Reducing E-Cigarette Use Among High School Students: An Evidence-Based Practice Improvement Project

BACKGROUND: Electronic cigarette (e-cigarette) use in adolescents has rapidly increased since 2017. Studies show that 80% of adolescent e-cigarette users have initiated use due to aggressive marketing and misunderstanding about associated risks. E-cigarettes negatively impact students' health and school performance.

LOCAL PROBLEM: The setting of this practice improvement project was a public high school in Middle Tennessee with increasing rates of e-cigarette use and no standardized e-cigarette education. Research and clinical experts support structured, evidence-based e-cigarette education programs in the classroom setting. The purpose of the project was to reduce e-cigarette use among students. The project aimed to reduce e-cigarette citations by 25% and reported e-cigarette use by 30% within three months of education implementation.

METHODS: The Evidence-Based Practice Improvement (EBPI) Model was the guiding framework for project implementation. The EBPI model utilizes Plan, Do, Study, Act (PDSA) cycles were used to refine and evaluate change during implementation. Pre- and post-implementation data was measured for evaluation of change in reported e-cigarette use and e-cigarette citations, as well as perceived harmfulness.

INTERVENTIONS: The CATCH My Breath e-cigarette education program was implemented in Wellness class, with four lessons delivered over two days.

RESULTS: Reported past 30-day use decreased by 33.7%. Perception of e-cigarette harmfulness as “not or slightly” harmful decreased by 88.9%. Perception of e-cigarette harmfulness as “mostly or very” harmful increased by 29.3%. There was no change in e-cigarette citations, however data was provided for the entire student body, not limited to the 10% that participated.

CONCLUSIONS: Implementing the evidence-based e-cigarette education program in wellness classes increased students' perception of e-cigarette harmfulness and decreasing reported use. Given the success of this no-cost intervention that aligns with state health education requirements, the project site has recommended continuation and expansion of the CATCH My Breath e-cigarette education program to all wellness classes.