Effects of a Social Media Intervention on Vaping Intentions: Randomized Dose-Response Experiment.

BACKGROUND: e-Cigarette use, especially by young adults, is at unacceptably high levels and represents a public health risk factor. Digital media are increasingly being used to deliver antivaping campaigns, but little is known about their effectiveness or the dose-response effects of content delivery. OBJECTIVE: The objectives of this study were to evaluate (1) the effectiveness of a 60-day antivaping social media intervention in changing vaping use intentions and beliefs related to the stimulus content and (2) the dose-response effects of varying levels of exposure to the intervention on vaping outcomes, including anti-industry beliefs, vaping intentions, and other attitudes and beliefs related to vaping. METHODS: Participants were adults aged 18 to 24 years in the United States. They were recruited into the study through Facebook (Meta Platforms) and Instagram (Meta Platforms), completed a baseline survey, and then randomized to 1 of the 5 conditions: 0 (control), 4, 8, 16, and 32 exposures over a 15-day period between each survey wave. Follow-up data were collected 30 and 60 days after randomization. We conducted stratified analyses of the full sample and in subsamples defined by the baseline vaping status (never, former, and current). Stimulus was delivered through Facebook and Instagram in four 15-second social media videos focused on anti-industry beliefs about vaping. The main outcome measures reported in this study were self-reported exposure to social media intervention content, attitudes and beliefs about vaping, and vaping intentions. We estimated a series of multivariate linear regressions in Stata 17 (StataCorp). To capture the dose-response effect, we assigned each study arm a numerical value corresponding to the number of advertisements (exposures) delivered to participants in each arm and used this number as our focal independent variable. In each model, the predictor was the treatment arm to which each participant was assigned. RESULTS: The baseline sample consisted of 1491 participants, and the final analysis sample consisted of 57.28% (854/1491) of the participants retained at the 60-day follow-up. We compared the retained participants with those lost to follow-up and found no statistically significant differences across demographic variables. We found a significant effect of the social media treatment on vaping intentions (ß=-0.138, 95% CI -0.266 to -0.010; P=.04) and anti-industry beliefs (ß=-0.122, 95% CI 0.008-0.237; P=.04) targeted by the intervention content among current vapers but not among the full sample or other strata. We found no significant effects of self-reported exposure to the stimulus. CONCLUSIONS: Social media interventions are a promising approach to preventing vaping among young adults. More research is needed on how to optimize the dosage of such interventions and the extent to which long-term exposure may affect vaping use over time. TRIAL REGISTRATION: ClinicalTrials.gov NCT04867668; https://clinicaltrials.gov/study/NCT04867668.

Digital Media for Behavior Change: Review of an Emerging Field of Study.

Digital media are omnipresent in modern life, but the science on the impact of digital media on behavior is still in its infancy. There is an emerging evidence base of how to use digital media for behavior change. Strategies to change behavior implemented using digital technology have included a variety of platforms and program strategies, all of which are potentially more effective with increased frequency, intensity, interactivity, and feedback. It is critical to accelerate the pace of research on digital platforms, including social media, to understand and address its effects on human behavior. The purpose of the current paper is to provide an overview and describe methods in this emerging field, present use cases, describe a future agenda, and raise central questions to be addressed in future digital health research for behavior change. Digital media for behavior change employs three main methods: (1) digital media interventions, (2) formative research using digital media, and (3) digital media used to conduct evaluations. We examine use cases across several content areas including healthy weight management, tobacco control, and vaccination uptake, to describe and illustrate the methods and potential impact of this emerging field of study. In the discussion, we note that digital media interventions need to explore the full range of functionality of digital devices and their near-constant role in personal self-management and day-to-day living to maximize opportunities for behavior change. Future experimental research should rigorously examine the effects of variable levels of engagement with, and frequency and intensity of exposure to, multiple forms of digital media for behavior change.

Implementation practice models for development in low- and middle-income countries: systematic review of peer-reviewed literature.

INTRODUCTION: This study operationally defines a relatively small, but growing field of study on implementation practice models for health behavior change in the context of international development. We define 'implementation practice models' as theoretical models that take a practical and practitioner-focused approach to behavior change, and we illustrate how these models have been developed and applied. The paper examines the continuum of behavioral theories and their application in the context of development programs and research in low- and middle-income countries (LMICs). We describe implementation practice models, examine how they have been used to design and evaluate theory-based interventions in LMIC, and describe the state of evidence in this field of study. METHODS: The authors conducted a systematic search of the published, peer-reviewed literature following the widely accepted PRISMA methods for systematic reviews. We aimed to identify all relevant manuscripts published in the English language in health, social science, and business literature that apply implementation practice models, located in an LMIC, with a behavior change objective. We located 1,078 articles through database searching and 106 through other means. Ultimately, we identified 25 relevant articles for inclusion. RESULTS: We found that the peer-reviewed literature on implementation practice models for development has been growing in recent years, with 80% of reviewed papers published since 2015. There was a wide range of different models revealed by this review but none demonstrated clear-cut evidence of being most effective. However, the models found in this review share common characteristics of focusing on the three central tenets of Opportunity, Ability, and Motivation (OAM). CONCLUSIONS: This review found that implementation practice models for development are a promising and growing approach to behavior change in LMICs. Intervention practice models research should be expanded and applied in new domains, such as vaccination.

Social Norms Change and Tobacco Use: A Protocol for a Systematic Review and Meta-Analysis of Interventions.

Tobacco use kills more than eight million individuals each year, and results in substantial economic and human capital loss across nations. While effective supply-side solutions to tobacco control exist, these approaches are less effective at promoting cessation among heavy smokers, and less feasible to implement in countries with weaker tobacco control policy environments. Thus, effective demand-side solutions are needed. Shifting social norms around tobacco use is one such promising approach. To this end, a systematic review and meta-analysis of social norms intervention studies to influence tobacco use will be conducted following PRISMA 2020 guidance. Tobacco intervention studies with at least two time points that explicitly mention social norms or social influence as part of an intervention or set of measured variables will be included. Literature sources will comprise PubMed, Scopus, PsycInfo, and the Cochrane Trial Registry, as well as several grey literature sources. Two reviewers will independently screen studies, and risk of bias will be assessed using the Cochrane Risk of Bias 2 and ROBINS-I tools. The primary outcomes will be change in tobacco use and change in social norms. A random-effects meta-analysis will be conducted for both outcomes. Sources of heterogeneity will be explored using meta-regression with key covariates. Non-reporting biases will be explored using funnel plots. PROSPERO: CRD42021251535.

Demand Creation for COVID-19 Vaccination: Overcoming Vaccine Hesitancy through Social Marketing.

The COVID-19 pandemic has led to millions of deaths and tested the capabilities of the medical and public health systems worldwide. Over the next two years as more approved vaccines are made available and supply meets or exceeds demand, medical and public health professionals will increasingly be faced with the challenge of vaccine hesitancy. There is an urgent need to create demand in groups that are either uninformed, vaccine hesitant, or actively resistant to COVID-19 vaccination. This study reviews theory, evidence, and practice recommendations to develop a vaccine demand creation strategy that has wide applicability. Specifically, we focus on key elements including supply side confidence, vaccine brand promotion strategy, service marketing as it relates to vaccine distribution, and competition strategy. We present evidence that these strategies can make a significant contribution to overcoming COVID-19 hesitancy in a high supply scenario. The paper also makes recommendations about factors that need to be considered in relation to vaccine delivery services and systems that, if done badly, may reduce uptake or result in the creation of more vaccine hesitancy. In summary, there is a need for well researched and tested demand creation strategies that integrate with brand strategy, supply side, and service delivery.

Engaging African American Parents to Develop a Mobile Health Technology for Breastfeeding: KULEA-NET.

BACKGROUND: African Americans breastfeed less than other groups, which has implications for health throughout the life course. Little is known about mobile health technologies to support breastfeeding. RESEARCH AIMS: This study proceeded in two phases. The aim of Phase 1 was to identify ideal technological components and content of a mobile health intervention. The aim of Phase 2 was to determine the usability of a prototype, KULEA-NET, based on the Phase 1 findings. METHODS: For this mixed-methods study, we used community-based participatory research methods and user-centered technology design methods. We used open coding in NVivo 11 to organize data from focus groups and in-depth interviews, then we analyzed the data. We then developed a prototype and tested the prototype's usability with the System Usability Scale. Fifty pregnant and postpartum African Americans from the District of Columbia participated. RESULTS: Participants preferred an app with text messaging technology and identified areas for intervention: self-efficacy, parent-child attachment beliefs, social support, public breastfeeding and social desirability, and returning to work. Desired features included local resources, support person access, baby care logs, identification of public breastfeeding venues, and peer discussions. The System Usability Scale score was 73.8, which indicates above average usability. CONCLUSIONS: A mobile health technology like KULEA-NET can be used to meet the breastfeeding needs of African Americans, build social desirability, and complement traditional health care. The appeal of an African American-specific intervention is unclear. Responding to mixed feeding practices is challenging. KULEA-NET is a mobile breastfeeding intervention guided by the preferences of African American parents and offers promising usability metrics.

Evaluation of Behavior Change Communication Campaigns to Promote Modern Cookstove Purchase and Use in Lower Middle Income Countries.

Nearly three billion people worldwide burn solid fuels and kerosene in open fires and inefficient stoves to cook, light, and heat their homes. Cleaner-burning stoves reduce emissions and can have positive health, climate, and women's empowerment benefits. This article reports on the protocol and baseline data from the evaluation of four behavior change communication (BCC) campaigns carried out in lower to middle income countries aimed at promoting the sale and use of cleaner-burning stoves. Interventions implemented in Bangladesh, Kenya, and Nigeria are using a range of BCC methods including mass media, digital media, outdoor advertising, and inter-personal communication. The mixed methods evaluation comprises three large-scale surveys: one pre-BCC and two follow-ups, along with smaller scale assessments of stove uptake and patterns of use. Baseline results revealed varying levels of awareness of previous promotions and positive attitudes and beliefs about modern (i.e., relatively clean-burning) cookstoves. Differences in cookstove preferences and behaviors by gender, socio-demographics, media use, and country/region were observed that may affect outcomes. Across all three countries, cost (lack of funds) a key perceived barrier to buying a cleaner-burning stove. Future multivariate analyses will examine potential dose-response effects of BCC on cookstove uptake and patterns of use. BCC campaigns have the potential to promote modern cookstoves at scale. More research on campaign effectiveness is needed, and on how to optimize messages and channels. This evaluation builds on a limited evidence base in the field.

Systematic Review to Inform Dual Tobacco Use Prevention.

With more tobacco products now available and heavily marketed, dual tobacco use is increasing among youth. We systematically reviewed literature on dual tobacco use interventions, with an emphasis on mass health communication strategies. The review identified 46 articles meeting initial criteria and ultimately included 8 articles. Included studies reported a mix of health communication and social marketing techniques. Although there is a body of research on dual tobacco use, there is limited literature describing interventions aimed at controlling it. Design and evaluation of such interventions showing reductions in dual use of cigarettes, smokeless, and alternative products would advance the field.

Pilot evaluation of the text4baby mobile health program.

BACKGROUND: Mobile phone technologies for health promotion and disease prevention have evolved rapidly, but few studies have tested the efficacy of mobile health in full-fledged programs. Text4baby is an example of mobile health based on behavioral theory, and it delivers text messages to traditionally underserved pregnant women and new mothers to change their health, health care beliefs, practices, and behaviors in order to improve clinical outcomes. The purpose of this pilot evaluation study is to assess the efficacy of this text messaging campaign. METHODS: We conducted a randomized pilot evaluation study. All participants were pregnant women first presenting for care at the Fairfax County, Virginia Health Department. We randomized participants to enroll in text4baby and receive usual health care (intervention), or continue simply to receive usual care (control). We then conducted a 24-item survey by telephone of attitudes and behaviors related to text4baby. We surveyed participants at baseline, before text4baby was delivered to the intervention group, and at follow-up at approximately 28 weeks of baby's gestational age. RESULTS: We completed 123 baseline interviews in English and in Spanish. Overall, the sample was predominantly of Hispanic origin (79.7%) with an average age of 27.6 years. We completed 90 follow-up interviews, and achieved a 73% retention rate. We used a logistic generalized estimating equation model to evaluate intervention effects on measured outcomes. We found a significant effect of text4baby intervention exposure on increased agreement with the attitude statement "I am prepared to be a new mother" (OR = 2.73, CI = 1.04, 7.18, p = 0.042) between baseline and follow-up. For those who had attained a high school education or greater, we observed a significantly higher overall agreement to attitudes against alcohol consumption during pregnancy (OR = 2.80, CI = 1.13, 6.90, p = 0.026). We also observed a significant improvement of attitudes toward alcohol consumption from baseline to follow-up (OR = 3.57, CI = 1.13 - 11.24, p = 0.029). CONCLUSIONS: This pilot study is the first randomized evaluation of text4baby. It is a promising program in that exposure to the text messages was associated with changes in specific beliefs targeted by the messages.