Feasibility, Acceptance and Initial Efficacy of the “Tobacco Status Project” – An Intervention to Help Young Adults Quit Smoking on Facebook

Background: With widespread use, engagement among users, and potential to capitalize on social support, social media represents a promising strategy to reach and intervene with young adult smokers. Mixed-methods formative work determined that a sizable minority (31%) of young adult smokers were interested in help to quit smoking on Facebook, with interest strongest among those motivated to quit. Approaches that respect privacy and tailor to readiness to quit were seen as most likely to maximize participation. Objective: We designed and tested the feasibility, acceptability, and initial efficacy of a smoking cessation intervention for young adults delivered within Facebook. Methods: We designed an intervention based on the Clinical Practice Guidelines and the Transtheoretical model and enrolled 79 participants into study-run secret Facebook groups matched on readiness to quit smoking. Intervention components included: daily stage-matched posts for 90 days; weekly “Ask the Doctor” interactive sessions; and for those who became ready to quit, one individual and six group cognitive-behavioral counseling sessions held over Facebook chat. We assessed program use and acceptance at intervention end (3mo), and smoking outcomes at 3mo and 6mo. Results: Participants were 79% male, 89% Caucasian, smoked 11 cigarettes per day on average (SD=8.2), and 73% were daily smokers. We held two precontemplation (n=34; 43%), three contemplation (n=35; 44%), and two preparation (n=10; 13%) Facebook secret groups. Follow-up was 76% (n=60) at 3mo and 78% (n=62) at 6mo. Participants reported reading most of the posts (mean usability rating=3.3/4) and interactions from the “Dr. Is In” sessions (3/4); they reported thinking about what they read (3/4) and would recommend the program to others (3.3/4). During the 90-day intervention period, 4 (5%) participants opted to change to a later stage group; 5 (6%) opted for CBT treatment and attended 6/7 chat sessions on average. CBT sessions were rated as easy to understand, useful, and helpful (all 3.3/4). At intervention end (3mo follow-up), 10% (n=6) reported 7-day abstinence (ppa), of which 4 were verified biochemically online. At 6mo follow-up, 22% (n=14) reported 7-day ppa, of which 7 were verified online. Most participants reported at least one cessation attempt at 3mo (55%, n=33) and 6mo (58%, n=37). There was a significant reduction in median past 7-day cigarettes smoked from BL to 3mo (70 vs. 40; W=337, p<.001) and BL to 6mo (70 vs. 30; W=371, p<.001). More participants were in the action or preparation stages of changes at 6mo FU (47%) compared to either 3mo FU (40%) or before the intervention (10%; Bowker’s X2=13.4, p=.004). Conclusions: Focused on young adult smokers, a challenging group to engage, the study’s high retention and usability ratings suggest the Facebook quit smoking intervention is attractive and feasible to deliver. Early efficacy data are encouraging and support further investigation in a larger sample with randomized design and control group and longer follow-up. []