A Facebook-Based Intervention to Reduce Smoking Among Young Adults: Evaluating Interest and Developing the Intervention and Procedures for Evaluation

Background: Tobacco is the leading preventable cause of death and disease worldwide. Approximately 5.4 million people die each year due to tobacco-related illnesses. Compared to other age groups, young adults are less likely to use behavioral interventions for smoking cessation, and studies of tobacco use and other health behaviors have reported great challenges in recruiting young adults. With nearly three-quarters (72%) of online 18-29 year olds using social media, it represents a promising yet untapped resource for helping young adults quit smoking. Objective: To evaluate interest, potential population targets, and most useful approaches for a Facebook-based smoking cessation intervention for young adults. We further aimed to describe the development of the Facebook intervention and design for a trial to follow-up with young adults smokers for 12 months. Methods: Quantitative data (N=570) were collected from young adults who had smoked at least once in the past month and completed an online survey of tobacco, Internet, and social media use. Qualitative data (N=30) were taken from a subset of survey completers, stratified by motivation to quit smoking, agreeing to participate in an interview over online chat. We then designed an intervention based on U.S. Clinical Practice Guidelines and transtheoretical model theory to be implemented through Facebook. Finally, we then planned a feasibility and efficacy evaluation process that included a randomized design, three follow-up periods through 12 months, and biochemical verification of abstinence online. Results: First, survey study results demonstrated that there was interest in use of Facebook for quitting smoking in 31% of young adult smokers. Interest was stronger among those motivated to quit smoking (χ2 = 75.2, p < .001). Qualitative interviews showed that approaches that respect privacy and tailor to readiness to quit were seen as most likely to maximize participation. Second, an intervention was developed, consisting of two Phases: Phase I consisted of 90 daily Facebook posts tailored to participants’ stage of change (Precontemplation, Contemplation, Preparation); Phase II was a 6-session group cognitive-behavioral intervention delivered over Facebook chat. A feasibility evaluation will implement the intervention in 48 young adult smokers recruited online using Facebook. We will evaluate recruitment characteristics, treatment engagement and receptivity, attrition, and implementation of at-home biochemical evaluation of tobacco abstinence. A randomized controlled trial with 480 young adults smokers will evaluate the efficacy of the intervention. Outcomes will include biochemically-verified 7-day point prevalence abstinence, change in commitment to abstinence, and likelihood of having made a quit attempt during 3, 6, and 12 month follow-up periods. Conclusions: There is a need for and interest in a Facebook-based intervention to help young adults quit smoking. Based on results of the mixed-methods study, an original intervention was developed that is grounded in behavior change theory and Clinical Practice Guidelines, and also makes use of Facebook’s social environment and maximizes privacy at the same time. Further research is required to assess the efficacy of such interventions on smoking cessation outcomes. Our study design can create an evidence-based approach to behavior change with broad reach. []