Testing Peer-led Network Intervention to Prevent Adolescent Vaping

摘要 青少年电子烟的使用率正在迅速上升。目前高中生使用电子vaping 产品（EVP）从2011年的1.5%上升到2018年的20.8%-从22万增加到305万 青少年用户。吸电子烟与呼吸道症状有关，接触尼古丁可以作为一种治疗方法。 使用其他药物的“门户”。迫切需要有效的、以学校为基础的干预措施来保护青少年 开始或继续使用EVP。美国卫生局局长最近的一份报告指出， 以社区为基础的预防计划，减少年轻人的电子烟行为。这项提议需要 国家支持的预防措施的优势，以测试以上的影响，电子烟（ATI- （五）。ATI-V培训同龄人提名的8 - 9年级同龄人领袖和成人顾问。同行领导者学习技能， 在传播科学的指导下开展全校范围的预防运动。初步数据显示 在培训了大约15%的八年级学生作为同伴领袖，他们在全校范围内开展活动， 同学领袖的朋友的学生减少了vaping意图和vaping行为第二学期 八年级。纽约州已经提供资金支持学校实施ATI-V，但没有资金用于效果 research.在纽约州和强大的调查团队的支持下，我们的项目有三个目标： 目标1.功效。这项研究的主要目的是确定ATI-V在防止使用vaping方面的影响（过去 30天任何vaping，尼古丁vaping，和定期使用）。使用随机对照试验设计，20所学校将被分配到（a） 立即ATI-V，或（B）24个月后ATI-V培训等待名单。大约3,800名8年级学生将在 在秋季8年级、春季8年级、春季9年级和10年级中期进行了入学和随访评估 年级我们将测试哪些学生ATI-V是最有效的，在什么样的学校环境（学校气氛）。 目标2.机制本研究的第二个目的是测试ATI-V影响的假设机制。到 为了实现这一目标，我们将对调解模型进行统计分析，以确定（a）ATI-V是否 提高学生的看法，即vaping是不可接受的同龄人（反vaping规范），连接到 支持成年人解决EVP问题，以及非vaping学生的社会影响;以及（B） ATI-V对减少吸电子烟行为的影响由这些改进介导。 目标3：实施（探索性）。我们的探索性目标是确定实施障碍， 通过从工作人员和学生那里收集定性数据（观察，半结构化访谈） 从高和低实施学校的子集。目的是确定什么样的实施 未来的学校需要战略和支持，以成功地实施ATI-V，如果有必要的话， 研究结果。如果研究假设得到支持，据我们所知，这项研究将提供第一个 以学校为基础的预防干预措施的证据，减少青少年vaping行为。

ABSTRACT Rates of adolescent vaping are increasing rapidly. Current high school student use of electronic vaping products (EVPs) rose from 1.5% in 2011 to 20.8% in 2018 – an increase from 220,000 to 3.05 million adolescent users. Vaping is associated with respiratory symptoms, and exposure to nicotine can act as a `gateway' to other drug use. Effective, school-based interventions are urgently needed to protect adolescents from initiating or continuing use of EVPs. A recent US Surgeon General's report identified no school or community based prevention program that reduces vaping behaviors among youth. This proposal takes advantage of a state-supported prevention initiative to test the efficacy of Above the Influence of Vaping (ATI- V). ATI-V trains peer nominated 8th-9th grade Peer Leader, and adult advisors. Peer Leaders learn skills and implement school-wide prevention campaigns informed by communication science. Preliminary data show that after training approximately 15% of 8th graders as Peer Leaders, who implemented school-wide campaigns, students who were friends of Peer leader had reduced vaping intentions and vaping behaviors 2nd semester of 8th grade. New York State has provided funds to support schools to implement ATI-V but no funds for efficacy research. With support from New York State and a strong team of investigators, our project has three aims: Aim 1. Efficacy. The primary aim of this study is to determine ATI-V impact in preventing vaping use (past 30 days any vaping, nicotine vaping, and regular use). Using an RCT design, 20 schools will be assigned to (a) immediate ATI-V, or (b) wait-list for ATI-V training after 24 months. Approximately 3,800 8th graders will be enrolled and followed for assessments in fall 8th grade, spring 8th grade, spring 9th grade, and mid-year 10th grade. We will test for which students ATI-V is most effective and in what school contexts (school climate). Aim 2. Mechanism. The second aim of this study to test the hypothesized mechanisms of ATI-V impact. To accomplish this aim we will conduct statistical analyses of a mediation model to determine (a) whether ATI-V improves students' perceptions that vaping is unacceptable to their peers (anti-vaping norms), connections to supportive adults to address EVP concerns, and social influence of non-vaping students; and (b) whether the impact of ATI-V on reduced vaping behavior is mediated by these improvements. Aim 3. Implementation (Exploratory). Our exploratory aim is to identify implementation barriers and facilitators by gathering qualitative data (observations, semi-structured interviews) from staff and students from a subset of high and low implementing schools. The purpose is to identify what implementation strategies and supports are needed for future schools to be successful in implementing ATI-V, if warranted by the study findings. If study hypotheses are supported, this study will provide, to our knowledge, the first evidence of a school-based prevention intervention that reduces adolescent vaping behaviors.