Emerging tobacco products such as electronic cigarettes (e-cigarettes or e-cigs) and hookahs are quickly gaining popularity among youth. According to a recent report from the Centers for Disease Control and Prevention (CDC), between 2011 and 2012, e-cigarette experimentation and use doubled among middle school and high school students. The CDC also reports that 1 in 10 high school students have experimented with e-cigarettes.(1)

Project ALERT has been a substance use awareness program of choice for middle schools throughout Orange County, California. In just over four years, 102 teachers and other professionals have been trained to implement Project ALERT and almost 57,000 students have received the program. Orange County is continuing to use Project ALERT for their latest Tobacco-Use Prevention Education (TUPE) grant that will serve 7 Orange County school districts through June 30, 2017. Ryan Crowdis, TUPE project manager at the Orange County Department of Education states, “We have had a lot of support implementing Project ALERT and it is an extremely valuable part of our prevention strategy.”

In 2013, the county began to see a steady rise in the use of e-cigarettes among youth and they became immediately active on two fronts. First, they developed a presentation that would inform school staff and parents about this emerging trend. At the time, there was little information readily available to the public about the product and its risks. This was a concern not only of those working in the schools but also for those in health and law enforcement agencies. After receiving numerous requests for information on this topic by school and district administration, Stacy Deeble-Reynolds, prevention coordinator for the Orange County Department of Education, contacted the Orange County Health Care Agency and the Orange County Sheriff’s Department to develop a presentation so that school staff and parents could learn about this emerging trend. This presentation has been given to over 1,000 school staff and parents in the last 11 months.  “We don’t want students to be continually smoking these devices, then 20 years down the road not be able to do things like play soccer with their kids because they can’t breathe,” says Deeble-Reynolds. Second, they developed a youth awareness and prevention campaign about the potential harmful effects of e-cigarettes and other electronic nicotine delivery devices, targeting students aged 12-17. The Orange County Department of Education again partnered with the Orange County Health Care Agency and the Orange County Sheriff’s Department to lead this effort.

The cornerstone of the campaign is the website notsosafe.org which consists of three main sections that present information and resources about e-cigarettes. The heart of the website is a meme(2) generator, located on the home page, which creates eye-catching, informative pictures and statements that can be easily shared via Facebook, Twitter, Instagram, and email.

The second section, “Vaping Facts” is designed to give readers information on the complex array of issues related to e-cigarette use. The third section provides links to resources that were used to develop the campaign.

The design team conducted focus groups with local middle and high school students and asked them what an effective e-cigarette prevention campaign would include. As the focus groups transpired, program staff learned that many students wanted to know what chemicals were in these products and what concrete information was available about e-cigarettes. A majority of participating students felt the best way to prevent their peers from using e-cigarettes would be to take a lesson from tobacco prevention campaigns and educate youth on what chemicals are found in e-cigarette vapor and how these chemicals may affect your body. The focus groups and key partners worked together to design the Not So Safe e-cigarette prevention campaign and the notsosafe.org website.

Since its launch in May 2014, teachers at middle schools in Orange County have been utilizing the notsosafe.orgwebsite as a way to enhance their tobacco-related Project ALERT lessons. Crowdis notes, “We chose Project ALERT because it has been used in the county for years and has a proven track record. Our team has found it very easy to insert supplemental information about electronic cigarettes into the curriculum.” The most common ways the website has been used within the lessons have been (A) classroom discussions, where teachers share and review the information on the website with students and ask them to do their own research on the topic of e-cigarettes, and (B) student meme generation, where teachers have students create their own memes using the website as a guide. Students can use the chemical names from the website or any of the other chemicals that have been found in e-cigarette vapor.

As e-cigarettes become more popular with youth, Crowdis and colleagues believe this campaign will be important in educating them about the consequences of their use. It will also encourage students and educators to dialogue about related issues and work together to prevent youth from using these devices.

Project ALERT Director's note: This article was written by Ryan Crowdis with editorial assistance from Dr. Pamela Luna. Educators like Ryan Crowdis and other leaders in Orange County, California offer an example of addressing emerging e-cigarette concerns and adapting Project ALERT to meet those needs, while maintaining fidelity to this evidence-based program. Others are encouraged to visit the notsosafe.org website.

Project ALERT Director’s note: Dr. Pamela Luna, a senior Project ALERT trainer, drafted the following suggestions to help instructors facilitate discussion about e-cigarettes into the established Project ALERT curriculum. As drug popularity and culture surrounding use fluctuates, it is important for Project ALERT teachers to stay informed about changes and be prepared to respond to student questions. The suggested modifications to the original Project ALERT curriculum, while not empirically tested, still match the core principles that drive the effectiveness of Project ALERT.

For additional help on how to integrate information on e-cigarettes into the program, in-person training is also available. Teachers might also benefit from refresher training, and Project ALERT trainers can help you out at a reasonable rate. Contact us to plan an in-person training that suits your needs. The following suggestions for e-cigarette inclusion are in line with the Project ALERT manual found online at http://www.projectalert.com/account.

Core Lesson 2: Consequences of Smoking Cigarettes and Marijuana

Activity 3: Compare Cigarettes and Smokeless Tobacco

In the discussion of effects for smokeless tobacco, ask “Which of these effects are also true for electronic cigarettes?”

Note that the long-term health effects of using e-cigarettes are unknown, yet are potentially harmful.  No one knows for sure what long-term damage vaping will do to your body.  And we won’t know for years. Here are some resources to review with or prior to discussions with students to help you answer their questions:

• Not So Safe
• Information from Kids Health
• NIDA for Teens

• Drug Facts from NIH
• Information from the US FDA
  
• More information from the US FDA
• CDC's Mortality and Morbidity Weekly 
  

The University of Michigan’s Monitoring the Future national survey of substance use among students in U.S. middle schools and high schools has released results from 2014. Overall, for 8th graders, use of alcohol, cigarettes, marijuana, and a number of other illicit drugs declined since the last survey in 2013. Overall trends for all students indicated that both alcohol and cigarette use in this most recent survey were at their lowest points since the study began back in 1975.

• 9.0% used alcohol
• 8.7% used e-cigarettes
• 6.5% used marijuana
• 4.0% smoked cigarettes
• 2.7% have been drunk
• 2.2% used inhalants

RAND is reviewing the state of the Project ALERT program, as well as how the program can be enhanced to meet the needs of educators and students.

We want to learn from you! How are you using Project ALERT? What would you like to see changed or improved? Please consider participating in a brief survey to let us know. It should only take about 10 minutes.

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