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.


BACKGROUND
Clinicaltrials.gov NCT02007369; https://clinicaltrials.gov/show/NCT02007369 (Archived by WebCite® at http://www.webcitation.org/6c3RbltQG).
School of Public Health, The University of Hong Kong, Hong Kong, China (Hong Kong). derekcheung@hku.hk.
Yee Tak Derek
http://orcid.org/0000-0002-5850-5349
YT
Cheung
Ching Han Helen
http://orcid.org/0000-0002-3543-3338
CH
Chan
Chi-Keung Jonah
http://orcid.org/0000-0002-3445-3601
CK
Lai
Wai Fung Vivian
http://orcid.org/0000-0003-2220-9238
WF
Chan
Man Ping
http://orcid.org/0000-0003-4000-2388
MP
Wang
Ho Cheung William
http://orcid.org/0000-0002-5643-3054
HC
Li
Sophia Siu Chee
http://orcid.org/0000-0002-6349-3717
SS
Chan
Tai-Hing
http://orcid.org/0000-0002-2033-9971
TH
Lam
D005260:Female; D015438:Health Behavior; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D055502:Secondary Prevention / Q000379:methods*; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D060756:Social Networking; D012944:Social Support
relapse prevention; smoking cessation; social media; social networking