Identifying student opinion leaders to lead e-cigarette interventions: protocol for a randomized controlled pragmatic trial

Abstract

Background After the US Surgeon General declared youth electronic cigarette (e-cigarette) use an epidemic in 2018, the number of youth e-cigarette users continued to surge, growing from 3.8 million in 2018 to over 5 million 2019. Youth who use e-cigarettes are at a substantially higher risk of transitioning to traditional cigarettes, becoming regular cigarette smokers, and increasing their risk of developing tobacco-related cancer. A majority of youth are misinformed about e-cigarettes, often believing they are not harmful or contain no nicotine. Middle school students using e-cigarettes have been affected by its normalization leading to influence by their peers. However, social and group dynamics can be leveraged for a school-based peer-led intervention to identify and recruit student leaders to be anti-e-cigarette champions to prevent e-cigarette initiation. This study outlines a project to use social network analysis to identify student opinion-leaders in schools and train them to conduct anti-e-cigarette programming to their peers. Methods In the 2019–2020 academic school year, 6th grade students from nine schools in the Pittsburgh area were recruited. A randomized controlled trial (RCT) was conducted with three arms—expert, elected peer-leader, and random peer-leader—for e-cigarette programming. Sixth grade students in each school completed a network survey that assessed the friendship networks in each class. Students also completed pre-intervention and post-intervention surveys about their intention-to-use, knowledge, and attitudes towards e-cigarettes. Within each peer-led arm, social network analysis was conducted to identify peer-nominated opinion leaders. An e-cigarette prevention program was administered by (1) an adult content-expert, (2) a peer-nominated opinion leader to assigned students, or (3) a peer-nominated opinion leader to random students. Discussion This study is the first to evaluate the feasibility of leveraging social network analysis to identify 6th grade opinion leaders to lead a school-based e-cigarette intervention. Trial registration ClinicalTrials.gov NCT04083469. Registered on September 10, 2019.

Mutual pathways between peer and own e-cigarette use among youth in the United States: a cross-lagged model

“…For example, prevention programs may benefit from incorporating peer-oriented strategies such as fostering resistance to peer pressure among nonusers or using peer-lead approaches to reduce e-cigarette use among users. In a recent publication, Chu and colleagues showed the feasibility of such a program: peer-lead approaches were well accepted among teachers and students [ 31 , 32 ]. Compared to an expert-led approach, peer-led approaches were more engaging; despite being statistically non-significant partially due to the limited sample size, point estimates suggested that peer-led approaches may be more effective than an expert-lead approach [ 31 ].…”

“…In a recent publication, Chu and colleagues showed the feasibility of such a program: peer-lead approaches were well accepted among teachers and students [ 31 , 32 ]. Compared to an expert-led approach, peer-led approaches were more engaging; despite being statistically non-significant partially due to the limited sample size, point estimates suggested that peer-led approaches may be more effective than an expert-lead approach [ 31 ]. Previous studies on adolescent alcohol use further suggest that peer influence can be a malleable socio-environmental factor for prevention and intervention [ 33 ].…”

Mutual Pathways between Peer and Own E-Cigarette Use among Youth in The United States: A Cross-Lagged Model

“…For example, prevention programs may bene t from incorporating peeroriented strategies such as fostering resistance to peer pressure among nonusers or using peer-lead approaches to reduce e-cigarette use among users. In a recent publication, Chu and colleagues showed the feasibility of such a program: peer-lead approaches were well accepted among teachers and students (35,36). Compared to an expert-led approach, peer-led approaches were more engaging; despite being statistically non-signi cant partially due to the limited sample size, point estimates suggested that peer-led approaches may be more effective than an expert-lead approach (35).…”

“…In a recent publication, Chu and colleagues showed the feasibility of such a program: peer-lead approaches were well accepted among teachers and students (35,36). Compared to an expert-led approach, peer-led approaches were more engaging; despite being statistically non-signi cant partially due to the limited sample size, point estimates suggested that peer-led approaches may be more effective than an expert-lead approach (35). Previous studies on adolescent alcohol use further suggest that peer in uence can be a malleable socio-environmental factor for prevention and intervention (Duncan et al).…”

Interventions to mitigate vaping misinformation: protocol for a scoping review

“…While there have been studies on preventing vaping among adolescents [ 12 , 13 ], and the effect of vaping misinformation on attitudes toward vapes [ 1 ], and vaping misinformation more broadly [ 10 , 14 , 15 ], there is limited research on interventions to mitigate misinformation about vapes. Thus, we are far from knowing when and how to intervene best.…”