Vaping lures middle schoolers
Trend reverses decadeslong anti-smoking campaign
The assistant principal of Salisbury High School was telling an audience about the school’s efforts to warn students about the dangers of vaping when several parents interjected.
“We need it in middle school,” one parent said.
“It’s on the bus. Middle school. It’s on the buses,” another said.
“They’re doing it on the bus!” one parent shouted.
Vaping horror stories typically are told in two pictures: the first is a glamorous Instagram
photo of a high school or college student showing off a colorful smoke cloud from a sleek vape pen, and the second is that same person unconscious on a hospital bed and hooked up to medical machinery.
The people who really need to see those pictures are middle school students, said parents at a Sept. 26 community forum on vaping held at Salisbury High hosted by St. Luke’s University Health Network. School administrators and parents say kids are starting to vape as young as middle school. They like the flavors and flashy technology and see their peers vaping.
“Unfortunately, if one or two cool kids do it, it doesn’t take long for other kids to follow,” said Kathleen Halkins, supervisor of health services at Bethlehem Area School District.
Health officials have been warning the public against the possible long-term health effects of e-cigarette use, but an escalating number of serious lung injuries the past year among young people has spurred action from policy makers and doctors across the country, including in the Lehigh Valley.
Nearly 1,100 mysterious vaping injuries have been reported across the country, including 18 deaths in 15 states, according to the latest report from the Centers for Disease Control and Prevention. Most patients said they have a history of using THC products, according to the agency.
Lehigh Valley Health Network has treated two young men with suspected vaping injuries, spokesman Brian Downs said.
As of last month, St. Luke’s University Health Network had treated about half-dozen suspected cases of vaping-related lung injuries in young adults in recent months.
The patients typically are young adults. Dr. Douglas Corwin, a pulmonologist from St. Luke’s told the audience at Salisbury High that he’s treated a 17-year-old, an 18-year-old and a 21-year-old. One had asthma and the other two were healthy, he said.
“These aren’t chronically ill people, these aren’t people on a bunch of medications. These aren’t your weak and feeble people,” Corwin said.
Doctors and scientists have not identified a chemical or product causing the injuries, but state Health Secretary Dr. Rachel Levine said illegally sold vape pens are causing the majority of these vaping injuries.
The injuries are on the rise as the popularity of e-cigarettes has surged among teens and young adults. Like tobacco, it is illegal for anyone under the age of 18 to buy vape pens, which have nicotine. Juul, the biggest seller of e-cigarette products, bans online sales to anyone under 21.
About half a million middle school students smoke e-cigarettes — jumping from 3.3% of middle school students in 2017 to 4.9% in 2018, according to the 2018 National Youth Tobacco Survey. The trend is even more alarming for high school students, where 1 in 5 used ecigarettes last year, nearly double the number from 2017. Ecigarettes have eclipsed cigarettes as the most commonly used tobacco product by teens, reversing decades of declining tobacco use among youths, according to the survey.
“It doesn’t smell like cigarettes. It comes in a million flavors, from cherry to bubble gum to mint. Kids don’t understand a lot of those chemicals that make it flavored can hurt you,” Halkins said.
When e-cigarettes hit the American market more than a decade ago, federal and state governments were slow to regulate the product. For example, the advertising restrictions placed on cigarettes don’t apply to e-cigarettes, allowing companies to promote their fruity-flavored products on television and in magazines, said Sarah Lawver, director of advocacy for Pennsylvania and West Virginia for the American Lung Association. And spending on e-cigarette advertising increased from $6.4 million in 2011 to $115 million in 2014, according to the CDC.
Additionally, the Food and Drug Administration, which gained regulatory power over e-cigarette manufacturers in 2016, isn’t scheduled to review e-cigarette products until 2020.
So, the e-cigarette industry captured some young smokers lost by the tobacco industry after decades of public health campaigns by rebranding cigarettes as flavorful, clean and fun, Corwin said.
During his presentation, Corwin showed a picture of colorful vape products in fun fonts.
“This looks like Sour Patch Kids,” he said, referring a popular brand of chewy candy.
“Talk about deceptive marketing. You want to talk about bait and switch?” he said.
On its website, Juul says it stopped selling non-tobacco and non-menthol pods in stores, and shut down its Facebook and Instagram accounts in the United States.
“Underage vaping is a serious problem. Juul Labs is committed to preventing underage use and has taken the most aggressive actions of anyone in the industry to proactively curb underage use,” Kevin Burns, then-CEO of Juul Labs, said in a statement on the website.
Public campaigns against cigarette smoking have successfully discouraged students from smoking by stripping away the glamour and highlighting the bad hygiene, smell and health risks. But e-cigarette marketers distanced the product from cigarette smoking, presenting vaping as an entirely different habit.
“‘I don’t smoke. I just vape.’ Has anyone heard that before?… They’ve done a fabulous job of marketing, right?” Corwin asked. “Able to separate smoking from vaping. Smoking is disgusting. Who would do that? That’s hideous. I just vape.”
That certainly rings true for Madison Ekdahl, a Salisbury High School student who has heard that sentiment expressed many times. “Everyone says it’s better than smoking,” she said.
It’s hard to know how to talk to her friends about vaping, she said. “You don’t want someone to stop being your friend.”
School districts are stepping in with programming to discourage students from vaping. The Bethlehem Area School District has a vaping webinar for teachers and is considering presentations to students. In the Salisbury Township School District, administrators brainstormed with students about how to teach about vaping, such as in large class assemblies and small group conversations.
The New York Times reported that on Monday three districts — in New York, Kansas and Missouri — sued Juul, accusing the company of endangering students and forcing schools to devote time and money to fighting nicotine addiction.
Vaping is not allowed in schools across the Lehigh Valley, and students caught breaking that rule face the same consequences as those caught smoking cigarettes.
However, vaping is easier to hide than smoking, Halkins said. Some vaping products look like a thumb drive and can fit under bracelets or wristbands.
With the health scare associated with vaping, lawmakers across the country are under pressure to make it harder for students to purchase e-cigarettes, such as raising the age to purchase and use tobacco products to 21 and regulating ecigarettes the same way as tobacco.
State Sen. Mario Scavello, R-Monroe, one of the senators who has introduced a bill lifting the smoking age to 21, said the goal is to keep cigarettes away from 18-year-olds who may spend time with younger teenagers.
“You don’t want them to be exposed to it so early,” he said.
Eighteen states, including New Jersey, New York and Maryland, and the District of Columbia have raised the smoking age to 21, according to the American Lung Association. Juul came out in support of such legislation last year.
While the evidence and arguments against vaping are compelling, students are unlikely to listen to adults about it, Nancy Thomas, a middle school health teacher and mother of teenagers, said at the St. Luke’s assembly.
“You got to find the right speaker. Otherwise, they’re just hearing sounds. They’re not listening.”
The best person to get through to teenagers is a teenager, she said.