Screening and Retaining Adolescents Recruited Through Social Media: Secondary Analysis from a Longitudinal Clinical Trial.

BACKGROUND: Social media has become a popular method to recruit participants, particularly for studies with hard-to-reach populations. These studies still face challenges in data quality and, for longitudinal studies, sample retention. However, in addition to aiding in recruitment, social media platforms can help researchers with participant verification and tracking procedures during the study. There is limited previous research describing how longitudinal studies can use social media to screen and retain participants. OBJECTIVE: This paper describes strategies implemented to screen and retain a nationwide sample of sexual minority youth who were recruited through social media platforms for a longitudinal study testing a drug abuse prevention program. METHODS: Our screening strategies for participants included collecting necessary demographic information (name, phone, email, and social media accounts), verifying this information using publicly available web-based records, and sending confirmation emails to ensure working email addresses and correct dates of birth. Retention strategies included communications designed to develop positive participant relationships, incentives for survey completion, regular updating of participant contact information, targeting hard-to-reach participants, and using social media as an alternative means of contacting participants. RESULTS: During enrollment, although the only demographic data required were a phone number and an email address, 87.58% (1065/1216) of participants provided their Instagram as an alternative means of contact. This form of alternative communication remains the most preferred with 87.40% (1047/1198) of participants continuing to provide an Instagram username as of January 2023, about 3 years after recruitment began. In comparison, other alternative means of contact (eg, Facebook and alternative email) were provided by only 6.43% (77/1198) to 56.18% (673/1198) of participants. Direct messaging on Instagram was used to successfully confirm participant identity, remind participants to take annual follow-up surveys, and update lost participant contact information. Screening and retention strategies used in the study have helped achieve 96.30% (1171/1216) to 96.79% (1177/1216) sample retention across 3 waves of data collection. CONCLUSIONS: Though social media can be a helpful tool to recruit participants, attrition and participant authenticity difficulties may be associated with this method. Screening and retention strategies can be implemented to improve retention. Internet searches are effective for screening youth to ensure they meet eligibility requirements. Additionally, social media-Instagram in this study-can help to track and locate participants who do not respond to traditional contact methods. TRIAL REGISTRATION: ClinicalTrials.gov NCT03954535; https://clinicaltrials.gov/study/NCT03954535.

Longitudinal Outcomes of a Smartphone Application to Prevent Drug Use Among Hispanic Youth.

OBJECTIVE: This trial tested the efficacy of a smartphone application (app) designed to prevent drug use among Hispanic youth. METHOD: Participants were recruited through online advertising and youth service agencies. The baseline sample (N = 644) had a mean age of 14.1 years, was primarily female (60%), and resided in 31 U.S. states and Puerto Rico. Youth assented to study participation and received parental permission to participate. Youth were randomly assigned to an intervention arm or a measurement-only control arm. Intervention-arm youth completed 10 prevention program sessions via a smartphone app. Following intervention delivery, all youth completed posttest and 1-, 2-, and 3-year follow-up measures. RESULTS: Analyzed within an Arm by Time interaction model, follow-up data showed that compared with control-arm youth, intervention-arm youth reported (a) less increase in alcohol use from baseline to 2-year follow-up; (b) less increase in marijuana use from baseline to 2- and 3-year follow-ups; and (c) less increase in polydrug use from baseline to 1-, 2-, and 3-year follow-ups. Compared with youth in the control arm, intervention-arm youth reported (a) less depressed mood and improved skills for refusing offers of alcohol and tobacco at posttest; (b) higher self-efficacy and social self-efficacy at 1-, 2-, and 3-year follow-ups; (c) improved skills for refusing offers of marijuana at 2- and 3-year follow-ups; (d) higher media literacy at 2- and 3-year follow-ups; and (e) better coping skills at 3-year follow-up. CONCLUSIONS: These longitudinal findings suggest that Hispanic youth can profit from tailored, skills-based content delivered via a smartphone app to prevent drug use.

Two- and three-year follow-up from a gender-specific, web-based drug abuse prevention program for adolescent girls.

INTRODUCTION: Rates of drug use among early adolescent girls meet or exceed rates of their male counterparts. Girls are also vulnerable to differential risk factors for drug use. Yet, expressly designed prevention programs targeting this population are absent. The present study reports 2- and 3-year findings on a web-based drug abuse prevention program for adolescent girls. METHODS: A sample of adolescent girls (N = 788) were recruited via Facebook. Online, all girls completed pretests; girls were randomly assigned to a 9-session intervention arm or to a measurement-only control arm and all girls completed posttests. All girls also completed 1-, 2-, and 3-year follow-up measurements. RESULTS: At 2-year follow-up and compared to girls in the control arm, intervention-arm girls reported less past-month cigarette, marijuana, and "other" drug use (club drugs, cocaine, ecstasy, hallucinogens, heroin, inhalants, methamphetamines, steroids, prescription drugs), lower rates of peer drug use, and increased scores on drug refusal skills, coping skills, self-esteem, media literacy, and self-efficacy. At 3-year follow-up, and compared to girls in the control arm, intervention-arm girls reported less past-month cigarette and e-cigarette use, lower rates of peer drug use, lower reported anxiety and stress, and increased scores on drug refusal skills, self-esteem, media literacy, self-efficacy, and body image. CONCLUSIONS: Longitudinal outcome data lend support to the efficacy of a gender-specific, web-based drug abuse prevention program to reduce adolescent girls' drug use rates and associated risk factors.

An Online Drug Abuse Prevention Program for Adolescent Girls: Posttest and 1-Year Outcomes.

Early adolescent girls' rates of drug use have matched, and in some instances, surpassed boys' rates. Though girls and boys share risk factors for drug use, girls also have gender-specific risks. Tailored interventions to prevent girls' drug use are warranted. This study developed and tested a web-based, drug abuse prevention program for adolescent girls. The nationwide sample of 13- and 14-year-old girls (N = 788) was recruited via Facebook ads. Enrolled girls were randomly assigned to the intervention or control condition. All girls completed pretest measures online. Following pretest, intervention girls interacted with the 9-session, gender-specific prevention program online. The program aimed to reduce girls' drug use and associated risk factors by improving their cognitive and behavioral skills around such areas as coping with stress, managing mood, maintaining a healthy body image, and refusing drug use offers. Girls in both conditions again completed measures at posttest and 1-year follow-up. At posttest, and compared to girls in the control condition, girls who received the intervention smoked fewer cigarettes and reported higher self-esteem, goal setting, media literacy, and self-efficacy. At 1-year follow-up, and compared to girls in the control condition, girls who received the intervention reported engaging in less binge drinking and cigarette smoking; girls assigned to the intervention condition also had higher alcohol, cigarette, and marijuana refusal skills, coping skills, and media literacy and lower rates of peer drug use. This study's findings support the use of tailored, online drug abuse prevention programming for early adolescent girls.

Is the Legalization of Marijuana Associated With Its Use by Adolescents?

BACKGROUND: Growing moves in the U.S. toward relaxed laws surrounding adult use of marijuana raise concerns about concurrent increases in adolescent use of marijuana. OBJECTIVES: This study collected and analyzed primary data on the relationship between marijuana legalization status in U.S. states and adolescents' marijuana use. METHODS: Recruited through social networking sites and youth-services community agencies, a sample of 1,310 adolescents from 48 U.S. states and the District of Columbia reported their use of marijuana. Youths' use rates were compared with the marijuana legalization status of youths' states of residence. RESULTS: Study findings failed to show a relationship between adolescents' use of marijuana and state laws regarding marijuana use. Relationships were found for increased marijuana use by older youths, females, and non-Hispanic youths. Youths whose parents completed 2 or more years of college were less likely to report marijuana use than those whose parents completed fewer than 2 years of college. CONCLUSIONS: Albeit study findings do not support predictions of growing marijuana use by adolescents in states with liberalized adult use laws, further monitoring of adolescents' use with larger and more representative samples is needed.

Using Facebook ads with traditional paper mailings to recruit adolescent girls for a clinical trial.

INTRODUCTION: Clinical trials require sufficient samples recruited within limited time and budget constraints. Trials with minors are additionally burdened by the requirement for youth assent and parental permission. This paper details the use of Facebook ads and traditional paper mailings to enroll 797 adolescent girls for a longitudinal, web-based, drug abuse prevention trial. Data on sample representativeness and retention are also provided. METHODS: Facebook ads appeared on the pages of females aged 13 or 14years who reside in the U.S. Ads linked girls to a recruitment website. Girls who wanted more information submitted contact information and were mailed information packets to their homes containing, among other things, youth assent and parent permission forms. Returned forms were verified for accuracy and validity. RESULTS: The Facebook ad campaign reached 2,267,848 girls and had a unique click-through rate of 3.0%. The campaign cost $41,202.37 with an average cost of $51.70 per enrolled girl. Information packets were mailed to 1,873 girls. Approximately one-half of girls returned the forms, and 797 girls were enrolled. The Facebook campaign's success varied by ad type, month, and day of the week. Baseline data revealed comparability to national data on demographic and substance use variables. CONCLUSIONS: Results suggest that Facebook ads provide a useful initial point of access to unparalleled numbers of adolescents. Clinical trials may benefit from a two-fold recruitment strategy that uses online ads to attract interested adolescents followed by traditional recruitment methods to communicate detailed information to adolescents and parents.

Computer-Based Prevention and Intervention to Reduce Substance Use in Youth.

PURPOSE OF REVIEW: Computer-based programs for substance use prevention and intervention among youth are on the ascendancy. Whether delivered by computer per se or by electronic tablet or smartphone, technology-driven programs are harmonious with how young people access information and interact with their worlds. This review examines recent evidence on computer-based programs aimed at substance use among youth, with particular attention to results from randomized trials. RECENT FINDINGS: Outcome studies of computer-based, substance use-related programs published over the past 5 years reveal mixed results amidst diverse intervention approaches and delivery settings. Many studies are marred by high attrition. Notable in the recent literature is the international nature of technology-driven substance use prevention and intervention programs. With some exceptions, most programs appear to not have been customized for their recipient populations. Though few in number, the highest-quality studies of computer-based programs show positive outcomes in reduced substance use rates. SUMMARY: Based on recent findings, considerable work needs to happen before computer-delivered approaches are a proven means for reducing substance use among youth. Original programs, expressly developed for subgroups of youth, are in short supply. Though controlled designs are becoming commonplace, too many studies of computer-based programs suffer from flaws-including high rates of attrition-that limit the discovery of positive outcomes.

Risk and protective factors associated with adolescent girls' substance use: Data from a nationwide Facebook sample.

BACKGROUND: Despite overall reductions in teenage substance use, adolescent girls' rates of substance use remain unacceptably high. This article examines whether girls' substance use is associated with general risk and protective factors (goal setting, problem solving, refusal skills, peer use, and self-efficacy) and gender-specific risk and protective factors (communication style, coping skills, self-esteem, body image, perceived stress, anxiety, and depression). METHODS: Cross-sectional data were collected in 2013 via online surveys from a nationwide sample of adolescent girls (N = 788), aged 13 and 14 years, who were recruited through Facebook. RESULTS: In multivariate analyses, controlling for correlates of adolescent substance use, 11 of the 13 general and gender-specific risk and protective factors were consistently associated with past-month alcohol, cigarette, and other drug use in the expected direction; past-month marijuana use was associated with 8 of the 13 factors. Refusal skills, peer use, coping, and depressive mood were most consistently and strongly associated with substance use. CONCLUSIONS: Substance abuse prevention programs targeting adolescent girls should focus on such general risk and protective factors as problem solving, refusal skills, peer influences, and self-efficacy, as well as such gender-specific risk and protective factors as communication style, coping, self-esteem, body image, perceived stress, and mood management.

Drug abuse risk and protective factors among Hispanic adolescents.

Drug use is a disquieting problem among the growing population of U.S. Hispanic adolescents. This study examined risk and protective factors associated with drug use in a sample of 507 Hispanic adolescents. Data were collected in 2014 and 2015 from youths across the United States. The sample had a mean age of 14.1 years and was 37.3% male. Youths responded to an online questionnaire about their drug use and risk and protective factors associated with drug use. Negative self-image, higher levels of stress, weaker coping skills, peer drug use, lower levels of self-control, goal-setting, problem-solving skills, and self-efficacy, and higher intentions to use drugs in the future were associated with increased odds of past-month drug use. Youths with higher self-images who spoke mostly English at home were less likely to use drugs than youths with higher self-images who spoke mostly Spanish at home.Study results have implications for gaining a better understanding of drug use risk and protective factors among America's growing population of Hispanic adolescents. Efforts to better examine and enhance Hispanic youths' cognitive-behavioral skills seem a wise investment.

Developing a Web-Based Intervention to Prevent Drug Use among Adolescent Girls.

OBJECTIVES: Girls' rates of drug use have met up with, and in some instances, surpassed boys' use. Though girls and boys share risk and protective factors associated with drug use, girls also have gender-specific risks. Interventions to prevent girls' drug use must be tailored to address the dynamics of female adolescence. METHODS: One such intervention, called RealTeen, is a 9-session, web-based drug abuse prevention program designed to address such gender-specific risk factors associated with young girls' drug use as depressed mood, low self-esteem, and high levels of perceived stress as well as general drug use risk factors of peer and social influences. Web-based delivery enables girls to interact with the program at their own pace and in a location of their choosing. IMPLICATIONS: This paper describes the processes and challenges associated with developing and programming a gender-specific, web-based intervention to prevent drug use among adolescent girls.

Preventing Drug Abuse Among Hispanic Adolescents: Developing a Responsive Intervention Approach.

Intervention research is essential to help Hispanic American adolescents avoid drug use. This article describes an intervention research program aimed at preventing drug use among these youths. Grounded in salient epidemiological data, the program is informed by bicultural competence, social learning, and motivational interviewing theories. The program, called Vamos, is aimed at the risk and protective factors as well as the cultural prerogatives that demark the adolescent years of Hispanic American youths. Innovative in its approach, the program is delivered through a smartphone application (app). By interacting with engaging content presented via the app, youths can acquire the cognitive-behavioral skills necessary to avoid risky situations, urges, and pressures associated with early drug use. The intervention development process is presented in detail, and an evaluation plan to determine the program's efficacy is outlined. Lessons for practice and intervention programming are discussed.

Preventing drug use among sexual-minority youths: findings from a tailored, web-based intervention.

PURPOSE: Rates of drug use among sexual-minority youths are disproportionately high. Yet, expressly designed prevention programs targeting this population are absent. This study developed and tested a web-based drug abuse prevention program for sexual-minority youths. METHODS: A sample (N = 236) of sexual-minority youths was recruited via Facebook. Online, all youths completed pretests; youths randomly assigned to the intervention received a 3-session prevention program; and all youths completed posttest and 3-month follow-up measurements. RESULTS: At 3-month follow-up and compared to youths in the control arm, intervention-arm youths reported less stress, reduced peer drug use, lower rates of past 30-day other drug use, and higher coping, problem solving, and drug-use refusal skills. CONCLUSIONS: Outcome data suggest the potential of tailored intervention content to address sexual-minority youths' drug use rates and related risk factors. Moreover, study procedures lend support to the feasibility of using the Internet to recruit sexual-minority youths, collect data, and deliver intervention.

Alcohol Use and Related Behaviors among Late Adolescent Urban Youth: Peer and Parent Influences.

Peer and parent influences on alcohol use and related risky behaviors were examined in a sample of late adolescent (M = 17.3 years; SD = 1.11 years) urban youth. Participants (N = 400) completed an online measure assessing peer influences of alcohol use and alcohol offers, and parent influences of rules against alcohol use and perceived levels of emotional family support, relative to youths' alcohol use, binge drinking, alcohol-related consequences, and intentions to drink. Hierarchical regression analyses revealed that increased peer alcohol use and alcohol offers were associated with youths' increased drinking, binge drinking, alcohol-related consequences, and intentions to drink. Controlling for peer influences, parental rules against alcohol use were associated with decreased drinking, binge drinking, and intentions to drink; increased levels of family support was associated with decreased alcohol-related consequences and intentions to drink. These findings suggest that parental influences, albeit small relative to peer influences, are associated with fewer instances of monthly alcohol use and related risky behaviors among late adolescent urban youth.

A web-based, health promotion program for adolescent girls and their mothers who reside in public housing.

This study tested a brief web-based, family-involvement health promotion program aimed at drug use, physical activity, and nutrition for adolescent girls, aged 10 to 12 years, who reside in public housing. Separately, girls (n=67) and their mothers (n=67) completed baseline measures online. Following baseline, 36 randomly assigned mother-daughter dyads jointly completed a 3-session, health promotion program online. Subsequently, all girls and mothers separately completed posttest and 5-month follow-up measures. Attrition at posttest and 5-month follow-up measures was 3% and 9%, respectively. At posttest, intervention-arm girls, relative to control-arm girls, reported greater mother-daughter communication and parental monitoring. Intervention-arm mothers reported greater mother-daughter communication and closeness as well as increased vegetable intake and physical activity. At 5-month follow-up, intervention-arm girls and mothers, relative to those in the control arm, reported greater levels of parental monitoring. Intervention-arm girls also reported greater mother-daughter communication and closeness, reduced stress, greater refusal skills, and increased fruit intake. Findings indicate the potential of a brief, web-based program to improve the health of low-income girls and their mothers.

Preventing alcohol use among late adolescent urban youth: 6-year results from a computer-based intervention.

OBJECTIVE: This study was undertaken to evaluate the efficacy of a skills-based CD-ROM intervention, with and without a parent component, to reduce alcohol use among urban youth at 6-year follow-up. METHOD: At recruitment, 513 youths with a mean age of 10.8 years were randomly assigned to one of three study arms: youth CD-ROM intervention plus parent component, youth CD-ROM intervention only, or control. All youths completed pretest, posttest, and annual follow-up measures. Youths and parents in their respective arms received the initial intervention program between pretest and posttest measures and received booster interventions between each follow-up measure. RESULTS: With 80% sample retention at 6-year follow-up, youths in both intervention arms reported less past-month alcohol and cigarette use and fewer instances of heavy drinking and negative alcohol-related consequences. Despite having similar numbers of drinking peers as youths in the control arm, youths in both intervention arms reported greater alcohol-refusal skills. Only past-month cigarette use differed between the two intervention arms, with youths in the intervention-plus-parent-component arm smoking less than youths in the CD-ROM intervention-only arm. CONCLUSIONS: Six years after initial intervention, youths who received a culturally tailored, skills-based prevention program had reduced alcohol use and lower rates of related risky behaviors than youths in the control arm.

Longitudinal outcomes of an alcohol abuse prevention program for urban adolescents.

PURPOSE: This randomized clinical trial examined longitudinal outcomes from an alcohol abuse prevention program aimed at urban youths. METHODS: Study participants were an ethnically and racially heterogeneous sample of early adolescents, recruited from community-based agencies in greater New York City and its environs. Once they assented to study participation and gained parental permission, youths were divided into three arms: youth intervention delivered by CD-ROM (CD), the same youth intervention plus parent intervention (CD(P)), and control. Once all youths completed baseline measures, those in CD and CD(P) arms received a computerized 10-session alcohol abuse prevention program. Parents of youths in the CD(P) arm received supplemental materials to support and strengthen their children's learning. All youths completed postintervention and annual follow-up measures, and CD- and CD(P)-arm participants received annual booster intervention sessions. RESULTS: Seven years following postintervention testing and relative to control-arm youths, youths in CD and CD(P) arms reported less alcohol use, cigarette use, binge drinking, and peer pressure to drink; fewer drinking friends; greater refusal of alcohol use opportunities; and lower intentions to drink. No differences were observed between CD and CD(P) arms. CONCLUSIONS: Study findings lend support to the potential of computerized, skills-based prevention programs to help urban youth reduce their risks for underage drinking.

Substance use among late adolescent urban youths: mental health and gender influences.

This paper explores gender and mental health influences on alcohol, tobacco, and illicit drug use among late adolescent urban youths. Specifically, we examine whether rates of substance use differ by gender, whether mental health indices differ by gender and are predictive of substance use, and whether gender moderates the relationship between mental health and substance use. Data from our non-clinical sample of 400 youths were collected primarily online. Analysis of cross-sectional data revealed no differences in substance use by gender. Indices of mental health differed by gender, with girls reporting greater symptoms of depression and anxiety. Ratings of hostility were similar for boys and girls. Alcohol, tobacco, and drug use were associated with greater symptoms of depression, anxiety, and hostility; this relationship, however, was not moderated by gender. Study findings provide evidence that among late adolescent youths living in urban areas, poorer mental health status is associated with increased substance use. Evidence of a moderating effect of gender on the relationship between mental health and substance use was not significant.

Preventing drug abuse among adolescent girls: outcome data from an internet-based intervention.

This study developed and tested an Internet-based gender-specific drug abuse prevention program for adolescent girls. A sample of seventh, eighth, and ninth grade girls (N = 236) from 42 states and 4 Canadian provinces were randomly assigned to an intervention or control group. All girls completed an online pretest battery. Following pretest, intervention girls interacted with a 12-session, Internet-based gender-specific drug prevention program. Girls in both groups completed the measurement battery at posttest and 6-month follow-up. Analysis of posttest scores revealed no differences between groups for 30-day reports of alcohol, marijuana, poly drug use, or total substance use (alcohol and drugs). At 6-month follow-up, between-group effects were found on measures of 30-day alcohol use, marijuana use, poly drug use, and total substance use. Relative to girls in the control group, girls exposed to the Internet-based intervention reported lower rates of use for these substances. Moreover, girls receiving the intervention achieved gains over girls in the control group on normative beliefs and self-efficacy at posttest and 6-month follow-up, respectively.

Drug abuse risk and protective factors among black urban adolescent girls: a group-randomized trial of computer-delivered mother-daughter intervention.

A group-randomized design tested a mother-daughter intervention in which researchers aimed to increase protective factors in a community sample of Black urban adolescent girls. Girls and their mothers at 2 community agencies were pretested and, by agency, were randomized to either an intervention arm or a control arm. Intervention arm girls and their mothers received a program for improving mother- daughter rapport. Posttest data collected 3 weeks after program delivery revealed that intervention arm mothers and daughters improved more than did control arm mothers and daughters on measures of communication and closeness. At 3-month follow-up, intervention arm mothers, relative to control arm mothers, continued to report better communication with and closeness to their daughters. Girls and mothers in the intervention arm rated the computer program favorably on parameters of enjoyment, comfort, relevance, usefulness of information, improvements to their relationship with one another, and whether they would recommend the computer program to friends.