Leveraging Community-Engaged Research to Co-Create Youth Vaping Prevention with Urban Indigenous Communities of the Southwest ABSTRACT The prevalence and early initiation of nicotine vaping among Indigenous youth surpass that of all other racial/ethnic groups. This concerning trend is prominent in urban environments, where approximately 60% of Indigenous youth reside. In urban settings, multilevel influences heighten risks for nicotine and cannabis vaping among Indigenous adolescents, including the intricate navigation of ethnic identity, which can compound challenges these youth face. Preventing adolescent nicotine and cannabis vaping is further complicated by the unique characteristics of vaping products. Their ease of concealability, the ability to purchase online, and the lower perception of adverse health consequences contribute to their attractiveness. Even among youth who successfully avoid traditional cigarette smoking, vaping nicotine remains a risk due to misinformation, misconceptions, and misperceptions. Therefore, interventions that have demonstrated efficacy in preventing the use of alcohol and other drugs may need to be adapted to specifically address the risks associated with vaping. Tailoring interventions to these unique challenges is crucial to achieve the intended impact and reduce the prevalence of vaping among Indigenous youth. However, no evidence-based interventions exist for urban Indigenous youth. For over a decade, our team has collaborated with Phoenix Indian Center to adapt and test substance use interventions for urban Indigenous youth. Now, Phoenix Indian Center has prioritized nicotine and cannabis vaping as the most problematic substances in the local urban Indigenous community. To address this community-driven priority with our long-term community partner, we now propose to build upon our extensive experience to rigorously test the efficacy of the evidence-based substance use prevention intervention, Living in 2 Worlds, adapted to include salient multilevel risk and protective factors for vaping for urban Indigenous adolescents. We will also examine barriers and facilitators of implementation to increase sustainability and the likelihood of real-world impact in eliminating racial and ethnic disparities in substance use. To further ensure that the Living in 2 Worlds intervention is designed, implemented, evaluated, and disseminated for cultural relevance and community specificity, we will engage an Indigenous Youth Advisory Board throughout the research process. Our long-term goal is to build the evidence to scale preventive vaping interventions across urban Indigenous communities in the U.S. As the next step towards this goal, we propose the following: Aim 1: Identify multilevel risk and protective factors for nicotine and cannabis vaping among urban Indigenous youth to adapt the Living in 2 Worlds intervention. Aim 2: Test the efficacy of the adapted Living in 2 Worlds intervention for preventing initiation and reducing use of nicotine and cannabis vaping, decreasing key risk factors for vaping initiation, and increasing skills that protect against vaping. Aim 2b. Identify implementation barriers and facilitators of Living in 2 Worlds. Aim 3: Advance the science for engaging youth throughout the research process.

PUBLIC HEALTH IMPACT STATEMENT Preventive vaping interventions are critically needed that target the unique multilevel risk and protective factors of urban Indigenous youth; however, no such evidence-based interventions currently exist. The proposed study will test if a youth intervention can prevent nicotine and cannabis vaping for urban Indigenous youth. This research should provide important information that can be used to prevent and reduce vaping disparities among urban Indigenous youth and the downstream harmful impact on health disparities.