(Special Issue) “Youth Smoke-Free” Teaching Activities for Preventing E-Cigarette Use: A Pilot Study Author: Kuan-Yi Liu (Department of Health Promotion and Health Education, National Taiwan Normal University), Jung-Yu Liao (Department of Public Health, Kaohsiung Medical University), Wen-Chi Chang (Institute of Clinical Nursing, National Yang Ming Chiao Tung University), Fang-Yi Liu (Health Center, Chongqing elementary school), Li-Ting Lu (Department of Nursing, University of Kang Ning)

Vol.&No.：Vol. 66, No. 4
Date：December 2021
Pages：167-182
DOI：https://doi.org/10.6209/JORIES.202112_66(4).0006

Abstract：
Aim and Motivation of the Study
　　Additives in electronic cigarettes (e-cigarettes) can damage the autonomous nervous, central nervous, cardiovascular, and digestive systems. Furthermore, these additives may contain cannabis, amphetamine, and other drugs. Therefore, e-cigarettes can be a route through which additive substances enter the body and cause physical and mental harm. Studies have indicated that the progression to future smoking in nonsmoking adolescents increased six-fold after e-cigarette use. A 2018 study revealed that the mean prevalence of e-cigarette use among adolescents in nine countries was 16.4%. The prevalence of e-cigarette use among adolescents in Taiwan is gradually increasing; in March 2021, nearly 60,000 Taiwanese adolescents used e-cigarettes, which illustrates the popularity of e-cigarette use in Taiwanese youth. Therefore, increasing adolescents’ caution toward e-cigarettes and preventing e-cigarettes from harming schools have become urgent concerns in health education.
Literature Review
　　In 2020, Liu, Gaiha, and Halpern-Felsher investigated methods for controlling e-cigarette use by examining 16 e-cigarette prevention and cessation or treatment programs. Of these programs, few were related to e-cigarette intervention. However, seven studies have evaluated the cognitive effectiveness of e-cigarette control programs. Two studies were conducted in 2021: that of Gaiha et al. referenced the Stanford Tobacco Prevention Toolkit to develop a 30-minute e-cigarette prevention educational activity and that of Weser et al. employed virtual reality to design an e-cigarette prevention activity called “Invite Only VR: A Vaping Prevention Game” (Invite Only VR). In the first study, researchers were able to increase junior and senior high school students’ e-cigarette awareness and decrease the students’ behavioral intention to try e-cigarettes. The second study demonstrated that moderate knowledge and perceived harm in junior high school students led to a decrease in reported likelihood of using e-cigarettes; however, no significant changes in attitudes, social perceptions, and self-efficacy were observed. Existing e-cigarette prevention and control programs lack comprehensive designs. Therefore, more evidence-based tools, resources, and related evaluation studies are required.
Study Methods
　　In this pilot study, students from a grade 5 and a grade 6 class were included as participants. Teachers combined a “smoke-free adolescence” teaching activity focused on controlling e-cigarette use with actual school classes to guide students through experiential classes. This enabled teachers to adjust the design of the teaching activities as required. A structured questionnaire was used in this study for pretest and posttest effectiveness evaluations of knowledge, attitudes, self-efficacy, and intention. SPSS 22.0 was used to perform a paired t test to compare differences in participants before and after course activities.
Study Results
　　A total of 53 elementary school students completed the questionnaire. A paired t test was used to assess the performance of the students with respect to knowledge, attitudes, self-efficacy, and intention. The results revealed no significant differences in levels of knowledge and self-efficacy. However, the mean values for both attitudes and intention were higher in the posttest than in the pretest, which indicates that teaching intervention to prevent e-cigarette harm can positively affect attitudes and intentions.
Discussion and Suggestions
　　Conventional health education in Taiwan provides health theme–related factual knowledge but lacks scenario-based guidance and integration. This causes student knowledge to be singular or fragmented and is not conducive to cultivating health literacy among students. The “smoke-free adolescence” school teaching activity use employed in this study was developed with consideration for individuals, families, schools, and the law, and various teaching materials were designed that combined the 4Fs (fact, feeling, finding, and future) and health literacy. These materials included scenarios and were presented in digital, comic, and animation formats, which have broad and flexible applications. The questionnaire included items measuring knowledge, attitudes, self-efficacy, and intention to not use e-cigarettes. The results of the evaluations support the usability of the course. The proposed course can be implemented in the future, and suitable themes can be selected according to on-site teaching contexts and subsequently evaluated for effectiveness.
In this pilot study, only one elementary school served as the study site, and convenience sampling was employed. Thus, the study is limited in its generalizability. We recommend that the sampling scope and size be increased in future studies and that random sampling be employed to improve sample representativeness. In addition, this was only a preliminary study. No control group was included for comparison, and student follow-up was not performed. Therefore, we were unable to elucidate the long-term effectiveness of the teaching materials; future studies can consider this aspect.

Keywords：Kuan-Yi Liu (Department of Health Promotion and Health Education, National Taiwan Normal University), Jung-Yu Liao (Department of Public Health, Kaohsiung Medical University), Wen-Chi Chang (Institute of Clinical Nursing, National Yang Ming Chiao Tung University), Fang-Yi Liu (Health Center, Chongqing elementary school), Li-Ting Lu (Department of Nursing, University of Kang Ning)

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