NR 436 Week 6 Vaping Cessation Program Proposal Example

Quit Before You Suspend: A School Nurse-Led Vaping Cessation Program for Linden Hollow High School

Student Name

College of Nursing, Chamberlain University

NR 436: Community, Public, and Population Health Nursing

Instructor Name

Month Day, Year

Quit Before You Suspend: A School Nurse-Led Vaping Cessation Program for Linden Hollow High School

The Problem This Program Answers

This proposal answers the priority diagnosis from the community assessment of Linden Hollow, a composite suburban school district of 38,400 residents: high school students in the district are at risk for nicotine dependence, driven by flavored products that are easy to buy, devices passed between friends, and a disciplinary approach that sends students home but never offers them help to quit. The current e-cigarette use rate among Linden Hollow high school students is 16.8 per 100, against 11.2 per 100 statewide and 10.0 per 100 nationally (Birdsey et al., 2023), and 31 of every 100 current users report use on most days. With 1,290 students enrolled at the high school, that rate represents about 217 students who vape, of whom roughly 67 are likely to be dependent.

The district's current response is a one-day suspension for a first offense and a three-day suspension for a second. Last year, the high school recorded 104 vaping suspensions involving 71 students, and none of those students was referred to cessation support, because none exists in the school. The program proposed here keeps the district's rules but changes what happens after a student is caught, and it opens the same support to any student who asks for it without being caught.

The Intervention

The program has two parts delivered by the high school nurse. The first is a brief cessation session, one-on-one or in groups of up to four, held in the nurse's office during a study period rather than during core classes. Each student completes a short dependence screen, sets a quit date within two weeks, and leaves enrolled in a free text message cessation program designed for young people who vape. The choice of a text program rests on a randomized trial in which young adults enrolled in a vaping cessation text program were more likely to report abstinence at seven months than those who received assessment only (Graham et al., 2021). Text messaging also fits the population: adolescents carry phones all day and are more likely to read a message than to return to an office.

The second part is follow-up. The nurse checks in with each enrolled student at one, four and twelve weeks, either in a two-minute hallway conversation or during a scheduled study period, and records self-reported use in the past seven days. Students who report cravings or withdrawal symptoms that interfere with school are referred to the school-based health center, which is staffed by a nurse practitioner two days a week and can discuss nicotine replacement with parents where appropriate. The program runs from the start of the spring semester, with sessions offered three mornings a week.

The Partners Who Hold the Key

The program depends on three partners, each of whom gains something from carrying it. The high school administration agrees to offer an alternative to suspension: a student caught vaping for the first time may choose to attend a cessation session and enroll in the text program instead of serving the suspension. Administration gains a response to vaping that parents and the student health advisory group have been requesting, and keeps students in class. The school-based health center, operated by a regional health system, accepts referrals and gains visits it can bill. The county health department's youth tobacco prevention coalition provides printed materials and parent information nights and gains a school partner for a coalition that has focused on cigarettes. The student health advisory group, a group of 14 students, helps design the flyers and posts about the program so that it does not look like punishment.

Reaching Students Who Would Never Walk In

Recruitment is treated as its own problem. Students who vape are unlikely to visit the nurse to ask for help, and a flyer on the office wall will reach few of them. The program therefore uses three routes. The first is the suspension alternative, which reaches every student caught. The second is peer promotion: the student advisory group posts about the program on school channels in words students use, framed around saving money and feeling less anxious rather than around health. The third is parent information, offered at two evening sessions and through the district's weekly email, since parents who find a device at home often do not know where to turn. Students may also self-refer through a QR code on restroom doors that opens a form sent only to the nurse. Participation is confidential beyond the nurse and, for suspension alternatives, the assistant principal.

Measures That Can Move

Process measure 1: Number of students enrolled each month, and the share referred through each route (suspension alternative, self-referral, parent referral).

Process measure 2: Percentage of enrolled students completing the one-, four- and twelve-week follow-up contacts; target 70 per 100 at twelve weeks.

Outcome measure 1: Self-reported abstinence from e-cigarettes in the past seven days at twelve weeks among enrolled students; target 25 per 100, which is close to the result reported in the trial that informed the program (Graham et al., 2021).

Outcome measure 2: Repeat vaping suspensions per 100 students with a first offense, compared with the prior school year; target a reduction of one third.

Outcome measure 3: Current e-cigarette use among high school students on the next biennial district youth survey, using the same question as the assessment, compared with the baseline of 16.8 per 100.

Timeline, Staffing and Cost

Planning runs through the first eight weeks of the fall semester, when the nurse completes a free online training in youth tobacco cessation, administration approves the suspension alternative, and the advisory group designs materials. The program launches in January and runs through May, with a report to the school board in June. Staffing requires about four hours a week of the high school nurse's time, drawn from time currently spent on health office visits that the school-based health center could absorb. Direct costs are limited to printing, estimated at 400 dollars for the year, and are covered by the county coalition. The text program is free to users.

What Could Go Wrong

Three assumptions carry risk. The first is that administration will accept a suspension alternative; if it does not, the program still runs through self-referral, but it will reach fewer of the students who need it most. The second is that students will be honest about their use at follow-up, which cannot be verified without testing that the school will not do; self-report is the standard measure in cessation research for this reason, but it likely overstates success. The third is that the nurse's time is available; a single flu outbreak or a staffing gap could suspend the program for weeks. The plan's answer to the third risk is to train the school-based health center nurse practitioner to deliver the same session, so that the program does not depend on one person. Federal guidance on young people and e-cigarettes stresses that a school response does most when it sits alongside policy and family involvement (U.S. Department of Health and Human Services, 2016), and this program is intended as one part of that response rather than the whole of it.

References

Birdsey, J., Cornelius, M., Jamal, A., Park-Lee, E., Cooper, M. R., Wang, J., Sawdey, M. D., Cullen, K. A., & Neff, L. (2023). Tobacco product use among U.S. middle and high school students: National Youth Tobacco Survey, 2023. Morbidity and Mortality Weekly Report, 72(44), 1173-1182. https://doi.org/10.15585/mmwr.mm7244a1

Graham, A. L., Amato, M. S., Cha, S., Jacobs, M. A., Bottcher, M. M., & Papandonatos, G. D. (2021). Effectiveness of a vaping cessation text message program among young adults: A randomized clinical trial. JAMA Internal Medicine, 181(7), 923-930. https://doi.org/10.1001/jamainternmed.2021.1793

U.S. Department of Health and Human Services. (2016). E-cigarette use among youth and young adults: A report of the Surgeon General. Centers for Disease Control and Prevention, Office on Smoking and Health.