Objective Twitter, a free social networking and micro-blogging service, offers potential for health promotion. Twitter may be a particularly appealing delivery channel for quit smoking programs given commonalities in the personality traits of heavy texters and smokers (e.g., high sensation seeking, impulsivity). This study examined the activity and popularity of Twitter quit smoking social network accounts. Design A cross-sectional analysis reviewed all Twitter accounts identified with the key words “quit or stop smoking” or “smoking cessation,” dating back to 2007, and examined recent account activity for the month of August 2010. Results A total of 153 activated Twitter quit smoking social network accounts were identified with a median of 155 followers and 82 total tweets per account; 49% of accounts had >100 tweets. Nearly half of the accounts (48%) linked to commercial sites for quitting smoking, 43% had tweets on e-cigarettes, and 26% posted automatic news alerts. Only 5% provided personal communications to support cessation and little content mapped onto clinical practice guidelines. In August 2010, 81 of the accounts (53%) were still active with a median of 23 tweets per account that month. Active accounts had more tweets overall and were more likely to have tweets on e-cigarettes compared to inactive accounts. Conclusions Study findings demonstrate interest in Twitter for building quit smoking social networks. However, many of the accounts are no longer active, and tweet content is largely inconsistent with clinical guidelines. Future research is needed to explore whether the popularity of Twitter can be leveraged for disseminating evidence-based tobacco treatment strategies on a national and global scale and to examine the effectiveness of this approach on smoking behavior.

Purpose To describe effective retention strategies in a clinical trial with a high risk, low income, and vulnerable patient population with serious mental illness. Design Follow-up assessments were conducted for a randomized clinical tobacco treatment trial at 3-, 6-, and 12-months post-baseline. Initial follow-up rates of <40% at 3-months led to implementation of proactive retention strategies including obtaining extensive contact information; building relationships with case managers and social workers; contacting jails and prisons; text messaging, e-mailing, and messaging via social networking sites; identifying appointments via electronic medical record; and field outreach to treatment facilities, residences, and parks. Setting Large urban public hospital Subjects Participants were current smokers recruited from 100% smoke-free locked psychiatry units. Measures Assessments covered demographics, substance use, and mental health functioning. Analysis Retention rates were plotted over time in relation to key retention strategies. Chi-square and t-tests were used to examine participant predictors of retention at each follow-up. At the 12-month follow-up, the retention strategies that most frequently led to assessment completion were identified. Results The sample (N=100) was 65% male; age M=39.5 years (SD=11.3); 44% non-Hispanic White; 46% on Medicaid and 34% uninsured; 79% unemployed; and 48% unstably housed. Proactive retention strategies dramatically increased follow-up rates, concluding at 3-months=82.65%, 6-months=89.69%, and 12-months=92.78%. Married and divorced/separated/widowed participants, those with higher income, and participants with alcohol or illicit drug problems had increased retention from 3 to 12-months follow-up. Conclusion Follow-up rates improved as proactive methods to contact participants were implemented. Dedicated research staff, multiple methods, community networking, and outreach within drug treatment settings improved retention.

Objective This investigation examined predictors of utilization of nicotine replacement therapy (NRT) during a smoke-free psychiatric hospitalization. Methods Smokers (N=324) were recruited from smoke-free adult inpatient psychiatric units. Exploratory analyses examined correlates of NRT provision and utilization. Results The prevalence of NRT use was 51% overall and was greater among patients offered NRT on admission (58%) versus later (34%), among patients with more severe depression and nicotine withdrawal, and among those who reported perceptions that NRT decreases nicotine withdrawal, provides a nicotine substitute, and helps with quitting smoking (p<.05, all comparisons). Although the ratio of nicotine patch dose to usual cigarettes per day was 1.2±.7, the ratio was negatively correlated with time to first cigarette (Spearman’s ρ=−.30, p<.01), suggesting potential underdosing of more dependent smokers. Conclusions During smoke-free psychiatric hospitalizations, clinical management of nicotine withdrawal may be enhanced by offering patients NRT directly on admission, educating patients on the benefits of NRT, and increasing the dosage for more dependent smokers.

Individuals with SMI-particularly those who are younger, have racial/ethnic minority status, and have been diagnosed with a psychotic disorder-are vulnerable to menthol cigarette use. FDA regulation of menthol may prevent initiation and may encourage cessation among smokers with SMI.

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