Social Media Anti-Vaping Messages to Reduce ENDS Use Among Sexual and Gender Minority Teens

The investigators long-term goal is to reduce tobacco use and tobacco-related health disparities among SGM populations. The objective of Project SMART (Social Media Anti-Vaping Messages to Reduce ENDS Use Among Sexual and Gender Minority Teens) is to evaluate the effectiveness of an sexual gender minority (SGM) -tailored social media intervention to prevent vaping initiation among SGM youth ages 13-20 years. The investigators central hypothesis is that SGM-tailored anti-vaping social media messages will be more effective than existing non-tailored messages to prevent vaping initiation among SGM youth. The scientific premise for this work is based on principles of cultural tailoring in health communication for vulnerable populations, the Health Equity Promotion Model, and the Message Impact Framework. The investigators are developing and evaluating a social media intervention because SGM youth have a high rate of social media use and are more likely to go online for health information than non-SGM youth. Social media, moreover, are increasingly used for health promotion to address health disparities and well-being of SGM populations. The investigators will conduct rapid-cycle feedback with stakeholders including SGM organization leaders to provide input on the message design, testing, and intervention implementation to ensure feasibility and acceptability of the intervention.

Aim 1: Explore salient beliefs and cultural tailoring preferences related to vaping initiation among sexual gender minority (SGM) youth to inform the development of anti-vaping social media messages.

Approach: An elicitation survey among 80 SGM youth and focus group discussions among a subsample of 48-64 youth who complete the elicitation survey will explore beliefs related to vaping initiation that SGM youth find most salient. Participants will include US SGM youth, ages 12-18 years, stratified by age (12-15 or 16-18), vaping status (never vaped and are susceptible or have initiated vaping in the past 1 year), and gender identity (cisgender or transgender/gender expansive). The investigators will further explore the social contexts of their vaping behavior and preferences for cultural tailoring of anti-vaping messages (i.e., peripheral, evidential, linguistic, and sociocultural values tailoring) among SGM youth.

Aim 2: Identify promising anti-vaping social media messages and cultural tailoring strategies to reduce vaping initiation among SGM youth.

Approach: Results from Aim 1 and input from community stakeholders will be utilized to develop SGM-tailored social media anti-vaping messages. An online discrete choice experiment among SGM youth ages 13-18 years (n=600) who have never vaped will be used to test the impact of anti-vaping messages and cultural tailoring strategies on perceived message effectiveness to reduce vaping initiation. Results will guide the construction of culturally tailored anti-vaping social media intervention for broader evaluation in Aim 3.

Aim 3: Evaluate the effectiveness of repeated exposure to SGM-tailored anti-vaping social media messages on subsequent vaping susceptibility among SGM youth.

Approach: The investigators will conduct a prospective 2-group randomized experiment among 1500 SGM youth and young adults ages 13-20 to test the hypothesis that repeated exposure to SGM-tailored anti-vaping social media messages will be associated with reduced vaping susceptibility, defined as the extent to which youth are open to vaping, compared with non-tailored messages.

Eligibility Criteria:
Inclusion Criteria:

* Identify as SGM
* ages 13-20
* not vaped or used other tobacco products in the past 30 days
* have access to a smartphone
* Able to read and speak in English
* willing to receive messages via texting for the study
* susceptible to e-cigarette use at intake (i.e., those do not state "definitely not" to all three susceptibility questions).

Exclusion Criteria:

* Current vapers
* Non-SGM youth