Georgia officials have been reacting as the national story about vaping casualties has hit home. As of Nov. 25, the state toll was 31 vaping-associated illnesses, three of them fatal, according to the Georgia Department of Public Health. In October, Gov. Brian Kemp issued a statement about the risks. He urged convenience stores, vape shops and community leaders "to join us in raising awareness."
Some state lawmakers are now talking about restricting sales. They may not have heard the Borrego boys’ podcasts, but they did hear from the twins’ mom, an internal medicine doctor at Northside Hospital Forsyth. The boys’ discoveries about vaping and its prevalence in schools galvanized her.
“When they told me about the nicotine withdrawals, I was amazed. I was floored,” Dr. Justine Henao said. They opened her eyes to the dangers before several ailing youths hit her hospital in Forsyth County.
Previously consumed with family life — getting her boys to soccer and keeping her young daughter supplied with books — Henao evolved into an activist. She rallied Atlanta’s medical community and lobbied lawmakers.
“She’s been absolutely a champion of this issue,” said David F. Waldrep, executive director of the Medical Association of Atlanta. The organization recently adopted her resolution to advocate for a crackdown. They want legislation prohibiting the sale of vapes and other tobacco products to anyone under 21 and banning flavored tobacco products, including vape liquid. Often referred to as “juice,” the liquid is vaporized by a device’s electronic heating element so it can be inhaled.
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At a hearing of the state House’s Health & Human Services Committee in early November, Henao showed pictures from inside the chest of a teenager who vaped. “Lungs can rupture, pop like a balloon,” and that’s what happened to this 17-year-old, she explained to the committee members. The top of his lungs were permanently stapled to seal them so they could inflate and function normally.
The boy's mother, Amy Sedgwick, said in a telephone interview that it's unclear how her son's long-term health will be affected by the vaping chemicals and the stapling.
“I want parents to know that their kids can die,” Sedgwick said. She had no idea her son had been vaping, until he admitted it in the hospital while sweating, shaking and vomiting through withdrawal. “How can they sell this crap to kids and think that it’s OK?”
Juul, a leader in the industry, positions itself as a smoking cessation company, saying on its website that it was founded by former smokers “with the goal of improving the lives of the world’s one billion adult smokers by eliminating cigarettes.”
Medical groups and other experts — spurred by a rising number of injuries and deaths — are increasingly questioning the value of e-cigarettes as an alternative to smoking. Juul came under heavy criticism for producing attractive flavors, such as mango and mint, and recently announced it would no longer sell them. The company has also implemented several other initiatives to prevent its products from appealing to and being sold to minors.
A Centers for Disease Control and Prevention estimate this year says 27.5% of high school students and 10.5% of middle school students reported using e-cigarettes within the past 30 days. The number of kids using is up about 1.7 million from last year, which means 5.3 million American youths are putting their developing brains at risk, health experts say.
Henao told lawmakers that vaping is more efficient at delivering nicotine than cigarettes, and kids can get more doses per day because they can do it in places where they cannot smoke. “The extraordinarily high levels of nicotine get kids addicted,” she said. “They’re doing it all day.”
She said she had not seen a teen with a collapsed lung in her dozen years at Northside, until the past few months, when she’d seen four.
In September, President Donald Trump said he was considering a ban on the sale of most flavored e-cigarettes. Then, in October, Juul said it would stop selling its fruit and dessert flavors online (it had already ceased those sales at stores), and in early November, it announced it was dropping its popular mint flavor.
The action was only voluntary, though, and vaping critics say regulation is needed. Flavored products from other sources are still available online, and Trump has been shifting positions. By mid-November, news reports indicated he was backpedaling on a flavor ban. Then, last week, he invited proponents and opponents to the White House and indicated he supports raising the age of sales to 21.
The American Medical Association recently called for an immediate ban on all e-cigarette and vaping products.
Absent movement at the federal level, states may act on their own. On Wednesday, Massachusetts Gov. Charlie Baker signed into law the first state ban on the sale of flavored tobacco and vaping products. Georgia legislators are talking about new restrictions, too, such as raising the age limit on sales. (It is currently 18, an age reached by many high school seniors who might share the devices with younger peers.)
“We have to be willing as a society to do something like that because our children are not always capable of making good decisions,” state Rep. Bonnie Rich, R-Suwanee, said in an interview after hearing testimony from Henao and other medical doctors. Representatives of the American College of Physicians and the Georgia Academy of Family Physicians told the lawmakers that their groups support the same legislation Henao is seeking, including raising the tax rate for vape sales.
Last year, Henao's sons published their first podcast with a couple of friends. In "4 Teens by Teens," they shared facts — cancer-causing agents have been found in the urine of vapers, for instance — talked to a lung doctor and interviewed a teen who had vaped.
“Everyone’s doing it basically, so it’s just like, why not,” said the girl who had by then quit. “It seems unharmful because it’s like, vapor. … It’s just water vapor.” The kids were getting the product from friends, and even from parents, she said.
Henao's sons wanted to do more, and started a group called Vaping-Attention to Prevention. They embarked on a series of podcasts this summer, naming the first episode "Unicorn Poop," after one of the kid-friendly flavors on the market. They also connected with experts, lawmakers and students from other high schools, including Suhas Das of north Fulton County.
Suhas, 17, said his first exposure to vaping was at a pool party the summer after his freshman year. He soon realized it was happening all around him: The Chattahoochee High School senior said students are vaping in a forest behind the school and on campus. "It's small, it's sleek, and it looks like a flash drive, so teens are like, 'I can get away with that.'"
Members of his school marching band were doing it, too, he said: The students were passing a vape device down the line while in formation on the field.
Suhas said he put it to his mouth but didn’t inhale.
“I felt really pressured into it,” he said, “and I think that’s what the problem is.”
Suhas’ mom, Vamsi Das, said he didn’t tell her about it until his junior year. She said she also learned from his younger sister that students were vaping in the bathroom at the middle school, adding that it shouldn’t have come as a surprise.
She counts five vape shops within a half-mile of their home.