An estimated 40% of women who smoke quit during their pregnancy, however, up to 80% of these women
relapse in the postpartum period, despite the health risks for themselves and their children. Relapse
prevention in the postpartum period offers a unique opportunity to capitalize on a positive behavioral change.
Yet, the design of effective smoking interventions for postpartum relapse prevention is challenging, due in large
part to the competing needs and stressors in this population, especially among low income women. New,
innovative intervention delivery models are needed to provide high levels of social support for ongoing
behavioral change, while simultaneously addressing the new demands associated with young babies. Twitter,
one of the most popular microblogging social media platforms that facilitate an instant mode of communication
via tweets (short texts), seems especially promising for delivering smoking cessation interventions among
underserved populations. Guided by the Cognitive-Social Health Information Processing (C-SHIP) framework,
as well as by health communication best practices, the proposed study will develop and test an evidence-
based, cognitive-behavioral twitter-enabled system-generated and participant-driven intervention
(Tweet2commit) designed to reduce postpartum smoking relapse among low-income minority women who
have quit immediately before or during their pregnancies. The Tweet2commit will be developed through a
systematic formative evaluation process that includes literature and evidence-based content review, followed
by an iterative cycling of text drafting, health literacy evaluation of texts, review by targeted focus group and
pre-test through usability testing. The overarching goal of Tweet2commit is to provide evidence-based
information and cognitive-behavioral coping strategies, as well as to harness the potential of peer-mediated
social interaction, for supporting smoking abstinence. The intervention will consist of: 1) system-generated
tweets targeting C-SHIP-based relapse factors and 2) user-generated tweets: participants will be asked to
tweet when commenting on the system-generated tweets or when experiencing needs for coping with lapse or
relapse so their peer can respond accordingly. We will also use a combination of best practice strategies to
engage online participation and peer-support exchange. A pilot RCT will be conducted to explore the efficacy
of the Tweet2commit intervention on reducing postpartum relapse rates, compared to a Usual Care control. A
mixed-methods approach including the analysis of objective Twitter usage data will be conducted to measure
participant’s engagement and satisfaction as well as perceived barriers. The proposed research will be the first
randomized controlled study that leverages the potential of Twitter for disseminating evidence-based smoking
cessation strategies and harnessing the participatory nature of tweeting for live interactive mobile support
groups among underserved postpartum women. The approach is innovative, evidence-based, highly
transportable for wide scale dissemination, and can readily be applied to other substance abuse contexts.
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