PHC6534: Electronic Nicotine Delivery System (ENDS) Cessation Intervention for High School Students in Sacramento California’s “Promise Zone"

Electronic nicotine delivery systems (ENDS) usage, otherwise known as vaping, is a growing epidemic in youth across the United States. Although overall rates of smoking among adolescents have decreased nationally, the introduction of electronic nicotine delivery systems (ENDS), such JUUL and Suorin, have led to a rise in adolescent ENDS use (Selekman, 2019). Tobacco industry marketing, numerous flavors, and high rates of peer pressure and stress are luring kids to these products (Kong et al., 2021; Selekman et al., 2019). The Youth Risk Behavioral Surveys have only recently begun assessing youth and young adults ENDS use that is classified under substance use, but preliminary research has found a positive association between the number of ACEs and percentage of ENDS use that is similar to the relationship between ACEs and smoking (Ford et al., 2016; Lensch et al., 2017; Maxson et al., 2019). The intention of this grant would be to provide electronic nicotine delivery system (ENDS) use and cessation services to referred high school students within Sacramento’s Promise Zone through a trauma-informed and ACEs aware approach (Sacramento Promise Zone, 2020). The Promise Zone is an under-resourced, low socioeconomic status, and low educational attainment area within Sacramento, CA that has a history of strong community engagement (Sacramento Promise Zone, 2021).  The Promise Zone was designated in 2015 by Housing and Urban Development and has current programming around economics, health, and neighborhood revitalization (Sacramento Promise Zone, 2021). This intervention will supplement current health behavior programming and efforts in the region by reducing the use of ENDS usage among high school students and by addressing cessation from a comprehensive trauma informed approach

The program will accept 50 students referred by their schools after being caught using ENDS on campus. Students will first participate in a group educational training that includes information on ENDS, tobacco use, the industry’s marketing, and the importance of quitting. Students would also be required to complete an ACEs screening at this training. After this training, students would begin their individualized cessation programs the following week and have sessions twice a week for four weeks. Students can opt to continue sessions up to nine months if they wish. All sessions will be provided by subcontracted, licensed trauma informed counselors. The intention of these sessions would be to reduce student ENDS use and teach them skills and coping strategies through supportive relationship building, motivational interviewing, and behavior skills training (Bricker et al., 2010).

This intervention was designed with a public health framework in mind to increase ENDS cessation in high school students in Sacramento’s Promise Zone and reduce overall youth vaping through a trauma-informed vaping cessation program (Sacramento Promise Zone, 2020). This program operates mainly in the secondary and tertiary levels of prevention but has implications for primary prevention (Simons-Morton et al., 2012). This program is specifically for youth caught using ENDS products, so this cessation program would serve as tertiary prevention because it would treat the health issue of vaping and improve student health by helping them quit (Haustein, 2004; Philanthropy Network Greater Philadelphia, 2016). It addresses secondary levels of prevention because students referred to the program would participate in an ACEs screening (Dube, 2018; Philanthropy Network Greater Philadelphia, 2016). This information would assist providers in developing an individualized trauma-informed cessation program that addresses the issue of vaping and possibly components of their ACEs that contributed to their ENDS usage. Primary prevention is addressed in this program because the long-term effects of improving student’s self-confidence, behavioral capability, and health knowledge could reduce student’s future engagement in negative health behaviors (Bricker et al., 2010; Philanthropy Network Greater Philadelphia, 2016). This program recognizes that ENDS use is often linked to ACEs, stress responses, and other societal factors and aims to better understand and incorporate these into treatment (Philanthropy Network Greater Philadelphia, 2016). Student’s overall wellbeing will be influenced by this program as it aims to reduce the negative physical effects of vaping and ACEs, improve student mental health, and teach social and behavioral skills that can contribute to long term health.

The CDC social ecological model also served as a guide for this intervention project. The program’s individualized ENDS cessation intervention will focus on the individual level and teach students stress management skills, coping strategies, and resiliency tools while addressing their ACEs and trauma experiences simultaneously (Bricker et al., 2010; CDC, 2021). The beginning intervention educational training would provide students increased knowledge about tobacco which can impact their individual decisions to use these products (CDC, 2021). This program will address the relationship level by teaching youth how to handle peer pressure surrounding tobacco use and will increase their abilities to communicate about health behaviors, how to create and maintain healthy relationships, and how to possibly change their peer group to ensure they stay tobacco-free (CDC, 2021). Smoke and tobacco free schools are fostered through this program as it is conducted at schools within the Promise Zone and this program is taking a step towards creating more safe and healthy places at the community level (Sacramento Promise Zone, 2021). Lastly, this program will address societal level change by creating more tobacco-free environments in the Promise Zone through education, cessation interventions, and skills development that will be taught to the next generation of this community (CDC, 2021; Sacramento Promise Zone, 2021). This predominately individual level focused intervention will have broader societal implications as these youth grow, develop, and carry this knowledge with them in their lives and begin to change societal norms surrounding the use of tobacco products, particularly ENDS (CDC, 2021).

SAMHSA’s trauma-informed care principles were also utilized in this program’s development to ensure that participants receive proper trauma-informed care throughout this proposed intervention. Although the program will incorporate aspects of all six key principles for trauma informed approaches, this intervention specifically emphasizes trustworthiness and transparency and empowerment, voice and choice (SAMHSA, 2014).

1. Safety will be incorporated into the intervention by ensuring the students know that this is an educational intervention that is safe, welcoming, and nonviolent (SAMHSA, 2014). This will be reiterated to the students by informing them that they are not being punished and that this program is designed to assist them in their health and lives.
2. Since this program includes counseling, trustworthiness and transparency are crucial and will be developed through staff listening to participants and providing transparency about the program (SAMHSA, 2014). Sessions will be provided in private, confidential rooms and staff will be transparent about the goals of each session (SAMHSA, 2014).
3. Peer support will be available as participants can share their experiences with other participants and interact with peers for support during the training (SAMHSA, 2014).
4. Collaboration and mutuality will be addressed by making certain that all staff involved in this project receive trauma informed approaches and ACE’s training (SAMHSA, 2014).
5. Empowerment, voice, and choice will be instilled by allowing participants to choose their participation level, leave room for their own decision making, and through skills building that is incorporated into the vaping cessation program to increase their voice and empowerment (SAMHSA, 2014).
6. SAMHSA's principle of cultural, historical and gender issues will be included through staff acknowledgement of these issues and through efforts to instill an inclusive and equitable environment and culture (2014).

This project is dedicated to providing a comprehensive trauma-informed approach and will reflect on these six principles at each weekly staff meeting to ensure they are incorporated. This program will be facilitated by an experienced tobacco prevention Project Director who will manage all of the project, except the individualized counseling sessions. This intervention will be measured with pre and post surveys measuring student vaping behaviors, their feelings about the training and sessions, as well as their self-reported evaluation about their knowledge, behavioral capability, confidence, and other internal measurements. Key informant interviews with also be conducted with staff on campuses to gain a greater understanding of the interventions impact.

Overall, the goal of this intervention is to address ENDS use through a comprehensive trauma informed cessation intervention program that provides students the support they need to remain tobacco free after the end of the intervention. On a larger scale, this would provide the next generation the skills to make healthy life choices and give them the knowledge, behavioral capability, self-confidence and resiliency to improve their lives and communities (Bricker et al., 2010).

References

Bricker, J. B., Liu, J., Comstock, B. A., Peterson, A. V., Kealey, K. A., & Marek, P. M. (2010).

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Maxson, C. Lensch, T., Diedrick, M., Zhang, F., Peek, J., Clements-Nolle, K., Yang, W. (2019). State of Nevada, Division of Public and Behavioral Health and the University of Nevada, Reno. 2019 Nevada High School Youth Risk Behavior Survey (YRBS): Adverse Childhood Experiences (ACEs) Special Report.

Philanthropy Network Greater Philadelphia, Thomas Scattergood Behavioral Health Foundation, and United Way of Greater Philadelphia and Southern New Jersey (2016). Trauma informed philanthropy: A funders resource guide for supporting trauma-informed practice in Delaware Valley.      

Sacramento Promise Zone. (2021). About the Sacramento promise zone. Sacramento Promise Zone: Connecting Partners and Resources. Retrieved from: https://www.sacramentopromisezone.org/

Selekman, J. (2019). Vaping: It’s all a smokescreen. Pediatric Nursing, 45(1), 12- 15, 35. http://pediatricnursing.net/in...s/14512_Selekman.pdf     

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