The RealU A Web-based Intervention to Reduce College Smoking

1. The RealUA Web-based Intervention to Reduce College Smoking Larry An, Colleen Klatt, Cheryl Perry, Harry Lando, Deb Hennrikus, Unto Pallonen, Dana Farley, Edward Ehlinger, Jas Ahluwalia University of Minnesota Funding: Clearway Minnesota

2. Cumulative risk at UK male 1990 ratesBMJ 2000; 321: 323-9 15 10 5 0 45 55 65 75 Age Stopping smoking: avoiding lung cancer Continued smoking: 16% dead from lung cancer % dead fromlung cancer Stopped age 50: 6% Stopped age 30: 2% Never smoked: <1%

3. Young Adult Prevention and Cessation • Promise • Early cessation avoids health effects of tobacco use. • Early intervention may limit the development of nicotine addiction. • If tobacco use behavior is less established, it may be easier to change.

4. Young Adult Prevention and Cessation • Challenges • Tobacco use rates for 18-24 year olds highest for any age group (college and non-college). • Median duration of use is 15-20 years. • Ambivalence. • “I’m not a smoker. I’m just a social smoker.” • “I’ll quit when I graduate.” • “If I were ever to get addicted, then I would quit.” • Social forces and life transitions encourage continued tobacco use. • Limited evidence of successful intervention.

5. RJR “Young Adult Motivational Research” January 10, 1985 503796119-6164, courtesy Pam Ling

6. Life Transitions and Smoking “A young adult is leaving childhood on his way to adulthood. He is leaving the security and regiment of high school and his home. He is taking a new job; he is going to college; he is enlisting in the military. He is out on his own, with less support from his friends and family. These situations will be true for all generations of younger adults as they go from a period of transition from one world to another…” “…significant choice moments in cigarette smoking tend to coincide with critical transitions stages in life.” RJR Marketing Research Department, Harden, 1984, #15 and Y&R, PM 1994 #6., courtesy Pam Ling

8. Young Adult Tobacco Cessation

9. The RealU • A web-based intervention to reduce cigarette use among UM college students. • Two-group randomized controlled trial. • Prevention and Cessation • Target: Any cigarette use in last 30 days • Population Based: Not only those ready to quit because people who don’t think they are smokers don’t think they need to quit. • Cessation and Reduction goals

10. The RealU: Study Flow

11. The RealU: Study Flow

12. RealU Health Screening Survey • Email Invitation plus 2 follow-up emails with non-respondents • Survey about College Life and Health • 45 Items • $100 Lottery incentive for completing the survey • Are survey respondents representative of the general college population?

13. Comparison of Mail, Phone, and Internet Surveys to Assess Tobacco Use Among College Students Larry An, MD, Deb Hennrikus, PhD, Kusuma Madmala, MPH, Mark Stanley, BS Don Nagel, BS Harry Lando, PhD, Edward Ehlinger, MD, MPH

14. Study Goals and Methods • Goal: To determine how mail, phone, and internet survey compare in evaluation of tobacco use by college students. • Methods: Simultaneous administration of 4 surveys to separate random samples of students at 1 mid-western campus • Mail: N=2000 • Long Internet: N=1500 • Short Internet: N=1500 • Phone: N=550

15. Results: Response Rate by Survey Method Chi2 p<0.01

16. Results: Prevalence of any 30-day tobacco use by survey method P=0.89

17. Results: Frequency of Tobacco Use among Current Tobacco Users Chi2 p=0.05

18. Internet Survey Summary • Short Internet Survey respondents are similar to the general college population in terms of the prevalence of smoking and cigarette consumption. • Internet survey respondents are more likely to be female and younger compared with the general college population.

20. Symptoms of Nicotine Dependence

21. Symptoms of Nicotine Dependence

22. Symptoms of Nicotine Dependence

23. Smoking Motives

24. Smoking Motives

25. The RealU: Study Flow

26. The RealU: Study Flow

27. The RealU: Eligibility • Eligibility Criteria • Any cigarette use in the prior 30 days • Between the ages of 18 and 24 • Plan to be enrolled for the next 2 semesters • Real-time eligibility screening of survey results with invitation to enroll. • How were smokers that enrolled different from smokers that did not enroll?

28. The RealU: Enrollment

29. The RealU: Enrollment

30. The RealU: Enrollment • Smokers who enrolled in the RealU were similar to smokers who did not enroll in many respects. • Females were more likely to enroll. • Smokers who enrolled smoked slightly more days per month and were slightly more likely to have some sort of idea that they would stop smoking in the near future.

31. The RealU: Study Flow

32. The RealU: Study Flow

33. The RealU Model

34. The RealU Beta Version

35. The RealU Beta Version

36. The RealU Beta Version Flops

37. Back to the Drawing Board

38. RealU Re-design • Broader focus on college life • 9 Student Writers for an On-line Magazine • Peer Support via email • Contextual Intervention for Smoking Triggers • Friends Smoking • Friendship: Friends vs. Smoking buddies • Drinking and Smoking • Drinking behavior and alternative fun activities • Stress and Smoking • Time Management, Sleep, Diet, Exercise • Health • Health and attractiveness

39. RealU Schematic

40. RealU1 Sample Page

41. RealU1 Article

42. The RealU: Participation

43. The RealU: Study Flow

44. The RealU: Study Flow

45. The RealU Evaluation

46. The RealU: 7-day Point Prevalence Abstinence *** *** * Quit & Win * p<0.05 Smoke-free Bars *** p<0.001

47. The RealU30-Day Abstinence at Week 20 * p < 0.001

48. The RealUCurrent Smoker Readiness to Quit

49. Abstinence rates by number of emails

50. The RealU: Study Flow