Johannes Thrul

Feasibility and Quit Rates of the Tobacco Status Project: A Facebook Smoking Cessation Intervention for Young Adults

Background Young adult smokers are a challenging group to engage in smoking cessation interventions. With wide reach and engagement among users, Facebook offers opportunity to engage young people in socially supportive communities for quitting smoking and sustaining abstinence. Objective We developed and tested initial efficacy, engagement, and acceptability of the Tobacco Status Project, a smoking cessation intervention for young adults delivered within Facebook. Methods The intervention was based on the US Public Health Service Clinical Practice Guidelines and the Transtheoretical Model and enrolled participants into study-run 3-month secret Facebook groups matched on readiness to quit smoking. Cigarette smokers (N=79) aged 18-25, who used Facebook on most days, were recruited via Facebook. All participants received the intervention and were randomized to one of three monetary incentive groups tied to engagement (commenting in groups). Assessments were completed at baseline, 3-, 6-, and 12-months follow-up. Analyses examined retention, smoking outcomes over 12 months (7-day point prevalence abstinence, ≥50% reduction in cigarettes smoked, quit attempts and strategies used, readiness to quit), engagement, and satisfaction with the intervention. Results Retention was 82% (65/79) at 6 months and 72% (57/79) at 12 months. From baseline to 12-months follow-up, there was a significant increase in the proportion prepared to quit (10/79, 13%; 36/79, 46%, P<.001). Over a third (28/79, 35%) reduced their cigarette consumption by 50% or greater, and 66% (52/79) made at least one 24-hour quit attempt during the study. In an intent-to-treat analysis, 13% (10/79) self-reported 7-day abstinence (6/79, 8% verified biochemically) at 12-months follow-up. In their quit attempts, 11% (9/79) used a nicotine replacement therapy approved by the Food and Drug Administration, while 18% (14/79) used an electronic nicotine delivery system to quit (eg, electronic cigarette). A majority (48/79, 61%) commented on at least one Facebook post, with more commenting among those with biochemically verified abstinence at 3 months (P=.036) and those randomized to receive a personal monetary incentive (P=.015). Over a third of participants (28/79, 35%) reported reading most or all of the Facebook posts. Highest acceptability ratings of the intervention were for post ease (57/79, 72%) and thinking about what they read (52/79, 66%); 71% (56/79) recommended the program to others. Only 5 participants attended the optional cognitive-behavioral counseling sessions, though their attendance was high (6/7 sessions overall) and the sessions were rated as easy to understand, useful, and helpful (all 90-100% agreed). Conclusions A Facebook quit smoking intervention is attractive and feasible to deliver, and early efficacy data are encouraging. However, the 1.5-fold greater use of electronic cigarettes over nicotine replacement products for quitting is concerning.

Smoking cessation intervention on facebook: Which content generates the best engagement?

Background Social media offer a great opportunity to deliver smoking cessation treatment to young adults, but previous online and social media interventions targeting health behavior change have struggled with low participant engagement. We examined engagement generated by content based on the Transtheoretical Model of Behavior Change (TTM) in a motivationally tailored smoking cessation intervention on Facebook. Objective This study aimed to identify which intervention content based on the TTM (Decisional Balance and 10 processes of change) generated the highest engagement among participants in pre-action stages of change (Precontemplation, Contemplation, and Preparation). Methods Participants (N=79, 20% female, mean age 20.8) were assessed for readiness to quit smoking and assigned to one of 7 secret Facebook groups tailored to their stage of change. Daily postings to the groups based on TTM Decisional Balance and the 10 processes of change were made by research staff over 3 months. Engagement was operationalized as the number of participant comments to each post. TTM content-based predictors of number of comments were analyzed and stratified by baseline stage of change, using negative binomial regression analyses with and without zero inflation. Results A total of 512 TTM-based posts generated 630 individual comments. In Precontemplation and Contemplation groups, Decisional Balance posts generated above average engagement (P=.01 and P<.001). In Contemplation groups, posts based on the TTM processes Dramatic Relief and Self-Liberation resulted in below average engagement (P=.01 and P=.005). In Preparation groups, posts based on Consciousness Raising generated above average engagement (P=.009). Participant engagement decreased over time and differed between groups within Precontemplation and Contemplation stages, but was independent of day of the week and time of day the content was posted to the groups. No participant baseline characteristics significantly predicted engagement. Conclusions Participants not ready to quit in the next 30 days (in Precontemplation or Contemplation) engaged most when prompted to think about the pros and cons of behavior change, while those in the Preparation stage engaged most when posts increased awareness about smoking and smoking cessation. Findings support tailoring intervention content to readiness to quit and suggest intervention components that may be most effective in generating high participant engagement on social media.

Binge drinking: Health impact, prevalence, correlates and interventions

Objective: Binge drinking (also called heavy episodic drinking, risky single-occasion drinking etc.) is a major public health problem. This paper provides an overview of recently published evidence concerning the definition and measurement, prevalence rates, health impact, demographic and psychosocial correlates of, and interventions for, binge drinking. Design: Narrative review. Results: Mostly occurring among young people at weekends, binge drinking increases the risk of both acute (e.g. injuries) and long-term negative consequences (e.g. alcohol disorders). Binge drinkers tend to be extrovert, impulsive and sensation-seeking. Stress, anxiety, traumatic events and depression are also related to binge drinking. Both alcohol-related behaviour of parents and general parenting (e.g. parenting styles, monitoring) are also important. Other major risk factors for binge drinking are frequently spending time with friends who drink, and the drinking norms observed in the wider social environment (e.g. school, community, culture). Emergency departments, birthday parties, fraternities and the workplace serve as settings for interventions; these are increasingly delivered via digital and mobile technology. There is evidence of small-sized effects across approaches (brief interventions, personalised normative feedback, protective behavioural strategies etc.) and populations. Conclusion: A more consistent terminology, investigating multi-level influences and identifying the most effective intervention components are challenges for future research.

Cessation Strategies Young Adult Smokers Use After Participating in a Facebook Intervention.

ABSTRACT Background: Young adults underutilize current evidence-based smoking cessation strategies; yet social media are widely used and accepted among this population. A better understanding of whether and how young adults try to quit smoking in the context of a social media smoking cessation intervention could inform future intervention improvements. Objectives: We examined frequency, strategies used, and predictors of self-initiated 24-hour quit attempts among young adults participating in a Facebook intervention. Methods: A total of 79 young adult smokers (mean age = 20.8; 20.3% female) were recruited on Facebook for a feasibility trial. Participants joined motivationally tailored private Facebook groups and received daily posts over 12 weeks. Assessments were completed at baseline, 3-, 6-, and 12-month follow-up. Results: In 12 months, 52 participants (65.5%) completed 215 quit attempts (mean = 4.1; median = 4; range 1-14); 75.4% of attempts were undertaken with the Facebook intervention alone, 17.7% used an electronic cigarette (e-cigarette), 7.4% used nicotine replacement therapy (NRT), and 3.7% used additional professional advice. Non-daily smokers, those who smoked fewer cigarettes, and those in an advanced stage of change at baseline were more likely to make a quit attempt. E-cigarette use to aide a quit attempt during the study period was associated with reporting a past year quit attempt at baseline. No baseline characteristics predicted NRT use. Conclusions: After participating in a Facebook smoking cessation intervention, young adults predominantly tried to quit without additional assistance. E-cigarettes are used more frequently as cessation aid than NRT. The use of evidence-based smoking cessation strategies should be improved in this population.

A Pilot Study of Retail ‘Vape Shops’ in the San Francisco Bay Area

INTRODUCTION The use of electronic cigarettes or vape devices is increasing, and products are evolving rapidly. This study assessed retail vape shops in the San Francisco Bay Area to describe store characteristics, products offered, advertisements and health claims, as well as employees’ perceptions of their customers’ demographics, and practices to support smoking cessation. METHODS We conducted store audits of shops that exclusively sell vape devices with physical addresses in San Francisco and Alameda counties (n=23, response rate 72%) and interviewed vape shop owners/employees. RESULTS While all stores carried second and third generation vape devices, 83% of stores did not carry first generation devices. Employees estimated the majority of their customers bought devices for smoking cessation or to replace tobacco, and a small minority purchased for first-time recreational use. Employees most frequently recommended dosing nicotine based on usual cigarette consumption, adjusting doses based on “throat hit” or cravings, use of a second or third generation e-cigarette, and encouraged customers to experiment and customize to “whatever works for you” as smoking cessation advice. CONCLUSIONS Vape shops report a significant number of their customers are interested in smoking cessation, and employees are giving smoking cessation advice. A subpopulation of customers includes some nicotine novices. Studies of vape shops should include both observations and interviews with employees in order to detect important informal practices that may differ from posted signs or printed advertising. These practices include cessation counseling, product claims, and custom discount prices or bargaining.

An Internet-based ecological momentary assessment study relying on participants' own mobile phones: insights from a study with young adult smokers.

Background: In this paper we describe a novel Internet-based cell phone-optimized assessment technique (ICAT) to conduct an ecological momentary assessment (EMA) study. Participants could access the assessment instrument via the web browsers of their mobile phones. Methods: We report results from 92 young adult smokers (18-25 years old) who completed the baseline assessment and the first of 4 waves (3 days/wave) of EMA. Random prompts were issued via text messages sent to the participants. The participants were also instructed to self-initiate reports of smoking situations. Results: Compliance with the study protocols was low. In total, the participants completed 885 assessments during the 3 days of monitoring. Only 50.2% of random prompts were responded to, and 52.4% of those were completed within the first 10 min after issuing. Furthermore, reports of smoking situations were rarely self-initiated. In a multivariate regression analysis, age (positively) and female gender (negatively) predicted the number of completed assessments. Conclusions: This study adds to the limited experiences made with ICAT in substance use research. Similar to the few prior ICAT studies, compliance was low compared to traditional EMA studies. While using ICAT is technically feasible, specific improvements should be implemented to tap ICATs full potential in future studies.

Prevention of teenage smoking through negative information giving, a cluster randomized controlled trial

Aims: The objective of this study was to evaluate the preventive effect of a clinic-based, emotionally arousing, negative information giving intervention on adolescents’ protective and risk factors of smoking. Methods: Data of 563 students (18 schools) from a cluster randomized controlled trial conducted in Heidelberg, Germany (2010–2011) were analysed. The intervention included a presentation about the risks of smoking, a live video session of a pulmonary endoscopy and a testimonial interview with a lung cancer patient. A prevention booklet served as the control condition. Students’ reaction to the intervention was assessed after 2 weeks, risk and protective factors of smoking and smoking status were assessed after 2.5 months. Findings: The clinic intervention received significantly better ratings of credibility, personal relevance and emotional arousal than the booklet. Differences between clinic and booklet groups failed to reach significance on smoking-related threat appraisal, coping appraisal, protection motivation, behavioural intention and smoking status. Conclusions: Although the clinic intervention generated a significant immediate reaction, there were no significant preventive effects at follow-up. These results are in line with previous research and add further evidence for the ineffectiveness of emotionally arousing negative information giving in smoking prevention with adolescents.

Young adults report increased pleasure from smoking cigarettes when drinking alcohol but not when using marijuana

Abstract Background: Among young adults, cigarette smoking is strongly associated with alcohol and marijuana use. The present study compared self-reported co-use of cigarettes and alcohol versus cigarettes and marijuana among young adults using cross-sectional survey data. Methods: Participants were young adult cigarette smokers (age 18 to 25) who also reported past month alcohol or marijuana use enrolled in a randomized trial testing a smoking cessation intervention on Facebook. Participants self-reported extent of cigarette smoking under the influence of alcohol or marijuana and differences in perceived pleasure from cigarette smoking when drinking alcohol compared to using marijuana. Results: Among cigarette smokers who drank alcohol and used marijuana in the past month (n = 200), a similar percentage of cigarettes were smoked under the influence of alcohol (42.4% ± 31.2%) and marijuana (43.1%  ± 30.0%). Among alcohol + marijuana users, perceived pleasure from smoking cigarettes was significantly greater when drinking alcohol versus when using marijuana (t(199) = 7.05, p < .001). There was, on average, an increase in perceived pleasure from smoking cigarettes when drinking alcohol, though perceived pleasure did not differ by binge drinking frequency. In contrast, there was on average no change in perceived pleasure from smoking cigarettes when using marijuana. Results from the cigarette smokers who used alcohol + marijuana were similar to cigarette smokers who only used alcohol (n = 158) or only used marijuana (n = 54). Conclusion: Findings highlight greater perceived reward from smoking cigarettes when drinking alcohol compared to when using marijuana, informing smoking cessation interventions that target users of multiple substances.

Are you in or out? Recruitment of adolescent smokers into a behavioral smoking cessation intervention.

Even though many adolescent smokers want to quit, it is difficult to recruit them into smoking cessation interventions. Little is known about which adolescent smokers are currently reached by these measures. In this study we compare participants of a group-based, cognitive behavioral smoking cessation intervention with adolescent smokers who decided against participating. Within a non-randomized controlled trial, data of 1053 smokers (age 11–19) from 42 German secondary schools were analyzed. Of these smokers, 272 were recruited into 47 courses of the intervention. An in-class information session, individually addressing potential participants, and incentives were used as means of recruitment. Personal predictors of participation were analyzed using regression analyses and multivariate path analyses to test for mediation. In the path analysis model, nicotine dependence, quit motivation, and a previous quit attempt were directly positively related to participation. Heavier smoking behavior was indirectly positively associated with participation through nicotine dependence and negatively through quit motivation, yielding an overall positive indirect effect. The positive effect of a previous quit attempt on participation was partially mediated through nicotine dependence and quit motivation. The proportion of smoking friends were indirectly positively related to participation, mediated through nicotine dependence. Since adolescents with heavier smoking behavior and stronger nicotine dependence are less likely to undertake a successful unassisted quit attempt, the reach of these young smokers with professional cessation interventions is desirable. Further measures to improve the recruitment of those currently not motivated to quit have to be examined in future studies.

The role of participants' self-selected future smoking goals in adolescent smoking cessation interventions

BACKGROUND There is an implicit assumption that abstinence is the treatment goal of young smokers that deliberately participate in cessation interventions, but this may not always be the case. To gain information on subgroups of adolescent intervention participants, we compare participants who want to achieve smoking abstinence (Abst) with those stating a non-abstinence future smoking goal (NAbst), with regard to baseline characteristics, reasons for participation, quit motivation, retention, goal attainment, and smoking abstinence. METHODS The sample consisted of 202 adolescent smokers (49.5% female). At baseline, 118 (58.4%) indicated abstinence as future smoking goal and 84 (41.6%) indicated non-abstinence. All participants received a behavioral smoking cessation intervention. Assessments took place before, during, and after treatment, and at 6-month follow-up. Regression analyses were conducted. RESULTS Abst and NAbst participants reported similar baseline characteristics. Abst participants, however, were more likely to report a previous quit attempt and indicated a higher quit motivation before and during treatment. Abst participants were more likely to participate based on own initiative and NAbst participants because of participating friends. Both groups attended a similar number of intervention sessions and were equally likely to attain their self-selected smoking goal. However, more Abst participants reported a successful quit attempt during treatment and abstinence at post-treatment and follow-up. CONCLUSIONS NAbst participants may represent a substantial subgroup in smoking cessation interventions for adolescents. Results indicate that future smoking goals can influence treatment outcomes. NAbst participants in treatment may benefit from additional information on the negative health consequences of light smoking.