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)
National Institute on Drug Abuse (NIDA)
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
Application #
Study Section
Special Emphasis Panel (ZDA1-GXM-A (15))
Program Officer
Grossman, Debra
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of California San Francisco
Schools of Medicine
San Francisco
United States
Zip Code
Ramo, Danielle E; Bahorik, Amber L; Delucchi, Kevin L et al. (2018) Alcohol and Drug Use, Pain and Psychiatric Symptoms among Adults Seeking Outpatient Psychiatric Treatment: Latent Class Patterns and Relationship to Health Status. J Psychoactive Drugs 50:43-53
Vogel, Erin A; Rubinstein, Mark L; Prochaska, Judith J et al. (2018) Associations between marijuana use and tobacco cessation outcomes in young adults. J Subst Abuse Treat 94:69-73
Ramo, Danielle E; Thrul, Johannes; Delucchi, Kevin L et al. (2018) A randomized controlled evaluation of the tobacco status project, a Facebook intervention for young adults. Addiction :
Thrul, Johannes; Meacham, Meredith C; Ramo, Danielle E (2018) A novel and remote biochemical verification method of smoking abstinence: Predictors of participant compliance. Tob Prev Cessat 4:
Gubner, Noah R; Thrul, Johannes; Kelly, Oona A et al. (2018) Young adults report increased pleasure from smoking cigarettes when drinking alcohol but not when using marijuana. Addict Res Theory 26:71-76
Meacham, Meredith C; Paul, Michael J; Ramo, Danielle E (2018) Understanding emerging forms of cannabis use through an online cannabis community: An analysis of relative post volume and subjective highness ratings. Drug Alcohol Depend 188:364-369
Cherian, Roy; Westbrook, Marisa; Ramo, Danielle et al. (2018) Representations of Codeine Misuse on Instagram: Content Analysis. JMIR Public Health Surveill 4:e22
McKelvey, Karma; Thrul, Johannes; Ramo, Danielle (2017) Impact of quitting smoking and smoking cessation treatment on substance use outcomes: An updated and narrative review. Addict Behav 65:161-170
Montgomery, LaTrice; Ramo, Danielle (2017) What Did You Expect?: The Interaction Between Cigarette and Blunt vs. Non-Blunt Marijuana Use among African American Young Adults. J Subst Use 22:612-616
Thrul, Johannes; Ramo, Danielle E (2017) Cessation Strategies Young Adult Smokers Use After Participating in a Facebook Intervention. Subst Use Misuse 52:259-264

Showing the most recent 10 out of 32 publications