By Dorothy Wigmore
The numbers are disturbing, and they’re getting worse. Millions of middle and high school students in the U.S. now are using e-cigarettes, just as efforts to reduce “traditional” smoking seemed to be paying off.
The 2019 National Youth Tobacco Survey found 27.5% of high school students—about 3.6 million—were using e-cigarettes, far outstripping any other kind of tobacco use. Among middle school students, it was 10.5%, up from 4.9% in 2018. The biggest increase in use occurred in 2017-18. About two-thirds of high school students using the devices prefer fruit, menthol and mint flavors.
It’s so bad that U.S. Surgeon General Jerome Adams declared youth vaping an epidemic in late 2018. Like others, he blamed the new format, for which a typical cartridge, also called a pod, has about as much nicotine as 20 regular cigarettes. They also can be used discreetly and come in flavors that appeal to youth.
The Trump administration took some action on certain vaping products containing fruit, mint and other e-cigarette flavors. Gov. Phil Murphy took further action on Jan. 21. As of April 20, the state will permanently ban the sale and distribution of all flavored vaping products, except tobacco, based on the Electric Smoking Device Task Force’s report. Supporters talked about the products being a “marketing ploy,” designed to attract and hook young people on nicotine, causing harm through the addiction.
One indication of the addiction is that vaping has become common inside schools—in classrooms, restrooms and halls.
“There’s little I can do if I’m focused on instruction,” says Sarah Reichenbecher, the Freehold Regional High School Education Association president. “Students can pull it out of their sleeve, take a hit, or go out in the hall and go to the bathroom and return. The fact it’s so discreet is problematic.”
E-cigarettes entered the U.S. in 2007. The JUUL version—introduced in 2015 with a funky USB-style design—became the top-selling brand by the end of 2017, especially among young people. JUUL has been investigated and sued for its alleged practice of targeting youth.
For almost 10 years, the devices—“electronic nicotine delivery systems” or ENDS—were unregulated because they do not contain tobacco. Companies could advertise and sell them without restrictions. Under pressure, the Food and Drug Administration (FDA) got authority in 2016 to treat them as tobacco products. The agency also cracked down on those selling to minors, issuing warning letters and fines, and instituting new rules for manufacturers. The vaping industry is fighting back, using the classic tobacco industry tactics of denial about hazards and fighting regulation.
ENDS are purported to be safer than traditional cigarettes because they don’t burn their ingredients and cause cancer. One result is the possibility of weaning those addicted to cigarettes off the killer product. Instead, they heat a liquid of nicotine and other chemicals to produce an aerosol (i.e., a vapor with fine particles in it) that users inhale. Liquids also can contain a wide variety of flavors (sometimes-toxic chemicals) or tetrahydrocannabinol (THC), marijuana’s “high” component, with Vitamin E acetate.
Propylene glycol and vegetable glycerin help produce the aerosol vapor, which can include a variety of nasty chemicals, depending on the voltage. Newer e-cigarettes, with adjustable voltages for a thicker vapor, may be worse.
In the last year, there have been reports of vaping-related deaths and serious hospitalizations across the U.S., and elsewhere. As of mid-January, the Centers for Disease Control (CDC) knew of 2,668 hospitalized cases, including 60 deaths—one in New Jersey. The state reported 107 known or suspected cases by the end of January; the numbers peaked in September 2019. Nationally, 15% of patients were under 18 and 37% between 18 to 24.
The CDC suspects Vitamin E acetate is the main culprit for e-cigarette or vaping-associated lung injury (EVALI). However, diacetyl flavorings linked to the devastating “popcorn lung” disease are also named in some EVALI cases. Some flavors may use nut-based allergy-causing chemicals. Other ingredients in the aerosol are hazardous. The few studies available link vaping to chronic lung diseases, asthma and increased wheezing.
Most e-cigarettes contain nicotine; its liquid form can catch fire. The highly-addictive substance increases heart rate and blood pressure, while effects on teens can:
• Harm brain development, until about age 25.
• Affect learning, memory and attention.
• Lead to mood disorders.
• Lower impulse control.
• Increase the odds of young people turning to “regular” cigarettes.
Increasingly, public health practitioners say that children, young people and pregnant women should not be exposed to, or use, ENDS, and those who are trying to quit smoking (i.e., deal with the addiction) should use other means.
The American Heart Association says the devices’ biggest threat to public health is that vaping “may ‘re-normalize’ smoking. Reversing the hard-won gains in the global effort to curb smoking would be catastrophic.”
Second-hand vapor, the exhaled aerosol, is a concern. Indoor air quality—often already a problem in schools—can be affected, depending on where vaping occurs, how many people vape in the same space, and air circulation. Vaping is a drug delivery system. The drug, nicotine, is highly addictive. When used in enclosed spaces those not already addicted are exposed to the drug and may ultimately be drawn into vaping or smoking.
“Teachers are still subject to whatever the secondary by-product is, in closely-contained classrooms, against our will,” Reichenbecher says. “Once that vapor’s in the air, it becomes something other students and teachers are breathing in involuntarily.”
There is little information about what ends up in the air, or in bystanders’ bodies. It’s reasonable to use the precautionary principle of better safe than sorry and focus on ways to prevent vaping.
Some New Jersey schools are clamping down by installing bathroom vaping sensors, assigning bathroom monitors, requiring students to get permission to use a bathroom, and enforcing punitive measures. But the expensive detectors aren’t always effective, some go off randomly, and it can be difficult to determine which students were vaping and who happened to be in the bathroom when the devices sounded.
Other administrations are trying to change behavior, adopting policies to steer students to counseling and treatment. Some use a youth tobacco cessation program. Students caught with an e-device are assigned to complete an online interactive program played something like a video game over eight hours.
“We have to educate, educate, educate,” says one teacher. “We have to make sure the youth understand it’s not just flavored water.”
Others warn that confiscating the product is not going to end the behavior for those who are addicted.
The New Jersey Department of Health has a special vaping website, VapeFactsNJ.com, that includes a microsite aimed at teens: incorruptible.us. Its theme is “Big tobacco will never own me.” The website points out that Marlboro cigarette maker Altria invested $12.8 billion in JUUL in 2018, saying “Vaping is tobacco’s newest hook.”