​The Anti-Smoking Network
Art by Lia Kantrowitz

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​The Anti-Smoking Network

How quitting smoking restored my faith in the internet.

Two weeks without a smoke, I was wandering around my neighborhood, a little drunk, yes, mulling the prospect of just, you know, maybe having one.

It was at the point in the quitting process when your brain physically seems to itch, when you're clenching your jaw and moving your face muscles around in a weird and vain attempt to scratch it, when it's a cool, just-right summer night and your favorite song just came on and you're in a terrible mood anyway.

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I typed "ugh" into my phone.

Within seconds—actually seconds—came a response: "Keep ur chin up!!! DFS. NOPE," tsrob said. Then another one, from MissDana1974: "NOPE NOPE NOPE NOPE. stay strong!! DFS." Another: "You got this!!"

In the Livestrong community, the app that's often referred to as the best "quit smoking" app on the market, NOPE stands for Not One Puff Ever, and DFS, as far as I can tell, is Don't Fuckin' Stress (or maybe Smoke). There is very little that can move the irritable, anxious soul of a recently quit smoker, but an outpouring of forceful empathy from other irritable, anxious souls can, it turns out, do the trick.

Livestrong is, of course, the brand made famous by disgraced cyclist Lance Armstrong. It was launched by the Lance Armstrong Foundation in 2004, and provided the slogan that stretched across the ubiquitous yellow bracelets sporty altruist types wore throughout the 00s. In 2008, Demand Media, then one of the web's biggest SEO farms, reached a deal to operate an advertising-based, for-profit version of Livestrong's website, Livestrong.com, alongside the nonprofit foundation website, Livestrong.org.

As part of the agreement, Demand Media gave 184,000 shares of its stock to Livestrong, and hired Armstrong as a spokesperson. A 2013 New York Times investigation raised questions about the ethicality of the maneuver: Mark Zimbelman, a professor specializing in accounting fraud, called the deal "unprecedented." The relationship between the two organizations grew even more complicated after Armstrong admitted, in 2012, to using performance enhancing drugs, and his foundation formally dropped its association with him and renamed itself Livestrong.

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Today, it's the for-profit Livestrong, operated by Demand Media, that runs what is, as far as I can tell, the web's biggest, liveliest chatroom for quitting smoking.

***

According to the traffic-analyzing firm Alexa, Livestrong.com is the 425th most-visited wesbite in the United States, and the 933rd most-clicked in the world. It attracts massive online communities, where users convene to discuss diet practices, health tips, workout regimens, and staying clean.

The "Quit Smoking" community appears to be, by far, the most-frequented forum on the site. A room called "Lose Weight" has 76,000 posts. "Fitness & Exercise" has 35,000. The second largest, "Support & Motivation" has 273,000 posts—"Quit Smoking" has well over twice that, with 617,000. By comparison, the site's "Stay Sober" community has just 4,000 posts. Something about the smoking cessation group just seems to click.

The app, which feeds mobile posts onto the website and vice versa, is a simple beast. Its uncomplicated, if ad-strewn, interface lets users tally cravings and slip-ups, chart their savings since quitting, and otherwise map out the progress they've made thus far. There's also a peripheral "mPoints" mobile rewards system that makes the quitting enterprise seem like a cyberpunk corporatocracy, but I'll get into that a bit later. Most of the action is in the Community section, basically a giant chat room. And it has what Silicon Valley values most: a critical mass of users with a powerful, positive network effect. Livestrong's Quit Smoking participants are dedicated, passionate, and prodigious in the amount they post.

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As for me, I'd been smober, in Livestrong-speak, for years after first quitting in my early twenties. But during a particularly stressful stretch, I'd wormed my way back into the habit, found that glorious old splintery crutch. The plan was to nip the creep in the bud; to go cold turkey all over again. As an afterthought, I figured I'd check in on the current spate of apps, programs, and online quit-smoking communities designed to help.

There were a handful of apps, naturally, like something called Smoke Free, that were personality-free and boring, and which I quickly deleted. There was r/StopSmoking subreddit that's well-intentioned and positive but a bit sleepy and unresponsive. There are a handful of forum boards and resources on the web, some for-profit, some sanctioned by government health orgs and NGOs. There are Facebook quit-smoking groups. But there was nothing like that weird ball of ad-powered, aggressively optimistic energy that Livestrong. Which makes sense; if you search 'Quit Smoking' on iTunes, it's by far the top result returned, with 907 user comments, and a 4.5 star rating after 4,525 reviews.

Yes, it's draped in New Age-y aesthetics (couples walking on the beach at sunrise, etc) and is plagued by ad clutter; but the thousands of people who frequent it don't seem to care. After using it for just a couple weeks, I can already identify a host of names and personalities—some are brash, and their posts resemble a coach's shouted encouragements, some are reflective, and post lines of their personal poetry, some are patient, and respond with positive aphorisms to anyone whose texts indicate they might be slipping. Some behaved suspiciously like admins, and post open-ended questions marked in that positive, anodyne manner meant to goad on discussion threads.

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All of their exhortations can veer towards the straightedge; a quit-at-all-costs attitude clearly dominates.

Still, everyone seems to feel extremely safe. There's a lack of negativity that's almost startling for those accustomed to navigating the modern web; either Livestrong is the most genuinely and thoroughly positive corner of the internet, or it employs its best moderators (which seems unlikely, given Demand Media's low-overhead strategies). Which was reassuring at a moment when we've been fast losing faith in our online institutions—or at least I have, though again, I'm currently mired in a nicotine-deprived state of irascibility and cynicism.

With Reddit collapsing into a misogynist, juvenile cesspool, media outlets shutting down their comment boards due to hostility and abuse, and the strain of harassment that's plagued Twitter of late, it was reaffirming to find a simple, unpolluted community where people were logging on just to chat, build relationships, and help each other out. The genuine goodwill, the kindness towards anonymous strangers, and the networked boost in productivity towards a valuable goal; this is the kind of social problem the internet once promised to help actively solve, with the kind of community it had promised to deliver.

Yes, a goddam app might be the rare technology that actually, really, seriously helps combat smoking.

Cigarettes, after all, may be the most diabolical innovation we humans have ever managed. They're sexy, addictive, wonderful, and toxic; a fairly sure, fairly noble form of suicide, as Kurt Vonnegut once wrote. The sheer number of technologies we've marched out over the years to combat our own dumb, terrible invention—none of which have really worked very well—is a revealing testament to the depths of cigarettes' deviousness.

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We came up with the patch, a slow burn dose of nicotine pumped directly into your body, and infused nicotine into a gum base, for quitters seeking a more casual vibe. Our psychologists have plotted behavioral therapies, our pharmaceutical concerns have concocted quit-happy drugs, like Zyban and Chantix, to quell the post-cessation blues. Today, we're tapping the high the e-varieties; cyborg cigarettes and pens that waft nicotine gently into your lungs on the winds of water vapor, free of smoke and harmful additives.

But Harvard researchers have shown that after six months, patchers and gum chewers are just as likely to relapse as everyone else. Studies reveal that Chantix and Zyban are only marginally more effective than a placebo. And the jury is still out on e-cigarettes and vaping, in just about every regard. So far, it's a dried tobacco leaf wrapped in paper versus our cutting edge cessation technologies, and the desiccated plant is winning.

Smoking kills 480,000 people a year in the US alone; internationally, it's 6 million, according to the World Health Organization. "Despite a steep drop in the number of smokers in the United States over the last three decades, researchers say that cigarettes remain a growth industry for the rest of the world," the LA Times reported in 2014. There are now nearly a billion smokers worldwide, and over 6 trillion cigarettes were puffed last year. No coincidence, then, that unless inroads are made into curbing smoking culture globally, the WHO predicts that smoking will kill a billion people this century.

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Basically, more people need to quit. And the vast majority of people still quit cold turkey. According to a recent Gallup survey, 48 percent of successful quitters say that's how they ultimately pulled it off. That is, they go "that's it," stop putting cigarettes into their mouths, and trust that their friends, families, and co-workers will put up with them as they inevitably transform into assholes for the next few weeks. And that's exactly what Livestrong's app helps users do, with a boost from network technology; it's a thriving, bustling support network for cold turkey quitters.

A recent, if preliminary study found that young smokers who tried to quit with the aid of an app were more than twice as likely to succeed than their peers who used traditional methods. A number of other studies have seized on the efficacy of social media's potential as a support group in quit-smoking efforts, though the arena still clearly needs more research.

I kept coming back to Livestrong. Mostly to read along, sometimes to post. "Two weeks. Still rough," I wrote, because it was. An outpouring of agreement, encouragement, and suggestion: "Two weeks is a great accomplishment. It will get better though," RoadTrip55 said, immediately. "I can't wait until I get to two weeks," louiselb said.

Sometimes, I even got a little trollish, just to see if there was anything that might spur any eyerolls or lols from bad faith lurkers or short-rope schadenfreuders. Once, I typed: "How does anyone do this there is just always something missing," which maybe was obviously a little much, and everyone was so kind that I immediately felt bad for pushing it (but let's be honest it is also true) as user after user offered consoling words, genuine warmth, or recommended I try counseling (not a bad idea, really).

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The one thing that I couldn't get past was the maddening mPoints system, which promises rewards for hitting milestones like staying smoke-free for a week, or regularly checking in with the app. That's where Livestrong primarily earns its revenue, surely—there's also a pervasive, distracting ad banner that can be turned off for a buck—the system is stuffed with ads, and it's the one glaringly flawed, more classically Demand Media-spammish part of the experience. Quitting smoking for a week will earn you an achievement, and mPoints—and a chance to earn even more by, say, clicking a Dunkin' Donuts ad. The ad, while probably auto-served from Demand Media's network, is certainly not the kindest suggestion to a susceptible, craving-mad group of quitters poised to unleash their neuroses on a fresh vice, especially given that overeating is a common habit for the newly quit.

Still, you can fairly easily ignore the whole ad freakshow by clicking around it, and at least one very popular post from a community member called for the ouster of the mPoints-generating achievements while I was there. The majority of the users seem to be ignoring the mPoints system altogether; just as most of us regularly try to enjoy the internet's good works while dodging the onslaught of noxious banners, pop-ups, and sponsored content that fund it.

***

In a way, Livestrong Quit Smoking embodies the lowered expectations-laden promise of web enterprise in 2015: A genuinely good, eminently useful service that might indeed empower a struggling community in ways never before possible—but loaded sidelong with cynically opportunistic ad placement, and kept aloft due to its exceptional user base.

Demand Media announced its first-quarter revenues for 2015 at $33 million, and CEO Sean Moriarty issued a statement noting that "we're encouraged by another quarter of strong results from our Marketplaces, Content Solutions, and Livestrong businesses, and we are confident we are heading in the right direction." He too seems to think he's found a killer app.

Me, I'm three weeks smoke free. It's another rough one; I'm scatter-brained, short-tempered, and fed up. I'm not the DFS NOPE type, but I'll stick out the ads, even if it's just to hang around the last bastion of the Good Internet I've stumbled on in months. Maybe longer.

I tap "Having a Craving."


Modern Medicine is a series on Motherboard about how health care and medical technology can move forward so rapidly while still being stuck in the past. Follow along here.