JMIR Publications

ABSTRACT

Background:

Substance abuse is among the greatest public health threats. Adolescent substance use remains at unacceptably high levels, and there is evidence that teens’ social norms are becoming more favorable toward recreational use and perceived relative safety of substances such as marijuana and prescription opioids. Social media offer a low-cost, potentially high impact approach to disseminating substance use prevention messages.

Objective:

Living the Example (LTE) is a program that trains adolescent youth ambassadors to develop and disseminate prevention messages within their own social media networks and through in-school activities. This study evaluated the effects of exposure to LTE social media on students in the youth ambassadors’ networks.

Methods:

The George Washington University (GW) designed and implemented a quasi-experimental evaluation of the LTE program in 3 Maryland high schools. Prior to program launch, a sample of 826 students (wave 1) at the 3 schools, drawn from a census of Freshmen enrolled in a required class, completed a survey. A total of 584 students were surveyed at a wave 2 program mid-point and 542 at a wave 3 end-point. The survey contained questions on a range of drug use related attitudes, beliefs, intentions, and behaviors, all based on validated measures. Following a previous analysis technique reported in Evans et al. (2017), we evaluated LTE effects on intended next 30-day drug use, controlling for LTE self-reported exposure, age and gender from wave 2 and 3 were appended into a single dataset. We first conducted ordinal logistic regressions for each drug use intention in wave 3 (i.e., sell/distribute illegal drugs, smoke cigarettes, drink beer/wine/hard liquor when parents don’t know about it, use marijuana, use LSD/cocaine/amphetamines or other illegal drugs, use heroin, use synthetic drugs, use any prescription pills without a prescription) to examine the association between LTE exposure and drug use intentions. Next, we included an interaction term for study wave to examine whether participants had stronger disagreement with drug use after the intervention had been implemented.

Results:

We found a significant positive effect of LTE exposure on all 8 measured drug use intentions: sell/distribute illegal drugs; smoke cigarettes; drink beer, wine or liquor when my parents don’t know about it; use marijuana; use LSD, cocaine, amphetamines, or other illegal drug; use heroin; use synthetic drugs; use any prescription pills without a prescription (all p<.05; odds ratios ranging from 2.12 to 3.71). We also found that boys were more likely than girls to exhibit reduced drug use intentions. We also found reductions in 30-day drug use intentions between second and third survey waves for all 8 measured drug use variables.

Conclusions:

Overall, results are consistent with and indicate a stronger LTE effect in this study compared to a previous pilot study. LTE appears to offer a protective effect, with exposure to program messages leading to reduced/improved drug use intentions. Future research should use a randomized controlled design to compare implementing and non-implementing schools and examine dose-response effects in greater depth. Clinical Trial: N/A