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these is EBP about Adolescent Nicotine and E-cigarette Use: Why it Matters and How Education and Mentoring Can Help can you add time frame for the introduction part and finish the evidence table at the bottom? Since the early 2000s, the use of electronic cigarettes has steadily grown in popularity, especially among adolescents. Though originally designed for and intended to help smokers quit their deadly addiction, somewhere along the way, these small, handheld devices became a gateway drug of sorts for the next generation of smokers. Fadus et al. (2019) found that the chances of an adolescent picking up a more traditional smoking habit increase threefold when they use e-cigarettes. Using nicotine before the brain has fully developed significantly increases the likelihood of lifelong use, addiction, health problems, and even death resulting from smoking-related causes (Shaikh et al., 2015). With this being the case, research, education, and early prevention of e-cigarette use among the youth will be vital. Nurses can help facilitate change through education and mentoring at-risk adolescents and communities. Background & Significance In 2020, nearly 1 in 20 middle schoolers and 1 out of 5 high schoolers in America reported using e-cigarettes within the last month. (CDC, 2020) Since 2014 electronic cigarettes have been the leading tobacco product used among adolescents (CDC, 2020). Tobacco use significantly increases health risks, serves as a significant cause for morbidity and mortality in America, and is a leading cause of preventable diseases and death in America. According to the Center for Disease Control (CDC, 2020), if current smoking rates continue among American youth, well over 5 million of them will die early from a smoking-related illness. The idea that e-cigarettes are less dangerous and “more socially acceptable than combustible cigarettes” has contributed to the increased use of tobacco products among youth (Fadus et al., 2019) The truth is e-cigarette use, especially among adolescents, has been shown to have numerous side effects, including damage to the heart, lungs, and brain. Nicotine toxicity, seizures, altered brain development (Bonner et al., 2021), oxidative stress, cardiovascular inflammation, arterial stiffness, altered hemodynamics, decreased platelet activity (Buchanan et al., 2019), a reduction in pulmonary immune function, and other respiratory issues (Fadus, 2019), among other issues, can all result from the use of e-cigarettes. Research has shown some benefits in preventing or minimizing substance use and abuse among adolescents through mentoring, but no studies have targeted the impact of mentoring adolescents on e-cigarettes specifically. Evidence, however, shows that social factors can heavily influence youth substance use (Hopkins, 2020) and that those with little to no support or involvement from parents or other adults are at an increased risk for youth tobacco use (CDC, 2020). One of the strongest predictors for adolescent substance use is peer substance use. Other social factors that heavily influence this outcome include ease of access, family history of abuse or neglect, low socioeconomic status, homelessness, and entering foster care (Hopkins, 2020). Factors that improve outcomes for adolescents to avoid substance use and abuse include positive and constructive relationships with parents and family members and establishing clear limits and consequences for the adolescent (Hopkins, 2020). While educating at-risk youth about the risks of tobacco use through advertising, social media, and school are helpful and important, studies have found that education paired with mentoring of some sort works better and that natural mentors work best (Hopkins, 2020). A natural mentor is a relationship that forms organically through school, church, or other extracurricular activities. John Hopkins (2020) found that natural mentoring led to more frequent and significant positive outcomes than its programmatic mentoring counterpart. Stating that “building on youth’s existing social resources and the presence of adult role models” could be a worthwhile endeavor in preventing adolescent substance use. (Hopkins, 2020) They also noted that adolescent brains are still developing. During this time, as adolescents start sorting out who they want to be and begin growing in independence, their “brains are neurologically wired to seek new experiences and take risks.” Because of this, they are at risk for engaging in potentially dangerous activities and developing unhealthy habits that may have long-term effects. (Hopkins, 2020) Mentors found it challenging to obtain parental consent to recruit adolescents, commute to the mentoring sites, handle scheduling conflicts, and maintain compliance with mentoring. (Hopkins, 2020) Internal and External Evidence A search for evidence-based literature began with Cochran library and expanded to MEDLINE, Pubmed, Web of Science, EBSCO, and CINAHL. The search for evidence-based articles relied on using appropriate words to identify sources in journal libraries. Keywords used in the search included ‘smoking,’ ‘electronic-cigarette,’ ‘mentor,’ ‘e-cigarettes,’ ‘nicotine,’ ‘youth,’ and ‘adolescent.’ Government online sources and publications, as well as peer-reviewed nursing journals, were targeted as the key database sources for the current research. These sources provide credible information since studies are conducted by qualified individuals in the field and reviewed by experts in nursing. Each article cited was appraised thorough assessment of the issue, clinical questions in the topic, and method of research used in each study. The relevance of the clinical question to the topic helped determine the usefulness of an article in research. Each publisher, author, journal, and source had to be examined to determine credibility and ensure that the writers were qualified in the clinical field. The problem, intervention, comparison, and outcome (PICOT) were used to measure the usefulness of the sources to the current research. In addition to using credible sources, the article should effectively respond to the research question, and the PICOT evidence-based table was used in the appraisal of the sources. Evidence Table PICOT Question: For the young adult smoking population, how does counseling compared to medications and nicotine alternatives, influence the likelihood of patients quitting smoking during the rehabilitation period? Citation: author(s), date of publication title Purpose of Study Level of Evidence Sample/Setting Interventions/variables studied Study Findings/Outcomes Buchanan, N. D., Grimmer, J. A., Tanwar, V., Schwieterman, N., Mohler, P. J., & Wold, L. E. (2019, November 7). Cardiovascular risk of electronic cigarettes: A review of Preclinical and Clinical Studies. OUP Academic. Citation: author(s), date of publication title Purpose of Study Level of Evidence Sample/Setting Interventions/variables studied Study Findings/Outcomes Centers for Disease Control and Prevention. (2020, December 16). Youth and tobacco use. Centers for Disease Control and Prevention. To determine the use of tobacco products among the youth in the United States Level I The study setting was among the young people aged below 17 years in the United States Tobacco products and the frequency of use among the American youth Policy changes at the local, state, and national levels could reduce the use of tobacco products. There is a need to target social and environmental factors affecting tobacco use. Citation: author(s), date of publication title Purpose of Study Level of Evidence Sample/Setting Interventions/variables studied Study Findings/Outcomes Fadus, M. C., Smith, T. T., & Squeglia, L. M. (2019, May 23). The rise of e-cigarettes, pod mod devices, and juul among youth: Factors influencing use, health implications, and downstream effects. Drug and Alcohol Dependence Citation: author(s), date of publication title Purpose of Study Level of Evidence Sample/Setting Interventions/variables studied Study Findings/Outcomes Johns Hopkins University. (2020, January). Mentoring for preventing and reducing substance use and associated risks among youth. Citation: author(s), date of publication & title Purpose of Study Level of Evidence Sample/Setting Interventions/variables studied Study Findings/Outcomes Shaikh, W., Nugawela, M. D., & Szatkowski, L. (2015). What are the main sources of smoking cessation support used by adolescent smokers in England? A cross-sectional study. The study aimed at deidentifying the support for smokers in England Level II Cross-sectional study of 617 current and ex-smokers Data collected on the participants showing their current and past smoking experience Smokers are likely to seek informal rather than formal interventions on smoking. Evidence Table Fully completed evidence table with all sections correctly done Synthesizes and compares/contrasts at least 4 relevant and recent journal articles; discusses findings, similarities, differences, and makes recommendations based on the evidence. Provides a full picture of the current state of the chosen topic. Clinical Question & Problem PICOT: For Adolescents ages 10-19, how does mentoring compared with education, influence the likelihood of at-risk youth avoiding nicotine and e-cigarette use within a year? Implementation Plan Make a plan to implement a practice change related to the available evidence. Describe how you will use (1) the evidence from the literature, (2) experiential evidence/clinical expertise, and (3) patient/family concerns to implement your practice change. Discuss your goals/objectives, how you will gain support and a step-by-step process of implementation. A timeline is required to be included in this assignment. See chapter 9 in your EBP text for tips about developing a plan; especially look at the samples on pages 282-283. Also, see chapter 14 for possible models of integration. Discuss your model if you choose to use one. See rubric below. Table A: Projected Timeline Although schools have done their part by initiating steps to bring drug and smoking awareness via the red ribbon week we suggest taking it further and implementing a program that would not only dedicate one week out of the year but would dedicate one day each week and talk about the dangers of substance use. This would be started in elementary school years (4-5th grade) and once the students entered middle school usually considered 6th grade our plan would transform into a 2 year program dedicated to further educating at-risk students the dangers and problems. This would include having past smokers come in as guest speakers and show the potential risk that smoking has. During this time we would implement a student-mentor partnership that would act as counseling sessions that the student may go to if they feel like they want to try smoking due to peer pressure or other factors the students face at home. This 2 year program Evaluation & Outcome Dissemination Plan Conclusion References A;, E. I. L. L. H. (2020, December 16). When do adolescents become smokers? annual seven-year population-based follow-up of tobacco habits among 2000 Swedish pupils–an open cohort study. Scandinavian journal of primary health care. Retrieved February 7, 2022, from https://pubmed.ncbi.nlm.nih.gov/19052959/ Buchanan, N. D., Grimmer, J. A., Tanwar, V., Schwieterman, N., Mohler, P. J., & Wold, L. E. (2019, November 7). Cardiovascular risk of electronic cigarettes: A review of Preclinical and Clinical Studies. OUP Academic. Retrieved February 4, 2022, from https://academic.oup.com/cardiovascres/article/116/1/40/5613736 Centers for Disease Control and Prevention. (2020, December 16). Youth and tobacco use. Center for Disease Control and Prevention. Retrieved January 23, 2022 from https://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/index.htm#references Fadus, M. C., Smith, T. T., & Squeglia, L. M. (2019, May 23). The rise of e-cigarettes, pod mod devices, and juul among youth: Factors influencing use, health implications, and downstream effects. Drug and Alcohol Dependence. Retrieved February 4, 2022, from https://www.sciencedirect.com/science/article/pii/S0376871619301553?casa_token=KC-qVaKoMVoAAAAA%3AiHuGC368XOCQLEyunnUkuPBNHEKV932g-Pwy1RfCEOpDFo-zTvIug1vm0wakYN35CD9Bf_EnSMQ Johns Hopkins University. (2020, January). Mentoring for preventing and reducing substance use and associated risks among youth. Retrieved February 2, 2022, from https://nationalmentoringresourcecenter.org/wp-content/uploads/2020/05/Mentoring_for_Preventing_and_Reducing_Substance_Use_and_Associated_Risks_Among_Youth_Outcome_Review.pdf Shaikh, W., Nugawela, M. D., & Szatkowski, L. (2015). What are the main sources of smoking cessation support used by adolescent smokers in England? A cross-sectional study. BMC Public Health, 15(1), 1-7. https://doi-org.ezproxy.uttyler.edu/10.1186/s12889-015-1925-9

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