Public health starts at the earliest stages of life and tries to put policy and practice into place to prevent unhealthy behaviors and exposures from starting in the first place.
One of the key public places where both good and bad health behaviors can begin is in school. That’s why public health researchers concentrate on local school districts to conduct research, then implement change.
Researchers can even partner with educators and older students to understand how lessons can be most effectively implemented so that the change can take root successfully.
According to the National Institutes of Health’s 2024 Monitoring the Future (MTF) survey, 9.6% of eighth graders and 21.0% of 12th graders reported vaping nicotine in the past year. That’s about 1 million young people exposed to nicotine in those two groups alone.
The MTF survey also reported some good news: the percentages of young vapers in these two grades were down slightly from 2023, at which time they were 11.4% and 23.2%, respectively.
It’s a public health priority to drive the numbers even lower, said Dr. Lori Crane, PhD, MPH, professor in the Department of Community and Behavioral Health at the Colorado School of Public Health.
Crane is a co-principal investigator for a pilot study of the YES-CAN! (Youth Engaged Strategies for Changing Adolescent Norms) project at ColoradoSPH. The National Institute on Drug Abuse-funded investigation aims to discourage vaping among young people by engaging with them to build partnerships for a healthier future.
“Young people are on the cusp of trying new things,” Crane said. “Nicotine vaping is super-addictive. We are trying to catch them before they experiment. This is an opportunity to prevent what could become a lifelong threat for them.”
The YES-CAN! strategy involves a partnership between adults and young people. Participating youths promote healthy behaviors through storytelling about their own experiences, said co-principal investigator Dr. Nancy Asdigian, PhD, research assistant professor in the Department of Community and Behavioral Health.
“It’s an approach that centers on youth voices,” Asdigian said. “It’s youths themselves who are in the situations in which vaping and other harmful behaviors come up. They know the language around vaping and what it’s like to be offered a vape or pressured to vape.”
A long-term commitment to youth-created narratives
Work on the YES-CAN! approach to behavior change launched in 2009 in Denver Public Schools with a focus on skin cancer prevention. YES-CAN! skin cancer prevention programs were subsequently implemented in the Cherry Creek and Aurora Public School districts, with high school students educating middle schoolers about the risks of overexposure to the sun.
The older students learned the science behind skin cancer in the classroom, then passed it on to the younger students with videos they produced themselves. The pilot study, published in 2023, showed that after participating in the program, the younger students recognized the risks of sun exposure and intended to protect themselves from it.
The current pilot program, focused on preventing vaping, also relies on using science education to help young people deliver knowledge and positive messages to their peers. Asdigian said she, Crane, and secondary school educators developed a package of 25 lessons for middle and high school teachers in the Denver-Aurora metro area.
The curriculum is mapped to standards schools must meet for teaching science, language arts, and other classes, Asdigian added.
Measuring the power of storytelling
Crane said she and Asdigian are still collecting and analyzing data from schools that are participating in the YES-CAN! project. But she added that focus groups with students conducted after the program suggest that the videos made an impression.
“I was really surprised,” Crane said. “They remembered details. They saw these videos only once, but they could recount the stories a couple of months later.”
The bigger question is whether the videos and the entire YES-CAN! program had an impact on students’ attitudes toward vaping and steered them toward making healthy choices. Crane said the team plans to address that with a survey in the coming weeks.
“What are their vaping attitudes, knowledge, and behaviors roughly six months after seeing the videos?” Crane said.
"If we weren’t flexible and malleable enough to meet community needs, this ordinance would have failed," Brodell said. "We want to help communities create accountable and sustainable systems through policy change."
Possible longer-term plans for YES-CAN!
She added that should the pilot study produce positive findings, the long-range plan is to do a larger study related to vaping that involves about a dozen Denver metro-area schools.
Asdigian noted that the core curriculum of YES-CAN! and its commitment to youth-created storytelling could be applied to many health issues, from marijuana use to mental health, a concern raised by parents in one school involved in the pilot study.
“I would love in the future to be able to be responsive to what schools identify as problems,” Asdigian said. “We can revise the first set of lessons in our curriculum to reflect a new content area and we’re good to go.”
Teachers and parents provide a strong foundation for the YES-CAN program, but its greatest strength lies in the students who participate, Asdigian and Crane agreed. “It’s an approach that centers on the youth voice,” Asdigian said. “It engages youth in a very unique way to address health risks across a variety of domains.”
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