Effectiveness of interactive workshops to raise awareness of the neurological harms associated with nitrous oxide use: a cross-sectional study.

Background: The Royal London Hospital, East London, receives a case of nitrous oxide (NO) myeloneuropathy roughly every 9 days. No formal education programme is widely available to warn young people of the risks of recreational NO use. Our aim was to develop and evaluate the effectiveness of workshops focusing on the neurological risks of NO, with the primary outcome to increase awareness of these risks among young people.

Methods: For this cross-sectional study, the workshop content was piloted with over 200 people at a community event, received input from a person with lived experience, and then piloted with a youth group, all in east London, UK. Between Oct 10, 2022, and April 11, 2023, 32 workshops were delivered to 984 young people in schools and youth groups in east London. The workshop included three interactive activities exploring how and why NO causes neurological damage. An online anonymous questionnaire including free text and 5-point Likert scale answers was provided after each workshop. The HRA ethical toolkit and NIHR INVOLVE guidance were consulted, and NHS ethics approval was not required.

Findings: 396 (40%) of 984 workshop participants completed the questionnaire. The median age bracket of attendees was 13-15 years. 38 (10%) of 396 respondents reported past use of NO, while 24 (6%) did not divulge use or non-use. Self-perceived likelihood of use was reduced after the workshop, with 261 (66%) very unlikely to use NO before the session compared with 290 (73%) after the session. 238 (60%) respondents reported an increase in self-perceived knowledge of the risks after the session. When asked about their understanding of the risks of NO, 206 (52%) relayed something related to NO causing neurological damage. 327 (83%) respondents found the workshop useful.

Interpretation: This work highlights the feasibility of raising awareness among young people of NO-myeloneuropathy in this workshop format. Limitations included difficulties involving many participants with lived experience in design, an absence of pre-existing interventions to compare against these workshops, and that data collection from young people required pragmatic, short questions. Overall, this work supports larger-scale preventive approaches to NO-myeloneuropathy, such as a national education programme.

Funding: Queen Mary Centre for Public Engagement Small Grant Fund.