Using a Media Campaign to Increase Engagement With a Mobile-Based Youth Smoking Cessation Program.

PURPOSE: To describe the impact of the National Cancer Institute's promotion of its youth smoking cessation program, Smokefree Teen (SFT). DESIGN: We provide a description of campaign strategies and outcomes as a means to engage a teen audience in cessation resources using a cost-effective approach. SETTING: The campaign occurred nationally, using traditional (TV and radio), online, and social media outreach. PARTICIPANTS: Ads targeted adolescent smokers (aged 14-17). The baseline population was 42 586 and increased to 464 357 during the campaign. MEASURES: Metrics used to assess outcomes include (1) visits to SFT website from traditional and online ads, (2) cost to get an online ad clicked (cost-per-click), and (3) SmokefreeTXT program enrollments during the 8-week campaign period. ANALYSIS: We conducted a quantitative performance review of all tactics. RESULTS: The SFT campaign achieved an online ad click-through rate of 0.33%, exceeding industry averages of 0.15%. Overall, web traffic to teen.smokefree.gov increased by 980%, and the online cost-per-click for ads, including social media actions, was approximately $1 as compared with $107 for traditional ads. Additionally, the campaign increased the SmokefreeTXT program teen sign-ups by 1334%. CONCLUSION: The campaign increased engagement with evidence-informed cessation resources for teen smokers. Results show the potential of using multiple, online channels to help increase engagement with core resources.

Understanding the Relationship of Cigarette Smoking Trajectories Through Adolescence and Weight Status in Young Adulthood in the United States.

PURPOSE: Adolescent cigarette smoking has steadily declined since 1999, whereas adolescent obesity rates have quadrupled since the 1980s. Few studies address the longitudinal relationship of smoking and weight in youth and young adulthood. This study examines the relationship of smoking trajectories beginning in adolescence on weight status in young adulthood in a nationally representative longitudinal sample. METHODS: The study sample was drawn from the National Longitudinal Study of Adolescent to Adult Health Waves I-IV (N = 13,361). Four trajectories were generated through repeated-measures latent class analyses using current cigarette smoking status in Waves I-IV and age of initiation: nonsmokers (44%), early establishers (23%), late establishers (21%), and former smokers (12%). Wave IV weight status included self-reported body mass index (BMI) and measured waist circumference. Bivariate analyses addressed associations between smoking trajectory and BMI at each wave. Multivariate linear regression models tested the relationship of smoking trajectory and weight status at Wave IV. RESULTS: In bivariate analyses, early and late establishers had a significantly lower BMI at Wave III and all smoking trajectories had a significantly lower BMI at Wave IV versus nonsmokers. All smoking trajectories had a significantly lower BMI than nonsmokers (early establishers: ß = -1.27, confidence interval [CI]: -1.56 to -.98]; late establishers: ß = -.84, CI: -1.16 to -.52; and former smokers: ß = -.63, CI: -.93 to -.34; p < .05) in an adjusted multivariable regression model. CONCLUSIONS: This study reveals that weight status increased over time for all trajectories; thus smoking does not mitigate obesity risk. These results have implications for both research and interventions to help youth and young adults avoid both smoking and obesity.

A geo-view into historical patterns of smoke-free policy coverage in the USA.

INTRODUCTION: Ample evidence shows that implementation of smoke-free policies can significantly reduce tobacco use. The indoor smoke-free policy coverage in the U.S. increased over the past 25 years. This study synthesized the available historical smoke-free policy data and achieved two complementary goals: 1) reconstructed historical patterns of indoor smoke-free policy coverage in the U.S., and 2) developed a web-based interactive tool for visualization and download of the U.S. historical smoke-free policy data for research. METHODS: Historical information on local and regional smoke-free policy was downloaded from the American Nonsmokers Rights Foundation (ANRF). Subsequent methodological processes included: geo-referencing of smoke-free policy data, spatial-temporal data linkage, spatial pattern analysis, data visualization, and the development of an interactive tool. RESULTS: The percentage of population covered by the smoke-free policies varies across the different geographic locations, scales, and over time. On average, the percentage of people covered by the smoke-free laws in the U.S. increased substantially in the recent decade. The Tobacco-Policy-Viewer reveals geographic patterns of increase in smoke-free policy adoption by cities, counties, and States over time. CONCLUSION: The utility of visualizing the historical patterns of smoke-free policy coverage in the U.S. is to understand where and for how long smoke-free policies were in place for indoor facilities and to inform planning for education and interventions in the areas of need. The benefit of data provided for download, via the Tobacco-Policy-Viewer, is to catalyze future research on the impacts of historical smoke-free policy coverage on reduction in secondhand-smoke exposures, tobacco use, and tobacco related diseases.

Analysing user-reported data for enhancement of SmokefreeTXT: a national text message smoking cessation intervention.

OBJECTIVE: This observational study highlights key insights related to participant engagement and cessation among adults who voluntarily subscribed to the nationwide US-based SmokefreeTXT program, a 42-day mobile phone text message smoking cessation program. METHODS: Point prevalence abstinence rates were calculated for subscribers who initiated treatment in the program (n=18 080). The primary outcomes for this study were treatment completion and point prevalence abstinence rate at the end of the 42-day treatment. Secondary outcomes were point prevalence abstinence rates at 7 days postquit, 3 months post-treatment and 6 months post-treatment, as well as response rates to point prevalence abstinence assessments. RESULTS: Over half the sample completed the 42-day treatment (n=9686). The end-of-treatment point prevalence abstinence for subscribers who initiated treatment was 7.2%. Among those who completed the entire 42 days of treatment, the end-of-treatment point prevalence abstinence was 12.9%. For subscribers who completed treatment, point prevalence abstinence results varied: 7 days postquit (23.7%), 3 months post-treatment (7.3%) and 6 months post-treatment (3.7%). Response rates for abstinence assessment messages ranged from 4.36% to 34.48%. CONCLUSIONS: Findings from this study illuminate the need to more deeply understand reasons for subscriber non-response and opt out and, in turn, improve program engagement and our ability to increase the likelihood for participants to stop smoking and measure long-term outcomes. Patterns of opt out for the program mirror the relapse curve generally observed for smoking cessation, thus highlighting time points at which to increase efforts to retain participants and provide additional support or incentives.

Exploration of the link between tobacco retailers in school neighborhoods and student smoking.

BACKGROUND: School smoking bans give officials the authority to provide a smoke-free environment, but enacting policies within the school walls is just one step in comprehensive tobacco prevention among students. It is necessary to investigate factors beyond the school campus and into the neighborhoods that surround schools. The purpose of this study was to explore the relationship between the density of tobacco retailers and the illegal tobacco sales rate within school neighborhoods and smoking behaviors among students. METHODS: This study utilized secondary data from the baseline of the Youth Tobacco Access Project. Data were collected from 10,662 students attending 21 middle schools and 19 high schools, in addition to 512 tobacco retailers, all within 24 towns in Illinois during 2002. A random-effects regression analysis was performed to assess the relationship between the density of tobacco retailers and illegal tobacco sales rates on current smoking and lifetime smoking prevalence. RESULTS: Schools had a range between 0 and 9 tobacco retailers within their neighborhood with a mean of 2.76 retailers (SD = 2.45). The illegal sales rate varied from 0% to 100%, with a mean of 13%. The density of tobacco retailers was significantly related to the prevalence of ever smoking among students (b = 0.09, t(29) = 2.03, p = .051, OR = 1.10), but not to current smoking (p > .05); the illegal tobacco sales rate was not related to current smoking or lifetime smoking prevalence (p > .05). CONCLUSION: Results indicate that tobacco retailer density may impact smoking experimentation/initiation.

If you build (and moderate) it, they will come: the Smokefree Women Facebook page.

This analysis explores the impact of modifying the Smokefree Women Facebook social media strategy, from primarily promoting resources to encouraging participation in communications about smoking cessation by posting user-generated content. Analyses were performed using data from the Smokefree Women Facebook page to assess the impact of the revised strategy on reach and engagement. Fan engagement increased 430%, and a strong and statistically significant correlation (P < .05) between the frequency of moderator posts and community engagement was observed. The reach of the page also increased by 420%. Our findings indicate that the strategy shift had a statistically significant and positive effect on the frequency of interactions on the Facebook page, providing an example of an approach that may prove useful for reaching and engaging users in online communities. Additional research is needed to assess the association between engagement in virtual communities and health behavior outcomes.

Descriptive characteristics and cluster analysis of male veteran hazardous drinkers in an alcohol moderation intervention.

Current efforts underway to develop the fifth edition of the Diagnostic and Statistical Manual (DSM-5) have reignited discussions for classifying the substance use disorders. This study's aim was to contribute to the understanding of abusive alcohol use and its validity as a diagnosis. Cluster analysis was used to identify relatively homogeneous groups of hazardous, nondependent drinkers by using data collected from the Prevention and Treatment of Hypertension Study (PATHS), a multisite trial that examined the ability of a cognitive-behavioral-based alcohol reduction intervention, compared to a control condition, to reduce alcohol use. Participants for this study (N = 511) were male military veterans. Variables theoretically associated with alcohol use (eg, demographic, tobacco use, and mental health) were used to create the clusters and a priori, empirically based external criteria were used to assess discriminant validity. Bivariate correlations among cluster variables were generally consistent with previous findings in the literature. Analyses of internal and discriminant validity of the identified clusters were largely nonsignificant, suggesting meaningful differences between clusters could not be identified. Although the typology literature has contributed supportive validity for the alcohol dependence diagnosis, this study's results do not lend supportive validity for the construct of alcohol abuse.

Smokeless tobacco use in the United States military: a systematic review.

INTRODUCTION: Smokeless tobacco (ST) use represents an important target for intervention in the U.S. military population because it impairs "military readiness" and harms the health of the military. This paper aims to provide a systematic review of ST studies conducted in the U.S. military population in order to assess the content of existing ST research in this population, provide estimates of prevalence and clinically relevant use patterns, and discuss how these findings might be used to guide future ST research among this population. METHODS: We reviewed articles published through December 2010 using PubMed and PsycINFO databases, Google Scholar, and any relevant articles' reference lists. Inclusion criteria included focus on a U.S. military sample, English language, measured tobacco use, and ST prevalence was reported or could be calculated. To the extent possible, each article was coded for demographics, socioeconomic status, prevalence, amount, frequency, and length of use, and quit intentions/attempts. RESULTS: Thirty-nine articles met criteria for inclusion. Less than half focused primarily on ST use among military personnel. The remaining studies measured ST use in the context of other behaviors. Findings related to clinically relevant behaviors included a need for more cohort and intervention studies, a better understanding of ST use in combination with cigarettes (i.e., concurrent use), and identifying risk factors for ST initiation and use. DISCUSSION: ST use is prevalent among military personnel, as is concurrent use of cigarettes and ST. We provide a number of recommendations to guide future research in this important, yet understudied, area.

Cancer survivorship in the age of YouTube and social media: a narrative analysis.

BACKGROUND: As evidenced by the increasing popularity of YouTube (www.youtube.com), personal narratives shared through social media are an area of rapid development in communication among cancer survivors. Identifying the thematic and linguistic characteristics of YouTube cancer stories can provide a better understanding of this naturally occurring communication channel and inform social media communication efforts aiming to use personal stories to reach individuals with serious illnesses. OBJECTIVE: The objective of our study was to provide an in-depth description of authentic personal cancer stories. Through a linguistically based narrative analysis of YouTube stories, the analysis explicates the common attributes of these narratives. METHODS: Informed by narrative theories, we conducted an iterative, bottom-up analysis of 35 YouTube videos identified by the search terms "cancer survivor" and "cancer stories". A list of shared thematic and linguistic characteristics was identified and analyzed. RESULTS: A subnarrative on the cancer diagnosis was present in 86% (30/35) of the stories under analysis. These diagnostic narratives were characterized by dramatic tension, emotional engagement, markers of the loss of agency or control, depersonalized reference to the medical personnel, and the unexpectedness of a cancer diagnosis. The analysis highlights the themes of story authenticity and emotional engagement in this online communication medium. CONCLUSIONS: Internet advances have enabled new and efficient exchange of personal stories, including the sharing of personal cancer experience among cancer survivors and their caregivers. The analytic results of this descriptive study point to the common characteristics of authentic cancer survivorship stories online. Furthermore, the results of this descriptive study may inform development of narrative-based communication, particularly in maintaining authenticity and emotional engagement.

Cracking Down On Youth Tobacco May Influence Drug Use.

This study evaluated the influence of tobacco Possession-Use-Purchase (PUP) law enforcement and illicit drug use and offers. Twenty-four towns were randomly assigned into two conditions. Both conditions focused on reducing minors' access to commercial sources of tobacco. The communities assigned to the experimental condition also increased their PUP law enforcement, whereas among communities in the control condition, PUP law enforcement remained at low levels. A Hierarchical Linear Modeling analytical approach was selected due to the multilevel data and nested design. The likelihood of a child currently using drugs, ever having used drugs, or illicit drug offers was lower in the experimental versus control conditions. These outcomes suggest that police efforts to reduce specific substance use behaviors (i.e., underage tobacco use) may have a positive spillover effect and help reduce teen drug use and illicit drug offers.

Social media use in the United States: implications for health communication.

BACKGROUND: Given the rapid changes in the communication landscape brought about by participative Internet use and social media, it is important to develop a better understanding of these technologies and their impact on health communication. The first step in this effort is to identify the characteristics of current social media users. Up-to-date reporting of current social media use will help monitor the growth of social media and inform health promotion/communication efforts aiming to effectively utilize social media. OBJECTIVE: The purpose of the study is to identify the sociodemographic and health-related factors associated with current adult social media users in the United States. METHODS: Data came from the 2007 iteration of the Health Information National Trends Study (HINTS, N = 7674). HINTS is a nationally representative cross-sectional survey on health-related communication trends and practices. Survey respondents who reported having accessed the Internet (N = 5078) were asked whether, over the past year, they had (1) participated in an online support group, (2) written in a blog, (3) visited a social networking site. Bivariate and multivariate logistic regression analyses were conducted to identify predictors of each type of social media use. RESULTS: Approximately 69% of US adults reported having access to the Internet in 2007. Among Internet users, 5% participated in an online support group, 7% reported blogging, and 23% used a social networking site. Multivariate analysis found that younger age was the only significant predictor of blogging and social networking site participation; a statistically significant linear relationship was observed, with younger categories reporting more frequent use. Younger age, poorer subjective health, and a personal cancer experience predicted support group participation. In general, social media are penetrating the US population independent of education, race/ethnicity, or health care access. CONCLUSIONS: Recent growth of social media is not uniformly distributed across age groups; therefore, health communication programs utilizing social media must first consider the age of the targeted population to help ensure that messages reach the intended audience. While racial/ethnic and health status-related disparities exist in Internet access, among those with Internet access, these characteristics do not affect social media use. This finding suggests that the new technologies, represented by social media, may be changing the communication pattern throughout the United States.

Youth tobacco access and possession policy interventions: effects on observed and perceived tobacco use.

This study evaluated the effects of tobacco Purchase, Use and Possession (PUP) laws on student perceptions of adolescent tobacco use within towns and schools. Twenty-four towns were randomly assigned into two conditions, the experimental condition (E PUP) involved efforts to increase both PUP law enforcement and reduce minors' access to commercial sources of tobacco, whereas the control condition (C) focused only on efforts to reduce minors' access to commercial sources of tobacco. A hierarchical linear modeling analytical approach was selected due to the multilevel data and nested design. The present study found that over time, youth in the experimental PUP condition observed less youth tobacco usage at school and in their town, and perceived lower rates of tobacco among their peers at school and among friends than youth in the control condition. The findings suggest that PUP law enforcement might be used to strengthen community norms against youth tobacco use.

Effects of youth tobacco access and possession policy interventions on heavy adolescent smokers.

This study evaluated the effects of tobacco PUP (Purchase, Use and Possession) laws on tobacco use patterns among students in twenty-four towns, which were randomly assigned into an experimental and a control group. The experimental group involved both PUP law enforcement and reducing minors' access to commercial sources of tobacco, and the condition for the control group involved only efforts to reduce minors' access to commercial sources of tobacco. The present study found that adolescents in the control group had a significantly greater increase in the percentage of youth who smoked 20 or more cigarettes per day when compared to the experimental group.

The relationship between school policies and youth tobacco use.

BACKGROUND: The school setting is frequently used both to educate youth about risks involved in tobacco use and to implement tobacco prevention and cessation programs. Given that school-based programs have resulted in limited success, it is necessary to identify other setting-level intervention strategies. School tobacco policies represent a type of universal intervention that might have some promise for preventing or reducing tobacco use. METHODS: Hierarchical linear modeling was used to assess whether school tobacco policies were related to observations of tobacco use and current smoking among 16,561 seventh through twelfth graders attending 40 middle and high schools in Illinois. RESULTS: Results indicated that the enforcement of school tobacco policies, but not the comprehensiveness of those policies, was associated with fewer observations of tobacco use by minors on school grounds as well as lower rates of current smoking among students. CONCLUSIONS: The school setting is a key system to impact youth tobacco use. Findings underscore the need to train school personnel to enforce school tobacco policy.

Youth caught in violation of tobacco purchase, use, and possession laws: education versus fines.

Each day, thousands of children are caught for violation of tobacco purchase, use, and possession (PUP) laws. Little is known about their impact on violators; we do not know how the youth who are caught perceive these consequences or the effects they have on their tobacco use. Moreover, many communities are beginning to use brief tobacco education programs as a diversion from the normal processing of PUP law violators (i.e., fining the youth violator) without knowing the consequences of these classes. Consequently, it is important to review the literature and studies that have evaluated the effects of civic fines versus tobacco education as a consequence for PUP law violations. A consolidation of this information along with a presentation of pilot data on this issue might suggest areas of needed future research as well as help policy officials make decisions about best practices in their communities regarding these types of laws.

Do fines for violating possession-use-purchase laws reduce youth tobacco use?

The present brief report followed children exposed to consequences for violating Purchase, Use, and Possession (PUP) laws over time to assess changes in their smoking status. Youth in 24 towns were surveyed once a year for 3 years, and rates of tobacco use for those fined for PUP law violations were assessed. Of those who were given a ticket for a PUP law violation, 35 (39%) reported not smoking during year 1. Students in grade 7 were more likely to have quit smoking (84%) than those in grade 8 (35%), grade 9 (32%), or grade 10 (21%). For the two follow-up years, 45% and 41% reported not smoking. Assuming those who attrited were smokers, it is possible that about 15% to 24% of the original sample of children cited actually quit smoking over the follow-up period. The implications of these findings are discussed.

University of Rhode Island Change Assessment-Trauma: preliminary psychometric properties in an alcohol-dependent PTSD sample.

The co-occurrence of posttraumatic stress disorder with substance use disorders (PTSD-SUD) is common and is associated with poorer treatment outcomes. Attrition represents an ongoing, but poorly understood challenge in PTSD-SUD treatment research. The current study examined the initial psychometric properties of the University of Rhode Island Change Assessment-Trauma (URICA-T), a scale designed to assess attitudes and behaviors related to addressing trauma issues, in a sample of 42 individuals meeting diagnostic criteria for PTSD and alcohol dependence. Results suggest that the URICA-T may have acceptable psychometric properties as a continuous measure of motivational readiness in a PTSD-SUD sample. Preliminary data also suggests higher URICA-T scores are associated with retention of alcohol dependent-PTSD participants in a study utilizing trauma-focused exposure.