Many international school administrators have had to deal with students using e-cigarettes or students smoking on the school grounds. The FCD, Freedom from Chemical Dependency organization, has gathered data from over 20,000 students on five continents, many of them from international schools, and they have found that rates of use of vaping/e-cigarettes among students vary from 24%-40%. This data indicates that e-cigarette use is prevalent among teens attending international schools [1].
Often students who are caught using e-cigarettes on school campuses are given off or on-campus suspensions [2]. However, the current research on nicotine addiction and its adverse effects should cause school administrators to rethink this approach. In order for administrators to develop the best policies and curriculum to deal with e-cigarettes, they should understand the current research examining the relationship between nicotine addiction and the adolescent brain.
Nicotine and the Teenage Brain
It has been found that nicotine addiction in adolescent brains has caused permanent physical changes to the prefrontal cortex, as well as Ventral Tegmental Area, VTA, which is part of the brain rewards system [3]. Vulnerability to this exposure to nicotine continues until the human brain is fully developed by the age of 25.
The adolescent brain is shown to be extremely vulnerable to nicotine with exposure to one or two uses of nicotine, causing genetic changes to take place. Research has shown that nicotine addiction in adolescents can begin within one week of daily use [3]. Using e-cigarettes is particularly dangerous as youth are attracted to the many unique flavors offered by e-cigarettes [4]. The use of e-cigarettes with flavors has been shown to increase the number of puffs and the duration of e-cigarette use, increasing the amount of nicotine they are exposed to and making it easier for e-cigarette users to become nicotine dependent [3]. Nicotine addiction happens much easier in the adolescent brain than the adult brain [4].
Nicotine has been shown to be a gateway drug that changes and rewires the teenage brain making adolescents much more vulnerable to begin using and abusing other drugs such as marijuana, alcohol, cocaine, and other illicit drugs [4]. Research has shown that over 90% of adults who were suffering from alcohol and other forms of drug addiction had suffered from nicotine addiction during adolescence.
How Nicotine Changes the Adolescent Brain (Source: Yuan et al., 2015)
Acute Nicotine
Adolescent: Enhances locomotor activity
Adult: Decreases locomotor activity
Sensitivity
Adolescent: More sensitive to nicotine’s rewarding effects
Adult: More sensitive to nicotine’s aversive effects
Nicotine Withdrawal
Adolescent: Display blunted withdrawal symptoms
Adult: Display more severe withdrawal symptoms
High Dose of Nicotine
Adolescent: Well tolerated; lowers aversion to high doses later in life
Adult: Aversive
Nicotine Pretreatment
Adolescent: Enhances acquisition of cocaine, meth, and alcohol self-administration
Adult: No effect on psychostimulant or alcohol self-administration
In terms of social and emotional health, nicotine poses a bigger threat to students attending international schools. The time during which an adolescent attends high school should be a time where they reach their full intellectual and emotional capacity. Research has shown that teenagers suffering from nicotine addiction or who have recently used nicotine have lowered cognitive function, attention focusing, and working memory [4]. The earlier the onset of nicotine use, the greater the impairment of emotional and intellectual function [4].
In adolescents, nicotine addiction has large emotional consequences. Adolescents who suffer from nicotine addiction are known to suffer greater anxiety, depression, and more susceptibility to long-term anxiety disorders, as well as the development of mood disorders such as ADHD.
Implications for Policy and Curriculum Within International Schools
Understanding that nicotine is a very addictive drug that has serious physiological and mental health implications means the leadership at international schools should evaluate the effectiveness of their school policies and curriculum in two areas: supporting students who are current nicotine users and supporting students to prevent them from becoming nicotine users.
In dealing with students caught using nicotine on school grounds, suspension is not an effective way to deal with students. Instead, policies that aim to support students in understanding the adverse effects of nicotine, the marketing tactics of e-cigarette manufacturers, and information in dealing with addictive behaviors are necessary to help students move beyond their e-cigarette use. The IN-DEPTH program by the American Heart Lung Association has free facilitator training and has a program that can be modified to meet the needs of international schools. Also, the Stanford: Tobacco Prevention Toolkit [6] provides lessons on nicotine addiction support alternatives to school suspensions.
It is shown that curiosity is one of the main factors that start teens on the road to begin using e-cigarettes and nicotine. Therefore, it is very important to embed nicotine prevention education into the curriculum. Since the earlier the onset of nicotine addiction in the teenage brain, the greater the effects on teen physiology and emotional health [3]. This is why the leader in the development of nicotine addiction prevention, CATCH MY BREATH [7], starts in the sixth grade or MYP one in the MYP program. It has a great potential for helping educators fulfill components of the MYP program. It uses peer facilitation, can be delivered in Science, English, Health, PE, and Advisory times, which means it could form the basis of an interdisciplinary unit. Its peer facilitation and other components could help students fulfill their service and action requirements. What is equally important is that the success of long-term prevention programs is dependent on multiple year-to-year sessions and the CATCH MY BREATH program offers a well-thought-out scope and sequence curriculum that spirals up through grade levels.
This article is intended to motivate leadership teams in international schools to rethink their own school policies and nicotine prevention programs.
References
1. Palmer, A. (2019, January 7). Vaping: Empowering Your International Community Through Preventative Education. Vaping: Empowering Your International Community Through Preventative Education https://www.linkedin.com/pulse/vaping-empowering-your- International-community-through-andrew-palmer
2. Ybarra, M. E. (2021). Intervention or discipline: A phenomenological study of secondary school administrators’ responses to student E-cigarette use (Order No. 28490225). Available from ProQuest Dissertations & Theses Global. (2544887246). Retrieved From https://www.proquest.com/dissertations-theses/Intervention-discipline Phenomenological-study/docview/2544887246/se-2?accountid=12043
3. Yuan M, Cross SJ, Loughlin SE, Leslie FM. Nicotine and the adolescent brain. J Physiol. 2015 Aug 15;593(16):3397-412. doi: 10.1113/JP270492. Epub 2015 Jun 23. PMID: 26018031; PMCID: PMC4560573
4. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. (2016). E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General. https://www.cdc.gov/tobacco/data_statistics/sgr/e-cigarettes/pdfs 2016_sgr_entire_report_508.pd
5. Kandel D. Stages in adolescent involvement in drug use. Science. 1975 Nov 28;190(4217):912-4. doi: 10.1126/science.1188374. PMID: 1188374.
6. American Lung Association. (2020, July 13). Helping Teens Quit. https://www.lung.org/quit-smoking/helping-teens-quit
7. Stanford Medicine: Tobacco Prevention Toolkit. (2020). The Tobacco Prevention Toolkit https://med.stanford.edu/tobaccopreventiontoolkit.html 8 Catch.org. (2020, October 13). Electronic Cigarette Dangers & Information - Vape Prevention Program. https://catchinfo.org/modulese-cigarettes/
---------------------------------------------------------------------------------Stephen Rhodes is currently a university counselor and head of science at Changchun American International School.
