Support Healthy Youth

The graphs above are snapshots of survey data collected from the WA Healthy Youth Survey. Visit the Healthy Youth Survey* website to generate fact sheets on a variety of topics, divided by grade, state/county, year, and other factors and to view the Data Dashboard.

The 2022 National Youth Tobacco Survey has similar use findings and provides more details about the most commonly used types of products – with e-cigarettes having the highest usage rates (9.4%).

*About the 2021 WA Healthy Youth Survey: The 2021 HYS differs from past surveys in several ways, so caution should be used when comparing HYS 2021 results to prior years and historical trends. The HYS is normally conducted in even years, but the pandemic shifted the survey to odd numbered years beginning in 2021. In addition to potential impacts of the pandemic, the 2021 survey was also primarily administered in an online format for the first time. Results from the 2023 survey are needed to assess whether the decrease in overall youth commercial tobacco use recorded in 2021 is a trend or an anomaly.

Almost all long-term commercial tobacco use starts in the teen and young adult years, which is why preventing initiation is so critical. The following are a few key ways to prevent youth from picking up e-cigarettes and other tobacco products:

Comprehensive Policies and Laws: Washington took an important step by raising the legal sale age to 21 in 2020, which is also now federal law. But that action is just part of a comprehensive policy strategy.
Making tobacco products less appealing by ending the sale of flavored products would prevent youth initiation because 81% of teens age 12-17 who ever used an e-cigarette, used a flavored e-cigarette first.⁷ Making e-cigarettes and other tobacco products more difficult to for youth to access through policies such as increasing taxes on vapor products and restricting retail locations near schools and playfields also reduces initiation and use.

Improving Funding for Prevention Strategies: More comprehensive and sustainable funding is needed to support a robust statewide tobacco prevention program. Increased funding is needed to support effective, evidence-based school programs, community programs, and social and mass media campaigns for youth grades 4 through 12.

Supporting Youth Education: More support for youth prevention programs that give teens the facts on why commercial tobacco products are harmful and promote healthy behaviors. The Vape Talk from the American Lung Association is a great resource for parents to learn how to start the conversation and to get all the facts on the dangers, signs, and symptoms of vaping. There are also many dedicated and innovative community coalitions, local health departments, and organizations that provide teen risk reduction education in middle school and high school classrooms throughout the state.

Fostering Environmental/Community Support: Setting a good role-model by not using commercial tobacco products is a critical piece to preventing initiation – particularly if you are a parent, educator, or healthcare professional. Strong family support and open communication between parents and adolescents/teens is also associated with reduced smoking risk.⁸

The tobacco industry is using the same tactics to attract kids to e-cigarettes that they used to addict kids to cigarettes for decades. These strategies include: adding appealing flavors, designing products that are easy to hide, offering promotions and discounts that make products more affordable for youth, advertising on social media, the internet, and TV.⁹ The tobacco industry knows that their customers are getting sick and dying from using their products, so they must appeal to young people to continue making money.

Stronger policies and more enforcement against manufacturers and retailers who violate marketing laws is needed to more effectively restrict marketing of commercial tobacco products to youth.

Washington Breathes is committed to supporting communities and working to counter the industry's targeted marketing of addictive products to youth and communities most impacted by commercial tobacco use.

Educational Programs and Resources for Educators and Parents

• The Association of Washington School Principals (AWSP) met with students to determine what school leaders can start doing, stop doing, and keep doing to address the teen vaping epidemic. For example, students suggested to start more awareness campaigns and pre-high school education, stop using only disciplinary procedures or limiting bathroom time, and continue having open conversations about the risks and harms. Read the students' recommendations: Students Weigh In: Vaping, What Can We Do?
• Stanford Medicine’s Tobacco Prevention Toolkit, Vaping Prevention Online Course
• American Heart Association, Youth Tobacco and Vaping Resources for Educators, Administrators, Parents, Students, Counselors, and Health Professionals
• There are a variety of protective factors that make it less likely for a teen to choose vaping. Reinforcing Social Emotional Learning (SEL) techniques like high self-esteem, parental involvement, school involvement, athletics, and positive role models provide students with the tools need to resist peer pressure.¹¹
• The Truth Initiative has compiled a variety of ways that educators can better support students if they are caught vaping at school.

Cessation Programs

• N-O-T (Not On Tobacco): Interactive smoking and vaping cessation program for teens by the American Lung Association. N-O-T is led by trained facilitators who deliver the structured curriculum in schools or community-based settings.
• This is Quitting: Teens can text DITCHJUUL to 88709 to learn tips and tricks and receive encouragement for quitting. It’s easy, free, totally anonymous and available 24/7.

See more cessation programs on our Cessation/Quitting Support Services page.

Campaigns

• Fresh Empire Campaign (U.S. FDA): Campaign designed to prevent and reduce cigarette smoking among youth ages 12-17 who identify with hip-hop culture – specifically African American, Hispanic, and Asian American and Pacific Islander youth.
• CDC's Office on Smoking and Health created the Empower Vape-Free Youth™ campaign to empower educators to speak with youth about the risks of e-cigarettes and nicotine addiction.

Support Students Mental Health

Identifying students who are using nicotine products is also important for identifying youth who need more behavioral health support. Data from the Healthy Youth Survey shows that youth who report vaping, smoking, or using other nicotine products also report higher rates of depression, use of marijuana or alcohol, and thoughts of suicide.

The Washington Office of Superintendent of Public Instruction (OSPI) has outlined ‘Red Flags for Support’ with recommendations for how schools can best support students who vape/smoke by focusing on prevention, reframing from discipline to support, and screening students using tobacco for other substance use and mental health concerns. About Youth Now has resources, including a webinar on the ‘Red Flags’, to support counselors and health care professionals.

Schools need more sustainable and dedicated funding to be able to effectively implement these recommendations.

Rethinking School Discipline Policies

Washington Breathes promotes supportive school interventions for students who use commercial tobacco products instead of punitive measures that can further harm a young person using these addictive products. Punishments, like suspensions and detentions, do not recognize the student’s dependence on nicotine and need for supportive services.

Washington State took some positive steps to improve overall school discipline policies in 2016 when the Legislature passed a new law that focuses on eliminating zero tolerance approaches, providing proactive and restorative supports, and using strategies that support students in meeting behavioral expectations.

The Washington Office of the Superintendent of Public Instruction (OSPI) partners with the WA School District Directors Association (WSDDA) to create model school policies:

• OSPI’s School Discipline webpage explains student discipline laws and provides resources.
• OSPI’s overview fact sheet: Student Discipline Policies - Substance Use and Possession
• The WSDDA has model policies that school boards can adapt to develop processes for addressing students who violate school policies. For example, the 3000 series has policy 3241/3241P – Student Discipline, which has links to a Policy, a Procedure, and Form 1 and 2. Form 1 has the Discipline Matrix. Form 2 has the Continuum of Discipline Responses to each Type of violation on the matrix.

Implementation of Washington’s new approach to school discipline has taken some time, beginning in the 2018-2019 school year, and the process is still underway. Resources and capacity to develop and implement the new policies and provide staff training varies greatly between large and small school districts, and from school to school. As a result, there are likely a range of different approaches currently being used in Washington schools. Increasing funding for this work so that it can be applied in every school and community would help youth reduce substance use and better support school professionals.

• Cascadia Youth Mental Health is an example of one group doing important work in Washington to transform discipline practices. They provide training and consulting services to school professionals to help reform school discipline, enhance alternatives to suspension, and support youth mental health.

There are a few other frameworks and initiatives that could be helpful if implemented in Washington State schools:

• Change Lab Solutions has developed a framework for School Discipline Practices and provides guidance on why non-punitive approaches are so important for a students learning and development. Punitive approaches (like expulsion or referrals to law enforcement, for example) exacerbate racial disparities, adverse childhood experiences (ACE’s) and external stressors for students.
  • Webinar: Positive Discipline and Healthy Kids - An Opportunity for Washington State
• The Vape Free Schools Initiative was created by the American Lung Association to assist schools in navigating the teen vaping epidemic by providing tools, resources, and guidance for students, parents, staff, and the community.
• The Public Health Law Center has developed a Commercial Tobacco Free K-12 School Model Policy with key findings, what needs to be included in the policy, developing the statements and exceptions, integrating cessation opportunities, enforcement, and dissemination of the policy.

Alternatives to Suspension

• INDEPTH (Intervention for Nicotine Dependence: Education, Prevention, Tobacco and Health): Interactive program, created by the American Lung Association, to address teen vaping and nicotine use in a more supportive way. INDEPTH is an alternative to suspension or citation program and is taught by a trained adult in four, 50-minute sessions.
• Stanford Medicine’s Tobacco Prevention Toolkit, Healthy Futures, is an alternative to suspension curriculum that is offered in two formats, one taught by an educator, counselor, or advisor in a group format and one self-paced online course.

The invention of vapor products created a new poisoning risk for younger children. Nicotine is classified as a poison at certain levels and e-liquids for vapor products are concentrated nicotine solutions. Flavored e-liquids are often labeled with colors and images that appeal to young children. Swallowing or inhaling nicotine or exposure through the skin can send a young child to the emergency room with serious symptoms, and can even cause death.

Most reported nicotine poisonings are in children under 5 years old. But nicotine poisonings also occur in all other age groups. Nicotine e-liquids are also toxic to pets.

Child-resistant packaging for nicotine e-liquids is required by state law (WA Vapor Products Act, RCW 70.345.130) and federal law (Child Nicotine Poisoning Act). Initially these laws seemed to help decrease the number of child poisonings. But there are legal loopholes. Under these laws, popular disposable e-cigarettes (e.g. Puff Bar and Elf Bar) and pod-based nicotine systems (e.g. JUUL and Sourin) do not need to be childproof.

Storing all commercial tobacco products out of reach of children and youth, preferably securely locked up, is an important safety measure to prevent poisonings and youth access. Stronger packaging requirements and eliminating flavored products would better protect children and youth.

Here are a few ways for our members and partners to get involved:

• Participate in Washington Breathes’ Supporting Healthy Youth workgroup
• Share supportive interventions and resources with educators/administrators so they can bring tobacco prevention education into their schools and classrooms
• Check up on your school/district's policies for commercial tobacco use. Are they offering supportive interventions to help students who are smoking or vaping?