Heather Ledbetter has watched high schools in Tennessee’s Maryville City Schools (MCS) grapple with the growing use electronic cigarettes by students. "Vaping" e-cigarettes even happens in hallways, she said, to the irritation of students who asked for help from administrators to make it stop.
Their complaints led district leaders to launch a program through CATCH My Breath, a nonprofit health organization that provides free curriculum materials, including those that focus on e-cigarettes that heat a liquid commonly called a "vapor" that the user inhales, for middle and high schools. MCS introduced the program to 8th and 9th graders this semester.
“[Students] were telling us, ‘I don’t want to walk through that,’” Ledbetter, who leads the district’s coordinated school health program, told Education Dive. “We recognized quickly that this is something we need to educate kids, and the community, on.”
New twist on old problem
Lessons on the dangers of tobacco and nicotine have been a part of public education programming for decades to encourage students to avoid smoking, and posters showing cross sections of a diseased lung coated in tar are common in health classes.
Anti-tobacco messaging is responsible for cutting the nation's smoking rates in half since the U.S. Surgeon General released its first warning about the danger of smoking in 1964, according to the 2014 report “The Health Consequences of Smoking — 50 Years of Progress.”
Then in 2015, JUUL, a device that lets people inhale a nicotine-laced brew rather than smoke a paper-wrapped tobacco cigarette, helped bring "vaping" into the mainstream. Adults began vaping on sidewalks and in offices, comfortable that they had found a way to continue their nicotine habit without infringing on others. There are many other vaping devices on the market now.
Teens also started using e-cigarettes — and in growing numbers. According to CATCH My Breath, as of 2018, 11.7% of high school students and 3.3% of middle school students had said they’d tried them in the past 30 days. Approximately 10.5 million students see ads for the devices on the internet. JUUL, in particular, is very attractive to children because it's a neatly packed thumb drive with fruit-like flavors and colorful packaging that makes it look like a "Willy Wonka and the Chocolate Factory" invention.
A JUUL starter kit is about $50, and students often chip in to share one, which can be charged by plugging it into a USB drive on a computer, according to Marcella Bianco, who directs CATCH My Breath’s youth e-cigarette prevention program. Teachers have even had students ask if they can charge while in class.
Students buy their own pod — the piece they put to their mouth to inhale — and a pack of four costs about $15. The pod holds the nicotine-laced liquid, and each one packs 5% nicotine — about the same as a pack of cigarettes.
Getting students' help
One crucial problem, said Bianco, who has worked in tobacco prevention for more than 14 years, is that some teens don’t know they’re inhaling nicotine. Another issue, she said, is that e-cigarettes and vaping aren’t part of some districts’ policies, making the devices hard to monitor, mitigate and control among students.
Even so, she’s heard anecdotally from some schools that teachers say so many of their students are vaping that they’re afraid to report the children, who could be suspended or taken out of class.
“One said, ‘I wouldn’t have any students in class if [e-cigarettes] were all removed,’” Bianco told Education Dive.
It's important, experts say, to help students who may be addicted to the nicotine they’re inhaling to seek help rather than avoid adults in fear of being punished. That’s something Colorado’s RMC Health focuses on— how to help schools create alternatives to suspension.
Natalie Boyer, a senior professional learning facilitator with RMC Health, said in an interview that educators "may need to consider how to support students who have a nicotine addiction, and instead refer them to cessation programs and provide them with support.”
RMC Health works predominately in Colorado, but also with schools and districts across the nation, and has pivoted to focus on e-cigarettes and vaping over the past two years. Its programming also addresses educators, administrators and adults in a child’s life, to help them understand vaping and e-cigarettes and how they’re being marketed to children.
“We want to raise people’s confidence about how to look for them,” Boyer said. “We know a trusted adult is a protective factor in substance use, including JUULs. Youth report that having an adult to go to makes them 31% less likely to vape.”
Initiating prevention lessons
CATCH My Breath programs are aimed at 6th through 12th graders, with four lessons for each grade that are 35 to 40 minutes each. The organization is also working to expand its lessons to grades 3 to 5, potentially by the spring of 2020.
“The caveat [for younger grades] is you have to look at whether it’s prevention or is it initiation,” said Bianco. “You may be introducing it to a student who never knew it existed, who says, ‘I never knew this existed in watermelon, I want to try it.’ We want to prevent, not initiate.”
Programs can be taught in P.E. and health classes, with teachers providing the initial lessons and peer facilitators taking the next step, allowing students to lead conversations. Students also can role play how to resist e-cigarettes — whether at a party, in a school bathroom or at home if an older sibling is giving them one to try.
“I just had a teacher today tell me the best thing about the program is that the kids can talk among themselves about e-cigarettes and JUULing in a safe environment,” she said.
Easy to hide, difficult to find
Ledbetter said one problem MCS faces is that it’s difficult for teachers to find e-cigarettes. There are clothes being marketed that allow students to hide them inside T-shirt pockets, she said, and one company even has sweatshirts with hoodie strings that hold pods can be easily slipped in the mouth to vape.
While the district is implementing the CATCH My Breath program, Ledbetter said it is also working directly with students, engaging them to help push an anti-vaping message out to their peers. Ten years ago, the district ran a campaign around cigarettes, teasing the number 54 — the number of people who died every day in Tennessee from tobacco-related illnesses — in principal addresses and through a student-launched Facebook page. A similar approach is being eyed for e-cigarettes.
“Cigarette smoke kind of lingers, and e-cigarettes may not linger as long, but you can see when someone is vaping and exhales,” she said. “[Secondhand smoke] is still part of the issue, and [the students] do not want that in their schools."