The Q&A: Alexandra Loukas

With each issue, Trib+Edu brings you an interview with experts on issues related to public education. Here is this week's subject:

Alexandra Loukas is a professor at the University of Texas at Austin’s College of Education. She does research on e-cigarette’s rise in popularity among college-aged students.

Editor's note: This interview has been edited for length and clarity.

Trib+Edu: Could you tell me a bit about your recent research projects regarding e-cigarette use among college-aged kids?

Alexandra Loukas: We’re doing a survey of Texas college students, and so we’re surveying kids in the four largest metropolitan areas — Austin, Dallas, San Antonio and Houston. We targeted 24 colleges, half of them are two-year colleges and half of them are four-year colleges.

What we’re trying to do is look at college student’s exposure to alternative tobacco products and to the marketing of these products. The question we’re asking is: How much exposure to marketing are they reporting at convenience stores around their schools or that they see on billboards or in magazines?

Trib+Edu: What has been your most interesting finding recently?

Loukas: One of the interesting findings is that a vast majority of tobacco users today are using more than one product. They’re not just pure cigarette users, they’re using maybe cigarettes and hookah, or e-cigarettes and hookah. The user of one product that you used to see 10 to 15 years ago really isn’t the typical college-aged user of products anymore.

The other thing I think is really interesting about alternative tobacco products — like e-cigarettes and hookah — is that they’re flavored. They have multiple different flavors that they come in, and I think e-cigarettes are available in over 7,000 different flavors.

However, because cigarettes are regulated, and have been regulated for quite a while, they’re only allowed to be sold in menthol. So what you’re seeing is that a large portion of our participants are also using these flavored products.   

E-cigarettes were brought on the market in the U.S. in the mid-to-late 2000s. We probably saw a peak in users in 2014, but it’s not yet clear because we’re kind of in the middle of this new and emerging phenomenon. There’s a portion of people who are just using them because they’re new and different, and we’re seeing an increase in use because of that.

Trib+Edu: What is theassociation between stress, depressive symptoms and tobacco use in vocational school students, if any?

Loukas: There are associations between stress, depression and tobacco use. What we found is that stress impacted kids’ level of depressive symptoms, and it was depressive symptoms that then, in turn, was associated with increased cigarette use among the vocational students. I think a lot of people do talk about the use of cigarettes for alleviated stress symptoms, so I think we will continue to see that.

Trib+Edu: How does your research on cigarette use among students differ from what you’ve found with the use of e-cigarettes and hookah?

Loukas: The research on cigarettes was different because we were just focused on the stress and depressive symptoms. But the biggest difference is the flavor piece. College students are reporting the use of flavored products — kind of an overwhelming majority are using these products in the flavor alternative, not in the non-flavor.

When we asked them if they would stop using the products if it wasn’t available in the flavor, a majority of people using them say that they would stop using them. So if any cigarette was only available in tobacco flavor or plain flavor, a lot of college students say they wouldn’t continue to use that e-cigarette.

Trib+Edu: Is there a role that academics play in educating students on the effects of e-cigarette use?

Loukas: Let’s take hookah for example. I think hookah is probably one of those products that we’re most concerned about at the college level. Even though we focus a lot of efforts on e-cigarettes, hookah has been used by college students and has a very high prevalence, or use, rate.

We find that college students have major misperceptions about the negative consequences of hookah use. A lot of college students believe that the tobacco, or whatever they’re smoking, in hookah is natural and that it doesn’t have the same contents as the products they’re smoking in cigarettes. But, in fact, the use of hookah can be just as damaging physically as is the use of cigarettes.

I think the role of the college would be to provide information to students about the negative consequences, potentially, of these products. First of all, all of these products contain nicotine and nicotine is addictive, whether it’s in hookah, a cigar or an e-cigarette.

For some of these products, in particular, something like a little cigar or cigarillo, they can have consequences in terms of the physical damage to the body that is just the same as is it for smoking cigarettes.