Social Media Messages for Reducing Teen Vaping

(SMART Trial)

Overseen By Elaine Hanby, MA

Age: < 65

Sex: Any

Trial Phase: Academic

Sponsor: Abramson Cancer Center at Penn Medicine

Disqualifiers: Current vapers, Non-SGM youth

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

1500 Participants Needed

Trial Summary

What is the purpose of this trial?

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.

Do I need to stop my current medications to join the trial?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Tailored in the clinical trial 'Social Media Messages for Reducing Teen Vaping'?

Research shows that social media-based interventions have been effective in helping young people quit smoking, suggesting that similar approaches could work for reducing teen vaping. Additionally, adding vaping cessation resources to social media posts has been shown to counteract the negative influence of pro-vaping content. ^{1 2 3 4 5}

Is the social media campaign for reducing teen vaping safe for humans?

The research does not provide specific safety data for the social media campaign aimed at reducing teen vaping. However, it highlights potential risks associated with electronic nicotine delivery systems (e-cigarettes), such as battery malfunctions leading to overheating, fires, and explosions. ^{6 7 8 9 10}

How does the treatment 'Tailored' differ from other treatments for reducing teen vaping?

The 'Tailored' treatment is unique because it uses social media messages specifically designed to resonate with teens, focusing on themes like social acceptability, independence, and perceived risks of vaping. This approach leverages the platforms teens frequently use, making it more likely to engage them effectively compared to traditional methods. ^{11 12 13 14 15}

Eligibility Criteria

This trial is for sexual and gender minority (SGM) teens aged 13-20 who are interested in the effects of anti-vaping messages. The study aims to prevent vaping initiation by using social media as a platform for health communication, specifically tailored to SGM youth.

Inclusion Criteria

Not vaped or used other tobacco products in the past 3 months

Have access to a smartphone

Identify as SGM

Exclusion Criteria

Current vapers

Non-SGM youth

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Development and Testing

Development of SGM-tailored anti-vaping social media messages and testing through an online discrete choice experiment

4-8 weeks

Online participation

Intervention

Participants receive SGM-tailored or non-tailored anti-vaping messages via text message

4 weeks

Text message delivery

Follow-up

Participants are monitored for susceptibility to vaping and vaping initiation

4 weeks

Online surveys at one week, two weeks, three weeks, and one month

Treatment Details

Interventions

• Tailored

Trial Overview The effectiveness of culturally-tailored anti-vaping social media messages is being tested against non-tailored ones. The goal is to see if these specialized messages can more effectively prevent vaping among SGM teens.

Participant Groups

Group I: Tailored Experimental Treatment 1 Intervention

Participants in the tailored arm will receive SGM-tailored anti-vaping health messages delivered via text message

Group II: Non-Tailored Active Control 1 Intervention

Participants in the non-tailored arm will receive non-tailored anti-vaping health messages delivered via text message

Who Is Running the Clinical Trial?

Abramson Cancer Center at Penn Medicine

Lead Sponsor

Trials

425

Recruited

464,000+

University of Florida

Collaborator

Trials

1,428

Recruited

987,000+

Findings from Research

This study outlines a randomized controlled trial testing an Instagram-based vaping cessation intervention for adolescents and young adults aged 13-21, aiming to provide evidence-based support for this vulnerable group.

The primary goal is to achieve biochemically verified 7-day point prevalence abstinence from nicotine vaping, with secondary outcomes including vaping reduction and readiness to quit, assessed at multiple time points after the intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Delivering vaping cessation interventions to adolescents and young adults on Instagram: protocol for a randomized controlled trial. Lyu, JC., Olson, SS., Ramo, DE., et al.[2022]

Daily social media use among adolescents who had never used e-cigarettes was linked to a higher likelihood of being susceptible to e-cigarette use and initiating use, with adjusted odds ratios indicating significant associations (aOR = 1.46 for susceptibility, aOR = 3.55 for past use, and aOR = 3.45 for current use).

However, for adolescents who had previously used e-cigarettes, social media use did not show a significant association with continued e-cigarette use, suggesting that while social media may influence initiation, it does not necessarily affect ongoing usage.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Social Media Use and Subsequent E-Cigarette Susceptibility, Initiation, and Continued Use Among US Adolescents. Lee, J., Krishnan-Sarin, S., Kong, G.[2023]

In a study of 399 middle and high school students in a rural Tennessee county, 12.5% reported current use of electronic nicotine delivery systems (ENDS), with social media engagement significantly associated with ENDS uptake (odds ratio of 3.98 for current use).

Snapchat and video platforms like Facebook, Instagram, and YouTube were the most commonly used social media, suggesting that these platforms may play a crucial role in influencing adolescents' decisions to use ENDS, highlighting the need for further research in communities facing tobacco-related health disparities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Social media and use of electronic nicotine delivery systems among school-going adolescents in a rural distressed Appalachian community. Mamudu, HM., Nwabueze, CA., Yang, JS., et al.[2022]

A study involving 138 young adults (ages 18-25) analyzed messages from a Facebook smoking cessation intervention, revealing that tailored messages based on participants' readiness to quit smoking effectively supported behavior change.

Four main themes emerged from participant posts: coping skills, support from friends and family, motivation to quit, and benefits of quitting, indicating that these factors are crucial in engaging young smokers, regardless of whether they received monetary incentives.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Conversation Within a Facebook Smoking Cessation Intervention Trial For Young Adults (Tobacco Status Project): Qualitative Analysis. McKelvey, K., Ramo, D.[2020]

In a study involving 2,179 young adults, adding a nicotine warning label and vaping cessation resources to pro-vaping Instagram posts improved perceptions of the influencers as honest and trustworthy, but did not significantly change intentions to use vaping products.

Participants exposed to posts with both the warning label and cessation resources showed lower susceptibility to using the advertised product and had reduced positive expectancies about vaping, suggesting that these features can help mitigate the influence of pro-vaping content.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of a nicotine warning label and vaping cessation resources on young adults' perceptions of pro-vaping instagram influencer posts. Vogel, EA., Unger, JB., Vassey, J., et al.[2023]

A study analyzing commercial tweets about e-cigarettes from January 2017 to December 2020 found that e-cigarette marketing on Twitter significantly increased on days with important FDA-related events, suggesting that these events influence advertising strategies.

The research highlights the need for regulation of e-cigarette marketing, as the frequency of tweets was also higher on weekdays and when companies like JUUL were actively tweeting, indicating a targeted approach to reach consumers, particularly youth.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exploring Factors That Predict Marketing of e-Cigarette Products on Twitter: Infodemiology Approach Using Time Series. Ezike, NC., Ames Boykin, A., Dobbs, PD., et al.[2023]

The FDA's anti-vaping campaign, 'The Real Cost,' launched in September 2018, has not significantly reduced the popularity of vaping on Instagram, as evidenced by a three-fold increase in the median 'like' count on vaping-related posts after the campaign.

Despite the campaign's efforts, vaping-related hashtags continued to dominate Instagram, with a notable rise in posts featuring high-nicotine 'pod' devices, indicating that social media marketing still strongly influences adolescent vaping behavior.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

#Vape: Measuring E-Cigarette Influence on Instagram With Deep Learning and Text Analysis. Vassey, J., Metayer, C., Kennedy, CJ., et al.[2022]

A content analysis of Twitter posts from 2012 to 2015 revealed that the primary reason for using electronic nicotine delivery systems (ENDS) in 2012 was to quit combustible cigarettes, cited in 43% of relevant tweets, but this reason declined to 29% by 2015.

By 2015, the focus shifted towards social image as the leading reason for vaping, increasing to 37%, indicating a change in motivations for using ENDS away from cessation and towards social acceptance.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Why do people use electronic nicotine delivery systems (electronic cigarettes)? A content analysis of Twitter, 2012-2015. Ayers, JW., Leas, EC., Allem, JP., et al.[2022]

Over half (52.5%) of adolescents in Texas reported exposure to tobacco-related social media, highlighting a significant presence of tobacco marketing among youth.

Adolescents who are susceptible to or currently use e-cigarettes and combustible tobacco are more likely to engage with tobacco-related social media, indicating that these platforms could be effective targets for prevention campaigns aimed at vulnerable youth.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exposure and Engagement With Tobacco- and E-Cigarette-Related Social Media. Hébert, ET., Case, KR., Kelder, SH., et al.[2022]

The study found that mentions of electronic nicotine delivery systems (ENDS) battery malfunctions, including overheating, fires, and explosions, have increased over time, with a total of 947 relevant mentions analyzed from social media over a one-month period each year from 2013-2017.

Social media monitoring can be an effective tool to supplement traditional surveillance systems, as it reveals a growing public awareness and concern regarding ENDS battery-related incidents, although only a small percentage of mentions provided preventive advice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Social Media Mentions of Electronic Nicotine Delivery Systems (ENDS) Battery-Related Overheating, Fires, and Explosions: Findings from a Pilot Study. Trigger, S., Coleman, B.[2020]

A study involving 1,564 participants aged 15 to 24 identified key messaging themes for a national anti-vape campaign, focusing on attitudes that differentiate between various groups of vape users.

The identified themes, such as social acceptability of vaping and perceived risk of harm, will help tailor effective messages to reduce e-cigarette use among youth, addressing the challenge of selecting impactful communication strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Identifying message themes to prevent e-cigarette use among youth and young adults. Rath, JM., Romberg, AR., Perks, SN., et al.[2023]

A study involving 928 high school adolescents found that social media messages significantly increased knowledge and beliefs about the harms of e-cigarettes, regardless of the message format used.

The majority of participants (79%) expressed a willingness to share these messages, indicating that social media campaigns could effectively educate peers about the risks associated with e-cigarette use.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Social Media Message Designs to Educate Adolescents About E-Cigarettes. Lazard, AJ.[2021]

A study involving 337 teens (ages 13-18) identified that effective vaping education commercials should include detailed facts about chemicals, physical consequences, and mental health, supported by engaging visuals and empathy.

The COVID-19 pandemic shifted teens' focus towards mental health and immunity, highlighting the importance of addressing the impact of vaping on friends, while traditional anti-industry messages were found to be less effective.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Creating More Effective Vape Education Campaigns: Qualitative Feedback from Teens in Nine U.S. States. Stalgaitis, CA., Jordan, JW., Isaac, K.[2023]

A significant 59% of middle and high school students reported exposure to pro-tobacco online marketing, which is linked to a higher likelihood of dual use of both electronic and combustible cigarettes, with dual users having 1.73 times the odds of exposure.

The study highlights a potential regulatory gap in the oversight of electronic cigarette marketing, suggesting that further policy actions are needed to protect minors from the influence of pro-tobacco advertising.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Online Pro-Tobacco Marketing Exposure Is Associated With Dual Tobacco Product Use Among Underage US Students. Marion, H., Garner, W., Estrada, A., et al.[2023]

A study of 459 young adults found that those who use e-cigarettes are more likely to engage with anti-vaping content on social media platforms like Twitter and TikTok, suggesting that these platforms could be effective for health campaigns.

Increased daily internet use and the number of social media sites used were positively associated with intentions to engage with anti-vaping Instagram posts, indicating that targeting social media-savvy audiences may enhance the impact of health messaging.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Characteristics Associated with Young Adults' Intentions to Engage with Anti-Vaping Instagram Posts. Liu, J., Lee, DN., Stevens, EM.[2023]

References

1. England pubmed.ncbi.nlm.nih.gov

Delivering vaping cessation interventions to adolescents and young adults on Instagram: protocol for a randomized controlled trial. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Social Media Use and Subsequent E-Cigarette Susceptibility, Initiation, and Continued Use Among US Adolescents. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

Social media and use of electronic nicotine delivery systems among school-going adolescents in a rural distressed Appalachian community. [2022]

4. Canada pubmed.ncbi.nlm.nih.gov

Conversation Within a Facebook Smoking Cessation Intervention Trial For Young Adults (Tobacco Status Project): Qualitative Analysis. [2020]

5. England pubmed.ncbi.nlm.nih.gov

Effects of a nicotine warning label and vaping cessation resources on young adults' perceptions of pro-vaping instagram influencer posts. [2023]

6. Canada pubmed.ncbi.nlm.nih.gov

Exploring Factors That Predict Marketing of e-Cigarette Products on Twitter: Infodemiology Approach Using Time Series. [2023]

7. Switzerland pubmed.ncbi.nlm.nih.gov

#Vape: Measuring E-Cigarette Influence on Instagram With Deep Learning and Text Analysis. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Why do people use electronic nicotine delivery systems (electronic cigarettes)? A content analysis of Twitter, 2012-2015. [2022]

9. United States pubmed.ncbi.nlm.nih.gov

Exposure and Engagement With Tobacco- and E-Cigarette-Related Social Media. [2022]

10. Switzerland pubmed.ncbi.nlm.nih.gov

Social Media Mentions of Electronic Nicotine Delivery Systems (ENDS) Battery-Related Overheating, Fires, and Explosions: Findings from a Pilot Study. [2020]

11. United States pubmed.ncbi.nlm.nih.gov

Identifying message themes to prevent e-cigarette use among youth and young adults. [2023]

12. United States pubmed.ncbi.nlm.nih.gov

Social Media Message Designs to Educate Adolescents About E-Cigarettes. [2021]

13. England pubmed.ncbi.nlm.nih.gov

Creating More Effective Vape Education Campaigns: Qualitative Feedback from Teens in Nine U.S. States. [2023]

14. United States pubmed.ncbi.nlm.nih.gov

Online Pro-Tobacco Marketing Exposure Is Associated With Dual Tobacco Product Use Among Underage US Students. [2023]

15. Switzerland pubmed.ncbi.nlm.nih.gov

Characteristics Associated with Young Adults' Intentions to Engage with Anti-Vaping Instagram Posts. [2023]