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Facebook Apps for Smoking Cessation: A Review of Content and Adherence to Evidence-Based Guidelines
1Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, United States
2The Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
3Department of Oncology, Georgetown University Medical Center / Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC, United States
*all authors contributed equally
Megan A Jacobs, MPH
Schroeder Institute for Tobacco Research and Policy Studies, Legacy
1724 Massachusetts Avenue, NW
Washington, DC, 20036
Phone: 1 202 454 5753
Fax: 1 202 454 5785
1]. In 2013, 57% of all American adults and 73% of those aged 12-17 years used Facebook . Intensity of use is also escalating: in 2014, 64% of Facebook users visited the site on a daily basis, up from 51% in 2010 . A primary channel through which users interact with Facebook is through millions of third-party software applications (apps) . Facebook apps are available on personal computers and some are also accessible on mobile and/or smartphones. The broad reach and intensive use of Facebook worldwide represents a potentially powerful opportunity to deliver health-related behavior change interventions.
Facebook cessation apps may represent a unique approach to treatment that can leverage the power of social network ties [4,5]. Upon installing an app, their personal profile data and social network graph are typically made available to the app. Real-time access to an individual’s social network may facilitate the provision of social support from network members and the spread of an intervention through social networks.
To date, there have been no reviews of the content or quality of Facebook cessation apps. Two reviews of mobile apps by Abroms et al [6,7] found that they were heavily downloaded but most did not adhere to clinical guidelines. Choi et al  found cessation mobile apps may be limited as autonomous interventions. The goals of this study were to (1) assess the availability of Facebook apps for smoking cessation, (2) describe their approach and features, and (3) examine their adherence to an index based on the US Public Health Service’s Clinical Practice Guideline for Treating Tobacco Dependence (the Guideline).
Identifying Facebook Apps
Two strategies were used to ensure we located apps likely to be encountered by the typical smoker searching Facebook for cessation assistance [9,10]. We searched for apps within Facebook using the general search toolbar with “Apps/Games” selected and using the App Center general search toolbar using cessation-related keywords (eg, “smoking”, “quit”, “cessation”, “cigarette cessation”). We used these same keywords in combination with “Facebook” in search engine queries on Google, Bing, and Yahoo! Since Internet searchers typically review only the first page of search engine results , the first two pages of results for each keyword were reviewed for any links or mention of a Facebook app. Links that led to a Facebook App Center page, directly to an app, or to an app page were saved for eligibility review. Searches were conducted in August 2013.
To determine eligibility for full review, two Master’s level coders catalogued basic information for each app link retrieved. This approach to app screening has been used in other reviews [6,7]. To be eligible for full review, apps had to be in English and include text related to cessation either in the Facebook App Center overview or within the app.
Coding of Apps
Eligible apps were installed using the native Facebook platform on a personal computer or the iPhone platform for mobile-only apps. Coders used apps over 3 days with at least 3 logins to ensure all features were utilized and coded. (Co-authors MAJ and ALG were involved in the development of one of the Facebook apps that was eligible for full review. Coders of this app were research staff not directly involved in app development or the associated research grant [R01 CA155369-01A1]). Apps were coded for publisher/developer type, cost, and content features (interactive, informational, and social). Operational definitions of content features were developed prior to coding and were noted as present or absent. Interactivity was defined as “any content-related user input that results in feedback from the website” . Informational features were those specific to smoking cessation, withdrawal symptoms, triggers to smoke/cravings, and/or ways to deal with cravings. Social features included (1) a within-app community with communication features (eg, public posting wall, personal message function), and (2) the ability to post updates or information to a user’s Facebook wall to share information with existing social network ties. Using an existing scheme [6,7], apps were classified as public pledge (eg, choose a reason for quitting and post to Facebook wall), calculator/tracker (eg, money saved/cigarettes not smoked calculated based on quit date), or multicomponent (eg, contained a calculator/tracker feature and quitting guide).
Apps were then coded for adherence to the Guideline  using a modified version of an established index [6,7]. Modifications included (1) removal of “Recommend counseling and medicines” and “Refer to recommended treatment” because they duplicated other “ASSIST with a quit plan” items, (2) editing of “Text alerts” to “Notifications (any type including text)” given alternative notification options within Facebook, and (3) addition of “Recommend talking to your health care provider about quitting” as key feature of cessation treatment (Table 1). Items were scored on a 3-point scale (0=not at all present, 1=partially present, or 2=fully present). For example, for the guideline to “ARRANGE for follow-up”, apps that did not mention any follow-up or send an invitation to return to the app received a 0; apps that either mentioned follow-up or sent an invitation to return received a score of 1; and apps that did both received a score of 2. For items such as “Enhance motivation: rewards”, apps that referred to specific rewards (eg, whiter teeth) received a 2; apps that referred only to generic rewards (eg, “quitting has lots of benefits”) received a 1; and apps that did not refer to any rewards received a 0.
Similar to Abroms et al , when scores between coders differed by 2 points (ie, 0 vs 2), coders discussed the discrepancy and recoded the item. After recoding, if item scores differed by 1 point or less, two scores were averaged; all item scores for each app were summed (maximum adherence score possible=40).
Frequencies and descriptive statistics were used to characterize apps. For each adherence index item, the proportion of apps receiving a 2 (fully present) by at least one coder was calculated (average score≥1.5; as in ). The relationship between publisher/developer source and app type on the adherence index summary score was examined. All analyses were performed in SPSS Version 21.
The search resulted in 19 apps from within Facebook’s internal search platform and 6 apps from Internet search engines (Figure 1). After removing duplicates (n=3), those available only on iPhone (n=3), and ineligible (n=8) and non-functional (n=2) apps, the final sample included 9 apps that were available on Facebook (see Multimedia Appendix 1).