We study the behavior-change process of smoking-cessation by leveraging longitudinal data from Twitter. Finding behavioral, social, and emotional differences between abstinence vs. relapse, we provide implications for designing technology-based interventions.

1. Motivation Method Findings
UNRAVELING
ABSTINENCE AND
RELAPSE
Smoking Cessation
Reflected in Social Media
Elizabeth Murnane
Scott Counts

2. Motivation Method Findings
Motivation
Healthy Behavior Change & CHI

3. Motivation Method Findings
Smoking
• Leading cause of preventable death in U.S.
• 44 million smokers (1/5 of population)
• 68.8% want to quit
• Over 50% attempted cessation
• Relapse common

4. Motivation Method Findings
Cessation
• Clinical intervention
– Group + individual therapy, physician care,
tailored self-help programs
– Access, affordability, tailoring, follow-ups

5. Motivation Method Findings
Cessation
• Clinical intervention
– Group + individual therapy, physician care,
tailored self-help programs
– Access, affordability, tailoring, follow-ups
• Digital tools
– Broad user base, personalized modeling,
constant monitoring

6. Motivation Method Findings
Theory + Computation
• Transtheoretical Model (TTM)
– Psychological state
– Social support
– Gradual progression through stages of change

7. Motivation Method Findings
Theory + Computation
• Transtheoretical Model (TTM)
– Psychological state
– Social support
– Gradual progression through stages of change
• Twitter (tweets and network data)

8. Motivation Method Findings
Theory + Computation
• Transtheoretical Model (TTM)
– Psychological state
– Social support
– Gradual progression through stages of change
• Twitter (tweets and network data)
– Linguistic analysis
– Social medium
– Longitudinal

9. Motivation Method Discussion
Method
Data Collection & Analysis

10. Motivation Method Discussion
The Cessation Event

11. Motivation Method Discussion
The Cessation Event
Sample smokers trying to quit:
• Determine cessation-relevant topics
• Query Twitter firehose
• Verification with 3 Mechanical Turkers per tweet
(Fleiss kappa = .7613)
• 733 unique smokers trying to quit
Just smoked my last cigarette ever!!! I officially quit!
Today I am going to quit smoking. Wish me luck
Last cigarette ever today. #promiseonmylife #bestfeelin

12. Motivation Method Discussion
Data Collection
For each verified smoker:
• Twitter profile data
• Twitter network connections
• 2 years of tweets per user (1 year prior & 1
year after cessation-event)
• 5,309,510 tweets (median 3236 tweets per
user)
s Sample aligns with CDC statistics

13. Motivation Method Discussion
Data Collection
Sample aligns with CDC statistics
! !
! !
Men Women
CDC 54% 46%
Twitter 59% 41%

14. Motivation Method Discussion
Outcome
Survivors
• Congratulations to me, still smoke free :)
• first few weeks were hard but I haven’t craved
a cig in months
Relapsers
• Well, tried to quit smokin tobacco but..had a
f**ed up day
• Day 26: Broke down and bought a pack of
smokes last weekend. Smoked the last one today.

15. Motivation Method Discussion
Measures
• Behavioral Markers
– Activity
– Sociality
– Sentiment
– TTM stage progression

16. Motivation Method Discussion
Measures
• Behavioral Markers
– Activity
– Sociality
– Sentiment
– TTM stage progression

17. Motivation Method Discussion
Measures
• Behavioral Markers
– Activity
– Sociality
– Sentiment
– TTM stage progression

18. Motivation Method Discussion
Measures
• Behavioral Markers
– Activity
– Sociality
– Sentiment
– TTM stage progression

19. Motivation Method Discussion
Measures
• Behavioral Markers
– Activity
– Sociality
– Sentiment
– TTM stage progression

20. Motivation Method Discussion
Measures
• Behavioral Markers
– Activity
– Sociality
– Sentiment
– TTM stage progression

21. Motivation Method Discussion
Measures
• Behavioral Markers
– Activity
– Sociality
– Sentiment
– TTM stage progression
• Motives
• Treatments

22. Motivation Method Discussion
Measures
• Behavioral Markers
– Activity
– Sociality
– Sentiment
– TTM stage progression
• Motives
• Treatments

23. Motivation Method Discussion
Findings
Results & Implications for Design

24. Motivation Method Discussion
Behavioral Signal: Sociality
• Friends
• Followers
• @mentions

25. Motivation Method Discussion
Behavioral Signal: Sociality
Survivors have more connections
• ~1.5x more friends & followers (p<.0001)
Starting the patch today. Everyone please support
me on the road to quitting smoking
Ok I started a really big challenge yesterday... I quit
smoking! I may need some help from you guys in
the upcoming days/weeks

26. Motivation Method Discussion
Behavioral Signal: Sociality
Survivors gain while Relapsers lose
connections
Day 2 of not smoking #bittersweet
I quit smoking yesterday and everyone is pissing me off!
Day 3 without a cig. Ooo I'm about to shoot someone

27. Motivation Method Discussion
Behavioral Signal: Sociality
Relapsers repel relationships
Day 2 no smoking. I hate everyone
I need a cigarette to calm down... im about
to punch something #nojokes

28. Motivation Method Discussion
Behavioral Signal: Sociality
Reaching Out: @mentions
• Survivors make 2x more @mentions across all
tweets (p<.05)

29. Motivation Method Discussion
Behavioral Signal: Sociality
Reaching Out: @mentions
• Survivors make 2x more @mentions across all
tweets (p<.05)
Selectivity
@username what is your opinion on vapor
cigarettes? Do you think they make it easier to quit?
I quit smoking today! A promise I made to
@username & I intend on keeping this promise

30. Motivation Method Discussion
Cessation Motives
!
Survivors Relapsers

31. Motivation Method Discussion
Self-Reevaluation
“When did cigarettes do this to my life? Ending
the smoking and starting a new me.”
!
Survivors Relapsers

32. Motivation Method Discussion
Relationships
“Today I quit smoking. My son came home with
an ashtray he made in art class. FML”
!
Survivors Relapsers

33. Motivation Method Discussion
Whim
“Quit smoking. Exercise. Eat healthier. Start a
savings account. Spend less money on
pointless shit. Vaycay to Vegas”
!
Survivors Relapsers

34. Motivation Method Discussion
“So today is my last day drinking and
smoking. Gotta get ma body right fa the
summer time and college!”
!

35. Motivation Method Discussion
Cessation Motives
Survivors
Relapsers
• Sincere
desires
• Permanent
circumstances
• Casual
impulses
• Flee3ng
whims
χ2
=
21.67,
df=1,
p<.001

36. Motivation Method Discussion
Designing Intervention Technology

37. Motivation Method Discussion
Designing Intervention Technology
• Likelihood of abstinence

38. Motivation Method Discussion
Designing Intervention Technology
• Likelihood of abstinence
• Personalized treatment plans

39. Motivation Method Discussion
Designing Intervention Technology
• Likelihood of abstinence
• Personalized treatment plans
• Adaptive intervention

40. Motivation Method Discussion
Designing Intervention Technology
• Likelihood of abstinence
• Personalized treatment plans
• Adaptive intervention
• Automation & user input
– Invisible behavior
– Preferences
– “Achievement”

41. Motivation Method Discussion
Summary
• Motivation
– Behavior Change
– Smoking Cessation
– Socio-Technical Systems
• Methods & study
– Twitter profiles, connections, and tweets
– Operationalizing variables
– Survivors vs. Relapsers
• Recommendations for technology design
– Diagnosis
– Prediction
– Intervention

42. Motivation Method Discussion
Summary
• Motivation
– Behavior Change
– Smoking Cessation
– Socio-Technical Systems
• Methods & study
– Twitter profiles, connections, and tweets
– Operationalizing variables
– Survivors vs. Relapsers
• Recommendations for technology design
– Diagnosis
– Prediction
– Intervention

43. Motivation Method Discussion
Summary
• Motivation
– Behavior Change
– Smoking Cessation
– Socio-Technical Systems
• Methods & study
– Twitter profiles, connections, and tweets
– Operationalizing variables
– Survivors vs. Relapsers
• Recommendations for technology design
– Diagnosis
– Prediction
– Intervention

44. Motivation Method Discussion
Thank You! Questions?
• Motivation
– Behavior Change
– Smoking Cessation
– Socio-Technical Systems
• Methods & study
– Twitter profiles, connections, and tweets
– Operationalizing variables
– Survivors vs. Relapsers
• Recommendations for technology design
– Diagnosis
– Prediction
– Intervention
Unraveling Abstinence and Relapse:
Smoking Cessation Reflected in Social Media
Elizabeth Murnane elm236@cornell.edu
Scott Counts counts@microsoft.com