Youth-Led Grassroots Health Communication: Clearing the Haze Around Hookah

Background: Youth hookah use rates have quickly surpassed youth cigarette smoking rates in New Mexico, with 21.9% of high school youth reporting having smoked hookah in the past 30 days.  Hookah use is not seen as a significant issue among youth or adults in New Mexico, as there are many misconceptions regarding its safety.

To address the knowledge gap and the rise in youth hookah use, the New Mexico Department of Health Tobacco Use Prevention and Control (TUPAC) Program funded Clear The Haze (CTH) in 2014.  CTH is a comprehensive grassroots health communications campaign working to educate parents and youth online, on-the-ground, and in the media.

Program background:The CTH campaign utilizes in-person interactions that are measurable and locally-driven, as well as digital media that provide cost-effective reach and repetition of messages to a large proportion of the campaign audience.

High school youth are trained as activists in their communities to drive in-person, local interactions.  These interactions include educational presentations to schools, parents, and community groups; school and community-based events; and one-on-one educational conversations. Youth collect Measures of Progress in order to track and evaluate the campaign’s effectiveness. Measures of Programs are simple data collection instruments that are easy to administer, such as surveys or quizzes.  In Year 1, CTH began collecting surveys to assess knowledge, access, and opinions of hookah. In Year 2, CTH developed a discussion-based quiz to engage youth and adults via in-person educational conversations about the dangers of hookah and to evaluate the impact of each interaction.

CTH utilizes Facebook, Instagram, and YouTube, allowing the campaign to cost-effectively reach its audience, tailor communication to each group (youth and adults) separately, and retarget the audience once they have engaged with the campaign, such as by viewing a video or clicking on an advertisement.

Evaluation Methods and Results: In Year 1, CTH collected 9,672 surveys to assess hookah knowledge and access. More than half (57.2%) of New Mexicans either thought hookah was safer than cigarettes or were not sure (22.8% said safer, 34.4% not sure). In Year 2, CTH organized over 35 school or community-based educational events and will have collected more than 10,000 discussion-based quizzes.  This amounts to more than 10,000 in-person interactions statewide. To date, 82% of discussion-based quiz-takers report learning something new about hookah, while 81% said they will talk to friends or family about the dangers of hookah. Between March 1 and March 17, the digital ad campaign spent $1,342.00 to reach 99,399 New Mexicans (69,867 parents & 29,532 youth) and generated 60,637 views of a flagship campaign commercial.

Conclusions: A blend of grassroots and digital strategies can be utilized to effectively implement a comprehensive health communications strategy that creates the reach and repetition required to drive knowledge change.

Implications for research and/or practice: Public health professionals can create cost-effective, impactful health communication campaigns using locally-driven in-person interaction and digital strategies without the use of a traditional mass media campaign.