Chen Yu, Lin Shujun, Lin Haoxiang, Wang Zining, Zhao Xinjie, Ao Peng, Cai Yujiang, Xu Jing, Yu Xinyao, Yang Xinrui, Chan Kin-Sun
School of Art and Communication, Fujian Polytechnic Normal University, Fuqing, China.
Institute for Global Health and Development, Peking University, Beijing, China.
Tob Induc Dis. 2025 Sep 13;23. doi: 10.18332/tid/208715. eCollection 2025.
E-cigarette use among young adults represents a growing public health concern. This pilot randomized controlled trial evaluated the preliminary effects of Protection Motivation Theory (PMT)-based peer education on strengthening university students' cognition to refuse e-cigarette use in China, where tobacco control policies remain limited.
A total of 289 participants completed baseline assessment and were randomly assigned to an intervention group (n=144) and a control group (n=145). The intervention consisted of a 1-month peer education program in which trained peer educators delivered PMT-based messages through weekly one-on-one conversations via phone or messaging platforms. Intervention participants received messages addressing all seven PMT constructs, while control participants received only messages about health risks of two PMT constructs. Primary outcomes were four PMT-based cognitive appraisals measured at baseline, 1 month, and 3 months. Linear mixed-models examined group × time interactions, and effect sizes were calculated for all comparisons.
No statistically significant between-group differences were observed for primary outcomes. Subgroup analysis revealed significant intervention effects at 3 months among participants with family or friends who used cigarettes/e-cigarettes: lower perceived rewards (mean difference= -0.55; 95% CI: -1.07 - -0.03, p=0.04) and greater perceived efficacy (mean difference=0.34; 95% CI: 0.06-0.62, p=0.02).
While overall effects were not statistically significant, observed effect sizes and significant subgroup findings suggest PMT-based peer education may influence cognitive precursors to e-cigarette use, particularly among students with social exposure to tobacco use. Larger trials with extended follow-up periods are warranted to confirm these preliminary findings.
年轻人使用电子烟已成为一个日益严重的公共卫生问题。在中国，烟草控制政策仍然有限，这项初步的随机对照试验评估了基于保护动机理论（PMT）的同伴教育对增强大学生拒绝使用电子烟认知的初步效果。
共有289名参与者完成了基线评估，并被随机分配到干预组（n = 144）和对照组（n = 145）。干预措施包括为期1个月的同伴教育项目，受过培训的同伴教育者通过每周一次的电话或信息平台一对一交流传递基于PMT的信息。干预组参与者收到涉及所有七个PMT构成要素的信息，而对照组参与者只收到关于两个PMT构成要素健康风险的信息。主要结局是在基线、1个月和3个月时测量的四个基于PMT的认知评估。线性混合模型检验组×时间交互作用，并计算所有比较的效应量。
主要结局在组间未观察到统计学上的显著差异。亚组分析显示，在有使用香烟/电子烟的家人或朋友的参与者中，3个月时干预效果显著：感知奖励较低（平均差异 = - 0.55；95%置信区间：- 1.07 - - 0.03，p = 0.04），感知效能较高（平均差异 = 0.34；95%置信区间：0.06 - 0.62，p = 0.02）。
虽然总体效果在统计学上不显著，但观察到的效应量和显著的亚组结果表明，基于PMT的同伴教育可能会影响电子烟使用的认知先兆，特别是在有烟草使用社交接触的学生中。有必要进行更长随访期的更大规模试验来证实这些初步发现。
