While tobacco use has declined among adolescents since the 1990s, the advent of candy and fruit-flavored e-cigarettes or vapes is ushering in a new era of high-risk habits that are appealing directly to middle and high school-aged youth.

The University of Notre Dame’s Lucy Family Institute for Data & Society and the St. Joseph County Department of Health partnered to evaluate and design technology-based interventions that call attention to the risks of e-cigarette use in young adults. Their goal for the study was to identify opportunities for improving health outcomes for St. Joseph County residents who may be at an increased risk of health complications due to social and economic factors including loss of livelihood, injuries or income instability.

With guidance from the Department of Health, Lucy Family Institute researchers leveraged geospatial analysis to create a data dashboard, which shows an overlay of cancer incidence and mortality data by zip codes within St. Joseph County. This technique enabled researchers to identify social determinants of health (SDOH) that might indicate social and economic vulnerabilities. This was then used to identify populations likely to have poor health outcomes.

“When we evaluated the results, lung cancer data generated distinctive differences across the different zip codes of the county,” said Matthew Sisk, associate professor of the practice at the Lucy Family Institute for Data & Society. Sisk, who also leads the Civic-Geospatial Analysis and Learning Lab, added, “Within South Bend, higher cases of lung cancer are reported in younger, more ethnically and racially diverse areas, while in other areas of the county, higher incidence trends toward older populations.”

These findings prompted further inquiries from the Department of Health and the Lucy Family Institute, who sought greater insight into the accessibility of tobacco products for youth in the county. “We also mapped the locations of schools, gas stations and tobacco shops within St. Joseph County,” said Sisk. The data indicates a pressing need for increased awareness of the risks of smoking for middle and high school students — many of whom attend school within a few miles of tobacco shops and gas stations where e-cigarettes are heavily advertised.

Researchers in the field also aim to understand how to leverage technology to stem teen e-cigarette use. In 2024, over 1.5 million students in middle and high schools within the United States reported using e-cigarettes, making it the most commonly used tobacco product among young adults ages 14 to 18. In Indiana, 6.3 percent of middle and high school students reported using e-cigarettes — roughly 1 percent higher than the national average.

To understand and reverse this rise in e-cigarette use, the researchers reviewed over 90 studies examining existing technology-based prevention and cessation interventions and strategies. Interviews with teenagers and public health stakeholders, designed by Karla Badillo-Urquiola, the Clare Boothe Luce Assistant Professor of Computer Science and Engineering, provided important insights into the effectiveness of various intervention strategies.

“We are committed to advancing the well-being of individuals in our local community. A critical component of these efforts is investing in the health of the next generation,” said Nitesh Chawla, the project’s principal investigator and founding director of the Lucy Family Institute for Data & Society at Notre Dame. “Through our collaboration with partners on campus and in South Bend, the Lucy Family Institute is generating key insights that can guide policy improvements for a healthier St. Joseph County,” he added.

The findings from the study inform future intervention strategies for implementation by the St. Joseph County Department of Health and other stakeholders in the community. The recommendations suggest an emphasis on the critical impact that middle and high school students could have in designing interventions that align with their preferences and digital habits. Additionally, program feedback loops were suggested that would welcome providers and public health workers to share the challenges and successes of intervention programs that can work to improve future models.

“The Health Department is dedicated to the well-being of our community. Using data and evidence-based interventions, we ensure our programs are impactful and effective. Public health is our priority, and we collaborate with educational institutions, community partners, local officials and the general public to create a healthier future for everyone,” said St. Joseph County Health Officer Diana Purushotham.

The recommendations were presented to the St. Joseph County Department of Health in December 2024. A poster presentation and a publication will follow.

Other collaborators involved in the project’s recommendations include Mary Mumbi Wachira, Johanna Olesk, Maria Milkowski and Matthew Stoner. The Health Department team included Dr. Diana Purushotham, Renata Williams, Alissa Balke and Brandon Gary.

For more information about projects within the Lucy Family Institute for Data & Society’s Health Equity Data Lab, please visit the website.

To learn more about the St. Joseph County Department of Health’s ongoing efforts to improve the lives and well-being of our community members, visit their website.

Contact: Brandi Wampler, associate director of media relations, 574-631-2632, brandiwampler@nd.edu