The Journal of School Nursing2025, Vol. 41(5) 535–547© The Author(s) 2023Article reuse guidelines:sagepub.com/journals-permissionsDOI: 10.1177/10598405231198020journals.sagepub.com/home/jsn
Abstract
There are effective prevention strategies to combat increasing rates of youth e-cigarette use. This study assessed the outcomes of an e-cigarette prevention program with teachers and parents/guardians across a three-county rural area. Researchers assessed teachers’ and parent/guardians’ increased knowledge and confidence in implementing vape prevention after receiving evidence-based trainings. Pre- and post-surveys demonstrated that teachers had a statistically significant increase in knowledge gain across all eight vape-specific domains assessed as expected. The parent/guardian pre- and postsurvey results also show that knowledge and confidence increased significantly across seven domains. Findings suggest that multicomponent e-cigarette education and prevention programs better prepare teachers and parents/guardians to intervene with youth e-cigarette use and initiation, including being more likely to talk to youth about the risks of tobacco and vaping. Recommendations for school nurses are discussed and include educating youth, families, and staff for positive impacts.
Keywords
alcohol/tobacco/drug use prevention, parent/family, health education, rural, multicomponent programming, e-cigarette prevention, teacher education, school nurse education
Youth today experience a myriad of challenges. Substance use, anxiety, depression, and bullying are all serious issues that impact many teens (Desilver, 2019). More recently, youth have received messaging that e-cigarettes are less harmful than smoking traditional cigarettes (Amrock et al., 2016), which may have contributed to perceived e-cigarette safety and increased rates of e-cigarette use among youth (Gorukanti et al., 2017; Murthy, 2017; Wills et al., 2015). Evidence-based prevention strategies can help combat these rising rates by helping to prevent youth from initiating tobacco use (U.S. Department of Health and Human Services [U.S. HHS], 2016). School nurses are well trained and equipped to provide prevention activities, support, and information to their students, but are often involved after students have been identified as using e-cigarettes (Blume & Lines, 2020; Smith et al., 2021); coupled with the additional demands placed on school nurses, multicomponent and multifaceted prevention programs offer support for their healthrelated efforts. Specifically, parents/guardians and teachers who regularly interact with youth can be the first line of defense in providing education and building protective factors, both important prevention strategies (Patel et al., 2019; Sallis et al., 2008). School nurses can also engage directly with each of these populations, including students as well as teachers, staff, and parents/guardians to initiate multifaceted efforts in their school or at the district level.
The program examined in this study is entitled Be Epic, Escape the Vape, developed by Utah State University Extension utilizing evidence-based approaches, which provides multicomponent prevention by reaching audiences of teachers, parents/guardians, and youth, as well as implementing a community-wide misinformation reduction social media campaign. While multicomponent prevention programs are crucial in the fight against increasing youth tobacco use, additional prevention program implementation evaluations are needed to examine the effectiveness of such a program. Therefore, the current study examined the short-term outcomes of the Be Epic, Escape the Vape program, focusing on teacher and parent/guardian intervention outcomes where evaluation efforts can be utilized and informative for school nurses who currently or will in the future engage in vape or e-cigarette prevention efforts.
Electronic nicotine systems, more commonly referred to as e-cigarettes or vapes, are battery-operated devices designed to heat a liquid into a vapor-like form to be inhaled by its users (Centers for Disease Control and Prevention [CDC], n.d.). The e-cigarette industry has grown in popularity and quickly expanded since its introduction in 2006 in the United States. As a result of this growth, e-cigarettes now come in many different forms and generations with varying features, such as names, functions, shapes, and sizes (Chun et al., 2017). They have become popular on the market, especially among youth, which resulted in professionals taking an interest in the relationship between advertising and use. Approximately 69% of high-school and middle-school students are exposed to e-cigarette advertisements online, through media sources (e.g., printed papers and cinema), or in retail stores (CDC, 2017). e-Cigarette marketing commonly uses themes of sex, independence, and rebellion that glamorize products (CDC, 2017; Pike et al., 2019). Additionally, e-cigarette advertisement spending has increased to over 100 million dollars while at this same time trends among youth show significant increases in e-cigarette use, suggesting that youth are vulnerable to these advertisements (CDC, 2017; Pike et al., 2019). In addition to advertising, the use and promotion of e-cigarettes by social media influencers are especially of concern as research has shown that the more time youth spend on social media platforms, the more likely they are to have greater intentions to use e-cigarettes (Vogel et al., 2021).
Nationally there has been growing concern about youth e-cigarette use, as approximately three million middle and high school students have reported using an e-cigarette during the past 30 days (Morbidity and Mortality Weekly Report [MMWR], 2021). Utah youth have not been immune to e-cigarette use, as 33.9% of Utah high school students reported having ever used an e-cigarette at least once (MMWR, 2018). Rural areas in [State blinded for review] have been especially vulnerable to youth e-cigarette use. For example, the southeast region of Utah has the highest rates of student e-cigarette use by health district in the state (21%; Public Health Indicator Based Information System [IBIS], 2020). Data suggests that e-cigarette use is rising each consecutive year in [state blinded for review] since 2011, except for 2021 (Bach Harrison LLC, 2022; Utah Department of Human Services Division of Substance Abuse and Mental Health, n.d.). This rise threatens the progress made in decreasing the number of people who use nicotine products.
Professionals are especially concerned about youth e-cigarette use because much of the long-term effects of e-cigarette use are unknown due to its relative newness to the market (Callahan-Lyon, 2014; Sapru et al., 2020). However, long-term nicotine use impacts brain development, such as cognition, memory, and attention (Dwyer et al., 2009; Stalgaitis et al., 2020), and users can experience mood swings, headaches, irritability, and impaired impulse control (Popova et al., 2021; U.S. HHS, 2016). Short-term e-cigarette use is associated with physical harms such as asthma, bronchitis, and other lung illnesses (Cho & Paik, 2016; Cobb & Solanki, 2020; Rose, 2017; Stalgaitis et al., 2020), coupled with an increased risk for youth developing habitual substance use (Dwyer et al., 2009; Pierce et al., 2021; Soneji et al., 2017; Wills et al., 2015). Youth are also particularly vulnerable to adverse developmental impacts, given that their brains continue to develop well into adulthood (Dwyer et al., 2009; Goriounova & Mansvelder, 2012). One recent study found that 13-to-24-year-old dual users (i.e., users of both e-cigarettes and traditional combustible cigarettes) had a seven times greater risk of contracting the novel coronavirus (COVID-19) than their nonuser counterparts (Gaiha et al., 2020). Together, these findings highlight that vaping increases youths’ health risks in the short term and later in life. Interventions focusing on prevention are one strategy used to address increasing vape rates among youth, which has historically been used to combat tobacco initiation among youth such as The Real Cost’s campaign launched in 2014 (U.S. HHS, n.d.; Food and Drug Administration [FDA], 2023).
In efforts to increase knowledge, break down misconceptions, and promote positive attitudinal change toward tobacco prevention, programs addressing vape and e-cigarette prevention or cessation have taken several approaches. Health professionals have used methods of social media campaigning (e.g., The National Truth campaign; Truth Initiative, n.d.), educating on substance safety, accounting for community acceptability and sentiment, or addressing individual independence and strength through self-identity building (Rath et al., 2021). Programming that uses multicomponent designs (multifaceted and comprehensive) is especially beneficial as it intervenes across multiple populations at multiple levels and demonstrates long-lasting impacts (Chu et al., 2021; Kelder et al., 2021; National Institute on Drug Abuse [NIDA], 2020; Substance Abuse and Mental Health Services Administration [SAMHSA], 2020a, 2020b). The FDA additionally supports multifaceted approaches that utilize marketing, education, and legal efforts to reduce youth e-cigarette use (Zeller, 2020). In one such example, the American Lung Association utilized a new multicomponent initiative (2020) called End the Youth Vaping Epidemic. This multicomponent program offered programming at the school, parent/guardian, and student levels with information (American Lung Association, n.d.). This sort of programming is promising for having broader impacts, addressing a larger portion of community groups at various prevention levels (SAMHSA, 2020a).
One component of such an intervention could occur with teachers since teachers spend a major portion of the school day with students and have an opportunity to positively influence student behaviors (Sallis et al., 2008). The U.S. Surgeon General has identified the role of educators as being critical in addressing student e-cigarette use (U.S. HHS, 2016). Teachers provide a positive influence by ensuring students understand the risks and harms of e-cigarette use (U.S. HHS, 2016), utilizing or incorporating programs or curricula (e.g., CATCH My Breath) into the classroom, and incorporating other educational resources that seek to prevent and intercede e-cigarette use (Schillo et al., 2020). Additionally, teachers can be effective interventionists by staying current on research and information about the harms of e-cigarette use, learning to identify current and new e-cigarette products (Schillo et al., 2020), and advocating for a tobacco-free space at school while promoting comprehensive school tobacco policies (that include vaping and e-cigarette prevention; Schillo et al., 2020). Meanwhile, parents/guardians have an important role when it comes to influencing their youth (Patel et al., 2019) and can help in deterring them from beginning e-cigarette use. Parents/guardians can have sincere discussions and answer questions honestly when talking with youth (UNDO, 2022). Parents/guardians can also provide trustworthy and knowledgeable information on e-cigarette contents and the risks associated with use (Less et al., 2021). Parental awareness and education about e-cigarette use can help deter youth from vaping (Choi et al., 2022). These educational interventions for parents/guardians and teachers are effective at creating behavior change, however, less is known about multicomponent efforts in community settings with broad impacts specific toe-cigarette prevention.
Different from other national campaigns, the current study sought to provide direct education to three rural counties with a high need for prevention. Programming was designed using the Social Learning Theory (Bandura & Walters, 1977) as a framework, which emphasizes the impact that interactions with other people and the environment have on human behaviors. While the environmental factors during our program remained unchanged (i.e., highrisk rural counties), the program sought to transfer accurate evidence-based knowledge to the primary program recipients (teachers and parents/guardians) and secondary participants (students). Additionally, the program design was influenced by Social Learning Theory where participants were taught positive behaviors to be modeled by the participating adults, reinforcing positive behaviors among youth. The current study sought to answer two primary research questions to address this gap in the evidence and the literature. First, did teachers increase their self-reported knowledge and confidence in implementing vape prevention in the classroom? The hypothesis for this first research question is that teachers’ knowledge and confidence will significantly increase between the pre- and post-intervention intervals. The second research question is whether parents/guardians increase their knowledge about e-cigarettes and confidence in talking with their youth about e-cigarettes (in the next 30 days)? The corresponding hypothesis for this research question is that parent/guardian knowledge and confidence will significantly increase between the pre- and postintervention intervals. Studies that evaluate the outcomes of school health education programs report that these programs are very effective in increasing knowledge (Bartlett, 1981). Additional studies suggest that multiple health outcomes, including decreasing substance and tobacco use, can be influenced by well-designed and well-implemented school health programs (CDC, 2023). Given the important and significant role that educators and parents play in health prevention, there is a justified need for an effective method to increase knowledge and confidence in delivering information among these groups. Pre- and post-surveys were used to examine the two research questions, both of which were short-term outcomes for the Be Epic, Escape the Vape multicomponent prevention program for teachers and parents/guardians in a three-county rural area.
To assess program outcomes, researchers used pre- and postsurveys across both components of the intervention to specifically examine teacher and parent/guardian knowledge and perceptions related to e-cigarettes. Before beginning the program evaluation, the Utah State University Institutional Review Board issued a letter of determination that our study was designated as “nonhuman subjects” which allowed us to conduct the evaluation of the program. No personal or identifying information was collected to ensure participant confidentiality. Participants in both components of the intervention received a letter upon enrollment explaining the study and describing the basic elements of consent.
This program was conducted in a three-county area, which is adjacent to each other, rural, and situated in southeast Utah. Carbon County (population: 20,356) has two middle schools and one high school; Emery County (population: 10,248) has two middle schools and two high schools; and Grand County (population: 9,754) has three district schools (one elementary, one middle, and one high school) and one charter school (County Health Rankings, 2020; U.S. Census Bureau, 2019). These three counties also experience high poverty and food insecurity rates (Gundersen et al., 2014; U.S. Census Bureau, 2019). The intervention’s teacher component was delivered virtually due to COVID-19 mitigation across nine schools over 2 months in the spring of 2021 during teachers’ in-service times. The parent/guardian component was delivered in a webinar-style format, also to adhere to COVID-19 mitigation standards, three times (one in each county in the program area) over 3 months in the spring of 2021. Participation in both program components was voluntary.
Recruiting voluntary participants for the teacher component involved sending emails to school principals who identified interested participants. Training was set up online and Zoom links were shared via email with identified voluntary participants. Meanwhile, recruiting participants for the parent/guardian component involved active advertising and flyer sharing through boosted social media posts, school districts’ websites and social media, local coalitions, religious institutions, community boards, radio advertising, newspaper placements, and other key stakeholders; with voluntary participant registration occurring using the free Eventbrite © services.
Both components of the Be Epic, Escape the Vape intervention were informed by the CATCH MY Breath curriculum (CATCH, 2020). The teacher component utilized CATCH’s evidence-based curriculum (Baker et al., 2022; Kelder, Haas et al., 2020; Kelder, Vaughn et al., 2021; Liu et al., 2020; SAMHSA, 2020a; Virk & Hunter, 2021), which includes slides and a script to ensure program fidelity was achieved. To increase program participation CATCH has a standard for online teacher trainings which can be accessed and delivered by certified CATCH My Breath Community Trainers (CATCH, 2020; Kelder et al., 2021). This program was chosen for its versatile use among youth with pre-made lessons provided to teachers at each grade level delivering tailored age-appropriate content (CATCH, 2020). Additionally, curricula are designed with ease in mind for teachers and staff, with each lesson duration lasting approximately 35 min and includes pre-created lesson plans with slides, notes, worksheets, and videos for teachers (CATCH, 2020; Kelder et al., 2021). Two part-time program coordinators employed by USU Extension were first trained and certified on the CATCH My Breath curriculum as “Community Trainers” so that they could facilitate in-service trainings in each county for teachers. Program coordinators emailed school districts, principals, and teachers to introduce Be Epic, Escape the Vape as well as offer enrollment and coordinate an in-service training on CATCH My Breath for teachers at no cost, at all schools in each district. Participants of the teacher component were invited to attend a 90-min training that provided them with up-to-date information about vaping, introduced the CATCH curriculum (which is free for teachers to use in the classroom), and included an overview of how to implement the curriculum in the classroom. The CATCH My Breath program is based on the social cognitive theory with the intent to change inaccurate perceptions held about smoking e-cigarettes, build skills among youth to resist peer pressure, teach skills to analyze and resist tobacco advertisements and build healthier attitudes toward e-cigarettes (CATCH, 2018). Both components (teacher and parent/guardian) in the current study built upon these principles to increase knowledge, change perception, and increase confidence.
The parent/guardian component of the intervention was developed by the project team but heavily influenced by the CATCH teacher training and parent information (CATCH, n.d.). The parent/guardian presentation included evidence-based information about local statistics (i.e., Student Health and Risk Prevention [SHARP] Prevention Needs Assessment Survey, n.d., 2019, from the Utah Department of Human Services Division of Substance Abuse and Mental Health), what e-cigarettes are, what they look like, how youth can hide them, signs of use, ingredients, harmful health effects, how to have discussions about tobacco use with youth, and ways to build protective factors at home (Blagev et al., 2019; Evans-Polce et al., 2020; Fadus et al., 2019; Wu & Chaffee, 2020, e.g., Bach Harrison LLC, 2022; CDC, n.d.; FDA, n.d.). Parents/guardians in the three-county area were invited to attend a 60-min webinar. Recruitment for parent/guardian education events consisted of word-of-mouth advertising with local key stakeholders (e.g., prevention coalitions, health departments, behavioral health agencies, schools, etc.), emails to local contacts and agencies with parent/guardian connections, radio advertisements, and social media advertisements as well as sponsored advertisements that reached parents in the target counties. Parents/guardians who were interested in attending the event registered for free online utilizing Eventbrite ©. Each participant was provided with a meal from a local restaurant and a swag bag which provided parents/guardians with a local resource booklet, parent information fact sheet, informational flyers, and small items (e.g., pen and face mask). Given the resource and funding constraints, a limited 100 registrations were open to enroll, on a first-come first-serve basis, in each county (collectively, 300 total spots available).
Teacher component. Once a school and its teachers had signed up to participate, the facilitator sent teachers a reminder email 1 week before the training. The initial email introduced the surveys and included an overview of the evaluation, including all elements of informed consent. A link to the pre-survey was embedded into the reminder email and a second reminder email was sent 3 days before the event. In an effort to increase survey participation, at the start of the training, the facilitator gave participants 5 minutes to complete the pre-survey. The pre-survey was administered through Qualtrics, and to link pre- and post-survey responses, we used participants’ self-reported initials and year of birth. The survey took no more than 5 min to complete. The training facilitator administered the post-survey at the end of the in-service training, giving participants time to complete the survey. The facilitator also sent a reminder email to those still needing to complete the post-survey.
Parent/guardian component. Once parents/guardians had registered for the webinar via a free online registration system (i.e., Eventbrite), the program facilitator sent an email through this system introducing the evaluation and including all elements of informed consent. A link to the presurvey was embedded into the reminder email and a second reminder email was sent 3 days before the webinar. Finally, a third reminder was sent on the day of the webinar. Additionally, at the start of the webinar, the facilitator took 5 minutes to allow participants to join and complete the presurvey. The pre-survey was administered through Qualtrics, and to link pre- and post-survey responses, we used participants’ self-reported initials and year of birth. The survey took no more than 10 min to complete. The post-survey was administered following the training by announcing it at the end of the webinar and sending four follow-up emails.
Both pre and post-surveys were created by adapting existing questions from the CATCH teacher and youth questionnaires provided by CATCH for use with program delivery. Because the CATCH survey for teachers was meant to administer following program delivery, we adapted their measures to understand the training outcomes of teachers instead of program delivery outcomes. Additionally, the parent/guardian program and the survey used to assess outcomes were based on an adaptation of the youth program; therefore, we adapted the CATCH survey to include measures that assessed outcomes relevant to parents/guardians.
Teacher pre- and post-survey measures. Teacher selfreported knowledge was measured by three questions with Likert scale response options: strongly disagree (1) to strongly agree (5). The three statements included: (a) I know the basics of what e-cigarettes are and how they work, (b) I know the health risks associated with youth vaping, and (c) I know the common misconceptions that minimize the impacts of youth vaping.
Teacher confidence was assessed across five questions with the same response options for all confidence questions: strongly disagree (1) to strongly agree (5). Statements included confidence in: discussing tobacco/vaping information with students, incorporating information into class discussions, discussing with students how to decline tobacco or vaping from peers, and modeling healthy behaviors to students.
Parent/guardian pre- and post-survey measures. Parent/guardian knowledge was assessed pre/post with nine questions utilizing a Likert scale for response options. Table 1 shows the nine measures with their response choices.
One item assessed parent/guardian intentions by asking how likely the parent/guardian was to talk with their child(ren) about the risks of tobacco or vaping during the next 30 days, with response choices ranging from extremely unlikely (1) to extremely likely (5).
Finally, two items assessed parent/guardian confidence, asking parents/guardians to identify their level of agreement for the following statements: (a) I know how to talk to my youth about the risks of tobacco and e-cigarettes and (b) I know activities I can do with my youth and family that act as a protective factor against e-cigarette use. Response choices ranged from strongly disagree (1) to strongly agree (5).
Survey questions were assessed at both the pre- and postprogram intervals. Data analysis was conducted using STATA 15 (Cooperation, 2017). We first conducted descriptive statistics to identify the mean and standard deviation for each outcome measure. With parent/guardian responses to knowledge questions, which had a correct answer, the percentage of correct answers and percent change was identified at pre- and post-program intervals. Finally, all other questions for both teacher and parent/guardian components were examined for significant differences using paired sample t-tests. While the sample size for the teacher preand post-surveys were low (less than 50 paired responses), the sample achieved is based on the real-world capacity and demand for the program and still meets the statistical power needed to utilize a paired sample t-test to examine significant differences.
Teacher survey results. Participant demographics can be found in Table 2. In total 42 participated in the training with fewer participants completing both the pre- and postsurveys (N = 38). Participants mostly identified as female (87.2%), White/Caucasian (92.3%), and most often taught more than one subject (34.2%). Teachers most often taught at the elementary school level (61.5%).
To answer Research Question 1: Did teachers increase their self-reported knowledge and confidence in implementing vape prevention in the classroom?, we first examined the pre- and post-survey mean scores for each of the eight survey items. Each item measured key outcomes of the program (knowledge and confidence). As Table 3 shows, when looking at the mean difference for each of the outcome measures, teachers saw increases in all knowledge and confidence questions which suggest that program participants had improvements in program outcomes. An increase in the mean can be interpreted as participants having a higher level of agreement with the statement assessed. For example, at the pre-survey interval, the mean response to the statement, “I know the basics of what e-cigarettes are and how they work” was 3.18, while at the post, the average response was 4.47 for an increase of 1.29. The results of the paired sampled t-tests found statistically significant difference between the pre- and post-survey response which indicated an increase in participant knowledge in this area (t = −6.47; p < .001).
To test for significant differences in knowledge and confidence gains, we conducted paired sample t-tests for all nine measures. Table 3 shows significant knowledge gains across all eight survey items, which is indicated by a p-value of 0.05 or less, suggesting that these increases are not likely due to chance alone.
Parent/guardian survey results. In total 242 parents/guardians enrolled into the webinar and 164 attended the webinar. Of those participants from the parent/guardian component (N = 68) who completed both the pre- and post-survey, with additional parents completing only the pre-survey (N = 96). Demographic results show that they mostly identified as female (71.7%), White/Caucasian (84.9%), and did not smoke or vape (82.1%). Table 4 shows the completed demographic information for the parent/guardian webinar.
To answer Research Question 2: Did parents/guardians increase their knowledge about e-cigarettes and confidence to talk to their youth about e-cigarettes?, we first examined the percentage of correct responses to five knowledge questions. Table 5 displays the percent correct at the pre- and post-survey intervals and the percent change in correct responses. As Table 5 shows, there were increases in the correct responses for four of the five knowledge questions, with the highest increase in correct responses on the question asking if flavored e-cigarettes contain nicotine (+26.0%).
Unsurprisingly, there was no change in scores at the preand post-intervals for the statement nicotine is addictive as it is a well-known fact. Changes in correct responses occurred in areas that presented more specific information about e-cigarettes. To test for significant differences in knowledge and confidence gains, we conducted paired sample t-tests using parent/guardian pre- and post-surveys. Table 6 shows significant knowledge gains across all seven survey items.
For example, the mean response to the statement, “I know the names and brands of e-cigarettes and could identify them in a conversation” was 1.75, while at the post, the average response was 3.90 for an increase of 2.15. The results of the paired sampled t-tests found statistically significant difference between the pre- and post-survey response which indicated an increase in participant knowledge in this area (t = −15.03; p < .001). Additionally, parents/guardians reported statistically significant increases in knowledge of protective/prevention activities (t = −8.67; p < .001), knowledge of how to talk with youth about risks of tobacco and e-cigarettes (t = −8.26; p < .001), and likelihood of talking with children about tobacco or vaping during the next 30 days (t = −4.18; p < .001).
Youth e-cigarette use continues to rise and remains a significant public health issue, but parents and teachers are in a position to impact their youth greatly and prevent initiation or use of e-cigarettes (Mantey et al., 2022; Murthy, 2017; Virk & Hunter, 2021). The current study examined the shortterm teacher and parent/guardian intervention outcomes of the Be Epic, Escape the Vape multicomponent prevention program which utilized evidence-based information and resources in programming efforts (e.g., CATCH, 2020). Our study results supported using a short-term multicomponent intervention to increase parent/guardian and educator knowledge and confidence related to e-cigarettes. Our results supported that our program elicited the short-term outcomes expected with teachers and parents/guardians. Specifically, we found significant knowledge gains for both target groups and confidence gains for parents/guardians. Previous literature supports the effectiveness of educating youth directly (e.g., the CATCH My Breath program; Kelder et al., 2021; Liu et al., 2020) and our findings build on the importance of providing education to teachers and parents or guardians of youth. Specifically, unlike previous studies and existing literature, this study describes teacher and parent/guardian knowledge and confidence change on e-cigarette use among youth following programming utilizing and adapting CATCH My Breath program resources (Baker et al., 2022; Kelder, Haas et al., 2020; Kelder, Vaughn et al., 2021; Moosbrugger et al., 2023). Our findings continue to support the effectiveness of multicomponent e-cigarette education and prevention programs delivered in rural communities for teachers and parents/guardians (Mantey et al., 2022; Moosbrugger et al., 2023; Virk & Hunter, 2021).
We specifically found that teachers’ self-reported knowledge about e-cigarettes and how they work, health risks for youth, and knowledge of common misconceptions all improved as a result of the CATCH My Breath training. We also found that teachers’ confidence in talking about information, incorporating the information in class, talking with students about how to decline e-cigarettes, modeling healthy behaviors, and confidence in finding resources to use in class for e-cigarette content improved as a result of the training. These findings for teachers are consistent with previous literature supporting implementing the CATCH My Breath program in the classroom (Virk & Hunter, 2021) and use of prepackaged prevention curricula in schools (Moosbrugger et al., 2023). The CATCH My Breath program nationally has completed numerous trainings reaching approximately 1.8 million students to date and in the current study we contacted all schools in the three-county area, resulting in training 42 teachers. While our evaluation focused on short-term outcomes, future programs should examine medium-term outcomes, such as teacher communication with youth, to examine how education programs impact teachers’ communication of program information in conversations with youth.
The parent/guardian education portion of our program also resulted in significant knowledge increases as expected among parents/guardians about identifying e-cigarettes, the purchasing restrictions in place, ingredients, and the physical effects on youth. Notably, we found that parent/guardian knowledge of activities for prevention and associated protective factors against e-cigarette use increased post-training and that knowledge about how to talk with youth about the risks of tobacco and e-cigarettes increased post-training. Most importantly, we found that the likelihood that parents/guardians would discuss these topics with their youth within the next 30 days post-training also increased significantly. The real-world impact of talking with their youth about the risks of tobacco products, including e-cigarettes and vape is key. Our study’s findings contribute to the literature on the importance of parent education and that these interventions can improve parent knowledge; research has shown that parents can use this training to communicate evidence-based information to youth (Keenan et al., 2022; Less et al., 2021). This is especially important because parental attitudes and education can lead to long-term decreases in youth e-cigarette use (Jha & Kraguljac, 2021; Mantey et al., 2022).
Our findings demonstrate that an intervention with teachers and parents/guardians using evidence-based training and information can positively impact vape and e-cigarette prevention efforts. School nurses are asked to serve many roles in their positions, and they often are tasked with providing health education to teachers, parents, and youth on significant health issues such as e-cigarettes which are increasing in use in youth (Westling et al., 2017) and in turn increasing risk for other substance use as well (Kristjansson et al., 2017). School nurses, therefore, could provide a similar intervention as the one described in this study, by providing evidence-based family education events to larger groups of parents/guardians all at once to maximize reach while addressing time constraints and other responsibilities. Secondary prevention efforts, such as an evidence-based curriculum or training, similar to the current study, could be provided to groups of parents/guardians when indicated and needed at their school to address multicomponent prevention for e-cigarette prevention needs as well. This again is something that school nurses are experienced with and play a crucial role in providing parents health and prevention education (Morrison-Sandberg et al., 2011).
Furthermore, nurses could provide similar interventions in the current study to teachers with direct education about e-cigarettes and evidence-based strategies which would increase the reach of the intervention within their school setting (Baker & Campbell, 2020). Specifically, one qualitative finding not reported in this study, was the teachers asked for more direction and organization within the school system to implement e-cigarette prevention programming (e.g., CATCH) successfully and with intentionality (e.g., see Croghan, 2017 and Voogd, 2014 for additional suggestions for individual and whole-school e-cigarette supports for school nurses). As such, this need for organization could be achieved by having the school nurse act as the educator and helping the school identify a plan of how to best implement it universally within their school similar to other health education that they often provide or oversee (e.g., mental health education, Bohnenkamp et al., 2015; obesity prevention education, Tucker & Lanningham-Foster, 2015). Therefore, school nurses have a unique opportunity to play a central role in addressing many of the health-related topics correlated with tobacco and e-cigarette use, as well as targeting cessation strategies and school policy for student health and wellness (Croghan, 2017; Voogd, 2014).
While school nurses are well equipped, and most likely the best person at their school, to intervene directly or provide prevention activities, their capacity may be limited due to the additional demands of their role and the diverse health concerns among the school’s youth (e.g., diabetes). CATCH is an ideal intervention because it uses a spoke and node approach (a social network approach that relies on social exchanges within networks, (e.g., Li et al., 2009), where the nurse can act as the central organizer and educator while providing the tools and resources to teachers so that they can diffuse the intervention across the school and reach a greater number of youth and parents/guardians. Additionally, school nurses can work with other key personnel at schools (e.g., social workers or school counselors) who and create a key mechanism by which to identify high-risk youth and their families in an effort to provide one-on-one prevention or cessation efforts. Using approaches, such as motivational interviewing, school nurses can use their training to discuss risky health behaviors, including e-cigarettes, with not only students, but also parents/guardians and teachers/staff (Blume & Lines, 2020; Smith et al., 2021; Wimmer, 2015).
Our study has several strengths identified throughout the programming implementation and our evaluation findings. The use of pre- and post-surveys to capture the knowledge and confidence of teachers and parents provides strong evidence for our programming effectiveness. Furthermore, using a multicomponent e-cigarette prevention program, a researchsupported approach to vape interventions, and the target population of both teachers and parents is a strength of the current study. Additionally, the statistically significant increases in both parent and teacher knowledge from one-time training highlights the success and implications of the study for real-world impacts based on the short-term impacts demonstrated through pre- and post-survey measures. Using parent and teacher education and providing evidence-based information is an important prevention strategy to address this public health concern (Murthy, 2017).
The current study also has several limitations that can be addressed with future research and programming efforts. First, it was infeasible to use a control group for the current study. While it is unlikely that parents or teachers would report such significant changes in knowledge without the intervention, we do not have the control group data needed to attribute knowledge growth due to programming alone. Second, our efforts were geographically limited, largely a homogenous group with limited diversity, which is consistent with local demographic information. Our efforts were also time-limited due to the nature of grant funding; however, our target groups and timeframe provide an excellent sample in the rural Northwest. Third, both teachers and parents/guardians who attended training had the option to self-select and attend the education training and events, which could introduce the possibility of self-selection bias in our results. Fourth, we did not restrict other staff at schools from participating in the CATCH My Breath training but also did not actively recruit them given the intended teacher use of the curriculum with students. Future studies may benefit from recruiting school nurses, counselors, and other staff who regularly interact with students regarding e-cigarette or vape prevention, cessation, or use. Finally, while our survey measures were adapted from an existing survey, these items have not been found valid or reliable, suggesting that caution is needed when considering the future applications of the measures. However, program evaluation often relies on measures created for assessing program outcomes because there is a lack of validated measures that meet the needs of specific program components.
Future studies can replicate the multicomponent design used in the current study with teachers and parents who spend significant time with their youth. Furthermore, school nurses can use a multicomponent intervention to intervene in their school(s) to address vaping concerns, prevention efforts, and educational interventions (Blume & Lines, 2020). Future evidence-based educational interventions should continue to emphasize local information, statistics, and resources that target their youth (SHARP, 2019) while strengthening their design with the findings from the current study (i.e., build on parent and teacher knowledge and confidence areas). Finally, matching demographic data to participants’ pre-post survey results may allow for analysis by subgroups and provide additional detailed information on why the information made the large impacts observed for various groups.
This research and prevention information would not be possible without the support of our grant funders. We appreciate having the opportunity to provide this information and conduct this research on this important issue. We would like to thank and acknowledge the Utah State University Extension faculty, staff, and project personnel involved in the programmatic success of this research. Specifically, we would like to thank Extension faculty and staff in Carbon, Emery, and Grand Counties for their support in disseminating information about upcoming events and connecting us with important collaborators in local communities. We would like to thank our local Health & Wellness Prevention Coordinators, Jenna Hawks and Jordyn Oman, for their valuable work. We would like to thank the Utah State University Extension Marketing team for their efforts in building a brand and website for future evidence-based information access. We would especially like to thank the community partners (e.g., the local health department, behavioral health, hospital and medical clinics, coalitions, and restaurants, among others) and those that participated in the events and programming efforts (i.e., teachers and parents/guardians) for their time and willingness to learn.
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Southeast Utah Health Department (E-Cigarette, Marijuana, and Other Drug Prevention Grant).
Ashley C. Yaugher https://orcid.org/0000-0001-6332-7922
Cristian L. Meier https://orcid.org/0000-0001-6328-4272
American Lung Association. (n.d.). End the youth vaping epidemic. https://www.lung.org/quit-smoking/end-youth-vaping
Amrock, S. M., Lee, L., & Weitzman, M. (2016). Perceptions of e-cigarettes and noncigarette tobacco products among US youth. Pediatrics, 138(5), e20154306. https://doi.org/10.1542/peds.2015-4306
Bach Harrison LLC. (2022). Utah SHARP Web Tool. Utah Department of Human Services Substance Abuse and Mental Health. http://www.bach-harrison.com/utahsharpwebtool/
Baker, K. A., & Campbell, N. J. (2020). Combatting teen vaping in school settings. Journal of Addictions Nursing, 31(2), 73–76. https://doi.org/10.1097/JAN.0000000000000330
Baker, K. A., Campbell, N. J., Noonan, D., Thompson, J. A., & Derouin, A. (2022). Vaping prevention in a middle school population using CATCH My Breath. Journal of Pediatric Health Care, 36(2), 90–98. https://doi.org/10.1016/j.pedhc.2021.07.013
Bandura, A., & Walters, R. H. (1977). Social learning theory (Vol. 1). Prentice Hall.
Bartlett, E. E. (1981). The contribution of school health education to community health promotion: What can we reasonably expect? American Journal of Public Health, 71, 1387–1391. https://doi.org/10.2105/AJPH.71.12.1384
Blagev, D. P., Harris, D., Dunn, A. C., Guidry, D. W., Grisson, C. K., & Lanspa, M. J. (2019). Clinical presentation, treatment, and short-term outcomes of lung injury associated with e-cigarettes or vaping: A prospective observation cohort study. The Lancet, 394(10214), 2073–2083. https://doi.org/10.1016/S0140-6736(19)32679-0
Blume, L. F., & Lines, S. (2020). The role of the school nurse in creating a vape-free school. NASN School Nurse, 35(3), 166–172. https://doi.org/10.1177/1942602X20913261
Bohnenkamp, J. H., Stephan, S. H., & Bobo, N. (2015). Supporting student mental health: The role of the school nurse in coordinated school mental health care. Psychology in the Schools, 52(7), 714–727. https://doi.org/10.1002/pits.21851
Callahan-Lyon, P. (2014). Electronic cigarettes: Human health effects. Tobacco Control, 23(2), ii36–ii40. https://doi.org/10.1136/tobaccocontrol-2013-051470
CATCH. (n.d.). CATCH my breath: Evidence-based vaping prevention program: Parent & community resources. https://catch.org/program/vaping-prevention/#parents
CATCH. (2018). CATCH global foundation webinar: CATCH my breath youth E-cigarette prevention program. Kelder. https://sph.uth.edu/research/centers/dell/webinars/Kelder%20CATCH%20My%20Breath%20Webinar%203-2018VR.pdf
CATCH. (2020). CATCH my breath vaping prevention program: State of the union of youth vaping epidemic and introduction to an evidence-based prevention program. https://letsgo.catch.org/pages/catch-my-breath
CDC. (2017). E-cigarette ads and youth. https://www.cdc.gov/vitalsigns/ecigarette-ads/index.html
Centers for Disease Control and Prevention (CDC). (n.d.). About electronic cigarettes (E-cigarettes): What are e-cigarettes? https://www.cdc.gov/tobacco/basic_information/e-cigarettes/aboute-cigarettes.html#what-are-e-cigarettes
Centers for Disease Control and Prevention (CDC). (2023). Health education. https://www.cdc.gov/healthyyouth/health0education/index.htm
Cho, J. H., & Paik, S. Y. (2016). Association between electronic cigarette use and asthma among high school students in South Korea. PLoS One, 11(3), e0151022. https://doi.org/10.1371/journal.pone.0151022
Choi, H. J., Miller-Day, M., Hecht, M., Glenn, S. D., Lyons, R. E., & Greene, K. (2022). A snapshot of parenting practices useful for preventing adolescent vaping. Addictive Behaviors Reports, 15, 100418. https://doi.org/10.1016/j.abrep.2022.100418
Chu, K. H., Sidani, J., Matheny, S., Rothenberger, S. D., Miller, E., Valente, T., & Robertson, L. (2021). Implementation of a cluster randomized controlled trial: Identifying student peer leaders to lead e-cigarette interventions. Addictive Behaviors, 114, 106726. https://doi.org/10.1016/j.addbeh.2020.106726
Chun, L., Moazed, F., Calfee, C., Matthay, M., & Gotts, J. (2017). Pulmonary toxicity of e-cigarettes. American Journal of Physiology-Lung Cellular and Molecular Physiology, 313(2), L193–L206. https://doi.org/10.1152/ajplung.00071.2017
Cobb, N. K., & Solanki, J. N. (2020). E-cigarettes, vaping devices, and acute lung injury. Respiratory Care, 65(5), 713–718. https://doi.org/10.4187/respcare.07733
Cooperation, S. (2017). Stata statistical software: release 15. StrataCorp LLC.
County Health Rankings. (2020). Utah: Carbon County; Emery County; Grand County. University of Wisconsin Population Health Institute. https://www.countyhealthrankings.org/app/utah/2020/rankings/carbon/county/outcomes/overall/snapshot
Croghan, E. (2017). Tobacco control and young people: A guide for school nurses. British Journal of School Nursing, 12(3), 120–124. https://doi.org/10.12968/bjsn.2017.12.3.120
Desilver, D. (2019, February 26). The concerns and challenges of being a U.S. teen: What the data show. Pew Research Center. https://www.pewresearch.org/fact-tank/2019/02/26/the-concerns-and-challenges-of-being-a-u-s-teen-what-the-data-show/
Dwyer, J. B., McQuown, S. C., & Leslie, F. M. (2009). The dynamic effects of nicotine on the developing brain. Pharmacology & Therapeutics, 122(2), 125–139. https://doi.org/10.1016/j.pharmthera.2009.02.003
Evans-Polce, R. J., Veliz, P., Boyd, C. J., & McCabe, S. E. (2020). Initiation patterns and trends of e-cigarette and cigarette use among U.S. adolescents. Journal of Adolescent Health, 66(1), 27–33. https://doi.org/10.1016/j.jadohealth.2019.07.002
Fadus, M. C., Smith, T. T., & Squeglia, L. M. (2019). The rise of e-cigarettes, pod mod devices, and JUUL among youth: Factors influencing use, health implications, and downstream effects. Drug and Alcohol Dependence, 201, 85–93. https://doi.org/10.1016/j.drugalcdep.2019.04.011
Food and Drug Administration (FDA). (n.d.). Nicotine is why tobacco products are addictive. https://www.fda.gov/tobaccoproducts/health-effects-tobacco-use/nicotine-why-tobaccoproducts-are-addictive
Food and Drug Administration (FDA). (2023). The real cost cigarette prevention campaign. https://www.fda.gov/tobacco-products/realcost-campaign/real-cost-cigarette-prevention-campaign#:∼:text=FDA’s%20first%20tobacco%20prevention%20campaign,to%20become%20established%20adult%20smokers
Gaiha, S. M., Cheng, J., & Halpern-Felsher, B. (2020). Association between youth smoking, electronic cigarette use, and COVID-19. Journal of Adolescent Health, 67(4), 519–523. https://doi.org/10.1016/j.jadohealth.2020.07.002
Goriounova, N. A., & Mansvelder, H. D. (2012). Short- and longterm consequences of nicotine exposure during adolescence for prefrontal cortex neuronal network function. Cold Spring Harbor Perspectives in Medicine, 2(12), a012120. https://doi.org/10.1101/cshperspect.a012120
Gorukanti, A., Delucchi, K., Ling, P., Fisher-Travis, R., & Halpern-Felsher, B. (2017). Adolescents’ attitudes towards e-cigarette ingredients, safety, addictive properties, social norms, and regulation. Preventive Medicine, 94, 65–71. https://doi.org/10.1016/j.ypmed.2016.10.019
Gundersen, C., Engelhard, E., & Waxman, E. (2014). Map the meal gap: Exploring food insecurity at the local level. Applied Economic Perspectives and Policy, 36(3), 373–386. https://doi.org/10.1093/aepp/ppu018
Jha, V., & Kraguljac, A. (2021). Assessing the social influences, self-esteem, and stress of high school students who vape. The Yale Journal of Biology and Medicine, 94(1), 95–106. PMID: 33795986; PMCID: PMC7995953.
Keenan, M., Keenan, K., Wrotniak, B., Qiao, H., & Emborsky, M. (2022). Do your kids vape?: Investigating parent knowledge of adolescent e-cigarette use. Pediatric Emergency Care, 38(6), e1309–e1313. https://doi.org/10.1097/PEC.0000000000002565
Kelder, S. H., Mantey, D. S., VanDusen, D., Case, K., Haas, A., & Springer, A. E. (2020). A middle school program to prevent e-cigarette use: A pilot study of “CATCH My Breath”. Public Health Reports, 132(2), 220–229. https://doi.org/10.1177/0033354919900887
Kelder, S. H., Mantey, D. S., Van Dusen, D., Vaughn, T., Bianco, M., & Springer, A. E. (2021). Dissemination of CATCH My Breath, a middle school e-cigarette prevention program. Addictive Behaviors, 113, 106698. https://doi.org/10.1016/j.addbeh.2020.106698
Kristjansson, A. L., Mann, M. J., & Smith, M. L. (2017). Prevalence of substance use among middle school-aged e-cigarette users compared with cigarette smokers, nonusers, and dual users: Implications for primary prevention. Substance Abuse, 38(4), 473–476. https://doi.org/10.1080/08897077.2017.1343218
Less, E. L., Mady, M., Beckman, K. J., & Kingsbury, J. H. (2021). “If someone has it, I’m gonna hit it”: Lessons learned from Minnesota teens about vaping. Health Promotion Practice, 23(6), 1028–1038. https://doi.org/10.1177/15248399211045353
Li, L. C., Grimshaw, J. M., Nielsen, C., Judd, M., Coyte, P. C., & Graham, I. D. (2009). Use of communities of practice in business and health care sectors: A systematic review. Implementation Science, 4, 27. https://doi.org/10.1186/1748-5908-4-27
Liu, J., Gaiha, S. M., & Halpern-Felsher, B. (2020). A breath of knowledge: Overview of current adolescent e-cigarette prevention and cessation programs. Current Addiction Reports, 7(4), 520–532. https://doi.org/10.1007/s40429-020-00345-5
Mantey, D. S., Clendennen, S. L., Springer, A. E., & Harrell, M. B. (2022). Perceived parental knowledge reduces risk for initiation of nicotine and cannabis vaping: A longitudinal study of adolescents. American Journal of Health Promotion, 36(4), 623–632. https://doi.org/10.1177/08901171211061941
Moosbrugger, M., Losee, T. M., González-Toro, C. M., Drewson, S. R., Stapleton, P. J., Ladda, S., & Cucina, I. (2023). Pre-service teachers’ perceptions and experiences implementing CATCH My Breath. American Journal of Health Education, 54(1), 20–28. https://doi.org/10.1080/19325037.2022.2142336
Morbidity and Mortality Weekly Report (MMWR). (2018, June 15). Youth risk behavior surveillance—United States, 2017. Centers for Disease Control and Prevention, U.S. Department of Health, and Human Services. https://www.cdc.gov/healthyyouth/data/yrbs/pdf/2017/ss6708.pdf
Morbidity and Mortality Weekly Report (MMWR). (2021, October 1). Notes from the field: E-cigarette use among middle and high school students - National Youth Tobacco Survey, United States, 2021. Centers for Disease Control and Prevention, U.S. Department of Health, and Human Services. https://www.cdc.gov/mmwr/volumes/70/wr/mm7039a4.htm
Morrison-Sandberg, L. F., Kubik, M. Y., & Johnson, K. E. (2011). Obesity prevention practices of elementary school nurses in Minnesota: Findings from interviews with licensed school nurses. The Journal of School Nursing, 27(1), 13–21. https://doi.org/10.1177/1059840510386380
Murthy, V. H. (2017). E-cigarette use among youth and young adults: A major public health concern. JAMA Pediatrics, 171(3), 209–210. https://doi.org/10.1001/jamapediatrics.2016.4662
National Institute on Drug Abuse (NIDA). (2020, June 2). What are the core elements of effective research-based prevention programs? https://nida.nih.gov/publications/preventing-drug-useamong-children-adolescents/chapter-3-applying-preventionprinciples-to-drug-abuse-programs/core-elements
Patel, M., Czaplicki, L., Perks, S. N., Cuccia, A. F., Liu, M., Hair, E. C., Schillo, B. A., & Vallone, D. M. (2019). Parents’ awareness and perceptions of JUUL and other e-cigarettes. American Journal of Preventive Medicine, 57(5), 695–699. https://doi.org/10.1016/j.amepre.2019.06.012
Pierce, J. P., Chen, R., Leas, E. C., White, M. M., Kealey, S., Stone, M. D., Behmarhnia, T., Trinidad, D. R., Strong, D. R., & Messer, K. (2021). Use of e-cigarettes and other tobacco products and progression to daily cigarette smoking. Pediatrics, 147(2), 1–8. https://doi.org/10.1542/peds.2020-025122
Pike, J. R., Tan, N., Miller, S., Cappelli, C., Xie, B., & Stacy, A. W. (2019). The effect of e-cigarette commercials on youth smoking: A prospective study. American Journal of Health Behavior, 43(6), 1103–1118. https://doi.org/10.5993/AJHB.43.6.8
Popova, L., Fairman, R. T., Akani, B., Dixon, K., & Weaver, S. R. (2021). “Don’t do vape, bro!” A qualitative study of youth’s and parents’ reactions to e-cigarette prevention advertisements. Addictive Behaviors, 112, 106565. https://doi.org/10.1016/j.addbeh.2020.106565
Public Health Indicator Based Information System (IBIS). (2020, December 23). Complete health indicator report of electronic cigarettes/vape products. Utah Department of Health. https://ibis.health.utah.gov/ibisph-view/indicator/complete_profile/ECig.html
Rath, J. M., Romberg, A. R., Perks, S. N., Edwards, D., Vallone, D. M., & Hair, E. C. (2021). Identifying message themes to prevent e-cigarette use among youth and young adults. Preventive Medicine, 150, 106683. https://doi.org/10.1016/j.ypmed.2021.106683
Rose, C. S. (2017). Early detection, clinical diagnosis, and management of lung disease from exposure to diacetyl. Toxicology, 388, 9–14. https://doi.org/10.1016/j.tox.2017.03.019
Sallis, J. F., Owen, N., & Fisher, E. B. (2008). Ecological models of health behavior. In K. Glanz, B. K. Rimer, & K. Viswanath (Eds.), Health behavior and health education: Theory, research, and practice (pp. 465–485). Jossey-Bass.
Sapru, S., Vardhan, M., Li, Q., Guo, Y., Li, X., & Saxena, D. (2020). E-cigarettes use in the United States: reasons for use, perceptions, and effects on health. BMC Public Health, 1518(2020), 1–10. https://doi.org/10.1186/s12889-020-09572-x
Schillo, B. A., Cuccia, A. F., Patel, M., Simard, B., Donovan, E. M., Hair, E. C., & Vallone, D. (2020). JUUL In school: Teacher and administrator awareness and policies of e-cigarettes and JUUL in US middle and high schools. Health Promotion Practice, 21(1), 20–24. https://doi.org/10.1177/1524839919868222
Smith, L. M., Boehm, L., Strang, L. V., DeMarre, C., & Marcyjanik, D. (2021). Targeted education for school staff on electronic nicotine delivery systems: A nurse led intervention. The Journal of School Nursing, 40(2), 223–230. https://doi.org/10.1177/10598405211043127
Soneji, S., Barrington-Trimis, J. L., Wills, T. A., Leventhal, A. M., Unger, J. B., Gibson, L. A., Yang, J., Primack, B. A., Andrews, J. A., Miech, R. A., Spindle, T. R., Dick, D. M., Eissenberg, T., Hornick, R. C., Dang, R., & Sargent, J. D. (2017). Association between initial use of e-cigarettes and subsequent cigarette smoking among adolescents and young adults: A systematic review and meta-analysis. JAMA Pediatrics, 171(8), 788–797. https://doi.org/10.1001/jamapediatrics.2017.1488
Stalgaitis, C. A., Djakaria, M., & Jordan, J. W. (2020). The vaping teenager: Understanding the psychographics and interests of adolescent vape users to inform health communication campaigns. Tobacco Use Insights, 13, 1179173X2094569. https://doi.org/10.1177/1179173X20945695
Substance Abuse and Mental Health Services Administration (SAMHSA). (2020a). Reducing vaping among youth and young adults (SAMHSA Publication No. PEP20-06-01-003). National Mental Health and Substance Use Policy Laboratory, U.S. Department of Health and Human Services. https://store.samhsa.gov/product/Reducing-Vaping-Among-Youth-and-Young-Adults/PEP20-06-01-003
Substance Abuse and Mental Health Services Administration (SAMHSA). (2020b). Focus on prevention (U.S. HHS Publication No. SMA10–4120). U.S. Department of Health and Human Services. https://store.samhsa.gov/product/Focuson-Prevention/sma10-4120
Truth Initiative. (n.d.). Youth smoking and vaping prevention. https://truthinitiative.org/what-we-do/youth-smoking-preventioneducation
Tucker, S., & Lanningham-Foster, L. M. (2015). Nurse-led schoolbased child obesity prevention. The Journal of School Nursing, 31(6), 450–466. https://doi.org/10.1177/1059840515574002
UNDO. (2022). Nicotine addiction and how to help. California Department of Public Health. https://www.flavorshookkids.org/parent-resources/
U.S. Census Bureau. (2019). Utah: Carbon County; Emery County; Grand County. https://www.census.gov/en.html
U.S. Department of Health and Human Services (U.S. HHS). (n.d.). The real cost. https://therealcost.betobaccofree.hhs.gov/
U.S. Department of Health and Human Services (U.S. HHS). (2016). E-cigarette use among youth and young adults: A report of the Surgeon General. https://e-cigarettes.surgeongeneral.gov/documents/2016_SGR_Full_Report_508.pdf
Utah Department of Human Services Division of Substance Abuse and Mental Health. (n.d.). Student health and risk prevention (SHARP): Prevention needs assessment survey: Results for State of Utah. https://sumh.utah.gov/data-reports/sharp-survey
Utah Department of Human Services Division of Substance Abuse and Mental Health. (2019). Student health and risk prevention (SHARP): Prevention needs assessment survey: Results for Four Corners District LSAA. https://dsamh.utah.gov/pdf/sharp/2019/Four%20Corners%20District.pdf
Virk, H., & Hunter, J. (2021). Vaping perceptions among youth and teachers. National Social Science Journal, 57(1), 47–53. ISSN 2154-1736. https://nssa.us/journals/pdf/NSS_Journal_57_1.pdf#page=49
Vogel, E. A., Ramo, D. E., Rubinstein, M. L., Delucchi, K. L., Darrow, S. M., Costello, C., & Prochaska, J. J. (2021). Effects of social media on adolescents’ willingness and intention to use e-cigarettes: An experimental investigation. Nicotine & Tobacco Research, 23(4), 694–701. https://doi.org/10.1093/ntr/ntaa003
Voogd, C. (2014). Young people friendly smoking prevention and cessation services. British Journal of School Nursing, 9(1), 17–20. https://doi.org/10.12968/bjsn.2014.9.1.17
Westling, E., Rusby, J. C., Crowley, R., & Light, J. M. (2017). Electronic cigarette use by youth: Prevalence, correlates, and use trajectories from middle to high school. Journal of Adolescent Health, 60(6), 660–666. https://doi.org/10.1016/j.jadohealth.2016.12.019
Wills, T. A., Knight, R., Williams, R. J., Pagano, I., & Sargent, J. D. (2015). Risk factors for exclusive e-cigarette use and dual e-cigarette use and tobacco use in adolescents. Pediatrics, 135(1), e43–e51. https://doi.org/10.1542/peds.2014-0760
Wimmer, H. P. (2015). E-cigarettes: A new challenge for public health and for school nurses. NASN School Nurse, 30(1), 26–28. https://doi.org/10.1177/1942602x14560374
Wu, T. S., & Chaffee, B. W. (2020). Parental awareness of youth tobacco use and the role of household tobacco rules in use prevention. Pediatrics, 146(5), 1–8. https://doi.org/10.1542/peds.2019-4034
Zeller, M. (2020). Youth e-cigarette use and the Food and Drug Administration’s multifaceted approach. American Journal of Public Health, 110(6), 772–773. https://doi.org/10.2105/AJPH.2020.305680
Ashley C. Yaugher, PhD, Health & Wellness faculty at Utah State University Extension, focuses on education for substance use disorder prevention, treatment, recovery, and other wellness issues in rural communities.
Christina C. Pay, MSHE, Family and Consumer Sciences Assistant Professor at Utah State University Extension, focuses on health and wellness, including positive youth development education.
Jenna Hawks, BS, Health & Wellness Prevention Coordinator at Utah State University Extension, is passionate about public health, including enhancing community health and well-being.
Cristian L. Meier, PhD, MPH, MSW, Assistant Professor in the Social Work Department at Utah State University, focuses on rural health and well-being using mixed method designs to evaluate Extension programming.
1 Utah State University, Cooperative Extension in Carbon, Emery, and Grand Counties, Logan, UT, USA
Corresponding Author: Ashley C. Yaugher, Utah State University, Cooperative Extension in Carbon, Emery, and Grand Counties, 4900 Old Main Hill, Logan, UT 84321, USA. Email: ashley.yaugher@usu.edu
