Medical practice

Facebook and Twitter could be used to help people quit smoking

"Using social media to kick the [smoking] habit means you're 'TWICE as likely to succeed'," the Mail Online reports. A study of a Canadian social media campaign aimed at helping young people quit smoking found it was twice as successful as telephone helplines.

The Break It Off (BIO) campaign compared stopping smoking to getting out of a toxic relationship with a terrible boyfriend or girlfriend, and allowed participants to share their progress on Facebook.

Researchers compared the effectiveness of the BIO campaign with anti-smoking telephone helplines. They conducted a trial involving 238 participants aged 19 to 29 who used one of the two methods to stop smoking. After three months, 32% of BIO participants and 14% of the Smokers' Helpline users had quit the habit for 30 days.

But the analysis was only performed on people who completed a survey and not on all of the participants in the study. This and numerous other biases make the results less reliable.

Still, the arguments made by the researchers are persuasive. Many young people do not have access to a landline, so may be unlikely to use telephone helplines, but most young people in developed nations have a smartphone.

This means anti-smoking campaigns aimed at young people may be more effective if they're delivered via social media rather than traditional media formats, such as print and television.  

Where did the story come from?

The study was carried out by researchers from the University of Waterloo, the University of Toronto, and the Canadian Cancer Society, and was funded by research grants from the Canadian Cancer Society Research Institute.

It was published in the peer-reviewed medical journal, Nicotine and Tobacco Research.

The Mail Online reported this story accurately, outlining the worldwide smoking problem and the potential strength of social media in reaching this target audience. But the story did not explain that the results were biased or point out any of the study's limitations.  

What kind of research was this?

This quasi-experimental study aimed to examine the effect of the Break It Off (BIO) social media campaign to help young adults stop smoking, comparing it with the Canadian Smokers' Helpline.

While this study design is appropriate, a randomised control trial would be better as participants would randomly be assigned to groups, reducing the chance of any possible bias.

Any internet-based research is prone to confounding factors, and in this case there were issues with low study recruitment and high loss to follow-up.

What did the research involve?

The study included young adult smokers aged 19 to 29 years from a number of Canadian provinces. Participants took part in one of two interventions aimed at smoking cessation: the Break It Off (BIO) campaign and the Canadian Smokers' Helpline.

The BIO campaign was run by the Canadian Cancer Society, and aimed to provide support and encourage young adults to "break up" with their smoking addiction. Participants were recruited to use the campaign's website between February and September 2012.

The site guided users through the challenging stages of ending an unhealthy relationship with smoking and provided information on quit methods. Visitors could upload a video of their "break-up with smoking" experience, as well as announce their "break-up status" to friends via Facebook. Three months after registration, participants were emailed a link to an online follow-up survey.

BIO participants received a $10 iTunes redemption code as an incentive for registering and another $15 iTunes redemption code when they completed the follow-up survey.

The researchers compared the campaign to the use of the Canadian Smokers' Helpline before September 2011. This is a telephone-based smoking cessation service. It is an established intervention, and provides smokers who want to quit with information, self-help materials, referrals to other resources, tailored motivational counselling, and proactive follow-up counselling.

The helpline was promoted in the media and through referrals from health organisations and professionals. The follow-up survey was conducted via telephone interview between October 2010 and September 2011.

At follow-up, participants were questioned on the following:

  • smoking status
  • cigarette consumption
  • heaviness of smoking (number of cigarettes smoked per day and time of first cigarette in the morning)
  • intention to quit
  • use of any cessation aid
  • whether they had taken at least one action towards quitting

Seven and 30-day abstinence rates were measured at three-month follow-up for both groups. The helpline participants provided the date of the last cigarette they smoked to determine abstinence at three months based on a seven-month follow-up.

Quit rates were based on those participants who completed the follow-up surveys. For both treatment groups, respondents who completed the follow-up survey but did not provide answers to the prevalence questions were considered to be smokers.

Participants were analysed on an intention-to-treat principle. This means participants were analysed in the groups they had been allocated to, regardless of whether they received or adhered to this intervention. 

What were the basic results?

A total of 238 participants completed the study and were included in the analysis. Follow-up rates were low – 34% for the BIO group and 52% for the helpline.

Differences were found between the groups at the start of the study: users of the helpline were more likely to be female, white and have received a high school education or less.

More participants in the helpline group intended to quit in the next 30 days (81% versus 70%) and were much more likely to be daily smokers (82% versus 59%). BIO users had significantly higher seven-day and 30-day quit rates compared with users of the helpline.

The seven-day quit rate for BIO (47%) was more than double that of the helpline (15%) after controlling for confounding factors such as education, ethnicity, and daily or occasional cigarette use. Quit rates at 30 days were 32% for BIO and 14% for the helpline.

BIO participants were more likely to make a quit attempt during the three-month intervention period (91%) compared with helpline participants (79%). Participants in both groups cut down the number of cigarettes smoked – 89% of BIO participants versus 79% in the helpline group.

Having a post-secondary education or higher and only smoking occasionally was found to be associated with an increased odds of quitting smoking.  

How did the researchers interpret the results?

The researchers concluded that, "A large number of young adults prefer a forum such as BIO for help to quit smoking in comparison to traditional quitline services.

"The reach of the campaign and findings on quitting success indicate that a multi-component digital and social media campaign offers a promising opportunity to promote smoking cessation." 


This quasi-experimental study compared the effects of two smoking cessation interventions. The study reported that the use of social media and multi-component digital interventions is more effective in promoting smoking cessation than traditional quitline services.

However, the researchers based their findings solely on the people who completed the final surveys, which will bias the results. This study has a number of other limitations, including the non-random assignment to study group, small sample size, and large loss to follow-up.

The studies were also performed at different time points, which may have affected the results, and some of the BIO participants may also have used the Smokers' Helpline and vice versa. The BIO participants also received incentives for participation, adding more potential for bias.

A very specific target group was included in the study. While this does reduce generalisability, young adults in Canada have the highest rate of smoking, but their use of cessation services is low.

The results of this study are promising and address a major public health issue. A much larger-scale trial needs to be carried out with a longer follow-up period, random allocation, and sub-group analysis for all possible social media and digital platforms to assess which are the most effective in aiding smoking cessation.

As the researchers discuss, smartphone ownership is expected to reach five billion people by 2025. Campaigns based on smartphone use, including social media, are likely to reach a wide audience, as well as being more cost-effective than other methods.

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