A Comparison of Virtual versus In-person Curriculum on Student Knowledge and Perceptions of E-cigarettes

Background: E-cigarettes are the most commonly used tobacco product by U.S. adolescents. Prior research shows that school-based e-cigarette prevention education was associated with reduced actual and intended use of e-cigarettes. During the COVID-19 pandemic, such e-cigarette education was delivered through virtual teaching in addition to in-person classes. The purpose of this study is to assess the effectiveness of e-cigarette prevention curriculum delivered virtually compared to in-person sessions in improving e-cigarette-related knowledge and reducing adolescents’ intent to try e-cigarettes.

Methods: A 30-minute educational presentation on e-cigarettes based on the Stanford Tobacco Prevention Toolkit was delivered to middle and high school students in Alabama from November 2020-May 2021. Study participants were divided into two groups based on the mode of receiving the presentation: 1) by an in-person educator (“in-person group”) and 2) by an off-site educator presenting through a recorded video or a video chatting platform (“virtual group”). The presentation covered e-cigarette contents, health effects, nicotine addiction and marketing. Using a quasi-experimental pre- and post-intervention group study we assessed students’ e-cigarette-related knowledge and perceptions on 15 questions, and intent to try e-cigarettes. Descriptive statistics were summarized for the total sample, in-person group and virtual group. Within-subject and within-group analyses were conducted for all perceptions and intent to try tobacco products using McNemar’s chi-squared exact tests of paired proportions. Between-group analyses were conducted using multi-level mixed-effects regression models to assess treatment effects by group and time on perceptions, addictiveness and intent to try e-cigarettes after adjusting for school-level clustering effects. Independent variables included grade (high school vs middle school) and race/ethnicity.

Results: Study participants were drawn from 10 schools and included 1031 total participants. 745 participants were in the virtual group (72.3%) and 286 participants were in the in-person group (27.74%). See participant characteristics in Table 1. Within-subject and within-group analyses showed positive significant changes after education in 8 out of 15 e-cigarette-related perceptions (for both groups), increase in perceived addictiveness among the virtual group and reduced intent to try e-cigarettes, particularly among the in-person group. Within-subject changes were more pronounced among high school participants. Time x group interaction effects show the in-person presentation was more effective compared to the virtual group at improving knowledge of e-cigarette nicotine content and delivery through aerosol and health effects (see Table 2). There was no significant difference in the treatment effect by study group on perceived addictiveness and intent to try e-cigarette products.

Conclusion: In our study, a one session in-person educational presentation was not more effective than virtual on student knowledge, perceived addictiveness and intended behavior. There were select aspects of knowledge that improved among students receiving in-person education.