As e-cigarette consumption among teens increases, Eugene researchers are creating resources to prevent usage. An online, interactive program for fifth and sixth graders could help reduce child vaping.
Partnered with the University of Arizona College of Nursing, Influents Innovations created Click City: Tobacco about ten years ago to keep children from using tobacco. After receiving $1.5 million from the National Institute on Drug Abuse in 2018, they have been able to update and test the program. The newest version of Click City: Tobacco will now include prevention strategies to curb e-cigarettes usage.
Preventing Vaping with Click City: Tobacco
Erika Westling is a research scientist at Influents Innovations. She said the program will address misconceptions about e-cigarettes.
“They often think it’s just flavored water vapor—they don’t think it has nicotine since they’re called vape pens or Juuls’ commonly—or mod pods,” said Westling. “They don’t even have the word ‘cigarette’ in the lingo that they’re using for it.”
Westling said the lack of nicotine awareness and use of e-cigarettes can make kids more prone to addiction of tobacco and other substances. The updated Click City: Tobacco will talk about the short-term and long-term health consequences, as well as how chemicals in e-cigarettes react when they are heated an inhaled.
“[Children] don’t realize it has nicotine. It can be addictive, and for youth in particular—with their brains still developing—it can really have lifelong consequences,” said Westling.
Kids interact with the program for a period of four weeks, for about 20 minutes twice a week. Similar to a videogame, Click City: Tobacco resembles a town in which players must explore the city and complete certain tasks.
“The kids are in a city—it kinda looks like Sim City—and they go around to different buildings and click on them and do an activity,” said Westling. “So in the science museum they do an activity, at the school playground they do an activity, at the newspaper office—or radio station—the do an activity.”
Although high adolescent e-cigarette usage is among teens, Westling said the use of tobacco products really jumps between fifth and sixth grade. She said the program is mainly made for fifth graders because it’s an age in which children have seen e-cigarettes and know what they are, but also have a lot of misconceptions about them.
When completing Click City: Tobacco, kids complete exercises such as Ecig 101 which explains what e-cigarettes are, and go to a science lab in Addiction 101 to see what addiction does to someone’s brain and body. They even work as a newspaper reporter where they interview kids and write a story about what they learned. The program also includes games, like Pong, where kids have to keep e-cigarettes from going into their mouths and becoming addictive, and a maze that takes longer to complete if they’re a smoker because they have to keep stopping to vape.
Westling said the program teaches students about media literacy by addressing social norms. She said kids who believe big tobacco advertisements that suggest smoking and vaping is cool, are more likely to use tobacco products.
“It goes through different activities that teaches them the consequences of using tobacco,” said Westling. “They play some games, but each activity is designed to target a mechanism that leads to use of tobacco products. So something like social norms. If they think people who use e-cigarettes are cool and popular and good-looking, they will then be more likely to use those products themselves.”
Keeping up with Big Tobacco
According to Westling, Influents Innovations has found that by the end of eighth grade, 28% of students have tried an e-cigarette. By ninth grade, a significant amount of students are using e-cigarettes daily.
“It is hard because researchers are behind on testing evidence-based strategies for that,” said Westling. “You can’t really just use the same ones as for cigarettes because e-cigarettes are different.”
Westling said it wasn’t necessarily ads in a magazine, but the marketing of social media influencers—such as people on YouTube and Instagram doing vape tricks and talking about their devices—that quickly infiltrated the culture of kids.
“One of the issues with prevention of vaping products right now, is that the vaping companies just launched out there and marketed it very heavily to kids,” said Westling. “They were not supposed to—or have claimed that they’re not—but they did.”
Since it takes a few years to develop and test evidence-based programs, Westling said tobacco researchers are now playing catch-up.
Oregon Elementary Schools are Behind the Curve
In regard to Click City: Tobacco, researchers are still looking for 44 elementary schools across Oregon and Arizona to begin their effectiveness trial to curb child e-cigarette usage. But as of now, McCornack Elementary School is the only school in the 4J district to confirm their participation. Since schools in Arizona start earlier, Westling said they already have at least 28 schools signed up to participate. Westling said only 4 schools in Oregon plan to participate, and they still need about 16 more schools for the trial. The Click City: Tobacco researcher has been speaking to principals at schools across Oregon in the hope they will join the trial.
“I think it’s really important in Lane County because of the rates of vaping we’ve seen going up so much in youth that we really need to get this program going to sort of start to stem that tide in the future,” said Westling.
According to Lane County Health and Human Services, e-cigarette usage among 11th graders has increased by 250%. Westling said schools in Bend, Redmond, and southern Oregon are participating. But it’s hard to get schools to join because schedules are already tight.
“We are giving them $1,000 however, and use of the curriculum for a year, and providing this curriculum that we think will be very effective on preventing tobacco use in kids,” said Westling. “But it’s just hard to get another program implemented. They’re busy. So we’re trying our best.”
Since there are no other evidence-based prevention programs available yet, she hopes more schools will jump on board.
Putting the Effectiveness Trial into Action
For years, many schools across the country have relied on the Drug Abuse Resistance Education (D.A.R.E.) program.
However, Westling said D.A.R.E. hasn’t worked because it’s not evidence-based.
“D.A.R.E. sounds great on paper, but when it was actually tested in randomized trials, kids who went through D.A.R.E. ended up using more substances,” said Westling. “So we do things like games, we show them experiments in a lab on how addiction effects the brain. So it’s a lot of information they’re getting—factual information—but also it’s engaging for them.”
To have an effective solution, she said programs—such as Click City—need to be designed with input from participants, schools staff, and parents. In addition to their previous fifth grade focus groups, Click City: Tobacco will receive input from fifth graders and school administrators.
“If we could do an effective prevention program in half an hour that would be great,” said Westling. “You can’t really do that. You need to target different mechanisms like health effects, social norms, media literacy—things like that—and you need to do that in kind of a series of activities or teachable moments. So we’ve designed it so that they have time in-between activities to think about the lessons they’ve learned, even think about the game they played and what the point of that was.”
Participating schools will be randomly assigned and half will do the program, completing a survey before and after. The other half will initially only do surveys on their attitudes, and perceptions, and beliefs, of tobacco products, and not complete the program until after the trial.
Of those who would intend to use tobacco products in the future, researchers are hoping to find that the willingness to consume tobacco will decrease after completing the program.
Click City: Tobacco also comes with parent newsletters to get parents involved and learn tips about how to talk to kids about tobacco use.
Westling said schools have until the first week in December to state their participation. The Click City: Tobacco effectiveness trial will begin in January. Westling hopes the program will be available nationwide by next school year.