Jamie R. Forrest

Adolescent Electronic Cigarette Use: Associations With Conventional Cigarette and Hookah Smoking.

INTRODUCTION The emerging trends and rapid growth of electronic cigarettes (e-cigarettes) among adolescents are being monitored closely. The trends are critical as policy to prevent uptake among adolescents is considered. The purpose of this study is to describe the prevalence of e-cigarette use and potential correlates for use. Associations between e-cigarettes, cigarettes, and hookah are assessed. METHODS This study used data from the 2013 Florida Youth Tobacco Survey. Prevalence estimates were calculated in 2014 and differences were determined based on CIs. Adjusted logistic regression models were used to identify correlates of e-cigarette use among participants based on demographic and other tobacco products used. RESULTS There were no sex differences in middle school, whereas male high school students reported higher use than their female counterparts. Cigarette smoking and hookah use were significantly associated with ever and current e-cigarette use among both middle and high school students. CONCLUSIONS Although e-cigarettes are being assessed as a potential replacement product for traditional tobacco, evidence from this study indicates the possibility of multiple product use among adolescents. E-cigarettes are not only associated with traditional cigarettes, but also with hookahs, a similar emerging product that offer tobacco flavors that may appeal to adolescents. Notably, many e-cigarette users also reported no cigarette or hookah use.

A Multiyear Assessment of Hookah Use Prevalence Among Florida High School Students

INTRODUCTION The purpose of this study was to assess the prevalence of hookah use among Florida high school students over time. Alternative tobacco products, including hookah, pose a public health threat to tobacco prevention efforts, especially among adolescents. METHODS Florida Youth Tobacco Survey data, representing all public high school students in the state, were analyzed to assess the prevalence of lifetime and current hookah use and were compared by demographic groups. Multiple years of data (2007-2012) were examined to assess changes over time. RESULTS During the past 6 years, there was an increase in lifetime hookah use among Florida high school students. While males remained at a higher rate overall, female adolescents increased at a faster rate. Hispanic and non-Hispanic White respondents reported increased trends as well. Current use trends did not change over 4 years, remaining at about 8%. CONCLUSIONS Hookah is a new tobacco product in the United States that appears attractive to youth, with dramatic increases among the state population. While cigarette use among youth is declining in Florida, the increasing uptake of alternative tobacco products may lessen the overall public health gains for tobacco use. There is a need for continued monitoring of hookah use among the adolescent population, for both prevention and cessation efforts as well as policy interventions to address this emerging trend.

New Evidence: Data Documenting Parental Support for Earlier Sexuality Education

BACKGROUND Numerous studies document support for sexuality education to be taught in high school, and often, in middle school. However, little research has been conducted addressing support for sexuality education in elementary schools. METHODS As part of the state Behavioral Risk Factor Surveillance System (BRFSS) Survey administration, the Florida Department of Health conducted the Florida Child Health Survey (FCHS) by calling back parents who had children in their home and who agreed to participate (N = 1715). RESULTS Most parents supported the following sexuality education topics being taught specifically in elementary school: communication skills (89%), human anatomy/reproductive information (65%), abstinence (61%), human immunodeficiency virus (HIV)/sexually transmitted infections (STIs) (53%), and gender/sexual orientation issues (52%). Support was even greater in middle school (62-91%) and high school (72-91%) for these topics and for birth control and condom education. Most parents supported comprehensive sexuality education (40.4%), followed by abstinence-plus (36.4%) and abstinence-only (23.2%). Chi-square results showed significant differences in the type of sexuality education supported by almost all parent demographic variables analyzed including sex, race, marital status, and education. CONCLUSIONS Results add substantial support for age-appropriate school-based sexuality education starting at the elementary school level, the new National Sexuality Education Standards, and funding to support evidence-based abstinence-plus or comprehensive sexuality education.

Hookah Smoking and Harm Perception Among Asthmatic Adolescents: Findings From the Florida Youth Tobacco Survey

BACKGROUND Hookah tobacco smoking has increased in prevalence among Florida adolescents and is often viewed as a safer alternative to cigarette smoking by young adults. Asthmatic adolescents are at increased risk of the negative health effects of hookah smoking. The purpose of this study is to examine if hookah use and harm perception vary by asthma status. METHODS The Florida Youth Tobacco Survey was conducted in 2012 among 36,578 high school students. Secondary data analysis was conducted to compare the rates of hookah use among asthmatic youth to their nonasthmatic counterparts. Risk perception of hookah use compared to cigarette smoking was also assessed among asthmatic and nonasthmatic adolescents. RESULTS One in 5 high school students reported lifetime asthma. These asthmatic students have a significantly higher prevalence of hookah smoking and greater perception of hookah use as being less harmful than cigarette smoking, than their nonasthmatic counterparts. Among asthmatics, 12th graders and Hispanic students had the highest prevalence of hookah smoking. CONCLUSION Common misperceptions of hookah smoking as being less harmful than cigarette smoking are prominent among high school students in Florida and are greater among students with asthma than those students who do not have asthma. Efforts to increase education to dispel the myths surrounding hookah smoking as a safer alternative to cigarette smoking needs to exist at the high school level for both students with and without asthma.

Are Students with Asthma at Increased Risk for Being a Victim of Bullying in School or Cyberspace? Findings from the 2011 Florida Youth Risk Behavior Survey.

BACKGROUND Adolescents with asthma are at risk for psychological and behavioral problems. The aim of this study was to determine whether high school students with asthma are at increased risk for bullying in school and cyberspace, and to explore the role of depressive symptoms in moderating this association. METHODS A secondary data analysis was completed with the 2011 Florida Youth Risk Behavior Survey. Participant included a random sample of adolescents in grades 9 through 12 who attended public high schools in Florida. Descriptive and inferential statistics were conducted using SPSS software. RESULTS We examined data from 6212 high school adolescents and found a significant relationship between current asthma and cyberbullying in adolescents. Of the sample diagnosed with asthma, 15.6% reported bullying and 17% cyberbullying (versus 10.2% and 11% of nonasthmatics). We further examined data using depressive symptoms as a mediating and moderating variable and found significance on all accounts. CONCLUSIONS Adolescents with asthma are at increased risk for being victims of bullying in school and cyberspace. Our findings suggest that adolescents with asthma who also report depressive symptoms are particularly at high risk for bullying than adolescents with asthma who did not report depressive symptoms. Efforts to increase education and decrease all types of bullying at the high school level for both students with and without asthma are warranted.

Developing asthma-Friendly childcare centers with Online Training and evaluation

In 2011, the Florida Asthma Coalition (FAC) began offering its Asthma-Friendly Childcare Center (AFCC) training online. This course teaches childcare center employees the fundamentals of effective asthma management. It covers basic asthma physiology, ways to recognize asthma attacks, techniques to help children experiencing attacks, and strategies to create healthy environments for asthmatics. A team of health services researchers evaluated both years of the online training. Evaluators used a quasi-experimental design with pretest, posttest, and follow-up assessment. Questions measured knowledge gain and retention, user satisfaction, and implementation of management strategies. Over 650 people from nearly all 67 Florida counties took AFCC training online between 2011 and 2013. Test scores improved by a minimum of 11% points in all program years evaluated. Gains in both knowledge and confidence were substantial and highly significant across years. While individual trainees did forget some content on follow-up, they seemed to retain the specific messages most relevant for their own workplaces. Most trainees also planned to implement multiple management strategies recommended by the training. A large majority of participants rated the training as excellent on all quality metrics, including relevance of content and time efficiency of the online format. Nearly all respondents perceived the training as useful for both providing improved care and fulfilling licensure or certification requirements. Many participants also indicated that their centers would pursue formal certification as AFCCs via the program offered by FAC. The online AFCC course performed strongly in its first years, yielding both high participant satisfaction and substantial improvement in workplace asthma management activity. This training holds promise for introducing and improving multidimensional asthma management strategies at childcare facilities nationwide.

Asthma 101 for Schools: Successes and Challenges in Transitioning to Online Delivery

Florida Asthma Program staff worked with evaluators from the Florida State University College of Medicine to assess participation and quality of the American Lung Association’s Asthma 101 asthma management education program for school faculty and staff between 2011 and 2014. This included transitioning the program to an online training format for the 2013–2014 school year. Asthma 101 helps school personnel master the basics of asthma physiology and management, with content tailored specifically for elementary and secondary educational settings. The program is assessed with questionnaires at multiple timepoints, yielding a quasi-experimental evaluation design. Evaluators reviewed quantitative data from pretests and qualitative and quantitative data from post-program satisfaction questionnaires. Program spreadsheets listing the dates for delivery and number of attendees were also reviewed. Overall, evaluation findings were positive. In the 2011–2012 program year, 16 different course sessions were offered, and more than half of enrolled participants came from Title I schools. A total of 228 people were trained. In the 2012–2013 program year, 19 different course sessions were offered. Enrollment totals (638) and matching pre- and posttest totals (562) soundly exceeded the target metric of 425. At least 170 (27%) of a total of 638 participants could be verified as coming from the target demographic of Title I school faculty and staff. In the 2013–2014 program year, the course was offered online on a rolling basis via the Florida TRAIN course management system. Enrollment remained high and learner outcomes remained consistently strong across all content areas for knowledge and satisfaction. A total of 406 people participated in the training; complete pre- and posttest data were available for 341 of these individuals; and satisfaction data were available for 325. Of the 406 trainees, 199 (49%) reported working for Title I schools. Evaluation yielded very positive results. An overwhelming majority of participants reported finding the course consistently strong across the board and highly impactful for their own ability to help students manage their asthma effectively. Most participants also reported that they would change/improve their asthma management behaviors in the workplace. Recommendations were developed to help expand future program reach.