PH 302 Final Paper

A rationale for the development of the ESCIA health promotion program to address e-cigarette usage and disengagement beliefs in adolescents Jeenera Hossain PH 302: Health Program Planning and Evaluation Wendy Vaughon December 17, 2020

Introduction Identifying the Health Problem Cigarette smoking is an issue that has been ravaging the health of populations all over the world. In an effort to combat this problem, e-cigarettes were introduced to help addicts wean off cigarettes (Cornell, 2019). However, this ‘solution’ bred many new problems, namely, the appeal it began to have among the adolescent population. Adolescents that did not smoke before were drawn in by the assortment of flavors that e-cigarettes offered, some of them not even knowing that the addictive chemical, nicotine, was in these products (Leventhal, 2019). According to a report by the CDC, in 2020, 20% of high school kids and 5% of middle school kids in the U.S. are currently using e-cigarettes (Wang, 2020). This amounts to about 3.8 million adolescent e-cigarette users. To draw a comparison, this is almost equivalent to the total population of Los Angeles, California-the 2nd most populous city in America (Census Bureau, 2019). Although there is sparse information regarding the health implications of e-cigarette usage, considering the fact that it has only recently become a larger issue, there has been some evidence of poorer oral health among adolescent e-cigarette users (Akinkugbe, 2018). E-cigarette usage has also become somewhat of a gateway into cigarette usage in the future (Barrington-Trimis, 2016). The vast array of flavors offered also appeals to younger people and some of them are even unaware that it contains nicotine, a very addictive substance. Narrowing the Health Problem As mentioned before, e-cigarettes were originally introduced as a safer alternative to cigarettes and used to help cigarette users overcome their addiction. However, adolescent usage of e-cigarettes has become a larger issue, namely in high school students in the U.S. (Dutra, 2016). It is an issue in middle school students as well but it has become much more concerning

the course of two weeks. A 20 minute class will be held in the place of an elective and will be composed of a presentation of the dangers and implications of e-cigarette usage. Prior to the start of the program, a pilot test will be conducted with a sample of students to assess how clearly the program staff are able to relay the educational material. A survey will be conducted at baseline about the students’ current knowledge of e-cigarettes and frequency of e-cigarette usage. Follow up surveys will be conducted after each week to see how much the students were able to learn and how effective and informative they believe the intervention is. A follow-up evaluation will also be conducted after 3 months to assess how well the students were able to retain the information they learned during the intervention and if it has caused them to decrease their e-cigarette usage or, if they weren’t smoking to begin with, refrain from using it. Benefits of the Program This program is beneficial when looking at the prospective view of it. Although the health implications of e-cigarette usage has not been completely evaluated since it is a recent issue, it is true that high schoolers that use e-cigarettes are more likely to use cigarettes in the future. The health adversities of cigarette usage are well established as cigarette smoking does account for most cases of lung cancer. Lung cancer is the most economically burdensome cancer to treat. In 2015, a study was conducted regarding the amount of lost earnings for each type of cancer and it was found that lung cancer accounted for most of it ($21.3 billion) (The Asco Post, 2019). The goal of this program is to preemptively halt e-cigarette usage knowing that it may result in more risky behaviors in the future and although literature about the health risks of e-cigarette usage are not yet available, it can be deduced that adolescent nicotine usage can not be beneficial to development.

Why the Program Will Be Successful This program will be successful because it will disrupt the disengagement belief present in adolescent e-cigarette users and past literature has shown evidence that when high school students are more aware and educated about the health risks of e-cigarettes, they are less likely to use them. The program will be held in such a duration that it will not impede with the student’s normal activities but will still be able to comprehensively teach all the material needed. It is important to address disengagement belief since it leads high school aged kids to believe that they are above the health risks that e-cigarettes pose and it will not affect them. This is a driving force behind e-cigarette usage and even though age limits have been instituted and the flavors available have been limited, e-cigarettes are still popular. Thus, educating adolescents is the last avenue that must be explored in order to solve this problem and prospectively, they will also be able to diffuse this knowledge to their peers and friends. The Plan Theory/Model My health promotion program will target behavior change at the individual level, The Health Belief Model (HBM) lines up best with the foundation of the program. The goal of ESCIA is to change the perceptions of e-cigarette usage in high school students as many of them are victims to disengagement beliefs. One of the main parts of HBM is that individuals need to believe that there is a perceived threat and that they can be affected by a certain problem. Adolescents, in general, do not believe they will face the consequences of smoking because they are younger and that leads them to believe that smoking is not a serious issue. Hence, they do not believe that there is a threat that they must be wary of. Another belief that is a part of this model is that individuals

identify two risk factors that lead to high school vaping behaviors. to vaping, followed by a question-and-answer discussion with students. ● Behavioral objective: 25% of the students who had reported smoking during the program will report decreased e-cigarette usage 3 months after the end of the program. Behavioral Intervention Activity: Guest speakers that have personal experience with e-cigarette and smoking usage will speak to students about the effect it has had on them. This will be followed by a question-and-answer discussion with students. ● Environmental objective : 80% of the students that participated in the program will be able make at least 1 informed decision about e-cigarette usage up to 3 months after the intervention. Environmental Intervention Activity: In order to understand how to navigate peer pressure, students will be asked to role play in groups and reenact situations where their peers may ask them to use e-cigarettes. Outcome Objective : By the end of 2021, e-cigarette usage among high schoolers in Oklahoma will be reduced to 11% which is a 5.4% decrease from the preprogram percentage. GOAL 2: To educate high school students in Oklahoma about the dangers of e-cigarette usage and weaken disengagement beliefs.

Process Objective 2a : During the pilot study, the program staff will receive a “good” rating from at least 75% of the participants. Process Objective 2b: By the end of the program, the program staff will have held 10 20-minute sessions. Impact Objectives ● Learning objective: After the first week of sessions, 50% of the students will be able to explain at least 2 dangers that e-cigarette usage poses. Learning Intervention Activity: Charts and pictures illustrating the dangers of e-cigarette will be presented during sessions. ● Behavioral objective: 80% of students will report that they believe that vaping is dangerous, 3 months after the end of the program. Behavioral Intervention Activity: Case-studies showing the adverse effects that e-cigarettes have on adolescents and young adults will be used to provide an example that the students can refer to. ● Environmental objective : 25% of students will have informed at least one of their peers and/or friends of the dangers of vaping within 3 months after the end of the program. Environmental Intervention Activity: Students will be asked to act out a situation in which they inform their friend about the dangers of e-cigarette usage. Outcome Objective : By the end of 2021, less than 10% of adolescents in Oklahoma will engage in risky behaviors involving smoking.

This survey will include the same questions as the baseline survey. Additional questions will be asked about the perceived effectiveness of the program and if the program has influenced any of their behaviors thus far. Survey at 2-Weeks The same questions that were included in the Week 1 Survey will be included in this survey, as well. A section to allow for overall comments about the program will be included. Follow-up Survey 3 Months Post-Program Students will be asked to complete a survey three months after the end of the program. The same questions that were asked at baseline will be asked again. The responses will be recorded in the same way and the percentages will be compared to the baseline numbers. Additional questions about whether or not the students have been able to apply the knowledge acquired during the program (ex. Making informed decisions about e-cigarette usage) will be included. These measures will allow us to assess the success of the program. Evaluation Team An internal evaluation will be conducted by an employee of the Oklahoma Health Care Authority (OHCA). The organization has been involved in tobacco cessation efforts and provides resources to individuals who are seeking to quit smoking. Their notions are in line with the goals of this program and are more local as this program will be held in Oklahoma. Technical results from surveys will need to be communicated efficiently so an internal evaluator would be the best choice. Evaluation Questions and Measures GOAL: To reduce the incidence of e-cigarette usage in high school students in Oklahoma.

Process Objective A : By the end of the program, the program staff will have recorded an average of 90% attendance for the sessions. Evaluation question: What percentage of students attended each program session? Evaluation measure: Keep an attendance list for each session and calculate the percentage of students that attended. Process Objective B : By the end of the program, the program staff will have distributed 2 surveys to all students. Evaluation question: How many surveys did each student take by the end of the program? Evaluation measure: Keep a record of the students and how many surveys each of them received. Learning objective: After the first week of classes, 50% of students will be able to identify two risk factors that lead to high school vaping behaviors. Evaluation question: Are a majority of students able to identify risk factors that lead to vaping after the program? Evaluation measure: Use information from the follow-up surveys to determine whether or not students were able to identify risk factors. Behavioral objective: 25% of the students who had reported smoking during the program will report decreased e-cigarette usage 3 months after the end of the program. Evaluation question: Is there a difference in pre-program and post-program e-cigarette smoking rates of students? Evaluation measure: Use information from the follow-up surveys to determine the difference in e-cigarette usage of the students.

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