Co-design of the 'OurFutures Vaping' programme: a school-based eHealth intervention to prevent e-cigarette use

Effective preventive interventions are urgently needed to address e-cigarette use ('vaping') and related harms among young people. There is a strong evidence base supporting the delivery of substance use preventive interventions in the school setting, and eHealth interventions can overcome common implementation barriers. However, there is a dearth of effective school-based e-cigarette preventive interventions available. This study summarizes the co-design and user testing of the 'OurFutures Vaping' programme, a universal school-based eHealth preventive intervention targeting e-cigarette use. The intervention is based on the effective 'OurFutures' prevention model, which adopts a harm minimization and comprehensive social influence approach to prevention and delivers content via interactive cartoons and supporting resources. Beginning in March 2022, the development process involved four iterative stages: (i) scoping of the literature; (ii) consultations with young people (n = 34; 14-16 years) to understand attitudes and perceptions about e-cigarettes/tobacco cigarettes and develop cartoon character profiles and storylines; (iii) content and web development; and (iv) user testing and refinement with students (n = 37; 13-14 years) and teachers (n = 13). Key areas for improvement included lesson length, believability and relevance of some storylines, incorporating resources on e-cigarette addiction and cessation, and tweaking illustrations. Refinements were made and the final intervention comprised four 40 min online cartoon lessons with accompanying teacher-facilitated activities, factsheets, and resources. The 'OurFutures Vaping' programme is the first school-based e-cigarette preventive intervention in Australia to be developed via iterative co-design, grounded in evidence, and to undergo rigorous evaluation (cluster randomized controlled trial, 2023-26), holding the potential to make significant health and economic impact.