Using peer crowds to segment Black youth for smoking intervention

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.

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.

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.

"It's Not Too Aggressive": Key Features of Social Branding Anti-Tobacco Interventions for High-Risk Young Adults

Purpose. Peer crowd-targeted campaigns are a novel approach to engage high-risk young adults in tobacco use prevention and cessation. We elicited the perspectives of young adult key informants to understand how and why two social branding interventions were effective: (1) "COMMUNE," designed for "Hipsters" as a movement of artists and musicians against Big Tobacco, and (2) "HAVOC," designed for "Partiers" as an exclusive, smoke-free clubbing experience. Design. Qualitative study (27 semistructured qualitative phone interviews). Setting. Intervention events held in bars in multiple U.S. cities. Participants: Twenty-seven key informants involved in COMMUNE or HAVOC as organizers (e.g., musicians, event coordinators) or event attendees. Measures. We conducted semistructured, in-depth interviews. Participants described intervention events and features that worked or did not work well. Analysis. We used an inductive-deductive approach to thematically code interview transcripts, integrating concepts from intervention design literature and emergent themes. Results: Participants emphasized the importance of fun, interactive, social environments that encouraged a sense of belonging. Anti-tobacco messaging was subtle and nonjudgmental and resonated with their interests, values, and aesthetics. Young adults who represented the intervention were admired and influential among peers, and intervention promotional materials encouraged brand recognition and social status. Conclusion. Anti-tobacco interventions for high-risk young adults should encourage fun experiences; resonate with their interests, values, and aesthetics; and use subtle, nonjudgmental messaging.

Racial Disparities in School Lunch Program Participation and Cigarette Use: Evidence from Arizona Youth Survey Data

Background: Cigarette and other tobacco product use among youth has become a serious public health issue in the United States. Thus, it is important to understand the social and contextural factors of cigarette use, especially for the young population. This study explores the relationship between participation in the National School Lunch Program (NSLP) and youth cigarettes use. Further, this study examines how this relationship differs across racial/ethnic groups. Methods: The 2016 Arizona Youth Survey (n = 34,373) data and multivariate logistic regressions were used to examine the association between NSLP participation (free and reduced-cost) and youth cigarette use, both lifetime and past 30-day smoking behaviors. In addition, subgroup analyses were conducted to test the racial disparities in NSLP participation and cigarette use. Results: Results showed that free lunch participation was associated with significantly higher odds of youth cigarette use, both lifetime (OR = 1.25; p < .001) and in the past 30-days (OR = 1.14; p < .05). However, reduced-cost lunch participation was associated with significantly higher odds only for lifetime cigarette use (OR = 1.20; p < .01). Subgroup analyses revealed differences across the six racial/ethnic groups. White and Latinx youth showed a significant relationship between NSLP participation and lifetime cigarette smoking, whereas only Latinx youth showed a significant relationship between NSLP participation and past 30-day smoking. Implications: The findings suggest that intervention approaches to smoking cessation and prevention should be tailored to different racial/ethnic groups to account for their differences. Given the findings that youth (especially Latinxs) who participate in free and reduced-cost lunch programs are at a higher risk of using cigarettes than youth who do not, this study suggests that health intervention programs can enhance their reach and effectiveness by building partnerships with schools with sizable NSLP programs.

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.

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.

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

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

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

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

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

Audience segmentation to improve targeting of conservation interventions for hunters

Audience segmentation could help improve the effectiveness of conservation interventions. Marketers use audience segmentation to define the target audience of a campaign. The technique involves subdividing a general population into groups that share similar profiles, such as sociodemographic or behavioral characteristics. Interventions are then designed to target the group or groups of interest. We explored the potential of audience segmentation for use in defining conservation target groups with a case study of hunters in Liberia. Using 2 data sets describing households (n = 476) and hunters (n = 205), we applied a clustering method in which infinite binomial mixture models group hunters and households according to livelihood and behavior variables and a simple method to define target groups based on hunting impact (hunting households and high-impact hunters). Clusters of hunters and households differed in their experiences with confiscation of catch at roadblocks and participation in livelihood-support programs, indicating that these interventions operate unevenly across subsets of the population. By contrast, the simple method masked these insights because profiles of hunting households and high-impact hunters were similar to those of the general population. Clustering results could be used to guide the development of livelihood and regulatory interventions. For example, a commonly promoted agricultural activity, cocoa farming, was practiced by only 2% (out of 87) of the largest hunter cluster of nonlocal gun hunters but was prevalent among local trappers, suggesting that assistance aimed at cocoa farmers is less appropriate for the former group. Our results support the use of audience segmentation across multiple variables to improve targeted intervention designs in conservation.

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.

Learning what our target audiences think and do: extending segmentation to all four bases

Background

While acknowledged as one of social marketing’s necessities, limited reporting of segmentation exists. The current study seeks to extend segmentation drawing on all four segmentation bases within the context of Queensland young adult sexual health behaviour.

Methods

An online survey was used to collect data from 15 to 29 year old people in Queensland, Australia. Data collection was undertaken online to capture the broader population of young adults and in person on campuses to gather data from students who were currently enrolled at University. Quotas were set to ensure a broad representation was attained reflecting the States demography.

Results

Two-step cluster analysis revealed three different segments. The most important variables in segment formation were age, household type, experience of risky sexual encounters and previously being tested or treated for sexually transmissible infections (STIs). The results suggest that demographic and behavioural variables were the most effective in segment definition.

Conclusions

This study investigated young people aged 15–29 in Queensland, Australia to examine group differences drawing from four bases. This study revealed three distinct segments in a sexual health context and highlighted the importance of behavioural variables in segment formation, insight and understanding.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6696-2) contains supplementary material, which is available to authorized users.

Contemporary College Students' Reflections of their High School Peer Crowds

High school peer crowds are fundamental components of adolescent development with influences on short-and long-term life trajectories. This study provides the perspectives of contemporary college students regarding their recent high school social landscapes, contributing to current research and theory on the social contexts of high school. This study also highlights the experiences of college-bound students who represent a growing segment of the adolescent population. 61 undergraduates attending universities in two states participated in 10 focus groups to reflect on their experiences with high school peer crowds during the late 2010s. Similar to seminal research on peer crowds, we examined crowds and individuals along several focal domains: popularity, extracurricular involvement, academic orientation, fringe media, illicit risk taking, and race-ethnicity. We find that names and characteristics of crowds reflect the current demographic and cultural moment (i.e., growing importance of having a college education, racial-ethnic diversity) and identify peer crowds that appear to be particularly salient for college-bound youth. Overall, this study illuminates how the retrospective accounts of college-bound students offer insight into high school social hierarchies during a time of rapid social change.

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.

Mapping of Crowdsourcing in Health: Systematic Review

Background

Crowdsourcing involves obtaining ideas, needed services, or content by soliciting Web-based contributions from a crowd. The 4 types of crowdsourced tasks (problem solving, data processing, surveillance or monitoring, and surveying) can be applied in the 3 categories of health (promotion, research, and care).

Objective

This study aimed to map the different applications of crowdsourcing in health to assess the fields of health that are using crowdsourcing and the crowdsourced tasks used. We also describe the logistics of crowdsourcing and the characteristics of crowd workers.

Methods

MEDLINE, EMBASE, and ClinicalTrials.gov were searched for available reports from inception to March 30, 2016, with no restriction on language or publication status.

Results

We identified 202 relevant studies that used crowdsourcing, including 9 randomized controlled trials, of which only one had posted results at ClinicalTrials.gov. Crowdsourcing was used in health promotion (91/202, 45.0%), research (73/202, 36.1%), and care (38/202, 18.8%). The 4 most frequent areas of application were public health (67/202, 33.2%), psychiatry (32/202, 15.8%), surgery (22/202, 10.9%), and oncology (14/202, 6.9%). Half of the reports (99/202, 49.0%) referred to data processing, 34.6% (70/202) referred to surveying, 10.4% (21/202) referred to surveillance or monitoring, and 5.9% (12/202) referred to problem-solving. Labor market platforms (eg, Amazon Mechanical Turk) were used in most studies (190/202, 94%). The crowd workers’ characteristics were poorly reported, and crowdsourcing logistics were missing from two-thirds of the reports. When reported, the median size of the crowd was 424 (first and third quartiles: 167-802); crowd workers’ median age was 34 years (32-36). Crowd workers were mainly recruited nationally, particularly in the United States. For many studies (58.9%, 119/202), previous experience in crowdsourcing was required, and passing a qualification test or training was seldom needed (11.9% of studies; 24/202). For half of the studies, monetary incentives were mentioned, with mainly less than US $1 to perform the task. The time needed to perform the task was mostly less than 10 min (58.9% of studies; 119/202). Data quality validation was used in 54/202 studies (26.7%), mainly by attention check questions or by replicating the task with several crowd workers.

Conclusions

The use of crowdsourcing, which allows access to a large pool of participants as well as saving time in data collection, lowering costs, and speeding up innovations, is increasing in health promotion, research, and care. However, the description of crowdsourcing logistics and crowd workers’ characteristics is frequently missing in study reports and needs to be precisely reported to better interpret the study findings and replicate them.

Peer Crowd Identification and Adolescent Health Behaviors: Results From a Statewide Representative Study

Purpose. Peer crowds are macro-level subcultures that share similarities across geographic areas. Over the past decade, dozens of studies have explored the association between adolescent peer crowds and risk behaviors, and how they can inform public health efforts. However, despite the interest, researchers have not yet reported on crowd size and risk levels from a representative sample, making it difficult for practitioners to apply peer crowd science to interventions. The current study reports findings from the first statewide representative sample of adolescent peer crowd identification and health behaviors. Methods. Weighted data were analyzed from the 2015 Virginia Youth Survey of Health Behaviors ( n = 4,367). Peer crowds were measured via the I-Base Survey™, a photo-based peer crowd survey instrument. Frequencies and confidence intervals of select behaviors including tobacco use, substance use, nutrition, physical activity, and violence were examined to identify high- and low-risk crowds. Logistic regression was used to calculate adjusted odds ratios for each crowd and behavior. Results. Risky behaviors clustered in two peer crowds. Hip Hop crowd identification was associated with substance use, violence, and some depression and suicidal behaviors. Alternative crowd identification was associated with increased risk for some substance use behaviors, depression and suicide, bullying, physical inactivity, and obesity. Mainstream and, to a lesser extent, Popular, identities were associated with decreased risk for most behaviors. Conclusions. Findings from the first representative study of peer crowds and adolescent behavior identify two high-risk groups, providing critical insights for practitioners seeking to maximize public health interventions by targeting high-risk crowds.

Peer crowd affiliation as a segmentation tool for young adult tobacco use

BACKGROUND

In California, young adult tobacco prevention is of prime importance; 63% of smokers start by the age of 18 years, and 97% start by the age of 26 years. We examined social affiliation with 'peer crowd' (eg, Hipsters) as an innovative way to identify high-risk tobacco users.

METHODS

Cross-sectional surveys were conducted in 2014 (N=3368) among young adult bar patrons in 3 California cities. We examined use rates of five products (cigarettes, e-cigarettes, hookah, cigars and smokeless tobacco) by five race/ethnicity categories. Peer crowd affiliation was scored based on respondents' selecting pictures of young adults representing those most and least likely to be in their friend group. Respondents were classified into categories based on the highest score; the peer crowd score was also examined as a continuous predictor. Logistic regression models with each tobacco product as the outcome tested the unique contribution of peer crowd affiliation, controlling for race/ethnicity, age, sex, sexual orientation and city.

RESULTS

Respondents affiliating with Hip Hop and Hipster peer crowds reported significantly higher rates of tobacco use. As a categorical predictor, peer crowd was related to tobacco use, independent of associations with race/ethnicity. As a continuous predictor, Hip Hop peer crowd affiliation was also associated with tobacco use, and Young Professional affiliation was negatively associated, independent of demographic factors.

CONCLUSIONS

Tobacco product use is not the same across racial/ethnic groups or peer crowds, and peer crowd predicts tobacco use independent of race/ethnicity. Antitobacco interventions targeting peer crowds may be an effective way to reach young adult tobacco users.

TRIAL REGISTRATION NUMBER

NCT01686178, Pre-results.

Reducing Cancer and Cancer Disparities: Lessons From a Youth-Generated Diabetes Prevention Campaign

Adolescence and young adulthood, a period essential for determining exposures over the life-course, is an ideal time to intervene to lower cancer risk. This demographic group can be viewed as both the target audience and generator of messages for cancer prevention, such as skin cancer, obesity-, tobacco-, and human papillomavirus-related cancers. The purpose of this paper is to encourage innovative health communications that target youth; youth behavior; and the structural, environmental, and social determinants of youth behavior as critical areas of focus for cancer prevention and disparities reduction. The authors describe the rationale, processes, products, and early impacts of an award-winning youth diabetes prevention communication campaign model (The Bigger Picture) that harnesses spoken-word messages in school-based and social media presentations. The campaign supports minority adolescent and young adult artists to create content that aligns with values held closely by youth-values likely to resonate and affect change, such as defiance against authority, inclusion, and social justice. This campaign can be leveraged to prevent obesity, which is a cancer risk factor. Then, the authors propose concrete ways that The Bigger Picture's pedagogical model could be adapted for broader cancer prevention messaging for youth of color and youth stakeholders regarding tobacco-related cancers, skin cancers, and human papillomavirus-related cancers. The goal is to demonstrate how a youth-generated and youth-targeted prevention campaign can: (1) reframe conversations about cancer prevention, (2) increase awareness that cancer prevention is about social justice and health equity, and (3) catalyze action to change social norms and confront the social and environmental drivers of cancer disparities.

Bars, Nightclubs, and Cancer Prevention: New Approaches to Reduce Young Adult Cigarette Smoking

INTRODUCTION

Tobacco contributes to multiple cancers, and it is largely preventable. As overall smoking prevalence in California declines, smoking has become concentrated among high-risk groups. Targeting social/cultural groups (i.e., "peer crowds") that share common values, aspirations, and activities in social venues like bars and nightclubs may reach high-risk young adult smokers. Lack of population data on young adult peer crowds limits the ability to assess the potential reach of such interventions.

METHODS

This multimodal population-based household survey included young adults residing in San Francisco and Alameda counties. Data were collected in 2014 and analyzed in 2016. Multivariable logistic regressions assessed smoking by sociodemographic factors, attitudes, self-rated health, peer crowd affiliation, and bar/nightclub attendance.

RESULTS

Smoking prevalence was 15.1% overall; 35.3% of respondents sometimes or frequently attended bars. In controlled analyses, bar attendance (AOR=2.13, 95% CI=1.00, 4.53) and binge drinking (AOR=3.17, 95% CI=1.59, 6.32) were associated with greater odds of smoking, as was affiliation with "Hip Hop" (AOR=4.32, 95% CI=1.48, 12.67) and "Country" (AOR=3.13, 95% CI=1.21, 8.09) peer crowds. Multivariable models controlling for demographics estimated a high probability of smoking among bar patrons affiliating with Hip Hop (47%) and Country (52%) peer crowds.

CONCLUSIONS

Bar attendance and affiliation with certain peer crowds confers significantly higher smoking risk. Interventions targeting Hip Hop and Country peer crowds could efficiently reach smokers, and peer crowd-tailored interventions have been associated with decreased smoking and binge drinking. Targeted interventions in bars and nightclubs may be an efficient way to address these cancer risks.

Countermarketing Alcohol and Unhealthy Food: An Effective Strategy for Preventing Noncommunicable Diseases? Lessons from Tobacco

Countermarketing campaigns use health communications to reduce the demand for unhealthy products by exposing motives and undermining marketing practices of producers. These campaigns can contribute to the prevention of noncommunicable diseases by denormalizing the marketing of tobacco, alcohol, and unhealthy food. By portraying these activities as outside the boundaries of civilized corporate behavior, countermarketing can reduce the demand for unhealthy products and lead to changes in industry marketing practices. Countermarketing blends consumer protection, media advocacy, and health education with the demand for corporate accountability. Countermarketing campaigns have been demonstrated to be an effective component of comprehensive tobacco control. This review describes common elements of tobacco countermarketing such as describing adverse health consequences, appealing to negative emotions, highlighting industry manipulation of consumers, and engaging users in the design or implementation of campaigns. It then assesses the potential for using these elements to reduce consumption of alcohol and unhealthy foods.

Why Peer Crowds Matter: Incorporating Youth Subcultures and Values in Health Education Campaigns

Grounded on research showing that peer crowds vary in risk behavior, several recent health behavior interventions, including the US Food and Drug Administration's Fresh Empire campaign, have targeted high-risk peer crowds. We establish the scientific foundations for using this approach. We introduce peer crowd targeting as a strategy for culturally targeting health behavior interventions to youths. We use social identity and social norms theory to explicate the theoretical underpinnings of this approach. We describe Fresh Empire to demonstrate how peer crowd targeting functions in a campaign and critically evaluate the benefits and limitations of this approach. By replacing unhealthy behavioral norms with desirable, healthy lifestyles, peer crowd-targeted interventions can create a lasting impact that resonates in the target audience's culture.

Treatment of Lung Cancer in Medically Compromised Patients

Outcomes for patients with lung cancer have been improved substantially through the integration of surgery, radiation, and systemic therapy for patients with early-stage disease. Meanwhile, advances in our understanding of molecular mechanisms have substantially advanced our treatment of patients with advanced lung cancer through the introduction of targeted therapies, immune approaches, improvements in chemotherapy, and better supportive care. However, the majority of these advances have occurred among patients with good functional status, normal organ function, and with the social and economic support systems to be able to benefit most from these treatments. The aim of this article is to bring greater attention to management of lung cancer in patients who are medically compromised, which remains a major barrier to care delivery. Impaired performance status is associated with poor outcomes and correlates with the high prevalence of cachexia among patients with advanced lung cancer. CT imaging is emerging as a research tool to quantify muscle loss in patients with cancer, and new therapeutics are on the horizon that may provide important adjunctive therapy in the future. The benefits of cancer therapy for patients with organ failure are poorly understood because of their exclusion from clinical trials. The availability of targeted therapy and immunotherapy may provide alternatives that may be easier to deliver in this population, but clinical trials of these new agents in this population are vital. Patients with lower socioeconomic status are disproportionately affected by lung cancer because of higher rates of tobacco addiction and the impact of socioeconomic status on delay in diagnosis, treatment, and outcomes. For all patients who are medically compromised with lung cancer, multidisciplinary approaches are particularly needed to evaluate these patients and to incorporate rapidly changing therapeutics to improve outcomes.

Evaluation of Bar and Nightclub Intervention to Decrease Young Adult Smoking in New Mexico

PURPOSE

Over 20% of young adults in New Mexico currently smoke. We evaluated cigarette smoking prevalence of young adult bar patrons during an anti-tobacco Social Branding intervention.

METHODS

The Social Branding intervention used a smoke-free brand, "HAVOC," to compete with tobacco marketing within the "Partier" young adult peer crowd. A series of cross-sectional surveys were collected from adults aged 18-26 in bars and nightclubs in Albuquerque, New Mexico, from 2009 to 2013 using randomized time-location sampling. Multivariable multinomial regression using full information maximum likelihood estimation to account for missing data evaluated differences in daily and nondaily smoking during the intervention, controlling for demographics, other risk behaviors, and tobacco-related attitudes.

RESULTS

Data were collected from 1,069 individuals at Time 1, and 720, 1,142, and 1,149 participants at Times 2, 3, and 4, respectively. Current smoking rates decreased from 47.5% at Time 1 to 37.5% at Time 4 (p < .001). Among Partiers, the odds of daily smoking decreased significantly, but nondaily smoking was unchanged. Partiers that recalled, liked, and understood the smoke-free message of HAVOC had lower odds of nondaily (odds ratio: .48, 95% CI: .31-.75) and daily (odds ratio: .31, 95% CI: .14-.68) smoking than those who did not recall HAVOC. HAVOC recall was associated with attitudes that were also associated with smoking behavior.

CONCLUSIONS

The significant decrease in daily smoking among young adult Partiers in New Mexico was associated with HAVOC recall and understanding. Social Branding interventions efficiently target and may decrease tobacco use among young adult bar patrons.

What Does Having Your Pack in Your Pocket Say About You? Characteristics and Attitude Differences of Youth Carrying Tobacco at a Music Festival

The purpose of this study is to understand differences in demographics, frequency of tobacco use, and tobacco-related attitudes between youth/young adults who carry tobacco products and those who do not. Carrying tobacco is hypothesized to affect individuals' smoker identity and thereby their tobacco-related attitudes. Carriers are an influential peer group, often serving as social sources of tobacco for others, setting tobacco-related social norms, and advertising tobacco via the packs they carry. Thus, understanding their characteristics and attitudes can aid in the targeting and tailoring of cessation messaging. In this study, 3,927 attendees ages 13 to 24 years at the Vans Warped Tour were surveyed using iPads and asked to photograph any tobacco products they were currently carrying. Current tobacco users were classified as proven carriers ( n = 363), unproven carriers ( n = 182), or noncarriers ( n = 1,426). Carriers ( N = 545) were older, were more often White, and used tobacco over twice as often as noncarriers. Results indicated carriers and noncarriers differed significantly on most antitobacco attitudes, with carriers feeling less strongly antitobacco.

Changing attitudes toward smoking and smoking susceptibility through peer crowd targeting: more evidence from a controlled study

Peer crowd identification consistently predicts an adolescent's smoking behavior. As such, several interventions have targeted adolescents and young adults based on their identification with a specific crowd (e.g., Hipsters). This study uses a controlled experimental design to isolate and test the effect of peer crowd targeting in an antismoking ad on antismoking attitudes and smoking susceptibility. Two hundred and thirty-nine adolescents, age 13-15 years, completed a baseline survey and then viewed an antismoking ad targeting one of eight crowds; 1 week later they completed a posttest. Participants were assessed on antismoking attitudes and smoking susceptibility. Adolescents who strongly identified with the crowd targeted by the ad reported stronger antismoking attitudes and lower levels of smoking susceptibility. Those who disidentified with the crowd targeted in the ad exhibited not statistically significant increases in smoking susceptibility and weaker antismoking attitudes at posttest. These findings indicate that targeting youths based on their peer crowd is a useful strategy for antismoking interventions. Additional research should further examine whether youths who disidentify with the targeted crowd in an ad exhibit reactance against the message.

Wreaking "havoc" on smoking: social branding to reach young adult "partiers" in Oklahoma

BACKGROUND

More than 25% of young adult Oklahomans smoked cigarettes in 2012. Tobacco marketing campaigns target young adults in social environments like bars/nightclubs. Social Branding interventions are designed to compete directly with this marketing.

PURPOSE

To evaluate an intervention to reduce smoking among young adult "Partiers" in Oklahoma. The Partier peer crowd was described as follows: attendance at large nightclubs, fashion consciousness, valuing physical attractiveness, and achieving social status by exuding an image of confidence and financial success.

DESIGN

Repeated cross-sectional study with three time points.

SETTING/PARTICIPANTS

Randomized time location survey samples of young adult Partier bar and club patrons in Oklahoma City (Time 1 [2010], n=1,383; Time 2 [2011], n=1,292; and Time 3 [2012], n=1,198). Data were analyzed in 2013.

INTERVENTION

The "HAVOC" Social Branding intervention was designed to associate a smoke-free lifestyle with Partiers' values, and included events at popular clubs, brand ambassador peer leaders who transmit the anti-tobacco message, social media, and tailored anti-tobacco messaging.

MAIN OUTCOME MEASURES

Daily and nondaily smoking rates, and binge drinking rates (secondary).

RESULTS

Overall, smoking rates did not change (44.1% at Time 1, 45.0% at Time 2, and 47.4% at Time 3; p=0.17), but there was a significant interaction between intervention duration and brand recall. Partiers reporting intervention recall had lower odds of daily smoking (OR=0.30 [0.10, 0.95]) and no difference in nondaily smoking, whereas Partiers who did not recall the intervention had increased odds of smoking (daily AOR=1.74 [1.04, 2.89]; nondaily AOR=1.97 [1.35, 2.87]). Among non-Partiers, those who recalled HAVOC reported no difference in smoking, and those who did not recall HAVOC reported significantly increased odds of smoking (daily AOR=1.53 [1.02, 2.31]; nondaily AOR=1.72 [1.26, 2.36]). Binge drinking rates were significantly lower (AOR=0.73 [0.59, 0.89]) overall.

CONCLUSIONS

HAVOC has the potential to affect smoking behavior among Oklahoma Partiers without increasing binge drinking.

Social branding to decrease smoking among young adults in bars

OBJECTIVES

We evaluated a Social Branding antitobacco intervention for "hipster" young adults that was implemented between 2008 and 2011 in San Diego, California.

METHODS

We conducted repeated cross-sectional surveys of random samples of young adults going to bars at baseline and over a 3-year follow-up. We used multinomial logistic regression to evaluate changes in daily smoking, nondaily smoking, and binge drinking, controlling for demographic characteristics, alcohol use, advertising receptivity, trend sensitivity, and tobacco-related attitudes.

RESULTS

During the intervention, current (past 30 day) smoking decreased from 57% (baseline) to 48% (at follow-up 3; P = .002), and daily smoking decreased from 22% to 15% (P < .001). There were significant interactions between hipster affiliation and alcohol use on smoking. Among hipster binge drinkers, the odds of daily smoking (odds ratio [OR] = 0.44; 95% confidence interval [CI] = 0.30, 0.63) and nondaily smoking (OR = 0.57; 95% CI = 0.42, 0.77) decreased significantly at follow-up 3. Binge drinking also decreased significantly at follow-up 3 (OR = 0.64; 95% CI = 0.53, 0.78).

CONCLUSIONS

Social Branding campaigns are a promising strategy to decrease smoking in young adult bar patrons.