Facebook Recruitment of Young Adult Smokers for a Cessation Trial: Methods, Metrics, and Lessons Learned.
ABSTRACT: Further understanding is needed of the functionalities and efficiency of social media for health intervention research recruitment. Facebook was examined as a mechanism to recruit young adults for a smoking cessation intervention. An ad campaign targeting young adult smokers tested specific messaging based on market theory and successful strategies used to recruit smokers in previous clinical trials (i.e. informative, call to action, scarcity, social norms), previously successful ads, and general messaging. Images were selected to target smokers (e.g., lit cigarette), appeal to the target age, vary demographically, and vary graphically (cartoon, photo, logo). Facebook's Ads Manager was used over 7 weeks (6/10/13 - 7/29/13), targeted by age (18-25), location (U.S.), and language (English), and employed multiple ad types (newsfeed, standard, promoted posts, sponsored stories) and keywords. Ads linked to the online screening survey or study Facebook page. The 36 different ads generated 3,198,373 impressions, 5,895 unique clicks, at an overall cost of $2,024 ($0.34/click). Images of smoking and newsfeed ads had the greatest reach and clicks at the lowest cost. Of 5,895 unique clicks, 586 (10%) were study eligible and 230 (39%) consented. Advertising costs averaged $8.80 per eligible, consented participant. The final study sample (n=79) was largely Caucasian (77%) and male (69%), averaging 11 cigarettes/day (SD=8.3) and 2.7 years smoking (SD=0.7). Facebook is a useful, cost-effective recruitment source for young adult smokers. Ads posted via newsfeed posts were particularly successful, likely because they were viewable via mobile phone. Efforts to engage more ethnic minorities, young women, and smokers motivated to quit are needed.
Project description:This study tested engagement in and acceptability of a digital smoking cessation intervention designed for young adults and tailored to sexual and gender minority (SGM) individuals. The intervention included 90 Facebook posts delivered in private groups tailored to readiness to quit smoking (Ready to quit in 30 days/Not Ready; 180 posts total; 101 posts SGM-tailored by content/image). Acceptability was evaluated over 30 days (3 posts/day). Participants' (N = 27) open-ended feedback was coded and tallied; posts with significant negative feedback were flagged for change. Flags and comment volume were examined by SGM tailoring (versus not tailored) and content category (motivational interviewing, experiential strategies, behavioral strategies, relevant topics). Engagement and acceptability were high. All participants reported viewing at least half of the posts, and the majority reported viewing all 90 posts (M comments per participant = 51.74). The majority of participants agreed or strongly agreed with statements about the intervention's helpfulness and clarity. Posts received an average of 8.08 comments (SD = 2.58), with 59 posts (32.8%) flagged for change. Posts engaged comments and were found to be acceptable at comparable levels regardless of SGM tailoring and content category (all p-values > .189). SGM young adult smokers were highly engaged in an SGM-tailored smoking cessation intervention on Facebook and rated the intervention positively. Both tailored and non-tailored Facebook posts in a variety of content areas were generally well-received by SGM young adults, an underserved population with high rates of smoking.
Project description:Facebook advertisements were used to recruit nulliparous women in the first 20 weeks of pregnancy for an online survey about their childbirth preferences. A campaign of ads was targeted to women, aged 18 to 44 years, residing in the United States. The ads were viewed 10,577,381 times by 7,248,985 unique Facebook users over 18 weeks in 2011. The ad campaign yielded 6,094 clicks by 5,963 unique users at a mean cost of $0.63 per click and a unique click-through rate of 0.08%. Of those who clicked through to the study site, 18% (n = 1,075) consented to participate. The participant pool was reduced to 344 women after application of strict eligibility criteria. Participants represented 43 states and the District of Columbia, their mean age was 20.9 years (Mdn = 19.0, SD = 4.0), and their mean weeks' gestation was 11.5 (SD = 5.8). The campaign cost was $3,821.81 or $11.11 per eligible participant.
Project description:INTRODUCTION:This trial investigated whether a Facebook smoking cessation intervention culturally tailored to young sexual and gender minority (SGM) smokers (versus non-tailored) would increase smoking abstinence. METHODS:Participants were 165 SGM young adult US smokers (age 18-25) recruited from Facebook in April 2018 and randomized to an SGM-tailored (POP; N = 84) or non-tailored (TSP-SGM; N = 81) intervention. Interventions delivered weekly live counseling sessions and 90 daily Facebook posts to participants in Facebook groups. Primary analyses compared POP and TSP-SGM on biochemically verified smoking abstinence (yes/no; primary outcome), self-reported 7-day point prevalence abstinence (yes/no), reduction in cigarettes per week by 50+% from baseline (yes/no), making a quit attempt during treatment (yes/no), and stage of change (precontemplation/contemplation vs. preparation/action). Supplemental analyses compared POP to two historical control groups. RESULTS:POP participants were more likely than TSP-SGM participants to report smoking abstinence at 3 (23.8% vs. 12.3%; OR = 2.50; p = .03) and 6 months (34.5% vs. 12.3%; OR = 4.06; p < .001) and reduction in smoking at 3 months (52.4% vs. 39.5%; OR = 2.11; p = .03). Biochemically verified smoking abstinence did not significantly differ between POP and TSP-SGM at 3 (OR = 2.00; p = .33) or 6 months (OR = 3.12; p = .08), potentially due to challenges with remote biochemical verification. In supplemental analyses, POP participants were more likely to report abstinence at 3 (OR = 6.82, p = .01) and 6 (OR = 2.75, p = .03) months and reduced smoking at 3 months (OR = 2.72, p = .01) than participants who received a referral to Smokefree.gov. CONCLUSIONS:This pilot study provides preliminary support for the effectiveness of a Facebook smoking cessation intervention tailored to SGM young adults. IMPLICATIONS:SGM individuals have disproportionately high smoking prevalence. It is unclear whether smoking cessation interventions culturally tailored to the SGM community are more effective than non-tailored interventions. This pilot trial found preliminary evidence that an SGM-tailored Facebook smoking cessation intervention increased reported abstinence from smoking, compared to a non-tailored intervention. TRIAL REGISTRATION:NCT03259360.
Project description:New dissemination methods are needed to engage physicians in evidence-based continuing medical education (CME).To examine the effectiveness of social media in engaging physicians in non-industry-sponsored CME.We tested the effect of different media platforms (e-mail, Facebook, paid Facebook and Twitter), CME topics, and different "hooks" (e.g., Q&A, clinical pearl and best evidence) on driving clicks to a landing site featuring non-industry sponsored CME. We modelled the effects of social media platform, CME topic, and hook using negative binomial regression on clicks to a single landing site. We used clicks to landing site adjusted for exposure and message number to calculate rate ratios. To understand how physicians interact with CME content on social media, we also conducted interviews with 10 physicians.The National Physicians Alliance (NPA) membership.NPA e-mail recipients, Facebook followers and friends, and Twitter followers.Clicks to the NPA's CME landing site.On average, 4,544 recipients received each message. Messages generated a total of 592 clicks to the landing site, for a rate of 5.4 clicks per 1000 recipients exposed. There were 5.4 clicks from e-mail, 11.9 clicks from Facebook, 5.5 clicks from paid Facebook, and 6.9 clicks from Twitter to the landing site for 1000 physicians exposed to each of 4 selected CME modules. A Facebook post generated 2.3x as many clicks to the landing site as did an e-mail after controlling for participant exposure, hook type and CME topic (p<0.001). Twitter posts (p = 0.13) and paid Facebook posts (p = 0.06) were not statistically different from e-mail in generating clicks to the landing site. Use of different hooks to engage physicians had no impact on clicks to the landing site. Interviews with physicians suggested that social media might not be a preferred vehicle for disseminating CME.Social media has a modest impact on driving traffic to evidence-based CME options. Facebook had a superior effect on driving physician web traffic to evidence-based CME compared to other social media platforms and email.
Project description:BACKGROUND:Social media use continues to gain momentum in academic neurosurgery. To increase journal impact and broaden engagement, many scholarly publications have turned to social media to disseminate research. The Journal of Neurosurgery Publishing Group (JNSPG) established a dedicated, specialized social media team (SMT) in November 2016 to provide targeted improvement in digital outreach. OBJECTIVE:The goal of this study was to examine the impact of the JNSPG SMT as measured by increased engagement. METHODS:We analyzed various metrics, including impressions, engagements, retweets, likes, profile clicks, and URL clicks, from consecutive social media posts from the JNSPG's Twitter and Facebook platforms between February 1, 2015 and February 28, 2019. Standard descriptive statistics were utilized. RESULTS:Between February 2015 and October 2016, when a specialized SMT was created, 170 tweets (8.1 tweets/month) were posted compared to 3220 tweets (115.0 tweets/month) between November 2016 and February 2019. All metrics significantly increased, including the impressions per tweet (mean 1646.3, SD 934.9 vs mean 4605.6, SD 65,546.5; P=.01), engagements per tweet (mean 35.2, SD 40.6 vs mean 198.2, SD 1037.2; P<.001), retweets (mean 2.5, SD 2.8 vs mean 10.5, SD 15.3; P<.001), likes (mean 2.5, SD 4.0 vs mean 18.0, SD 37.9; P<.001), profile clicks (mean 1.5, SD 2.0 vs mean 5.2, SD 43.3; P<.001), and URL clicks (mean 13.1, SD 14.9 vs mean 38.3, SD 67.9; P<.001). Tweets that were posted on the weekend compared to weekdays had significantly more retweets (mean 9.2, SD 9.8 vs mean 13.4, SD 25.6; P<.001), likes (mean 15.3, SD 17.9 vs mean 23.7, SD 70.4; P=.001), and URL clicks (mean 33.4, SD 40.5 vs mean 49.5, SD 117.3; P<.001). Between November 2015 and October 2016, 49 Facebook posts (2.3 posts/month) were sent compared to 2282 posts (81.5 posts/month) sent between November 2016 and February 2019. All Facebook metrics significantly increased, including impressions (mean 5475.9, SD 5483.0 vs mean 8506.1, SD 13,113.9; P<.001), engagements (mean 119.3, SD 194.8 vs mean 283.8, SD 733.8; P<.001), and reach (mean 2266.6, SD 2388.3 vs mean 5344.1, SD 8399.2; P<.001). Weekend Facebook posts had significantly more impressions per post (mean 7967.9, SD 9901.0 vs mean 9737.8, SD 19,013.4; P=.03) and a higher total reach (mean 4975.8, SD 6309.8 vs mean 6108.2, SD 12,219.7; P=.03) than weekday posts. CONCLUSIONS:Social media has been established as a crucial tool for the propagation of neurosurgical research and education. Implementation of the JNSPG specialized SMT had a demonstrable impact on increasing the online visibility of social media content.
Project description:BACKGROUND:Substance use among young pregnant women is a common and significant public health concern associated with a number of adverse outcomes for both mothers and infants. Social media posts by young women can provide valuable, real-world insight into their perceptions of substance use immediately before and during pregnancy. OBJECTIVE:The aim of this study was to characterize the frequency and content of posts regarding substance use in the year before pregnancy and during pregnancy among young mothers. METHODS:Facebook posts were mined from young pregnant women (age, 16-24 years) who consented from 2 Midwest primary care clinics that serve a predominantly low-income community. Natural language processing was used to identify posts related to substance use by keyword searching (eg, drunk, drugs, pot, and meth). Using mixed-methods techniques, 2 investigators iteratively coded and identified major themes around substance use from these mined Facebook posts. Outcome measures include the frequency of posts and major themes expressed regarding substance use before and during pregnancy. RESULTS:Women in our sample (N=43) had a mean age of 21 (SD 2.3) years, and the largest subgroup (21/43, 49%) identified as non-Hispanic black; 26% (11/43) identified as non-Hispanic white; 16% (7/43) as Hispanic; and 9% (4/43) as non-Hispanic mixed race, Native American, or other. The largest subgroup (20/43, 47%) graduated high school without further education, while 30% (13/43) completed only some high school and 23% (10/43) completed at least some postsecondary education. Young women discussed substance use on social media before and during pregnancy, although compared with the year before pregnancy, the average frequency of substance-related posts during pregnancy decreased. Themes identified included craving alcohol or marijuana, social use of alcohol or marijuana, reasons for abstaining from substance use, and intoxication. CONCLUSIONS:Facebook posts reveal that young pregnant women discuss the use of substances, predominantly alcohol and marijuana. Future work can explore clinical opportunities to prevent and treat substance use before and during pregnancy among young, at-risk mothers.
Project description:BACKGROUND:Tobacco use and heavy episodic drinking (HED) commonly co-occur in young adults. We developed and tested usability of the Smoking Tobacco and Drinking (STAND) intervention for young adults delivered on Facebook. METHODS:To inform the intervention, focus groups were held with 25 young adults age 18 to 25 (12% female; Mean age?=?20.4) who smoked cigarettes and reported at least one HED episode in the past month. Facebook intervention posts (N?=?180) were tailored to readiness to quit smoking, and tested in two private Facebook behavioral change groups (Ready, Not Ready) with N?=?29 young adults (10% female; Mean age?=?20.8). Participants flagged posts in need of change, and we assessed engagement (comment frequency). RESULTS:Focus groups revealed preference for changing one substance at a time and greater receptivity to quitting smoking than reducing drinking. Mean comments per post were 5.3 (SD?=?1.1) in Ready groups and 11.7 (SD?=?5.1) in Not Ready groups; 94/180 (52.2%) posts were flagged for change. The level of engagement and the flagging of posts for change did not differ by group or by whether the post targeted tobacco, alcohol, or both substances combined (all p?>?.10). Overall, STAND was rated as easy to understand, providing sound advice, worthy of recommendation, and helpful (all agreement 100% among Ready; 50-70% among Not Ready). CONCLUSIONS:The current findings informed development of a social media-based intervention targeting tobacco and alcohol use in young adults. Although there was greater interest in making changes in smoking than drinking behavior, receptivity and acceptability of the Facebook post messages in the STAND intervention was high overall. The intervention is being further refined for evaluation in a larger trial. Trial registration Name of the registry Smoking Tobacco and Drinking Study (STAND); Trial registration number NCT03163303; Date of registration 5/23/17; URL of trial registry record https://clinicaltrials.gov/ct2/show/NCT03163303 .
Project description:BACKGROUND:Smoking cessation interventions delivered through social media have the potential to engage young people in behavior change. OBJECTIVE:The aim of this study was to describe participant-posted messages in a Facebook smoking cessation intervention for young adults to discern support for behavior change. METHODS:We qualitatively analyzed data from the treatment arm of a randomized trial testing the efficacy of the Tobacco Status Project Facebook intervention. Young adults (N=138) aged 18-25 years (female: 81/138, 58.7%; white: 101/138, 73.2%; mean age 21 years) were recruited using Facebook and placed into one of the 15 secret Facebook groups based on readiness-to-quit smoking. Messages posted to groups for 90 consecutive days were tailored to readiness-to-quit: Not Ready (46/138, 33.3%), Thinking (66/138, 47.8%), and Getting Ready (26/138, 18.8%). Groups were randomized to receive up to US $90 for posting or no incentive. Two independent coders conducted open coding of user posts. We considered content by readiness-to-quit group and incentive condition. RESULTS:There were 4 dominant themes across all groups: coping skills, friends and family, motivation to quit, and benefits of quitting. The dominant themes in Not Ready groups were friends and family (incentive) and motivation to quit (no incentive), whereas coping skills was the dominant theme in Thinking and Getting Ready groups. The expression of themes varied by readiness-to-quit group but not by incentive condition. CONCLUSIONS:Intervention messages tailored to readiness-to-quit appear useful in eliciting the desired responses from young adult smokers, with limited influence by monetary incentive. TRIAL REGISTRATION:ClinicalTrials.gov NCT02207036; https://clinicaltrials.gov/ct2/show/NCT02207036 (Archived by WebCite at http://www.webcitation.org/722XAEAAz).
Project description:INTRODUCTION:Exposure to "The Real Cost" campaign has prevented smoking initiation among its target audience (U.S. youth aged 12-17 years). This study examines reactions to "The Real Cost" advertisements among a potential secondary audience: U.S. young adults. METHODS:An online convenience sample of young adult (ages 18-29 years) smokers (n=225) and susceptible nonsmokers (n=339) participated in a within-subjects experiment in 2017. Participants viewed three TV ads from "The Real Cost" campaign and reported their past exposure to, conversations about, and reactions to the ads. In 2017, analyses examined message-level and person-level predictors of perceived message effectiveness using multilevel modeling. RESULTS:About half of smokers (47%) and susceptible nonsmokers (51%) had seen at least one of the three ads in the past 3 months. About one in four smokers (23%) and susceptible nonsmokers (24%) had at least one conversation about the ads in the past 3 months. Susceptible nonsmokers rated the ads higher on perceived message effectiveness than smokers (p<0.01), but lower on message relevance and negative affective reactions to the ads (both p<0.05). In both samples, ads that elicited higher negative affective reactions and message relevance, and lower message reactance (i.e., resistance) received higher perceived message effectiveness ratings (all p<0.05). CONCLUSIONS:"The Real Cost" ads have reached and generated conversations among a convenience sample of young adult smokers and susceptible nonsmokers. Increasing the perceived relevance and emotional reactions of campaigns may increase their impact. Future studies should examine reactions to "The Real Cost" campaign and effects on smoking behavior using nationally representative samples of young adults. SUPPLEMENT INFORMATION:This article is part of a supplement entitled Fifth Anniversary Retrospective of "The Real Cost," the Food and Drug Administration's Historic Youth Smoking Prevention Media Campaign, which is sponsored by the U.S. Food and Drug Administration.
Project description:Evidence shows that behavioral nudges could be used to enhance enrollment rates in randomized controlled trials (RCTs) by addressing enrollment barriers, but research on this topic is limited. We conducted an online field quasi-experiment with separate pretest (October 2017-January 2018) and posttest (February-May 2018) samples designed to examine the use of behavioral nudges to engage pregnant smokers in a couple-focused smoking cessation RCT relying on online enrollment through paid Facebook ads and a dedicated website, by reporting aggregate Facebook ads and Google Analytics data. The Facebook ads pretest conversion rate of 1.6% doubled and reached 3.41% in the posttest period. The pretest eligibility assessment rate decreased from 10.3% to 6.46%, but registered a relative increase of approximately 50% in the posttest period, as opposed to the pretest. The number of women who signed the informed consent in the posttest period has increased with 63%, from a proportion of 8.54% in the pretest to 11.73% in the posttest period. These findings might lend support to integrating behavioral nudges in the recruitment and enrollment materials of RCTs to boost enrollment.