Youth experiencing homelessness and housing instability (YEH) face disproportionate health risks and structural barriers to health equity, which were intensified during the COVID-19 pandemic. We conducted a community-based participatory research study with 21 adolescents (ages 13–17) and transitional-aged youth (ages 18–26) experiencing homelessness or housing instability in San Diego, California, USA. Between February and July 2023, we conducted six “arts-based engagement sessions” (5 in English, 1 in Spanish) that blended expressive arts and focus group approaches to examine how YEH accessed, evaluated, and applied health information, and how trust and material and structural resource constraints shaped engagement with COVID-19 information and prevention guidance. We analyzed data via applied thematic analysis. Participants described how COVID-19 restrictions and economic disruption amplified pre-existing housing precarity, worsening material conditions and mental health. Participants selectively trusted COVID-19 information based on who provided it, how credible it felt, and whether it aligned with their lived experiences. Community-based providers and, for some, churches and cultural or ancestral knowledge were key information sources. Trust in government and public health messaging was conditional and shaped by perceptions of credibility, coherence, and political motivation. Participants described information overload and rapidly changing guidance as overwhelming and often incompatible with their material realities, leading to disengagement, reliance on intuition, or deprioritization of prevention behaviors. Effective communication during future health emergencies must center trusted relational messengers, align guidance with lived realities, and address the structural conditions that shape whether health information can be meaningfully acted upon.

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 Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn.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: Youth experiencing homelessness and housing instability exhibit disparities in tobacco use and co-use of tobacco and cannabis products compared to their stably housed peers. Interventions to address these disparities have had limited success to date. This may be related to a lack of fit between intervention approaches and the unique needs and preferences of this marginalized population. Leveraging strategies to facilitate authentic engagement of youth in intervention research, including collaborating with youth in the cocreation of intervention goals and strategies, presents an opportunity to overcome challenges of previous research to mitigate tobacco-related disparities among youth experiencing homelessness and housing instability. Objective: This protocol aims to engage youth collaborators in intervention research to address tobacco-related disparities among youth experiencing homelessness and housing instability. It outlines strategies to recruit and partner with youth to cocreate a strengths-based, expressive arts intervention to reduce harms associated with tobacco use and tobacco/cannabis co-use and evaluate our youth engagement strategies. Methods: The community and academic partners leading this intervention study developed a structure that allows for two levels of youth collaboration. This structure, developed through consultation with a youth action board, facilitates youth (aged between 14 and 26 years) involvement in intervention design, implementation, and pilot testing. At the higher collaboration level, youth will join the intervention research team as “co-researchers,” engaging weekly with study-related tasks and contributing equitably to the research processes (eg, selecting intervention strategies and supporting data analysis) in alignment with their personal and professional goals. At the lower collaboration level, youth will engage with the research team as “advisors,” providing targeted feedback at key points during intervention development. Brief surveys, field notes, ethnographic memos, focus group discussions, and semistructured interviews will be used to evaluate our process and impact among the engaged youth. Results: To date, we have engaged 7 co-researchers who have participated in several capacity-building and professional development activities, including research ethics training and tobacco prevention advocacy training. Co-researchers have contributed to intervention development brainstorming sessions, evaluated available interventions to address youth tobacco use, and developed materials to expand the group of co-researchers and advisors. Preliminary data suggest sufficient youth engagement (study goal of engaging 10 co-researchers in a 2-year study period) and that engagement processes are highly acceptable to youth collaborators. Lessons learned to date have helped us to improve and refine our engagement processes (eg, technological barriers). Conclusions: This protocol describes a holistic approach to equitably and authentically engaging youth as collaborators in intervention research to address tobacco-related disparities among youth experiencing homelessness and housing instability. The approach may serve as a useful model that can be adapted for other youth-focused intervention research.

Background: Youth experiencing homelessness and housing instability exhibit disparities in tobacco use and co-use of tobacco and cannabis products compared to their stably housed peers. Interventions to address these disparities have had limited success to date. This may be related to a lack of fit between intervention approaches and the unique needs and preferences of this marginalized population. Leveraging strategies to facilitate authentic engagement of youth in intervention research, including collaborating with youth in the cocreation of intervention goals and strategies, presents an opportunity to overcome challenges of previous research to mitigate tobacco-related disparities among youth experiencing homelessness and housing instability. Objective: This protocol aims to engage youth collaborators in intervention research to address tobacco-related disparities among youth experiencing homelessness and housing instability. It outlines strategies to recruit and partner with youth to cocreate a strengths-based, expressive arts intervention to reduce harms associated with tobacco use and tobacco/cannabis co-use and evaluate our youth engagement strategies. Methods: The community and academic partners leading this intervention study developed a structure that allows for two levels of youth collaboration. This structure, developed through consultation with a youth action board, facilitates youth (aged between 14 and 26 years) involvement in intervention design, implementation, and pilot testing. At the higher collaboration level, youth will join the intervention research team as “co-researchers,” engaging weekly with study-related tasks and contributing equitably to the research processes (eg, selecting intervention strategies and supporting data analysis) in alignment with their personal and professional goals. At the lower collaboration level, youth will engage with the research team as “advisors,” providing targeted feedback at key points during intervention development. Brief surveys, field notes, ethnographic memos, focus group discussions, and semistructured interviews will be used to evaluate our process and impact among the engaged youth. Results: To date, we have engaged 7 co-researchers who have participated in several capacity-building and professional development activities, including research ethics training and tobacco prevention advocacy training. Co-researchers have contributed to intervention development brainstorming sessions, evaluated available interventions to address youth tobacco use, and developed materials to expand the group of co-researchers and advisors. Preliminary data suggest sufficient youth engagement (study goal of engaging 10 co-researchers in a 2-year study period) and that engagement processes are highly acceptable to youth collaborators. Lessons learned to date have helped us to improve and refine our engagement processes (eg, technological barriers). Conclusions: This protocol describes a holistic approach to equitably and authentically engaging youth as collaborators in intervention research to address tobacco-related disparities among youth experiencing homelessness and housing instability. The approach may serve as a useful model that can be adapted for other youth-focused intervention research. International Registered Report Identifier (IRRID): DERR1-10.2196/69441