How Tobacco Cessation Programs Are Grappling With E-Cigs' Rising Popularity

Nov 18, 2015

Demonstrations of the harmful effects of smoking are displayed during a Clinton County school assembly.
Credit Charlotte Tuggle / WBAA

Youth e-cigarette use is on the rise and state cessation programs are having to adapt their outreach. But, it’s unclear if existing anti-smoking campaigns can keep up with the trend.

In Clinton County, schoolchildren assemble for Red Ribbon Week, where a woman shows them one of the newest “drugs.” The “drug” in question is about the size of a pen, and it’s found increasingly in the hands of schoolkids.

“I’ve seen it at one of my baseball games before in Fishers.”

“And at Walmart, or not Walmart, but at like CVS.”

We met fourth graders Luke Davison and Erika Robbins at a school assembly in Clinton County.

The Center for Disease Control reports e-cigarette use among middle and high school students tripled from 2013 to 2014. As the trend grows, programs like this assembly are trying to get ahead of the problem by teaching even younger kids not to start smoking.

Healthy Communities of Clinton County Operations Director Lorra Archibald says middle and high schoolers can be told e-cigarettes are addictive, but elementary schoolers need to be taught.

“Elementary kids are fascinated because they’ve usually never seen them,” Archibald says. “Well, we want the first time they see them to be with a responsible adult, telling them they’re dangerous.”

Still, when asked if e-cigarettes were a drug, many schoolkids were confused on how to classify them.

And Healthy Communities Tobacco Use Prevention and Cessation Coordinator Kathy Martin says that misunderstanding spans two generations.

“The end goal is to get them educated, not just the students, but also the parents,” Martin says. “We’re finding out that parents aren’t even understanding the e-cigarettes and the vaping problem, and so, when we educate students, we’re also able to educate the parents and for them, to understand that this is not something that’s a safe alternative.”

Martin says the same programs are used, but the presentations are molded to emphasize e-cigarettes. Archibald has also issued a warning to teachers about keeping a sharp eye on other emerging tobacco products.

But West Lafayette Smoke Shop Manager George Muhdi says it’s not just the younger audience buying the product.

“Old people, young people, mid-range, everything – younger people are hookah smokers majority of the time so that’s why they get into it and then the older people just want to quit smoking cigarettes,” Muhdi says.

The question now is whether these education programs can contend with the growing popularity of e-cigarette, hookah and vapor products.

Miranda Spitznagle directs the Indiana State Department of Health’s Tobacco Prevention and Cessation Commission and says while overall smoking rates are down, the lack of conclusive evidence about the long-term use of e-vapors may be pushing more people to use them instead of traditional cigarettes.

“A lot of those studies have not been done, or at least, not done conclusively,” Spitznagle says. “Of the research that has been out to date, there is much need for concern.”

The uncertainty surrounding the long-term effects has cessation programs pushing for more regulation. The Food and Drug Administration is proposing a rule that would allow the agency to give final say about whether e-cigarettes – or any product – is safer than tobacco.

Indiana’s current regulation on vapor products is limited to a ban on sales to minors.

But to get any evidence, cessation programs may have to do their own short-term research. Marifran Mattson is a Purdue professor who studies health communication...

“We always suggest making sure you do your formative research and that is talking to, interviewing, surveying your target audiences and showing them messages to then find out whether or not those messages are going to be effective with those target audiences, rather than assuming that you know what will work,” Mattson says.

One message at the Clinton County assembly warranted an especially strong response from the elementary schoolers – fourth grader Erika Robbins said it was her favorite part.

“Mine was probably the THINK part where it said what the T stands for and what the H stands for, and what all the letters in THINK stand for,” Robbins says. “I thought that was cool.”

THINK is the acronym coordinator Archibald used to end the tobacco cessation assembly. She says each letter stands for a different concern children should have with any drug -- e-cigarettes included.

T stands for take time to think, The H, I and N ask kids to choose whether an action is healthy, intelligent, or necessary. And the K—a fatal K—can something kill? When asked if e-cigarettes kill, the kids were unequivocal.

But smoke shop owner George Muhdi says that’s just the program’s opinion...

“I wouldn’t go out of my way to try to convince anyone,” he says. “If that’s the way they think, that’s the way they think.”

And without any long-term studies to back up the claims, it’s the word of the cessation program against the word of the industry.