title: Young Adult Utilization of a Smoking Cessation Website: An Observational Study Comparing Young and Older Adult Patterns of Use.
abstract: BACKGROUND
  There is little research on how young adults or young adult subgroups utilize and engage with Web-based cessation interventions when trying to quit smoking. Addressing this knowledge gap is important to identify opportunities to optimize the effectiveness of online cessation programs across diverse young adult users.
  
  
  OBJECTIVE
  This study examines utilization of the BecomeAnEX.org smoking cessation website among young adults and young adult subgroups compared with older adults to identify patterns of use by age, gender, and race/ethnicity.
  
  
  METHODS
  Study participants were 5983 new registered users on a free smoking cessation website who were aged 18 to 70 years. Website utilization was tracked for 6 months; metrics of use included website visits, pages per visit, length of visit, and interaction with specific website features. Differences in website use by age were examined via bivariate analyses and multivariate logistic regression adjusted for age, gender, and race/ethnicity. Interactions were examined to determine differences by gender and race/ethnicity within young (18- to 24-year-olds and 25- to 34-year-olds) and older (35 years and older) adult segments.
  
  
  RESULTS
  A greater percentage of young adults aged 18 to 34 years visited the site only once compared with older adults aged 35 years and older (72.05% vs 56.59%, respectively; P<.001). Young adults also spent less time on the site and viewed fewer pages than older adults. In adjusted analyses, young adults were significantly less likely than older adults to visit the site more than once (18-24 years: adjusted odds ratio [AOR] 0.58, 95% CI 0.49-0.68, P<.001; 25-34 years: AOR 0.56, 95% CI 0.50-0.64, P<.001), spend more than 3 minutes on the site (18-24 years: AOR 0.67, 95% CI 0.57-0.79, P<.001; 25-34 years: AOR 0.56, 95% CI 0.49-0.64, P<.001), view 12 or more pages (18-24 years: AOR 0.72, 95% CI 0.61-0.83; P<.001; 25-34 years: AOR 0.67, 95% CI 0.59-0.76, P<.001), utilize the BecomeAnEX.org community (18-24 years: AOR 0.61, 95% CI 0.48-0.79, P<.001; 25-34 years: AOR 0.73, 95% CI 0.60-0.88, P<.001), or utilize Separation Exercises (18-24 years: AOR 0.68, 95% CI 0.51-0.89, P<.01; 25-34 years: AOR 0.77, 95% CI 0.63-0.94, P<.01). Gender differences in utilization were more pronounced among young adults compared with older adults, with lower levels of utilization among young men than young women. For all age groups, utilization was higher among whites and African Americans than among Hispanics and other racial minorities, with one exception-BecomeAnEX.org community utilization was significantly higher among Hispanic young adults compared with white and African American young adults.
  
  
  CONCLUSIONS
  Results point to important areas of inquiry for future research and development efforts. Research should focus on enhancing demand and increasing engagement among younger adults and men, examining strategies for capitalizing on young adult developmental needs, and increasing utilization of effective site features among diverse young adult users.
authors.affiliation: Evaluation Science and Research, Truth Initiative, Washington, DC, United States. jcantrell@truthinitiative.org.
authors.forename: Jennifer
authors.identifier: http://orcid.org/0000-0003-4730-2535
authors.initials: J
authors.lastname: Cantrell
authors.forename: Vinu
authors.identifier: http://orcid.org/0000-0002-7827-0639
authors.initials: V
authors.lastname: Ilakkuvan
authors.forename: Amanda L
authors.identifier: http://orcid.org/0000-0003-3036-9653
authors.initials: AL
authors.lastname: Graham
authors.forename: Amanda
authors.identifier: http://orcid.org/0000-0001-5070-7168
authors.initials: A
authors.lastname: Richardson
authors.forename: Haijun
authors.identifier: http://orcid.org/0000-0002-6146-0946
authors.initials: H
authors.lastname: Xiao
authors.forename: Robin J
authors.identifier: http://orcid.org/0000-0002-8690-1074
authors.initials: RJ
authors.lastname: Mermelstein
authors.forename: Susan J
authors.identifier: http://orcid.org/0000-0001-8508-436X
authors.initials: SJ
authors.lastname: Curry
authors.forename: Amy K
authors.identifier: http://orcid.org/0000-0002-5262-8612
authors.initials: AK
authors.lastname: Sporer
authors.forename: Donna M
authors.identifier: http://orcid.org/0000-0001-9841-9333
authors.initials: DM
authors.lastname: Vallone
keywords: young adults, smoking cessation, Internet, utilization