PITTSBURGH, June 14, 2023 — When three prime-time TV medical dramas — “Grey’s Anatomy,” “New Amsterdam” and “Chicago Med” — coincidentally featured storylines about the dangers of youth vaping within a few weeks of each other, University of Pittsburgh social scientist Beth Hoffman, Ph.D., saw an opportunity to engage real-life adolescents in a discussion about electronic cigarettes.
It turns out that Pittsburgh middle schoolers are very willing to talk about vaping — or e-cigarette use, which is by far the most popular way young people use tobacco — after first viewing TV clips that depicted fictional adolescents with vaping-associated lung disease. The results, published today in the journal Health Promotion Practice, are the first to explore using entertainment television to engage U.S. youth in dialogue about the health effects of using e-cigarettes.
“Most kids who use e-cigarettes start experimenting with vaping in middle school, so this is the ideal time for an intervention aimed at encouraging adolescents to think critically about the dangers and bolstering their resistance,” said Hoffman, a postdoctoral associate in Pitt Public Health’s Department of Behavioral and Community Health Sciences. “The realistic TV storylines gave the students a jumping off point to share their opinions and ask questions.”
According to the 2022 U.S. National Youth Tobacco Survey, over 2.5 million high school and 380,000 middle school students reported using e-cigarettes within the past month. EVALI, or “e-cigarette or vaping use-associated lung injury,” is a persistent condition with symptoms that include shortness of breath and coughing that first garnered attention in July 2019, with more than 2,800 hospitalizations and 68 deaths reported by February 2020.
After Hoffman’s previous research found that vaping storylines in TV medical dramas provoked spirited dialogue on Twitter, with some people saying they planned to quit vaping as a direct result of viewing the shows, she decided to dig deeper. Hoffman partnered with a mentorship program called CHAMP, which connects Pittsburgh Public School District’s Arsenal Middle School students with Pitt Medical School students and faculty and hosts educational events and curricula at the school. Together, they ran four focus groups for a total of 78 Arsenal Middle School seventh and eighth graders.
Hoffman and her team shared clips from January 2020 when “Grey’s Anatomy,” “New Amsterdam” and “Chicago Med” each ran episodes featuring an adolescent hospitalized with EVALI. They then asked the students a series of open-ended questions about the storylines and vaping.
The students, who were mostly 13 to 14 years old and about half of whom were Black, didn’t have prior knowledge of EVALI, and few had previously watched any of the shows. While watching the clips, the majority displayed engaged body language, such as leaning in, shaking their heads and audibly gasping.
Overall, the students agreed the clips could be useful for raising awareness of the harms from e-cigarette use and that viewing the clips was more interesting than a lecture or presentation. Among the comments, an eighth grader said: “That was better than any DARE program,” and a seventh grader explained that “sometimes you have to see it to believe it.”
“Something surprising, which we wouldn’t have known without these focus groups, is that although all of the students knew the term ‘vaping,’ several said they did not know what e-cigarettes were,” said Hoffman. “So, an intervention built around talking to students about e-cigarettes likely wouldn’t be as effective or engaging as one using their terminology.”
Additionally, after viewing the “Grey’s Anatomy” clip where the characters brought up tobacco marketing, some students spontaneously asked questions about how the tobacco companies that market e-cigarettes seemed to be targeting younger people with advertisements for flavored products.
“These comments pointed to another great strategy called ‘media literacy’ that helps dissuade adolescents from using e-cigarettes by tapping into their inherent rebelliousness,” Hoffman said. “They don’t want to be fooled by advertisers.”
Hoffman said further studies will need to be done to see if what they learned from middle schoolers in a city school district extends to those in suburban and rural areas, or different grades. In the meantime, she is looking into ways to incorporate the TV clips and what they learned from the Pittsburgh students into an intervention that better equips adolescents to resist experimenting with e-cigarettes.
Additional authors on this research are Jaime E. Sidani, Ph.D., M.P.H., Elizabeth Miller, M.D., Ph.D., Kar-Hai Chu, Ph.D., and Jessica G. Burke, Ph.D., M.H.S., all of Pitt, and Jennifer A. Manganello, Ph.D., of the University of Albany.
