As students across the White River Valley prepare to head back to school, educators and health professionals are keeping a watchful eye for an increasingly common iteration of substance use on campus.
Vaping, which requires a handheld device that flamelessly converts liquid nicotine into an extremely fine mist or aerosol, has become one of the go-to methods for students looking to use nicotine on campus. The method, which was barely on the radar of most educators just a few years ago, has exploded in popularity in recent years, due to dizzying array of flavors and what appears to be a widely-held opinion that vaporized nicotine is a safe alternative when compared to smoked tobacco.
Nationally, the e-cigarette and vaping market has expanded exponentially, growing by 40% in the past year with Juul Labs—a leading e-cigarette manufacturer that was created in 2015—witnessing a 700% revenue increase in 2017, topping out at more than $224 million last year.
Issuing a public health advisory in March 2017 that urged Vermonters “to discourage tobacco use in any form, including e-cigarettes,” the Vermont Department of Health cited results from their semi-annual Vermont Youth Risk Behavior Survey as a reason for concern, noting that “a higher percentage of Vermont high school students reported current e-cigarette use than smoking cigarettes (15% versus 11%).”
The advisory also noted that, over the past six years, the number of U.S. high school students who had used an e-cigarette in the past 30 days had increased by more than 900%.
According to district-level data gathered by the 2015 and 2017 Youth Risk Behavior Surveys, the number of students, particularly high school boys, in the Orange Southwest Supervisory District who have used an e-cigarette has risen from seven to 12% in the past two years, a general trend acknowledged by Randolph Union High School Principal Elijah Hawkes.
“There’s definitely been an increase in the use of vape pens in our student body and there’s also been an increase in the consequences associated with them,” said Hawkes. “They were nonexistent when I started working here seven or eight years ago and now they’re a much more significant part of our work when it comes to substance use and abuse in schools.”
Naturally drawn to new and emerging technology, students seem to be embracing the popular e-cigarettes because they’re easier to hide than a traditional cigarette, Hawkes said.
“What’s special about the vape technology is the possibility for concealment,” explained Hawkes. “It smells less strong [and] there isn’t, as I understand it, fire involved. That means that it can be much more difficult to detect.”
Hawkes also explained that, despite the lack of traditional tobacco and the dubious marketing that frames e-cigarettes as an alternative to smoking, the vaporizers still fall under the school’s broader rules regarding substance usage on campus and are subject to Vermont’s Act 135, which bans smoking in schools and child care facilities.
“The use of vaping technology just falls under the tobacco policy,” he said, broadly addressing the rules. “Hey everybody! Vape pens count under this umbrella.”
For Dr. Chris Lukonis, who specializes in addiction medicine at Gifford Medical Center, the advent of the vaporized e-cigarette presents unique challenges to physicians working to curb tobacco and nicotine usage, particularly when so little is known about a relatively new products on the market.
“The solutions themselves that make up the vaping component have a lot of different chemicals in them which have been poorly studied, in terms of combusting them and inhaling them into your lungs,” said Lukonis, referring to data from the Surgeon General and the Centers for Disease Control and Prevention demonstrating that e-cigarette vapor can contain heavy metals and flavoring compounds such as diacetyl— which has been linked to lung disease in consumers.
“The other thing to think about is that the solutions that contain nicotine are quite addictive,” added Lukonis. “It looks like—particularly for those youth who are vaping high concentrations of nicotine—there appears to be a high incidence of them picking up actual smoking. That’s a concern.”
Acknowledging that e-cigarettes are, indeed, less harmful than traditional smoking, due to their lack of tar and other harmful substances, Lukonis recommended against using the devices as a way to quit smoking.
“If we’re looking at reducing harm, certainly vaping appears to be less physically harmful than smoking,” he said. “But on the other hand, we have other mechanisms to help people reduce harm like nicotine patches and gum, which are much safer than vaping. No doubt.”
Dr. Lukonis’ concerns over the health effects of such high concentrations of nicotine in e-cigarettes were echoed at the international level this week when Israel joined more than a dozen other nations to prohibit the sale and import of e-cigarettes, citing a “grave risk to public health.”
As far as the apparent student embrace of e-cigarettes and the liquid nicotine they dispense, Lukonis is quick to point to the immense variety of flavors—many of which appear to be oriented toward youth— that are currently on the market.
“I think, the last I looked, there were probably over 7,000 different flavors to choose from out there,” said Lukonis, citing a study in the journal Pediatrics. “You can find anything. It’s hard to imagine who they’re marketing to, if not youth, when they have flavors like bubblegum.”
This variety of flavors, when taken with packaging that appears to deliberately mimic popular consumer goods such as whipped cream and Warheads candy—a practice that prompted a flurry of warning letters from the Federal Trade Commission and the Food and Drug Administration in May—sets up a situation that, Lukonis believes, downplays the yet-unknown risks of e-cigarettes to youth.
“I think [students] need to understand that there’s certainly a risk— with vaping particularly—with products that contain nicotine,” he said. “They may be setting themselves up for an addiction that they never really signed up for.”
-- DYLAN KELLEY