Pilot study protocol to increase resistance to peer pressure in tobacco use among nursing students (T-RESIST)

Pilot study protocol to increase resistance to peer pressure in tobacco use among nursing students (T-RESIST) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Pilot study protocol to increase resistance to peer pressure in tobacco use among nursing students (T-RESIST) Chareni Itzel Vázquez Jiménez, Angélica Susana López Arellano, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7683017/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background: In Mexico, tobacco use represents one of the leading threats to public health, being associated with thousands of preventable deaths and diseases. Social factors, such as peer pressure, play a significant role in the initiation of tobacco use among young people, who seek acceptance and identity. Although intervention studies exist, few address peer pressure comprehensively and from a theoretical framework. Therefore, a psychoeducational intervention is proposed for university students, with the aim of assessing its acceptability and feasibility, as well as exploring changes in self-esteem, emotional dependence, and social skills. Its contribution lies in providing preliminary evidence for future large-scale clinical trials. Methods: The study was designed as a prospective, single-arm pilot. Nursing students from a faculty in Veracruz will participate, with a recruitment target of 30 students aged 18 years or older. The group intervention consists of four 50-minute sessions, in addition to pre- and post-test evaluations, addressing peer pressure, self-esteem, social skills, and emotional dependence. Discussion: Tobacco use among young people is a multifactorial problem in which peer pressure constitutes a central factor. The proposed psychoeducational intervention seeks to strengthen resistance, promote self-esteem, enhance social skills, and address emotional dependence. Its implementation entails practical challenges, including student participation, retention, logistical organization, and resource availability. This study will allow for the evaluation of the intervention’s acceptability and feasibility, generating preliminary evidence for future trials. The findings will contribute to the design of evidence-based preventive strategies relevant to the university setting and adolescent public health. Trial registration UMIN000059102. peer pressure tobacco use social skills self-esteem prevention emotional dependence young adults university students. Background In Mexico, each year approximately 50,000 people develop illnesses caused by tobacco consumption [ 1 ], and 8.4% of deaths are attributable to tobacco-related diseases [ 2 ]. Consequently, tobacco use is considered one of the major threats to public health. This is largely due to the fact that conventional cigarette smoke contains more than seven thousand toxic chemical substances that affect nearly all organs of the body [ 3 ]. Tobacco use is influenced by a series of personal and social factors, such as curiosity, the desire to belong, the influence of peers, and family environment. However, peer pressure plays a particularly important role in the initiation and continuation of tobacco use [ 4 ]. In this regard, it has been observed that the onset of tobacco use among young people is strongly associated with peer pressure, where the need for social acceptance and the imitation of group behaviors are key determinants between the ages of 15 and 19, a developmental stage in which adolescents are seeking their own identity [ 5 ]. Consistent with this, some intervention studies have indicated that young people often fail to adequately recognize or effectively cope with peer pressure [ 6 , 7 ]. Nevertheless, few studies have addressed peer pressure comprehensively and from a theoretical framework [ 8 – 9 ]. Therefore, the purpose of this proposal is to strengthen young people’s resistance to peer pressure and prevent the initiation of tobacco use. To achieve this, the intervention is structured under a preventive and psychological approach, employing group techniques that promote the development of knowledge, skills, and attitudes. Following the framework proposed by Sidani and Braden [ 10 ], a logic model of the problem was constructed using Roy’s Adaptation Model (1991) as the theoretical foundation and empirical evidence to integrate the proposed intervention [ 11 ]. These approaches made it possible to identify that one of the factors leading young people to engage in tobacco use is peer pressure, in addition to other elements such as low self-esteem—which renders them vulnerable to body-related insecurities [ 12 ]; emotional dependence, understood as an excessive or extreme need for another person [ 13 ]; and a lack of social skills to cope with stress or to refuse undesired activities. At this developmental stage, many young people seek to conform to social expectations due to fear of rejection [ 14 ]. Based on the above, this study proposes the design of a psychoeducational intervention aimed at reducing peer pressure related to tobacco use among university students (T-RESIST). The primary objective is to evaluate the acceptability and feasibility of the intervention for application in academic settings. The secondary objective is to determine whether participation in the intervention produces changes in self-esteem, emotional dependence, social skills, and susceptibility to peer pressure for tobacco use. This pilot study will not include formal hypothesis testing, as it does not have sufficient power to detect clinically significant changes in outcomes. However, the preliminary results will provide evidence to determine whether the intervention may be effective in a larger-scale clinical trial. Methods Study Design This pilot study will be conducted exclusively within the nursing faculty of a public university in Poza Rica de Hidalgo, Veracruz, using a prospective single-arm design. Outcomes will be assessed at baseline, post-intervention, and six months after the intervention. Sample Size A sample of 30 students will be selected to assess the feasibility of the T-RESIST intervention, focusing on practical considerations and the precision of key indicators such as recruitment, retention, acceptability, and fidelity, rather than statistical power calculations [ 15 ]. Although this pilot will be single-arm, limiting the evaluation of retention, acceptability in a control group, and randomization, the definitive trial will include a control group receiving standard care, allowing comparison of results and assessment of randomization and retention feasibility in both groups [ 10 , 15 , 16 ]. Target Population University students. For this study, participants will be undergraduate nursing students. Inclusion Criteria Undergraduate nursing students aged 18 years or older, whether they are conventional cigarette smokers, who agree to participate and provide written informed consent. Exclusion Criteria Students with any condition that prevents them from performing the cognitive or physical activities required during the intervention. Recruitment and Informed Consent Process Participants will be recruited at the nursing faculty of a public university in Poza Rica de Hidalgo, Veracruz, Mexico. Students will be invited to participate in person within their academic settings. Those who agree to participate will be presented with the intervention proposal, including objectives, components, activities, sessions, and dosage. Interested students will receive an informed consent form describing their rights during participation. They will also be assured that all information will be treated confidentially for research purposes, and that the intervention does not pose health risks to participants [ 17 ]. Intervention The T-RESIST intervention will be delivered in groups, consisting of four active sessions plus two evaluation sessions (pre-test and post-test), each lasting 50 minutes (Table 1 ). The sessions will address strategies to recognize and cope with peer pressure, enhance self-esteem to resist peer influence, reduce emotional dependence on friendships, and develop social skills to avoid yielding to pressure for the sake of group acceptance. At the end of the sessions, evaluations will be conducted through games, activities, and group logs (Table 2 ). Each participant will receive a manual detailing every activity and its duration. Manuals will also be provided to the logistics coordinator, observer, and participants, while the interventionist will retain a copy for guidance. Measurements for Acceptability The acceptability of the T-RESIST intervention will be evaluated qualitatively through a focus group interview guide conducted at the beginning of the intervention, during, and at the end of each session. Sample guiding questions include, Do I feel motivated to participate in an intervention focused on peer pressure related to tobacco use? Do I consider it valuable to discuss and reflect on strategies to resist peer pressure? Do I believe this intervention can strengthen my ability to make autonomous decisions when facing peer pressure? Are the focus and content of the intervention appropriate for my age and academic stage? What are your thoughts on the duration and total number of sessions? Table 2 Development of T-RESIST Intervention Sessions Theoretical Component Active Ingredient Component Session Activities Focal Stimulus: Peer pressure to use tobacco Mechanisms of peer pressure influencing tobacco use among university students Recognition of peer pressure mechanisms in university students Session 1 Workshop on peer pressure mechanisms related to tobacco use Coping Processes: Social skills Social skills to resist peer pressure for tobacco use among university students Application of coping strategies to manage peer pressure to use tobacco Session 2 Training to improve social skills and develop assertiveness; Development of assertive communication skills among students to resist peer pressure Modes of Adaptation: Self-esteem Improvement of self-esteem to resist peer pressure for tobacco use among university students Strengthening self-esteem to resist peer pressure for tobacco use Session 3 Workshop on personal recognition as the foundation for self-esteem development Interdependence: Emotional dependence Improving emotional autonomy to resist peer pressure for tobacco use among university students Strengthening self-concept and skills to resist peer pressure; Promoting non-dependence on peers Session 4 Reinforcement of students’ self-concept, fostering resistance to peer pressure for tobacco use; Development of non-dependence on peers Measurements for Feasibility Feasibility of T-RESIST will be assessed through recruitment rate, acceptance and participation rates, retention rate, and completion and follow-up rates. Measurements for Preliminary Outcomes Peer Pressure: The Peer Pressure Resistance Scale for Conventional Cigarette Use in University Students, consisting of 13 items with Likert-type response options ranging from never to always, with a Cronbach’s alpha of 0.85 [ 4 ]. Self-Esteem: The Coopersmith Self-Esteem Inventory (1967) consisting of 58 items with response options of like me and not like me, with a Cronbach’s alpha of .79.[ 18 ] Social Skills: The Social Skills Inventory, which includes 38 items with Likert-type responses ranging from never or rarely to always or almost always, with a Cronbach’s alpha of .80.[ 19 ] Emotional Dependence on Friendships: The Emotional Dependence Scale [ 20 ], consisting of 12 items with five Likert-type response options ranging from strongly disagree to strongly agree, with a Cronbach’s alpha of 0.93. Qualitative Evaluation Instruments To qualitatively assess the effects of T-RESIST on participants, the guiding questions listed in Table 3 will be used. Procedure For the formal implementation of T-RESIST, the necessary permissions will be obtained from the university administration and the institutional ethics committee, ensuring compliance with ethical principles for research involving human subjects. An informational session will then be held with students to explain the objectives, methodology, duration, topics, and benefits of T-RESIST, followed by a 10-item questionnaire to assess expectations and preferences. Once informed consent is obtained, a pretest will be administered to evaluate participants’ knowledge, attitudes, behaviors, and skills. The intervention will then be implemented, with each session audio-recorded for subsequent transcription and analysis, ensuring confidentiality of the data. Finally, a post-test will be applied immediately after T-RESIST and again at six months to assess changes attributable to the intervention. Table 3 Questions for Assessing the Preliminary Qualitative Effects of the T-RESIST Intervention Component Question Self-esteem How did this intervention help you trust yourself more in order to say “no” to tobacco despite peer pressure? Social skills How did this intervention help you develop assertive social skills to resist peer pressure regarding tobacco use? Peer pressure How did this intervention help you manage peer pressure? Do you consider that you have improved your ability to refuse a cigarette when offered? Emotional dependence How did this intervention help you improve your emotional independence in making decisions regarding peer pressure to use tobacco? Results Criteria to Determine Feasibility For the T-RESIST intervention, the following feasibility criteria will be applied, using a green/amber/red progression system to allow more flexible interpretation of results: Recruitment rate: acceptable if ≥ 80% of the target of 30 nursing students are recruited (24–30 students, green); moderate if 60–79% are recruited (18–23 students, amber); and not feasible if < 60% are recruited (< 18 students, red). Acceptance and participation in the intervention: expected if ≥ 80% of invited students agree to participate (green); considered moderate and requiring modifications if 60–79% agree (amber); or not feasible if < 60% agree (red). Retention rate: expected if ≥ 85% of students who begin T-RESIST complete it (green); considered moderate and indicating the need for adjustments if 65–79% complete (amber); or not feasible if < 65% complete (red). Descriptive graphs and preliminary tables will be used to explore feasibility and to inform the decision to progress to a full randomized controlled trial. Criteria to Determine Acceptability The acceptability of T-RESIST will be qualitatively assessed throughout different study phases (beginning, during, and end). A high level of acceptance is anticipated among invited students, with favorable consent and completion rates. Participation in the program is expected to be associated with the acquisition of the intended outcomes, fostering positive thinking and assertive resistance to peer pressure. Preliminary Results Analysis Descriptive statistics will be used to present baseline characteristics and feasibility outcomes of T-RESIST. A paired t-test or Wilcoxon signed-rank test (depending on data distribution) will be applied to evaluate changes in outcomes before and after the intervention, reporting mean differences and 95% confidence intervals. For qualitative analysis, T-RESIST sessions and interviews will be audio-recorded and transcribed verbatim, followed by thematic analysis. Safety Reports As this is a small-scale feasibility and acceptability study, the T-RESIST intervention team will meet at the end of each session to review and document events in accordance with the protocol. Although the intervention poses minimal health risk, should any adverse emotional or psychological effects arise in a student, they will be immediately referred to the psychology department for timely care. Likewise, if unforeseen logistical issues occur during T-RESIST sessions—such as technical failures, power outages, or other unanticipated events—the intervention team will implement predefined contingency measures, such as rescheduling the session, relocating to an alternate space, or utilizing auxiliary resources, to ensure continuity and quality of the intervention. Discussion In Mexico, in 2022, the prevalence of tobacco use among individuals aged 10 to 19 years was estimated at 4.6% of adolescents and young adults, confirming its relevance as a public health problem [ 21 ]. Literature review shows that tobacco use in young people is a multicausal phenomenon, with peer pressure recognized as a significant risk factor [ 5 ]. This phenomenon results from the interaction of individual and social factors that act in complex ways to determine vulnerability to this addictive behavior. In this context, the proposed T-RESIST intervention may prove effective, as it focuses on strengthening resistance to peer pressure, improving low self-esteem, developing social skills, and addressing dependence on friendships. [ 21 ] highlight the importance of providing guidance and support to young people in need, while therapies centered on acceptance and accompaniment have demonstrated effectiveness in strengthening self-esteem and self-perception. These are complemented by the learning of assertive responses that enable young people to appropriately refuse substance offers in socially pressured contexts [ 22 ]. Within this framework, the T-RESIST psychoeducational intervention aimed at strengthening resistance to peer pressure emerges as a promising tool, as it is based on teaching and coping techniques that foster autonomy in decision-making [ 23 ]. Such interventions aim to equip young people with reliable information, practical strategies, and personal resources that strengthen self-esteem, reduce emotional dependence, and enhance the development of social skills [ 24 ]. Analyzing the feasibility and acceptability of the T-RESIST intervention designed to enhance resistance to peer pressure for tobacco use in university contexts will help optimize the intervention components while providing evidence regarding the magnitude and variability of its effects. Together, the results will contribute to designing subsequent evaluations that deepen the understanding of the role of social pressure in initiating tobacco use among young people. They will also provide a solid foundation for implementing evidence-based preventive strategies, which are more effective in educational and public health settings. This pilot study will be conducted as a single-arm trial, which limits the ability to evaluate retention and acceptability in a control group, as well as the implementation of randomization. To address this limitation, the definitive clinical trial will include a control group receiving standard care, allowing for comparison of intervention outcomes with usual practice. This design will enable the assessment of the feasibility of implementing randomization, retention of participants in both groups, and comparative acceptability of the intervention, as recommended in previous feasibility studies [ 10 , 15 ]. Abbreviations Not applicable. Declarations Ethics approval and consent to participate The Research Committee of the Faculty of Nursing, where the study will be conducted, approved the protocol under number P-ME-02-2025B . Participants will provide written informed consent prior to their involvement in this study. The consent form includes the study preamble, objectives, eligibility criteria, data collection and follow-up procedures, a summarized explanation of the intervention, the potential risks and benefits involved, voluntary participation, the right to withdraw, information regarding confidentiality and the sharing of anonymized data, as well as participant identification. Consent for publication Not applicable. Availability of data and materials Not applicable. Competing interests The authors declare no competing interests. Funding This study received no funding. Authors’ contributions CIVJ and DZH conceived the study. CIVJ, ASLA, MCSB, and DZH developed the study design and intervention and were responsible for drafting the first version of the study protocol. CIVJ is a master’s student leading the study on-site. All authors contributed to refining the study protocol and approved the final submitted manuscript. Acknowledgments Not applicable. Authors’ information 1 Master’s Student in Nursing, Faculty of Nursing, Veracruzana University, Mexico. 2 Faculty of Nursing, Autonomous University of Baja California, Mexico. 3 Faculty of Nursing, Veracruzana University, Mexico. References Medina B. Young people lead smoking statistics in Mexico [Internet]. Autonomous University of Nuevo León; 2019 [cited 2025 Sep 9]. Available from: https://www.uanl.mx/noticias/jovenes-lideran-estadistica-de-fumadores-en-mexico/ Ministry of Health. Technical sheet for the commemoration of World No Tobacco Day (WNDT) [Internet]. 2024 [cited 2025 Sep 9]. 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Intervention resources for working on social skills with adolescents: A qualitative systematic review [Internet]. 2023 [cited 2025 Sep 9]. Available from: https://ojs.rmie.mx/index.php/rmie/article/view/50/85 Supplementary Files SPIRIT2025.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 03 Feb, 2026 Reviewers invited by journal 09 Nov, 2025 Editor assigned by journal 06 Oct, 2025 First submitted to journal 03 Oct, 2025 Editorial decision: Minor revision 26 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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caused by tobacco consumption [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], and 8.4% of deaths are attributable to tobacco-related diseases [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Consequently, tobacco use is considered one of the major threats to public health. This is largely due to the fact that conventional cigarette smoke contains more than seven thousand toxic chemical substances that affect nearly all organs of the body [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTobacco use is influenced by a series of personal and social factors, such as curiosity, the desire to belong, the influence of peers, and family environment. However, peer pressure plays a particularly important role in the initiation and continuation of tobacco use [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In this regard, it has been observed that the onset of tobacco use among young people is strongly associated with peer pressure, where the need for social acceptance and the imitation of group behaviors are key determinants between the ages of 15 and 19, a developmental stage in which adolescents are seeking their own identity [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eConsistent with this, some intervention studies have indicated that young people often fail to adequately recognize or effectively cope with peer pressure [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Nevertheless, few studies have addressed peer pressure comprehensively and from a theoretical framework [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Therefore, the purpose of this proposal is to strengthen young people\u0026rsquo;s resistance to peer pressure and prevent the initiation of tobacco use. To achieve this, the intervention is structured under a preventive and psychological approach, employing group techniques that promote the development of knowledge, skills, and attitudes. Following the framework proposed by Sidani and Braden [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], a logic model of the problem was constructed using Roy\u0026rsquo;s Adaptation Model (1991) as the theoretical foundation and empirical evidence to integrate the proposed intervention [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThese approaches made it possible to identify that one of the factors leading young people to engage in tobacco use is peer pressure, in addition to other elements such as low self-esteem\u0026mdash;which renders them vulnerable to body-related insecurities [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]; emotional dependence, understood as an excessive or extreme need for another person [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]; and a lack of social skills to cope with stress or to refuse undesired activities. At this developmental stage, many young people seek to conform to social expectations due to fear of rejection [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBased on the above, this study proposes the design of a psychoeducational intervention aimed at reducing peer pressure related to tobacco use among university students (T-RESIST). The primary objective is to evaluate the acceptability and feasibility of the intervention for application in academic settings. The secondary objective is to determine whether participation in the intervention produces changes in self-esteem, emotional dependence, social skills, and susceptibility to peer pressure for tobacco use. This pilot study will not include formal hypothesis testing, as it does not have sufficient power to detect clinically significant changes in outcomes. However, the preliminary results will provide evidence to determine whether the intervention may be effective in a larger-scale clinical trial.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design\u003c/h2\u003e\u003cp\u003eThis pilot study will be conducted exclusively within the nursing faculty of a public university in Poza Rica de Hidalgo, Veracruz, using a prospective single-arm design. Outcomes will be assessed at baseline, post-intervention, and six months after the intervention.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSample Size\u003c/h3\u003e\n\u003cp\u003eA sample of 30 students will be selected to assess the feasibility of the T-RESIST intervention, focusing on practical considerations and the precision of key indicators such as recruitment, retention, acceptability, and fidelity, rather than statistical power calculations [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Although this pilot will be single-arm, limiting the evaluation of retention, acceptability in a control group, and randomization, the definitive trial will include a control group receiving standard care, allowing comparison of results and assessment of randomization and retention feasibility in both groups [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eTarget Population\u003c/h3\u003e\n\u003cp\u003eUniversity students. For this study, participants will be undergraduate nursing students.\u003c/p\u003e\n\u003ch3\u003eInclusion Criteria\u003c/h3\u003e\n\u003cp\u003eUndergraduate nursing students aged 18 years or older, whether they are conventional cigarette smokers, who agree to participate and provide written informed consent.\u003c/p\u003e\n\u003ch3\u003eExclusion Criteria\u003c/h3\u003e\n\u003cp\u003eStudents with any condition that prevents them from performing the cognitive or physical activities required during the intervention.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eRecruitment and Informed Consent Process\u003c/h2\u003e\u003cp\u003e Participants will be recruited at the nursing faculty of a public university in Poza Rica de Hidalgo, Veracruz, Mexico. Students will be invited to participate in person within their academic settings. Those who agree to participate will be presented with the intervention proposal, including objectives, components, activities, sessions, and dosage. Interested students will receive an informed consent form describing their rights during participation. They will also be assured that all information will be treated confidentially for research purposes, and that the intervention does not pose health risks to participants [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eIntervention\u003c/h3\u003e\n\u003cp\u003eThe T-RESIST intervention will be delivered in groups, consisting of four active sessions plus two evaluation sessions (pre-test and post-test), each lasting 50 minutes (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The sessions will address strategies to recognize and cope with peer pressure, enhance self-esteem to resist peer influence, reduce emotional dependence on friendships, and develop social skills to avoid yielding to pressure for the sake of group acceptance. At the end of the sessions, evaluations will be conducted through games, activities, and group logs (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Each participant will receive a manual detailing every activity and its duration. Manuals will also be provided to the logistics coordinator, observer, and participants, while the interventionist will retain a copy for guidance.\u003c/p\u003e\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/132203_cef980177e9a226b/132203_custom_files/img1763540522.png\" width=\"695\" height=\"678\"\u003e\u003c/p\u003e\n\u003ch3\u003eMeasurements for Acceptability\u003c/h3\u003e\n\u003cp\u003eThe acceptability of the T-RESIST intervention will be evaluated qualitatively through a focus group interview guide conducted at the beginning of the intervention, during, and at the end of each session. Sample guiding questions include, Do I feel motivated to participate in an intervention focused on peer pressure related to tobacco use? Do I consider it valuable to discuss and reflect on strategies to resist peer pressure? Do I believe this intervention can strengthen my ability to make autonomous decisions when facing peer pressure? Are the focus and content of the intervention appropriate for my age and academic stage? What are your thoughts on the duration and total number of sessions?\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDevelopment of T-RESIST Intervention Sessions\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheoretical Component\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eActive Ingredient\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eComponent\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSession\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eActivities\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFocal Stimulus: Peer pressure to use tobacco\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMechanisms of peer pressure influencing tobacco use among university students\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRecognition of peer pressure mechanisms in university students\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSession 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eWorkshop on peer pressure mechanisms related to tobacco use\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCoping Processes: Social skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSocial skills to resist peer pressure for tobacco use among university students\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eApplication of coping strategies to manage peer pressure to use tobacco\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSession 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTraining to improve social skills and develop assertiveness; Development of assertive communication skills among students to resist peer pressure\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModes of Adaptation: Self-esteem\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eImprovement of self-esteem to resist peer pressure for tobacco use among university students\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrengthening self-esteem to resist peer pressure for tobacco use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSession 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eWorkshop on personal recognition as the foundation for self-esteem development\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInterdependence: Emotional dependence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eImproving emotional autonomy to resist peer pressure for tobacco use among university students\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrengthening self-concept and skills to resist peer pressure; Promoting non-dependence on peers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSession 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReinforcement of students\u0026rsquo; self-concept, fostering resistance to peer pressure for tobacco use; Development of non-dependence on peers\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eMeasurements for Feasibility\u003c/h2\u003e\u003cp\u003eFeasibility of T-RESIST will be assessed through recruitment rate, acceptance and participation rates, retention rate, and completion and follow-up rates.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eMeasurements for Preliminary Outcomes\u003c/h2\u003e\u003cp\u003ePeer Pressure: The Peer Pressure Resistance Scale for Conventional Cigarette Use in University Students, consisting of 13 items with Likert-type response options ranging from never to always, with a Cronbach\u0026rsquo;s alpha of 0.85 [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSelf-Esteem: The Coopersmith Self-Esteem Inventory (1967) consisting of 58 items with response options of like me and not like me, with a Cronbach\u0026rsquo;s alpha of .79.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eSocial Skills: The Social Skills Inventory, which includes 38 items with Likert-type responses ranging from never or rarely to always or almost always, with a Cronbach\u0026rsquo;s alpha of .80.[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eEmotional Dependence on Friendships: The Emotional Dependence Scale [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], consisting of 12 items with five Likert-type response options ranging from strongly disagree to strongly agree, with a Cronbach\u0026rsquo;s alpha of 0.93.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eQualitative Evaluation Instruments\u003c/h2\u003e\u003cp\u003eTo qualitatively assess the effects of T-RESIST on participants, the guiding questions listed in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e will be used.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eProcedure\u003c/h2\u003e\u003cp\u003e For the formal implementation of T-RESIST, the necessary permissions will be obtained from the university administration and the institutional ethics committee, ensuring compliance with ethical principles for research involving human subjects. An informational session will then be held with students to explain the objectives, methodology, duration, topics, and benefits of T-RESIST, followed by a 10-item questionnaire to assess expectations and preferences. Once informed consent is obtained, a pretest will be administered to evaluate participants\u0026rsquo; knowledge, attitudes, behaviors, and skills. The intervention will then be implemented, with each session audio-recorded for subsequent transcription and analysis, ensuring confidentiality of the data. Finally, a post-test will be applied immediately after T-RESIST and again at six months to assess changes attributable to the intervention.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eQuestions for Assessing the Preliminary Qualitative Effects of the T-RESIST Intervention\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComponent\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQuestion\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-esteem\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHow did this intervention help you trust yourself more in order to say \u0026ldquo;no\u0026rdquo; to tobacco despite peer pressure?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocial skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHow did this intervention help you develop assertive social skills to resist peer pressure regarding tobacco use?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePeer pressure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHow did this intervention help you manage peer pressure?\u003c/p\u003e\u003cp\u003eDo you consider that you have improved your ability to refuse a cigarette when offered?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmotional dependence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHow did this intervention help you improve your emotional independence in making decisions regarding peer pressure to use tobacco?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eCriteria to Determine Feasibility\u003c/h2\u003e\u003cp\u003eFor the T-RESIST intervention, the following feasibility criteria will be applied, using a green/amber/red progression system to allow more flexible interpretation of results:\u003c/p\u003e\u003cp\u003eRecruitment rate: acceptable if\u0026thinsp;\u0026ge;\u0026thinsp;80% of the target of 30 nursing students are recruited (24\u0026ndash;30 students, green); moderate if 60\u0026ndash;79% are recruited (18\u0026ndash;23 students, amber); and not feasible if\u0026thinsp;\u0026lt;\u0026thinsp;60% are recruited (\u0026lt;\u0026thinsp;18 students, red).\u003c/p\u003e\u003cp\u003eAcceptance and participation in the intervention: expected if\u0026thinsp;\u0026ge;\u0026thinsp;80% of invited students agree to participate (green); considered moderate and requiring modifications if 60\u0026ndash;79% agree (amber); or not feasible if\u0026thinsp;\u0026lt;\u0026thinsp;60% agree (red).\u003c/p\u003e\u003cp\u003eRetention rate: expected if\u0026thinsp;\u0026ge;\u0026thinsp;85% of students who begin T-RESIST complete it (green); considered moderate and indicating the need for adjustments if 65\u0026ndash;79% complete (amber); or not feasible if\u0026thinsp;\u0026lt;\u0026thinsp;65% complete (red).\u003c/p\u003e\u003cp\u003eDescriptive graphs and preliminary tables will be used to explore feasibility and to inform the decision to progress to a full randomized controlled trial.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eCriteria to Determine Acceptability\u003c/h2\u003e\u003cp\u003eThe acceptability of T-RESIST will be qualitatively assessed throughout different study phases (beginning, during, and end). A high level of acceptance is anticipated among invited students, with favorable consent and completion rates. Participation in the program is expected to be associated with the acquisition of the intended outcomes, fostering positive thinking and assertive resistance to peer pressure.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003ePreliminary Results Analysis\u003c/h2\u003e\u003cp\u003eDescriptive statistics will be used to present baseline characteristics and feasibility outcomes of T-RESIST. A paired t-test or Wilcoxon signed-rank test (depending on data distribution) will be applied to evaluate changes in outcomes before and after the intervention, reporting mean differences and 95% confidence intervals. For qualitative analysis, T-RESIST sessions and interviews will be audio-recorded and transcribed verbatim, followed by thematic analysis.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eSafety Reports\u003c/h2\u003e\u003cp\u003eAs this is a small-scale feasibility and acceptability study, the T-RESIST intervention team will meet at the end of each session to review and document events in accordance with the protocol. Although the intervention poses minimal health risk, should any adverse emotional or psychological effects arise in a student, they will be immediately referred to the psychology department for timely care. Likewise, if unforeseen logistical issues occur during T-RESIST sessions\u0026mdash;such as technical failures, power outages, or other unanticipated events\u0026mdash;the intervention team will implement predefined contingency measures, such as rescheduling the session, relocating to an alternate space, or utilizing auxiliary resources, to ensure continuity and quality of the intervention.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn Mexico, in 2022, the prevalence of tobacco use among individuals aged 10 to 19 years was estimated at 4.6% of adolescents and young adults, confirming its relevance as a public health problem [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Literature review shows that tobacco use in young people is a multicausal phenomenon, with peer pressure recognized as a significant risk factor [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This phenomenon results from the interaction of individual and social factors that act in complex ways to determine vulnerability to this addictive behavior.\u003c/p\u003e\u003cp\u003eIn this context, the proposed T-RESIST intervention may prove effective, as it focuses on strengthening resistance to peer pressure, improving low self-esteem, developing social skills, and addressing dependence on friendships. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] highlight the importance of providing guidance and support to young people in need, while therapies centered on acceptance and accompaniment have demonstrated effectiveness in strengthening self-esteem and self-perception. These are complemented by the learning of assertive responses that enable young people to appropriately refuse substance offers in socially pressured contexts [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWithin this framework, the T-RESIST psychoeducational intervention aimed at strengthening resistance to peer pressure emerges as a promising tool, as it is based on teaching and coping techniques that foster autonomy in decision-making [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Such interventions aim to equip young people with reliable information, practical strategies, and personal resources that strengthen self-esteem, reduce emotional dependence, and enhance the development of social skills [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAnalyzing the feasibility and acceptability of the T-RESIST intervention designed to enhance resistance to peer pressure for tobacco use in university contexts will help optimize the intervention components while providing evidence regarding the magnitude and variability of its effects. Together, the results will contribute to designing subsequent evaluations that deepen the understanding of the role of social pressure in initiating tobacco use among young people. They will also provide a solid foundation for implementing evidence-based preventive strategies, which are more effective in educational and public health settings.\u003c/p\u003e\u003cp\u003eThis pilot study will be conducted as a single-arm trial, which limits the ability to evaluate retention and acceptability in a control group, as well as the implementation of randomization. To address this limitation, the definitive clinical trial will include a control group receiving standard care, allowing for comparison of intervention outcomes with usual practice. This design will enable the assessment of the feasibility of implementing randomization, retention of participants in both groups, and comparative acceptability of the intervention, as recommended in previous feasibility studies [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Research Committee of the Faculty of Nursing, where the study will be conducted, approved the protocol under number \u003cstrong\u003eP-ME-02-2025B\u003c/strong\u003e. Participants will provide written informed consent prior to their involvement in this study. The consent form includes the study preamble, objectives, eligibility criteria, data collection and follow-up procedures, a summarized explanation of the intervention, the potential risks and benefits involved, voluntary participation, the right to withdraw, information regarding confidentiality and the sharing of anonymized data, as well as participant identification.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received no funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCIVJ and DZH conceived the study. CIVJ, ASLA, MCSB, and DZH developed the study design and intervention and were responsible for drafting the first version of the study protocol. CIVJ is a master\u0026rsquo;s student leading the study on-site. All authors contributed to refining the study protocol and approved the final submitted manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e Master\u0026rsquo;s Student in Nursing, Faculty of Nursing, Veracruzana University, Mexico.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003e Faculty of Nursing, Autonomous University of Baja California, Mexico.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e3\u003c/sup\u003e Faculty of Nursing, Veracruzana University, Mexico.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMedina B. Young people lead smoking statistics in Mexico [Internet]. Autonomous University of Nuevo Le\u0026oacute;n; 2019 [cited 2025 Sep 9]. 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Intervention resources for working on social skills with adolescents: A qualitative systematic review [Internet]. 2023 [cited 2025 Sep 9]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://ojs.rmie.mx/index.php/rmie/article/view/50/85\u003c/span\u003e\u003cspan address=\"https://ojs.rmie.mx/index.php/rmie/article/view/50/85\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"pilot-and-feasibility-studies","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pafs","sideBox":"Learn more about [Pilot and Feasibility Studies](http://pilotfeasibilitystudies.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/PAFS/default.aspx","title":"Pilot and Feasibility Studies","twitterHandle":"@MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"peer pressure, tobacco use, social skills, self-esteem, prevention, emotional dependence, young adults, university students.","lastPublishedDoi":"10.21203/rs.3.rs-7683017/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7683017/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e In Mexico, tobacco use represents one of the leading threats to public health, being associated with thousands of preventable deaths and diseases. Social factors, such as peer pressure, play a significant role in the initiation of tobacco use among young people, who seek acceptance and identity. Although intervention studies exist, few address peer pressure comprehensively and from a theoretical framework. Therefore, a psychoeducational intervention is proposed for university students, with the aim of assessing its acceptability and feasibility, as well as exploring changes in self-esteem, emotional dependence, and social skills. Its contribution lies in providing preliminary evidence for future large-scale clinical trials.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e The study was designed as a prospective, single-arm pilot. Nursing students from a faculty in Veracruz will participate, with a recruitment target of 30 students aged 18 years or older. The group intervention consists of four 50-minute sessions, in addition to pre- and post-test evaluations, addressing peer pressure, self-esteem, social skills, and emotional dependence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion:\u003c/strong\u003e Tobacco use among young people is a multifactorial problem in which peer pressure constitutes a central factor. The proposed psychoeducational intervention seeks to strengthen resistance, promote self-esteem, enhance social skills, and address emotional dependence. Its implementation entails practical challenges, including student participation, retention, logistical organization, and resource availability. This study will allow for the evaluation of the intervention’s acceptability and feasibility, generating preliminary evidence for future trials. The findings will contribute to the design of evidence-based preventive strategies relevant to the university setting and adolescent public health.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration\u003c/strong\u003e UMIN000059102.\u003c/p\u003e","manuscriptTitle":"Pilot study protocol to increase resistance to peer pressure in tobacco use among nursing students (T-RESIST)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-19 08:25:53","doi":"10.21203/rs.3.rs-7683017/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2026-02-03T07:26:35+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-09T20:46:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-07T02:40:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"Pilot and Feasibility Studies","date":"2025-10-04T00:50:45+00:00","index":"","fulltext":""},{"type":"decision","content":"Minor revision","date":"2025-09-26T11:11:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"pilot-and-feasibility-studies","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pafs","sideBox":"Learn more about [Pilot and Feasibility Studies](http://pilotfeasibilitystudies.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/PAFS/default.aspx","title":"Pilot and Feasibility Studies","twitterHandle":"@MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f1286e1f-ca61-4f31-93ff-3d0f07ae7e6c","owner":[],"postedDate":"November 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-20T05:49:49+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-19 08:25:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7683017","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7683017","identity":"rs-7683017","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}