Design and Baseline Evaluation of Social Media Vaping Prevention Trial: Randomized Controlled Trial Study

Abstract

Background: Electronic cigarette (e-cigarette) use is a major public health problem and young adults aged 18-24 years are at high risk. Furthermore, oral nicotine products (ONPs) are growing in popularity in this population. Poly-use is widespread. New methodologies for rigorous online studies using social media have been conducted and shown to reduce nicotine use.

Objective: We report on the design and baseline evaluation of a large-scale social media-based randomized controlled trial to evaluate the effects of antivaping social media on young adult vaping and determinants of use.

Methods: Using the Virtual Lab social media platform, participants were recruited using an artificial intelligence chatbot and social media advertising, completed a baseline survey, and were randomized to 1 of 4 study arms. The design was to achieve specific numbers of impressions per arm over 3 survey time points. We recruited 8437 participants, stratified by vaper (n=5026) and nonvaper (n=3321) status. Questionnaire data were collected using the Qualtrics survey platform. Future analyses will examine the effects of social media content on vaping at the endline. Our data analysis describes the 2 cohort samples, examines balance across the 4 study arms on baseline variables in each of the cohorts, and evaluates the internal consistency of several multi-indicator measures of psychosocial constructs.

Results: Among vapers, almost three-fourths were current vapers, >40% were current smokers (using in the past 30 days), and >48% were current poly-users (using e-cigarettes and ≥1 other tobacco products). Substantial numbers of current vapers also currently use some other product, including cigars (n=1520, 30.2%), hookah (n=794, 15.8%), smokeless devices (n=462, 9.2%), and ONPs (n=578, 11.5%). The average age of participants was 21.2 (SD 2) years. Just less than 45% of participants were non-Hispanic White (n=3728, 44.7%), just less than 47% (n=3913, 46.9%) of the sample was male, more than 44% (n=3704, 44.4%) reported completing high school, and 79.3% reported meeting basic needs or better. There were no significant differences between arms and strata by any of these demographics. We calculated scale scores for depression and covariates related to nicotine use and found high alphas. Finally, participants who reported having seen antitobacco brand advertising were more likely to have higher levels of these variables and scales than participants who reported not having seen the advertisements. These results will be examined in future studies.

Conclusions: Social media can be used as a platform at scale for longitudinal randomized controlled trials over extended periods, which extends previous research on short-term trials. Interventions delivered by social media can be used with large samples to evaluate social media health behavior change interventions. Future studies based on this research will evaluate the intervention and dose-response effects of social media exposure on vaping behavior and determinants.

Trial registration: ClinicalTrials.gov NCT04867668; https://clinicaltrials.gov/study/NCT04867668.

Keywords: e-cigarettes; nicotine; nicotine poly-use; oral nicotine products; randomized controlled trial; social media.