants (79%) to have made a quit attempt (p=0.04).
Cheung et al (2015)²⁷	Hong Kong	WhatsApp & Facebook	Pilot cluster RCT	6 months	136 recent quitters who completed an 8-week treatment program (mean age = 40.5 years [SD=9.9]); 77% male	Self-help booklet on smoking cessation and healthy diet and 2-month group discussion moderated by a smoking cessation counselor on WhatsApp compared to Facebook. 3 reminders sent each week by program moderator who was a social worker or nurse with smoking cessation counseling experience to reinforce abstinence and program content. Compared to self-help booklet only control group.	Lower relapse in the WhatsApp group compared to control group at 2-months (17% vs. 42.6%; p<0.05) and 6-months (52.5% vs. 61.1%; p<0.05). No differences in relapse in the Facebook group compared to control at 2-months (30% vs. 42.6%) and 6-months (52.2% vs. 61.1%). There was a trend for more posts in the WhatsApp group from the moderator (p=0.07) and participants (p=0.07) compared to the Facebook group, which could explain increased effectiveness. Biochemically verified abstinence did not differ between groups.
Cobb et al (2016)²⁸ Study protocol: Cobb et al (2014)³⁵	United States	Facebook	RCT	30 days	9,042 smokers (mean age = 43.9 years [SD=14.1]); 30% male	UbiQUITous Facebook app based on US Public Health Service ‘5As’ model (Ask, Advise, Assess, Assist and Arrange). Users interact with Dr. Youkwitz, a character who supports quitting and setting a quit date. App is also available for non-smoker supporters. Trial compared 3 app components: duration of use, content sharing, and use by non-smoker supporters.	Diffusion of the application through Facebook was primary outcome. Combined strategies for sharing and increasing duration of use contributed to highest level of diffusion. Involving non- smoker supporters did not affect diffusion. No smoking-related outcomes reported.
Haines- Saah et al (2015)²⁶	Canada	Facebook	Mixed methods feasibility study	12 weeks	60 young adult smokers or recent quitters (range 19–24 years); 57% male	“Picture Me Smokefree” is a Facebook photography group. Participants are encouraged to post pictures with captions related to quitting smoking. M oderator posts photo-challenges, topics, or contests.	Photo group appeared feasible and provided opportunity for young adults to access peer support for quitting smoking. Participants indicated preference for mixed gender groups. Challenges with attracting and retaining participants. M ore interactive features are necessary in future interventions.
Pechmann et al (2015)²⁹	United States	Twitter	Pre-post feasibility study	60 days	40 smokers (mean age = 36.5 years [SD=9.5]; range 20–57 years); 40% male	Tweet2Quit includes closed groups on Twitter with 20 people and daily automated messages to encourage group discussion about evidence- based smoking cessation topics, or to provide individualized feedback to participants about their interaction in the group. Automated Twitter intervention combined with evidence-based practices. Participants were sent nicotine patches, were referred to the National Institutes of Health online quit-smoking guide, and were instructed	M ore frequent tweeting was not related to abstinence. Tweeting about smoking related topics such as setting a quit date or using nicotine patches (p=0.024), overcoming barriers to quitting smoking (p=0.008), and expressing confidence about quitting (p=0.032) were related to abstinence.
Pechmann et al (2016)³⁰ Secondary outcomes: Lakon et al (2016)³²	United States	Twitter	RCT	60 days	160 smokers (mean age = 35.7 years [SD=9.9]; range 18–59 years); 26% male	Tweet2Quit consists of automated tweets to encourage discussion about quitting smoking sent daily and individualized automated feedback text messages sent to participants’ phones daily for 100 days. Combined with usual care consisting of nicotine patches, referral to smokefree.gov cessation website, and instructions to set a quit date within 7 days. Compared to usual care only control condition.	Intent-to-treat analyses showed that sustained abstinence was greater among Tweet2Quit participants compared to control participants at 7 days (41.25% vs. 37.50%), 30 days (57.50% vs. 38.75%), and 60 days (55.00% vs. 41.25%; p=0.021). Among study completers at 60 days follow-up, Tweet2Quit showed greater sustained abstinence (40.0%, 26/65) compared to the control group (20.0%, 14/70; p=0.017). Greater tweet volume was associated with sustained abstinence (p<0.001).
Ramo et al (2015)³¹ Secondary outcomes: Ramo et al (2014)³³ and Thrul et al (2015)³⁴	United States	Facebook	Pre-post feasibility study	12 months	79 young adult smokers (mean age = 20.8 years [SD=2.1]; range 18–25 years); 69% male	Secret Facebook groups tailored to participants’ stage of change: Precontemplation (“Not Ready to Quit”), Contemplation (“Thinking About Quitting”), or Preparation (“Getting Ready to Quit”). Targeted Facebook posts daily for 90 days consistent with US Public Health Service guidelines. Weekly interactive sessions moderated by the lead researcher to address any questions related to smoking or quitting. Additional optional group cognitive behavioral therapy counseling through Facebook chat.	Participants prepared to quit increased from 10 (13%) to 36 (46%) at 12-months. 28 (35%) participants reduced cigarette consumption by 50% or greater; 52 (66%) made a 24-hour quit attempt during the study. Assuming that missing participants are still smoking, then biochemically verified abstinence was 5% at 3-months, 8% at 6- months, and 8% at 12-months, compared to self- reported 7-day point prevalence of 9% at 3- months, 18% at 6-months, and 13% at 12-months. Posting more comments in the Facebook group was associated with biochemically verified abstinence at 3-months (p=0.036).