Preventive Psychiatry, Social Networking, Vaping
Conditions
Keywords
preventive intervention, e-cigarettes, middle school, high school, messaging, network informed prevention
Brief summary
Rates of adolescent vaping are increasing rapidly. Current high school student use of electronic vaping products (EVPs) rose from 1.5% in 2011 to 20.8% in 2018 - an increase from 220,000 to 3.05 million adolescent users. Effective, school-based interventions are urgently needed to protect adolescents from initiating or continuing use of electronic vaping products (EVPs). This study leverages a state-supported prevention initiative to test the effectiveness of a promising intervention that trains 8th-9th grade student peer leaders to deliver school-wide vaping prevention campaigns with ongoing adult mentoring. If study hypotheses are supported, the study will provide the first evidence of a school-based preventive intervention that reduces adolescent vaping behaviors, as well as insight into how peer communications can be harnessed to prevent vaping.
Detailed description
Above the Influence of Vaping (ATI-V) trains peer nominated 8th-9th grade Peer Leader, and adult advisors. Peer Leaders learn skills and implement school-wide prevention campaigns informed by communication science.New York State has provided funds to support schools to implement ATI-V but no funds for efficacy research. With support from New York State and a strong team of investigators, our project has two aims: Aim 1. Efficacy. The primary aim of this study is to determine ATI-V impact in preventing vaping use (past 30 days any vaping, nicotine vaping, and regular use). Using an RCT design, 20 schools will be assigned to (a) immediate ATI-V, or (b) wait-list for ATI-V training after 24 months. Approximately 3,800 8th graders will be enrolled and followed for assessments in fall 8th grade, spring 8th grade, spring 9th grade, and mid-year 10th grade. We will test for which students ATI-V is most effective and in what school contexts (school climate). Aim 2. Mechanism. The second aim of this study to test the hypothesized mechanisms of ATI-V impact. To accomplish this aim we will conduct statistical analyses of a mediation model to determine (a) whether ATI-V improves students' perceptions that vaping is unacceptable to their peers (anti-vaping norms), connections to supportive adults to address EVP concerns, and social influence of non-vaping students; and (b) whether the impact of ATI-V on reduced vaping behavior is mediated by these improvements.
Interventions
BEHAVIORALAbove the Influence-Vaping (ATI-V)
Peer-nominated 8th grade and 9th grade Peer Leaders (PL) will be trained in a half day ATI-V training. Adult Advisors (AA; not enrolled subjects) will attend a half day ATI-V AA training and the PL training. The training day builds leadership skills in the PLs, develops skills for rising above pressure to vape including identification of personal reasons to rise, identification of healthy support people, teaching accurate use statistics, and sharing stories of prior success in rising above negative pressures. The ATI-V team of PLs and AAs then will run four interactive messaging campaigns to reach the rest of the student body. These four campaigns are (1) Introduction to ATI-V and My Reasons to Rise (2) Gain and Loss (3) Who's Got My Back (4) The Facts. Each campaign features a portion in which PLs model healthy norms and behaviors, and a second portion in which all the rest of the students engage in an interactive component to build and demonstrate the target skill.
Sponsors
University of Rochester
National Institute on Drug Abuse (NIDA)
Texas Tech University
Claremont Graduate University
Penn State University
University of North Carolina, Chapel Hill
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
Immediate intervention and delayed intervention groups - by school over 2 cohorts
Eligibility
Sex/Gender
ALL
Age
12 Years to 18 Years
Healthy volunteers
Yes
Inclusion criteria
* current 8th grade student of study school at start of school participation * No person shall be excluded from participation, denied benefits, or discriminated against because of race, color, national origin, sexual orientation, sex, gender identity, age, or ability (i.e., special education status).
Exclusion criteria
* non-English speaking students
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Any Past 30 Day Any Vaping | 28 months | Self reported use of any electronic vaping product during the past 30 days, assessed using participant questionnaire. The outcome is reported as the number of participants reporting any vaping within the previous 30 days. |
| Number of Participants With Any Past 30 Day Nicotine Vaping | 28 months | Self reported nicotine containing electronic vaping product use during the previous 30 days, assessed by participant questionnaire. The outcome is reported as the number of participants reporting nicotine vaping. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Score Electronic Vaping Product Harm | 28 months | Perceived harm of electronic vaping products was assessed using a single questionnaire item scored from 0 (No risk) to 3 (Great risk). Higher scores indicate greater perceived harm. |
| Mean Electronic Vaping Product Attitudes | 28 months | Attitudes toward electronic vaping products were assessed using participant responses to 7 items evaluating whether vaping is good, fun, interesting, or exciting. Responses were averaged to produce a mean score ranging from 1 (Strongly disagree) to 5 (Strongly agree). Higher scores indicate more favorable attitudes toward vaping. |
| Total Number of Trusted Adults | 28 months | Participants identified trusted adults at school with whom they could discuss personal concerns. The outcome is reported as the total number of trusted adults identified (range 0 to 7). |
Countries
United States
Participant flow
Recruitment details
Nineteen schools in 14 school districts recruited students across three cohorts. A total of 2,967 students completed the baseline assessment. Additional eligible students entered the study at subsequent assessment waves, resulting in a cumulative enrollment of 3,950 participants. The final analysis sample included 3,515 participants.
Pre-assignment details
The first two cohorts had 4 schools, so two each were assigned to waitlist and intervention. To balance school size, in the third cohort one large district (3 middle schools) was randomized with 3 smaller schools.
Baseline characteristics
| Characteristic | — |
|---|---|
| 30 day any vaping | 54 Participants |
| Age, Continuous | 13.14 years STANDARD_DEVIATION 0.36 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 203 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 2200 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 17 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 24 Participants |
| Race (NIH/OMB) Asian | 71 Participants |
| Race (NIH/OMB) Black or African American | 163 Participants |
| Race (NIH/OMB) More than one race | 143 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 3 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 463 Participants |
| Race (NIH/OMB) White | 1852 Participants |
| Sex/Gender, Customized Sex Female | 1352 Participants |
| Sex/Gender, Customized Sex Male | 747 Participants |
| Sex/Gender, Customized Sex Other/Not Reported | 91 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 1,800 | 0 / 1,715 |
| other Total, other adverse events | 0 / 1,800 | 0 / 1,715 |
| serious Total, serious adverse events | 0 / 1,800 | 0 / 1,715 |
Outcome results
None listed