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      The Tobacco Status Project (TSP): Study protocol for a randomized controlled trial of a Facebook smoking cessation intervention for young adults

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          Abstract

          Background

          Tobacco use remains the leading cause of premature morbidity and mortality in the United States. Young adults are less successful at quitting, use cessation treatment less often than smokers of other ages, and can be a challenge to retain in treatment. Social media, integrated into the lives of many young adults, represents a promising strategy to deliver evidence-based smoking cessation treatment to a large, diverse audience. The goal of this trial is to test the efficacy of a stage-based smoking cessation intervention on Facebook for young adults age 18 to 25 on smoking abstinence, reduction in cigarettes smoked, and thoughts about smoking abstinence.

          Methods/Design

          This is a randomized controlled trial. Young adult smokers throughout the United States are recruited online and randomized to either the 3 month Tobacco Status Project intervention on Facebook or a referral to a smoking cessation website. The intervention consists of assignment to a secret Facebook group tailored to readiness to quit smoking (precontemplation, contemplation, preparation), daily Facebook contacts tailored to readiness to quit smoking, weekly live counseling sessions, and for those in preparation, weekly Cognitive Behavioral Therapy counseling sessions on Facebook. Primary outcome measure is biochemically-verified 7-day point prevalence abstinence from smoking at posttreatment (3 months), 6, and 12 months. Secondary outcome measures are reduction of 50 % or more in cigarettes smoked, 24 h quit attempts, and commitment to abstinence at each time point. A secondary aim is to test, within the TSP condition, the effect of a monetary incentive at increasing engagement in the intervention.

          Discussion

          This randomized controlled trial is testing a novel Facebook intervention for treating young adults’ tobacco use. If efficacious, the social media intervention could be disseminated widely and expanded to address additional health risks.

          Trial registration

          ClinicalTrials.gov: NCT02207036, May 13, 2014.

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          Most cited references45

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          Stages and processes of self-change of smoking: toward an integrative model of change.

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            The process of smoking cessation: an analysis of precontemplation, contemplation, and preparation stages of change.

            Traditionally smoking cessation studies use smoker and nonsmoker categories almost exclusively to represent individuals quitting smoking. This study tested the transtheoretical model of change that posits a series of stages through which smokers move as they successfully change the smoking habit. Subjects in precontemplation (n = 166), contemplation (n = 794), and preparation (n = 506) stages of change were compared on smoking history, 10 processes of change, pretest self-efficacy, and decisional balance, as well as 1-month and 6-month cessation activity. Results strongly support the stages of change model. All groups were similar on smoking history but differed dramatically on current cessation activity. Stage differences predicted attempts to quit smoking and cessation success at 1- and 6-month follow-up. Implications for recruitment, intervention, and research are discussed.
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              Broad Reach and Targeted Recruitment Using Facebook for an Online Survey of Young Adult Substance Use

              Background Studies of tobacco use and other health behaviors have reported great challenges in recruiting young adults. Social media is widely used by young adults in the United States and represents a potentially fast, affordable method of recruiting study participants for survey research. Objective The present study examined Facebook as a mechanism to reach and survey young adults about tobacco and other substance use. Methods Participants were cigarette users, age 18-25 years old, living throughout the United States and recruited through Facebook to complete a survey about tobacco and other substance use. Paid advertising using Facebook’s Ad program over 13 months from 2010 Feb 28 to 2011 Apr 4 targeted by age (18-25), location (United States or California), language (English), and tobacco- and/or marijuana-related keywords. Facebook approved all ads. Results The campaign used 20 ads, which generated 28,683,151 impressions, yielding 14,808 clicks (0.7% of targeted Facebook members), at an overall cost of $6,628.24. The average cost per click on an ad was $0.45. The success of individual ads varied widely. There was a rise in both clicks and impressions as the campaign grew. However, the peak for clicks was 3 months before the peak for ad impressions. Of the 69,937,080 accounts for those age 18-25 in the United States, Facebook estimated that 2.8% (n = 1,980,240) were reached through tobacco and marijuana keywords. Our campaign yielded 5237 signed consents (35.4% of clicks), of which 3093 (59%) met criteria, and 1548 (50% of those who met criteria) completed the survey. The final cost per valid completed survey was $4.28. The majority of completed surveys came from whites (69%) and males (72%). The sample averaged 8.9 cigarettes per day (SD 7.5), 3.8 years of smoking (SD 2.9), with a median of 1 lifetime quit attempts; 48% did not intend to quit smoking in the next 6 months. Conclusions Despite wide variety in the success of individual ads and potential concerns about sample representativeness, Facebook was a useful, cost-effective recruitment source for young-adult smokers to complete a survey about the use of tobacco and other substances. The current findings support Facebook as a viable recruitment option for assessment of health behavior in young adults.
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                Author and article information

                Contributors
                Danielle.Ramo@ucsf.edu
                Johannes.Thrul@ucsf.edu
                Kevin.Delucchi@ucsf.edu
                Pamela.Ling@ucsf.edu
                Sharon.Hall@ucsf.edu
                Jodi.Prochaska@stanford.edu
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                15 September 2015
                15 September 2015
                2015
                : 15
                : 897
                Affiliations
                [ ]Department of Psychiatry, University of California, 401 Parnassus Avenue, Box TRC 0984, San Francisco, CA 94143 USA
                [ ]Center for Tobacco Control Research and Education, University of California, 530 Parnassus Avenue, San Francisco, CA 94143 USA
                [ ]Division of General Internal Medicine, University of California, 1545 Divisadero Street, San Francisco, CA 94143 USA
                [ ]Department of Medicine, Stanford Prevention Research Center, Stanford University, 1265 Welch Road, Stanford, CA 94305 USA
                Author information
                http://orcid.org/0000-0002-9875-5713
                Article
                2217
                10.1186/s12889-015-2217-0
                4572690
                26374203
                b597ebf8-d3aa-4183-a27c-9ec008a187f1
                © Ramo et al. 2015

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 5 August 2015
                : 2 September 2015
                Categories
                Study Protocol
                Custom metadata
                © The Author(s) 2015

                Public health
                Public health

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