Exploring Stakeholder and Parent Perspectives of a County Response to Adolescent Vaping and E-Cigarette Use
Author | Amanda Sharp,Natasha Kurji,Thomas Koza,Kathleen Moore |
Published date | 01 July 2021 |
Date | 01 July 2021 |
DOI | http://doi.org/10.1177/0022042621993495 |
Subject Matter | Articles |
https://doi.org/10.1177/0022042621993495
Journal of Drug Issues
2021, Vol. 51(3) 420 –441
© The Author(s) 2021
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DOI: 10.1177/0022042621993495
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Article
Exploring Stakeholder and
Parent Perspectives of a County
Response to Adolescent Vaping and
E-Cigarette Use
Natasha Kurji1, Thomas Koza2,
Amanda Sharp1, and Kathleen Moore1
Abstract
In the United States, regular cigarette use has steadily declined over the years; however, it
has been met with an increase in vaping and e-cigarette use. In Tampa, Florida, this trend has
been found especially prevalent among school-aged youth. To combat issues of substance use
among youth and prevent criminalization for nonviolent crimes, school-age youth cited for
use and possession of tobacco products in Hillsborough County were mandated to attend the
Youth Tobacco Awareness Course (YTAC). The aim of this study was to investigate YTAC for
its perceived effectiveness and usefulness in mitigating adolescent e-cigarette use. Classroom
observations, parent focus groups, and program stakeholder interviews were conducted
to comprehensively evaluate this program. Findings from this evaluation led to a deeper
understanding of the barriers and facilitators to an effective course, the needs and perceptions
of program stakeholders, as well as recommendations for improved future interventions.
Keywords
vaping, e-cigarettes, community-based program, smoking cessation, focus groups, adolescents
Introduction
E-cigarettes are battery-operated devices that are used to inhale an aerosol that can contain nico-
tine, flavorings, and other substances such as marijuana or THC (National Institute on Drug
Abuse [NIDA], 2019a). Vaping consists of puffing from the device which activates the battery-
powered heating device, vaporizes the liquid in the cartridge, and results in a vapor (Centers for
Disease Control and Prevention [CDC], 2020). Adolescents in the United States have been found
to be progressively inclined to use e-cigarettes; this increase may be due to the easy availability,
attractiveness and taste of e-liquid flavors (e.g., strawberry, chocolate, and mint), and misconcep-
tions that e-cigarettes are safe. E-cigarettes have recently been the cause of numerous and serious
lung disease outbreaks across the United States, some resulting in death. As of mid-February
2020, a total of 2,807 cases of hospitalizations or deaths associated with vaping-related lung
1University of South Florida, Tampa, FL, USA
2Lewis University, Romeoville, IL, USA
Corresponding Author:
Natasha Kurji, College of Public Health, Health Services Research, University of South Florida, 13201 Bruce B. Downs
Blvd., Tampa, FL 33620, USA.
Email: nnkurji@usf.edu
993495JODXXX10.1177/0022042621993495Journal of Drug IssuesKurji et al.
research-article2021
Kurji et al. 421
injuries were reported (CDC, 2020). Officials at the CDC have found strong evidence linking
vitamin E acetate in illegally distributed products to be the cause of the outbreak, specifically
THC cartridges used for vaping (CDC, 2020).
In the United States, regular cigarette use has steadily declined over the years. Among 12- to
17-year olds, the rate of past-month cigarette use declined from 13% in 2002 to 5.6% in 2013
(NIDA, 2015). However, young people are now vaping substances using electronic cigarettes,
also known as e-cigarettes or e-vaporizers. Nationally, between 2017 and 2018, vaping increased
from 13.3% to 17.6% among eighth graders, 23.9% to 32.3% among 10th graders, and 27.8% to
37.3% among 12th graders (NIDA, 2019b). National studies have indicated that the majority of
illicit drug use (54.1%) begins during the teenage years (under 18 years of age) and 70.3% of new
users initiate drug use with marijuana (CDC; NIDA, 2015). In addition, nearly nine out of 10
cigarette smokers first try cigarette smoking by age 18 (CDC, 2019b).
Similar to national trends, in the State of Florida, the Florida Youth Substance Abuse Survey
(FYSAS), which assesses the risk, protective factors, and prevalence for substance use, found
cigarette use decreased over time, marijuana use has remained stable, and e-cigarettes use dra-
matically increased (Florida Department of Children and Families [DCF], 2019). In 2018, the
past 30-day rate of e-cigarette use (13.7%) was more than 5 times the rate of conventional ciga-
rette use (Florida DCF, 2019). Similar to the national trends, among middle and high school
students in Hillsborough County specifically, cigarette use has decreased from 17.3% in 2012 to
7.9% in 2018 while e-cigarette use remained at an average of 25% between 2016 and 2018
(Moore et al., 2017). In 2018, after alcohol use, e-cigarettes and marijuana were the second and
third most used substances among students (after alcohol) (Moore et al., 2017). With this
increased use of e-cigarettes, it is imperative to understand not just the health impacts of their
substance use choices, but also how their behaviors can be most effectively mitigated to prevent
future use.
Health Effects of Vaping and E-Cigarette Use for Adolescents
According to NIDA, nicotine is an addictive substance derived from tobacco that can trigger
compulsive drug-seeking behaviors despite negative health effects (NIDA, 2019c). The surge of
endorphins, brief euphoria, and increases in dopamine levels all reinforce the continued use of
tobacco products (NIDA, 2019c). Repeated exposure, especially at a young age, leads to altered
brain chemistry and circuitry (NIDA, 2019c). The effects of marijuana, even when consumed
using an e-cigarette, are similar to those of nicotine (Office of Adolescent Health, 2019). Research
indicates that marijuana use can lead to altered brain structure, connectivity issues, and blood
flow problems (Office of Adolescent Health, 2019). These changes during adolescence can lead
to long-term effects such as lower IQ, poor memory, and attention deficits (Office of Adolescent
Health, 2019). Individuals who start smoking marijuana before the age of 18 are 4 to 7 times
more likely to develop a marijuana use disorder (Office of Adolescent Health, 2019). One factor
found to decrease the risk of substance use is increased parental involvement.
Facilitators of Youth Vaping and E-Cigarette Use
Lack of parental involvement. When not in school, parents and guardians play a large role in chil-
dren and adolescent lives. Positive parental support can act as a protective factor. A parent–child
bond (i.e., communication, support, involvement) can make a large impact on whether or not a
child is able to refrain from or stop substance use (NIDA and the U.S. Department of Health &
Human Services, 2019). Lack of knowledge about drug use or education among parents, as well
as personal use of substances at home, is an issue which may affect their child’s substance use
habits (NIDA and the U.S. Department of Health & Human Services, 2019). Some parents are
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