Reducing Youth Vaping: A Pilot Test of the Peer-Led "Youth Engaged Strategies for Changing Adolescent Norms!" (YES-CAN!) Program

Young people's experiences of vaping in their community: a co-created study between embedded researchers and local authority public health practitioners

AIM

This qualitative study aimed to investigate how young people understand vaping among their peers to directly inform practice within a Local Authority (LA) public health team in the North of England.

METHOD

The study was undertaken using a co-creation model of qualitative research between LA practitioners and Health Determinants Research Collaboration (HDRC) embedded researchers. The study team collaboratively planned and collected data and analysed findings. Four focus groups were held with 17 young people aged between 13 and 23 years between May and August 2024. Participants were recruited from communities with reported high electronic cigarette (vape) use. Data analysis was informed by Braun and Clarke's reflexive thematic analysis approach.

RESULTS

Results suggest the importance of friendship groups, social media, mental wellbeing and family in the prevalence of youth vaping, alongside the accessibility and appeal of flavours, colours, and brands of vapes. Young people identified a lack of clear information and guidance about vapes with a mixed understanding of legal frameworks. They made valuable suggestions including specialist advisors within schools, increased regulation of the accessibility and promotion of vapes, and further information about health harms.

CONCLUSIONS

This study supports existing findings about the appeal of vapes to young people. The findings also add important knowledge about experiences of young people from a range of backgrounds where vaping has been identified as more prevalent locally and which mirrors health inequality data. Findings also highlight lack of awareness of legal frameworks and health harms of vaping products. Young people's suggestions on support to reduce vaping point towards several policy and practice interventions for use in LA settings, including providing accurate and clear information on vape harms, enhancing support services and reducing vape access and appeal.

The Role of the School Nurse in E-Cigarette Prevention and Cessation: A Scoping Review

E-cigarettes have rapidly gained popularity among youth in recent years. This scoping review identifies opportunities for school nurses to incorporate e-cigarette prevention strategies into their practice and identifies gaps for future research in school nursing evidence-based practice. Using the methodological framework developed by Arksey and O'Malley and advanced by Levac et al., a literature review was conducted using PubMed, Cumulative Index to Nursing and Allied Health (CINAHL), and Education Resources Information Center (ERIC) databases. A total of 15 articles were included in the final review. Articles for inclusion addressed interventions aimed at reducing e-cigarette use in K-12 schools. The results highlight two general types of school-based interventions: (1) universal e-cigarette prevention education and (2) targeted e-cigarette use-cessation programs. Each of these types of interventions presents a leadership opportunity for school nurses to engage within all domains of their scope of practice.

Public Health Interventions Targeting the Prevention of Adolescent Vaping: A Scoping Review

OBJECTIVE

Despite a brief decline during the COVID-19 pandemic, vaping behaviors among adolescents continue to be an international public health concern because of associated health risks and harms. A thorough investigation of existing interventions preventing adolescent vaping is needed to help address this public health crisis and reduce serious and avoidable vaping-related health risks. We reviewed the literature to identify public health interventions aimed at preventing adolescent vaping and summarized their key components and outcome measures.

DESIGN

We conducted a scoping review of the literature using the Joanna Briggs Institute methodology searching in MEDLINE, CINAHL, Embase, PubMed, PsycINFO, ProQuest, and Web of Science. Two reviewers screened 589 records for relevance. Studies from any location, reported in English, and described vaping prevention interventions targeting adolescents were included. Records were excluded if they were reported in other languages, published outside the review timeframe, lacked an evaluation, focused on cessation-based interventions, or were review articles. Data extracted included intervention type, key components, and outcome measures.

RESULTS

Thirty-eight included articles were identified and categorized into three intervention categories: school-based, public education/risk communication campaigns, and public policies/government regulations. Key components of the interventions included format, duration, and topics. Formats varied from single to multi-sessions. Prominent topics covered included risks and harms associated with vaping, and the most frequently reported outcome measures used were knowledge, attitudes, and beliefs.

CONCLUSION

Our findings summarize existing public health interventions found in the literature and insights into approaches used to address the global adolescent vaping crisis.

A Systematic Review and Meta-analysis of School-Based Preventive Interventions Targeting E-Cigarette Use Among Adolescents

This study aimed to examine the efficacy of school-based e-cigarette preventive interventions via a systematic review and meta-analysis. We searched Medline, Embase, PsycINFO, Scopus, CINAHL, Cochrane, and clinical trial registries for studies published between January 2000 and June 2023 using keywords for e-cigarettes, adolescents, and school. Of 1566 double-screened records, 11 met the criteria of targeting adolescents, evaluating an e-cigarette preventive intervention, being conducted in a secondary school, using a randomized controlled trial (RCT), cluster RCT, or quasi-experimental design, and comparing an intervention to a control. Pre-specified data pertaining to the study design, outcomes, and quality were extracted by one reviewer and confirmed by a second, and where necessary, a third reviewer. Meta-analyses found no evidence that school-based interventions prevented e-cigarette use at the longest follow-up, which ranged between 6 and 36 months post-intervention (OR = 0.43, 95% CI = 0.16, 1.12; p = 0.09). However, subgroup analyses identified significant effects at post-test and when studies with < 12-month follow-up were omitted. No effect was found for tobacco use at the longest follow-up (OR = 1.01, 95% CI = 0.65, 1.59, p = 0.95); however, reductions in past 30-day tobacco use (OR = 0.59, 95% CI = 0.39, 0.89, p = 0.01) which encompassed e-cigarettes in some studies were identified. Narrative synthesis supported these mixed results and found some school-based interventions prevented or reduced e-cigarette and/or tobacco use; however, some increased use. School-based interventions were also associated with improved knowledge (SMD =  - 0.38, 95% CI =  - 0.68, - 0.08, p = 0.01), intentions (SMD =  - 0.15, 95% CI =  - 0.22, - 0.07, p = 0.0001), and attitudes (SMD =  - 0.14, 95% CI =  - 0.22, - 0.06; p = 0.0007) in the short term. Overall, the quality of evidence was low-to-moderate. School-based interventions hold the potential for addressing e-cigarette use, however, can have null or iatrogenic effects. More high-quality research is needed to develop efficacious interventions, and schools must be supported to adopt evidence-based programs. This is the first systematic review and meta-analysis to examine the efficacy of school-based preventive interventions for e-cigarette use. It provides crucial new knowledge about the efficacy of such interventions in preventing e-cigarette use and improving other outcomes (e.g., tobacco use, knowledge, intentions, attitudes, and mental health) among adolescents and the key characteristics associated with efficacious interventions. Our findings have important practical implications, highlighting future research directions for the development and evaluation of e-cigarette preventive interventions, along with the need to provide support to schools to help them identify and adopt evidence-based programs.