Using WhatsApp and Facebook social groups for smoking relapse prevention: A pilot pragmatic randomized controlled tria

Abstract

BACKGROUND AND OBJECTIVES: Quit attempters often have episodes of smoking relapse before they can eventually quit. Social media is becoming popular for smoking cessation and relapse prevention, but its effectiveness has not been fully explored. Our randomized controlled trial (RCT) tested the effect of group discussion and reminders via the WhatsApp or Facebook social group to prevent smoking relapse in quitters who had stopped smoking recently. METHODS: A single-blinded, pragmatic parallel three-arm pilot cluster RCT. Recent quitters, who had completed an 8-week treatment and reported abstinence for at least 7 days, were randomly allocated to WhatsApp (n = 42), Facebook (n = 40), and Control group (n = 54). The 2 intervention groups participated in a 2-month group discussion moderated by a trained smoking cessation counselor and received a self-help booklet on smoking cessation. The Control group only received the booklet. FINDINGS: Fewer subjects in the WhatsApp group (14.3%) reported smoking in the past 7 days than the Control group (44.4%) at 2- (odds ratio (OR) = 0.21, 95%CI 0.08-0.58) and 6-month follow-up (35.7% versus 61.1%, OR = 0.35, 95%CI 0.15-0.82). Facebook group showed a lower smoking rate at 2- (30.0 % versus 44.4%, OR = 0.54, 95%CI 0.23-1.27) and 6-month follow-up (52.5 % versus 61.1%, OR = 0.70, 95%CI 0.31-1.61), but the difference was not significant. WhatsApp social groups had more moderators’ posts (Median: 60 versus 31.5; Mann-Whitney U test: p=.05) and subjects’ posts (Median: 35 versus 6; Mann-Whitney U test: p=.07) than Facebook counterparts. CONCLUSIONS: The intervention via 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. Funding: The work was funded by Tung Wah Group of Hospitals. The organization was funded by the Tobacco Control Office of the Department of Health. Corresponding Author: Yee Tak Derek Cheung, The University of Hong Kong, Hong Kong, derekcheung@hku.hk