JMIR Publications

ABSTRACT

Background:

Adolescent tobacco and nicotine use is a major public health concern, with lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) adolescents showing disproportionately high use compared to their heterosexual and cisgender peers. Research suggests factors such as socialization, stress, mood, and craving exacerbate tobacco and nicotine use, however, there is a dearth of knowledge of how these factors influence tobacco, nicotine, and cannabis use among LGBTQ+ adolescents in general, and particularly on a momentary basis.

Objective:

The Puff Break study aimed to utilize ecological momentary assessment (EMA) to assess real-time predictors of tobacco, nicotine, and cannabis product use among LGBTQ+ adolescents.

Methods:

The Puff Break study protocol was adapted from existing EMA protocols, key informant recommendations, LGBTQ+ adolescent perspectives, and insights from community members. Recruitment occurred via multiple channels, with high recruitment results via social media. Eligible participants were ages 14-19, self-identified as LGBTQ+, and used tobacco, nicotine, or cannabis products at least once in the past 30 days. The EMA pilot began with a 1.5 hour-long in-person or virtual meeting where participants completed a timeline-follow-back assessment for tobacco and nicotine use, salivary cotinine assessment, baseline survey, and EMA protocol training. Then, participants completed a 2-week EMA trial where they received 1-2 minute surveys 5 times a day. Within a week of completing the EMA trial, participants concluded with an exit survey and exit interview.

Results:

Analyses will include overall descriptive statistics on the demographics of our enrolled participants, along with evaluating the feasibility and acceptability of the Puff Break EMA protocol. We will also use multilevel modeling techniques to estimate both contemporaneous and lagged associations between stress, socialization, and craving (exposures) and smoking (outcome: combustible cigarette, smokeless product, e-cigarette, and cannabis use). Lastly, qualitative thematic analysis will be used to identify robust tailoring variables, intervention options, and decision rules to support future Just-in-Time-Adaptive Intervention (JITAI) development.

Conclusions:

Puff Break is an innovative EMA protocol developed to capture factors influencing tobacco, nicotine, and cannabis use among LGBTQ+ youth. Despite some inherent limitations to the EMA design, the Puff Break protocol has potential to inform the development of a JITAI to reduce tobacco, nicotine, and cannabis use among LGBTQ+ adolescents. Clinical Trial: Not applicable - This study is not registered as a trial.