Quitting Smoking Goes Viral

Using "Virality" for the good of Public Health

Published on April 10, 2013by Megan Jacobs

When it comes to health, “viral” is not usually a good thing. It conjures up images of coughing coworkers, sick kids, crowded hospitals, and flu maps.

Virality on the Internet is something altogether different. It’s what introduced over a billion YouTube viewers to Gangnam Style and prompted hundreds of thousands of us to water each other’s virtual plants in Farmville. Online, each of us has the power to contribute to anything going viral, “exposing” and “infecting” our friends and family with anything through a group email, a shared Facebook link, a retweet.

Virality has certainly proven to be enormously powerful in pop culture.  But what if we could harness the same spreading power of virality to improve our health? That’s exactly what our team at the Schroeder Institute for Tobacco Research and Policy Studies is trying to do. We are starting an “epidemic” of behavior change to solve one of the most lethal and vexing public health problems of our time: we want quitting smoking to go viral.

Smoking remains the leading cause of preventable death. In the US alone, smoking accounts for 443,000 preventable deaths each year. In 2010, 19 percent of adults, or 45 million Americans aged 18 and over, were current cigarette smokers. Smoking costs nearly $100 billion in lost productivity and immeasurable costs as we lose our parents, children, friends, and neighbors to smoking.

With 45 million lives at stake, a one-by-one approach to smoking cessation just isn’t going to cut it.

Here’s where the Internet comes into play. Reports show that 6-9 percent of all Internet users – as many as 10 million adults or more – search for smoking cessation tools online each year. Each of those 10 million people is connected to dozens of other people, smokers and non-smokers alike. Imagine if we could get a powerful quit smoking program into the hands of those that need it. Imagine too if that program were to go viral, spreading far and wide, efficiently and inexpensively. Smokers trying to quit would invite fellow smokers into the program to support each other, creating a cascading swell of smoking cessation. Perhaps smokers would even invite non-smokers to support them in quitting, potentially creating links between groups of smokers who don’t even know each other.

It’s no small feat to engineer virality, though: just ask the scores of app and game developers striving to create the next Words With Friends, or the hordes of budding YouTube actors hoping to shoot the next “Call Me Maybe.”

But the science tells us that the potential exists. Research by Harvard scientist, Nicholas Christakis, has shown that smokers tend to cluster, meaning that smokers often have friends and family who are also smokers. In his research on obesity, David Bahr and his colleagues have shown that interventions targeting highly connected individuals may cause greater weight loss through clusters of overweight individuals. University of Southern California researcher Thomas Valente has spent years studying how an intervention that targets a user’s entire social network, not simply the individual, can accelerate behavior change and promote broader impact. A 2010 study out of M.I.T. found that individual adoption of a behavior was much more likely when participants received social reinforcement from multiple neighbors in their social network.  The bottom line seems to be that our behavior is connected to the behavior of the people in our personal social network, and interventions that target our social networks may be even more effective than ones that target just us.

So, how do we start an epidemic of quitting smoking? It begins with a basic epidemiological virality equation. Viruses that spread have a high “reproductive rate,” which is a function of the duration of the infection, its contagiousness, and the number of contacts infected individuals have that they could potentially ‘infect.’ Our team spent a year building a Facebook app called UbiQUIToussm (“Quit smoking anytime, everywhere”) that is intentionally designed to maximize each of these characteristics so that it, too, would go viral.

For example, features like quit guides on topics smokers care about (like gaining weight while quitting, or how to manage stress), and Facebook notifications to alert users when new content is available are intended to engage users so they spend more time on the app (i.e., duration). Features like the ability to like/share content, inviting friends to support a quit attempt, and Timeline posts that pop when a user hits quit milestones (like surviving 3 days smokefree) are focused on enhancing contagiousness so that users are likely to  “infect” their network.

The app also has features such as competition between users, rewards for reaching quit milestones, bragging opportunities to Facebook friends, and a fun way to crush cigarette cravings. To top it off, we leverage social network support inherent to Facebook to encourage users and hold them to their quit dates. You survive another day smokefree, and your friends and family can pour on the virtual congratulations. Ideally, your quitting encourages others to pass the app on to their friends and family so they can quit smoking, too.

Funding from the National Cancer Institute of the National Institutes of Health makes it possible for our team to examine which features of the UbiQUITous app make quitting…  well, ubiquitous. Our hope is that our results will help address other vexing public health issues like obesity and medication adherence, and even those not yet on our radar.

Viruses and bacteria, and indeed, behavior, can spread rapidly from host to host. If we are to make a meaningful impact on tobacco use, it’s time to make quitting smoking contagious.

Thanks to Dr. Nathan Cobb and Dr. Amanda Graham for their contributions to this piece. Edited by Abdul El-Sayed.