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Prevention curricula rely on audience engagement to effectively communicate their messages. However, to date, measurement of engagement has primarily focused on self-report that is often an indicator of liking or satisfaction. Emerging technologies for intervention delivery hold promise not only for additional engagement indicators but also for dissemination outside of traditional vehicles such as classroom delivery. The present study, grounded in the theory of active involvement (Greene 2013), explores the role of engagement (as measured by self-report, program analytics, and observation) with short-term substance use prevention outcomes such as self-efficacy to counter-argue and descriptive and injunctive norms. The study tracks 4-H youth (N = 310) engaged with a media literacy focused e-learning substance prevention curriculum, REAL media. Results indicate that self-reports of engagement predicted self-efficacy to counter-argue, but a program-analytic indicator of dosage predicted lower injunctive and descriptive norms, all at 3 months. The observational indicator was correlated with self-efficacy to counter-argue but not significant in the predictive models. The implications and directions for future research regarding how engagement is measured in prevention and included in studying program effects are discussed. Clinical trial: NCT03157700, May 2017.
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Alfabetização Digital , Currículo , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Humanos , Autoeficácia , Autorrelato , Transtornos Relacionados ao Uso de Substâncias/prevenção & controleRESUMO
OBJECTIVE: Accurate diagnosis of sport-related concussions relies heavily on truthful self-reporting of symptom severity. Previous studies have emphasized lack of knowledge as a factor in symptom nondisclosure. This study sought to examine concussion knowledge and the relationship of knowledge to reasons for symptom nondisclosure. DESIGN: Cross-sectional study. SETTING: Data were collected during preparticipation athletic evaluations via electronic survey. PARTICIPANTS: One hundred fifty-six incoming National Collegiate Athletic Association Division I student-athletes. MAIN OUTCOME MEASURES: Survey items included previous concussion diagnosis, concussion fact and symptom knowledge, reasons and situational contexts for nondisclosure, and stakeholder attitudes. RESULTS: Participants, on average, had substantial concussion symptom and fact knowledge. Unexpectedly, participants with higher concussion fact knowledge endorsed more reasons that athletes may hide symptoms. Concussion symptom knowledge was unrelated to reasons for nondisclosure. Athletes believed that symptom reporting was less likely in high-stakes versus low-stakes situations and consistently identified their teammates as holding attitudes that support underreporting and athletic trainers as engaging in behaviors that support player safety. CONCLUSIONS: Greater concussion knowledge did not reduce the number of reasons that participants viewed as drivers for concussion nondisclosure. In other words, participants understood why athletes choose to hide symptoms even when they also understood the symptoms, risks, sequelae, and consequences of concussion (and potential harm of nondisclosure). Situational contexts and important stakeholder attitudes also appeared to importantly influence symptom disclosure decisions. A multifaceted approach that goes beyond current educational strategies to addresses situational, social, and athletic pressures may be needed to initiate a widespread cultural shift away from concussion nondisclosure.
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Atletas/psicologia , Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Revelação/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Autorrelato , Adolescente , Estudos Transversais , Feminino , Humanos , Masculino , Motivação , Participação dos Interessados , Inquéritos e QuestionáriosRESUMO
Engagement is central to the effectiveness of online health messages and the related educational programs that aim to deliver these messages to the intended audience (Li, Won, Yang et al. 2019: Lin, Hung, Kinshuk et al. 2019). Drawing from health communication and social learning theories, the Theory of Active Involvement (TAI) (Greene, 2013) posits that an online prevention program's impact depends on how engaged participants are. In practice, measuring engagement in this context has relied primarily on self-report measures (e.g., Hamutoglu, Gemikonakli, Duman et al. 2019). However, the emergence and growth of online learning platforms to deliver health-specific information offers other options for assessing engagement. This includes program analytics that capture interaction with content and facilitate examination of patterns via multiple indicators such as responses to interactive questions and time spent in the program (Herodotou, Rienties, Boroowa, et al. 2019; Li, Wong, Yang et al. 2019; van Leeuwen, 2019). However, little is known about the relationships between these different indicators of engagement as it applies to health curricula. This study uses self-report, observational, and program analytic data collected on a small (N = 38) sample using REAL media, an online substance use prevention program, to examine relationships among various indicators of engagement. Findings suggest a cluster of indicators across the three modalities that provide a useful way of measuring engagement. A cluster centered around complexity suggests a separate factor to be considered when designing engaging interventions.
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Adolescent-produced anti-substance use messaging is an increasingly popular and effective prevention strategy. However, little is known about the content of these messages and the production elements adolescents use to bring that content to life. In this article, we present a content analysis of 95 anti-substance use messages developed by 4-H club members across nine U.S. states as part of their participation in the media literacy program REAL media. Posters and videos were content-analyzed for target substance, prevention goal, message form, message content, persuasion strategies, and production elements. Results of the content analysis revealed that combustible tobacco (smoking) was the most popular target substance in the sample among the choices of alcohol, marijuana, e-cigarettes, and chewing tobacco. More youth developed messages with the goal of preventing substance use, rather than stopping current use. Slogans were used in the majority of messages, and nearly all messages took an informational form, rather than narrative or statistical form. Persuasion strategies covered in the curriculum, including fun with the group, unexpected, style, and endorsement were scantily used. Finally, results showed that production value was high in this sample, reflected by the extensive use of color and variety of fonts and font sizes. Implications for future media literacy interventions and research are discussed.
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Comunicação em Saúde/métodos , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Adolescente , Feminino , Letramento em Saúde , Humanos , Masculino , Meios de Comunicação de Massa , Comunicação Persuasiva , Estados UnidosRESUMO
This study examined race and gender differences in use of specific types of protective behavioral strategies (PBS) and the moderating effects of race and gender on the relationship between PBS use and alcohol problems, controlling for alcohol use, among a large sample of Asian, Black, and White college drinkers. There were significant racial and gender differences in the types of PBS used. Moderation analyses indicated that PBS were more protective for women than men against experiencing alcohol-related problems. There were no significant race effects or race-by-gender interaction effects on alcohol problems. Implementing PBS may be beneficial for all college students.
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Consumo de Álcool na Faculdade/psicologia , Consumo de Bebidas Alcoólicas/epidemiologia , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Estudantes/estatística & dados numéricos , Negro ou Afro-Americano/estatística & dados numéricos , Consumo de Bebidas Alcoólicas/etnologia , Transtornos Relacionados ao Uso de Álcool/etnologia , Transtornos Relacionados ao Uso de Álcool/prevenção & controle , Povo Asiático/estatística & dados numéricos , Feminino , Humanos , Masculino , Fatores Sexuais , Universidades , População BrancaRESUMO
BACKGROUND: For over 2 decades, brief motivational interventions (BMIs) have been implemented on college campuses to reduce heavy drinking and related negative consequences. Such interventions include in-person motivational interviews (MIs), often incorporating personalized feedback (PF), and stand-alone PF interventions delivered via mail, computer, or the Web. Both narrative and meta-analytic reviews using aggregate data from published studies suggest at least short-term efficacy of BMIs, although overall effect sizes have been small. METHODS: This study was an individual participant-level data (IPD) meta-analysis of 17 randomized clinical trials evaluating BMIs. Unlike typical meta-analysis based on summary data, IPD meta-analysis allows for an analysis that correctly accommodates the sampling, sample characteristics, and distributions of the pooled data. In particular, highly skewed distributions with many zeroes are typical for drinking outcomes, but have not been adequately accounted for in existing studies. Data are from Project INTEGRATE, one of the largest IPD meta-analysis projects to date in alcohol intervention research, representing 6,713 individuals each with 2 to 5 repeated measures up to 12 months postbaseline. RESULTS: We used Bayesian multilevel over dispersed Poisson hurdle models to estimate intervention effects on drinks per week and peak drinking, and Gaussian models for alcohol problems. Estimates of overall intervention effects were very small and not statistically significant for any of the outcomes. We further conducted post hoc comparisons of 3 intervention types (individual MI with PF, PF only, and group MI) versus control. There was a small, statistically significant reduction in alcohol problems among participants who received an individual MI with PF. Short-term and long-term results were similar. CONCLUSIONS: This study questions the efficacy and magnitude of effects of BMIs for college drinking prevention and intervention and suggests a need for the development of more effective intervention strategies.
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Consumo de Álcool na Faculdade/psicologia , Entrevista Motivacional , Psicoterapia Breve , Teorema de Bayes , Biorretroalimentação Psicológica , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Personalized feedback interventions (PFIs) to reduce drinking in college students often provide feedback about negative alcohol-related consequences experienced by students to motivate them to drink less. Yet, there is evidence which suggests that not everyone perceives consequences as negative and raises questions regarding the utility of consequence-specific feedback for some individuals. The purpose of the current study was to extend this research to examine salience of consequences among both college and non-college emerging adults, differences in ratings by sex, age, and frequency of experiencing consequences, and the relationship between salience measured in emerging adulthood and drinking patterns in young adulthood. Data were from an accelerated cohort study of males and females (N = 1,308), who were either age 18, 21, or 24 years at the time of consequence evaluation and followed-up 7 years later. Most experienced consequences were rated as at least a little bothersome. Regression analyses indicated that females, older participants, and those who experienced a consequence more often evaluated consequences as more bothersome but there were no differences by college status. Mean ratings of bother did not predict quitting drinking or alcohol problems 7 years later, whereas the number of consequences experienced did. Overall, the results suggest that most consequences are rated similarly by emerging adults regardless of college attendance but that feedback on consequences may be more salient for females and older emerging adults. PFIs may need to differ in the types of feedback they provide depending on demographic characteristics and baseline level of alcohol problems.
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Consumo de Bebidas Alcoólicas/efeitos adversos , Adolescente , Adulto , Feminino , Humanos , Masculino , Adulto JovemRESUMO
Excessive alcohol consumption represents a significant concern on U.S. college campuses, and there is a need to identify students who may be at risk for engaging in risky alcohol use. The current study examined how variables measured prior to college matriculation, specifically alcohol-related decision-making variables drawn from the Theory of Reasoned Action (i.e., alcohol expectancies, attitudes, and normative beliefs), were associated with patterns of alcohol use prior to and throughout the first semesters of college. Participants were 392 undergraduate students (56% female) from a large Northeastern U.S. university. Decision-making variables were assessed prior to college matriculation, and alcohol use was measured with five assessments before and throughout freshman and sophomore semesters. Latent profile analysis was used to identify types of students with distinct patterns of decision-making variables. These decision-making profiles were subsequently linked to distinct patterns of alcohol use using latent transition analysis. Four distinct decision-making profiles were found and were labeled "Anti-Drinking," "Unfavorable," "Mixed," and "Risky." Five drinking patterns were observed and included participants who reported consistently low, moderate, or high rates of alcohol use. Two patterns described low or non-drinking at the pre-college baseline with drinking escalation during the measurement period. Students' likelihood of following the various drinking patterns varied according to their decision-making. Findings suggest the early identification of at-risk students may be improved by assessing decision-making variables in addition to alcohol use. The findings also have implications for the design of early identification assessments to identify at-risk college students and for the targeting of alcohol prevention efforts to students based on their alcohol-related attitudes and beliefs.
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Consumo de Bebidas Alcoólicas/prevenção & controle , Tomada de Decisões , Universidades , Adolescente , Comportamento do Adolescente , Consumo de Bebidas Alcoólicas/epidemiologia , Feminino , Humanos , Masculino , Medição de Risco , Fatores de Risco , Inquéritos e Questionários , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: College students who play drinking games (DGs) more frequently report higher levels of alcohol use and experience more alcohol-related harm. However, the extent to which they are at risk for increased consumption and harm as a result of DG play on a given event after accounting for their typical DG participation, and typical and event drinking, is unclear. OBJECTIVES: We examined whether first-year students consumed more alcohol and were more likely to experience consequences on drinking occasions when they played DGs. METHODS: Participants (n = 336) completed up to six web-based surveys following weekend drinking events in their first semester. Alcohol use, DG play, and consequences were reported for the Friday and Saturday prior to each survey. Typical DG tendencies were controlled in all models. Typical and event alcohol use were controlled in models predicting risk for consequences. RESULTS: Participants consumed more alcohol on DG versus non-DG events. All students were more likely to experience blackout drinking consequences when they played DGs. Women were more likely to experience social-interpersonal consequences when they played DGs. CONCLUSION: DG play is an event-specific risk factor for increased alcohol use among first-year students, regardless of individual DG play tendencies. Further, event DG play signals increased risk for blackout drinking consequences for all students, and social-interpersonal consequences for women, aside from the amount of alcohol consumed on those occasions as well as typical drinking behaviors. Prevention efforts to reduce high-risk drinking may be strengthened by highlighting both event- and person-specific risks of DG play.
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Consumo de Bebidas Alcoólicas/psicologia , Transtornos Relacionados ao Uso de Álcool/psicologia , Jogos e Brinquedos/psicologia , Estudantes/psicologia , Universidades , Adolescente , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Modelos Psicológicos , Fatores de Risco , Fatores Sexuais , Estudantes/estatística & dados numéricos , Adulto JovemRESUMO
Combining alcohol and energy drinks (e.g., Red Bull and vodka) is a significant problem on college campuses. To date, few studies have examined psychosocial constructs specific to alcohol-energy drink cocktail (AmED) consumption that could be amenable to change via prevention efforts targeting this population. The aim of the current study was to examine differences in AmED-specific attitudes, beliefs, normative perceptions among students who report AmED use compared to college student drinkers who consume alcohol only. In addition, these two groups were compared on their intentions to consume AmEDs, actual AmED use, and other drinking outcomes using a longitudinal design. Participants (N = 386, 59% female) completed a web-based survey in the spring of their first year of college and fall of their second year assessing alcohol-energy drink cocktail use, psychosocial decision-making constructs, heavy drinking, and alcohol-related consequences. Findings revealed that combiners of alcohol and energy drinks had more positive attitudes and beliefs about AmED use, higher perceived peer norms, and stronger intentions toward future use. Accordingly, at Time 2, this group reported significantly higher AmED use, along with high-risk drinking and related consequences. The findings reinforce that AmED use is associated with risky drinking practices, and suggest potential targets for change for future prevention efforts.
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This study is a formative assessment of REAL Parenting (RP): a brief, digital intervention for parents of high school students that encourages parent-teen communication about alcohol and, in turn, aims to prevent teen alcohol use. The aims of this study were to describe engagement with, and acceptability and usability of RP; and to explore the relationship of these measures with each other and with short-term outcomes. Participants were 160 parents randomly assigned to the treatment group who received RP as part of a randomized pilot trial (Mage = 45.43[SD = 7.26], 59.3% female, 56% White, 19% Hispanic). App-based program analytics captured real-time engagement with RP. Parents completed self-report measures of acceptability, usability, perceived communication effectiveness, perceived self-efficacy to communicate, and frequency of communication post-intervention. Descriptive statistics were calculated to describe engagement, acceptability and usability, and zero-order correlations were calculated to examine associations between these and self-report variables. About 75% (n = 118) of parents accessed the intervention and two-thirds (n = 110) accessed at least one module. Self-report ratings of acceptability and usability were neutral to positive, and mothers liked RP more than fathers. Self-report, but not program analytic indicators were associated with short-term outcomes. Findings suggest that, with little incentive, most parents will access an app focused on parent-teen communication about alcohol. While parent feedback was positive, it also highlighted areas for improvement with app content and design. Correlations suggest that analytic metrics of engagement are useful to discern who is and is not using interventions, and self-report measures are important for understanding pathways by which interventions are associated with short-term outcomes.
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Consumo de Bebidas Alcoólicas , Poder Familiar , Adolescente , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Consumo de Bebidas Alcoólicas/prevenção & controle , Estudantes , Autorrelato , ComunicaçãoRESUMO
BACKGROUND: Underage drinking and related risky sexual behavior (RSB) are major public health concerns on United States college campuses. Although technology-delivered personalized feedback interventions (PFIs) are considered a best practice for individual-level campus alcohol prevention, there is room for improving the effectiveness of this approach with regard to alcohol-related RSB. OBJECTIVE: The aims of this study are to (1) evaluate the impact of a brief PFI that integrates content on alcohol use and RSB and is adapted to include a novel cross-tailored dynamic feedback (CDF) component for at-risk first-year college students and (2) identify implementation factors critical to the CDF's success to facilitate future scale-up in campus settings. METHODS: This study uses a hybrid type 1 effectiveness-implementation design and will be conducted in 3 phases. Phase 1 is a stakeholder-engaged PFI+CDF adaptation guided by focus groups and usability testing. In phase 2, 600 first-year college students who drink and are sexually active will be recruited from 2 sites (n=300 per site) to participate in a 4-group randomized controlled trial to examine the effectiveness of PFI+CDF in reducing alcohol-related RSB. Eligible participants will complete a baseline survey during the first week of the semester and follow-up surveys at 1, 2, 3, 6, and 13 months post baseline. Phase 3 is a qualitative evaluation with stakeholders to better understand relevant implementation factors. RESULTS: Recruitment and enrollment for phase 1 began in January 2022. Recruitment for phases 2 and 3 is planned for the summer of 2023 and 2024, respectively. Upon collection of data, the effectiveness of PFI+CDF will be examined, and factors critical to implementation will be evaluated. CONCLUSIONS: This hybrid type 1 trial is designed to impact the field by testing an innovative adaptation that extends evidence-based alcohol programs to reduce alcohol-related RSB and provides insights related to implementation to bridge the gap between research and practice at the university level. TRIAL REGISTRATION: ClinicalTrials.gov NCT05011903; https://clinicaltrials.gov/ct2/show/NCT05011903. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/43986.
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Objective: To examine race, gender, and alcohol use level as moderators of the association between protective behavioral strategies (PBS) and alcohol-related problems. Participants: A sample of 12,011 participants who reported recent drinking (87.7% White, 61% Women) from Project INTEGRATE, a study that combined individual participant data (IPD) from 24 brief motivational intervention trials for college students. Methods: Hierarchical regressions were conducted to determine whether there was a moderated effect of PBS on alcohol problems across alcohol use levels, and whether the moderated protective effect of PBS by alcohol use differed by gender and race. Results: The protective association between PBS and alcohol-related problems was greater for those who drank less. This moderated effect did not differ across men and women or across racial groups. Conclusions: College drinking prevention programs should ensure that students are aware of the limits of PBS as a mitigator of alcohol problems.
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Consumo de Álcool na Faculdade , Transtornos Relacionados ao Uso de Álcool , Consumo de Bebidas Alcoólicas/prevenção & controle , Feminino , Humanos , Masculino , Estudantes , UniversidadesRESUMO
Frequent indoor tanning bed use is an established public health concern, yet research on tanning cessation interventions for frequent tanners is lacking. We describe the protocol for a brief, web-based tanning behavior change intervention and present evidence that it is acceptable and engaging to frequent indoor tanners. Lower tanning rates were not observed among participants receiving the intervention in a randomized controlled trial but participants' interest in changing tanning increased. This intervention could be a useful approach to increasing frequent tanners' interest in behavior change and openness to engaging within a more intensive, multi-component tanning cessation program.Trial Registration: NCT03448224 Clinical Trials.gov (https://clinicaltrials.gov/ct2/show/NCT03448224?cond=NCT03448224&draw=2&rank=1).
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Banho de Sol , Retroalimentação , Comportamentos Relacionados com a Saúde , Humanos , InternetRESUMO
The study examined parent profiles among high school athletes transitioning to college and their association with high-risk drinking in a multi-site, randomized trial. Students (n = 587) were randomized to a control or combined parent-based and brief motivational intervention condition and completed measures at baseline and at 5- and 10-month follow-ups. Four parent profiles (authoritative, authoritarian, permissive, indifferent) were observed among participants. Findings indicated control participants with authoritarian parenting were at the greatest risk for heavy drinking. Alternately, students exposed to permissive or authoritarian parenting reported lower peak drinking when administered the combined intervention, compared to controls. Findings suggest the combined intervention was efficacious in reducing peak alcohol consumption among high-risk students based on athlete status and parenting profiles.
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BACKGROUND: The current study tested age of onset as a moderator of intervention efficacy on drinking and consequence outcomes among a high-risk population of college students (i.e., former high school athletes). METHODS: Students were randomized to one of four conditions: assessment only control, combined parent-based intervention (PBI) and brief motivational intervention (BMI), PBI alone, and BMI alone. Participants (n = 1,275) completed web-administered measures at baseline (summer before starting college) and 10-month follow-up. RESULTS: Overall, the combined intervention demonstrated the strongest and most consistent reductions across all outcomes, particularly with the youngest initiators. Participants who initiated drinking at the youngest ages had significantly lower peak drinking, typical weekly drinking, and reported consequences at follow-up when they received the combined intervention when compared to the control group. The BMI and PBI groups, when examined independently, demonstrated significant effects across outcomes but were inconsistent across the different age groups. CONCLUSION: Results suggest the combination of a PBI and a peer-delivered BMI is an appropriate and efficacious way to reduce drinking and related consequences among individuals who initiated drinking earlier in adolescence and are at an increased risk of experiencing alcohol problems.
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Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/psicologia , Motivação , Relações Pais-Filho , Estudantes/psicologia , Universidades , Adolescente , Fatores Etários , Idade de Início , Consumo de Bebidas Alcoólicas/terapia , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Transtornos Relacionados ao Uso de Álcool/psicologia , Transtornos Relacionados ao Uso de Álcool/terapia , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Resultado do TratamentoRESUMO
Research indicates that for many students excessive drinking in college is a continuation of high school drinking tendencies. However, there have been limited theory-driven, systematic interventions targeting students so as to prevent alcohol misuse in their transition to college. Almost all current prevention approaches tend to be focused on younger populations and college-drinking interventions are typically delivered to students when they are already on campus. These analyses draw from a novel program of research involving parents of college freshmen based on the work of Turrisi et al. [Turrisi et al. [2001] Psychology of Addictive Behaviors, 15(4), 366-372; Turrisi, et al. [2009] Journal of Applied Social Psychology, 7, 315-326] and focuses on examining: (1) the relationship between parenting and student drinking tendencies during the transitional period between high school and college and into the first year of college, and (2) the mediation process by which sustained parenting throughout the first year is related to college-drinking outcomes and consequences so as to inform future intervention efforts. The empirical evidence from this study suggests that sustained parental efforts have a beneficial effect on reducing high-risk drinking and preventing harm even at this late stage of late adolescent/early adult development.
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Consumo de Bebidas Alcoólicas/prevenção & controle , Consumo de Bebidas Alcoólicas/psicologia , Poder Familiar/psicologia , Estudantes/psicologia , Adolescente , Humanos , Relações Pais-Filho , Universidades , Adulto JovemRESUMO
BACKGROUND: The primary aim of this study was to evaluate the short-term effects of testing an e-learning program to reduce adolescent substance use and abuse. Early initiation of substance use is linked to a variety of negative outcomes, thus effective intervention programs are needed. One approach is to use media literacy to capitalize on adolescents' immersion with media in a variety of forms. We developed, implemented, and tested an engaging substance use prevention program by collaborating with a youth-oriented community partner (4-H). METHODS: 639 middle adolescents from nine U.S. states participated in an RCT of REAL media. Participants completed a series of online surveys and were randomized to use an online substance prevention program (REAL media) or serve as control (delayed program use). Self-report surveys were administered at three points in time. This short-term evaluation uses data from the pretest (Time 1) and short-term posttest three-month surveys, which measured demographics, self-efficacy to counterargue, and injunctive and descriptive substance use norms. RESULTS: Participants who completed the REAL media program reported increased self-efficacy to counterargue and decreased positive injunctive norms compared to control participants who did not complete the program. No significant differences were observed for descriptive norms. CONCLUSIONS: We found support for the REAL media program in changing key predictors of youth substance use demonstrating (1) the efficacy of media literacy interventions targeting adolescents and (2) that e-learning substance use prevention efforts can be adapted for and implemented through community organizations.
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Instrução por Computador , Promoção da Saúde , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Adolescente , Comportamento do Adolescente , Currículo , Feminino , Humanos , Alfabetização , Masculino , Autoeficácia , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Certain types of smokeless tobacco (SLT) products, particularly snus, carry fewer health risks than cigarette smoking and might be able to serve as harm-reduction products for smokers. However, studies frequently find that smokers misperceive SLT and snus to be as or more harmful than smoking. This perception is often measured with a single general harm question, and research on underlying risk perceptions is limited. METHODS: Using a sample of 256 current smokers, we utilized Latent Profile Analysis to examine response profiles to items that assessed perceived risk of specific health outcomes (lung cancer, heart disease, oral cancer) from snus relative to cigarettes, along with the typical single item measure of overall harm from snus compared to cigarettes. RESULTS: Three smoker response profiles emerged. Almost half (44.9%) of smokers perceived snus to be as or more risky than cigarettes for all three specific health outcomes (group 1), while over one third (38.3%) had an elevated perceived risk for oral cancer only (group 2). About 17% of smokers perceived snus to have lower risks for lung cancer only (group 3). Across each profile, perceived risk was highest for oral cancer. CONCLUSIONS: If smokers are to consider snus for harm-reduction, efforts may be needed to better inform smokers about their lower relative risks, including for particular health outcomes of interest. This study also suggests that smokers may vary in their level of need for information to correct their relative risk misperceptions.
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Fumar Cigarros , Conhecimentos, Atitudes e Prática em Saúde , Fumantes , Produtos do Tabaco , Tabaco sem Fumaça , Adulto , Idoso , Feminino , Redução do Dano , Cardiopatias , Humanos , Análise de Classes Latentes , Neoplasias Pulmonares , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais , Percepção , Risco , Comportamento de Redução do Risco , Adulto JovemRESUMO
BACKGROUND: There is a need for evidence-based substance use prevention efforts that target high school-aged youth that are easy to implement and suitable for dissemination in school and community groups. The Youth Message Development (YMD) program is a brief, four-lesson, in-person curriculum that aims to prevent youth substance use through the development of youth media literacy. Specifically, YMD aims to increase understanding of advertising reach and costs, along with the techniques used to sell products; develop counterarguing and critical thinking skills in response to advertisements; and facilitate application of these skills to the development of youth-generated antisubstance messages. Although YMD has demonstrated evidence of success, it is limited by its delivery method and focus on alcohol and smoking. OBJECTIVE: Study objectives were two-fold: (1) to adapt the YMD curriculum to a self-paced, interactive, electronic-learning (e-learning) format and expand its content to cover alcohol, combustible cigarettes, e-cigarettes, smokeless tobacco, marijuana, and prescription drugs, and (2) to test the feasibility of the adapted curriculum in partnership with a national youth organization. METHODS: An iterative process was employed in partnership with the 4-H youth development organization and a technology developer and consisted of six phases: (1) focus groups to guide adaptation, (2) adaptation to an e-learning format renamed REAL media, (3) pilot-testing of the REAL media prototype to determine feasibility and acceptability, (4) program revisions, (5) usability testing of the revised prototype, and (6) final revisions. Focus groups and pilot and usability testing were conducted with 4-H youth club members and adult club leaders. RESULTS: Focus group feedback guided the build of an e-learning prototype of REAL media, which consisted of five online levels and interactive content guided by a mix of narration and on-screen text. Results of a pilot test of the prototype were neutral to positive, and the program was refined based on end-user feedback. An independent usability test indicated that youth 4-H members felt favorably about navigating REAL media, and they reported high self-efficacy in applying skills learned in the program. Additional refinements to the program were made based on their feedback. CONCLUSIONS: The iterative build process involving the end user from the outset yielded an overall successful technology-driven adaptation of an evidence-based curriculum. This should increase the likelihood of effectively impacting behavioral outcomes as well as uptake within community organizations.