Helping smokers quit, millions at a time

How many times have public health researchers developed highly effective behavioral interventions to improve a population’s health, only to be thwarted by one simple truth: not enough of the population is using them to make a significant impact?

Indeed, the real-world impact of many public health interventions proven effective in clinical trials is often limited by low levels of reach, since impact is a function of effectiveness times reach.

It can be difficult enough to get proven interventions into the hands of those who actually seek help. Disseminating interventions to an entire population is even more challenging.

Online social networks such as Facebook offer an exciting new approach for disseminating evidence-based health interventions. Countless commercial health apps involve online social networks, with popular apps focused on fitness and diet tracking such as MapMyRun or MyFitnessPal currently in use by millions of people.

Health behavior change interventions delivered within online social networks enable users to tap into an existing pool of social support through existing connections with friends and family. In addition, users may also act as social influences on their networks, encouraging friends and family to adopt the same behavior.

Plus, social network platforms like Facebook make it easy for users to like and share content and to invite and engage with their network to make dissemination a one-click proposition. Since online interventions can track literally every action that users undertake, it is possible – and quite easy – to measure the spread of an intervention beyond the initial individuals targeted by the intervention itself. These “externalities” have long gone uncounted in more traditional research settings, but may represent an important aspect of health behavior change in a population.

Funding from the National Cancer Institute of the National Institutes of Health has made it possible for our group at the Schroeder Institute for Tobacco Research and Policy Studies at Legacy to develop a Facebook app, UbiQUIToussm, that helps smokers quit through a variety of evidence-based methods combined with social network theory and gamification techniques.

Users set a quit date and then check-in daily to track their progress, get personalized quitting advice, and earn rewards for hitting quitting milestones. UbiQUITous features information about quitting and tips for dealing with common barriers to quitting like stress and weight gain and other triggers.

UbiQUITous users can also track their successes (how much money they’ve saved) and take advantage of the app’s fun ways to manage cravings. Most importantly, the app leverages the social support and social influence inherent in online networks to encourage users and hold them accountable to their quit dates. By surviving another day smokefree, users are rewarded by friends and family pouring on the virtual congratulations.

Our research is designed to examine which features of a quit smoking Facebook app make it most likely to spread from one user to another, and how non-smokers may play a role in helping disseminate a cessation app.

We hope this study will inform other health behavior change interventions such as those that address issues like obesity or medication adherence. What we learn about building social network-driven interventions will also help others in the public health community consider potential advantages for conducting their work online, no matter what the health issue.

Millions of individuals are online, and more and more everyday are joining and using social network platforms. They come to connect with friends, play games, get involved in their communities, and even to look for ways to become healthier versions of themselves. We want to be there when they do. And hopefully, we can move the needle toward healthy lifestyles not just one, but millions at a time.

We could improve the total public health impact of our evidence-based interventions if we can dramatically increase their reach. Social networks may be just the tool to help us achieve this goal.