Social media may be the most effective smoking quitline for young adults, a new study suggests.

Led by Danielle Ramo, an associate professor of psychiatry at UC San Francisco and member of its Weill Institute for Neurosciences, the researchers found that young adult smokers are 2.5 times more likely to quit smoking with programs conducted entirely on Facebook than other online quit-smoking programs.

The study is published in the journal Addiction.

The problem

As early as sixth grade, many kids have smoked their first cigarette. According a national survey in 2015, every day, about 2,300 kids under 18 try smoking for the first time, and more than 350 of them are expected to become new daily smokers.

Nicotine, a highly addictive drug in cigarettes, can severely damage physical and mental development, leaving teens especially vulnerable. In the same survey mentioned above, while half of high school smokers said they tried quitting, 75 percent of them ended up smoking into adulthood.

While young adult smokers are not less motivated to quit smoking than older smokers, they tend to avoid participating in traditional quitting tools, such as medication or counseling. They may not have yet experienced strong consequences from smoking, or they may not even know about all the tools available to quit smoking.

However, consequences are serious. In the same survey mentioned above, roughly 1 out of 3 teenagers who become regular smokers before 18 are expected to die mainly from smoking. It’s just a matter of time.

The UCSF researchers wondered if young adult smokers would respond better to quitting programs conducted through social media, a platform they already use so often.

“We wanted to see, if we offered a treatment on a platform that they were already using multiple times a day, would they be more likely to try to quit and do so successfully,” said Ramo.

The study

The team’s three-month program, called the Tobacco Status Project, was conducted entirely on Facebook, the most widely used social media platform worldwide.

Reflecting the U.S. population of smokers, the study sample had 500 participants with an average age of 21, of which 45 percent were males, 73 percent were white, and 87 percent were daily smokers.

The participants did not have to want to quit smoking to participate in the study.

“We were doing something very ambitious by taking those who were not necessarily ready to stop smoking and seeing if this form of intervention could help,” Ramo said in a statement.

While the control groups were referred to the National Cancer Institute’s smokefree.gov website, one of the traditional treatment tools, other groups were assigned to “secret” Facebook groups with similar readiness to quit smoking and were given daily posts, live question and answer sessions, and cognitive behavioral counseling sessions with a doctoral level counselor on a weekly basis.

“Young adults had told us that they did not want to quit smoking publicly on social media – they did not want their whole social network to know they were smoking, much less quitting,” said Ramo.

The researchers assessed abstinence at four points in time: at the beginning, at three months, at six months, and finally at 12 months. They gave gift cards and bonus cash worth up to $100 in total to incentivize participants to take the assessments.

The results

The researchers found that although its effect was not sustained for a full year, the social media program had a significant effect on quitting while the program was active.

For three months, those assigned to Facebook groups were 2.5 times more likely to have biochemically verified abstinence from smoking than those in control groups (8.3 percent vs. 3.2 percent). However, over 12 months, that difference was no longer significant.

What accounts for the success of the Facebook program?

According to Ramo, for young adult smokers who are already on social media so often, the same information and counseling become way more digestible when received through a post or a private Facebook page than an hour-long video or a travel to a counselor’s office.

“We found that we could reach a hard-to-reach population, have short-term abstinence, and also have excellent engagement,” she said in a statement. “It suggests that the social media environment can be an engaging tobacco treatment tool, even for those not ready to quit.”

Although neither the researchers nor participants provided or used nicotine replacement, the researchers noted that nicotine replacement along with online treatment may help to improve quit rates in future studies.

The next step

According to Ramo, the team will expand their Facebook model to study both tobacco use and heavy binge-drinking and to help young LGBTQ smokers to quit.

The team is currently running three clinical trials to find the best model for the two studies.

“This is exciting. It (social media) was highly engaging for the participants. This is a form of intervention that really appeals to young people,” said Ramo.