Digital Social Media Intervention in Smoking Cessation: A Review

This literature review examines the use of digital social media platforms, including Facebook, WhatsApp, Twitter, and Instagram, as interventions for smoking cessation, particularly among young adults. The report analyzes various studies and intervention programs, exploring their methodologies and outcomes. It discusses the popularity of each platform among young adults and how they are utilized to disseminate information, provide support, and encourage quitting. The review assesses the effectiveness of different intervention strategies, such as daily posts, automated messages, and group support, and identifies key factors that contribute to successful cessation. The study also addresses the limitations of the research and implications for future interventions. The review uses a systematic approach in analyzing data from Google Scholar and government surveys. The report also evaluates intervention programs based on Facebook, WhatsApp, Twitter and Instagram. Overall, the report provides a comprehensive overview of the current state of digital social media interventions in smoking cessation and their potential for improving public health outcomes.

INTERVENTION OF DIGITAL SOCIAL MEDIA IN SMOKING CESSATION
INTERVENTION OF DIGITAL SOCIAL MEDIA IN SMOKING CESSATION
A LITERATURE REVIEW
Name of the Student
Name of the University
Author’s Note

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Executive Summary
Eight million deaths from tobacco use were recorded last year globally in a survey conducted
by WHO survey and the prevalence of smoking amongst the young adults is extremely high.
As the young adults are more prone to addiction as they aimed by researchers as the focus
targets for quitting campaigns. The digital social media has the power of reaching out to the
young adults and inspiring them towards tobacco dependence free future. It has the potential
in bringing individuals from different parts of the world on a single virtual platform where
the participants can help each other, motivate and encourage one another to quit smoking and
cease the use of tobacco. The digital social media platforms namely Facebook, WhatsApp,
Twitter and Instagram are known platforms for being widely accepted and popular amongst
the young adults and can be extensively used as the digital social medium to disseminate
information based on the varied emotional and behavioural changes taking place during
smoking cessation. The study encompasses such virtual intervention programs and its
effectiveness and robustness in successful cessation of smoking.
Keywords: Cessation, Cigarette, Tobacco control, Social media intervention, Young adults,
Digital Social Media

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Table of Contents
A. Introduction...........................................................................................................................3
B. Objective................................................................................................................................4
C. Data source............................................................................................................................4
D. Discussion.............................................................................................................................5
Systemic review for data collection.......................................................................................5
Digital Social Media popularity.........................................................................................5
1. Facebook based study..............................................................................................6
2. WhatsApp based study.............................................................................................7
3. Twitter based study..................................................................................................7
4. Instagram based study..............................................................................................8
Statistical analysis of various interventions...........................................................................9
Analysis of the Digital Social Media interventions.........................................................10
1. Facebook Intervention Analysis............................................................................10
2. WhatsApp Intervention Analysis...........................................................................10
3. Twitter Intervention Analysis................................................................................11
4. Instagram Intervention Analysis............................................................................12
E. Conclusion...........................................................................................................................12
1. Implications of the research..........................................................................................13
2. Study Limitations..........................................................................................................14
F. References............................................................................................................................16

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A. Introduction
Tobacco abuse and addiction to nicotine is one of the major preventable chronic
health problems that affect individuals worldwide. The tobacco smoke comprises of various
injurious carcinogenic chemicals which are associated with cardiac diseases, cerebral stroke,
hypertension, infertility, chronic renal diseases, and pulmonary complication including lung
cancer and chronic obstructive pulmonary disease and so on. An astounding figure of eight
million deaths from tobacco use was recorded last year, globally (WHO survey, 2019). The
age ranged between 18 to 25 years is defined as young adulthood as referred to by the
National Survey of Drug Use and Health, and this age group has a high incidence of smoking,
globally (NSDUH, 2014). The use of cigarette and smoke free tobacco amongst the young
adults is rapidly escalating in several countries and in some; the tobacco use is nowadays
more regularly used by the youth than the adults (Tobaccoatlas, 2018).
Studies revealed that a few percentages of people understood the health risks and
complications that arise from tobacco abuse. A survey analysis showed only 40% of the
cigarette smokers acknowledged that heart diseases are caused by smoking and a mere 27%
revealed that they knew that smoking causes cerebral stroke (Yang et al., 2016). Majority of
the smokers who are aware of its detrimental health effects want to quit and 35% of the
smokers admitted that quitting would improve their health within six months from the day of
smoking cessation (Yang et al., 2016). Therefore, the will to quit is present but a strong
support system is required to motivate these individuals to act in the right direction for their
health benefits.
The digital media consists of all that can be produced, visualized, distributed,
customized and conserved on digital devices including television, smart phones, and

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computers and so on. Smart phones with internet are ubiquitously present amongst majority
of the youngsters. Various platforms termed as social media are present which can be
accessed via these internet connected smart phones which unite individuals worldwide for the
exchange of information and data. A survey revealed that amongst the young adults of age 18
to 29 who possessed a smart phone, 97% had access to internet and were daily users of
various internet based platforms (Baskerville et al., 2015). As young adults are more prone to
addiction, they are the main target on which the social media interventions on tobacco
cessation and prevention programmes are mainly targeted towards.
B. Objective
The objective of this analytical study was aimed at achieving the following.
(1) Evaluation of the digital social media interventions on abstinence from smoking followed
by complete cessation.
(2) Identification of the various moderators included in the intervention efficacy.
(3) Determining the robustness of such interventions and monitoring its outcomes.
C. Data source
Data source for the study is a systemic literature review based evaluation on published
works available on Google Scholar along with government aided survey information and data
briefs. The secondary data was then pooled and analysed to attend the aims of the study
objectives. The data for research based evidence analysed on intervention programs on
Facebook was taken from study conducted by Ramo et al. (2018), intervention programs on
WhatsApp was researched by Durmaz et al. (2019), intervention programs on Twitter was

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researched by Pechmann et al. (2015) and data source for intervention program on Instagram
was acquired from study conducted by Murray (2019).
D. Discussion
Systemic review for data collection
The digital social media has potential of delivering promising strategies for evidence-
based intervention sessions on smoking cessation with the young adults. The social media
platforms are widely accepted and popular amongst young adults and can be extensively used
as the medium to disseminate information based on the varied emotional and behavioural
changes taking place during smoking cessation (Yoo, Yang & Cho, 2016). Social media is
being widely used for the deliverance of data on smoking hazards, promotion of fitness and
nutrition (Johns, Langley & Lewis, 2017).
Digital Social Media popularity
Facebook is by far the most extensively used platform on digital social media
amongst the young adults (Duggan et al., 2015). Eighty seven percent of the young adults
have an account on Facebook whereas 70 % of them access it on a daily basis; thereby the
use of Facebook seems like a promising platform in delivering public health related
intervention programs on smoking cessation to the youth (Cobb et al., 2016). Facebook has
been successfully used before as a platform for peer interventions of HIV (Simoni et al.,
2012); for the promotion of sexual well being (Gold et al., 2011); for discussing
complications of sexual health (Bull et al., 2012); physical activity online interventions for
post-partum mothers (Kernot et al., 2013); and many weight loss programmes (Cavallo et al.,
2012; Patrick et al., 2014; Napolitano et al., 2013). The use of Instagram is next on the
digital social media’s popularity list with over 70% of young adults accessing it daily,

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followed by Twitter which 50% of the young adults use it daily (Kim et al., 2017). Text
messaging based WhatsApp has 1.5 billion active users worldwide and is the third most
downloaded application, besides Facebook and YouTube (WhatsApp survey, 2019).
Demographics of Twitter reveal an approximate 50% of its users to be in the 18 to 29 age
group while 32% are college students (Tien, 2018).
1. Facebook based study
In majority of the studies, the participants were primarily chosen from Facebook
based on the users accessing targeted Facebook advertisements focused on age, location and
the keywords searched related to tobacco or cigarette use (Ramo et al., 2018). The
advertisements used by the researchers were compatible with Facebook guidelines and were
aimed at attracting or motivating cigarette users to pursue further by clicking on it. If the
users were eligible respondents within the young age criteria, then they were lead to the
study’s consent page and added to the “secret group” (Facebook term for private groups
where other users are forbidden to access and no identity of its group members are exposed to
outsiders).
The Facebook secret group housed the 18-25 aged young adult smokers and are
introduced to the various intervention programmes for smoking cessation under the study
named tobacco status project. The tobacco status project (TSP) was carried for six months
which included strategizing ways to moderate the interventions which had three main
features. Firstly were the daily posts and articles, on ways to quit smoking, were shared to all
the members of the secret groups. The evidence based articles and posts were all based on the
US Clinical Practice Guidelines for cessation of smoking along with the Transtheoretical
Model (TTM) related to behavior change (Ramo et al., 2018).

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The group which comprised of the pre-contemplating participants was guided with
motivational web based interviewing sessions and reviewed personal thoughts based on the 5
R namely risks, relevance, roadblocks, rewards, and repetition which interfered with the
attempts of quitting. Posts on setting a date or deadline with majority of the participants were
also made in order to emphasize the decision of quitting. This was done so that the
participants could virtually support and encourage each other to reach the target.
The group of participants in the contemplation set was referred to articles and posts
directed towards self liberation, ways to control stimulus, and counter conditioning by
engaging oneself in other activities and behaviors. Web based interview sessions were also
conducted for personalized advices on ways to approach various blockades in order to
successfully quit (Ramo et al., 2018). Various polls were also designed to track the changes
in habits of the participants which would reflect the experience as they continued their
abstinence.
2. WhatsApp based study
A messaging based application which enables transfer of audio, texts, video,
documents and contact details, WhatsApp is a low cost and an extremely popular digital
social media platform used by today’s youth. With daily improvements of various
encryptions and no advertisements, it is preferred by millions for personal communication
and the feature which allows the sender to track the status of delivery and read messages.
WhatsApp based interventions were also evaluated to monitor their effectiveness in
encouraging young adults to quit (Durmaz et al., 2019). This study comprised of 132
randomly selected smokers from Ege University Hospital’s Department of Public Health
Smoking Cessation Clinic. The content for the WhatsApp group intervention project was
prepared and around 60 messages were uploaded daily to motivate and inspire the subjects to
either quit smoking altogether or to influence them to sufficiently abstain for a relative period

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of time. The results were then gathered from the intervention group and a control group
where no messages or posts were sent and evaluated to understand whether the intervention
had any positive effect on the subjects.
3. Twitter based study
Data was also gathered from Twitter based intervention study (Pechmann et al., 2015)
where the participants were recruited online via surveys and the participants were sent
automated messages daily based on smoking cessation. Every morning for 100 days
automated messages were sent and auto feedback of all the individuals were tracked. Polls
were then structured to review the progress of the participants and the group members were
asked to follow each other’s progress on twitter and to maintain anonymity outside the group.
This intervention was performed without any group moderator as it was kept fully automated
and the researchers chose Twitter as they preferred the privacy of Twitter groups, monitoring
of the participants was simple, the responses were easily scalable and the language
programming was deemed superior by them (Van der Tempel et al., 2016). The survey was
assessed based on participants’ age, smoking history and online test of nicotine dependence.
Mapping of Twitter based smoking cessation response was also studied to scrutinize
the number of smokers that were being influenced (Lakon et al., 2016). The pattern of
abstinence followed by cessation was followed over a period of time for crucial analysis.
4. Instagram based study
@smokefreeus is a platform on Instagram which promotes successful cessation of
smoking and influences smokers to quit. @smokefreeus engages its followers with
motivational quotes and success stories to promote healthy smoke free lifestyle.
@smokefreeus has also achieved favourable response in generating awareness of the hazards
caused by smoking (Murray 2019).

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Investigation of all the above data is required to ascertain whether usage of the digital
social media is effective as an intervention platform for cessation of smoking and whether the
rate of abstinence can be maintained over 1 year.
Statistical analysis of various interventions
Figure 1: Global prevalence of cigarette and tobacco use amongst boys and girls (Source:
Tobaccoatlas, 2018)
As WHO FCTC (World Health Organization Framework Convention on Tobacco
Control) continues its battle against the surging tides of tobacco usage, more awareness and
individualized intervention programs are necessary in bringing down the percentage of
tobacco users (WHO survey, 2019). WHO FCTC has already enforced the MPOWER
strategy which is inclusive of Monitoring of tobacco usage along with the prevention policies
(M), Protection of the people from the harmful tobacco smoke (P), Offering help and support
to individual who are contemplating to quit (O), Warning people about the hazards of tobacco

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use (W), Enforcing various bans with government help on tobacco advertisements (E) and
Raise on tobacco taxes (R). Therefore, digital media interventions on smoking cessation are
supported by government bodies and health departments (World Health Organization 2018).
Analysis of the Digital Social Media interventions
1. Facebook Intervention Analysis
The intervention in the Facebook based groups of 480 test members and a control group
of 80 members, observed a quit rate of 20% in contrast to the 9% quit rate seen in a control
group with no guided interventions or virtual support mechanisms (Figure 1). Fifty percent of
the members claimed to have abstained for a week but eventually relapsing but 20% were
successful is quitting permanently, as reported in a survey conducted after six months of
intervention (Ramo et al., 2018). The effectiveness of the Facebook intervention program
prompted the researchers to apply for a clinical government trial to officially conduct virtual
intervention programs in expanding the awareness (US ClinicalTrials.gov Identifier:
NCT02207036).
First month
After six months
0 5 10 15 20 25 30 35 40
Figure 1: Results from Facebook intervention program
(Ramo et al., 2018)

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2. WhatsApp Intervention Analysis
The WhatsApp based platform for smoking cessation showed a high abstinence rate of
65.9% during the first month of intervention compared to the 40.9% in the control set,
followed by 50% quit rate amongst the test individuals compared to 30.7% after the 3rd month
of intervention and a 40.9% quit rate amongst the test individuals compared to 22.7% after
the 6th month (Durmaz et al., 2019). The rate of overall abstinence was 2.50 times higher in
the invention group therefore establishing the effectiveness of such virtual intervention
programs (Figure 2).
After 1 month
After 3 months
After 6 months
0 10 20 30 40 50 60 70
Figure 2: Results from WhatsApp intervention program
(Durmaz et al., 2019)
3. Twitter Intervention Analysis
All the Tweet2Quit participants taking part in the Twitter smoking cessation intervention
programme had received 100 days of intervention with nicotine patches, instructions related
to setting a date of smoking along with Twitter posts on smoking cessation, motivational
strategies, discussion topics and daily engagement based on response and feedback texts.
Firstly the automated messages spiked the usage of Twitter by 24% amongst the participants.
Analysis of results revealed that Tweet2Quit intervention program had doubled the sustained