%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69425 %T Effectiveness of a Mobile Phone-Delivered Multiple Health Behavior Change Intervention (LIFE4YOUth) in Adolescents: Randomized Controlled Trial %A Seiterö,Anna %A Henriksson,Pontus %A Thomas,Kristin %A Henriksson,Hanna %A Löf,Marie %A Bendtsen,Marcus %A Müssener,Ulrika %+ Department of Health, Medicine and Caring Sciences, Linköping University, Campus US, Linköping, SE-58183, Sweden, 46 700895376, anna.seitero@liu.se %K mHealth %K multiple behavior %K high school students %K digital behavior change intervention %K public health %K telemedicine %K randomized controlled trial %D 2025 %7 22.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Although mobile health (mHealth) interventions have demonstrated effectiveness in modifying 1 or 2 health-risk behaviors at a time, there is a knowledge gap regarding the effects of stand-alone mHealth interventions on multiple health risk behaviors. Objective: This study aimed to estimate the 2- and 4-month effectiveness of an mHealth intervention (LIFE4YOUth) targeting alcohol consumption, diet, physical activity, and smoking among Swedish high school students, compared with a waiting-list control condition. Methods: A 2-arm parallel group, single-blind randomized controlled trial (1:1) was conducted from September 2020 to June 2023. Eligibility criteria included nonadherence to guidelines related to the primary outcomes, such as weekly alcohol consumption (standard drinks), monthly frequency of heavy episodic drinking (ie, ≥4 standard drinks), daily intake of fruit and vegetables (100-g portions), weekly consumption of sugary drinks (33-cL servings), weekly duration of moderate to vigorous physical activity (minutes), and 4-week point prevalence of smoking abstinence. The intervention group had 16 weeks of access to LIFE4YOUth, a fully automated intervention including recurring screening, text message services, and a web-based dashboard. Intention-to-treat analysis was conducted on available and imputed 2- and 4-month self-reported data from participants at risk for each outcome respectively, at baseline. Effects were estimated using multilevel models with adaptive intercepts (per individual) and time by group interactions, adjusted for baseline age, sex, household economy, and self-perceived importance, confidence, and know-how to change behaviors. Bayesian inference with standard (half-)normal priors and null-hypothesis testing was used to estimate the parameters of statistical models. Results: In total, 756 students (aged 15-20, mean 17.1, SD 1.2 years; 69%, 520/756 females; 31%, 236/756 males) from high schools across Sweden participated in the trial. Follow-up surveys were completed by 71% (539/756) of participants at 2 months and 57% (431/756) of participants at 4 months. Most participants in the intervention group (219/377, 58%) engaged with the intervention at least once. At 2 months, results indicated positive effects in the intervention group, with complete case data indicating median between-group differences in fruit and vegetable consumption (0.32 portions per day, 95% CI 0.13-0.52), physical activity (50 minutes per week, 95% CI –0.2 to 99.7), and incidence rate ratio for heavy episodic drinking (0.77, 95% CI 0.55-1.07). The odds ratio for smoking abstinence (1.09, 95% CI 0.34-3.64), incidence rate ratio for weekly alcohol consumption (0.69, 95% CI 0.27-1.83), and the number of sugary drinks consumed weekly (0.89, 95% CI 0.73-1.1) indicated inconclusive evidence for effects due to uncertainty in the estimates. At 4 months, a remaining effect was observed on physical activity only. Conclusions: Although underpowered, our findings suggest modest short-term effects of the LIFE4YOUth intervention, primarily on physical activity and fruit and vegetable consumption. Our results provide inconclusive evidence regarding weekly alcohol consumption and smoking abstinence. Trial Registration: ISRCTN Registry ISRCTN34468623; https://doi.org/10.1186/ISRCTN34468623 %M 40262133 %R 10.2196/69425 %U https://www.jmir.org/2025/1/e69425 %U https://doi.org/10.2196/69425 %U http://www.ncbi.nlm.nih.gov/pubmed/40262133 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e72002 %T Design and Baseline Evaluation of Social Media Vaping Prevention Trial: Randomized Controlled Trial Study %A Evans,William Douglas %A Ichimiya,Megumi %A Bingenheimer,Jeffrey B %A Cantrell,Jennifer %A D'Esterre,Alexander P %A Pincus,Olivia %A Yu,Linda Q %A Hair,Elizabeth C %+ Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue NW, Washington, DC, 20052, United States, 1 2023519546, wdevans@gwu.edu %K social media %K e-cigarettes %K randomized controlled trial %K nicotine %K oral nicotine products %K nicotine poly-use %D 2025 %7 31.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic cigarette (e-cigarette) use is a major public health problem and young adults aged 18-24 years are at high risk. Furthermore, oral nicotine products (ONPs) are growing in popularity in this population. Poly-use is widespread. New methodologies for rigorous online studies using social media have been conducted and shown to reduce nicotine use. Objective: We report on the design and baseline evaluation of a large-scale social media–based randomized controlled trial to evaluate the effects of antivaping social media on young adult vaping and determinants of use. Methods: Using the Virtual Lab social media platform, participants were recruited using an artificial intelligence chatbot and social media advertising, completed a baseline survey, and were randomized to 1 of 4 study arms. The design was to achieve specific numbers of impressions per arm over 3 survey time points. We recruited 8437 participants, stratified by vaper (n=5026) and nonvaper (n=3321) status. Questionnaire data were collected using the Qualtrics survey platform. Future analyses will examine the effects of social media content on vaping at the endline. Our data analysis describes the 2 cohort samples, examines balance across the 4 study arms on baseline variables in each of the cohorts, and evaluates the internal consistency of several multi-indicator measures of psychosocial constructs. Results: Among vapers, almost three-fourths were current vapers, >40% were current smokers (using in the past 30 days), and >48% were current poly-users (using e-cigarettes and ≥1 other tobacco products). Substantial numbers of current vapers also currently use some other product, including cigars (n=1520, 30.2%), hookah (n=794, 15.8%), smokeless devices (n=462, 9.2%), and ONPs (n=578, 11.5%). The average age of participants was 21.2 (SD 2) years. Just less than 45% of participants were non-Hispanic White (n=3728, 44.7%), just less than 47% (n=3913, 46.9%) of the sample was male, more than 44% (n=3704, 44.4%) reported completing high school, and 79.3% reported meeting basic needs or better. There were no significant differences between arms and strata by any of these demographics. We calculated scale scores for depression and covariates related to nicotine use and found high alphas. Finally, participants who reported having seen antitobacco brand advertising were more likely to have higher levels of these variables and scales than participants who reported not having seen the advertisements. These results will be examined in future studies. Conclusions: Social media can be used as a platform at scale for longitudinal randomized controlled trials over extended periods, which extends previous research on short-term trials. Interventions delivered by social media can be used with large samples to evaluate social media health behavior change interventions. Future studies based on this research will evaluate the intervention and dose-response effects of social media exposure on vaping behavior and determinants. Trial Registration: ClinicalTrials.gov NCT04867668; https://clinicaltrials.gov/study/NCT04867668 %M 40164170 %R 10.2196/72002 %U https://www.jmir.org/2025/1/e72002 %U https://doi.org/10.2196/72002 %U http://www.ncbi.nlm.nih.gov/pubmed/40164170 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66010 %T Contextualizing Changes in e-Cigarette Use During the Early COVID-19 Pandemic and Accompanying Infodemic (“So Much Contradictory Evidence”): Qualitative Document Analysis of Reddit Forums %A Watkins,Shannon Lea %A Snodgrass,Katherine %A Fahrion,Lexi %A Shaw,Emily %+ Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N Riverside Dr, Iowa City, IA, 52242, United States, 1 3194671489, shannon-watkins@uiowa.edu %K vaping %K nicotine %K tobacco %K health communication %K social media %K new media %D 2025 %7 20.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Understanding how social media platforms facilitate information exchange and influence behavior during health crises can enhance public health responses during times of uncertainty. While some risk factors for COVID-19 susceptibility and severity (eg, old age) were clear, whether e-cigarette use increased risk was not clear. People who used e-cigarettes had to navigate both the COVID-19 infodemic and a conflicting, politicized, and changing information environment about the interaction between COVID-19 and e-cigarette use. Objective: This study aims to characterize and contextualize e-cigarette–related behavior changes during the early COVID-19 pandemic and illuminate the role that social media played in decision-making. Methods: We conducted a qualitative analysis of COVID-19–related e-cigarette discussions on 3 Reddit forums about e-cigarettes. We collected 189 relevant discussion threads made in the first 6 months of the pandemic (collected from June 27, 2020, to July 3, 2020). Threads included 3155 total comments (mean 17 comments) from approximately 1200 unique Redditors. We developed and applied emergent codes related to e-cigarette perceptions and behaviors (eg, the role of nicotine in COVID-19 and do-it-yourself narratives) and web-based community interactions (eg, advice), identified thematic patterns across codes, and developed a model to synthesize the socioecological context of e-cigarette behaviors. Results: e-Cigarette subreddits provided a platform for Redditors to discuss perceptions and experiences with e-cigarettes, make sense of information, and provide emotional support. Discussions reflected an array of e-cigarette–related behavioral responses, including increases and decreases in use intensity, changes in purchasing practices (eg, stockpiling), and changes in vaping practices (eg, reusing disposable pods). This study presented a theoretically and empirically informed model of how circumstances created by the pandemic (eg, changes in activity space and product shortages) compelled behavior changes. Redditors drew from their existing perceptions, intentions, and experiences with nicotine and tobacco products; their personal pandemic experiences; and their participation on Reddit to decide whether and how to change their e-cigarette behaviors during the early pandemic. Forums reflected uncertainty, stress, and debate about the rapidly evolving and complicated public health information. Consumption and discussion of media (eg, news articles and peer-reviewed publications) on Reddit informed e-cigarette perceptions and behaviors. Decisions were complicated by distrust of the media. Conclusions: Variations in individual traits and environmental circumstances during the early COVID-19 pandemic provide context for why there was no unified direction of e-cigarette behavior change during this period. Information and discussion on Reddit also informed risk perceptions and decisions during the pandemic. Social media is an effective and important place to communicate public health information, particularly during crisis or disaster situations. Moving forward, transparent, accurate, and specific message development should consider the stress, struggles, and stigma of people who use e-cigarettes and address the roles mistrust and misinformation play in decisions. %M 40112286 %R 10.2196/66010 %U https://www.jmir.org/2025/1/e66010 %U https://doi.org/10.2196/66010 %U http://www.ncbi.nlm.nih.gov/pubmed/40112286 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e60527 %T Enhancing Text Message Support With Media Literacy and Financial Incentives for Vaping Cessation in Young Adults: Protocol for a Pilot Randomized Controlled Trial %A Michaud,Tzeyu %A Puga,Troy %A Archer,Rex %A Theye,Elijah %A Zagurski,Cleo %A Estabrooks,Paul %A Dai,Hongying Daisy %+ Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, NE, 68198, United States, 1 4028369195, tzeyu.michaud@unmc.edu %K contingency management %K e-cigarettes %K social support %K youth %K electronic health record %K opt-in %K recruitment %K tobacco marketing %K cessation %K peer support %K young adult %K feasibility %K public health %D 2025 %7 21.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: The persistent high prevalence of e-cigarette use among young adults remains a significant public health concern, with limited evidence and guidance on effective vaping cessation programs targeting this population. Objective: This study aims to outline the study design and protocol of a pilot randomized controlled trial aimed at investigating feasibility and assessing whether media literacy education or financial incentives enhance the effectiveness of evidence-based text message support in promoting vaping abstinence among young adult e-cigarette users. Methods: The pilot study uses a 4-arm (1:1:1:1) randomized controlled trial design to assess the potential impact of different combinations of media literacy education, financial incentives, and text message support on vaping abstinence over a 3-month period. The first month serves as a preparatory phase for quitting, followed by 2 months focused on abstinence. A total of 80 individuals, aged 19-29 years, who have used e-cigarettes within the past 30 days, have internet access, and express interest in quitting vaping within the next 30 days, will be enrolled. Eligible individuals will be randomized into one of the four study groups: (1) Text Message, (2) Media Literacy, (3) Financial Incentive, and (4) Combined. All participants, regardless of group assignment, will receive text message support. Participants will be followed for 12 weeks, with abstinence status assessed at week 12, as well as during remote check-ins at weeks 6, 8, and 10. Feasibility measures include recruitment rate, reach, engagement, and retention. Other outcomes of interest include self-reported 7-day abstinence and changes in nicotine dependence and media literacy scores. Exit interviews will be conducted with those who complete the study to explore facilitators of and barriers to participation and engagement in vaping cessation, which will inform future program refinement and uptake. Results: Recruitment for the study commenced in December 2023 and concluded in August 2024. A total of 40 participants were randomized into these groups: 9 for Text Message, 11 for Media Literacy, 10 for Financial Incentive, and 10 for the Combined group. The final assessment was completed in November 2024, and analyses are currently ongoing. Conclusions: The findings from this trial could provide valuable insights into the design and uptake of vaping cessation strategies among the young adult population. Trial Registration: ClinicalTrials.gov NCT05586308; https://clinicaltrials.gov/study/NCT05586308 International Registered Report Identifier (IRRID): DERR1-10.2196/60527 %M 39983103 %R 10.2196/60527 %U https://www.researchprotocols.org/2025/1/e60527 %U https://doi.org/10.2196/60527 %U http://www.ncbi.nlm.nih.gov/pubmed/39983103 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54661 %T Concerns Over Vuse e-Cigarette Digital Marketing and Implications for Public Health Regulation: Content Analysis %A Han,Eileen %A Lempert,Lauren K %A Vescia,Francesca %A Halpern-Felsher,Bonnie %K e-cigarette %K social media marketing %K Vuse %K adolescents and young adults %K Food and Drug Administration %K FDA %K smoker %K smoking %K smoking device %K tobacco %K social media %K Instagram %K Facebook %K promote %K marketing %K mobile phone %D 2024 %7 27.12.2024 %9 %J JMIR Form Res %G English %X Background: Electronic cigarettes (e-cigarettes) are the most used form of tobacco products among adolescents and young adults, and Vuse is one of the most popular brands of e-cigarettes among US adolescents. In October 2021, Vuse Solo became the first e-cigarette brand to receive marketing granted orders (MGOs) from the US Food and Drug Administration (FDA), authorizing its marketing and their tobacco-flavored pods. Vuse Ciro and Vuse Vibe, and their tobacco-only (“original”) e-liquids, were authorized for marketing in May 2022 and Vuse Alto tobacco-flavored devices were authorized in July 2024. These marketing authorizations are contingent upon the company adhering to the MGOs’ stated marketing restrictions, including reducing exposure and appeal to youth via digital, radio, television, print, and point-of-sale advertising. Objective: In this study, we analyzed the official social media channels of Vuse (Instagram and Facebook) to examine how Vuse marketed its products on social media and whether these marketing posts contain potentially youth-appealing themes. Methods: We conducted content analysis of the official RJ Reynolds Vapor Company Instagram and Facebook accounts. We collected all posts from October 10, 2019, when RJ Reynolds Vapor Company submitted its premarket tobacco product application to the FDA, to February 21, 2022, to cover the first winter holiday season after the MGO. Two coders developed the codebook with 17 themes based on the Content Appealing to Youth index to capture the posts’ characteristics and potentially youth-appealing content. We calculated the percentage of posts in which each code was present. Results: A total of 439 unique posts were identified. During this study’s period, there were no posts on Instagram or Facebook marketing Vuse Solo (the authorized product at that time). Instead, Vuse Alto (unauthorized to date of study) was heavily marketed, with 59.5% (n=261) of the posts specifically mentioning the product name. Further, “Vuse” more generally was marketed on social media without differentiating between the authorized and unauthorized products (n=182, 41.5%). The marketing messages contained several potentially youth-appealing themes including creativity or innovation (n=189, 43.1%), individuality or freedom (n=106, 24.2%), and themes related to art (n=150, 34.2%), music (n=77, 17.5%), sports (n=125, 28.5%), nature (with n=49, 11.2% of the posts containing flora imageries), alcohol imagery (n=10, 2.3%), and technology (n=6, 1.4%). Conclusions: Although Vuse Alto e-cigarettes had not yet obtained FDA marketing authorization during the 28 months of data collection, they were the primary Vuse e-cigarette devices marketed on social media. Vuse social media posts use themes that are appealing to and likely promote youth use, including creativity and innovation, individuality or freedom, arts and music, nature, technology, and alcohol imagery. The FDA should (1) prohibit companies from comarketing unauthorized products alongside authorized products, and (2) exercise enforcement against even authorized products that are marketed using youth-appealing features. %R 10.2196/54661 %U https://formative.jmir.org/2024/1/e54661 %U https://doi.org/10.2196/54661 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57747 %T Short-Form Video Informed Consent Compared With Written Consent for Adolescents and Young Adults: Randomized Experiment %A Afolabi,Aliyyat %A Cheung,Elaine %A Lyu,Joanne Chen %A Ling,Pamela M %+ Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366, San Francisco, CA, 94143-1390, United States, 1 4155148627, Pamela.Ling@ucsf.edu %K health communication %K video informed consent %K randomized experiment %K informed consent %K adolescent %K video %K consent %K e-cigarette %K vaping %K health research %K social media %K vaping cessation %K smoking cessation %D 2024 %7 22.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescents and young adults have the highest prevalence of e-cigarette use (“vaping”), but they are difficult to enroll in health research studies. Previous studies have found that video consent can improve comprehension and make informed consent procedures more accessible, but the videos in previous studies are much longer than videos on contemporary social media platforms that are popular among young people. Objective: This study aimed to examine the effectiveness of a short-form (90-second) video consent compared with a standard written consent for a vaping cessation study for adolescents and young adults. Methods: We conducted a web-based experiment with 435 adolescents and young adults (aged 13-24 years) recruited by a web-based survey research provider. Each participant was randomly assigned to view either a short-form video consent or a written consent form describing a behavioral study of a social media–based vaping cessation program. Participants completed a postexposure survey measuring three outcomes: (1) comprehension of the consent information, (2) satisfaction with the consent process, and (3) willingness to participate in the described study. Independent sample 2-tailed t tests and chi-square tests were conducted to compare the outcomes between the 2 groups. Results: In total, 435 cases comprised the final analytic sample (video: n=215, 49.4%; written: n=220, 50.6%). There was no significant difference in characteristics between the 2 groups (all P>.05). Participants who watched the short-form video completed the consent review and postconsent survey process in less time (average 4.5 minutes) than those in the written consent group (5.1 minutes). A total of 83.2% (179/215) of the participants in the video consent condition reported satisfaction with the overall consent process compared with 76.3% (168/220) in the written consent condition (P=.047). There was no difference in the ability to complete consent unassisted and satisfaction with the amount of time between study conditions. There was no difference in the composite measure of overall comprehension, although in individual measures, participants who watched the short-form video consent performed better in 4 measures of comprehension about risk, privacy, and procedures, while participants who read the written document consent had better comprehension of 2 measures of study procedures. There was no difference between the groups in willingness to participate in the described study. Conclusions: Short-form informed consent videos had similar comprehension and satisfaction with the consent procedure among adolescents and young adults. Short-form informed consent videos may be a feasible and acceptable alternative to the standard written consent process, although video and written consent forms have different strengths with respect to comprehension. Because they match how young people consume media, short-form videos may be particularly well suited for adolescents and young adults participating in research. %M 39576682 %R 10.2196/57747 %U https://formative.jmir.org/2024/1/e57747 %U https://doi.org/10.2196/57747 %U http://www.ncbi.nlm.nih.gov/pubmed/39576682 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51870 %T Concurrent Mentions of Vaping and Alcohol on Twitter: Latent Dirichlet Analysis %A Ranker,Lynsie R %A Tofu,David Assefa %A Lu,Manyuan %A Wu,Jiaxi %A Bhatnagar,Aruni %A Robertson,Rose Marie %A Wijaya,Derry %A Hong,Traci %A Fetterman,Jessica L %A Xuan,Ziming %+ Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, 4th Floor, Boston, MA, 02215, United States, 1 617 358 2310, lranker@bu.edu %K e-cigarettes %K alcohol %K social media %K vape %K tweet %K vaping %K alcohol use %K co-use %K substance use disorder %K social networking site %K insight %K regulation %K youth %K vaping policy %D 2024 %7 12.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Co-use of alcohol and e-cigarettes (often called vaping) has been linked with long-term health outcomes, including increased risk for substance use disorder. Co-use may have been exacerbated by the COVID-19 pandemic. Social networking sites may offer insights into current perspectives on polysubstance use. Objective: The aims of this study were to investigate concurrent mentions of vaping and alcohol on Twitter (subsequently rebranded X) during a time of changing vaping regulations in the United States and the emergence of the COVID-19 pandemic. Methods: Tweets including both vape- and alcohol-related terms posted between October 2019 and September 2020 were analyzed using latent Dirichlet allocation modeling. Distinct topics were identified and described. Results: Three topics were identified across 6437 tweets: (1) flavors and flavor ban (n=3334, 51.8% of tweets), (2) co-use discourse (n=1119, 17.4%), and (3) availability and access regulation (n=1984, 30.8%). Co-use discussions often portrayed co-use as positive and prosocial. Tweets focused on regulation often used alcohol regulations for comparison. Some focused on the perceived overregulation of vaping (compared to alcohol), while others supported limiting youth access but not at the expense of adult access (eg, stronger age verification over product bans). Across topics, vaping was typically portrayed as less harmful than alcohol use. The benefits of flavors for adult smoking cessation were also discussed. The distribution of topics across time varied across both pre– and post–regulatory change and pre– and post–COVID-19 pandemic declaration periods, suggesting shifts in topic focus salience across time. Conclusions: Co-use discussions on social media during this time of regulatory change and social upheaval typically portrayed both vaping and alcohol use in a positive light. It also included debates surrounding the differences in regulation of the 2 substances—particularly as it related to limiting youth access. Emergent themes from the analysis suggest that alcohol was perceived as more harmful but less regulated and more accessible to underage youth than vaping products. Frequent discussions and comparisons of the 2 substances as it relates to their regulation emphasize the still-evolving vaping policy landscape. Social media content analyses during times of change may help regulators and policy makers to better understand and respond to common concerns and potential misconceptions surrounding drug-related policies and accessibility. %M 39531640 %R 10.2196/51870 %U https://www.jmir.org/2024/1/e51870 %U https://doi.org/10.2196/51870 %U http://www.ncbi.nlm.nih.gov/pubmed/39531640 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55555 %T Tobacco and Alcohol Content in Top Vietnamese YouTube Music Videos: Content Analysis %A Tran,Thi Phuong Thao %A Vu,Thu Trang %A Li,Yachao %A Popova,Lucy %+ School of Public Health, Georgia State University, 140 Decatur St. SE, Atlanta, GA, 30303, United States, 1 4709626086, ttran217@gsu.edu %K risk %K risk factor %K tobacco content %K alcohol content %K tobacco %K alcohol %K tobacco portrayal %K alcohol portrayal %K music video %K Vietnam %K Vietnamese %K YouTube %K social media %K socials %K youth %K adolescent %K teen %K teenager %K young adult %D 2024 %7 8.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Seeing portrayals of tobacco and alcohol in music videos (MVs) may reduce perceived risks, increase susceptibility, and lead to the initiation of tobacco and alcohol use among adolescents and young adults. Previous studies have predominantly concentrated on assessing tobacco and alcohol contents in English-language MVs within Western countries. However, many other countries have not only been influenced by the English music market but have also produced music in their native languages, and this content remains underexamined. Objective: This study aims to investigate the prevalence of tobacco- and alcohol-related content in top Vietnamese MVs on YouTube from 2013 to 2021, to describe how tobacco and alcohol are portrayed in these MVs, and to examine associations between these portrayals and MV characteristics. Methods: A total of 410 Vietnamese MVs, including the top 40 or 50 most viewed released each year between 2013 and 2021, were analyzed. General information, such as the song name, its release date and ranking, age restriction, musical genre, and type of MV, was collected. We examined tobacco and alcohol content in the MVs, with specific details such as tobacco types, their brands, as well as the number, age, sex, and roles of individuals smoking or drinking. Results: Among the 410 MVs, 36 (8.8%) contained tobacco-related content and 136 (33.2%) featured alcohol-related content. Additionally, 28 (6.8%) out of 410 MVs included both tobacco and alcohol content. The prevalence of videos with tobacco and alcohol content fluctuated over the years. In MVs with tobacco-related content, a higher proportion of hip-hop or rap songs contained tobacco-related content (n=6, 30%) compared to other music genres. In MVs with tobacco-related content, cigarettes were the most frequently shown product (n=28, 77.8%), and smoking scenes were often depicted at parties (n=13, 36.1%) and during dancing and singing scenes (n=12, 33.3%). Among the 31 MVs portraying actual tobacco use, tobacco use was typically depicted with 1 person, often a young adult male, while 38.7% (n=12) showed singer(s) smoking. For MVs with alcohol-related content, there was a high proportion showing alcohol images at parties, bars, or pubs (n=96, 70.6%). Among 87 MVs containing drinking scenes, 60.9% (n=53) involved groups of young adults of both sexes, and 64% (n=56) depicted singers drinking. Additionally, only 2 (5.6%) MVs included health warnings about tobacco harm, and 2 MVs (1.5%) included warnings about drinking restricted to individuals 18 years and above. Conclusions: The notable prevalence of tobacco and alcohol content in leading Vietnamese YouTube MVs raises concerns, especially as most of this content is portrayed without any warnings. The study underscores a regulatory gap in addressing such content on the internet, emphasizing the urgent need for stricter regulations and age restrictions on platforms such as YouTube. %M 39514854 %R 10.2196/55555 %U https://www.jmir.org/2024/1/e55555 %U https://doi.org/10.2196/55555 %U http://www.ncbi.nlm.nih.gov/pubmed/39514854 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51594 %T Social Media Marketing Strategies for Electronic Cigarettes: Content Analysis of Chinese Weibo Accounts %A Zhou,Xinyi %A Hao,Xinyu %A Chen,Yuhang %A Deng,Hui %A Fang,Ling %A Zhang,Lingyun %A Yan,Xiaotao %A Zheng,Pinpin %A Wang,Fan %+ Fudan Development Institute, Fudan University, Think Tank Building, Room 415, 220 Handan Road, Shanghai, 200433, China, 86 21 55664081, wangfan512@126.com %K e-cigarette %K marketing strategy %K social media %K teenagers %K content analysis %D 2024 %7 7.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: E-cigarettes have gained popularity among teenagers due to extensive marketing strategies on social media platforms. This widespread promotion is a risk factor, as it fosters more positive attitudes toward e-cigarette use among teenagers and increases the perception that using e-cigarettes is normal. Therefore, the marketing of e-cigarettes on social media is a serious global health concern, and its strategies and impact should be clearly identified. Objective: This study examined how e-cigarette companies popularize their products via Weibo and identified the specific strategies influencing the effectiveness of their marketing. Methods: In phase 1, we conducted a search on Qcc.com and identified 32 e-cigarette brands with active Weibo accounts between October 1 and December 31, 2020, along with 863 Weibo posts. The data were investigated through content analysis. The codebook was developed into four categories: (1) product and features, (2) sales and promotions, (3) social contact and interaction, and (4) restrictions and warnings. To further understand the factors influencing e-cigarette brand marketing, we conducted a multiple linear regression analysis. Results: Marketing tactics by e-cigarette companies on Chinese social media were documented, including emphasizing attractive product features, using trendy characters, implicit promotions, downplaying health concerns, and engaging with Weibo users in various ways. Out of 863 posts, 449 (52%) mentioned product characteristics. In 313 (36.3%) posts, visible figures were used to attract attention. Product promotion was absent in 762 (88.3%) posts, and purchase channels were not mentioned in 790 (98.3%) posts. Social interaction–related posts received attention (n=548, 63.5%), particularly those featuring hashtag content (n=538, 62.3%). Most posts did not include claims for restrictions on teenagers' purchases or use (n=687, 79.6%) or information on health warnings (n=839, 97.2%). Multiple linear regression analysis identified marketing strategies that effectively increase the exposure of e-cigarette posts on Weibo. Posts including engagement via posts encouraging reposts, comments, and likes (P<.001) and engagement topics related to e-cigarette brands were positively correlated with the number of reposts (P=.009). Posts highlighting nonmonetary incentives (P=.004), posts with age restriction statements (P<.001), engaging via stories and idea collection (P<.001), and engagement topics related to products (P<.001) and current affairs (P=.002) had a positive effect on the number of comments. Engagement topics related to brands (P<.001) or interactive sweepstakes (P<.001) had a positive effect on the number of likes. Conclusions: E-cigarette posts on Weibo that focus on product features and social interaction attract public attention, especially from teenagers. Stricter regulations and monitoring should be adopted to restrict the social media marketing of e-cigarettes. %M 39509702 %R 10.2196/51594 %U https://www.jmir.org/2024/1/e51594 %U https://doi.org/10.2196/51594 %U http://www.ncbi.nlm.nih.gov/pubmed/39509702 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e63296 %T Risk Perception and Knowledge Following a Social Game–Based Tobacco Prevention Program for Adolescents: Pilot Randomized Comparative Trial %A Khalil,Georges %A Ramirez,Erica %A Khan,Meerah %A Zhao,Bairu %A Ribeiro,Nuno %A Balian,Patrick %+ Department of Health Outcomes and Biomedical Informatics, University of Florida, Malachowsky Hall for Data Science and Information Technology, 1889 Museum Rd, Suite 7000, Gainesville, FL, 32603, United States, 1 3526279467, gkhalil@ufl.edu %K tobacco prevention %K vaping %K combustible tobacco %K risk perception %K adolescent %K games %K social interaction %D 2024 %7 5.11.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Adolescence is a critical developmental stage that is particularly vulnerable to the initiation of tobacco use. Despite the well-documented health risks associated with tobacco use, it remains prevalent among adolescents. Games for health are a promising strategy for tobacco prevention, using experiential and social learning theories to enhance engagement and improve behavior change. Objective: This pilot study aims to (1) compare the social game–based program Storm-Heroes to a nonsocial program regarding adolescents’ personal and social experiences and (2) examine how these experiences predict higher tobacco knowledge and perceived risks of vaping and conventional tobacco use. Methods: In a cluster-randomized comparative design, 4 after-school sites (N=79 adolescents) were recruited in person and randomized in a single-blinded format to 1 of 2 interventions: the social game Storm-Heroes (44/79, 56%) or the nonsocial program A Smoking Prevention Interactive Experience (ASPIRE; 35/79, 44%). A study team member supervised both interventions. Data were collected at baseline, immediate follow-up, and a 1.5-month follow-up (45/74, 61% retained). Repeated measures mixed effects models were conducted. Results: A total of 45 participants continued until the 1.5-month follow-up. Participants in the Strom-Heroes group were more likely to increase their perceived risk of vaping (B=0.40; P<.001), perceived risk of conventional tobacco use (B=0.35; P=.046), and tobacco knowledge (B=1.63; P<.001) than those in the control condition. The usability level of the program was related to a higher perceived risk of vaping (B=0.16; P=.003) and conventional tobacco use (B=0.16; P=.02) by follow-up. Attention to the program was also related to higher perceived risk of vaping (B=0.12; P=.002) and conventional tobacco use (B=0.14; P<.001). Distraction was not related to either perceived risk of vaping (P=.15) or perceived risk of conventional tobacco use (P=.71). In contrast, both more attention (B=0.60; P<.001) and less distraction (B=–0.37; P<.001) were related to higher tobacco knowledge. Conclusions: The increased perceived risk of vaping and conventional tobacco among Storm-Heroes participants aligns with the program’s goals of improving participants’ awareness of the risks associated with tobacco use and their tobacco knowledge. However, distraction weakened the effect of the program on tobacco knowledge, indicating that emphasis needs to be placed on minimizing distraction for better outcomes. With the results of this study, researchers can work to advance the current version of Storm-Heroes and amplify engagement in the program to improve its potential for preventing adolescents’ initiation of tobacco use. Trial Registration: ClinicalTrials.gov NCT02703597; https://clinicaltrials.gov/study/NCT02703597 %M 39499912 %R 10.2196/63296 %U https://games.jmir.org/2024/1/e63296 %U https://doi.org/10.2196/63296 %U http://www.ncbi.nlm.nih.gov/pubmed/39499912 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50343 %T Online Interest in Elf Bar in the United States: Google Health Trends Analysis %A Bhagavathula,Akshaya Srikanth %A Dobbs,Page D %+ Department of Health, Human Performance and Recreation, University of Arkansas, Suite 317, 346 West Ave, Fayetteville, AR, 72701, United States, 1 479 575 2858, pdobbs@uark.edu %K e-cigarettes %K Elf Bar %K JUUL %K tobacco %K Google Trends %K Google Health Trends %D 2024 %7 5.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the popularity of JUUL e-cigarettes, other brands (eg, Elf Bar) may be gaining digital attention. Objective: This study compared Google searches for Elf Bar and JUUL from 2022 to 2023 using Google Health Trends Application Programming Interface data. Methods: Using an infodemiology approach, we examined weekly trends in Google searches (per 10 million) for “Elf Bar” and “JUUL” at the US national and state levels from January 1, 2022, to December 31, 2023. Joinpoint regression was used to assess statistically significant trends in the search probabilities for “Elf Bar” and “JUUL” during the study period. Results: Elf Bar had less online interest than JUUL at the beginning of 2022. When the US Food and Drug Administration denied JUUL marketing authority on June 23, 2022, JUUL searches peaked at 2609.3 × 107 and fell to 83.9 × 107 on September 3, 2023. Elf Bar searches surpassed JUUL on July 10, 2022, and steadily increased, reaching 523.2 × 107 on December 4, 2022. Overall, Elf Bar’s weekly search probability increased by 1.6% (95% CI 1.5%-1.7%; P=.05) from January 2022 to December 2023, with the greatest increase between May 29 and June 19, 2022 (87.7%, 95% CI 35.9%-123.9%; P=.001). Elf Bar searches increased after JUUL’s suspension in Pennsylvania (1010%), Minnesota (872.5%), Connecticut (803.5%), New York (738.1%), and New Jersey (702.9%). Conclusions: Increasing trends in Google searches for Elf Bar indicate that there was a growing online interest in this brand in the United States in 2022. %M 39499924 %R 10.2196/50343 %U https://www.jmir.org/2024/1/e50343 %U https://doi.org/10.2196/50343 %U http://www.ncbi.nlm.nih.gov/pubmed/39499924 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63156 %T Desires and Needs for Quitting Both e-Cigarettes and Cigarettes Among Young Adults: Formative Qualitative Study Informing the Development of a Smartphone Intervention for Dual Tobacco Cessation %A Nguyen,Nhung %A Koester,Kimberly A %A Tran,Christine %A Ling,Pamela M %+ Center for Tobacco Control Research and Education, University of California, San Francisco, 530 Parnassus Ave, San Francisco, CA, 94502, United States, 1 6508889207, Nhung.Nguyen@ucsf.edu %K smoking cessation %K vaping cessation %K mHealth intervention %K mobile health %K e-cigarettes %K cigarettes %K smartphone intervention %K nicotine dependence %K additive adverse health effects %K tobacco cessation %D 2024 %7 22.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Dual use of both e-cigarettes and cigarettes is popular among young adults and may lead to greater nicotine dependence and additive adverse health effects than single-product use. However, existing cessation programs target quitting either e-cigarettes or cigarettes, highlighting a need for interventions to help young adults quit both products (ie, dual tobacco cessation). Objective: This formative study is part of a larger project to develop a smartphone intervention for dual tobacco cessation among young adults. This study aimed to (1) explore desires for and experiences with quitting both e-cigarettes and cigarettes and (2) identify needs and preferences for dual tobacco cessation intervention programming. Methods: Semistructured interviews were conducted to elicit the need for and experience with dual tobacco cessation among 14 young adults (18-29 years old) recruited through Instagram (Meta) advertisements in 2023. We conducted a thematic analysis to identify common themes related to quitting experiences and cessation needs. Results: Participants expressed a strong desire for dual tobacco cessation and had attempted to quit both tobacco products, mostly “cold turkey.” The priority product for quitting first varied by the individual’s perceived harm or level of consumption. Targets for dual tobacco cessation interventions included (1) highlighting the health effects of dual tobacco use compared with single product use, (2) providing cessation support to quit one prioritized product while cutting down the other product with the explicit goal to quit both, (3) emphasizing unique facilitators and barriers to quitting each product (eg, unpleasant smell of cigarettes facilitating smoking cessation and accessibility and flavors of e-cigarettes hindering vaping cessation), and (4) addressing co-use of tobacco with alcohol or cannabis. Participants wanted personalized interventions through smartphone apps that would tailor support to their tobacco use patterns and unique quitting goals and needs. They also suggested presenting intervention content in multimedia (eg, videos, graphic pictures, quizzes, and games) to increase engagement. Conclusions: This study provides important insights into young adults’ experiences, needs, and preferences for dual tobacco product cessation. We highlight important targets for future smartphone apps to deliver personalized and tailored support to meet the heterogeneous needs and preferences of young people who want to quit using both e-cigarettes and cigarettes. %M 39437386 %R 10.2196/63156 %U https://formative.jmir.org/2024/1/e63156 %U https://doi.org/10.2196/63156 %U http://www.ncbi.nlm.nih.gov/pubmed/39437386 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58919 %T Public Response to Federal Electronic Cigarette Regulations Analyzed Using Social Media Data Through Natural Language Processing: Topic Modeling Study %A Lin,Shuo-Yu %A Tulabandu,Sahithi Kiran %A Koch,J Randy %A Hayes,Rashelle %A Barnes,Andrew %A Purohit,Hemant %A Chen,Songqing %A Han,Bo %A Xue,Hong %+ Department of Health Administration and Policy, George Mason University, 4400 University Dr, Fairfax, VA, 22030, United States, 1 703 993 9833, hxue4@gmu.edu %K social media analysis %K data mining %K natural language processing %K topic modeling %K sentiment analysis %K e-cigarette regulation %K vaping %K Twitter analysis %K public health related policy %K marketing denial orders %D 2024 %7 1.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: e-Cigarette (electronic cigarette) use has been a public health issue in the United States. On June 23, 2022, the US Food and Drug Administration (FDA) issued marketing denial orders (MDOs) to Juul Labs Inc for all their products currently marketed in the United States. However, one day later, on June 24, 2022, a federal appeals court granted a temporary reprieve to Juul Labs that allowed it to keep its e-cigarettes on the market. As the conversation around Juul continues to evolve, it is crucial to gain insights into the sentiments and opinions expressed by individuals on social media. Objective: This study aims to conduct a comprehensive analysis of tweets before and after the ban on Juul, aiming to shed light on public perceptions and sentiments surrounding this contentious topic and to better understand the life cycle of public health–related policy on social media. Methods: Natural language processing (NLP) techniques were used, including state-of-the-art BERTopic topic modeling and sentiment analysis. A total of 6023 tweets and 22,288 replies or retweets were collected from Twitter (rebranded as X in 2023) between June 2022 and October 2022. The encoded topics were used in time-trend analysis to depict the boom-and-bust cycle. Content analyses of retweets were also performed to better understand public perceptions and sentiments about this contentious topic. Results: The attention surrounding the FDA’s ban on Juul lasted no longer than a week on Twitter. Not only the news (ie, tweets with a YouTube link that directs to the news site) related to the announcement itself, but the surrounding discussions (eg, potential consequences of this ban or block and concerns toward kids or youth health) diminished shortly after June 23, 2022, the date when the ban was officially announced. Although a short rebound was observed on July 4, 2022, which was contributed by the suspension on the following day, discussions dried out in 2 days. Out of the top 50 most retweeted tweets, we observed that, except for neutral (23/45, 51%) sentiment that broadcasted the announcement, posters responded more negatively (19/45, 42%) to the FDA’s ban. Conclusions: We observed a short life cycle for this news announcement, with a preponderance of negative sentiment toward the FDA’s ban on Juul. Policy makers could use tactics such as issuing ongoing updates and reminders about the ban, highlighting its impact on public health, and actively engaging with influential social media users who can help maintain the conversation. %M 39352739 %R 10.2196/58919 %U https://www.jmir.org/2024/1/e58919 %U https://doi.org/10.2196/58919 %U http://www.ncbi.nlm.nih.gov/pubmed/39352739 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56371 %T Public Perceptions of the Food and Drug Administration's Regulatory Authority Over Synthetic Nicotine on Twitter: Observational Study %A Zou,Jonathan %A Feliciano,Juan Ramon %A Xie,Zidian %A Li,Dongmei %+ Department of Clinical and Translational Research, University of Rochester Medical Center, 265 Crittenden Boulevard Cu 420708, Rochester, NY, 14642-0708, United States, 1 5852767285, Dongmei_Li@urmc.rochester.edu %K FDA %K synthetic nicotine %K omnibus %K Twitter %K Food and Drug Administration %D 2024 %7 19.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The Omnibus Budget Bill, known as H. R. 2471, passed through Congress on March 10, 2022, and was eventually signed by President Biden on March 15, 2022. This bill amended the Federal Food, Drug, and Cosmetic Act granting the Food and Drug Administration (FDA) regulatory authority over synthetic nicotine. Objective: This study aims to examine the public perceptions of the Omnibus Bill that regulates synthetic nicotine products as tobacco products on Twitter (rebranded as X). Methods: Through the X streaming application programming interface, we collected and identified 964 tweets related to the Omnibus Bill on synthetic nicotine between March 8, 2022, and April 13, 2022. The longitudinal trend was used to examine the discussions related to the bill over time. An inductive method was used for the content analysis of related tweets. By hand-coding 200 randomly selected tweets by 2 human coders respectively with high interrater reliability, the codebook was developed for relevance, major topics, and attitude to the bill, which was used to single-code the rest of the tweets. Results: Between March 8, 2022, and April 13, 2022, we identified 964 tweets related to the Omnibus Bill regulating synthetic nicotine. Our longitudinal trend analysis showed a spike in the number of tweets related to the bill during the immediate period following the bill’s introduction, with roughly half of the tweets identified being posted between March 8 and 11, 2022. A majority of the tweets (497/964, 51.56%) had a negative sentiment toward the bill, while a much smaller percentage of tweets (164/964, 17.01%) had a positive sentiment toward the bill. Around 31.43% (303/964) of all tweets were categorized as objective news or questions about the bill. The most popular topic for opposing the bill was users believing that this bill would lead users back to smoking (145/497, 29.18%), followed by negative implications for small vape businesses (122/497, 24.55%) and government or FDA mistrust (94/497, 18.91%). The most popular topic for supporting the bill was that this bill would take a dangerous tobacco product targeted at teens off the market (94/164, 57.32%). Conclusions: We observed a more negative sentiment toward the bill on X, largely due to users believing it would lead users back to smoking and negatively impact small vape businesses. This study provides insight into public perceptions and discussions of this bill on X and adds valuable information for future regulations on alternative nicotine products. %M 39298747 %R 10.2196/56371 %U https://formative.jmir.org/2024/1/e56371 %U https://doi.org/10.2196/56371 %U http://www.ncbi.nlm.nih.gov/pubmed/39298747 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55591 %T The Normalization of Vaping on TikTok Using Computer Vision, Natural Language Processing, and Qualitative Thematic Analysis: Mixed Methods Study %A Jung,Sungwon %A Murthy,Dhiraj %A Bateineh,Bara S %A Loukas,Alexandra %A Wilkinson,Anna V %+ School of Journalism and Media, University of Texas at Austin, 300 W Dean Keeton St, Austin, TX, 78712, United States, 1 512 749 3267, sungwon.jung@utexas.edu %K electronic cigarettes %K vaping %K social media %K natural language processing %K computer vision %D 2024 %7 11.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media posts that portray vaping in positive social contexts shape people’s perceptions and serve to normalize vaping. Despite restrictions on depicting or promoting controlled substances, vape-related content is easily accessible on TikTok. There is a need to understand strategies used in promoting vaping on TikTok, especially among susceptible youth audiences. Objective: This study seeks to comprehensively describe direct (ie, explicit promotional efforts) and indirect (ie, subtler strategies) themes promoting vaping on TikTok using a mixture of computational and qualitative thematic analyses of social media posts. In addition, we aim to describe how these themes might play a role in normalizing vaping behavior on TikTok for youth audiences, thereby informing public health communication and regulatory policies regarding vaping endorsements on TikTok. Methods: We collected 14,002 unique TikTok posts using 50 vape-related hashtags (eg, #vapetok and #boxmod). Using the k-means unsupervised machine learning algorithm, we identified clusters and then categorized posts qualitatively based on themes. Next, we organized all videos from the posts thematically and extracted the visual features of each theme using 3 machine learning–based model architectures: residual network (ResNet) with 50 layers (ResNet50), Visual Geometry Group model with 16 layers, and vision transformer. We chose the best-performing model, ResNet50, to thoroughly analyze the image clustering output. To assess clustering accuracy, we examined 4.01% (441/10,990) of the samples from each video cluster. Finally, we randomly selected 50 videos (5% of the total videos) from each theme, which were qualitatively coded and compared with the machine-derived classification for validation. Results: We successfully identified 5 major themes from the TikTok posts. Vape product marketing (1160/10,990, 8.28%) reflected direct marketing, while the other 4 themes reflected indirect marketing: TikTok influencer (3775/14,002, 26.96%), general vape (2741/14,002, 19.58%), vape brands (2042/14,002, 14.58%), and vaping cessation (1272/14,002, 9.08%). The ResNet50 model successfully classified clusters based on image features, achieving an average F1-score of 0.97, the highest among the 3 models. Qualitative content analyses indicated that vaping was depicted as a normal, routine part of daily life, with TikTok influencers subtly incorporating vaping into popular culture (eg, gaming, skateboarding, and tattooing) and social practices (eg, shopping sprees, driving, and grocery shopping). Conclusions: The results from both computational and qualitative analyses of text and visual data reveal that vaping is normalized on TikTok. Our identified themes underscore how everyday conversations, promotional content, and the influence of popular figures collectively contribute to depicting vaping as a normal and accepted aspect of daily life on TikTok. Our study provides valuable insights for regulatory policies and public health initiatives aimed at tackling the normalization of vaping on social media platforms. %M 39259963 %R 10.2196/55591 %U https://www.jmir.org/2024/1/e55591 %U https://doi.org/10.2196/55591 %U http://www.ncbi.nlm.nih.gov/pubmed/39259963 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e51307 %T Mobile App Intervention to Reduce Substance Use, Gambling, and Digital Media Use in Vocational School Students: Exploratory Analysis of the Intervention Arm of a Randomized Controlled Trial %A Grahlher,Kristin %A Morgenstern,Matthis %A Pietsch,Benjamin %A Gomes de Matos,Elena %A Rossa,Monika %A Lochbühler,Kirsten %A Daubmann,Anne %A Thomasius,Rainer %A Arnaud,Nicolas %+ German Centre for Addiction Research in Childhood and Adolescence, University Medical Centre Hamburg-Eppendorf, Martinistr 52, Hamburg, 20246, Germany, 49 40741059307, n.arnaud@uke.de %K prevention %K vocational students %K adolescents %K mobile intervention %K voluntary commitment %K substance use %K internet-related problems %K mobile phone %K adolescent %K youths %K student %K students %K use %D 2024 %7 23.7.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: During adolescence, substance use and digital media exposure usually peak and can become major health risks. Prevention activities are mainly implemented in the regular school setting, and youth outside this system are not reached. A mobile app (“Meine Zeit ohne”) has been developed specifically for vocational students and encourages participants to voluntarily reduce or abstain from a self-chosen addictive behavior including the use of a substance, gambling, or a media-related habit such as gaming or social media use for 2 weeks. Results from a randomized study indicate a significant impact on health-promoting behavior change after using the app. This exploratory study focuses on the intervention arm of this study, focusing on acceptance and differential effectiveness. Objective: The aims of this study were (1) to examine the characteristics of participants who used the app, (2) to explore the effectiveness of the mobile intervention depending on how the app was used and depending on participants’ characteristics, and (3) to study how variations in app use were related to participants’ baseline characteristics. Methods: Log data from study participants in the intervention group were analyzed including the frequency of app use (in days), selection of a specific challenge, and personal relevance (ie, the user was above a predefined risk score for a certain addictive behavior) of challenge selection (“congruent use”: eg, a smoker selected a challenge related to reducing or quitting smoking). Dichotomous outcomes (change vs no change) referred to past-month substance use, gambling, and media-related behaviors. The relationship between these variables was analyzed using binary, multilevel, mixed-effects logistic regression models. Results: The intervention group consisted of 2367 vocational students, and 1458 (61.6%; mean age 19.0, SD 3.5 years; 830/1458, 56.9% male) of them provided full data. Of these 1458 students, 894 (61.3%) started a challenge and could be included in the analysis (mean 18.7, SD 3.5 years; 363/894, 40.6% female). Of these 894 students, 466 (52.1%) were considered frequent app users with more than 4 days of active use over the 2-week period. The challenge area most often chosen in the analyzed sample was related to social media use (332/894, 37.1%). A total of 407 (45.5%) of the 894 students selected a challenge in a behavioral domain of personal relevance. The effects of app use on outcomes were higher when the area of individual challenge choice was equal to the area of behavior change, challenge choice was related to a behavior of personal relevance, and the individual risk of engaging in different addictive behaviors was high. Conclusions: The domain-specific effectiveness of the program was confirmed with no spillover between behavioral domains. Effectiveness appeared to be dependent on app use and users’ characteristics. Trial Registration: German Clinical Trials Register DRKS00023788; https://tinyurl.com/4pzpjkmj International Registered Report Identifier (IRRID): RR2-10.1186/s13063-022-06231-x %M 39042436 %R 10.2196/51307 %U https://mhealth.jmir.org/2024/1/e51307 %U https://doi.org/10.2196/51307 %U http://www.ncbi.nlm.nih.gov/pubmed/39042436 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51327 %T Public Perceptions and Discussions of the US Food and Drug Administration's JUUL Ban Policy on Twitter: Observational Study %A Liu,Pinxin %A Lou,Xubin %A Xie,Zidian %A Shang,Ce %A Li,Dongmei %+ Department of Clinical and Translational Research, University of Rochester Medical Center, 265 Crittenden Boulevard CU 420708, Rochester, NY, 14642-0708, United States, 1 5852767285, Dongmei_Li@urmc.rochester.edu %K e-cigarettes %K JUUL %K Twitter %K deep learning %K FDA %K Food and Drug Administration %K vape %K vaping %K smoking %K social media %K regulation %D 2024 %7 11.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: On June 23, 2022, the US Food and Drug Administration announced a JUUL ban policy, to ban all vaping and electronic cigarette products sold by Juul Labs. Objective: This study aims to understand public perceptions and discussions of this policy using Twitter (subsequently rebranded as X) data. Methods: Using the Twitter streaming application programming interface, 17,007 tweets potentially related to the JUUL ban policy were collected between June 22, 2022, and July 25, 2022. Based on 2600 hand-coded tweets, a deep learning model (RoBERTa) was trained to classify all tweets into propolicy, antipolicy, neutral, and irrelevant categories. A deep learning model (M3 model) was used to estimate basic demographics (such as age and gender) of Twitter users. Furthermore, major topics were identified using latent Dirichlet allocation modeling. A logistic regression model was used to examine the association of different Twitter users with their attitudes toward the policy. Results: Among 10,480 tweets related to the JUUL ban policy, there were similar proportions of propolicy and antipolicy tweets (n=2777, 26.5% vs n=2666, 25.44%). Major propolicy topics included “JUUL causes youth addition,” “market surge of JUUL,” and “health effects of JUUL.” In contrast, major antipolicy topics included “cigarette should be banned instead of JUUL,” “against the irrational policy,” and “emotional catharsis.” Twitter users older than 29 years were more likely to be propolicy (have a positive attitude toward the JUUL ban policy) than those younger than 29 years. Conclusions: Our study showed that the public showed different responses to the JUUL ban policy, which varies depending on the demographic characteristics of Twitter users. Our findings could provide valuable information to the Food and Drug Administration for future electronic cigarette and other tobacco product regulations. %M 38990633 %R 10.2196/51327 %U https://formative.jmir.org/2024/1/e51327 %U https://doi.org/10.2196/51327 %U http://www.ncbi.nlm.nih.gov/pubmed/38990633 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49344 %T The Influence of Billboard-Based Tobacco Prevention Posters on Memorization, Attitudes, and Craving: Immersive Virtual Reality Study %A Bonneterre,Solenne %A Zerhouni,Oulmann %A Boffo,Marilisa %+ Université Paris Nanterre, 200 Avenue de la République, Nanterre, 92000, France, 33 06161484588, solenne.bonneterre@gmail.com %K tobacco %K smoking %K health promotion %K health prevention campaigns %K immersive virtual reality %K incidental exposure %K advertising %D 2024 %7 9.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Health prevention campaigns often face challenges in reaching their target audience and achieving the desired impact on health behaviors. These campaigns, particularly those aimed at reducing tobacco use, require rigorous evaluation methods to assess their effectiveness. Objective: This study aims to use immersive virtual reality (iVR) to systematically evaluate recall, attitudinal, and craving responses to antitobacco prevention messages when presented in a realistic virtual environment, thereby exploring the potential of iVR as a novel tool to improve the effectiveness of public health campaigns. Methods: A total of 121 undergraduate students (mean age 19.6, SD 3.7 years), mostly female (n=99, 82.5%), were invited to take a guided walk in the virtual environment, where they were randomly exposed to a different ratio of prevention and general advertising posters (80/20 or 20/80) depending on the experimental condition. Participants’ gaze was tracked throughout the procedure, and outcomes were assessed after the iVR exposure. Results: Incidental exposure to antitobacco prevention and general advertising posters did not significantly alter attitudes toward tobacco. Memorization of prevention posters was unexpectedly better in the condition where advertising was more frequent (β=–6.15; P<.001), and high contrast between poster types led to a better memorization of the less frequent type. Despite a nonsignificant trend, directing attention to prevention posters slightly improved their memorization (β=.02; P=.07). In addition, the duration of exposure to prevention posters relative to advertisements negatively affected memorization of advertising posters (β=–2.30; P=.01). Conclusions: Although this study did not find significant changes in attitudes toward tobacco after exposure to prevention campaigns using iVR, the technology does show promise as an evaluation tool. To fully evaluate the use of iVR in public health prevention strategies, future research should examine different types of content, longer exposure durations, and different contexts. Trial Registration: Open Science Framework E3YK7; https://osf.io/e3yk7 %M 38980707 %R 10.2196/49344 %U https://www.jmir.org/2024/1/e49344 %U https://doi.org/10.2196/49344 %U http://www.ncbi.nlm.nih.gov/pubmed/38980707 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55031 %T Digital Interventions for Recreational Cannabis Use Among Young Adults: Systematic Review, Meta-Analysis, and Behavior Change Technique Analysis of Randomized Controlled Studies %A Côté,José %A Chicoine,Gabrielle %A Vinette,Billy %A Auger,Patricia %A Rouleau,Geneviève %A Fontaine,Guillaume %A Jutras-Aswad,Didier %+ Research Centre of the Centre Hospitalier de l’Université de Montréal, 850 Saint-Denis, Montreal, QC, H2X 0A9, Canada, 1 514 890 8000, jose.cote@umontreal.ca %K cannabis %K young adults %K digital intervention %K systematic review %K meta-analysis %K behavior change technique analysis %K mobile phone %D 2024 %7 17.4.2024 %9 Review %J J Med Internet Res %G English %X Background: The high prevalence of cannabis use among young adults poses substantial global health concerns due to the associated acute and long-term health and psychosocial risks. Digital modalities, including websites, digital platforms, and mobile apps, have emerged as promising tools to enhance the accessibility and availability of evidence-based interventions for young adults for cannabis use. However, existing reviews do not consider young adults specifically, combine cannabis-related outcomes with those of many other substances in their meta-analytical results, and do not solely target interventions for cannabis use. Objective: We aimed to evaluate the effectiveness and active ingredients of digital interventions designed specifically for cannabis use among young adults living in the community. Methods: We conducted a systematic search of 7 databases for empirical studies published between database inception and February 13, 2023, assessing the following outcomes: cannabis use (frequency, quantity, or both) and cannabis-related negative consequences. The reference lists of included studies were consulted, and forward citation searching was also conducted. We included randomized studies assessing web- or mobile-based interventions that included a comparator or control group. Studies were excluded if they targeted other substance use (eg, alcohol), did not report cannabis use separately as an outcome, did not include young adults (aged 16-35 y), had unpublished data, were delivered via teleconference through mobile phones and computers or in a hospital-based setting, or involved people with mental health disorders or substance use disorders or dependence. Data were independently extracted by 2 reviewers using a pilot-tested extraction form. Authors were contacted to clarify study details and obtain additional data. The characteristics of the included studies, study participants, digital interventions, and their comparators were summarized. Meta-analysis results were combined using a random-effects model and pooled as standardized mean differences. Results: Of 6606 unique records, 19 (0.29%) were included (n=6710 participants). Half (9/19, 47%) of these articles reported an intervention effect on cannabis use frequency. The digital interventions included in the review were mostly web-based. A total of 184 behavior change techniques were identified across the interventions (range 5-19), and feedback on behavior was the most frequently used (17/19, 89%). Digital interventions for young adults reduced cannabis use frequency at the 3-month follow-up compared to control conditions (including passive and active controls) by −6.79 days of use in the previous month (95% CI −9.59 to −4.00; P<.001). Conclusions: Our results indicate the potential of digital interventions to reduce cannabis use in young adults but raise important questions about what optimal exposure dose could be more effective, both in terms of intervention duration and frequency. Further high-quality research is still needed to investigate the effects of digital interventions on cannabis use among young adults. Trial Registration: PROSPERO CRD42020196959; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=196959 %M 38630515 %R 10.2196/55031 %U https://www.jmir.org/2024/1/e55031 %U https://doi.org/10.2196/55031 %U http://www.ncbi.nlm.nih.gov/pubmed/38630515 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53644 %T Investigation of the Association Between e-Cigarette Smoking and Oral Mucosal Health Status Among Young People: Protocol for a Case-Control Trial %A Cheng,Siyuan %+ Massachusetts College of Pharmacy and Health Sciences, 179 Longwood Avenue, Boston, MA, 02115, United States, 1 617 732 2850, m0496197@stu.mcphs.edu %K oral mucosal lesions %K e-cigarette %K youth %K oral %K moth %K lesion %K lesions %K cigarette %K cigarettes %K smoker %K smoking %K smokers %K smoke %K mucosa %K mucosal %K dental %K dentist %K dentistry %D 2024 %7 26.1.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Given the paucity of current safety studies related to e-cigarettes, there are no definitive studies on whether e-cigarettes cause oral mucosal lesions or even oral cancer. Although it is still undetermined whether e-cigarettes are harmless, an increasing number of teenagers choose to smoke e-cigarettes and believe that they are not harmful to the human body. Objective: This aims to determine whether e-cigarettes cause damage to the oral mucosa. This study also aims to evaluate the association between e-cigarette smoking and oral mucous membrane lesions in young adults. The objectives are to (1) compare the oral mucosal conditions in participants with and without e-cigarette smoking habits, (2) assess the effect of the amount of e-cigarette smoking on oral mucosal conditions, and (3) assess the effect of the duration of e-cigarette smoking on oral mucosal conditions. Methods: In this prospective study, 304 youths aged 15 to 24 years (n=152, 50% who smoke only e-cigarettes and n=152, 50% who do not smoke e-cigarettes or cigarettes) will be divided into 2 groups for a controlled study. Whether e-cigarettes cause oral mucosal lesions will be verified by comparing the odds of oral mucosal lesions in the 2 experimental groups. For this experiment, the predefined power is 80% (P=.04), and the predefined proportions of groups 1 and 2 are 11% and 2.5%, respectively. Results: This experiment is at the conceptualization phase and has not yet been carried out. Experimenters have not been recruited and no data have been collected. Conclusions: e-Cigarettes are still an unfamiliar topic to the public, and it is still unknown whether they can cause damage to the oral mucosa. This experiment aims to find out whether there is a link between the 2. There are still many limitations in this study, such as the lack of categorization of e-cigarettes and the lack of testing methods for oral mucosal status. These limitations are expected to be addressed in the future as the experiment is formally conducted and further optimized. International Registered Report Identifier (IRRID): PRR1-10.2196/53644 %M 38171545 %R 10.2196/53644 %U https://www.researchprotocols.org/2024/1/e53644 %U https://doi.org/10.2196/53644 %U http://www.ncbi.nlm.nih.gov/pubmed/38171545 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e42956 %T Supporting Youth Vaping Cessation With the Crush the Crave Smartphone App: Protocol for a Randomized Controlled Trial %A Sanchez,Sherald %A Deck,Alicia %A Baskerville,Neill Bruce %A Chaiton,Michael %+ Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin St, Toronto, ON, M5S 2S1, Canada, 1 416 435 8501, Michael.Chaiton@camh.ca %K e-cigarettes %K vaping cessation %K youth and young adult health %K adult %K youth %K effectiveness %K smartphone %K application %K vaping %K cessation %K assessment %K intervention %D 2023 %7 27.1.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The use of e-cigarettes, or vaping, has increased exponentially in the past decade, particularly among youth. Emerging evidence indicates growing nicotine dependence among youth, revealing historically higher rates of dependence among current e-cigarette users compared to rates seen in earlier research. Despite the urgent need for youth vaping cessation interventions, there is limited knowledge about the process of vaping cessation, and few evidence-based interventions are available to young people seeking support. A notable literature review on vaping cessation resources for young people recommended technology-based interventions, such as smartphone apps and SMS text messaging services, as a promising area of vaping cessation research and intervention development. Objective: The primary aim of our study is to determine the effectiveness of the Crush the Crave app in supporting vaping cessation among youth recruited to the intervention arm via comparison with an assessment-only control group. The primary hypothesis is that participants in the intervention group—those using Crush the Crave—will be more likely to be abstinent at the 6-month follow-up point than participants in the assessment-only control arm. Methods: A 2-arm, single-blind, parallel randomized controlled trial will be conducted over 12 months. Study invitations will be sent to 600 youth (age: 16-18 years) and young adult (age: 19-29 years) e-cigarette users and randomized between an intervention arm, which will be using Crush the Crave (n=300), and an assessment-only control arm (n=300) in a 1:1 ratio. The primary hypothesis is that participants in the intervention group—those using Crush the Crave—will be more likely to be abstinent at the 6-month follow-up point. Results: Study recruitment began on March 4, 2022. Recruitment is anticipated to be completed in December 2022. Conclusions: This protocol describes one of the first-ever randomized controlled trial studies to evaluate the effectiveness of an app-based intervention for supporting vaping cessation among youth aged 16 to 18 years and young adults aged 19 to 29 years. The findings from our trial will help increase our understanding of the process of vaping cessation among youth and provide evidence on the effectiveness of an app-based intervention in helping young people quit vaping. The trial results will also have implications in the development of current and future approaches to youth vaping cessation. Trial Registration: OSF Registries osf.io/hmd87; https://doi.org/10.17605/OSF.IO/HMD87 International Registered Report Identifier (IRRID): DERR1-10.2196/42956 %M 36705967 %R 10.2196/42956 %U https://www.researchprotocols.org/2023/1/e42956 %U https://doi.org/10.2196/42956 %U http://www.ncbi.nlm.nih.gov/pubmed/36705967 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e34530 %T A Web-Based Alcohol and Other Drug Prevention Program (Strong & Deadly Futures) for Aboriginal and Torres Strait Islander School Students: Protocol for a Cluster Randomized Controlled Trial %A Stapinski,Lexine %A Routledge,Kylie %A Snijder,Mieke %A Doyle,Michael %A Champion,Katrina %A Chapman,Cath %A Ward,James %A Baumgart,Amanda %A Lee,K S Kylie %A Teesson,Maree %A Newton,Nicola %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Lvl 6, Jane Foss Russell Building G02, Darlington, 2006, Australia, 61 286279039, lexine.stapinski@sydney.edu.au %K Aboriginal and Torres Strait Islander %K prevention %K alcohol %K tobacco %K substance use %K universal prevention %K well-being %K harm minimization %K Indigenous %K web-based %D 2022 %7 7.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: There are no available school-based alcohol and drug prevention programs with evidence of effectiveness among Aboriginal and Torres Strait Islander youth. To address this, we codeveloped the Strong & Deadly Futures well-being and alcohol and drug prevention program in partnership with an Indigenous creative design agency and 4 Australian schools. Objective: This paper presents the protocol to evaluate the effectiveness of Strong & Deadly Futures in reducing alcohol and other drug use and improving well-being among Aboriginal and Torres Strait Islander youth. Methods: The target sample will be 960 year 7 and 8 students from 24 secondary schools in Australia, of which approximately 40% (384/960) will identify as Aboriginal or Torres Strait Islander. The study design is a 2-group, parallel cluster randomized controlled trial with allocation concealment. Recruited schools will be block randomized (ratio 1:1), stratified by geographical remoteness, by an independent statistician. Schools will be randomized to receive Strong & Deadly Futures, a web-based alcohol and drug prevention and social and emotional well-being program that delivers curriculum-aligned content over 6 lessons via an illustrated story, or health education as usual (control). Control schools will be supported to implement Strong & Deadly Futures following trial completion. Surveys will be administered at baseline, 6 weeks, 12 months, and 24 months (primary end point) post baseline. Primary outcomes are alcohol use (adapted from the National Drug Strategy Household Survey), tobacco use (Standard High School Youth Risk Behavior Survey), and psychological distress (Kessler-5 Psychological Distress Scale). Secondary outcomes are alcohol and drug knowledge and intentions, alcohol-related harms, binge drinking, cannabis use, well-being, empowerment, appreciation of cultural diversity, and truancy. Results: The trial was funded by the National Health and Medical Research Council in January 2019, approved by the Human Research Ethics Committee of the University of Sydney (2020/039, April 2020), the Aboriginal Health and Medical Research Council of New South Wales (1620/19, February 2020), the Western Australian Aboriginal Health Ethics Committee (998, October 2021), and the ethics committees of each participating school, including the New South Wales Department of Education (2020170, June 2020), Catholic Education Western Australia (RP2020/39, November 2020), and the Queensland Department of Education (550/27/2390, August 2021). Projected dates of data collection are 2022-2024, and we expect to publish the results in 2025. A total of 24 schools have been recruited as of submission of the manuscript. Conclusions: This will be the first cluster randomized controlled trial of a culturally inclusive, school-based alcohol and drug prevention program for Aboriginal and Torres Strait Islander youth; therefore, it has significant potential to address alcohol and other drug harms among Aboriginal and Torres Strait Islander youth. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620001038987; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380038&isReview=true International Registered Report Identifier (IRRID): PRR1-10.2196/34530 %M 34994696 %R 10.2196/34530 %U https://www.researchprotocols.org/2022/1/e34530 %U https://doi.org/10.2196/34530 %U http://www.ncbi.nlm.nih.gov/pubmed/34994696 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 13 %N 3 %P e29945 %T Developing Graphic Messages for Vaping Prevention Among Black and Latino Adolescents: Participatory Research Approach %A Cartujano-Barrera,Francisco %A Azogini,Chiamaka %A McIntosh,Scott %A Bansal-Travers,Maansi %A Ossip,Deborah J %A Cupertino,Ana Paula %+ Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd, Box 420644, Rochester, NY, 14642, United States, 1 585 298 2031, Francisco_cartujano@urmc.rochester.edu %K vaping %K electronic cigarettes %K adolescents %K Latino %K Black %D 2021 %7 23.11.2021 %9 Original Paper %J J Particip Med %G English %X Background: As an important transition stage in human development, adolescence is a critical window for vaping prevention. There is a substantial gap in communication research on vaping prevention among racial and ethnic minority groups. Their representation is essential to develop, implement, and disseminate innovative and effective interventions for vaping prevention. Objective: The aim of this study is to describe the participatory research (PR) procedures used with Black and Latino adolescents to develop culturally and linguistically appropriate graphic messages for vaping prevention. Methods: This PR study used a qualitative, user-centered design method. We conducted a series of focus groups with 16 Black and Latino adolescents to develop culturally and linguistically appropriate graphic messages for vaping prevention. The biobehavioral model of nicotine addiction provided a framework for the development of the graphic messages. Participants met 4 times to provide iterative feedback on the graphic messages until they reached a consensus on overall quality and content. Results: At baseline, the participants’ mean age was 15.4 years (SD 1.4). Of the participants, 50% (8/16) were female, 88% (14/16) were heterosexual, 56% (9/16) were Black/African American, and 44% (7/16) were Hispanic/Latino. A total of 12 of the 16 participants (75%) chose to participate in the English sessions. Participants decided to create four types of graphic messages: (1) financial reward, (2) health reward, (3) social norms, and (4) self-efficacy. Meeting 4 times with the 4 groups provided sufficient opportunities for iterative feedback on the graphic messages to reach a consensus on overall quality and content. Conclusions: It is feasible and practical to build PR among Black and Latino adolescents focused on vaping prevention. Adolescents added innovation and creativity to the development of culturally and linguistically appropriate graphic messages for vaping prevention. Appropriate staffing, funding, and approaches are key for successful PR efforts among Black and Latino adolescents. Future research is needed to evaluate the impact of the graphic messages on vaping prevention. %M 34812734 %R 10.2196/29945 %U https://jopm.jmir.org/2021/3/e29945 %U https://doi.org/10.2196/29945 %U http://www.ncbi.nlm.nih.gov/pubmed/34812734 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e28069 %T Characterizing Vaping Industry Political Influence and Mobilization on Facebook: Social Network Analysis %A Haupt,Michael Robert %A Xu,Qing %A Yang,Joshua %A Cai,Mingxiang %A Mackey,Tim K %+ Global Health Program, Department of Anthropology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, United States, 1 951 491 4161, tmackey@ucsd.edu %K vaping %K alternative tobacco industry %K e-cigarettes %K Facebook %K social network analysis %K social networks %K ehealth %K health policy %D 2021 %7 29.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In response to recent policy efforts to regulate tobacco and vaping products, the vaping industry has been aggressive in mobilizing opposition by using a network of manufacturers, trade associations, and tobacco user communities, and by appealing to the general public. One strategy the alternative tobacco industry uses to mobilize political action is coordinating on social media platforms, such as the social networking site Facebook. However, few studies have specifically assessed how platforms such as Facebook are used to influence public sentiment and attitudes towards tobacco control policy. Objective: This study used social network analysis to examine how the alternative tobacco industry uses Facebook to mobilize online users to influence tobacco control policy outcomes with a focus on the state of California. Methods: Data were collected from local and national alternative tobacco Facebook groups that had affiliations with activities in the state of California. Network ties were constructed based on users’ reactions to posts (eg, “like” and “love”) and comments to characterize political mobilization networks. Results: Findings show that alternative tobacco industry employees were more likely to engage within these networks and that these employees were also more likely to be influential members (ie, be more active) in the network. Comparisons between subnetworks show that communication within the local alternative tobacco advocacy group network was less dense and more centralized in contrast to a national advocacy group that had overall higher levels of engagement among members. A timeline analysis found that a higher number of influential posts that disseminated widely across networks occurred during e-cigarette–related legislative events, suggesting strategic online engagement and increased mobilization of online activity for the purposes of influencing policy outcomes. Conclusions: Results from this study provide important insights into how tobacco industry–related advocacy groups leverage the Facebook platform to mobilize their online constituents in an effort to influence public perceptions and coordinate to defeat tobacco control efforts at the local, state, and federal level. Study results reveal one part of a vast network of socially enabled alternative tobacco industry actors and constituents that use Facebook as a mobilization point to support goals of the alternative tobacco industry. %M 34714245 %R 10.2196/28069 %U https://www.jmir.org/2021/10/e28069 %U https://doi.org/10.2196/28069 %U http://www.ncbi.nlm.nih.gov/pubmed/34714245 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e30681 %T Videos With the Hashtag #vaping on TikTok and Implications for Informed Decision-making by Adolescents: Descriptive Study %A Basch,Corey H %A Fera,Joseph %A Pellicane,Alessia %A Basch,Charles E %+ William Paterson University, 300 Pompton Rd, Wayne, NJ, 07470, United States, 1 973 720 2603, baschc@wpunj.edu %K vaping %K TikTok %K social media %K misinformation %K decision-making %K adolescents %K young adults %K e-cigarettes %K public health %K informed decision-making %D 2021 %7 25.10.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Despite the public health importance of vaping and the widespread use of TikTok by adolescents and young adults, research is lacking on the nature and scope of vaping content on this networking service. Objective: The purpose of this study is to describe the content of TikTok videos related to vaping. Methods: By searching the hashtag #vaping in the discover feature, ~478.4 million views were seen during the time of data collection. The first 100 relevant videos under that hashtag were used in this study. Relevance was determined by simply noting if the video was related in any way to vaping. Coding consisted of several categories directly related to vaping and additional categories, including the number of likes, comments, and views, and if the video involved music, humor, or dance. Results: The 100 videos included in the sample garnered 156,331,347 views; 20,335,800 likes; and 296,460 comments. The majority of the videos (n=59) used music and over one-third (n=37) used humor. The only content category observed in the majority of the videos sampled was the promotion of vaping, which was included in 57 videos that garnered over 74 million views (47.5% of cumulative views). A total of 42% (n=42) of the 100 videos sampled featured someone vaping or in the presence of vape pens, and these videos garnered over 22% (>35 million) of the total views. Conclusions: It is necessary for public health agencies to improve understanding of the nature and content of videos that attract viewers’ attention and harness the strength of this communication channel to promote informed decision-making about vaping. %M 34694231 %R 10.2196/30681 %U https://pediatrics.jmir.org/2021/4/e30681 %U https://doi.org/10.2196/30681 %U http://www.ncbi.nlm.nih.gov/pubmed/34694231 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e23989 %T Text Messaging Intervention for Young Smokers Experiencing Homelessness: Lessons Learned From a Randomized Controlled Trial %A Linnemayr,Sebastian %A Zutshi,Rushil %A Shadel,William %A Pedersen,Eric %A DeYoreo,Maria %A Tucker,Joan %+ RAND Corporation, 1776 Main Street, Santa Monica, CA, , United States, 1 310 393 0411 ext 6734, slinnema@rand.org %K smokers %K quitting %K text messaging %K homeless %K young adults %K cessation resources %K peer support %K smoking rate %K smartphone %D 2021 %7 1.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smoking rates are significantly higher among young people experiencing homelessness than in the general population. Despite a willingness to quit, homeless youth have little success in doing so on their own, and existing cessation resources tailored to this population are lacking. Homeless youth generally enjoy the camaraderie and peer support that group-based programs offer, but continuous in-person support during a quit attempt can be prohibitively expensive. Objective: This study aimed to assess the feasibility and acceptability of an automated text messaging intervention (TMI) as an adjunct to group-based cessation counseling and provision of nicotine patches to help homeless youth quit smoking. This paper outlines the lessons learned from the implementation of the TMI intervention. Methods: Homeless youth smokers aged 18 to 25 years who were interested in quitting (n=77) were recruited from drop-in centers serving homeless youth in the Los Angeles area. In this pilot randomized controlled trial, all participants received a group-based cessation counseling session and nicotine patches, with 52% (40/77) randomly assigned to receive 6 weeks of text messages to provide additional support for their quit attempt. Participants received text messages on their own phone rather than receiving a study-issued phone for the TMI. We analyzed baseline and follow-up survey data as well as back-end data from the messaging platform to gauge the acceptability and feasibility of the TMI among the 40 participants who received it. Results: Participants had widespread (smart)phone ownership—16.4% (36/219) were ineligible for study participation because they did not have a phone that could receive text messages. Participants experienced interruptions in their phone use (eg, 44% [16/36] changed phone numbers during the follow-up period) but reported being able to receive the majority of messages. These survey results were corroborated by back-end data (from the program used to administer the TMI) showing a message delivery rate of about 95%. Participant feedback points to the importance of carefully crafting text messages, which led to high (typically above 70%) approval of most text messaging components of the intervention. Qualitative feedback indicated that participants enjoyed the group counseling session that preceded the TMI and suggested including more such group elements into the intervention. Conclusions: The TMI was well accepted and feasible to support smoking cessation among homeless youth. Given high rates of smartphone ownership, the next generation of phone-based smoking cessation interventions for this population should consider using approaches beyond text messages and focus on finding ways to develop effective approaches to include group interaction using remote implementation. Given overall resource constraints and in particular the exigencies of the currently ongoing COVID-19 epidemic, phone-based interventions are a promising approach to support homeless youth, a population urgently in need of effective smoking cessation interventions. Trial Registration: ClinicalTrials.gov NCT03874585; https://clinicaltrials.gov/ct2/show/NCT03874585 International Registered Report Identifier (IRRID): RR2-10.1186/s13722-020-00187-6 %M 33792551 %R 10.2196/23989 %U https://mhealth.jmir.org/2021/4/e23989 %U https://doi.org/10.2196/23989 %U http://www.ncbi.nlm.nih.gov/pubmed/33792551 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 10 %P e21100 %T Tobacco-Free Duo Adult-Child Contract for Prevention of Tobacco Use Among Adolescents and Parents: Protocol for a Mixed-Design Evaluation %A Galanti,Maria Rosaria %A Pulkki-Brännström,Anni-Maria %A Nilsson,Maria %+ Centre for Epidemiology and Community Health, Solnavägen 1E, Stockholm , Sweden, 46 704718984, rosaria.galanti@ki.se %K tobacco use %K prevention %K school %K social influence %K public commitment %K cluster randomized trial %K observational study %D 2020 %7 29.10.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Universal tobacco-prevention programs targeting youths usually involve significant adults, who are assumed to be important social influences. Commitment not to use tobacco, or to quit use, as a formal contract between an adolescent and a significant adult is a preventive model that has not been widely practiced or explored and has been formally evaluated even less. In this paper, we present the rationale and protocol for the evaluation of the Swedish Tobacco-free Duo program, a multicomponent school-based program the core of which rests on a formal agreement between an adolescent and an adult. The adolescent’s commitment mainly concerns avoiding the onset of any tobacco use while the adult commits to support the adolescent in staying tobacco free, being a role model by not using tobacco themselves. Objective: To assess (1) whether Tobacco-free Duo is superior to an education-only program in preventing smoking onset among adolescents and promoting cessation among their parents, (2) whether exposure to core components (adult-child agreement) entails more positive effects than exposure to other components, (3) the impact of the program on whole school tobacco use, (4) potential negative side effects, and (5) school-level factors related to fidelity of the program’s implementation. Methods: A mixed-design approach was developed. First, a cluster randomized controlled trial was designed with schools randomly assigned to either the comprehensive multicomponent program or its educational component only. Primary outcome at the adolescent level was identified as not having tried tobacco during the 3-year junior high school compulsory grades (12-15 years of age). An intention-to-treat cohort-wise approach and an as-treated approach complemented with a whole school repeated cross-sectional approach was devised as analytical methods of the trial data. Second, an observational study was added in order to compare smoking incidence in the schools participating in the experiment with that of a convenience sample of schools that were not part of the experimental study. Diverse secondary outcomes at both adolescent and adult levels were also included. Results: The study was approved by the Umeå Regional Ethics Review Board (registration number 2017/255-31) in 2017. Recruitment of schools started in fall 2017 and continued until June 2018. In total, 43 schools were recruited to the experimental study, and 16 schools were recruited to the observational study. Data collection started in the fall 2018, is ongoing, and is planned to be finished in spring 2021. Conclusions: Methodological, ethical, and practical implications of the evaluation protocol were discussed, especially the advantage of combining several sources of data, to triangulate the study questions. The results of these studies will help revise the agenda of this program as well as those of similar programs. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 52858080; https://doi.org/10.1186/ISRCTN52858080 International Registered Report Identifier (IRRID): DERR1-10.2196/21100 %M 33000762 %R 10.2196/21100 %U http://www.researchprotocols.org/2020/10/e21100/ %U https://doi.org/10.2196/21100 %U http://www.ncbi.nlm.nih.gov/pubmed/33000762 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e18583 %T A Mobile Health Intervention for Adolescents Exposed to Secondhand Smoke: Pilot Feasibility and Efficacy Study %A Nardone,Natalie %A Giberson,Jeremy %A Prochaska,Judith J %A Jain,Shonul %A Benowitz,Neal L %+ Clinical Pharmacology Research Program, Division of Cardiology, Department of Medicine, University of California, Building 30, Room 3316, 1001 Potrero Ave, San Francisco, CA, 94110, United States, 1 628 206 8324, neal.benowitz@ucsf.edu %K secondhand smoke %K adolescents %K cotinine %K mHealth %K intervention %D 2020 %7 19.8.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Secondhand smoke (SHS) exposure in children and adolescents has adverse health effects. For adolescents of lower socioeconomic status (SES), exposure is widespread, evidenced in the measurement of urinary cotinine, a major metabolite of nicotine. Direct intervention with exposed children has been proposed as a novel method, yet there is minimal evidence of its efficacy. Combining this approach with a mobile health (mHealth) intervention may be more time and cost-effective and feasible for adolescent populations. Objective: In this pilot study, we assessed the feasibility and preliminary evidence of efficacy of a 30-day text message–based mHealth intervention targeted at reducing SHS exposure in adolescent populations of low SES. Methods: For the study, 14 nonsmoking and nonvaping participants between the ages of 12-21 years exposed to SHS were enrolled. The intervention consisted of a daily text message sent to the participants over the course of a month. Text message types included facts and information about SHS, behavioral methods for SHS avoidance, or true-or-false questions. Participants were asked to respond to each message within 24 hours as confirmation of receipt. Feasibility outcomes included completion of the 30-day intervention, receiving and responding to text messages, and feedback on the messages. Efficacy outcomes included a reduction in urinary cotinine, accuracy of true-or-false responses, and participants’ perceptions of effectiveness. Results: Of the 14 participants that were enrolled, 13 completed the intervention. Though not required, all participants had their own cell phones with unlimited text messaging plans. Of the total number of text messages sent to the 13 completers, 91% (372/407) of them received on-time responses. Participant feedback was generally positive, with most requesting more informational and true-or-false questions. In terms of efficacy, 54% (6/11) of participants reduced their cotinine levels (however, change for the group overall was not statistically significant (P=.33) and 45% (5/11) of participants increased their cotinine levels. Of the total number of true-or-false questions sent across all completers, 77% (56/73) were answered correctly. Participants’ ratings of message effectiveness averaged 85 on a scale of 100. Conclusions: In this pilot study, the intervention was feasible as the majority of participants had access to a cell phone, completed the study, and engaged by responding to the messages. The efficacy of the study requires further replication, as only half of the participants reduced their cotinine levels. However, participants answered the majority of true-or-false questions accurately and reported that the messages were helpful. %M 32812888 %R 10.2196/18583 %U http://formative.jmir.org/2020/8/e18583/ %U https://doi.org/10.2196/18583 %U http://www.ncbi.nlm.nih.gov/pubmed/32812888 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e18943 %T Tactics for Drawing Youth to Vaping: Content Analysis of Electronic Cigarette Advertisements %A Struik,Laura L %A Dow-Fleisner,Sarah %A Belliveau,Michelle %A Thompson,Desiree %A Janke,Robert %+ School of Nursing, Department of Health and Social Development, University of British Columbia Okanagan, ARTS 140, 1147 Research Road, Kelowna, BC, V1V1V7, Canada, 1 2508077792, laura.struik@ubc.ca %K qualitative research %K electronic nicotine delivery systems %K marketing %K advertisement %K youth %K vaping %D 2020 %7 14.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of electronic cigarettes (e-cigarettes), also known as vaping, has risen exponentially among North American youth in recent years and has become a critical public health concern. The marketing strategies used by e-cigarette companies have been associated with the uptick in use among youth, with video advertisements on television and other electronic platforms being the most pervasive strategy. It is unknown how these advertisements may be tapping into youth needs and preferences. Objective: The aim of this 2-phase study was to examine the marketing strategies that underpin e-cigarette advertisements, specifically in the context of television. Methods: In phase 1, a scoping review was conducted to identify various influences on e-cigarette uptake among youth. Results of this scoping review informed the development of a coding framework. In phase 2, this framework was used to analyze the content of e-cigarette advertisements as seen on 2 popular television channels (Discovery and AMC). Results: In phase 1, a total of 20 articles met the inclusion criteria. The resultant framework consisted of 16 key influences on e-cigarette uptake among youth, which were categorized under 4 headings: personal, relational, environmental, and product-related. In phase 2, 38 e-cigarette advertisements were collected from iSpot.tv and represented 11 popular e-cigarette brands. All of the advertisements tapped into the cited influences of youth e-cigarette uptake, with the most commonly cited influences (product and relational) tapping into the most, at 97% (37/38) and 53% (20/38), respectively. Conclusions: The findings highlight the multidimensional influences on youth uptake of e-cigarettes, which has important implications for developing effective antivaping messages, and assist public health professionals in providing more comprehensive prevention and cessation support as it relates to e-cigarette use. The findings also bring forward tangible strategies employed by e-cigarette companies to recruit youth into vaping. Understanding this is vital to the development of cohesive strategies that combat these provaping messages. %M 32663163 %R 10.2196/18943 %U https://www.jmir.org/2020/8/e18943 %U https://doi.org/10.2196/18943 %U http://www.ncbi.nlm.nih.gov/pubmed/32663163 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e12619 %T Effectiveness of Social Media Approaches to Recruiting Young Adult Cigarillo Smokers: Cross-Sectional Study %A Cavallo,David %A Lim,Rock %A Ishler,Karen %A Pagano,Maria %A Perovsek,Rachel %A Albert,Elizabeth %A Koopman Gonzalez,Sarah %A Trapl,Erika %A Flocke,Susan %+ Department of Nutrition, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-4954, United States, 1 216 368 6627, david.cavallo@case.edu %K adolescent, young adult %K tobacco products %K social media %K research subject recruitment %D 2020 %7 22.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The prevalence of social media use among youth and young adults suggests it is an appropriate platform for study recruitment from this population. Previous studies have examined the use of social media for recruitment, but few have compared platforms, and none, to our knowledge, have attempted to recruit cigarillo users. Objective: The purpose of this study was to examine the effectiveness of different social media platforms and advertisement images for recruiting cigarillo users aged 14-28 years to complete a cigarillo use survey. Methods: We obtained objective data for advertisement impressions for a 39-week social media recruitment campaign. Advertisements were targeted to users based on their age, geography, and interests. Effectiveness was defined as the percentage of approved surveys per advertising impression. Chi-square tests were performed to compare the effectiveness of different advertisement images and platforms. Results: Valid survey completers (n=1089) were predominately older (25-28 years old, n=839, 77%). Of the 1089 survey completers, 568 (52%) identified as male, 335 (31%) as African American, and 196 (18%) as Hispanic. Advertisements delivered via Facebook/Instagram were more effective than Twitter; 311/1,027,738 (0.03%) vs 661/2,998,715 (0.02%); χ21=21.45, N=4,026,453); P<.001. Across platforms, ads featuring exclusively an image of cigarillos were more effective (397/682,994, 0.06%) than ads with images of individuals smoking (254/1,308,675, 0.02%), individuals not smoking (239/1,393,134, .02%), and groups not smoking (82/641,650, 0.01%); χ23133.73, N=4,026,453; P<.001. Conclusions: The campaign was effective in recruiting a diverse sample representative of relevant racial/ethnic categories. Advertisements on Facebook were more effective than Twitter. Advertisements that featured an image of a cigarillo were consistently the most effective and should be considered by others recruiting cigarillo users via social media. %M 32459629 %R 10.2196/12619 %U https://www.jmir.org/2020/7/e12619 %U https://doi.org/10.2196/12619 %U http://www.ncbi.nlm.nih.gov/pubmed/32459629 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 1 %P e13031 %T Using Digital Media to Empower Adolescents in Smoking Prevention: Mixed Methods Study %A Park,Eunhee %A Chang,Yu-Ping %+ University at Buffalo, 3435 Main Street, Buffalo, NY, 14214, United States, 1 7168293701, eunheepa@buffalo.edu %K adolescent %K children %K digital media production %K technology %K empowerment %K smoking prevention %D 2020 %7 31.3.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: There is a critical need for effective health education methods for adolescent smoking prevention. The coproduction of antismoking videos shows promising results for adolescent health education. Objective: This study explored the feasibility of a smoking prevention program using the coproduction of antismoking videos in order to empower adolescents in smoking prevention and tobacco control. A smoking prevention program based on coproduction of antismoking videos over eight sessions was implemented in a low-income neighborhood. Methods: A mixed methods design with a concurrent embedded approach was used. In total, 23 adolescents participated in the program. During the prevention program, small groups of participants used video cameras and laptops to produce video clips containing antismoking messages. Quantitative data were analyzed using the Wilcoxon signed-rank test to examine changes in participants’ psychological empowerment levels between pre- and postintervention; qualitative interview data were analyzed using content analysis. Results: Pre- and postcomparison data revealed that participants’ psychological empowerment levels were significantly enhanced for all three domains—intrapersonal, interactional, and behavioral—of psychological empowerment (P<.05). Interviews confirmed that the coproduction of antismoking videos is feasible in empowering participants, by supporting nonsmoking behaviors and providing them with an opportunity to help build a smoke-free community. Conclusions: Both quantitative and qualitative data supported the feasibility of the coproduction of antismoking videos in empowering adolescents in smoking prevention. Coproduction of antismoking videos with adolescents was a beneficial health education method. %M 32229463 %R 10.2196/13031 %U http://pediatrics.jmir.org/2020/1/e13031/ %U https://doi.org/10.2196/13031 %U http://www.ncbi.nlm.nih.gov/pubmed/32229463