Tobacco is still the biggest cause of preventable death in the world. Although the total number of smokers is falling, a high percentage of teenagers and young people in their 20s continue to smoke.
Although many young people want to quit, few are successful. Most do not access face-to-face or telephone cessation services and so may be missing out on the support they need to quit successfully. It may be that quitting smoking presents a different set of issues for young people than for older adults.
For example, they may be more concerned with how smoking affects their social identity than their long-term health concerns. So the more medicalised cessation services, such as consulting a healthcare professional or trying nicotine replacement therapy (NRT), may be less relevant and appealing.
These traditional cessation services may also be outdated and out of sight from young people’s perspectives. As a result, it’s important to understand the role of more modern communication channels such as social media in supporting smoking cessation. When young people think about quitting smoking, do they first seek help from their GP or do they turn to their close friends or social media contacts for support?
New research
A recently published quasi-experimental study tried to determine the effectiveness of social media as a quitting tool by studying the Canadian “Break It Off” (BIO) campaign aimed at smokers aged between 19 and 29. The researchers compared BIO to a telephone smokers’ helpline service.
The BIO website featured details of traditional cessation methods (telephone counselling and NRT) but also encouraged users to upload a YouTube video of their quitting experience and announce their resolve to friends via Facebook. There was also a BIO smartphone app that offered instant advice messages and personal progress-tracking to help deal with cravings.
The campaign narrative likened quitting smoking to breaking off a romantic relationship turned toxic. This was a pertinent means of getting this message through to young people, given that their romantic relationships are typically characterised by instability.
Of the website’s 37,325 unique visitors from January to March 2012, 339 used the Facebook and YouTube components of BIO while only 21 subsequently accessed the telephone helpline.
The researchers asked participants to complete a follow-up questionnaire about their smoking behaviour and their use and opinion of cessation services. More than half of participants dropped out of the study and those that stayed were different from typical helpline users, who were more likely than BIO participants to be female, daily smokers and intending to quit within a month. This means the conclusions we can draw are limited. However, BIO participants had significantly higher seven-day and 30-day quit rates compared with helpline users.
The majority of young people, certainly in the developed world, now own smartphones and spend a significant amount of time using social media every day. So it may have the upper hand over standalone websites for delivering smoking cessation information.
Given consumer demand for instant information, bite-sized chunks of advice and support presented little and often (for example Twitter feeds) may be more palatable than a whole website of material.
All about image
We also know that youth is a time when relationships and social networks mean so much to young people’s developing self-image and perceived place in society. So perhaps, regardless of the platform for the BIO campaign, its core messages around relationships were more compelling and relevant to young people’s motivations for quitting than the more clinically oriented smokers’ helpline.
However, the online platform of BIO may have additional benefits as a smoking cessation intervention. It provides scope for community support, as people can receive support from their friends within their online communities (such as Facebook) and learn from others’ experiences and quitting attempts (YouTube videos). It’s also more informal and accessible than a one-to-one consultation with a healthcare professional, where perhaps formality is a barrier to young people accessing health services.
Unfortunately, with the available evidence, it isn’t possible to unpack these various potential mechanisms and gain an understanding of what works, why and for whom. Social media is commonly just one component of a smoking cessation intervention. What we don’t yet know is whether it makes other components more effective.
Alice Pennington, an undergraduate medical student at Cardiff University, conducted background research for this article.