Vaping and Teen E-Cigarette Addiction: Will Conventional Harm Reduction Programs Work?

The prevalence and use of electronic cigarettes has increased rapidly over the past decade, particularly among youth.  The extraordinary growth of e-cigarettes has also raised significant public health concerns about the emergence of a new generation of teens with nicotine dependency.  Changes in the design and marketing of vaporizers with the introduction in 2015 of more stylish, sleekly-designed, discreet high-tech devices, known as JUUL, have proven irresistible to teens and become the latest ‘nightmare’ for today’s high school principals and teachers.

School authorities in Canada as well as the United States are coming rather late to the challenge of combating vaping and its associated health risks.  Advance promotion of e-cigarettes as a smoking cessation device may have contributed to the initial ambivalent, almost helter-skelter, response.  A May 2019 Ontario Tobacco Research Unit report confirms that schools were caught off-guard by the surge of vaping among never-smokers and responded with interventions once used to combat smoking or imported from the United States, where the craze is far more advanced among youth.

Five years after the arrival of JUUL, public concern has reached a panic stage with the spread of fear over a recent spate of lung-disease cases involving teen users of e-cigarettes. Breathing in flavoured aerosol that contains nicotine was already a worry of doctors, parents and schools.  Over the past few months, some 380 people in 36 different American states have been struck by a mysterious lung infection linked to chemicals inhaled through e-cigarettes, and seven of those affected died.  Shortly after Health Canada issued a September 6, 2019 advisory, a London, Ontario, hospital disclosed that a local high school student suffering from vaping-related illness had been placed on life support before recovering and being sent home. It could become worse in mid-December 2019 when the sale of vaping liquids containing cannabis compounds becomes legal in Canada.

Schools are on the front lines of the current teen health scare. Since entering the Canadian retail market in 2009, e-cigarettes have morphed from a smoking-cessation aid to a full-blown health concern among today’s youth. Ten years ago, Health Canada greeted e-cigarettes with an advisory warning of the dangers of the new nicotine delivery devices, expressing concern over the lack of scientific research to support claims that they were safe for adults and teens. More recently, Canadian health authorities monitoring the spread of e-cigarette use have been echoing the U.S. National Academies of Science, Engineering and Medicine research finding that ” e-cigarettes are not without biological effects on humans” and, rather than aiding in cessation, can lead to further dependency.

Vaping devices and products containing nicotine are now flooding the Canadian market and readily available in local convenience stores and gas stations. Since September 1918, JUUL, the San Francisco-based company that controls over 50 per cent of the market, has been selling its sleek devices that look like a computer flash drive and are re-chargable at a USB port. They have proven more popular that the Imperial Tobacco brand Vype, released Canada in the Spring of 2018, and Japan Tobacco‘s Logic brand released in early 2019.

First introduced by Juul Labs in mid-2015 as a smoking-cessation device, JUUL became the so-called “iPhone of e-cigarettes.” The extraordinary sales growth of the product was driven by a variety of effective, wide-ranging and engaging campaigns reaching youth through social media, particularly on You Tube, Twitter, and Instagram. Five million Canadians, mostly aged 15 to 34, had tried e-cigarettes by 2017 and 300,000 reported using it every day. One more recent study, published in the British Medical Journal, reported that the proportion of Canadian teens (aged 16 to 19) vaping rose from 8.4 per cent in 2017 to 14.8 per cent in 2018, a 74 per cent increase. 

The Ontario Tobacco Research Unit conducted an environmental scan of current harm reduction programs and quickly recognized that there were, as of the Spring of 2019, no studies of the effectiveness of such interventions. Most intervention programs were public education and school-based efforts, typically aimed at teaching children and youth about the dangers of vaping in the hope of reducing or eliminating the practice. Three of the programs reviewed were E-Cigarettes: What You Need to Know (Grades 6 -12, Scholastic), CATCH My Breath (Ages 11-18, CATCH), and School E-Cigarette Toolkit (Grades 6-12, Minnesota Department of Health).  The report also examined interventions outside of schools, including community-based initiatives, public health efforts, health-care programs, and public policy strategies such as advertising and promotion restrictions, age restrictions, labelling and health warnings, flavouring restrictions, and safety requirements.

Most of the actual school-based interventions were embedded in existing tobacco control programs and sought to counter the marketing messages of companies claiming it is a safe, smoking cessation activity. The Ontario Tobacco Research Unit recognized the scattered approach being taken and recommended considering interventions that proved successful at reducing rates of regular cigarette smoking among youth. They also identified the need for a more coordinated and planned anti-vaping strategy.

Vaping has overtaken smoking as the favoured health-risk behaviour of high school students.  Some 15.8 per cent of Ontario Grade 9 students vaped in 2017, and only 6.2 per cent smoked cigarettes. As many as one out of every three high schoolers may now be regular users of vaporizers with nicotine-laced fluids. The recent health scares may have jolted users and curbed the growth in usage, but it remains the biggest, mostly unaddressed health issue in our high schools.

Why have health agencies and school authorities been so slow off-the-mark in combating the spread of vaping among adolescents? What more can be done to regulate and curtail the marketing of e-cigarettes among the youth market segment?  Where are the research initiatives aimed at identifying the real health risks for teens of vaping nicotine and cannabis products?  Should vaping cessation programs simply mimic smoking control strategies and programs?  What can be done to develop more effective student-centered vaping cessation programs? 

 

Read Full Post »

Violence and Student Behaviour: What’s Compounding the Rising Incidence of Violence against Educators?

Biting, kicking, spitting, scratching, punching, throwing objects, and threatening harm are on the rise in Canadian elementary classrooms from coast to coast. More and more educators are not only reporting the violent incidents, but being hurt on the job in our classrooms, hallways, and playgrounds. Whole classrooms are being evacuated to allow disruptive children to calm down. That escalating crisis was recently highlighted in a fine September 7, 2019 piece of investigative journalism by The Globe and Mail’s national education reporter Caroline Alphonso.

Her investigation of how school districts are actually managing children with behavioural challenges and complex needs is eye-opening for those unfamiliar with teaching on today’s frontlines. Periodic surveys of teachers and education assistants have identified an escalating crisis, but — until now–provincial school authorities and local school districts have been slow to collect the data and most reluctant to share violent incident report information with parents or the public. Indeed, Alphonso and her Globe team found it impossible to secure the data from some provinces and major metropolitan school districts.

The facts are gradually emerging and harassment and violence against educators is becoming commonplace.  One September 2019 study, conducted by University of Ottawa researchers Darcy A. Santor, Chris Bruckert, and Kyle McBride, showed a sharp spike in the level of violence teachers face in Ontario elementary schools. In a December 2018 online survey of 1,600 educators, they found a seven-fold increase in reported incidents over the past 12 years. While only 7 per cent of Ontario elementary teachers reported experiencing bullying in 2005, some 54 per cent now report encountering violence perpetrated mostly by students, but also by parents, and administrators. Furthermore, some 72 per cent reported experiencing explicit verbal insults, putdowns, or obscene gestures from a student during 2017-18.

Out of ten provincial ministries of education, only Nova Scotia provided Alphonso and the Globe and Mail with comprehensive data.  In the 2014-15, school year, there were 631 recorded incidents of violence against an educator by a student, and the following year, 2015-16, there were 683, the vast majority of which occurred in the elementary schools. The Ontario government turned down the Globe and Mail Freedom of Information request and other provinces either claimed not to have data or unable to access it without going through school boards or other government agencies.

Nova Scotia Teachers’ Union (NSTU) president Paul Wozney expressed concern over the problem and provided what amounted to a worst case scenario. In Nova Scotia, one classroom was evacuated 12 times in a month — and students were forced to find sanctuary in another room until the disruptive child calmed down. He also reported that Nova Scotia educators, like their New Brunswick counterparts, were now wearing bite-resistant sleeves and Kevlar vests in certain high risk classrooms.

What can be done to address the problem? Most teacher union surveys and research reports, including the University of Ottawa study, are stronger on diagnosis than on prescription. The most common policy solutions, investing in more classroom resources, more teaching assistants, or more specialized professional development, are predictably in every set of recommendations and strongly favoured by school districts, teachers’ unions, and parent education funding lobby groups.

Two of the detailed University of Ottawa study findings got short shrift and deserve closer scrutiny.  Workplace violence is likely being under-reported because of fears of blame (from administration) and reprisal ( from students) in “an organizational culture” which is “ill-equipped to deal with the issue.” More importantly, in school boards which espouse “progressive discipline” under provincial mandates, there are “few consequences for students’ harassing or violent behaviour” (p. 34).

Digging deeper, it’s clear that two fundamental components of prevailing student behaviour philosophy and practice need to be seriously re-examined and likely replaced with more effective strategies: the cure-all of Positive Behaviour Supports Programs (PEBIS) and the misapplication of school restorative justice. From province-to-province, right across Canada, few educators seem to be either aware of, or attuned to, growing evidence that positive, progressive discipline has unanticipated negative long-term consequences for school principals and frontline teachers in classrooms.

Clamouring for more resources, increased staff levels, or better training has not worked, to date, so it’s surely not the ultimate answer. It’s time to adopt a completely new strategy, more in tune with the latest research on student behaviour and effective school management.  School leaders and principals need significant training in creating a culture of respect and responsibility and it’s time to look at alternatives to progressive, positive discipline and its step-child, restorative justice. It’s captured nicely in one of the University of Ottawa study recommendations calling for the “consistent application” and “implementation of student consequences that are appropriate and effective”(p. 35).

Why are teachers and education assistants facing increased violence in elementary schools?  How much of the increased student violence is the result of the rising incidence of students with severe learning challenges and complex needs? Will investing more in the prevailing student behavour programs make any real difference?  Is it time to rethink school leadership and to properly equip principals and teachers with strategies and programs that are research-proven and far more effective in ensuring safe, secure and purposeful learning for everyone? 

 

 

 

 

 

Read Full Post »