Leveraging Community-Engaged Research to Co-Create Youth Vaping Prevention with Urban
Indigenous Communities of the Southwest
ABSTRACT
The prevalence and early initiation of nicotine vaping among Indigenous youth surpass that of all other
racial/ethnic groups. This concerning trend is prominent in urban environments, where approximately 60% of
Indigenous youth reside. In urban settings, multilevel influences heighten risks for nicotine and cannabis
vaping among Indigenous adolescents, including the intricate navigation of ethnic identity, which can
compound challenges these youth face. Preventing adolescent nicotine and cannabis vaping is further
complicated by the unique characteristics of vaping products. Their ease of concealability, the ability to
purchase online, and the lower perception of adverse health consequences contribute to their attractiveness.
Even among youth who successfully avoid traditional cigarette smoking, vaping nicotine remains a risk due to
misinformation, misconceptions, and misperceptions. Therefore, interventions that have demonstrated efficacy
in preventing the use of alcohol and other drugs may need to be adapted to specifically address the risks
associated with vaping. Tailoring interventions to these unique challenges is crucial to achieve the intended
impact and reduce the prevalence of vaping among Indigenous youth. However, no evidence-based
interventions exist for urban Indigenous youth. For over a decade, our team has collaborated with Phoenix
Indian Center to adapt and test substance use interventions for urban Indigenous youth. Now, Phoenix Indian
Center has prioritized nicotine and cannabis vaping as the most problematic substances in the local urban
Indigenous community. To address this community-driven priority with our long-term community partner, we
now propose to build upon our extensive experience to rigorously test the efficacy of the evidence-based
substance use prevention intervention, Living in 2 Worlds, adapted to include salient multilevel risk and
protective factors for vaping for urban Indigenous adolescents. We will also examine barriers and facilitators of
implementation to increase sustainability and the likelihood of real-world impact in eliminating racial and ethnic
disparities in substance use. To further ensure that the Living in 2 Worlds intervention is designed,
implemented, evaluated, and disseminated for cultural relevance and community specificity, we will engage an
Indigenous Youth Advisory Board throughout the research process. Our long-term goal is to build the evidence
to scale preventive vaping interventions across urban Indigenous communities in the U.S. As the next step
towards this goal, we propose the following: Aim 1: Identify multilevel risk and protective factors for nicotine
and cannabis vaping among urban Indigenous youth to adapt the Living in 2 Worlds intervention. Aim 2: Test
the efficacy of the adapted Living in 2 Worlds intervention for preventing initiation and reducing use of nicotine
and cannabis vaping, decreasing key risk factors for vaping initiation, and increasing skills that protect against
vaping. Aim 2b. Identify implementation barriers and facilitators of Living in 2 Worlds. Aim 3: Advance the
science for engaging youth throughout the research process.
