Study protocol for the Breathe Easy All Together e-cigarette prevention program: a RE-AIM framework-based experimental process and impact evaluation.

BACKGROUND: Effective preventative interventions are urgently needed to address the increasing rates of e-cigarette use among young people and to complement the Australian government's latest tobacco control measures. School-based interventions using peer leaders can effectively shape social norms and expectations associated with tobacco use. This paper describes the protocol for the Breathe Easy All Together (BEAT) study, a process and impact evaluation of the first school-based peer-leadership intervention to prevent adolescent e-cigarette use in Australia.

METHODS: A pre-post test design will be used to conduct process and impact evaluation of the BEAT program using the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework. The intervention utilises a multi-component peer-education model driven by students, to promote respiratory health and resist e-cigarette use within a supportive school environment. Volunteer Year 10 students (14- to 16-years-old) will be trained by the research team as peer leaders, to deliver two 60-min lessons to Year 7 students (11- to 13-years-old) during routine health education classes. Year 10 peer leaders and Year 7 students will complete online self-report surveys pre- and post-program to assess changes in the primary outcome of past-30-day e-cigarette use. Secondary outcomes include tobacco use behaviours, e-cigarette knowledge, perceptions, refusal skills, intentions to use e-cigarettes, and acceptability of intervention components. School staff involved in the delivery of the program will participate in semi-structured interviews to examine acceptability and factors affecting program implementation. Descriptive statistics and changes between data collection points will be assessed using Wilcoxon signed rank tests to investigate intervention effect on primary and secondary outcomes. Qualitative data will be analysed in alignment with RE-AIM constructs using Framework Analysis.

DISCUSSION: Building upon an evidence-based peer-education model, BEAT presents a novel peer-led solution to address a gap in current research practice to prevent adolescent e-cigarette use in Australia. It has the potential to protect the future health and wellbeing of students from the harms of e-cigarette use and nicotine addiction. The RE-AIM framework is a comprehensive approach to conducting robust evaluation of multi-faceted interventions in the school environment. If effective, funding support will be sought for wider dissemination and further evaluation.