Tobacco use remains the number one cause of premature morbidity and mortality in the United States. Despite comparable rates of smoking, young adults are less successful at quitting and use cessation treatment less often than smokers of other ages. Studies of Internet-based smoking cessation interventions have poor retention rates with young adult smokers, and websites for young adult smokers have primarily targeted the college student population. 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 of young adult smokers. However, little is known about how to maximally utilize social media to engage young adults in an empirically-based intervention for smoking cessation. The overall goal of this proposal is to support the candidate's development of skills to perform smoking cessation intervention research with young adults using online social media. The career plan includes training in the conduct of clinical trials, use of social media for health behavior change, ethical issues in online research, tobacco policy and marketing to young people, and leadership in psychiatry and outcomes research. The UCSF Department of Psychiatry and the NIDA-funded San Francisco Treatment Research Center (P50 DA009253) provide an exceptional research environment. The primary mentor holds expertise in treatment of tobacco dependence in special populations including use of computer-delivered interventions with young adults. The advisory team brings further expertise in research and treatment ethical issues, online interventions, and tobacco control research, media, and policy. The overall goal of the proposed research is to develop and test in a randomized clinical trial the efficacy of a stage-based smoking cessation intervention for young adults age 18 to 25 to be delivered online using Facebook.
The specific aims are to: 1) Design and test the feasibility (N = 48) of a motivationally tailored Facebook- based smoking cessation intervention for young adults and;2) Evaluate the efficacy of the intervention in a randomized trial (N = 480). It is hypothesized that the intervention will successfully engage young adult smokers and that social media is a feasible delivery mechanism for smoking cessation treatment. Further, the intervention is hypothesized to be more effective than a control condition (referral to a national smoking cessation website) in producing biochemically verified abstinence from cigarettes, increased commitment to abstinence, and greater likelihood of making a quit attempt at 3, 6, and 12 months follow up. Given the complex risk behavior profiles of young adult smokers, and the potential to leverage social media interventions to address additional risks, a secondary aim will examine the frequency and correlates of other health risk behaviors in our study sample, including alcohol and illicit drug use;poor sleep quality, sedentary behavior, unhealthy diet, depression, and high-risk sexual behavior. Results will inform the extension of the intervention to address health risk behaviors in addition to tobacco during the next stage of the applicant's career.

Public Health Relevance

Rates of smoking have been stagnant among young adults age 18 to 25 in recent years, and thus, tobacco use is likely to remain the number one cause of premature death and disability into the next generation. Despite the availability of effective smoking cessation treatments, use of these treatments by young adults remains disappointingly low. Social media, particularly Facebook, is fully integrated into the lives of many young adults and can be a powerful tool to spread messages about health behavior change. Critically, the tool to be developed and tested through the proposed research will reach a wide audience of young adult smokers and will be adaptable to other health risk behaviors common among this population.

National Institute of Health (NIH)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZDA1)
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Grossman, Debra
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University of California San Francisco
Schools of Medicine
San Francisco
United States
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Ramo, Danielle E; Liu, Howard; Prochaska, Judith J (2015) A mixed-methods study of young adults' receptivity to using Facebook for smoking cessation: if you build it, will they come? Am J Health Promot 29:e126-35
Ramo, Danielle E; Young-Wolff, Kelly C; Prochaska, Judith J (2015) Prevalence and correlates of electronic-cigarette use in young adults: findings from three studies over five years. Addict Behav 41:142-7
Ramo, Danielle E; Rodriguez, Theresa M S; Chavez, Kathryn et al. (2014) Facebook Recruitment of Young Adult Smokers for a Cessation Trial: Methods, Metrics, and Lessons Learned. Internet Interv 1:58-64
Ramo, Danielle E; Delucchi, Kevin L; Liu, Howard et al. (2014) Young adults who smoke cigarettes and marijuana: analysis of thoughts and behaviors. Addict Behav 39:77-84
Prochaska, Judith J; Fromont, Sebastien C; Wa, Christina et al. (2013) Tobacco use and its treatment among young people in mental health settings: a qualitative analysis. Nicotine Tob Res 15:1427-35
Ramo, Danielle E; Liu, Howard; Prochaska, Judith J (2013) Validity and reliability of the nicotine and marijuana interaction expectancy (NAMIE) questionnaire. Drug Alcohol Depend 131:166-70
Ramo, Danielle E; Delucchi, Kevin L; Hall, Sharon M et al. (2013) Marijuana and tobacco co-use in young adults: patterns and thoughts about use. J Stud Alcohol Drugs 74:301-10
Finch, Karen A; Ramo, Danielle E; Delucchi, Kevin L et al. (2013) Subjective social status and substance use severity in a young adult sample. Psychol Addict Behav 27:901-8