And with the final piece of the wheel in place, the finale of our Big 6 blog series is here! Welcome to the sixth instalment of our series about “The Big 6:” the six key health behaviours that play a critical role in the physical and mental health of youth, both now and in the long-term [1,2]. These six health behaviours are: healthy dietary intake, being physically active, healthy sleep, limiting sedentary recreational screen time, alcohol use, and tobacco/e-cigarette use.
In one of the largest school-based prevention clinical trials in Australia, the Health4Life program found significant associations between each of the Big 6 and depression, anxiety, and psychological distress symptoms in adolescents [1-3].
This blog post will cover the tobacco/e-cigarette use component of the Big Six and how it impacts youth wellbeing.
Tobacco/e-cigarette use and youth wellbeing
Although youth smoking has been declining for decades, recent years have seen a troubling shift, with teen tobacco smoking now increasing for the first time in 25 years [4]. This shift coincides with the recent rise of e-cigarette/vape use in youth, and has become a key concern for parents, educators, and public health experts alike.
Alarmingly, 12-year-olds who vape are 29 times more likely to try cigarettes [5]. Often incorrectly dismissed as ‘less harmful’ than tobacco cigarettes, e-cigarettes can still deliver high levels of nicotine, a highly addictive substance that interferes with brain development during adolescence. This can impair attention, learning, memory, and mood, and increase the risk of mental health issues such as anxiety and depression[6]. Early nicotine exposure can “wire” the brain to be more addicted to nicotine, as well as increase the likelihood of co-morbid substance use and other addictions, memory impairments and other mental disorders [6]. This means that adolescents are at a higher risk of nicotine dependence.
Despite not having long term health data relating to vape usage yet, we know that whether an e-cigarette contains nicotine or not, there are still risks involved. This is due to the fact that e-liquids (the substance inhaled when vaping) and their aerosol contain flavourings and hundreds of chemicals, many of which are known causes of cancer and lung damage. These include heavy metals, volatile organic compounds (VOCs), and other dangerous chemicals that are found in products such as paint stripper, petrol, weed killer, and rat poison [7,8].
Click here to view a page of the Student Summary PDF from Module 3 of the Health4Life program that highlights the physical and mental health effects of smoking cigarettes or vaping.
The Big 6: Tobacco/e-cigarette use
The 2023 study conducted using the Health4Life data investigated associations between the Big 6 health behaviours and mental health among adolescents in Australia [1,3].
For smoking, the study found that:
- Young people who had not smoked a cigarette in the previous six months had 29% lower anxiety, 49% lower depression, and 39% lower psychological distress than those who had smoked.
Separately, for vaping, the 2022-2023 Australian secondary schools survey found:
- 30% of secondary students had tried vaping at least once
- 13% of 12-15-year-olds had vaped in the last month
- 22% of 16-17-year-olds had vaped in the last month
Young people with higher depressive symptoms and stress have also been found to be more likely to vape. Read more on this here.
How does the Health4Life program target tobacco and e-cigarette use?
The Health4Life program adopts a strength-based, harm-minimisation approach and uses normative education to educate young people on the risks of tobacco smoking and vaping with the aim of preventing the onset of smoking or vaping early on. The program covers:
- The prevalence and patterns of tobacco and vape use among young Australians
- Short term consequences of smoking and vaping
- Social, financial, and legal consequences of smoking and vaping
- Ways to avoid peer pressure and how to ‘say no’
The normative education approach is an evidence-based approach that corrects students’ misconceptions on the use of tobacco smoking or vaping. Teens may have an exaggerated sense of how many of their peers partake in these behaviours, which can lead to them feeling like they’re the odd one out if they don’t. The truth is, most people don’t vape or smoke. Normalising non-use and reinforcing positive social norms highlights the healthy majority over focusing on the unhealthy minority.
In the Health4Life program, students work through six cartoon lessons that impart knowledge about improving diet and physical activity, healthy sleep patterns, reducing recreational screentime and reducing smoking and alcohol use. Short quizzes and ‘Stop & Think’ activities are embedded in each lesson to assess and consolidate learning. Optional activities, including interactive activities and additional PDF-based activities, are provided to reinforce the material taught in the cartoons and encourage students to apply the preventative messages and skills. Additionally, lesson summaries are provided for students, teachers and parents.
Some example slides below highlight the normative education approach, as well as a ‘Stop & Think’ activity to assess and consolidate learning.
And that’s a wrap on our Big 6 blog series! While this series has focused on each of the individual six health behaviours that shape youth physical and mental health, the aim is to improve the ‘Big 6’ behaviours in unison, particularly as they are interrelated with each other and youth wellbeing. The program’s Multiple Health Behaviour Change (MHBC) approach ensures that related health behaviours (The ‘Big 6’) are addressed together to efficiently promote behaviour change among students.
The Health4Life program is the first online health education program teaching year 7-8 secondary school students about these Big 6 health behaviours. The program is aligned with the Australian HPE curriculum and the NSW PDHPE syllabus and requires no teacher training and minimal preparation for all class and homework activities.
Read more about Health4Life here.
Want to learn more about resources specific to vaping and tobacco smoking? The OurFutures Vaping Prevention Program has recently been released. Recommended for students in years 7 and 8, it includes four cartoon-based and curriculum-mapped lessons. With funding support from the Australian Government, it is now available at no cost and you can register your school here.
Author: Francesca Wallis.
With expert review by researchers at the Matilda Centre for Research in Mental Health and Substance Use.
References:
[1] S. Smout, L. A. Gardner, N. Newton, and K. E. Champion, “Dose–response associations between modifiable lifestyle behaviours and anxiety, depression and psychological distress symptoms in early adolescence,” Australian and New Zealand Journal of Public Health, vol. 47, no. 1, p. 100010, Feb. 2023, doi: https://doi.org/10.1016/j.anzjph.2022.100010.[2] Teesson M, Champion KE, Newton NC, et al, “Study protocol of the Health4Life initiative: a cluster randomised controlled trial of an eHealth school-based program targeting multiple lifestyle risk behaviours among young Australians.” BMJ Open 2020;10:e035662. doi: 10.1136/bmjopen-2019-035662
[3] S. Smout and L. Gardner, “The big six modifiable factors for youth mental health,” InSight+, 2023. https://insightplus.mja.com.au/2023/17/the-big-six-modifiable-factors-for-youth-mental-health/
[4] Quit, “Rising E-Cigarette Use Data – Australian Teen Smoking Increased 1st…,” Quit.org.au, 2023. https://newsroom.quit.org.au/news/new-data-shows-australian-teen-smoking-increasing-for-the-first-time-in-25-years-against-a-backdrop-of-rising-e-cigarette-use
[5] S. Egger et al., “The association between vaping and subsequent initiation of cigarette smoking in young Australians from age 12 to 17 years: a retrospective cohort analysis using cross-sectional recall data from 5114 adolescents,” Australian and New Zealand Journal of Public Health, vol. 48, no. 5, pp. 100173–100173, Sep. 2024, doi: https://doi.org/10.1016/j.anzjph.2024.100173.
[6] F. Wallis, “How to Tackle Vaping in Schools: With Dr. Emily Stockings,” Our Futures Institute, Jul. 31, 2023. https://ourfuturesinstitute.org.au/how-to-tackle-vaping-in-schools-some-tips-from-matilda-centres-vaping-expert-dr-emily-stockings/
[7] L. A. Gardner et al., “Study protocol of the OurFutures Vaping Trial: a cluster randomised controlled trial of a school-based eHealth intervention to prevent e-cigarette use among adolescents,” BMC Public Health, vol. 23, no. 1, Apr. 2023, doi: https://doi.org/10.1186/s12889-023-15609-8.
[8] E. Banks et al., “Electronic cigarettes and health outcomes: systematic review of global evidence,” Australian Department of Health, Apr. 2022. Available: https://www.nhmrc.gov.au/sites/default/files/documents/attachments/ecigarettes/Electronic_cigarettes_and_health_outcomes_%20systematic_review_of_evidence.pdf
