Developing and Evaluating a School-Based Tobacco and E-Cigarette Prevention Program for Deaf and Hard-of-Hearing Youth

By Alison K. Herrmann

Tobacco use, a leading cause of preventable death in the U.S., most frequently begins in adolescence. E-cigarettes are now the most widely used tobacco products among adolescents and young adults, and the prevalence of vaping among young people threatens to roll back years of progress in tobacco prevention and control. School-based programming has a critical place in tobacco prevention efforts for youth. Given the shifting trends in product use, these programs increasingly focus on e-cigarettes/vaping.

However, where Deaf and Hard-of-Hearing (D/HH) youth are concerned data are lacking regarding use and this group’s knowledge regarding the full range of tobacco products. Moreover, existing school-based tobacco prevention programs are frequently culturally and linguistically inaccessible to DHH youth, many of whom use American Sign Language (ASL) to communicate and for whom English is their second or third language. ASL is a distinct language, with no written version and no direct translation to English. These gaps in research and programming are concerning given prior research that has shown DHH youth to be vulnerable to peer pressure and risk- taking, including with respect to use of tobacco products, particularly in mainstream school settings where DHH students are increasingly educated.

To better understand use patterns and knowledge, and to guide development of appropriate programming for this population, we are conducting a program of research that included a pilot study among DHH middle school (MS) and high school (HS) students attending Schools for the Deaf and mainstream schools in California (n=114). We administered surveys in ASL, before and after receipt of a draft curriculum delivered by health or physical education teachers, to assess product use and knowledge regarding health consequences and other aspects of tobacco use. Key informant interviews were conducted with teachers following program delivery to guide further program modifications.

Thirty-five percent of the DHH students who completed the baseline survey reported exposure to tobacco products at home, including cigarettes (19%) and e-cigarettes (15%). Knowledge regarding tobacco products among these students was limited; 35% of students knew e-cigarettes contain nicotine and 56% were aware vaping is prohibited on school grounds. Current product use was reported by 16% of students, most commonly e-cigarettes (12%) and cigarettes (10%); overall, 7% of students reported dual use. Use was greater among HS versus MS students. Changes in student knowledge following program delivery included increased understanding of harmful chemicals in tobacco products, including nicotine in e-cigarettes. Post-program debriefings with teachers yielded specific recommendations for modifying the draft curriculum to better meet the educational needs of DHH students, who present with widely varied educational capabilities even within the same grade level and classroom.

Guided by these results and the feedback received, we revised our draft curriculum, emphasizing the inclusion of visual imagery as well as video content featuring DHH youth using ASL to communicate key concepts. We included English voiceover and captioning on all of the videos to ensure accessibility for all students, both hearing and non-hearing. We view this to be particularly important given the trend toward mainstream education among DHH youth, and a promising practice based upon the few differences we observed in tobacco-related knowledge and experiences between students attending Schools for the Deaf and mainstream schools. A program that allows DHH youth to learn side-by-side with their hearing peers, utilizing the same materials and minimal external supports, holds the promise of enriching the education of all students, is reflective of a commitment to educational and health equity and can contribute to meeting the needs of this traditionally underserved population. We are now conducting a randomized controlled trial to evaluate the revised curriculum and look forward to disseminating the results and the programming on the national level, to better meet the tobacco prevention needs of DHH and all students.

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Article details
Developing and Evaluating a School-Based Tobacco and E-Cigarette Prevention Program for Deaf and Hard-of-Hearing Youth
Alison K. Herrmann, Burton Cowgill, Debra Guthmann, Jessica Richardson, L. Cindy Chang, Catherine M. Crespi, Everett Glenn, Michael McKee & Barbara Berman
First Published: February 9, 2023
DOI: 10.1177/15248399221151180
Health Promotion Practice

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Dr. Alison Herrmann is a health services researcher, with a background and training in psychology. Dr. Herrmann is Associate Director of the UCLA Kaiser Permanente Center for Health Equity and Research Scientist in the UCLA Fielding School of Public Health. She is also Co-Director of Disparities, Community Outreach and Engagement at the UCLA Jonsson Comprehensive Cancer Center. In these roles, she is responsible for identifying and facilitating opportunities to engage faculty and community stakeholders, designing and delivering training and capacity building activities to increase community partners’ ability to use evidence-based approaches, and providing technical assistance, oversight and quality control monitoring for community-based research projects conducted in a variety of settings including clinics, churches and worksites.

Dr. Herrmann’s primary interest is in the design, implementation and evaluation of sustainable, systems-based interventions to improve health behaviors and mitigate chronic disease disparities among diverse population groups. She is committed to collaborating with community members and organizations across societal sectors in this work and has extensive experience in the development of culturally appropriate research materials. Dr. Herrmann currently serves as an investigator on multiple ongoing community-partnered research projects aimed to address some of the most pressing public health challenges facing the nation today: childhood obesity, low uptake of HPV vaccination and colorectal cancer screening, and e-cigarette use among youth. Population groups included in this work include low-income children and families, safety net clinic patients, youth who are Deaf or Hard-of-Hearing and Indigenous Mexican agricultural workers.