Adolescents’ health and well-being are influenced by their broader physical and social environments, yet they often lack the power and resources to create change. Youth participatory action research (YPAR) is a promising framework to support adolescents to explore issues relevant to their lives and take action to address them, while also supporting positive youth development by fulfilling key developmental needs. YPAR is increasingly implemented in schools in collaboration with university researchers, yet such collaborations are rarely embedded within university courses that can provide training in YPAR methods to university students. To address this gap, we introduce a novel “classroom-to-classroom” model of YPAR that brings together university and secondary school classrooms to engage in mutual learning and joint action and integrates strengths of traditional models of school-based YPAR and critical service learning. We illustrate how this model can be applied through a case study of our collaboration between a graduate seminar and high school classroom to investigate how pressing issues such as mental health, gun violence, and social needs (e.g., housing, green spaces) impact local youth. We discuss the unique opportunities and challenges this model presents, with a particular focus on the role of relationships and resources. We reflect on how we navigated these challenges and offer practical recommendations for university researchers and teachers seeking to promote positive youth development through YPAR across educational contexts.

INTRODUCTION:Understanding which theories have been effectively applied in tobacco control efforts for sexual and gender minority (SGM) individuals will help identify constructs to incorporate into future tobacco control efforts aimed at reducing SGM tobacco disparities. This scoping review summarizes the use of theory in SGM-focused tobacco control efforts. METHODS:We searched four databases using SGM- and tobacco-focused terms in November 2023. Two trained coders independently screened each title and abstract, reviewed the full text, and extracted data about theories used and which tobacco control measures from the World Health Organization Framework Convention on Tobacco Control were included. RESULTS:The final analytic sample included 86 papers. Of those, 11 (12.9%) discussed price/tax manipulations, 15 (17.7%) discussed secondhand smoke and smoke-free policies, 11 (12.9%) discussed product characteristics (e.g., flavors), 5 (5.9%) discussed product disclosures (e.g., warning labels), 7 (8.1%) discussed packaging, 23 (27.1%) discussed education, communication and public awareness, 15 (17.7%) discussed tobacco advertising and promotion, 49 (57.7%) discussed tobacco prevention/cessation interventions, and 1 discussed Tobacco 21 (1%). Under half (31 articles, 36.0%) explicitly presented theoretical models. CONCLUSIONS:This review found a relative lack of theoretical models applied in tobacco control initiatives for SGM people. Of the 31 studies that did, most used theory to help clarify the etiology and associated factors of tobacco use (e.g., minority stress, increased exposure to marketing) or tailor prevention/cessation interventions focused on SGM individuals. Future studies should be grounded in theory to increase the effectiveness of these activities while preventing potential unintended consequences. IMPLICATION:This scoping review aimed to summarize which theoretical models have been implemented in relation to tobacco control measures among SGM individuals. Most theories were integrated in helping explain disparities or tailor interventions. Large-scale tobacco control initiatives may cause unique harm to SGM samples when critical theories are not integrated into their design and implementation.

Curiosity motivates the consumption of new information and facilitates memory for information encountered. Given the prevalent strategy of using social media metrics to boost engagement with new information, this paper examined whether social value norms can change curiosity and memory. Consistent with previous work, higher than usual levels of curiosity during information exposure was associated with better memory, such that people were more likely to remember the information when they reported higher than usual levels of curiosity. Across the three studies, high social value norms had weak or inconsistent effects on curiosity, while low social value norms consistently decreased curiosity. Surprisingly, low social value norms boosted memory, an effect that was observed across two of the three studies, indicating a role for low social norms to impact memory beyond their effects on curiosity. Together, these studies advance understanding of how social value norms shape information processing and memory, and reveal that low social value norms can influence memory for information in ways that are not fully explained by their effects on curiosity.

Online health information-seeking involves actively trying to resolve uncertainty by searching for, evaluating, and updating knowledge in response to information. The present study examined whether adults learn from brief online health information searches and whether learning outcomes are associated with intellectual humility and access to authoritative sources. In a laboratory study, 111 adults (mean age = 38.95 years, 44.1% women) completed a multi-trial health information-seeking task, answering factual questions before and after online search. Participants were randomly assigned to an experimental condition in which they received links to authoritative sources prior to search (n=53) or to a control condition in which no links were provided (n=58). Participants showed improved accuracy (b=1.68, p<0.001) and confidence (b=1.17, p<0.001) following search, but access to authoritative sources did not significantly improve accuracy (b=-0.17, p=0.66) or confidence (b=-0.34, p=0.08) overall. Intellectual humility was positively associated with post-search answer accuracy (b=1.05, p=0.01). Intellectual humility also moderated the effect of authoritative source access on confidence (b=0.92, p=0.01), such that the association between intellectual humility and post-search confidence was stronger when an authoritative source was provided. Findings suggest that access to high-quality information alone may be insufficient for learning and that intellectual humility may help determine how effectively individuals learn from and respond to online health information.

This research examines how gender expressions in health messages influence perceived message effectiveness (PME) for sexual and gender minority (SGM) young adults through perceived character similarity. In an online experiment, 1,113 SGM young adults were randomly assigned to view six anti-smoking messages portraying one of four gender expressions: feminine, masculine, gender expansive, or multiple gender. Findings indicated that messages with multiple gender expressions increased perceived character similarity among SGM young adults compared to messages showing masculine expressions; perceived character similarity mediated the relationship between message exposure and PME. However, messages with multiple gender expressions were associated with lower PME than all other conditions. Furthermore, moderation analysis revealed nuanced differences in responses based on participants' gender identities. Theoretically, this study underscores the mediating role of perceived character similarity in tailored communication, while suggesting that other factors may also contribute to PME. The findings have practical implications for designing health campaigns that resonate with the diverse gender identity groups within the SGM community.

INTRODUCTION:Sexual and/or gender-minoritized (SGM) people are more likely to smoke if they live where SGM stigma is high, and existing SGM-tailored cessation interventions do not address the unique challenges of these environments. This paper reports outcomes from a single-arm pilot trial of an Empowerment Theory (ET)-based smoking cessation intervention for SGM people living in high-stigma environments. METHODS:SGM adults willing to quit smoking (N = 20; Oklahoma) participated in a 12-week intervention comprised of online SGM-serving volunteer activity sessions concurrent with remotely delivered smoking cessation support (ie, behavioral support plus combination nicotine replacement therapy [NRT]). Baseline and exit surveys and in-depth exit interviews addressed retention, acceptability, engagement, and adherence. RESULTS:Study retention was 80.0% (16/20). Most exit survey respondents attended ≥4 volunteer activity sessions (62.5%; 10/16) and ≥4 cessation counseling sessions (87.5%; 14/16), had moderate/high NRT adherence (patch 84.6%; 11/13 and gum/lozenge 76.9%; 10/13), and would recommend the intervention (81.3%; 13/16). At the exit, 7-day point prevalence abstinence was self-reported by 45.0% (9/20; missing = smoking) of all participants and 56.3% (9/16) of exit survey respondents. At least half of the participants reported pre-post intervention increases in perceived assertiveness and/or decreases in sexual identity acceptance concerns, concealment concerns, and internalized transphobia. Interviews identified intervention endorsement reasons, including experiencing greater belonging and hope. CONCLUSIONS:A novel approach to SGM-tailored smoking cessation treatment that leveraged ET was feasible and acceptable. Future work should refine and adapt this intervention for other high-stigma places, test its efficacy and treatment mechanisms, and measure organizational and individual-level outcomes. IMPLICATIONS:This study adds to the literature on culturally tailored smoking cessation interventions as the first tobacco intervention tailored for SGM people in high-stigma environments. It used a novel application of ET to advance SGM smoking cessation and resilience in the face of minority stress. Findings from this pilot study in Oklahoma indicate promising feasibility and acceptability and will inform future interventions to address tobacco use disparities among SGM people in high-stigma environments.

INTRODUCTION:Sexual and gender minority (SGM) youth have higher rates of nicotine vaping than other youth in the United States. While social media can be effective in reaching youth and discouraging vaping, informed cultural tailoring is necessary to ensure effective messaging to SGM youth. This study aimed to understand SGM youth perspectives on anti-vaping social media messages and tailoring approaches. AIMS AND METHODS:In-depth, qualitative videoconference interviews were conducted from February to July 2022 with 34 SGM youth recruited in the United States via social media ads. The interview guide addressed participants' beliefs about vaping, the context of vaping, perspectives on tailoring messages, and responses to examples of social media anti-vaping messages. Coding and thematic analysis followed a team-based approach. RESULTS:SGM youth perspectives fell into four categories-representation and diversity, facts and evidence, empowering messages, and source credibility. Participants stressed the importance of accurate, genuine representation of SGM youth in messages, but also noted that more overt representation may be seen as tokenizing. Participants recommended partnering with known LGBTQ + influencers who can promote or share anti-vaping messages on social media platforms. They also recommended using culturally tailored language, including statistics specific to SGM youth, and invoking themes of empowerment to improve the relevance, reach, and effectiveness of anti-vaping campaigns. CONCLUSIONS:Findings can inform future efforts to develop anti-vaping messages for SGM youth with effective reach through social media. Nuanced perspectives on SGM representation in messages suggest a careful approach to tailoring. Concerns around inauthenticity may be minimized by ensuring SGM youth are included in message development and dissemination. IMPLICATIONS:This study describes the importance of being attentive to the tailoring preferences among the current generation of SGM youth. Findings will inform social media-based messaging strategies that discourage nicotine vaping tailored for SGM youth in health campaign material design and evaluation, ensuring that tailored messages are designed in ways that avoid unintended consequences. The study also describes methods for effectively engaging SGM youth in research to improve the relevance of health education materials for this population and increase reach, which in turn can lead to a reduction in vaping practices among SGM youth.

INTRODUCTION:Understanding e-cigarette use among those with multiple intersecting marginalized identities is important since those individuals might experience intersectional minority stress, which is associated with tobacco use. This study examined the prevalence of e-cigarette use at the intersection of race-ethnicity and sexual identity among US adults. METHODS:We analyzed the pooled 2021-2023 National Health Interview Survey (NHIS) dataset adult samples (N = 86 655). We conducted an adjusted binomial logistic regression analysis to predict past-30-day e-cigarette use with sexual identity (straight, gay/lesbian/bisexual/something else [LGB+]), race-ethnicity (non-Hispanic White, non-Hispanic Black/African American, non-Hispanic Asian, non-Hispanic American Indian and Alaska Native, Hispanic, and Other races) and an interaction term between sexual identity and race-ethnicity in one model, adjusted for age, education, cigarette smoking, and diagnoses of chronic diseases. The results were stratified by sex and the adjusted predicted margins were estimated. RESULTS:Among total respondents, 5.5% (weighted) reported past-30-day e-cigarette use, 5.3% were LGB+, 11.8% were non-Hispanic Black, 6.1% were non-Hispanic Asian, 1.4% were non-Hispanic American Indian and Alaska Native, and 17.2% were Hispanic. The overall interaction effect between sexual identity and race-ethnicity on outcome was significant among total respondents (p = .004) and females (p < .001), but not males. Among females, the adjusted predicted margins for current e-cigarette use between LGB+ individuals and heterosexual individuals in Hispanic groups (4.0% vs 1.0%) were significantly different from those in the non-Hispanic White group (4.4% vs 3.4%). CONCLUSIONS:Sexual minority adults in Hispanic groups, particularly Hispanic sexual minority females, may be at increased risk of e-cigarette use compared to Hispanic heterosexual females. IMPLICATIONS:This study highlights the risk of e-cigarette use among sexual minority adults in non-White racial-ethnic groups, particularly Hispanic sexual minority females. These findings underscore the need for future research to understand the unique drivers of e-cigarette use among Hispanic sexual minority females.

OBJECTIVE:To estimate the association between online harassment and same-day disordered eating among a sample of US-based transgender and/or gender diverse young adults. METHOD:Participants (n = 150) were US residents aged 18-25 years, English-speaking, and identified as transgender, nonbinary, and/or another gender different than that assigned at birth. We collected data between September 2022 and August 2023 using a 10-day daily diary design. Multilevel models were employed to estimate the association between any/no online harassment in the past-24 h and odds of same-day disordered eating behavior (overeating, binge eating, weight-controlling behavior, coping-related eating, and body dissatisfaction). RESULTS:The sample included 1192 diaries (mean per participant = 7.95, range = 1, 9). Online harassment was associated with greater odds of same-day overeating (adjusted odds ratio, aOR = 3.38, 95% confidence interval, CI = 1.02, 9.17), binge eating (aOR = 15.09, 95% CI = 2.73, 83.43), and coping-related eating behavior (aOR = 4.07, 95% CI = 1.51, 10.93). DISCUSSION:Experiencing online harassment was associated with higher odds of same-day disordered eating behavior in a sample of transgender and/or gender diverse young adults. Clinical and public health interventions must focus on improving safety in online environments and mitigating potential harms arising from negative digital interactions.

This study examines how community-based organizations (CBOs) in a large city in the northeast United States helped to bridge potential gaps in their community members' access to and use of a communication infrastructure relevant to the COVID-19 vaccine for children. Using a purposive sampling strategy, we conducted 10 semi-structured interviews between July and September 2022 with staff members of CBOs who communicated about COVID-19 vaccination for children (ages 17 and younger) in their community. We constructed themes from the transcribed interviews using our deductive codes informed by the interview guide and the conceptual model of the communication infrastructure as a social determinant of health. We also used inductive codes to capture emerging themes from the interviews. CBO leaders described a misalignment between the supply and demand of relevant and accessible information about the COVID-19 vaccine for children among parents in their communities. Building and maintaining trust, in particular, was a crucial foundation for facilitating CBOs' information sharing about the vaccine with community members. CBO leaders led various messaging strategies tailored to help meet the information needs of their community members. However, CBO leaders highlighted some challenges in evaluating the reach and effectiveness of the messaging efforts. Our findings highlight how CBOs can support their community members' access to and comprehension of health information about the COVID-19 vaccine for children but also underscore the importance of ensuring CBOs have sufficient funding and resources to develop strong relationships with community members before moments of crisis, such as the coronavirus pandemic.

Background Sexual and gender minority youth (SGMY) vape at higher rates than their heterosexual and/or cisgender peers. SGMY prefer SGM-specific anti-tobacco messaging; however, there have been no vaping prevention campaigns designed for SGMY. Purpose Using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, we sought to explore specific barriers, facilitators, and best practices for health promotion for SGMY that will inform future vaping prevention campaigns. Methods We conducted 11 qualitative interviews with key stakeholders from government and non-profit organizations who work in public health campaigns or with SGMY at national, state, and local levels. Data were coded and analyzed using thematic analysis. Results We identified 4 main themes from our analysis: (1) youth engagement, (2) sociopolitical context, (3) dissemination and measurement, and (4) inter-organizational collaboration. Participants described barriers and facilitators in the 4 themes. Conclusions Based on these findings, we developed 3 recommendations to guide and improve the success of future vaping prevention campaigns for SGMY. First, youth engagement should be at the forefront of campaign development and dissemination. Second, SGMY of color should be centered and represented in campaigns due to racial inequity in tobacco-related illness and death. Third, inter-organizational collaboration is strongly encouraged to minimize the resource burden on each organization and maximize potential collective output.

Sexual and gender minority (SGM) youth are at high risk for vaping, yet few interventions are tailored toward this population. To address this gap, we explored SGM youth's preferences for anti-vaping messages to inform the development of tailored anti-vaping campaigns. Participants were 245 SGM-identifying US youth, ages 13-18 years. Participants completed a discrete choice experiment that assessed which types of images were preferred by SGM youth for a social media anti-vaping campaign. Images varied on two attributes: SGM tailoring (none, low, high), and number of people in the image (1, 2, 3 + people). Choice-based conjoint analysis (hierarchical Bayesian estimation) was conducted utilizing Sawtooth Software. Tailoring had higher importance for image selection than number of people. Images with high SGM tailoring were most preferred, and images with no tailoring were least preferred. Most preferred images contained two people with high tailoring and 3 + people with no or low tailoring. The least preferred images included 3 + people and high tailoring. Tailoring anti-vaping messaging for SGM youth may increase the likelihood that youth will notice, engage with, and share the content with peers. These findings provide insight into components that may increase the efficacy of preventative anti-vaping social media campaigns for SGM youth.

Objective:Rural areas in the United States (U.S.) have a higher smoking prevalence than urban areas. This disparity is influenced by lower odds of quitting smoking in rural versus urban areas, and lower use of evidence-based treatments, including nicotine replacement therapy (NRT). To inform strategies for promoting NRT, this qualitative study elicited and ranked NRT beliefs among rural people who smoke cigarettes. Methods:In 2023, we conducted an online, semi-qualitative, elicitation survey with US rural residing adults (ages 21+) who smoke (n = 52), using open-ended questions to probe about: perceived advantages/disadvantages of using NRT to quit smoking and facilitators/barriers towards using NRT. Responses were coded based on belief themes and the frequencies of these themes were tabulated. Results:Leading perceived advantages of NRT for a quit attempt included help with cravings (42 %), making quitting easier (23 %) and easing withdrawal (17 %), while perceived disadvantages were concerns about becoming addicted to another product (29 %), high cost (23 %), side effects (19 %), and being ineffective (13-17 %). Leading perceived barriers to NRT use referred to high cost (52 %), negative taste (19 %), not enough nicotine (13 %), and lack of access (11 %), while leading perceived facilitators to use were free or lower cost (54 %) and better access/availability (13 %) and flavors/taste (13 %). Conclusions:Boosting NRT use among rural communities could be achieved by (1) adopting approaches to enhance the affordability and accessibility of NRT, (2) rectifying NRT misperceptions, and (3) offering guidance on the proper use of NRT and managing side effects.

Misperceptions about nicotine are associated with reduced smoking cessation success and a lower likelihood of using less harmful nicotine products. Three priority populations - Black/African American adults, rural adults, and young adults who smoke in the United States - tend to hold more nicotine false beliefs relative to other groups and are at risk for poor smoking cessation outcomes. The present study used an optimization phase in the form of a 23 factorial design to identify the curiosity-eliciting message components (social signals, questions, ratings) with the greatest likelihood of reducing nicotine false beliefs in each priority population (n = 200 for each population). Following message optimization, we compared exposure to targeted messages (from the optimization phase) with no message exposure and exposure to standard nicotine messages in new samples (n = 200 for each priority population). Targeted messages significantly reduced nicotine false beliefs (and other relevant outcomes) in Black/African American adults who smoke and rural adults who smoke. In young adults who smoke, targeted messages significantly reduced nicotine false beliefs compared to the no message exposure condition, but did not show additional benefits beyond standard nicotine messages. Findings highlight the benefit of an optimization phase and curiosity-eliciting strategies in messages designed to reduce nicotine false beliefs.

Large language model (LLM) chatbots show increasing promise in persuasive communication. Yet their real-world utility remains uncertain, particularly in clinical settings where sustained conversations are difficult to scale. In a pre-registered randomized controlled trial, we enrolled 915 U.S. adults (ages 45-75) who had never completed colorectal cancer (CRC) screening. Participants were randomized to: (1) no message control, (2) expert-written patient materials, (3) single AI-generated message, or (4) a motivational interviewing chatbot. All participants were required to remain in their assigned condition for at least three minutes. Both AI arms tailored content using participant's self-reported demographics including age and gender. Both AI interventions significantly increased stool test intentions by over 12 points (12.9-13.8/100), compared to a 7.5 gain for expert materials (p<.001 for all comparisons). While the AI arms outperformed the no message control for colonoscopy intent, neither showed improvement xover expert materials. Notably, for both outcomes, the chatbot did not outperform the single AI message in boosting intent despite participants spending 3.5 minutes more on average engaging with it. These findings suggest concise, demographically tailored AI messages may offer a more scalable and clinically viable path to health behavior change than more complex conversational agents and generic time intensive expert-written materials. Moreover, LLMs appear more persuasive for lesser-known and less-invasive screening approaches like stool testing, but may be less effective for entrenched preferences like colonoscopy. Future work should examine which facets of personalization drive behavior change, whether integrating structural supports can translate these modest intent gains into completed screenings, and which health behaviors are most responsive to AI-supported guidance.