Background

Facebook's advertising platform reaches most US households and has been used for health-related research recruitment. The platform allows for advertising segmentation by age, gender, and location; however, it does not explicitly allow for targeting by race or ethnicity to facilitate a diverse participant pool.

Objective

This study looked at the efficacy of zip code targeting in Facebook advertising to reach blacks/African Americans and Hispanics/Latinos who smoke daily for a quit-smoking web-based social media study.

Methods

We ran a general market campaign for 61 weeks using all continental US zip codes as a baseline. Concurrently, we ran 2 campaigns to reach black/African American and Hispanic-/Latino-identified adults, targeting zip codes ranked first by the percentage of households of the racial or ethnic group of interest and then by cigarette expenditure per household. We also ran a Spanish language campaign for 13 weeks, targeting all continental US zip codes but utilizing Facebook's Spanish language targeting. The advertising images and language were common across campaigns. Costs were compared for advertisement clicks, queries, applications, and participants, and yields were compared for the final three outcomes. We examined outcomes before and after the Cambridge Analytica scandal that broke in March 2018. Finally, we examined 2 promoted Facebook features: lookalike audiences and audience network placement.

Results

Zip code targeting campaigns were effective for yielding the racial or ethnic groups of interest. The black-/African American-focused versus general market campaign increased black/African American weekly queries (mean 9.48, SD 5.69 vs general market mean 2.83, SD 2.05; P<.001) and applicants (mean 1.11, SD 1.21 vs general market mean 0.54, SD 0.58; P<.001). The Hispanic-/Latino-focused versus general market campaign increased Hispanic/Latino weekly queries (mean 3.10, SD 2.16 vs general market mean 0.71, SD 0.48; P<.001) and applicants (mean 0.36, SD 0.55 vs general market mean 0.10, SD 0.14; P=.001). Cost metrics did not differ between campaigns at generating participants (overall P=.54). Costs increased post- versus prescandal for the black-/African American-focused campaign for queries (mean US $8.51, SD 3.08 vs US $5.87, SD 1.89; P=.001) and applicants (mean US $59.64, SD 35.63 vs US $38.96, SD 28.31; P=.004) and for the Hispanic-/Latino-focused campaign for queries (mean US $9.24, SD 4.74 vs US $7.04, SD 3.39; P=.005) and applicants (mean US $61.19, SD 40.08 vs US $38.19, SD 21.20; P=.001).

Conclusions

Zip code targeting in Facebook advertising is an effective way to recruit diverse populations for health-based interventions. Audience network placement should be avoided. The Facebook lookalike audience may not be necessary for recruitment, with drawbacks including an unknown algorithm and unclear use of Facebook user data, and so public concerns around data privacy should be considered.

Trial registration

ClinicalTrial.gov NCT02823028; https://clinicaltrials.gov/ct2/show/NCT02823028.

BACKGROUND

Facebook’s advertising platform reaches most US households and has been used for health-related research recruitment. The platform allows for advertising segmentation by age, gender, and location; however, it does not explicitly allow for targeting by race or ethnicity to facilitate a diverse participant pool.

OBJECTIVE

This study looked at the efficacy of zip code targeting in Facebook advertising to reach blacks/African Americans and Hispanics/Latinos who smoke daily for a quit-smoking web-based social media study.

METHODS

We ran a general market campaign for 61 weeks using all continental US zip codes as a baseline. Concurrently, we ran 2 campaigns to reach black/African American and Hispanic-/Latino-identified adults, targeting zip codes ranked first by the percentage of households of the racial or ethnic group of interest and then by cigarette expenditure per household. We also ran a Spanish language campaign for 13 weeks, targeting all continental US zip codes but utilizing Facebook’s Spanish language targeting. The advertising images and language were common across campaigns. Costs were compared for advertisement clicks, queries, applications, and participants, and yields were compared for the final three outcomes. We examined outcomes before and after the Cambridge Analytica scandal that broke in March 2018. Finally, we examined 2 promoted Facebook features: lookalike audiences and audience network placement.

RESULTS

Zip code targeting campaigns were effective for yielding the racial or ethnic groups of interest. The black-/African American–focused versus general market campaign increased black/African American weekly queries (mean 9.48, SD 5.69 vs general market mean 2.83, SD 2.05; P<.001) and applicants (mean 1.11, SD 1.21 vs general market mean 0.54, SD 0.58; P<.001). The Hispanic-/Latino-focused versus general market campaign increased Hispanic/Latino weekly queries (mean 3.10, SD 2.16 vs general market mean 0.71, SD 0.48; P<.001) and applicants (mean 0.36, SD 0.55 vs general market mean 0.10, SD 0.14; P=.001). Cost metrics did not differ between campaigns at generating participants (overall P=.54). Costs increased post- versus prescandal for the black-/African American–focused campaign for queries (mean US $8.51, SD 3.08 vs US $5.87, SD 1.89; P=.001) and applicants (mean US $59.64, SD 35.63 vs US $38.96, SD 28.31; P=.004) and for the Hispanic-/Latino-focused campaign for queries (mean US $9.24, SD 4.74 vs US $7.04, SD 3.39; P=.005) and applicants (mean US $61.19, SD 40.08 vs US $38.19, SD 21.20; P=.001).

CONCLUSIONS

Zip code targeting in Facebook advertising is an effective way to recruit diverse populations for health-based interventions. Audience network placement should be avoided. The Facebook lookalike audience may not be necessary for recruitment, with drawbacks including an unknown algorithm and unclear use of Facebook user data, and so public concerns around data privacy should be considered.

CLINICALTRIAL

ClinicalTrial.gov NCT02823028; https://clinicaltrials.gov/ct2/show/NCT02823028

Purpose

We aimed to better understand hesitancy to use nicotine replacement therapy (NRT) to quit smoking.

Design

We content coded and analyzed NRT-related posts in online quit smoking support groups to understand NRT-use hesitancy and to examine associations with health outcomes.

Setting

NRT posts were analyzed in unmoderated social-media support groups with free NRT.

Sample

Adults who smoked daily (n = 438) and posted about NRT were studied, 339 of whom reported on NRT usage and 403 reported on smoking abstinence.

Measures

Surveys at 1-month post-quit date assessed NRT usage and smoking abstinence.

Analysis

Relationships among NRT posts, NRT usage and smoking abstinence were analyzed using GEE models accounting for support group and covariates.

Results

Nearly all (96.17%) participants reported using the study-provided NRT once, most (70.21%) used NRT during the past week, but less than half (45.72%) used NRT daily for the full month as recommended. Nearly two-thirds (65.34%) of NRT posts were negative. Posts reflecting dislike or no longer needing NRT were associated with a lower likelihood of using NRT in the past week at least once (B = -.66, P = .005 and B = -.37, P = .045), use occasions (B = -1.86, P = .018 and B = -1.10, P = .016) and used daily for full month (B = -.56, P = .044 and B = -.53, P = .009). Posts related to the effectiveness of NRT related to past-week NRT used at least once (B = .15, P = .023), used daily for full month (B = .25, P = .001), and smoking abstinence (B = .27, P = .002).

Conclusion

Strategies are needed to address dislike of NRT and strengthen perceptions of NRT efficacy, especially on social media where posts may be amplified.

Background

Existing smoking cessation treatments are challenged by low engagement and high relapse rates, suggesting the need for more innovative, accessible, and interactive treatment strategies. Twitter is a Web-based platform that allows people to communicate with each other throughout the day using their phone.

Objective

This study aims to leverage the social media platform of Twitter for fostering peer-to-peer support to decrease relapse with quitting smoking. Furthermore, the study will compare the effects of coed versus women-only groups on women's success with quitting smoking.

Methods

The study design is a Web-based, three-arm randomized controlled trial with two treatment arms (a coed or women-only Twitter support group) and a control arm. Participants are recruited online and are randomized to one of the conditions. All participants will receive 8 weeks of combination nicotine replacement therapy (patches plus their choice of gum or lozenges), serial emails with links to Smokefree.gov quit guides, and instructions to record their quit date online (and to quit smoking on that date) on a date falling within a week of initiation of the study. Participants randomized to a treatment arm are placed in a fully automated Twitter support group (coed or women-only), paired with a buddy (matched on age, gender, location, and education), and encouraged to communicate with the group and buddy via daily tweeted discussion topics and daily automated feedback texts (a positive tweet if they tweet and an encouraging tweet if they miss tweeting). Recruited online from across the continental United States, the sample consists of 215 male and 745 female current cigarette smokers wanting to quit, aged between 21 and 59 years. Self-assessed follow-up surveys are completed online at 1, 3, and 6 months after the date they selected to quit smoking, with salivary cotinine validation at 3 and 6 months. The primary outcome is sustained biochemically confirmed abstinence at the 6-month follow-up.

Results

From November 2016 to September 2018, 960 participants in 36 groups were recruited for the randomized controlled trial, in addition to 20 participants in an initial pilot group. Data analysis will commence soon for the randomized controlled trial based on data from 896 of the 960 participants (93.3%), with 56 participants lost to follow-up and 8 dropouts.

Conclusions

This study combines the mobile platform of Twitter with a support group for quitting smoking. Findings will inform the efficacy of virtual peer-to-peer support groups for quitting smoking and potentially elucidate gender differences in quit rates found in prior research.

Trial registration

ClinicalTrials.gov NCT02823028; https://clinicaltrials.gov/ct2/show/NCT02823028.

International registered report identifier (irrid)

DERR1-10.2196/16417.

BACKGROUND

Existing smoking cessation treatments are challenged by low engagement and high relapse rates, suggesting the need for more innovative, accessible, and interactive treatment strategies. Twitter is a Web-based platform that allows people to communicate with each other throughout the day using their phone.

OBJECTIVE

This study aims to leverage the social media platform of Twitter for fostering peer-to-peer support to decrease relapse with quitting smoking. Furthermore, the study will compare the effects of coed versus women-only groups on women’s success with quitting smoking.

METHODS

The study design is a Web-based, three-arm randomized controlled trial with two treatment arms (a coed or women-only Twitter support group) and a control arm. Participants are recruited online and are randomized to one of the conditions. All participants will receive 8 weeks of combination nicotine replacement therapy (patches plus their choice of gum or lozenges), serial emails with links to Smokefree.gov quit guides, and instructions to record their quit date online (and to quit smoking on that date) on a date falling within a week of initiation of the study. Participants randomized to a treatment arm are placed in a fully automated Twitter support group (coed or women-only), paired with a buddy (matched on age, gender, location, and education), and encouraged to communicate with the group and buddy via daily tweeted discussion topics and daily automated feedback texts (a positive tweet if they tweet and an encouraging tweet if they miss tweeting). Recruited online from across the continental United States, the sample consists of 215 male and 745 female current cigarette smokers wanting to quit, aged between 21 and 59 years. Self-assessed follow-up surveys are completed online at 1, 3, and 6 months after the date they selected to quit smoking, with salivary cotinine validation at 3 and 6 months. The primary outcome is sustained biochemically confirmed abstinence at the 6-month follow-up.

RESULTS

From November 2016 to September 2018, 960 participants in 36 groups were recruited for the randomized controlled trial, in addition to 20 participants in an initial pilot group. Data analysis will commence soon for the randomized controlled trial based on data from 896 of the 960 participants (93.3%), with 56 participants lost to follow-up and 8 dropouts.

CONCLUSIONS

This study combines the mobile platform of Twitter with a support group for quitting smoking. Findings will inform the efficacy of virtual peer-to-peer support groups for quitting smoking and potentially elucidate gender differences in quit rates found in prior research.

CLINICALTRIAL

ClinicalTrials.gov NCT02823028; https://clinicaltrials.gov/ct2/show/NCT02823028

Circulating monocytes participate in pain chronification but the molecular events that cause their deployment are unclear. Using a mouse model of hyperalgesic priming (HP), we show that monocytes enable progression to pain chronicity through a mechanism that requires transient activation of the hydrolase, N-acylethanolamine acid amidase (NAAA), and the consequent suppression of NAAA-regulated lipid signaling at peroxisome proliferator-activated receptor-α (PPAR-α). Inhibiting NAAA in the 72 hours following administration of a priming stimulus prevented HP. This effect was phenocopied by NAAA deletion and depended on PPAR-α recruitment. Mice lacking NAAA in CD11b+ cells - monocytes, macrophages, and neutrophils - were resistant to HP induction. Conversely, mice overexpressing NAAA or lacking PPAR-α in the same cells were constitutively primed. Depletion of monocytes, but not resident macrophages, generated mice that were refractory to HP. The results identify NAAA-regulated signaling in monocytes as a control node in the induction of HP and, potentially, the transition to pain chronicity.