Vaping among teens still a problem

Despite a state ban on flavored nicotine products, vaping continues to be popular among teens, and flavored e-cigarettes remain the favorite choice, according to a recent federal survey.

The online survey asked students in grades 6-12 about their use of vaping devices. It was performed from Jan. 18 to May 21 of this year, when many students were doing their schoolwork remotely. Results were released Sept. 30, 2021 by the U.S. Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA).

The CDC estimates, based on voluntary responses to the survey, that:

• More than 2 million teens vape.
• Approximately 27.6 percent of high school students who vape, do so daily. About 43.6 percent of high school students and 17.2 percent of middle school students who said they vaped said they did so at least 20 of the past 30 days.
• Almost 85 percent choose flavors other than tobacco (fruit, candy, other sweets, mint and menthol).
• Disposable e-cigarettes were the most popular (53.7 percent), followed by devices using prefilled or refillable pods or cartridges (28.7 percent).

According to the Massachusetts Department of Public Health, in 2019, 32 percent of high school students said they had vaped in the past 30 days and 51.2 percent of high school students said they had tried vaping, much more so than other forms of tobacco.

Prior to the popularity of vaping, tobacco smoking rates were declining.

“We were winning the battle,” lamented Hyannis thoracic surgeon Jeffrey J. Spillane, MD, FACS. “These kids would not pick up cigarettes,” he continued, they “see them as dirty and disgusting.”

Most of his work revolves around care of lung cancer patients and, for several years, he has given presentations on the dangers of smoking and vaping. He believes increased awareness and the pandemic may have caused a slight dip in teen vaping, but the problem remains pervasive.

Manufacturers first rolled out e-cigarettes as an alternative for adult smokers, but soon targeted teens and young people with sweet flavors, Dr. Spillane said. This was similar to the way Big Tobacco targeted women in the 1970s with Virginia Slims cigarettes and African-Americans with menthol cigarettes, he said. These large corporations have the financial clout to influence national lawmakers to protect their interests over public health, he said.

E-cigarette vapor may not include the tar and combustion products of traditional tobacco cigarettes, but it can contain cancer-causing chemicals, fine particles, heavy metals and volatile organic compounds, according to the state DPH. The pods also contain propylene glycol, diacetyls, and a lot of highly addictive nicotine, Dr. Spillane said.

“A pod of Juul (a popular device brand) is the nicotine equivalent of a pack of cigarettes.”

E-cigarette use irritates the respiratory system, he said, introduces highly reactive molecules called free radicals, and has been blamed for causing “vape lung” or EVALI, a severe respiratory illness linked to vaping products containing THC (the chemical in marijuana that gets you high) and vitamin E acetate.

Nicotine can harm the developing brain in teenagers, according to the CDC. Vaping is harmful and young users are more likely to later take up tobacco cigarettes.

The full danger of vaping likely won’t be known for decades, Dr. Spillane said.

“In oncology, in medicine, you have to wait for problems to develop,” he said, so a rise in cancer rates from vaping probably won’t be seen for 20 to 30 years.

“We’ll likely see lung cancer; and probably see more interstitial lung disease,” he said.

New Products and Regulations

E-cigarettes entered the U.S. market in 2006, and President Obama signed a law allowing the FDA to regulate the tobacco industry in 2009, according to the CASAA (Consumer Advocates for Smoke-Free Alternatives), a consumer nonprofit advocacy organization. Vaping has become the most popular form of ingesting nicotine among youth since 2014, according to the CDC.

In December 2019, Massachusetts enacted regulations aimed at curtailing sale of flavored tobacco and nicotine products. Most stores were banned from selling flavored products – only smoking bars could sell flavored nicotine products for on-site consumption by adults. Smoking bars also could sell traditional tobacco products, including flavored chewing tobacco and menthol cigarettes, for on-site consumption.

Teens have little trouble obtaining vaping products, despite restrictions on their sale. A quick search online showed some websites declined to ship flavored products to Massachusetts, and others asked for your age to enter. However, a website for Direct Vapor, which sells a variety of brands of disposable vape pens, pod starter kits, and device parts and supplies, will ship to this state. It lists shipping restrictions for all 50 states, with the only products it won’t ship to Massachusetts being CBD liquid for e-cigarettes and other CBD products. Another site, Demandvape, says the person signing for receipt of a package in Massachusetts must be 21.

CBD, or cannabidiol, is one of several compounds in marijuana, and users credit it with helping relieve certain health problems. These claims have not been scientifically proven, according to the FDA, which notes the drug can injure your liver, affect mood, and increase drowsiness when taken with alcohol or sedatives.

“There are kids who sell the pods in schools,” Dr. Spillane said. “If one kid has a Juul, they share them, trade them.”

The FDA has rejected over a million proposals for vaping products, but recently approved three Vuse brand devices from tobacco giant RJ Reynolds for marketing as tobacco-flavored products that could help addicted adult smokers reduce their exposure to harmful chemicals in cigarette smoke. The Oct. 12, 2021 decision was the FDA’s first such approval, and the agency said the potential for smokers to switch to Vuse devices or reduce their cigarette use outweighed the risk to youth. It cited the 2021 National Youth Tobacco Survey in its decision, saying tobacco-flavored products are less appealing to teens.

Dr. Spillane said government approval for marketing of a tobacco-flavored vaping system, while also warning consumers – especially teens and young adults – against vaping, sends a confusing message to the public. He said he believes today’s teens may turn to vaping as a way of coping with stresses they’ve experienced, including school shootings.

“I generally try to appeal to their friends,” Dr. Spillane said. “That generation cares a great deal for each other.”

He said many parents don’t realize that their children likely have tried vaping, in part because the devices are easily concealed. The time to convince teens not to start an addicting and unhealthy habit is in middle school, he said.

“Hey, you’re being played,” Dr. Spillane said he tells students. “I don’t think anyone wants to get played.”