E-cigarettes, teens’ new way to smoke, give parents, schools new worry

Vaping, on rise in Atlanta and U.S., is easier for teens to hide
Students holding signs walk through downtown Jonesboro to demonstrate tobacco’s deadly effects on March 20, 2019. Youth use of electronic cigarettes “has reached an epidemic proportion,” the leader of the Food and Drug Administration and the U.S. surgeon general have said recently. HYOSUB SHIN / HSHIN@AJC.COM

Students holding signs walk through downtown Jonesboro to demonstrate tobacco’s deadly effects on March 20, 2019. Youth use of electronic cigarettes “has reached an epidemic proportion,” the leader of the Food and Drug Administration and the U.S. surgeon general have said recently. HYOSUB SHIN / HSHIN@AJC.COM

Smoking among teens, which had declined sharply from the mid-1970s to early 2000s, is on the rise nationwide and in metro Atlanta, and a likely part of the reason is a new technology — e-cigarettes — that allows students to sneak hits of nicotine and other substances banned on school grounds.

Though many young users don't know it, e-cigarettes deliver high levels of nicotine, raising fears about the impact on the sensitive, developing brains of young people and hooking a new generation on the potent drug.

The pen-like devices are easy to get and easy to conceal, making “vaping” often difficult for teachers and parents to detect. They don’t burn fingers or emit a lasting, strong odor and the chemical hit they give comes in flavors kids like.

“I’ve seen kids using their pens in the hallways between classes,” said Jhanai Gates, a junior at Mundy’s Mill High in Clayton County. “They do it in the locker rooms — everywhere. The teachers have no idea that they are doing it.”

Many kids believe the water vapor in the devices is harmless.

In a survey taken in August by Grady High students for an article in the school newspaper, more than half of the 222 respondents reported they’d used e-cigarettes and a third thought vaping was safer than smoking regular cigarettes.

They're mistaken, scientists say. "The subjects in our study who used vaping devices described much more addictive behavior than the ones who smoked (regular) cigarettes," said Dr. Rachel Boykan, a co-author of a study released last month by The American Academy of Pediatrics and a member of the executive committee of the academy's section on tobacco control. "The high concentration of nicotine itself is a concern."

That study asked 517 youngsters aged 12 to 21 how often they used tobacco, e-cigarettes and marijuana. Of all the e-cigarette users with high levels of cotinine, an indicator of tobacco use, a quarter said their vaping device didn’t contain nicotine or that they didn’t think it contained nicotine.

Georgia Department of Education data from the 2017-2018 school year shows that statewide vaping by students as young as sixth grade increased dramatically over the previous year while cigarette use increased by about a third. And the top districts by size in metro Atlanta (Gwinnett, Cobb, DeKalb, Fulton, Clayton and APS respectively) show a combined increase in vaping of almost half, with an even bigger increase in Atlanta Public Schools.

Late last year when Surgeon General Jerome Adams issued a rare advisory, the fourth in 10 years from his office, he said, "I am officially declaring e-cigarette use (vaping) among youth an epidemic in the United States." That was a day after a University of Michigan study found the proportion of high school seniors who reported vaping nicotine in the past month had doubled, to more than one in five, in 2018. All told, about 1.3 million more adolescents were vaping in 2018, the researchers said.

Teachers, administrators and parents often don’t often know what to look for.

Gwinnett County parent Tanya Porter said she knows almost nothing about the devices.

“I’m sure more kids are doing it because they think that since there’s no foul smell it’s harmless,” she said. “And they think those little pens are cute!” When thinking about peer pressure and her own middle school-age daughter, she vowed to do more research.

E-cigarettes create an aerosol by using a battery to heat up liquid stored in pods. That liquid usually contains nicotine, flavorings and other additives. Users inhale this aerosol. E-cigarettes can also be used to deliver marijuana and other drugs. Each pod generally contains as much nicotine as a full pack of regular cigarettes, said Boykan, adding that many respondents in her study said they use as many as two pods a day.

Besides nicotine, the liquids often contain flavoring such diacetyl, a chemical linked to lung disease; volatile organic compounds such as benzene, which is found in car exhaust; and heavy metals, such as nickel, tin, and lead. Scientists are still working to understand more fully the health effects of e-cigarette contents when they are heated and turned into an aerosol, both for users who inhale from a device and for those who are exposed to the aerosol secondhand.

Peyton Holston, a senior at Martha Ellen Stillwell School of the Arts, said students are always trying to persuade others to try it.

“I’m not interested in that stuff,” he said. “I know it’s addictive and not healthy.”

He and a few dozen Clayton County students participated in a nationwide demonstration on March 20 to raise awareness about the dangers of e-cigarette use. “Kick Butts Day” was sponsored by the Campaign for Tobacco-Free Kids.

Industry advocates insist vaping pens are created solely for adults.

“Simply put, smokers smoke for the nicotine, but they die from the tar and smoke. Vaping products involve no combustion, so the number of and volume of chemicals present in vaping aerosol is tiny in comparison to cigarette smoke. With vaping products, adults not only get nicotine, but they can replicate the hand-to-mouth and inhalation without the toxic chemicals present in cigarette smoke,” said Gregory Conley, president of the American Vaping Association.

He added that sweet flavors, which critics say show that the marketing of vaping pens targets teens, are essential to helping many adult smokers quit. "The FDA's own longitudinal PATH survey found that adults over age 25 using fruit or sweet flavors were more likely to quit smoking than users of other products," Conley said.

On the flip side, research has shown that sweet-tasting flavors are particularly appealing to teens and young adults. The same Food and Drug Administration survey Conley referred to also found that nearly four out of five youths ages 12-17 and nearly three quarters of young adults ages 18-25 who were current tobacco users in 2014 reported that the first tobacco product they ever used was flavored.

The FDA has already banned tobacco cigarettes with certain kid-appealing flavors, which are added to reduce harshness, bitterness and astringency. It announced in March that it is researching how flavors influence tobacco use and addiction, with the goal of identifying regulatory actions.

One popular vaping device is called Juul. Boykan estimated about 20 percent of teens who vape use Juuls, which look like a flash drive and are easy to hide.

From gas stations to vape shops, Juuls are accessible to kids. After the initial $35 for a device and less than $20 for a pack of four pods, a student could spend less per week on vaping than lunch.

State and local governments are debating legislation to make 21 the minimum age to purchase cigarettes, vaping devices and other tobacco products. The current age limit is 18.

In the meantime, schools are working on ways to stop kids from using them.

Angela Horrison-Collier, Clayton County Schools director of Student Services, said the county is working to educate all administrators and staff about vaping devices and dangers. “We see this as a student health issue.”

The state Department of Education sponsored a recent summit about the vaping the epidemic.

DeKalb County Schools offers the Georgia QUIT LINE, whose services include nicotine-replacement therapy. It's been offered since 2016 and 39 teenagers (13 to 17) have called. The Quit Line claims a 32% quit rate after 30 days for all callers.

An alternative-to-suspension program is available for students using ASPIRE, an online smoking-cessation program developed by the MD Anderson Cancer Center. Currently, 132 students from fifth grade up are enrolled, with the youngest 10 years old. Twenty-five DeKalb County schools have signed a community partnership agreement to offer the ASPIRE program to youth. “While some schools use ASPIRE as a punitive measure, some educators make it a part of the classroom curriculum,” said Giselle Montes, a spokeswoman for MD Anderson.

Students caught vaping in Gwinnett County schools face punishment ranging from an administrative warning up to a nine-day suspension.

“Our teachers, counselors and administrators have been trained to recognize the signs of vaping and are sharing information with students in a variety of ways— literature, assemblies, and big events like homecoming and prom — to ensure students understand the importance of making good decisions,” said spokesman Bernard Watson.

“However, this not just a school issue … it is critical for parents to learn more about this issue so that they can speak with their children about vaping. This is a perfect example of where the school and home can work together to help students make good decisions.”

Signs of teen vaping

  • Vaping does not emit tobacco-smelling smoke, tar or ash. Although the vapor quickly dissipates, it still makes a slight haze and a faint odor. If you notice the bathroom, bedroom, car or another enclosed area frequently smells faintly of vanilla, fruit, mint, or similar unexplained odors, you might need to dig further.
  • Sometimes pods leak oils called "vape juice." And to save money some users fill devices themselves. Oily stains on pants pockets, shirts, book bags, furniture, etc. that doesn't smell like the usual pizza grease may be a sign of vaping.
  • A discarded pod is direct evidence that a minor is vaping. Juul pods have small, colored dust covers. The pods are usually clear reservoirs with a metallic coil in the middle.
  • Unlike marijuana, tobacco or alcohol, the signs that a child is vaping are quite subtle. They won't stink of booze or weed. Physical signs are mild dehydration including dry nasal passages and dry mouth. Frequent nose bleeds may be a sign of vaping as well as increased thirst.
  • Nicotine can make people more sensitive to caffeine. If your child begins to stay away from coffee, Coke or Red Bull, it may indicate they are vaping.

Sources: FDA, CDC, KidsHealth.org, BeachHouseRehabCenter.com