What Will it Take to Reverse the Youth E-Cigarette Epidemic?

By: Melinda J. Ickes, PhD
Associate Professor, Health Promotion; Faculty Associate, Center for Innovation and Population Health, University of Kentucky

When we send young people to school, we think about what they are learning, how they are being prepared for a future career path, if they are building friendships, and hope they engage in positive social emotional learning. However, we are now worried about youth using and becoming dependent on e-cigarettes, which just might derail all of those other efforts.

You might be curious to find that many of the products that look like school supplies in a student’s backpack could in fact be e-cigarettes or other innovatively designed tobacco products targeting our youth. According to the 2018 National Youth Tobacco Survey data, one in five high school students and one in 20 middle school students (over 3.6 million youth) are currently using e-cigarettes or ‘vaping’ – a resounding 80% increase from 2017.

Pod-based e-cigarettes like Juul, currently the most common brand used by young people, have garnered the fascination of youth. The e-liquid used in the ‘pods’ or cartridges of these devices has comparable concentration of nicotine as a pack (or more) of combustible cigarettes, which puts our youth at risk for dependence and subsequent combustible cigarette use. E-cigarette companies make appealing and fun flavors (e.g., strawberry, mango, zombie dust), use targeted and tailored marketing, and aim to create a norm where it seems acceptable for youth to use these products.

Beyond the risk for dependence, e-cigarettes contain numerous chemicals previously linked to increased risk for cavities, seizures, heart disease, cancer, and more recently, an outbreak of lung disease across all states. Sounds eerily similar to warnings included in the Surgeon General’s Report over 50 years ago when talking about combustible cigarettes, right? Along those lines, we also know it is not just water vapor, as the companies might want our young people to believe. The secondhand aerosol given off by e-cigarettes includes tiny particles that are easily breathed into the lungs, as well as nicotine and low levels of toxins, putting even us bystanders at risk. These products are setting up future generations for a lifetime of health risks if we do not intervene now.

Recent research indicates that e-cigarette use is more common among students with lower school connectedness. This reinforces the importance of schools and the need to help strengthen school connectedness for students through adult support, providing opportunities for youth to belong to a positive peer group, and promote an overall positive school environment. The good news is this affords all of us an opportunity to help prevent youth from initiating use and support youth who are already using e-cigarettes to quit. This might seem like a daunting task, but regardless of your role in a young person’s life, we can integrate strategies we already know help promote connectedness. Ask yourself how you might support the development of relationships between youth and positive adults in their lives (e.g., teachers, coaches). Could you be that positive connection they are looking for? Consider how you can encourage student engagement that strengthens social networks and connections. Are there school and/or local club/organizations you might share? Another successful strategy is to create or help support peer-delivered prevention programs and support groups. Youth resonate with other youth and are often more open to having an open and honest dialogue with each other – how can you help support efforts like this in your community?

Given all of this, we also know that prevention is critical – we cannot wait until high school to talk with youth about e-cigarettes and we cannot assume that a one-day presentation is going to reverse this epidemic or promote connectedness. Prevention needs to be supported by:

· Integrating evidence-based, developmentally appropriate, skills-based substance use (including tobacco and e-cigarettes) prevention throughout all grades

· Creating open lines of communication and support systems for youth in and outside of our schools

· Engaging (and educating) parents, advisory councils, administrators, school staff/personnel, healthcare providers, and all others who interact with youth in the conversation

· Empowering students with opportunities to learn more about the issue, problem solve, and develop action projects in their schools and communities to make a difference

If youth are using e-cigarettes, support is essential to understand how their dependence may affect their life now and in the future. Put them in touch with relatable quitting resources and be a shoulder to lean on when needed. This is not the place for judgement or blame, but the time to practice empathy and open dialogue. What makes it difficult for them to quit? What can you do to support them? How can schools create an environment conducive to quitting? For more info on support tailored for young people: https://truthinitiative.org/thisisquitting

While we may not have all of the answers, we know that building connectedness with all youth, particularly those at-risk for e-cigarette and other substance use is imperative to supporting an empowered generation and ending this e-cigarette epidemic.


To discuss partnerships to bring #iCANendthetrend, a peer-led e-cigarette prevention and empowerment program, to your community, email: icanendthetrend@uky.edu

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