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Background: E-cigarette prevention education aims to mitigate adolescent e-cigarette use. Such education is increasingly delivered through virtual/video-based teaching platforms (e.g. Zoom, Google Classrooms). However, there is little evidence about the effectiveness of virtual e-cigarette education compared to in-person education on adolescents' knowledge about e-cigarettes, perceived addictiveness and intent to try e-cigarettes, cigarettes, and marijuana. Objective: To evaluate the effectiveness of virtual e-cigarette education compared to in-person education on student knowledge and perceived addictiveness of e-cigarettes and intent to try e-cigarettes. Design, Setting and Method: We conducted a pre- and post-education evaluation among 10 middle and high school students in the Greater Birmingham area, Alabama, who were non-randomly assigned to receive either virtual (n = 745) or in-person e-cigarette education (n = 286) (mean age: 14.36 years). The study used a 25-minute educational presentation about the health effects of e-cigarettes, the risks of second- and third-hand smoke, the addictive nature of nicotine, and marketing strategies of e-cigarette companies. Participants completed a 10-minute self-administered survey immediately before and after the presentation. Results and conclusion: Except for certain e-cigarette knowledge-related items, our study shows that both virtual and in-person education had similar effects on improving knowledge about e-cigarettes, increasing perceived addictiveness and reducing intent to try e-cigarettes, cigarettes and marijuana among participants. Virtual education may be applied where in-person education is not feasible (e.g. in rural communities).

Cannabis vaping may increase susceptibility to COVID-19 infection and related outcomes; however, little is known about the impact of the pandemic on cannabis vaping among US young populations. This study examined self-reported changes in cannabis vaping since the pandemic and factors associated with changes. A national, cross-sectional survey was conducted among 4,351 US adolescents and young adults (13-24 years old) in May 2020. Of those, 1,553 participants who reported ever vaping cannabis were included in the analytic sample. Binary outcome was self-reported increase in cannabis vaping (more hours/times of vaping in a day) vs. no change/quitting/reducing/switching. Weighted logistic regression examined associations between independent variables (i.e., risk perceptions of vaping, cannabis dependence, and stress/anxiety) and the outcome, controlling for sociodemographic factors. Overall, 6.8% reported increasing cannabis vaping since the pandemic, 37.0% quitting or reducing vaping in general, and 42.3% no change. Participants were more likely to report increased cannabis vaping if they perceived "Vaping is safer than smoking cigarettes" (Adjusted Odds Ratio [AOR] = 3.66; 95%CI = 1.43-9.38), reported more dependence on cannabis vaping (AOR = 1.59; 95%CI = 1.11-2.27), and were female (AOR = 2.80; 95%CI = 1.23-6.36). Those perceiving "Vaping cannabis can cause lung injuries" were less likely to increase cannabis vaping (AOR = 0.37; 95%CI = 0.18-0.76). Findings indicate that adolescent and young adult ever-cannabis vapers were more likely to report decreasing vaping generally than increasing cannabis vaping and most did not change use during the early pandemic. Educational campaigns should address potential health risks of cannabis vaping and focus on lung health to reduce use among young people during and following the pandemic.

Health behavior theorists and prevention researchers use a variety of measures of adolescent and young adult (AYA) risk and benefit perceptions to predict tobacco-use and marijuana-use behaviors. However, studies have not examined whether and how perception measures that ask about likelihood of more general outcomes such as "harm" versus ask about specific risk or benefit outcomes compare or whether they differentially predict AYA willingness to use if one of your best friends were to offer it and intentions to use in the next year; and if these measures have differential ability to predict actual use of tobacco and marijuana. We used data from a prospective cohort of California AYAs to create and test new scales to measure perceptions of specific health and social outcomes related to risks (e.g., smell bad) and benefits (e.g., look cool) related to tobacco and marijuana, and then addressed three questions: (1) Whether and how measures of perceptions of specific social and health risks and benefits (for our purposes "specific measures") and measures of perceived general harm are differentially associated with measures of willingness, social norms, and intentions to use? (2) Are specific versus general measures differentially associated with and predictive of tobacco and cannabis use behavior? (3) Are specific perceptions measures differentially predictive of behavior compared to measures of willingness, social norms, and behavioral intentions? Our results demonstrate that to better predict AYA tobacco and marijuana use, measures that address general outcomes, such as harmfulness, as well as willingness and behavioral intention should be used. We also found that measures of specific perceived risks (short-term, long-term, social) and benefits were unrelated and correlated differently with different products. For example, adolescents perceived both risks and benefits from using products like e-cigarettes, and perceived greater risk from smokeless tobacco compared to combustible cigarettes. These findings indicate that measures of specific perceived social and health outcomes can be useful to discern nuanced differences in motivation for using different substances. Study implications are important for survey dimension-reduction and assessing relationships among perceptions, motivations, and use of tobacco and marijuana products.

Background: We developed the Tobacco Prevention Toolkit (Toolkit) to enhance the impact of school-based tobacco education. This study describes the process of developing the Toolkit, its contents, and reach. Methods: Qualitative community-based participatory research (CBPR), including focus group discussions (N = 152) and working groups with parents, educators, researchers, and youth (N = 87) were used to develop the Toolkit and design its implementation. Toolkit reach was assessed through number of trained educators using the Toolkit, estimated number of youth recipients of the Toolkit resources, and using Google Analytics for online engagement. Results: The Toolkit is a free, online resource aimed at preventing tobacco use by middle and high school students. Toolkit content addresses varied forms of tobacco including electronic cigarettes, hookah, smokeless tobacco, and cigarettes; addiction; and positive youth development; and is available in multiple interactive formats such as real-time quizzes, factsheets, activities, and presentations. The Toolkit is mainly delivered by trained educators, who adapt its content and duration to tailor their drug prevention teaching to student needs. As of April 2020, when data for this paper were collected, 4,750 educators have reached an estimated 1.3 million youth. The Toolkit website has 186,116 users and 802,602 page views, growing steadily since 2016. As of August 2021, additional students have been reached, for now a total of 1.85 million students reached. Conclusion: The Toolkit resources are evidence-based, comprehensive, responsive, interactive, easily accessible, and flexible. Applying CBPR was instrumental in developing the Toolkit and expanding its reach.

Background: Limited evidence exists on the effectiveness of using an entertainment-education methodology to address multiple public health issues and of using participatory street theatre to improve public understanding related to public health. Objective: To assess the feasibility, acceptability and impact of the Actor-Doctor project, an intervention involving theatre professionals and medical specialists to jointly deliver street-theatre-based public health education. Design: A real-world, mixed-methods post-intervention study evaluated the Actor-Doctor project among 486 participants in Ahmedabad, India, in 2017. Setting and method: Focus group discussions with actors and semi-structured interviews with doctors and implementers assessed project feasibility, acceptability and perceived impact. Post-intervention surveys among actors, audience and a control group assessed impact on knowledge and attitudes related to select public health issues. Quantitative data were analysed using multivariable regression, and qualitative data were analysed using an inductive thematic analysis. Results: The Actor-Doctor project was feasible to implement, as 20 street theatre performances on five public health themes were developed and staged. Members of the audience showed higher knowledge of environmental health, anaemia and openness to discussing sexual health issues, compared to a control group (omega squared 0.03-0.24; p < 0.001). Actors and doctors collaborating to create theatre-based public health education derived satisfaction from the project. Balancing scientific accuracy and entertainment, especially humour was challenging. Conclusion: The Actor-Doctor project was instrumental in improving public-health-related engagement between actors, doctors and the public.

Background: Perceptions of health harms and addictiveness related to nicotine products, THC e-cigarettes, and e-cigarettes with other ingredients are an important predictor of use. This study examined differences in perceived harm and addiction across such products among adolescents, young adults, and adults. Methods: We conducted a cross-sectional survey (N = 6,131, ages 13–40 years old) in which participants reported perceived harm and addictiveness for 11 products (cigarettes, disposable nicotine e-cigarettes, pod-based nicotine e-cigarettes, other nicotine e-cigarettes, THC e-cigarettes, e-cigarettes with other ingredients, nicotine pouches, nicotine lozenges, nicotine gums, nicotine tablets, nicotine toothpicks). We applied adjusted regression models and conducted pairwise comparisons between age groups (13–17, 18–20, 21–25, and 26–40) and product use status (never, ever, and past-30-day use), adjusting for gender, race/ethnicity, sexual orientation, and financial comfort. Results: Overall, participants in younger age groups perceived products to be more harmful and addictive than those in older age groups, with the exception of e-cigarettes with other ingredients. For all products, participants who never used perceived each product to be more harmful than those who ever used. For all products, participants who used the products in the past 30-days had lower perceived harm and addictiveness compared to never and ever use. Certain sociodemographic groups, such as people who identify as LGBTQ+, Non-Hispanic Black, or Hispanic, had lower perceived harm and addictiveness for most products. Discussion: Efforts should be made to educate all age groups and minoritized groups on harms and addictiveness of all nicotine products, THC e-cigarettes, and e-cigarettes with other ingredients. [ABSTRACT FROM AUTHOR]