Cigarette smoking is the leading preventable cause of death in the United States and smoking cessation rates must increase to reach our national goals to reduce smoking prevalence. While mass media has been used to promote smoking cessation, there is growing interest in alternative channels to distribute smoking cessation information, like social media, due to the increasing fragmentation, shrinking audience, and expense of mass media. Social media, a mediated interpersonal channel, may provide an effective alternative to mass media. Twitter is a social media microblogging site (each message is 140 characters or less) available across a wide variety of platforms that is being used by the National Cancer Institute (NCI) and others to disseminate tobacco control messages. However, little is known about the mechanisms underlying effective Twitter interventions, such as what message features are most relevant and useful, as evidenced by passing the information on to others.
It is also not known if experience with national Twitter smoking cessation campaigns can be applied to promote smoking cessation in high risk populations. One relevant priority population is Lesbian Gay Bisexual and Transgendered (LGBT) young adults, as smoking rates for LGBT individuals are disproportionately high, and young adult smoking rates are higher than for any other age group in the United States. Young adulthood is an essential time for smoking cessation, as quitting smoking before the age of 30 mitigates most smoking-related health effects. However, young adults are less likely to use traditional cessation resources, so Twitter may be a promising new way to reach them. This study will explore the use of Twitter to promote smoking cessation by achieving two Aims: (1) Identify themes (e.g. suggesting quit methods, providing social support) and other message content (e.g. hashtags or links to websites) that increase the likelihood of smoking cessation tweets being transmitted to others (retweeted). (2) Explore the feasibility of implementing a Twitter intervention to support smoking cessation efforts among LGBT young adults by describing their use of Twitter and responses to smoking cessation tweets
Aim 1 will be accomplished with a content analysis using data from three existing NCI smoking cessation interventions on Twitter covering an 11-month period including over 9,000 Twitter messages. We will code a randomly selected sample of 4800 Twitter messages to identify the themes of tweets, the presence of hashtags and links to websites, and whether the messages were retweeted (transferred to others) to identify the features of tweets that are most frequently retweeted. Aim 2 will will be accomplished using qualitative data collected from LGBT young adults in the San Francisco/Bay area to explore how they use Twitter generally, their willingness to use Twitter to support smoking cessation attempts, and their responses to a sample of the tweets from the NCI intervention that were retweeted frequently. This study will provide an independent assessment of the existing NCI Twitter smoking cessation campaigns and provide important information to guide the development of future social media interventions to promote smoking cessation.