former health educator for Tennessee's rural Marion and
Sequatchie counties, realized that vaping was a problem
in her community when a number of vape shops opened up.
The proximity and volume of shops made it easier for
adults and even teenagers to start vaping and cause
damage to their lungs. Even worse, a school administrator
told her that children as young as 5th grade
had been caught vaping.
From 2018 to 2019, Bond worked with school health
coordinators in each county to give presentations about
the dangers of vaping to middle and high school students.
In that time, she reached about 1,650 students. With each
presentation, Bond would co-present with student
volunteers. “I explained what vapes are, what
chemicals you find in them, how Big Tobacco profits off
hooking youth, what nicotine is and why it's bad for
adolescents, tips to help break the cycle of addiction,
and Tennessee Tobacco
QuitLine information,” she said.
The second half of the presentation was given by
Tennessee Teens Talk Tobacco (T4) students, who had
visual aids like a jar of phlegm and healthy/unhealthy
pig lungs to show attendees what tobacco does to the
body. Bond remembers the students' reactions during the
pig lung presentation. “They're just very
engrossed in what the T4 student was talking to them
about. All eyes were on her,” Bond said.
According to the National Institute on Drug Abuse (NIDA),
vaping devices, also called e-cigarettes or
electronic nicotine delivery systems, are often made up
of a cartridge holding a liquid solution, an atomizer, a
power source, and a mouthpiece. The atomizer heats up the
liquid, which almost always contains the addictive
chemical nicotine, and the user inhales the aerosol.
While e-cigarette companies have marketed their products
as a way for adults to quit smoking, in recent years many
adolescents have been introduced to nicotine through
e-cigarettes. In fact, research
shows that teenagers who reported trying e-cigarettes
were more likely than non-users to later report trying
Some e-cigarettes contain
higher levels of nicotine than traditional
cigarettes, and e-cigarettes that use nicotine salts
deliver high levels of nicotine more quickly than other
tobacco products. Nicotine is especially harmful to
teenagers and young adults, since their brains haven't
fully developed yet.
Thomas Ylioja, PhD, MSW, Clinical Director of Health
Initiatives at National Jewish
Health, said, “What we're seeing now with
vaping is that a lot of young people are looking for help
and they just have so much higher nicotine dependence, so
much stronger addiction to nicotine compared to when they
He added, “They experience very powerful
nicotine withdrawal symptoms, often leaving school early
with headaches and feeling nauseous. They are having
difficulty concentrating on their schoolwork and are
thinking about how to get more nicotine when they are
playing sports or trying to study. They don't want their
parents to know, so they suffer in secret.”
So how many teens are vaping? The NIDA
Monitoring the Future survey from 2019, with
responses from 42,531 students (8th,
10th, and 12th grade) across the
country, shows that 25.5% of 12th graders
reported vaping nicotine in the past month, and 11.7%
of this grade reported vaping nicotine every day. For
10th graders, 19.9% reported vaping nicotine
in the past month, while 6.9% reported vaping nicotine
every day. For 8th graders, 9.6% reported
nicotine vaping in the past month, with 1.9% reporting
nicotine vaping every day.
While the majority of teenagers do not vape, groups
across the country are working to reduce the numbers of
those who do and to prevent other teens from starting.
Providing Education, Not Lectures
Bond said some students challenged the information she
presented, so she would present research that disputed
the student's claim or, if a particular claim seemed
plausible, thank the student for letting her know and
telling them she'd look into it. Sometimes these
conversations led Bond to adding new information to her
presentation. This approach let students know they were
Students reached out for advice, help, and resources for
themselves, their family members, and/or their friends. I
really appreciated students being vulnerable with me and
trusting me with the information they shared.
The presentations also had a question-and-answer session,
but Bond said the one-on-one conversations she had with
students after the presentations were more fruitful.
“Students reached out for advice, help, and
resources for themselves, their family members, and/or
their friends. I really appreciated students being
vulnerable with me and trusting me with the information
they shared,” she said.
In California, Dawn Charlton is a youth educator for
Being Adept, a drug education program. While she lives
and works in San Francisco, Charlton travels to rural
Point Reyes Station and Tomales to present Being Adept to
West Marin Elementary School's 6th grade class
and Tomales Elementary School's 8th grade
Christina Hetzer is the Prevention and Early Intervention
(PEI) school-based counselor at Shoreline Unified School
District and is primarily based at West Marin. She said
middle school students in this district have been caught
with vaping devices and have been found vaping in
bathrooms and on campus after school hours.
Unlike drug education models of the past, which tended to
rely on scare tactics, Being Adept teaches
5th-8th grade students what drugs
do to the brain and other parts of the body and helps
them make decisions that feel right for them.
Being Adept Curriculum
Being Adept's curriculum offers eight lessons (no
longer available online):
Nicotine & E-Cigarettes
Rx Drugs & Opioids
Media Literacy (glamorization of substance use,
companies' marketing strategies)
Stress Busters (healthy ways to reduce stress)
Pressure & Decisions (different types of peer
pressure, defining personal values)
The Nicotine & E-Cigarettes lesson covers the following
“Statistics of teen e-cigarette
“The difference between a vapor and
“The potentially harmful and harmful
chemicals found in e-cig 'juice'”
“The concept of third-hand
“How and why companies market their
products to kids”
“How nicotine impacts the cardiovascular
and the brain's reward systems”
Charlton said Being Adept helps students reconcile the
science of how drugs harm the body with some students'
experiences of seeing family members smoke, drink, or use
other substances. In addition, a number of these
community members work in the wine or cannabis industry.
She tells students that “the effects are
gradual and hard to notice, the effects are unpredictable
and very different for different individuals, and
addiction is still very stigmatized, so people don't talk
openly about their struggles.”
Charlton also discusses the short-term and long-term
effects of nicotine on the lungs as well as the heart and
brain. “You cannot just assume that these
youngsters have the same information I did about the
dangers of traditional cigarettes,” she said.
“The public awareness work around the dangers
of smoking traditional cigarettes was so ubiquitous my
whole life up until about 10 years ago, when I think the
numbers really did start to get lower and we just assumed
everybody knew.” She also compares the aerosol
from vaping products to California's recent wildfires,
since both produce particles that are harmful to people's
Charlton also uses surveys like the California
Healthy Kids Survey and the NIDA Monitoring the
Future survey to show students that the number of
teenagers actually using different substances is often
lower than these students may think.
At any given moment the more popular choice is actually
not using and, if you choose not to use, you're
definitely not alone.
Charlton tells students, “At any given moment
the more popular choice is actually not using and, if you
choose not to use, you're definitely not
In Colorado, Ylioja and his National Jewish Health
colleagues found that not many teenagers were using the
National Cancer Institute's 1-800-QUIT-NOW to quit
nicotine products, including vaping — despite
an uptick in the number of teenagers using e-cigarettes.
He and his colleagues wanted to better understand how
they could serve teenagers looking to quit tobacco.
Through focus groups and interviews in the spring of
2019, Ylioja and his colleagues learned that teenagers
knew about the quit line but thought it was for adults
only. He added that the focus group “wanted a
program that they knew was designed for young people.
They really wanted to know that it would address vaping,
that they wouldn't be talked down to, that they wouldn't
be getting a parent or a teacher on the phone, they
wanted it to be confidential, that we would not release
With this input, National Jewish Health launched the
My Life, My Quit
program in July 2019, complete with an online chat option
and a text message option. “It was really key
that we had a program that was clearly designed for teens
with input from teens,” Ylioja said.
My Life, My Quit serves rural and urban teens from 18
states: Colorado, Idaho, Iowa, Kansas, Kentucky,
Massachusetts, Michigan, Minnesota, Montana, Nevada, New
Hampshire, North Dakota, Ohio, Oklahoma, Pennsylvania,
Rhode Island, Utah, and Wyoming. When the program
receives calls from people outside these states, these
callers are referred to 1-800-QUIT-NOW, the Truth
Initiative's This Is
Quitting text messaging program, or any local
Other Programs to Help Teens Quit
This Is Quitting
The Truth Initiative's This Is
Quitting is a free, anonymous program to help young
people (about 13 to 24 years old) quit vaping. Those
who want to enroll can text DITCHVAPE to 88709.
Enrollees can set their own quit date and receive one
text message per day, and they can text COPE, STRESS,
SLIP, or MORE for on-demand support.
Parents can text QUIT to 202.899.7550 for support in
helping their children quit vaping.
Not On Tobacco
Not On Tobacco® (N-O-T): This American Lung
Association program provides ten 50-minute sessions for
participants aged 14 to 19. Facilitators receive seven
hours of training and then can teach the curriculum in
a school or community setting.
Smokefree Teen, a National Cancer Institute
program, offers the SmokefreeTXT texting program (text
QUIT to 47848); the quitSTART app; live online chat
with a trained counselor; and blog posts about vaping
triggers, cravings, and withdrawal symptoms.
My Life, My Quit sessions with a tobacco/vaping cessation
coach are free and confidential. Through five coaching
sessions, trained coaches help participants set up a quit
plan, identify and find a way to deal with their triggers
to smoke or vape, and determine behaviors that will help
them manage cravings and withdrawal symptoms.
Rural residents face barriers to access tobacco
cessation services, such as travel, cost, or lack of
in-person services in the area. For rural teens trying to
quit, a program like My Life, My Quit allows them to talk
with a cessation coach without having to travel to a
doctor's office. Teens schedule appointments that fit
“One of the nice things about quit lines
generally and the My Life, My Quit program as well is
that they're highly accessible, as long as you have
access to a smartphone or any phone, really, or if you
have access to the internet,” Ylioja said.
Like the My Life, My Quit program, Being Adept values
teens' input. Charlton has the students brainstorm why
teens vape. The brainstorming and discussions teach her
what students already know and help her adjust
presentations accordingly. While drug education models
usually focus on peer pressure and a desire to fit in,
students often bring up stress and depression as reasons
teens use. She also has students brainstorm healthy ways
to manage their stress.
The lessons are designed so that Charlton can visit the
same group of students more than once and talk about
different topics. Multiple visits help her build a
rapport with students and reinforce what they learned
during previous lessons. Students have told Hetzer, the
PEI counselor, that the Being Adept lessons are helpful.
The 8th graders told her they especially
benefited from the stress management lessons, while the
6th graders seemed interested in all the
topics, as the information presented was new to them.
Tennessee encourages student engagement through its
Tennessee Teens Talk Tobacco (T4) group, in which middle
and high school students host events for their
classmates. Along with attending the annual TNSTRONG
Youth Summit, Marion County's T4 group volunteered at
Healthy Horizons, a day-long event for 4th graders to
learn about tobacco, nutrition, and exercise.
Bond and the T4 students also celebrated Tennessee Quit
Week in February and Kick Butts Day (now called Take Down
Tobacco) in March. For Kick Butts Day, Marion County
held a Breathe Easy Track Meet, which included different
events for middle school students like Get Rid of that
Cigarette as Fast as You Can! Team Dynamics Relay,
Breathe Through a Straw, and Crush Big Tobacco – Knock
Down Tobacco Ads. Bond said students seemed to most enjoy
knocking down vaping and cigarette ads.
T4 students presented at the Marion County school board
meeting to advocate for vaping policy changes.
Previously, students who were caught vaping were sent to
alternative school, which was ineffective in changing
students' behavior. Bond and T4 students felt that a
Saturday School, which both the student and
parents/guardians had to attend, would work better. The
T4 students created a presentation and delivered it to
the Marion County Board of Education, who approved the
Saturday School plan. Bond received a Sequachee Valley
Electric Cooperative grant to fund the pilot program.
Ylioja from My Life, My Quit said he has early data
showing quit rates above 40% three months after program
enrollment. He has also studied how people learn about My
Life, My Quit. About a third learn about the program
online, through an ad or social media. Another third
learn through traditional methods like TV or radio ads,
flyers, and event booths. The rest were referred to the
program through their school.
Schools are really vital to the solution of youth vaping
because they just interact with young people so much that
they can just deliver the message about the potential
harms of vaping to young people. They can also talk to
them about resources that are available to help them
“Schools are really vital to the solution of
youth vaping because they just interact with young people
so much that they can just deliver the message about the
potential harms of vaping to young people,”
Ylioja said. “They can also talk to them about
resources that are available to help them
Ylioja and his colleagues also work with the department
of health in each state of its service area to promote My
Life, My Quit. National Jewish Health provides
promotional materials and encourages the departments of
health to partner with schools and healthcare providers.
In California, Being Adept parent nights allow families
to come to the school and ask questions about teen
substance use and effective ways to talk to their
children. A panel of local high school students share
their experiences, and families leave with a handout of
tips and resources, including how to help teenagers quit
tobacco products. Charlton said that some of her
attendees at past parent events in West Marin and Tomales
were primarily Spanish speakers, so she worked with an
interpreter to translate parents' questions and her
A teen board also makes videos for the youth educators to
share with students and works with youth educators to
share their experiences, recent trends in teen substance
use, and teen slang. On one parent night panel, a high
school senior said about vaping, “It's not cool
anymore. It's just sad,” and Charlton added
that quote to her presentation for middle school
students. Every year, Being Adept uses student input and
the latest research to update materials.
Communities and schools interested in implementing Being
Adept can purchase the online curriculum (no longer
available online), which includes training materials and
lesson plans. People interested in becoming a youth
educator complete a training program included with the
curriculum package to learn about motivational
interviewing and substance use research and prevention.
Charlton said youth educators can be a college student, a
community member in recovery, or a parent or teacher.
Bond in Tennessee advised partnering with schools,
community members, health coalitions/councils, and other
key stakeholders instead of trying to go it alone. She
also recommended being flexible when working with
schools: “School systems are limited in the
time they can allot for these efforts, so being able to
work with them on their timeline and within their
schedule is of paramount importance.”
Allee Mead is a web writer for the Rural Health Information Hub. She has written on important rural issues, including maternal mortality and farmers' mental health, and has presented nationally on RHIhub's opioid resources. Originally from rural North Dakota, she has a master's degree in English. Full Biography