The Preliminary Efficacy of a Mhealth Preventive Intervention on Cigarette Use Among Youth

Introduction: Youth in the United States disproportionately engage in substance use behaviors, including cigarette use. Findings from the Monitoring the Future (MTF) study indicate that 38.1% and 16.3% of youth report lifetime and past 30-day cigarette use, respectively. Data from the Youth Risk Behavior Surveillance Survey suggest that 9.3% of youth smoked a whole cigarette before age 13, and 8.6% of current cigarette smokers smoked > 10 cigarettes per day. Cigarette use is a risk behavior for cancer and accounts for approximately 30% of all cancer deaths. Despite shifts in policy and advances in technology that provide opportunities for researchers and clinicians to deliver and evaluate mobile-health (mHealth) prevention programs in health clinics, research is limited. We employed the principles of community-based participatory research to develop tobacco modules to include as part of the S4E mHealth preventive intervention. S4E is culturally congruent such that the development of S4E tobacco modules was youth-driven in consultation with a youth in the targeted health clinic. S4E is theory-driven, guided by empowerment and ecodevelopmental frameworks, aims to improve tobacco use refusal self-efficacy and clinician-youth communication during the healthcare visit via innovative storytelling to prevent/reduce tobacco use behaviors in at-risk youth. The purpose of this study was to examine the preliminary efficacy of S4E, relative to Usual Care, in preventing and reducing tobacco use among adolescents in a health clinic.

Methods: A predominately racial minority sample (>50% African American) of youth were recruited from a youth-centered community health care clinic in Southeast Michigan and randomized to either S4E (n=25) or Usual Care (n=25). Youth were assessed at baseline and 1 month follow-up and completed self-report measures to assess lifetime and current tobacco use behaviors, self-efficacy tobacco refusal skills, and clinician-youth communication.  We used linear mixed models (LMM) for continuous outcomes (e.g., clinician-adolescent communication) and generalized linear mixed models (GLMM) for discrete data (e.g., cigarette use). Given sample size and preliminary efficacy nature of our study, we did not conduct a formal test of outcomes or attempt to obtain an estimate of effect size.  Our primary purpose was to estimate the critical parameters required to establish whether S4E, relative to Usual Care, has sufficient preliminary efficacy to inform the potential effects of S4E in a larger RCT.

Results: Preliminary findings indicate that, at 30-day follow-up, participants reported fewer frequencies of tobacco use, with the majority of these participants completing the S4E intervention, a clinically meaningful effect which suggests preliminary efficacy for the experimental condition.

Conclusions: Despite a recent downward trend in cigarette use among youth, tobacco use behaviors remain a significant public health priority. This study sought to examine the preliminary efficacy of S4E, relative to usual care, on youth tobacco use. Findings demonstrate the potential of S4E and suggest that a larger efficacy trial may be warranted.