Smoking was originally the domain of men. When tobacco companies began to target women in the 1920s-30s, they promoted cigarettes as symbols of women’s liberation, an empowering tool and form of weight control. Yet, when it comes to quitting smoking, tobacco treatment research shows that women have a harder time liberating themselves from cigarettes than do men. Why is there a significant difference in successful smoking cessation rates between men and women? And what can be done to help women quit? Jodi Prochaska, associate professor of medicine at the Stanford Research Prevention Center, is looking for answers in a unique way—through creating and studying virtual social networks for quitting smoking.

Prochaska emphasizes that the harms of tobacco for women are substantial. As summarized in the Surgeon General’s 50th anniversary report on the negative health consequences of smoking, compared to men, women smokers are at greater risk for lung cancer, are more prone to get breast cancer and emphysema at an earlier age, are at greater risk of dying from heart disease, and they face reproductive health problems including altered ovarian cycle, lower ovarian reserve, perinatal mortality and earlier menopause.

Women have a harder time quitting smoking

Prochaska says that stress, negative affect, and withdrawal have been identified as important triggers for women to smoke. She reports that tobacco treatment studies have found that inclusion of behavioral support is more important for women than men. Notably, however, very few studies have looked at creating women-only interventions, or have examined how men and women may need different types of support to quit smoking. In one of the few women-only interventions conducted that included behavioral support groups, she notes, the women involved only attended half of the support meetings.  

Tweet2Quit: Social networks support quitting 

Prochaska’s new study tested an innovative approach to providing behavioral support for busy people. Together with researchers from the University of California Irvine, Prochaska worked to develop the Tweet2Quit program, which uses Twitter to create a social network support group for individuals attempting to quit smoking. Prochaska says that Twitter may be uniquely suited as a support system for women in particular. For starters, women tend to be more active Twitter users: according to the Pew Research Center, there are more women Twitter users than men Twitter users.  

To test this new approach, Prochaska recruited 42 men and 118 women daily smokers who were also daily social media users. Everyone received a supply of free Nicotine Replacement Therapy (NRT) patches and gum and was given access to a quit-smoking guide on the web. Two groups were formed, each with about half the men and half the women participants. One group was enrolled in the Tweet2Quit support program. They were prompted to tweet daily for 100 days, and they received a new group discussion topic every evening. The topics were informed by tobacco treatment clinical practice guidelines. The Tweet2Quit groups were popular, averaging about 1,000 tweets per group and about 59 tweets per person over the course of the experiment; 24 percent of participants’ tweets were in response to the automessage prompts or discussion topics, while 76 percent were spontaneous group member communications.

Prochaska found that being part of a Tweet2Quit group made a significant difference in whether participants were able to quit smoking successfully. Being a member of a Tweet2Quit group doubled the likelihood of quitting. Sustained quit rates over 60 days of follow-up were 20 percent in the control condition compared to 40 percent among participants assigned to a Tweet2Quit group. Additionally, participants who tweeted more were the most likely to quit smoking successfully. Each additional 10 tweets increased the tweeter’s odds of abstaining from smoking by 20 percent, on average. However, despite these encouraging findings, Prochaska and her group found that men were still more likely to quit smoking, both in the Tweet2Quit groups and in the control condition. 

Being a member of a Tweet2Quit group doubled the likelihood of quitting. 

Prochaska explained, “Women in Tweet2Quit had lower quit rates than men, but not because they tweeted less; they simply had more trouble quitting overall. Research shows women do not benefit in the same way as men from standard cessation interventions.”

To better understand gender differences in quitting smoking and with the goal of developing an intervention to better support women, Prochaska is continuing her research. Recently, she learned that her team’s R01 proposal to the National Cancer Institute to compare women-only versus co-ed social network quit smoking groups was scored in the top two percentile in peer review. Final notification on funding is pending NIH Council. With original methods, the study aims to recruit nearly 1000 smokers and will examine commonalities and differences in the ways men and women communicate and relate in co-ed versus women-only quit smoking groups. Outcomes will be tracked out to six months follow-up with biological confirmation of abstinence. If successful, the intervention has great potential for scalabiliy and broad dissemination as a platform for networking women in virtual support groups to address the leading preventable cause of death in the US. 

Further information:

To learn more about the next Tweet2Quit smoking study, contact Dr. Prochaska’s research group at tobaccotx@stanford.edu.

SRITA (Stanford Research into the Impact of Tobacco Advertising) online library of over 25,000 tobacco advertising images over the decades: http://tobacco.stanford.edu.

For medical education and information on treating tobacco use: http://rxforchange.ucsf.edu.