Online Social Networks for Dissemination of Smoking Cessation Interventions

描述（由申请人提供）：大规模减少吸烟率是公共卫生的当务之急。PHS临床实践指南推荐的循证干预措施存在，但未得到充分利用。即使是能够以具有成本效益的方式传播的简短干预措施，也无法达到目前4400万吸烟者中的绝大多数，例如通过包括互联网在内的多种方式提供的基于5A模式（询问、建议、评估、协助、安排）的干预措施。研究和荟萃分析表明，基于证据的在线干预措施是有效的，禁欲的相对风险为1.44，戒烟率为7- 26%。我们以前的工作表明，成功的互联网戒烟是由用户融入网站社交网络的程度介导的：整合几乎是3倍（OR=2.71），3个月后戒烟的机会，而积极使用互动工具的戒烟率在6个月时增加了一倍多（21.9%对8.3%）。从理论上讲，这些项目的广泛普及应该会对吸烟率产生显著影响（影响=达到x功效）：大多数（74%）的美国成年人是互联网用户，包括西班牙裔（64%），黑人（70%）和收入低于30美元的人，报告显示，每年有6-9%的互联网用户（超过1000万成年人）搜索戒烟。尽管如此，我们和其他人的工作表明，只有三分之一的搜索者达到了基于证据的干预措施，其中不到四分之一的用户利用了2008年指南建议的社会支持。为了实现在线干预措施的承诺并产生重大的公共卫生影响，需要在干预措施的制定方面进行重大的范式转变-干预措施必须积极地在线分发给吸烟者。这项拟议的研究是一项随机试验的贡献者扩散的循证戒烟软件应用程序嵌入在Facebook的社交网络。它旨在通过测试一种新的扩散策略，通过大规模现有的在线社交网络进行循证干预，从而扩展现有的理论和实践。这项研究结合了连锁招聘技术（“病毒传播”）与以前验证的互联网戒烟方法传播。干预设计和评估将使用多阶段方法，将戒烟应用程序的多个假设驱动的变体植入Facebook，并在析因模型下检测不同变体组件之间的相互作用。我们的目标是确定干预措施的特点，从而修改变量，直接影响扩散（繁殖率），并最终增加我们的知识基础，构建干预措施能够自我传播和分布。这项研究将增加我们的知识基础和理论，以帮助定义一个新的模式，广泛传播的行为干预和公共卫生的影响。这些研究结果将使短期内，未来一代有效的卫生干预措施，以低成本，有效的方式传播到广大人口。 公共卫生相关性：通过互联网提供戒烟的有效循证干预措施存在，但消费者的接受度和依从性仍然很低。需要有可扩展和有效的机制来在线传播这些干预措施，现有的在线社交网络提供了一个潜在的机制。这是一项通过大规模Facebook社交网络传播循证干预措施的随机析因试验，目的是确定驱动病毒传播的干预特征。

DESCRIPTION (provided by applicant): Large scale reduction in smoking prevalence is a public health imperative. Evidenced based interventions recommended by the PHS Clinical Practice Guideline for Treatment exist but are massively underutilized. Even brief interventions that can be cost efficiently disseminated do not reach the vast majority of 44 million current smokers - such as those based on the 5A model (Ask, Advise, Assess, Assist, Arrange) delivered over multiple modalities including the Internet. Studies and meta-analysis show evidence based online interventions are effective with a relative risk of abstinence of 1.44 and quit rates of 7-26%. Our previous work suggests that successful Internet cessation is mediated by the degree of a user's integration into the site's social network: integration almost triples (OR=2.71) the chances of quitting 3 months later, while active use of interactive tools more than doubled rates of cessation (21.9% vs. 8.3%) at 6 months. In theory, wide availability of these programs should provide for a marked impact on smoking rates (impact = reach x efficacy): the majority (74%) of US adults are Internet users, including Hispanics (64%), Blacks (70%), and those with incomes less than $30,000/year (60%) while reports show 6-9% of all Internet users (more than 10 million adults) search for quitting smoking annually. Despite this, our work and that of others, indicates that only a third of searchers reach evidence based interventions and of those less than a quarter of users take advantage the social support recommended by the 2008 Guideline. To meet the promise of online interventions and make a significant public health impact, a major paradigm shift in intervention development is needed - interventions must be actively distributed to smokers online. The proposed study is a randomized trial of the contributors to diffusion of an evidence-based software application for smoking cessation embedded within the Facebook social network. It aims to extend existing theory and practice by testing a novel diffusion strategy for an evidence-based intervention through a large-scale existing online social network. This study combines chain recruitment techniques ("viral spread") for dissemination with previously validated Internet cessation approaches. Intervention design and evaluation will use a multi-phase methodology, seeding multiple, hypothesis-driven variants of a smoking cessation application into Facebook, and powered to detect interaction effects between the components of different variants under a factorial model. The goal is to determine the intervention characteristics, and thus modifiable variables, that directly impact diffusion (the reproductive rate) and ultimately add to our knowledge base about constructing interventions capable of self-propagation and distribution. This study will add to our knowledge base and theory to help define a new paradigm for broad scale dissemination of behavioral interventions and public health impact. These findings will enable a near-term, future generation of effective health interventions to be disseminated to large populations in a low-cost, efficient manner. PUBLIC HEALTH RELEVANCE: Effective evidence-based interventions exist for smoking cessation delivered over the Internet, but consumer acceptance and adherence remains low. Scalable and efficient mechanisms to disseminate these interventions online are needed, and existing online social networks provide a potential mechanism. This is a proposal for a randomized, factorial trial of the dissemination of an evidence-based intervention through the massive Facebook social network, with the goal of determining intervention characteristics that drive viral spread.