IS VAPING MAKING YOUR KIDS STUPID?! Maybe, who knows! Everette Keller David Braak

Background: Exposure Current E-cigarette use has been increasing meteorically among adolescents in the past decade. From 1.3% in 2011 to 13.4% in 2014.1 Public Health England found e-cigarettes to have 95% reduced risk compared to smoking, but still not healthy2,3 Adolescence is a developmental period with unique vulnerability to many different substances, including nicotine.4

Background: Outcome Poor Academic Performance5 School-reported GPA from Wando High School Off-Cohort status for students repeating grades School-reported dropping out Effects of Dropping Out5 The employment rate for a HS dropout is 23% lower than a HS graduate HS dropouts were 4.5% more likely to be institutionalized than students still in HS and 5.3% more likely than HS graduates. Compared to a HS graduate, HS dropouts were 14.6% more likely to be a member of a poor or near poor family than a HS graduate. The lifetime net fiscal contribution of a HS dropout was -$5,191 which is $282,000 less than the net fiscal contribution of one with a HS diploma.

Study Question: Hypothesis Students who have used, or been exposed to e-cigarettes will have poorer academic outcomes than those students who have not. Outcome measured: School-reported GPA from Wando High School Off-Cohort status for students repeating grades School-reported dropping out Exposure Measured: National Youth Tobacco Survey to assess e-cigarette and other tobacco use Demographics Measured: Youth Smoking Survey: Parent’s Questionnaire will be used to gather demographic data about Youth and Family.

Study Design Cross-sectional study design, with surveys for parents and children. Based on Enrollment at the beginning of the year, surveys will be sent to families within Wando High School. Demographics: Parents Tobacco Self-Report: Students We will get consent to link survey data to academic data. At the end of the school year, we will collect academic data from Wando High School as our outcome measurement. Used of e-cigarettes (frequency in the last 30 days) will be compared to Academic performance (GPA), and grade repeat rate.

Study Population Current Target Population – High school students (grades 9-12) enrolled at Wando High School at the start of the school year. Recruitment Plan – Surveys sent to families of high school students within Wando High School as per enrollment at the beginning of the year. Statistics show that this population is generalizable to the high school population for South Carolina in gender However there is a difference in the percentage of race/ethnicities between Wando High School and the entire population in South Carolina thus we will wait to compare the results for these demographics.

Exposure Outcome The National Youth Tobacco Survey collects information on use of tobacco products within the last year including Frequency of use Overall length of time of use Generally studies have shown that past 30-day use frequency is the best measure of current product use, and we expect a dose response relative to academic performance. We will also assess use in the last 12 months, because this measurement often captures experimenters, who may have some of the same environmental exposures to current users. GPA is the primary measure of academic performance, however analysis will include those who are held back or school reported dropping out due to academic performance. GPA: 4.0 scale Repeat: Off-cohort status School reported dropping out Covariates Smoking SES Gender

Sample Size With a study population of at least 4000 students enrolled at Wando High School at the start of the 2017-18 school year, we can determine our sample size based on two scenarios. Our goal is to detect an Odds Ratio of 2.0; however if that is not possible based on the response rate, we can adjust our Odds Ratio to fit our response rate. For an Odds Ratio of 2.0, we would need a sample size of 2130. This would yield a response rate of about 50%. Assuming our response rate is 75%, then we would have a sample size of 3000 for an Odds Ratio of 1.8 With a response rate of 100%, we would have an Odds Ratio of 1.69.

Limitations Our study is seeking to ascertain the association between e-cigarette use and academic performance. In performing a cross-sectional study, we are missing information on other factors that caused poorer academic performance though e-cigarette use occurred. Our idea is that the association gathered from this study will lead to additional studies that can measure how e-cigarette use affects these factors which ultimately lead to poorer academic performance in those individuals.

References 1. Arrazola, R. A., Singh, T., Corey, C. G., Husten, C. G., Neff, L. J., Apelberg, B. J., … Caraballo, R. S. (2015). Tobacco use among middle and high school students - United States, 2011-2014. MMWR. Morbidity and Mortality Weekly Report, 64(14), 381–385. 2. McNeill, A., Brose, L. S., Calder, R., Bauld, L., & Robson, D. (n.d.). Evidence review of e- cigarettes and heated tobacco products 2018 (p. 243). 3. National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, Board on Population Health and Public Health Practice, & Committee on the Review of the Health Effects of Electronic Nicotine Delivery Systems. (2018). Public Health Consequences of E-Cigarettes. (D. L. Eaton, L. Y. Kwan, & K. Stratton, Eds.). Washington (DC): National Academies Press (US). Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK507171/ 4. Spear, L. P. (2013). Adolescent Neurodevelopment. The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine, 52(2 0 2), S7-13. https://doi.org/10.1016/j.jadohealth.2012.05.006 5. Sum, A. (n.d.). The consequences of dropping out of high school : joblessness and jailing for high school dropouts and the high cost for taxpayers., 16.