Social Media Anti-Vaping Messages to Reduce ENDS Use Among Sexual and Gender Minority Teens

Abramson Cancer Center at Penn Medicine1,155 enrolled

Overview

The investigators long-term goal is to reduce tobacco use and tobacco-related health disparities among SGM populations. The objective of Project SMART (Social Media Anti-Vaping Messages to Reduce ENDS Use Among Sexual and Gender Minority Teens) is to evaluate the effectiveness of an sexual gender minority (SGM) -tailored social media intervention to prevent vaping initiation among SGM youth ages 13-20 years. The investigators central hypothesis is that SGM-tailored anti-vaping social media messages will be more effective than existing non-tailored messages to prevent vaping initiation among SGM youth. The scientific premise for this work is based on principles of cultural tailoring in health communication for vulnerable populations, the Health Equity Promotion Model, and the Message Impact Framework. The investigators are developing and evaluating a social media intervention because SGM youth have a high rate of social media use and are more likely to go online for health information than non-SGM youth. Social media, moreover, are increasingly used for health promotion to address health disparities and well-being of SGM populations. The investigators will conduct rapid-cycle feedback with stakeholders including SGM organization leaders to provide input on the message design, testing, and intervention implementation to ensure feasibility and acceptability of the intervention.

Aim 1: Explore salient beliefs and cultural tailoring preferences related to vaping initiation among sexual gender minority (SGM) youth to inform the development of anti-vaping social media messages. Approach: An elicitation survey among 80 SGM youth and focus group discussions among a subsample of 48-64 youth who complete the elicitation survey will explore beliefs related to vaping initiation that SGM youth find most salient. Participants will include US SGM youth, ages 12-18 years, stratified by age (12-15 or 16-18), vaping status (never vaped and are susceptible or have initiated vaping in the past 1 year), and gender identity (cisgender or transgender/gender expansive). The investigators will further explore the social contexts of their vaping behavior and preferences for cultural tailoring of anti-vaping messages (i.e., peripheral, evidential, linguistic, and sociocultural values tailoring) among SGM youth. Aim 2: Identify promising anti-vaping social media messages and cultural tailoring strategies to reduce vaping initiation among SGM youth. Approach: Results from Aim 1 and input from community stakeholders will be utilized to develop SGM-tailored social media anti-vaping messages. An online discrete choice experiment among SGM youth ages 13-18 years (n=600) who have never vaped will be used to test the impact of anti-vaping messages and cultural tailoring strategies on perceived message effectiveness to reduce vaping initiation. Results will guide the construction of culturally tailored anti-vaping social media intervention for broader evaluation in Aim 3. Aim 3: Evaluate the effectiveness of repeated exposure to SGM-tailored anti-vaping social media messages on subsequent vaping susceptibility among SGM youth. Approach: The investigators will conduct a prospective 2-group randomized experiment among 1500 SGM youth and young adults ages 13-20 to test the hypothesis that repeated exposure to SGM-tailored anti-vaping social media messages will be associated with reduced vaping susceptibility, defined as the extent to which youth are open to vaping, compared with non-tailored messages.

Interventions

TailoredOTHER

Messages will be in the form of high-quality English-language anti-vaping messages comprising static text and imagery designed to resemble social media posts (e.g., image and a caption). We will create 24 messages based on the top-ranked tailoring features and belief themes tested in Aim 2 to comprise SGM-tailored messages. For the non-tailored message condition, we will create 24 anti-vaping social media messages that mirror the SGM-tailored messages but do not contain SGM identity cues. We will match the belief themes used in the tailored and non-tailored messages such that they represent a range of belief targets (e.g., addiction, physical health effects, mental health effects) as indicated in Aims 1 and 2. We do not utilize a social media platform for the delivery of the message to avoid potential contamination across randomized conditions.

Outcomes

Primary Outcomes

Susceptibility to vaping

We will measure susceptibility to vaping using four items previously used on PATH Wave 7 youth questionnaire and NYTS 2022 Questionnaire: 1. Have you ever been curious about using an e-cigarette or other electronic nicotine products? (1 = Not at all curious; 2 = A little curious; 3 = Somewhat curious; 4 = Very curious) 2. Do you think you will use an e-cigarette or an electronic nicotine product in the next year? (1 = Definitely not; 2 = Probably not; 3 = Probably yes; 4 = Definitely yes) 3. Do you think you will use an e-cigarette or an electronic nicotine product soon? (1 = Definitely not; 2 = Probably not; 3 = Probably yes; 4 = Definitely yes) 4. If one of your best friends were to offer you an e-cigarette or an electronic nicotine product, would you use it? (1 = Definitely not; 2 = Probably not; 3 = Probably yes; 4 = Definitely yes) The responses to these items will be averaged to create a score of vaping susceptibility.

Time frame: One week, Two weeks, Three weeks, and One month

Secondary Outcomes

Vaping initiation

We will measure vaping initiation in the past 1 week using one item: 1\) Have you used an e-cigarette or vape, even once or twice in the past week? (1 = Yes; 2 = No)