Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Social media has numerous applications for health promotion and disease prevention efforts, and the benefits of using social media for public health communication have been documented. Generating participant engagement is vital for effective health promotion, and increases the likelihood of effecting sustainable behavior change. However, there is limited evidence on effective strategies for engaging Latino immigrant youth using social media. The authors, as part of the Avance Center for the Advancement of Immigrant/Refugee Health, implemented Adelante, a branded primary prevention program (2012-2017) to address risk factors for co-occurring substance use, sexual risk and interpersonal violence among Latino immigrant adolescents, ages 12-19 in a Washington, DC suburb. Objective: We established the Adelante Facebook fan page in October of 2013, and the Adelante social marketing campaign utilized this platform for campaign activities from September 2015 to September 2016. This study had the following aims: 1) to characterize Adelante participant Facebook reach and engagement; 2) to identify post content and features that resulted in greater user engagement; and 3) to examine the content and features of the most engaging posts to identify patterns and compare to all posts. Methods: We used Facebook Insights metrics to examine reach and post engagement of Adelante Facebook page fans (n=743). Data consisted of Facebook fan page posts between October 1, 2013 and September 30, 2016 (n=871). We developed a two-phased mixed-methods analytical plan and coding scheme, and explored the association between post content/features and Post Engagement by conducting separate one-way ANOVA tests. For variables with samples sizes below 50 for an IV, we used the non-parametric Wilcoxon-Mann Whitney test. We used a p-value of p<.05 to determine statistical significance. Results: The Adelante Facebook page reached a total of 739 fans with 871 posts. There were a total of 34,318 post clicks, 473 post comments, 9,080 post likes/reactions, and 617 post shares. Post content categories that were statistically significantly associated with user engagement included: Adelante program updates (F=24.654, P<.001); youth achievement showcases (P=.001); news links (F=12.501, P<.001); and prevention topics, including substance abuse (P<.001), safe sex (P=.01), STDs (P<.001), and violence/fighting (P=.04). Post features that were associated with user engagement included: Spanish language (F=3.546, P=.02); portrayal of mixed gender youth (F=10.122, P=.002) in groups (F=16.613, P<.001); boosting (F=44.821, P<.001); and synchronicity with the social marketing campaign (F=8.125, P<.001). Conclusions: Youth were particularly interested in social media posts insofar as they were an extension of the in-person activities. We recommend that programs include online efforts that intersect with in-person programming as a strategy to augment youth engagement. Additionally, social media prevention messages and posts should be created in collaboration with the intended audience, thus including content and features that are most likely to result in youth engagement.

Background: Substance use by adolescents remains to be at unacceptably high levels, and there is evidence that teens’ social norms are becoming more favorable toward recreational use and perceived safety of substances such as marijuana and prescription opioids. Social media offer a low-cost, potentially high-impact approach to disseminate 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 aimed to evaluate the effects of exposure to LTE-based social media on students in the youth ambassadors’ networks. Methods: The George Washington (GW) University designed and implemented a quasi-experimental evaluation of the LTE program in 3 Maryland high schools. Before program launch, a sample of 826 students (wave 1) at the 3 schools, drawn from a census of freshmen enrolled in a class attended by all students at the grade level, completed a survey. A total of 584 students were surveyed at the wave 2 program midpoint and 542 at the wave 3 endpoint. The survey contained questions on drug use–related attitudes, beliefs, intentions, and behaviors, all based on validated measures. We evaluated the effects of LTE on the intended next 30-day drug use, and controlling for LTE self-reported exposure, age, and gender from waves 2 and 3 was appended into a single dataset. We first conducted ordinal logistic regressions for each drug use intention in wave 3 (ie, sell or distribute illegal drugs, smoke cigarettes, drink beer/wine/hard liquor when parents do not know about it, use marijuana, use lysergic acid diethylamide, cocaine, amphetamines or other illegal drugs, use heroin, use synthetic drugs, and use any prescription pills without a prescription) to examine the association between LTE exposure and drug use intentions. We included an interaction term for the study wave to examine intervention effects. 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 do not know about it; use marijuana; use 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 intentions between the second and third survey waves for all 8 measured drug use variables. Conclusions: Overall, the results are consistent with and indicate a stronger LTE effect in this study compared with a previous pilot study. LTE appears to offer a protective effect, with exposure to program messages leading to reduced/improved drug use intentions.

Entertainment-education (E-E) approaches for young audiences continue to evolve in order to keep stride with younger generations’ affinity for technology. E-E and novelas have been used with a wide variety of audiences in the United States, in particular hard-to-reach Latino populations, and have demonstrated effectiveness in disseminating culturally relevant prevention information for a wide variety of health-related risk factors and behaviors. This study discusses the formative research and active engagement of Latino youth living in Langley Park, Maryland, for the development and filming of an innovative 6-episode webnovela titled Victor and Erika (V&E). V&E is part of a larger branding strategy of the Adelante Positive Youth Development intervention that seeks to prevent substance abuse, sexual risk, and interpersonal violence among Latino youth; V&E is also an intervention component. The V&E webnovela is a dramatic portrayal of the lives of 2 immigrant Latino teenagers that also disseminates risk prevention messages. The storyline represents the turning the corner (to a better life) theme that underlies the Adelante intervention brand. Formative research was conducted for character development (n = 20) and creative development of the episodes (n = 14). Results of the formative research showed that youth recommended inclusion of the following topics in V&E episodes: sex, unintended pregnancy, fidelity, trust, family dynamics, immigration status, violence, school dropout, respect, home life, and poverty. Detailed character and episode descriptions are provided, and the implications of using the V&E series as a tool for in-person and online engagement of youth and the dissemination of prevention messages are also discussed.

This study assessed the Government of Puerto Rico’s crisis and emergency risk communications following Hurricane María and the post-disaster information environment to identify factors that may have contributed to negative public perceptions of mortality reports. Data included Government of Puerto Rico press releases, press conference audio recordings and Facebook Live transmissions, digital media news and social media commentary, and interviews with Government of Puerto Rico personnel and community stakeholders. Study findings indicate that inadequate crisis communication planning and training, coupled with information gaps and inconsistencies, contributed to rumors around the issue of mortality. As a consequence, the Government of Puerto Rico lost the ability to effectively manage messaging, thus decreasing their credibility, perceived transparency, and public trust. Recommendations regarding future preparedness activities and research are offered.

Immigrant Latino youth represent a high-risk subgroup that should be targeted with health promotion efforts. However, there are considerable barriers to engagement in health-related programming. Little is known about the engagement possibilities of social marketing campaigns and digital strategies for traditionally ‘hard-to-reach’ immigrants, underscoring the importance of testing these techniques with immigrant Latino adolescents. We developed and piloted a place-based social marketing campaign in coordination with the branded, Positive Youth Development-based (PYD) Adelante intervention targeting risk factors for co-occurring youth substance abuse, sexual risk and violence. Building on prior research, we conducted a four-phase formative research process, and planned the Adelante social marketing campaign based on findings from one group interview and ongoing consultation with Adelante staff (n=8) and four focus groups with youth (n=35). Participants identified four overarching campaign themes, and suggested portrayal of resilient, proud youth who achieved goals despite adversity. Youth guided selection of campaign features and engagement strategies, including message/visual content, stylistic elements, and a mixed language approach. We developed a 12-month campaign to be delivered via print ads, multi-platform social media promotion, contests, youth-generated videos, blog posts, and text messaging. We describe the process and outcome of campaign development and make recommendations for future campaigns.

This article outlines the theory and resulting approach employed in a multilevel, integrated, collaborative community intervention called Adelante, implemented by a university–community partnership in a Latino immigrant community to address co-occurring health disparities of substance abuse, sex risk, and interpersonal violence among youth. The basis for the intervention is a social–ecological interpretation of positive youth development theory, which focuses on changes in the person environment context and community assets as a preventive mechanism. This approach is viewed as appropriate for a community facing multiple barriers to health equity. The article describes the translation of this positive youth development model to practice, including the design of the intervention, intervention components, and the protocol for evaluation. The Adelante intervention is intended to reduce health disparities and, in addition, to add a broader community model to the evidence base.