Health Messaging Strategies for Vaping Prevention and Cessation Among Youth and Young Adults: A Systematic Review

This systematic review evaluates health messaging strategies for the prevention and cessation of e-cigarette use among youth and young adults. Health messaging strategies were defined as the strategic process of developing messages with the intent to shape, reinforce, or change recipients' health attitudes and behaviors. McGuire's Communication/Persuasion Model guided the analysis of the messaging strategies, focusing on the model's five communication inputs (i.e. source, message, channel, audience, destination) and 14 persuasive outcomes. Nine databases were searched from January 2007 to September 2023. The inclusion criteria encompassed studies in English that presented quantitative data on messaging strategies aimed at discouraging vaping among youth and young adults. Each study was also coded for study characteristics and the utilization of theory. Out of 6,045 studies, 25 met the inclusion criteria. The reviewed studies exhibit a diverse array of research methods and a consistent integration of theories. The review emphasizes the nuanced main and interaction effects of various communication inputs, such as message features and audience characteristics, while also pointing out a research gap in message sources. In addition, the utilization of social media for effective messaging to engage the audience requires further research. Only one study specifically evaluated messaging strategies for vaping cessation. More research is imperative to develop targeted and tailored messages that effectively prevent and reduce vaping, especially among populations at higher risk of vaping-related harms, while also leveraging effective channels and innovative communication technologies to engage the audience.

Young adult peer crowds, e-cigarette advertising exposure, and e-cigarette use: Test of a mediation model

BACKGROUND

Young people often make lifestyle choices or engage in behaviors, including tobacco product use, based on the norms of peer crowds they affiliate with. Peer crowds are defined as reputation-based peer groups centered around lifestyle norms (e.g., Hipster, Surfer, Hip Hop). This study examined the effects of peer crowd affiliation on e-cigarette use via increased exposure to e-cigarette advertising and increased social network e-cigarette use.

METHOD

Data were collected from 1398 ethnically diverse young adults (Mean age = 22.3; SD = 3.2; 62% women) in six-month intervals over one year. Path analyses were used to test a mediation model in which advertising exposure and social network e-cigarette use at six-month follow-up were specified to mediate the effects of baseline peer crowd affiliation on current e-cigarette use at one-year follow-up.

RESULTS

Affiliations with Popular-Social and Alternative peer crowds at baseline were associated with higher e-cigarette advertising exposure at six-month follow-up. Affiliation with Popular-Social peer crowd at baseline was associated with increased social network e-cigarette use at six-month follow-up. Affiliation with Popular-Social peer crowds at baseline was found to have a statistically significant indirect effect on increased e-cigarette use at one-year follow-up via increased e-cigarette advertising exposure at six-month follow-up.

CONCLUSIONS

Better understanding Popular-Social peer crowds may be highly relevant for development of tailored media and other interventions for e-cigarette use prevention among young adults.

Queer Peer Crowds on Campus: LGBT Crowd Affiliation as a Critical Correlate of College Students' Loneliness, Academic Well-Being, & Stress

The current study explored whether affiliating with an LGBT peer crowd on a college campus differentially predicts college adjustment (including loneliness, college belongingness, academic well-being, and stress), as opposed to affiliating with a non-LGBT peer crowd. Based on a sample of 692 students from a small liberal arts college in Southern California, factor and path analyses were carried out. Results indicated that, of all the crowd affiliations, affiliating with an LGBT peer crowd was the strongest predictor of loneliness, academic well-being, and stress. However, affiliating with an LGBT peer crowd was not the strongest predictor of college belongingness. Implications and applications of these results are discussed.

Young Adult Responses to Peer Crowd-Based Targeting in E-cigarette Advertisements: An Experimental Study

AIMS

To examine the effects of psychographically targeted e-cigarette advertisements on young adults.

METHODS

A total of 2100 young adults (18-29 years old) representing five peer crowds (groups with shared values, interests, and lifestyle: Mainstream, Young Professional, Hip Hop, Hipster, and Partier) were recruited from a nationwide opt-in online panel. Participants were randomly assigned to view e-cigarette advertisements featuring characters that either did or did not match their own peer crowd affiliation and evaluated advertising effectiveness using Likert-type and semantic differential scales. Participants also reported their attitudes toward using e-cigarettes.

RESULTS

No significant overall effect of peer crowd matching was observed. However, significant two-way interaction effects emerged where matching advertisements yielded higher evaluations than mismatching advertisements among those who currently do not use tobacco and nicotine products and among Mainstream participants. Advertisements featuring Mainstream characters were in general rated more highly than other advertisements. Additional analyses found significant effects of peer crowd matching among those who viewed advertisements featuring non-Mainstream characters.

CONCLUSIONS

Peer crowd-based targeting can increase the effectiveness of e-cigarette advertisements which may impact initiation among current nonusers, requiring stricter marketing regulations. More research is needed to determine if anti-tobacco messaging tailored by peer crowds may effectively counteract targeted e-cigarette marketing.

IMPLICATIONS

E-cigarette advertisements often use psychographic targeting strategies, using lifestyles, attitudes, and values. Low-risk young adults (eg, those who currently do not use tobacco and nicotine products) are susceptible to psychographically targeted e-cigarette advertisements. This may result in the initiation of e-cigarette use among young adults who would otherwise be less likely to use tobacco and nicotine products. Stricter marketing regulations for emerging tobacco and nicotine products are required to reduce marketing exposure.

Peer Crowds and Tobacco Product Use in Hawai'i: A Qualitative Study

BACKGROUND

Young adults often derive self-identity from affiliation with peer crowds, which may be defined as reputation-based peer groups centered around characterizable lifestyle norms. Little is known about peer crowds prevalent among Asian American, Native Hawaiian, and other Pacific Islander (AANHPI) populations and the peer crowds' normative tobacco and other substance use behavior. To address this gap in knowledge, this study conducted focus groups with young adult community college students.

METHODS

Focus group discussions were conducted with a convenience sample of 42 young adults (Mean age = 21.5, SD = 2.7) recruited across community colleges on O'ahu, Hawai'i. The participants represented 60% women, 55% NHPI, and 29% Asian American.

RESULTS

Results indicated the presence of a wide range of peer crowds in the population, which may be classified into the following seven categories prevalent in the literature: Regular, Academic, Alternative, Athlete, Geek, High Risk, and Popular. Several peer crowds within the Alternative, Athlete, Geek, High Risk, and Popular categories appeared to represent subcultures relevant for NHPI young adults. High-risk peer crowds were reported to be vulnerable to different types of substance use. Tobacco product use, particularly e-cigarette use or vaping, was noted to be characteristically present among Popular crowds and certain Athlete crowds.

CONCLUSION

Tobacco and other substance use prevention interventions, such as mass media campaigns, may benefit from targeting high-risk peer crowds, especially those relevant for NHPI young adults, who are at high risk for tobacco and other substance use. E-cigarette use prevention interventions may benefit from paying close attention to vulnerable Popular and Athlete groups.

Exploring factors associated with smokeless tobacco use among young people: A systematic scoping review

PURPOSE

While smoking is declining among young people, smokeless tobacco use is increasing. Identifying who is using smokeless tobacco and why is essential in preventing smokeless tobacco use. This study aimed to comprehensively explore the factors of young people's use of smokeless tobacco in western countries and identify research gaps.

METHODS

We conducted a systematic scoping review of studies that examined factors associated with smokeless tobacco use among young people (ages 13-29) from western countries published between January 2011 and September 2021. Searches were conducted in CINAHL, Medline, and Scopus. Studies on adults, total tobacco use (i.e., did not differentiate between tobacco product types), dual and multiple uses of tobacco, and studies on smokeless tobacco cessation programs were excluded.

RESULTS

A total of 160 studies were included in this scoping review. The studies were primarily undertaken in the US and the Scandinavian countries, and the majority explored smokeless tobacco use without distinguishing between the specific types. Smokeless tobacco users were more likely to be male, non-Hispanic white, engaging in physical activity, and using other substances, including cigarettes and alcohol. The role of friends and family were identified as critical factors that were related to the use of smokeless tobacco.

CONCLUSIONS

This scoping review suggests that preventative measures against smokeless tobacco use should focus on peer and family members' roles and that these measures may benefit from targeting males. Additional research, including systematic reviews on this area to validate the identified associated factors, would improve the understanding of smokeless tobacco use.

Psychographic segmentation to identify higher-risk teen peer crowds for health communications: Validation of Virginia's Mindset Lens Survey

Audience segmentation is necessary in health communications to ensure equitable resource distribution. Peer crowds, which are macro-level teen subcultures, are effective psychographic segments for health communications because each crowd has unique mindsets, values, norms, and health behavior profiles. These mindsets affect behaviors, and can be used to develop targeted health communication campaigns to reach those in greatest need. Though peer crowd research is plentiful, no existing peer crowd measurement tool has been formally validated. As such, we developed and validated Virginia's Mindset Lens Survey (V-MLS), a mindset-based teen peer crowd segmentation survey to support health communication efforts. Using an online convenience sample of teens (N = 1,113), we assessed convergent and discriminant validity by comparing the V-MLS against an existing, widely-used peer crowd survey (I-Base Survey^®) utilizing a multi-trait multi-method matrix. We also examined the V-MLS's predictive ability through a series of regressions using peer crowd scores to predict behaviors, experiences, and traits relevant to health communication campaign planning. The V-MLS demonstrated reliability and convergent and discriminant validity. Additionally, the V-MLS effectively distinguished teen peer crowds with unique health behaviors, experiences, and personal traits. When combined with appropriate information processing and campaign development frameworks, this new tool can complement existing instruments to inform message framing, tone, and style for campaigns that target at-risk teens to increase campaign equity and reach.

Reach, Receptivity, And Beliefs Associated With the Fresh Empire Campaign to Prevent and Reduce Cigarette Use Among Youth in the United States

PURPOSE

To determine the association between exposure to FDA's Fresh Empire tobacco public education campaign and tobacco-related beliefs.

DESIGN

Repeated cross-sectional data collection design with embedded longitudinal cohort over six data collection waves.

SETTING

30 US evaluation markets.

SAMPLE

Hip Hop peer crowd-identified US youth aged 12-18 (N = 5,378).

MEASURES

Self-reported brand and video ad awareness (saw any ad at least sometimes) and perceived effectiveness (1-5 scale) to describe campaign awareness and receptivity. Exogenous exposure was measured using population-adjusted broadcast and digital video impressions. Tobacco-related beliefs included beliefs about smoking risks, attitudes towards tobacco-free people and lifestyles, and normative beliefs about smoking.

ANALYSIS

Descriptive analyses of awareness, receptivity, and agreement with tobacco-related beliefs. Logistic regression models to determine the relationship between broadcast and digital video impressions and beliefs.

INTERVENTION

Fresh Empire campaign.

RESULTS

The campaign generated a high level of reach (71% brand and 66% video ad awareness at final wave) and messages were well-received (across waves 3.5-4.1 mean perceived effectiveness scores). Higher broadcast television exposure was associated with increased agreement with five beliefs related to addiction/control, being a bad influence on family/friends, and cosmetic effects of smoking (breath and attractiveness) (ORs = 1.16-1.27, (Ps < .05)).

CONCLUSION

Fresh Empire successfully reached and resonated with Hip Hop-identified youth. The campaign was associated with a limited number of targeted beliefs.

Final Evaluation Findings for This Free Life, a 3-Year, Multi-Market Tobacco Public Education Campaign for Gender and Sexual Minority Young Adults in the United States

INTRODUCTION

This Free Life was the first multi-market, primarily digital campaign designed to change tobacco-related beliefs among lesbian, gay, bisexual, and transgender (LGBT) young adults. Our evaluation sought to determine whether campaign exposure resulted in changes in tobacco-related beliefs. We summarize awareness and receptivity at the conclusion of the campaign and assess the effect of campaign exposure on tobacco-related beliefs in campaign treatment markets compared with control markets.

AIMS AND METHODS

Twenty-four US designated market areas were selected to receive the campaign or serve as control markets. A baseline survey was conducted in 2016, with six follow-up surveys conducted approximately 6 months apart over the course of the 3-year campaign. 12 324 LGBT young adult survey participants were recruited via intercept interviews and social media. Campaign effects on outcomes were estimated using difference-in-difference panel regression models, with p-values corrected for multiple comparisons.

RESULTS

Brand and ad awareness peaked in treatment markets approximately 2.5 years into the 3-year campaign and were significantly higher in treatment than control markets. Brand equity and ad receptivity were generally high and similar across LGBT subgroups. There were small but significant campaign effects on five tobacco-related beliefs, with difference-in-difference estimates ranging from 1.9 to 5.6 percentage points.

CONCLUSIONS

This Free Life, the first multi-market tobacco public education campaign for LGBT young adults, reached and resonated with a large and diverse population, and had a small effect on beliefs involving social aspects of smoking. These findings should inform future communication efforts aimed at reducing tobacco use among LGBT young adults.

IMPLICATIONS

Modest overall campaign effects suggest that further research on effective campaign messaging and delivery to LGBT young adults is needed. Campaign messaging style, delivery channels, and targeted outcomes likely contributed to these findings. Health communication efforts for LGBT young adults should consider the limitations of digital media in achieving sufficient exposure. Ad style and content optimized for a digital environment is an area that will benefit from further development.

The Need for Marijuana Perceived Risk Interventions Targeting College Students at a Historically Black College and University

The purpose of this pilot study was to test a peer-led Hip-Hop Development Model (HHD) prevention intervention designed to increase the perceived risk from drug use for undergraduate college students attending a Historically Black College and University (HBCU). The HHD model was used to develop prevention messaging to increase the perceived risk from drug use. This study examined the following outcomes of peer-group-based development of public service announcements grounded in HHD: (1) feasibility, (2) acceptability, and (3) potential for immediate posttest and 1-year impact on perceived risk from marijuana use. Findings indicated that the college students were able to produce public service announcements over the course of a semester that could be broadcast to other students on campus. At the 1-year follow-up, perceived risk from marijuana use was significantly higher than at baseline. Perceived risk from marijuana use at baseline was low with 36% of participants who responded moderate or great risk which increased to 63% at immediate and 50% at 1-year posttest. This small pilot study provides insights into what is needed to implement and evaluate youth-targeted marijuana prevention messaging, in a context of rapid increase in the liberalization of adult marijuana use across the United States.

LGBT young adults' awareness of and receptivity to the This Free Life tobacco public education campaign

PURPOSE

This study measures awareness of and receptivity to the Food and Drug Administration's This Free Life campaign seeking to change tobacco-related attitudes and beliefs among lesbian, gay, bisexual and/or transgender (LGBT) young adults.

METHODS

Participants were young adults who self-identify as LGBT. The evaluation uses a treatment-control design. This study includes data from four survey rounds with participants from each round invited to participate in subsequent rounds and new participants invited to account for attrition. Bivariate analyses assess treatment-control differences in campaign awareness by round. We used multivariable logistic regression models with a time×treatment interaction and covariates to assess whether increases in awareness were greater in treatment than control from follow-ups 1 to 4. Descriptive statistics describe perceived effectiveness and models explore covariates of perceived effectiveness.

RESULTS

At each round, an increasing number of participants in treatment were brand aware (25%-67%) and reported high (16%-34%) and medium (16%-25%) video awareness compared with control (all p<0.001). Regressions revealed interactions in brand and video awareness, wherein the effect of treatment on awareness increased more over time, with significant treatment-control differences in change from follow-up 1 to 4 (all p<0.05). Reactions to all but one ad were positive (one neutral) with mean perceived effectiveness scores from 3.21 to 3.92 ('neither disagree nor agree' to 'agree' on 5-point scale). Perceived effectiveness differed by LGBT identity (all p<0.05).

CONCLUSIONS

At follow-up 4, This Free Life reached most of the campaign audience in treatment markets and has achieved higher awareness in treatment than control markets, at individual survey rounds and over time.

Using Peer Crowd Affiliation to Address Dual Use of Cigarettes and E-Cigarettes among San Francisco Bay Area Young Adults: A Cross Sectional Study

Given the emerging tobacco landscape, dual use of cigarettes and e-cigarettes has increased among young adults, but little is known about its associated factors. Peer crowds, defined as macro-level connections between individuals with similar core values (e.g., "Hip Hop" describing a group that prefers hip hop music and values strength, honor, and respect), are a promising way to understand tobacco use patterns. We examined associations between peer crowds and tobacco use patterns by using data from a cross sectional survey of 1340 young adults in the San Francisco Bay Area in 2014. Outcomes were the past 30-day use of: neither cigarettes nor e-cigarettes; cigarettes but not e-cigarettes; e-cigarettes but not cigarettes; and both cigarettes and e-cigarettes. Peer crowds included Hipster, Hip Hop, Country, Partier, Homebody, and Young Professional. Multinomial regression analysis indicated that peer crowds were significantly associated with different tobacco use patterns. Compared to Young Professionals, Hip Hop and Hipster crowds were more likely to dual use; Hipsters were more likely to use e-cigarettes only, and Country participants were more likely to smoke cigarettes only. These findings suggest that tobacco control campaigns and cessation interventions should be tailored to different young adult peer crowds and address poly-tobacco use.

The Vaping Teenager: Understanding the Psychographics and Interests of Adolescent Vape Users to Inform Health Communication Campaigns

Background:

Adolescent vaping continues to rise, yet little is known about teen vape users beyond demographics. Effective intervention requires a deeper understanding of the psychographics and interests of adolescent vape users to facilitate targeted communication campaigns.

Methods:

We analyzed the 2017-2018 weighted cross-sectional online survey data from Virginia high school students (N = 1594) to identify and describe subgroups of adolescents who vaped. Participants reported 30-day vape use, identification with 5 peer crowds (Alternative, Country, Hip Hop, Mainstream, Popular), social prioritization, agreement with personal values statements, social media and smartphone use, and television and event preferences. We compared vaping rates and frequency by peer crowd using a chi-square analysis with follow-up testing to identify higher-risk crowds and confirmed associations using binary and multinomial logistic regression models with peer crowd scores predicting vaping, controlling for demographics. We then used chi-square and t tests to describe the psychographics, media use, and interests of higher-risk peer crowds and current vape users within those crowds.

Results:

Any current vaping was the highest among those with Hip Hop peer crowd identification (25.4%), then Popular (21.3%). Stronger peer crowd identification was associated with increased odds of any current vaping for both crowds, vaping on 1 to 19 days for both crowds, and vaping on 20 to 30 days for Hip Hop only. Compared with other peer crowds and non-users, Hip Hop and Popular youth and current vape users reported greater social prioritization and agreement with values related to being social and fashionable. Hip Hop and Popular youth and current vape users reported heavy Instagram and Snapchat use, as well as unique television show and event preferences.

Conclusions:

Hip Hop and Popular adolescents are most likely to vape and should be priority audiences for vaping prevention campaigns. Findings should guide the development of targeted health communication campaigns delivered via carefully designed media strategies.

Awareness of and Receptivity to the Fresh Empire Tobacco Public Education Campaign Among Hip Hop Youth

PURPOSE

The aim of the study was to assess awareness of and receptivity to the U.S. Food and Drug Administration's Fresh Empire tobacco public education campaign designed to reach Hip Hop-identified youth, who are at higher smoking risk.

METHODS

The evaluation uses a randomized treatment-control design with 15 campaign-targeted treatment and 15 control markets. We conducted surveys among 12- to 17-year-olds before campaign launch and at approximately 6-month intervals. Analyses explore treatment-control differences in Fresh Empire brand and video advertisement awareness at individual survey rounds and over time and perceived effectiveness of advertisements.

RESULTS

Awareness of the Fresh Empire brand was higher among youth in treatment than control markets following campaign launch (ps < .01). Awareness of the Fresh Empire brand increased more in treatment than control over time (adjusted odds ratio = 3.26, 95% confidence interval = 1.90-5.58). At follow-ups 1 and 3, youth in treatment (vs. control) were more likely to report high and less likely to report low awareness of video advertisements (ps < .05). There were no treatment-control differences in video awareness at follow-up 2 (not significant). Fresh Empire video advertisements had perceived effectiveness scores ranging from 3.66 to 4.11 (1-5 scale) across three survey rounds.

CONCLUSIONS

Among the campaign audience of Hip Hop-identified youth, awareness of the Fresh Empire campaign was higher in treatment than control markets at individual survey rounds, and increases in campaign awareness were greater in treatment than control markets over time. Campaign advertisements also elicited positive audience reactions. Findings suggest that heavily digital campaigns may take longer to achieve Centers for Disease Control and Prevention-recommended 75% quarterly awareness.

Join the Commune: A Controlled Study of Social Branding Influencers to Decrease Smoking Among Young Adult Hipsters

PURPOSE

To evaluate the impact of a Social Branding intervention in bars and nightclubs on smoking behavior.

DESIGN

Quasi-experimental controlled study.

SETTING

Bars and nightclubs in San Diego and San Francisco (intervention) and Los Angeles (control).

PARTICIPANTS

"Hipster" young adults (age 18-26) attending bars and nightclubs.

INTERVENTION

Anti-tobacco messages delivered through monthly anti-tobacco music/social events, opinion leaders, original art, direct mail, promotional activities, and online media.

MEASURES

A total of 7240 surveys were collected in 3 cities using randomized time location sampling at baseline (2012-2013) and follow-up (2015-2016); data were analyzed in 2018. The primary outcome was current smoking.

ANALYSIS

Multivariable logistic regression assessed correlates of smoking, adjusting for covariates including electronic cigarette use; differences between cities were evaluated using location-by-time interactions.

RESULTS

Smoking in San Francisco decreased at a significantly faster rate (51.1%-44.1%) than Los Angeles (45.2%-44.5%) (P = .034). Smoking in San Diego (mean: 39.6%) was significantly lower than Los Angeles (44.8%, P < .001) at both time points with no difference in rate of change. Brand recall was not associated with smoking behavior, but recall was associated with anti-tobacco attitudes that were associated with smoking.

CONCLUSION

This is the first controlled study of Social Branding interventions. Intervention implementation was accompanied by decreases in smoking (San Francisco) and sustained lower smoking (San Diego) among young adult bar patrons over 3 years.

Peer crowd-based targeting in E-cigarette advertisements: a qualitative study to inform counter-marketing

Background

Cigarette lifestyle marketing with psychographic targeting has been well documented, but few studies address non-cigarette tobacco products. This study examined how young adults respond to e-cigarette advertisements featuring diverse peer crowds – peer groups with shared identities and lifestyles – to inform tobacco counter-marketing design.

Methods

Fifty-nine young adult tobacco users in California participated in interviews and viewed four to five e-cigarette advertisements that featured characters from various peer crowd groups. For each participant, half of the advertisements they viewed showed characters from the same peer crowd as their own, and the other half of the advertisements featured characters from a different peer crowd. Advertisements were presented in random order. Questions probed what types of cues are noticed in the advertisements, and whether and how much participants liked or disliked the advertisements.

Results

Results suggest that participants liked and provided richer descriptions of characters and social situations in the advertisements featuring their own peer crowd more than the advertisements featuring a different peer crowd. Mismatching age or device type was also noted: participants reported advertisements showing older adults were not intended for them. Participants who used larger vaporizers tended to dislike cigalike advertisements even if they featured a matching peer crowd.

Conclusion

Peer crowd and lifestyle cues, age and device type are all salient features of e-cigarette advertising for young adults. Similarly, educational campaigns about e-cigarettes should employ peer crowd-based targeting to engage young adults, though messages should be carefully tested to ensure authentic and realistic portrayals.

Perceived Ease of Access and Age Attenuate the Association Between Marijuana Ad Exposure and Marijuana Use in Adolescents

This study theorizes and tests moderators (perceived availability of marijuana and age-group) of the association between adolescents' frequency of marijuana ad exposure and past-year marijuana use. To test this model, I analyzed national survey data from 9,024 American adolescents with hierarchical regression techniques. Results showed that being a male (95% confidence interval [CI] for unstandardized regression coefficient [0.06, 0.16]) and peer pressure (95% CI [0.04, 0.14]) were positively associated with past-year marijuana use, and father education (95% CI [-0.11, -0.06]) was negatively associated with it. Perceived ease of access (95% CI [0.18, 0.22]), ad exposure (95% CI [0.03, 0.14]), and age (95% CI [0.16, 0.27]) were positively associated with past-year marijuana use. Importantly, the associations of perceived ease of access and age with past-year marijuana use were significantly larger than that of ad exposure. Age (95% CI [0.00, 0.15]) and perceived ease of access (95% CI [0.01, 0.07]) independently strengthened the ad exposure to use association. There was a significant three-way interaction (95% CI [0.01, 0.12]) showing that age increases the positive influence of perceived ease of access on the marijuana ad exposure to past-year marijuana use association. An exploratory analysis further revealed that male adolescents are more strongly influenced by perceived ease of access compared to females. Based on the findings, I suggest that approaches for reducing perceived marijuana availability and for implementing age-specific interventions are promising avenues for prevention programs aimed at decreasing marijuana use in adolescents.

'Social screens' and 'the mainstream': longitudinal competitors of non-organized physical activity in the transition from childhood to adolescence

Background

Physical activity (PA) tends to decline during late childhood and adolescence. In Australia, this decline has been shown to occur particularly in non-organized PA (e.g. active play and informal sport). Using a social marketing approach, segments of youth may be identified and targeted based on their profile of alternative activities that compete with non-organized PA during the transition to adolescence. The objectives of this study were to identify and describe segments of youth whose participation in non-organized PA declined between 11 and 13 years, based on changes in other potential competing activities during this period.

Methods

Data were sourced from Waves 4 and 5 of the Longitudinal Study of Australian Children. Participation in non-organized PA and thirteen alternative activities (e.g. video games, homework, sleep) were measured using 24-h time-use diaries. Analyses were limited to participants whose non-organized PA had declined between 11 and 13 years (n = 1043). Two-stage cluster analysis was conducted and segments were described using chi-square and t-tests.

Results

Among the analytic sample, average non-organized PA participation declined by 87 min/day between 11y and 13y (p < 0.001). Two segments were identified (κ = 0.66). The ‘Social Screens’ segment (n = 143) had large increases in texting, emailing and social media use (+ 56 min/day, p < 0.001) and other internet use (+ 32 min/day, p < 0.001). Conversely, ‘the Mainstream’ segment (n = 900) had smaller increases in a wider range of activities, including other PA (organized PA, active transport, active chores/work) (+ 16.0 min/day, p < 0.001), homework/study (+ 9.5 min/day, p < 0.001) and electronic gaming (+ 6.7 min/day, p < 0.05). ‘Social Screens’ were more likely to attend public school, live in urban areas and have more advanced pubertal development (girls only). ‘The Mainstream’ were more likely to participate in PA and out-of-school activities.

Conclusions

The ‘Social Screens’ segment had a much larger increase in texting, emailing, social media and other internet use, and lower participation in overall PA and out-of-school activities, compared with ‘the Mainstream’. Future research may trial PA promotion strategies to replace benefits that this segment may seek in competing activities (e.g. social PA apps).

Keeping It Fresh With Hip-Hop Teens: Promising Targeting Strategies for Delivering Public Health Messages to Hard-to-Reach Audiences

Despite overall declines in youth cigarette use, tobacco use inequities exist by race/ethnicity. Health communication campaigns can be effective in changing tobacco-related attitudes, intentions, and behaviors and can be used to address tobacco use inequities by targeting young people who are at high risk for tobacco use. In 2015, the U.S. Food and Drug Administration launched Fresh Empire, the first tobacco public education campaign designed to reach primarily African American, Hispanic, and/or Asian American/Pacific Islander youth ages 12 to 17 years who identify with the Hip-Hop peer crowd. This article presents an overview of two targeting strategies-(a) influencers on social media and (b) paid digital and social media advertisements-that Fresh Empire uses to reach its audience and increase message credibility that can inform future campaigns targeting hard-to-reach populations. These strategies help the campaign expand its reach, be authentic, and increase engagement with the target audience. Microinfluencers are selected for their alignment with Hip-Hop values and high engagement rates; local influencers are teens recruited to promote the campaign in their communities; and digital and social ads are purchased with a minimum number of in-target guaranteed impressions. Across both strategies, metrics have met or exceeded expectations, including a sentiment analysis that revealed 87.3% of comments on microinfluencer posts were positive. Initial findings suggest that the tobacco prevention messages have reached the target population and resonated positively, which may help to increase message credibility and improve receptivity to tobacco prevention messages.

Who Uses Tobacco Products? Using Peer Crowd Segmentation to Identify Youth at Risk for Cigarettes, Cigar Products, Hookah, and E-Cigarettes

Background: Understanding which adolescents are at greatest risk for cigarettes and other tobacco products is critical to inform tailored and targeted interventions. Objectives: We used peer crowds (macro-level subcultures) to identify subgroups of adolescents at-risk for using and being open to using cigarettes; cigars, cigarillos, and little cigars (cigar products); hookah; e-cigarettes; any tobacco product; and multiple products. Methods: In 2017, youth ages 12-17 in five U.S. states completed cross-sectional surveys (n = 1,167). Participants provided data on cigarette use (experimentation) and openness to use (susceptibility); cigar product, hookah, and e-cigarette use (ever use) and openness to use (curiosity); and identification with five peer crowds (Alternative, Country, Hip Hop, Mainstream, Popular). We used chi-square tests to compare rates by peer crowd, and multivariate logistic regressions to assess odds of use and openness for each crowd (reference: Mainstream). Results: Risk differed by peer crowd. Hip Hop youth reported high rates of use, ranging from 12.8% (cigarettes) to 33.4% (e-cigarettes). Regressions revealed increased odds of use for Hip Hop compared to Mainstream for all products, especially cigar products and multi-product use. Popular (cigar products, e-cigarettes) and Alternative (cigarettes) demonstrated increased odds of use compared to Mainstream. We also observed elevated odds of cigarette openness among Alternative, Country, and Hip Hop youth, and of hookah openness among Hip Hop and Popular youth compared to Mainstream. Conclusions/Importance: Peer crowd-tailored cigarette education campaigns can be extended to address other tobacco product risk, especially for higher-risk peer crowds such as Hip Hop.

Youth peer crowds and risk of cigarette use: The effects of dual peer crowd identification among hip hop youth

Introduction

Recent research has found that the Hip Hop peer crowd has a strong link to risky health behaviors, including tobacco use. The current study expands on previous research on the Hip Hop peer crowd by investigating the nuances of the effects on cigarette risk that Hip Hop identification has in combination with other peer crowds.

Methods

Targeted social media advertisements were used to recruit youth to complete an online survey. Participants (n = 4681) self-reported peer crowd identification via the I-Base Survey™, and cigarette smoking status. Smoking status was compared between peer crowd groups consisting of participants who had identification with only one peer crowd, and those who had identification with the Hip Hop peer crowd and one other crowd (i.e., Hip Hop dual peer crowd identification).

Results

Significant differences in cigarette status were observed among the dual and single peer crowd groups. Specifically, differences in cigarette Non-susceptible Non-triers and Experimenters demonstrated that youth who identified as Mainstream Only were at lowest risk while youth who identified as Hip Hop/Alternative had the highest rates of cigarette experimentation. There were no differences between peer crowd groups on proportions of Susceptible Non-triers.

Conclusions

Examining dual peer crowd identifications provides a nuanced understanding of risk. Dual identification with Hip Hop seems to have differential effects compared to solo identification with other crowds, whereby Hip Hop identification may increase cigarette experimentation when combined with another peer crowd. Findings demonstrate the potential of considering multiple peer crowd identification to inform public education campaign development.

•

Peer crowds have previously investigated the Hip Hop peer crowd in isolation.

•

FDA's multicultural youth tobacco education campaign tailors messages Hip Hop peer crowd.

•

Data comes from the first nationally-recruited sample of youth peer crowd and smoking.

•

Peer crowds had differential levels of risk based on dual membership.

•

Hip Hop peer crowd targeting should consider the effects of other peer crowds.

Patterns of Alcohol, Tobacco, and Substance Use Among Young Adult Peer Crowds

INTRODUCTION

The association between peer crowd identification and substance use is well documented among adolescents, but less is known about substance use among young adult peer crowds.

METHODS

This study leverages data from the Truth Initiative Young Adult Cohort Study (Wave 8, June-July 2015), a nationally representative cohort sample of young adults aged 18-34 years. The current cross-sectional analyses (conducted in 2018) focused on 1,341 individuals aged 18-24 years in this sample. Participants reported their peer crowd identification and current use of alcohol, marijuana, other drugs, and tobacco (cigarettes, little cigars/cigarillos, e-cigarettes, hookah, smokeless tobacco). Adjusted logistic regression models assessed associations between peer crowd identification and substance use.

RESULTS

In general, young adults who identified as homebody, young professional, or religious had lower odds of substance use than their counterparts. Young adults who identified as social/partier were more likely to be current users of alcohol, marijuana, any tobacco, cigarettes, and e-cigarettes than those who did not identify as social/partier. Those who identified as alternative were more likely to be current users of marijuana and other drugs than those not identified as alternative. Those who identified as country were more likely than those not identified as country to be current users of cigarettes and smokeless tobacco. Those who identified as hip hop were more likely to be current users of marijuana and e-cigarettes.

CONCLUSIONS

Peer crowd identification is associated with substance use among young adults. These findings can help identify target populations for prevention and cessation interventions and inform intervention design and delivery.

Peer crowd segmentation for targeting public education campaigns: Hip hop youth and tobacco use

This study examines the potential association between strength of Hip Hop peer crowd identification and tobacco use in one of the first large samples of Hip Hop youth in the United States. Data are from a geographically-targeted, address-based convenience sample of 2194 youths aged 12–17 who identify with the Hip Hop peer crowd collected via in-person and web interviews in 30 U.S. media markets in 2015. We examined strength of Hip Hop peer crowd identification, perceived peer tobacco use, and tobacco use outcomes. Overall, 18.3% of Hip Hop youth reported current blunt (cigar with added marijuana) use, followed by electronic cigarettes (e-cigarettes) (11.6%), cigar (without added marijuana) (8.8%), hookah (6.5%), and cigarette (5.6%) use. Stronger Hip Hop peer crowd identification was associated with increased odds of using cigarettes (OR = 2.25, p < 0.05), cigars (OR = 2.14, p < 0.05), and blunts (OR = 1.61, p < 0.05), controlling for demographic characteristics and perceived peer tobacco use. Results suggest that a Hip Hop peer crowd–targeted public education prevention campaign for youth can be promising for a variety of tobacco products.

Combustible and Electronic Tobacco and Marijuana Products in Hip-Hop Music Videos, 2013-2017

IMPORTANCE

Hip-hop is the leading music genre in the United States and its fan base includes a large proportion of adolescents and young adults of all racial and ethnic groups, particularly minorities. The appearance of combustible and electronic tobacco and marijuana products, especially brand placement and use by popular and influential artists, may increase the risk of tobacco and marijuana use and decrease perceptions of harm.

OBJECTIVE

To assess the prevalence of the appearance and use of combustible and electronic tobacco and marijuana products, including brand placement, in leading hip-hop songs.

DESIGN, SETTING, AND PARTICIPANTS

Analysis of top 50 songs from 2013 to 2017 of Billboard magazine's weekly Hot R&B/Hip-Hop Songs with videos that included the appearance or use of combustible tobacco and marijuana products (manufactured cigarettes, cigars, hookah or waterpipe, pipe, hand-rolled tobacco and marijuana products, marijuana buds); appearance of exhaled smoke or vapor without an identifiable source product; appearance or use of electronic tobacco and marijuana products (eg, electronic cigarettes); tobacco or marijuana brand placement; appearance or use of combustible and electronic tobacco and marijuana by main or featured artist. Data were collected from December 6, 2017, to June 4, 2018.

MAIN OUTCOMES AND MEASURES

Prevalence of (1) appearance or use of combustible tobacco and marijuana products, (2) appearance of smoke or vapor, (3) appearance or use of electronic tobacco and marijuana products, (4) tobacco or marijuana brand placement, and (5) appearance or use of combustible and electronic tobacco and marijuana by main or featured artist. Probability of appearance or use of combustible and electronic tobacco and marijuana products by quartile of viewership of videos.

RESULTS

The proportion of leading hip-hop videos containing combustible use, electronic use, or smoke or vapor ranged from 40.2% (76 of 189) in 2015, to 50.7% (102 of 201) in 2016. For each year, the leading category of combustible use was hand-rolled products. The appearance of branded products increased from 0% in 2013 (0 of 82) to 9.9% in 2017 (10 of 101) for combustible products, and from 25.0% in 2013 (3 of 12) to 87.5% in 2017 (14 of 16) for electronic products. The prevalence of combustible or electronic product use or exhaled smoke or vapor increased by quartile of total number of views: 41.9% (8700 to 19 million views) among songs in the first quartile of viewership and 49.7% among songs in the fourth quartile of viewership (112 million to 4 billion views).

CONCLUSIONS AND RELEVANCE

Combustible and electronic tobacco and marijuana use frequently occurred in popular hip-hop music videos. The genre's broad appeal, use of branded products by influential artists, and rise of electronic product and marijuana use may contribute to a growing public health concern of tobacco and marijuana use.

Freedom From Chew: Using Social Branding to Reduce Chewing Tobacco Use Among Country Peer Crowd Teens

Background. Peer crowds are macro-level, reputation-based subcultures with shared preferences, values, and behavior. The Country peer crowd has been the focus of tobacco industry research and marketing but has yet to be the primary focus of public health research. The current study explores the utility of Down and Dirty, a Social Branding tobacco education campaign, in changing Virginia Country teens’ chewing tobacco-related attitudes and behavior. The relationship between chew use and Country peer crowd identification was also explored. Method. To evaluate the campaign, a cross-sectional survey was administered online for 3 years from 2014 to 2016. Responses were collected via social media advertisements targeting 13- to 18-year-old Country youth from Virginia (total n = 1,264). Participants reported peer crowd identification, chew-related attitudes and behavior, and campaign engagement and appeal. Results. Compared with Wave 1, Waves 2 and 3 Country teens who engaged with Down and Dirty had greater odds of holding strong attitudes against chew. Among campaign-engaged Country teens, odds of chew use were lower at Waves 2 and 3, and lower odds were associated with liking the campaign. Related to chew prevalence, Country teens demonstrated greater odds of past 30-day chew use compared to non-Country teens, and higher Country identification was associated with greater odds of chew use. Discussion. Down and Dirty is a promising intervention associated with positive attitudinal and behavioral outcomes for high-risk Country teens. Additionally, this study helps document tobacco-related behavioral patterns of the Country peer crowd, a priority for ongoing tobacco education, especially around chew.

The Hip Hop peer crowd: An opportunity for intervention to reduce tobacco use among at-risk youth

INTRODUCTION

Peer crowds, peer groups with macro-level connections and shared norms that transcend geography and race/ethnicity, have been linked to risky health behaviors. Research has demonstrated that Hip Hop peer crowd identification, which is common among multicultural youth, is associated with increased risk of tobacco use. To address this, the FDA Center for Tobacco Products created Fresh Empire, the first national tobacco education campaign tailored for Hip Hop youth aged 12-17 who are multicultural (Hispanic, African American, Asian-Pacific Islander, or Multiracial). As part of campaign development, peer crowd (Hip Hop, Mainstream, Popular, Alternative, Country) and cigarette smoking status were examined for the first time with a nationally recruited sample.

METHODS

Youth were recruited via targeted social media advertisements. Participants aged 13-17 (n = 5153) self-reported peer crowd identification via the I-Base Survey™ and cigarette smoking status. Differences in smoking status by peer crowd were examined using chi-square and followed up with z-tests to identify specific differences.

RESULTS

Alternative youth were most at risk of cigarette smoking, followed by Hip Hop. Specifically, Hip Hop youth were significantly less likely to be Non-susceptible Non-triers than Popular, Mainstream, and Country youth, and more likely to be Experimenters than Popular and Mainstream youth.

CONCLUSIONS

Representative studies show that Alternative is relatively small compared to other high-risk crowds, such as the Hip Hop peer crowd. The current research underscores the potential utility of interventions tailored to larger at-risk crowds for campaigns like Fresh Empire.