Impact of School Tobacco-Free Policies and Tobacco Risk Education on E-Cigarette and Other Tobacco use by Georgia Youth

INTRODUCTION. Even though smoking rates have declined over the last half-century, e-cigarette use has more than tripled in the recent years; in 2016 11.3% of youth used e-cigarettes regularly. Youth are often drawn to novel products and are shown to be at increased risk of using e-cigarettes. This is particularly disconcerting because smoking behavior (habit formation) and nicotine addiction begins during youth; 90% of smoking initiation typically occurs by age 18. This often results in a lifetime pattern and significantly impacts individual’s health, including tobacco-caused diseases. Health education and tobacco-free policies are critical to help prevent youth from initiating and/or maintaining tobacco use.

The overarching objective of this study is to estimate the effect of school-level tobacco prevention policies on student use of e-cigarettes and other tobacco. More specifically, this study (1) examines the prevalence of tobacco-free policies and tobacco risk education in Georgia middle and high schools and (2) estimates how tobacco risk-behavior education and tobacco-free school policies impact youth e-cigarette and other tobacco use.

METHODS and DATA. We used individual-level data from the 2013 and 2015 Georgia Youth Tobacco Survey (GYTS) obtained from the Georgia Department of Public Health. The GYTS is a state-level representative sample of middle and high school students. Our 2013 sample includes 2,100 middle school and 1,776 high school students. Our 2015 sample includes 1,434 high school students (middle schools were not surveyed). We test for statistical differences in tobacco use status across tobacco prevention policies. We use regression analysis to estimate the impact of school tobacco-free policies, tobacco risk education, socio-economic and behavioral factors on the e-cigarette and other tobacco use.

RESULTS/CONCLUSIONS. About 4% of the middle school and 12% of high school students are currently using e-cigarettes, which increases with grade level. Results show that, in average, 66% of the students indicated that their school has tobacco-free policy and 43% attended classes focused on tobacco risk education. Statistical tests showed statistically significant differences in current e-cigarette and other tobacco use status and tobacco-free policies and tobacco risk education among most school subgroups (i.e. 2013 middle school, 2013 and 2015 high school students).

Results of multiple regression analysis showed significant relationships between tobacco-free policies and use of several tobacco products indicating that the odds of students using these products were over 50% lower in schools with these polices. Meanwhile, tobacco risk education was only significantly associated with e-cigarette use among high school students in the 2015 cohort. Overall, our results suggest that school tobacco-free policies have higher impact on youth tobacco use than tobacco risk education initiatives. While our data do not indicate consistent statistically significant relationship between tobacco risk education and tobacco use, future research is warranted to study the intensity/frequency and tactics of such educational initiatives. A future research may test tobacco use outcomes for varying degrees of exposure to tobacco risk education by content, message appeal, and endorser types.