The use of Juuls and other e-cigarettes has increased in Vermont high schools over the past year. Many students are not aware of the risks associated with the use of these products and believe that they cause no harm. This project focused on increasing communication between high school students and their healthcare providers to improve dialogue and learn the facts about using these projects.https://scholarworks.uvm.edu/fmclerk/1434/thumbnail.jp

Wigmore, Daniel JD

English

UVM ScholarWorks

University of VermontScholarWorks @ UVMFamily Medicine Clerkship Student Projects Larner College of Medicine2018Increasing Awareness of the Risks Associated withJuuls in High School StudentsDaniel JD WigmoreFollow this and additional works at: https://scholarworks.uvm.edu/fmclerkPart of the Medical Education Commons, and the Primary Care CommonsThis Book is brought to you for free and open access by the Larner College of Medicine at ScholarWorks @ UVM. It has been accepted for inclusion inFamily Medicine Clerkship Student Projects by an authorized administrator of ScholarWorks @ UVM. For more information, please contactdonna.omalley@uvm.edu.Recommended CitationWigmore, Daniel JD, "Increasing Awareness of the Risks Associated with Juuls in High School Students" (2018). Family MedicineClerkship Student Projects. 365.https://scholarworks.uvm.edu/fmclerk/365Increasing Awareness of the  Risks Associated with Juuls in High School StudentsDan WigmoreJune 2018Dr. BakerRutland, Vermont1Problem Identification• According to the Vermont Youth Risk Behavior Survey, in 2017 34% of high school students reported that they had tried an electronic vapor product (EVP) compared to 24% of students reporting that they have tried cigarettes• Many of these products have been marketed to adults as a way to stop using other tobacco products, however, only 5% of students who have used EVP in the past 30 days reported that as their primary reason for use• The report shows that 84% of students report peer disapproval of cigarette use and 86% of students understand that regular cigarette use poses a moderate-to-great health risk, however, most teens also believe that EVP are safer than cigarettes• This data was collected prior to the recent Juul trend which was first noted by the VT Department of Health in the fall of 2017• Anecdotal evidence suggests that current numbers are much higher, with the Vermont Department of Health recently hosting a seminar on the topic2Public Health Cost• Data is still being collected, however, at this time it is clear that there is a general lack of understanding surrounding what Juuls are and what impact they could have• Only 37% of Juul users knew that the product always contained Nicotine, additionally the amount of nicotine delivered varies by device and user at times surpassing conventional cigarettes• In teens, EVP use has been shown to increase risk of experimenting with cigarette smoking with very few using them as a tool to quit other tobacco products• Consequences of chronic vapor inhalation are unknown and levels of toxic and carcinogenic compounds vary by component and device• Even though flavoring was banned in tobacco products by the FDA in an attempt to limit their appeal to kids, these products are available in fruit and candy flavors• A study of 11th and 12th graders revealed an association with EVP use and chronic bronchitis symptoms• Full impact can not be estimated until research has been able to fully evaluate the health effects of these products, however, the fact that these products increase the likelihood of cigarette smoking in teens makes it a significant concern3Community Perspective• Sarah Roy, Vermont Department of Health Substance Abuse Prevention Consultant• “Juul use has picked up over the last school year, starting in the fall and snow-balled across the state in the winter. The tobacco unit has received consistent requests for more information but at this point there is still not enough information available. Students believe that there is no nicotine in Juuls. They don’t understand that there is any issue using them…they are viewed as a “new-age” alternative to smoking.”• Rutland High School Student A• “They’re everywhere. I’ll walk into the bathroom and somebody will be using them in the stall. Kids have told me that there’s nothing bad in them.”• Rutland High School Student B• “A lot of kids have one on them at all times. I’ve started seeing things about how dangerous they are, but I hate those things that just try to scare you into not doing the something.”4Intervention and Methodology• An informational flyer was created to be hung in healthcare offices in an attempt to spark conversation between healthcare providers and high-school students• Providers were also supplied with an information sheet with facts from multiple sources that are most relevant and eye-opening for this age group• The information presented on the flyer was selected in collaboration with multiple members of the target audience in an attempt to provide facts relevant to this age group and dispel some of the prevalent myths surrounding Juuls• The interviews revealed that standard methods of information delivery such as informational brochures would have limited effectiveness in this age group, though, at the same time students preferred a straight-forward approach• Interviews also revealed that students were unaware that when cigarettes first became popular there was also a lack of knowledge surrounding long-term effects5Results• Flyer and fact-sheet was discussed with high school students to evaluate and improve appeal to this age-group• Students attested that myths presented were similar to statements they have heard by peers and that they could understand language used in flyer• Flyer and fact sheet was provided to area physicians, the Department of Health and area schools6Evaluation of Effectiveness & Limitations• Due to the short-time frame surrounding this project the effectiveness was not able to be formally evaluated• If time allowed, a pre-intervention and post-intervention survey that evaluated accuracy of knowledge surrounding Juuls could have been used to assess the effectiveness• On a smaller scale, any increase in discussions noted by providers would indicate that this intervention was effective• In addition to the time-frame, this project was also limited by the lack of current scientific research regarding long-term use of Juuls7Recommendations for Future Interventions• Future interventions should continue to dispel the myths surrounding Juuls• Since a majority of high-school students displayed an understanding of the health consequences of cigarette smoking continued use of comparisons could prove to be effective• Facts should be provided to students in a straight-forward manner instead of in an attempt to scare them• A survey similar to the one outlined on the previous slide that assesses the accuracy of knowledge regarding Juuls could be widely distributed to high-school students as well as parents, teachers and healthcare providers8References2017 Vermont Youth Risk Behavior Survey. (2018).Bahl, V., Lin, S., Xu, N., Davis, B., Wang, Y. H., & Talbot, P. (2012). Comparison of electronic cigarette refill fluid cytotoxicity using embryonic and adult models. Reprod Toxicol, 34(4), 529-537. doi:10.1016/j.reprotox.2012.08.001Barrington-Trimis, J. L., Samet, J. M., & McConnell, R. (2014). Flavorings in electronic cigarettes: an unrecognized respiratory health hazard? JAMA, 312(23), 2493-2494. doi:10.1001/jama.2014.14830Barrington-Trimis, J. L., Urman, R., Berhane, K., Unger, J. B., Cruz, T. B., Pentz, M. A., . . . McConnell, R. (2016). E-Cigarettes and Future Cigarette Use. Pediatrics, 138(1). doi:10.1542/peds.2016-0379Behar, R. Z., Davis, B., Wang, Y., Bahl, V., Lin, S., & Talbot, P. (2014). Identification of toxicants in cinnamon-flavored electronic cigarette refill fluids. Toxicol In Vitro, 28(2), 198-208. Bunnell, R. E., Agaku, I. T., Arrazola, R. A., Apelberg, B. J., Caraballo, R. S., Corey, C. G., . . . King, B. A. (2015). Intentions to smoke cigarettes among never-smoking US middle and high school electronic cigarette users: National Youth Tobacco Survey, 2011-2013. Nicotine Tob Res, 17(2), 228-235. doi:10.1093/ntr/ntu166Dawkins, L., & Corcoran, O. (2014). Acute electronic cigarette use: nicotine delivery and subjective effects in regular users. Psychopharmacology (Berl), 231(2), 401-407. doi:10.1007/s00213-013-3249-8Dutra, L. M., & Glantz, S. A. (2014). Electronic cigarettes and conventional cigarette use among U.S. adolescents: a cross-sectional study. JAMA Pediatr, 168(7), 610-617. doi:10.1001/jamapediatrics.2013.5488Farsalinos, K. E., Kistler, K. A., Gillman, G., & Voudris, V. (2015). Evaluation of electronic cigarette liquids and aerosol for the presence of selected inhalation toxins. Nicotine Tob Res, 17(2), 168-174. doi:10.1093/ntr/ntu176Farsalinos, K. E., Romagna, G., Allifranchini, E., Ripamonti, E., Bocchietto, E., Todeschi, S., . . . Voudris, V. (2013). Comparison of the cytotoxic potential of cigarette smoke and electronic cigarette vapour extract on cultured myocardial cells. Int J Environ Res Public Health, 10(10), 5146-5162. doi:10.3390/ijerph10105146Farsalinos, K. E., Romagna, G., Tsiapras, D., Kyrzopoulos, S., & Voudris, V. (2013). Evaluating nicotine levels selection and patterns of electronic cigarette use in a group of "vapers" who had achieved complete substitution of smoking. Subst Abuse, 7, 139-146. doi:10.4137/SART.S12756Huang, L. L., Baker, H. M., Meernik, C., Ranney, L. M., Richardson, A., & Goldstein, A. O. (2017). Impact of non-menthol flavours in tobacco products on perceptions and use among youth, young adults and adults: a systematic review. Tob Control, 26(6), 709-719. doi:10.1136/tobaccocontrol-2016-053196Kosmider, L., Sobczak, A., Fik, M., Knysak, J., Zaciera, M., Kurek, J., & Goniewicz, M. L. (2014). Carbonyl compounds in electronic cigarette vapors: effects of nicotine solvent and battery output voltage. Nicotine Tob Res, 16(10), 1319-1326. doi:10.1093/ntr/ntu078Leventhal, A. M., Strong, D. R., Kirkpatrick, M. G., Unger, J. B., Sussman, S., Riggs, N. R., . . . Audrain-McGovern, J. (2015). Association of Electronic Cigarette Use With Initiation of Combustible Tobacco Product Smoking in Early Adolescence. JAMA, 314(7), 700-707. doi:10.1001/jama.2015.8950McConnell, R., Barrington-Trimis, J. L., Wang, K., Urman, R., Hong, H., Unger, J., . . . Berhane, K. (2017). Electronic Cigarette Use and Respiratory Symptoms in Adolescents. Am J Respir Crit Care Med, 195(8), 1043-1049. doi:10.1164/rccm.201604-0804OCPark, J. Y., Seo, D. C., & Lin, H. C. (2016). E-Cigarette Use and Intention to Initiate or Quit Smoking Among US Youths. Am J Public Health, 106(4), 672-678. doi:10.2105/AJPH.2015.302994Primack, B. A., Soneji, S., Stoolmiller, M., Fine, M. J., & Sargent, J. D. (2015). Progression to Traditional Cigarette Smoking After Electronic Cigarette Use Among US Adolescents and Young Adults. JAMA Pediatr, 169(11), 1018-1023. doi:10.1001/jamapediatrics.2015.1742Public health consequences of e-cigarettes. (2018). Washington, DC: National Academies Press.Shahab, L., Goniewicz, M. L., Blount, B. C., Brown, J., McNeill, A., Alwis, K. U., . . . West, R. (2017). Nicotine, Carcinogen, and Toxin Exposure in Long-Term E-Cigarette and Nicotine Replacement Therapy Users: A Cross-sectional Study. Ann Intern Med, 166(6), 390-400. doi:10.7326/M16-1107Soneji, S. (2018). Errors in Data Input in Meta-analysis on Association Between Initial Use of e-Cigarettes and Subsequent Cigarette Smoking Among Adolescents and Young Adults. JAMA Pediatr, 172(1), 92-93. doi:10.1001/jamapediatrics.2017.4200Soneji, S., Barrington-Trimis, J. L., Wills, T. A., Leventhal, A. M., Unger, J. B., Gibson, L. A., . . . 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 Pediatr, 171(8), 788-797. doi:10.1001/jamapediatrics.2017.1488Vansickel, A. R., & Eissenberg, T. (2013). Electronic cigarettes: effective nicotine delivery after acute administration. Nicotine Tob Res, 15(1), 267-270. doi:10.1093/ntr/ntr316Wackowski, O. A., & Delnevo, C. D. (2016). Young Adults' Risk Perceptions of Various Tobacco Products Relative to Cigarettes: Results From the National Young Adult Health Survey. Health Educ Behav, 43(3), 328-336. doi:10.1177/1090198115599988Willett, J. G., Bennett, M., Hair, E. C., Xiao, H., Greenberg, M. S., Harvey, E., . . . Vallone, D. (2018). Recognition, use and perceptions of JUUL among youth and young adults. Tob Control. doi:10.1136/tobaccocontrol-2018-054273Zhang, Y., Sumner, W., & Chen, D. R. (2013). In vitro particle size distributions in electronic and conventional cigarette aerosols suggest comparable deposition patterns. Nicotine Tob Res, 15(2), 501-508. doi:10.1093/ntr/nts165 9

Increasing Awareness of the  Risks Associated with Juuls in High School Students

https://scholarworks.uvm.edu/cgi/viewcontent.cgi?article=1434&amp;context=fmclerk

Increasing Awareness of the Risks Associated with Juuls in High School Students

Abstract

Similar works

Full text

Available Versions

UVM ScholarWorks