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Twice as many high school seniors vaped last year than the year before.
This article originally appeared on Stateline, an initiative of the Pew Charitable Trusts.
SOUTH PORTLAND, Maine — The hallways at South Portland High School were buzzing last week with talk of the mystery disease that has struck hundreds of young adults who vape. Snapchat, Facebook and Instagram have been filled with grisly photos of severely damaged lungs and stories about vaping-related deaths.
Kara Tierney-Trevor, the school’s social worker, said a handful of students have come to her and admitted that they vape regularly. They say they’re hooked on the sugary-tasting nicotine in their Juuls and they want to quit — but can’t.
“That’s never happened before,” Tierney-Trevor said. “No one ever came to us on their own and asked for help.”
Maine last week banned vaping or possession of an e-cigarette on school grounds, joining Montana, Oklahoma and Virginia. And in the past three years, at least 18 states have raised the legal smoking age for both traditional and e-cigarettes to 21 in response to the meteoric rise in adolescent vaping.
Other states have tackled flavors in e-cigarettes. Earlier this month, Democratic Gov. Gretchen Whitmer of Michigan became the first to issue a ban on flavored e-cigarette products to stem adolescent vaping. New York Gov. Andrew Cuomo, also a Democrat, issued a similar order. And the Trump administration has asked the Food and Drug Administration to consider a nationwide ban on all flavors of nicotine other than tobacco.
Meanwhile, a bill that would ban sweet-tasting nicotine products is gaining momentum in Massachusetts, and lawmakers in Arkansas, New Jersey and Utah are discussing similar restrictions.
Most people struck with the mystery lung disease had been vaping oils with THC, the psychoactive compound in marijuana, according to the U.S. Centers for Disease Control and Prevention.
But the national scare has given politicians an opening to regulate the nicotine vaping industry, which parents, teachers and some students blame for creating an epidemic of adolescent nicotine vaping.
The new flavoring bans are meant to reduce the allure of nicotine-laced vaping liquids for kids, and federal announcements and media coverage of the health risks to youths who vape aim to discourage them from experimenting with the addictive substance.
But research shows that fear doesn’t work when it comes to preventing adolescents from engaging in risky behavior. In fact, it may attract them. It’s hard to convince adolescents that vaping is dangerous if they see their teachers and parents doing it. And selling vaping products to kids under 18 is already against the law in all 50 states.
South Portland High School has found some strategies that may be working. Like other schools, they’re patrolling bathrooms and hallways and confiscating the devices when they find them.
But instead of suspending students for four to five days as they did under the old policy, school leaders are sending them home for just one day and giving them a thorough behavioral health assessment. School officials also are helping kids find social activities that don’t involve vaping and offering mental health and addiction counseling to kids who are already hooked.
A Sudden Surge
Adolescent cigarette smoking declined for more than four decades, but the most recent annual survey by the National Institute on Drug Abuse found an increase in adolescents using Juuls and other e-cigarettes to inhale nicotine vapors. Almost twice as many high school seniors surveyed were vaping in 2018 as in 2017, increasing from 11% to nearly 21%.
Vaping has been marketed to adults who already smoke tobacco as a healthier alternative to cigarettes and an effective way to quit.
But the FDA earlier this month ordered Juul Labs, which controls roughly three-quarters of the e-cigarette market, to stop advertising those unproven claims. The safety of e-cigarettes has yet to be scientifically proven, the FDA said.
And vaping nicotine is worse for adolescents, whose brains are still developing and who are more susceptible to addiction.
The nicotine salts used in vaping cartridges affect the brain faster than nicotine in traditional tobacco products.
Because liquid nicotine also metabolizes quickly, kids and adults who become addicted to it need a fix every 20 minutes to avoid feeling ill. For middle- and high-school students, that means raising their hand to go to the bathroom more than twice in a 60- to 90-minute class.
In response to recent lawsuits and federal investigations, Juul Labs has said it will cooperate in efforts to prevent adolescents from vaping. The company denies that it ever marketed to adolescents.
“Today, our marketing efforts exclusively feature adult smokers aged 35+ who offer their personal experiences about switching to JUUL products,” Juul Labs said in a statement emailed to Stateline, “all conveyed in a style, tone and message that is a direct appeal to current adult smokers.”
Nationwide, nearly 4 in 10 high school seniors reported using a vaping device for marijuana, nicotine or flavored liquids in 2018, according to the National Institute on Drug Abuse. At South Portland High School, Tierney-Trevor said the numbers appeared to be much higher. “Almost every student here has at least experimented with it,” she said. “Not all, but almost all.”
Assistant Principal Kimberlee Bennett agreed. Vaping hit South Portland High School hard in September 2017. “We were totally caught off guard,” she said.
By October of that year, Bennett said school officers were constantly finding kids using the devices in bathrooms and carrying them in the halls.
But after dozens of devices were confiscated and educational programs at the school raised awareness of the problem, the number of students suspended for vaping or possessing a device started dropping.
By 2018, far fewer kids were caught vaping, Bennett said, and this year no devices have been confiscated yet.
But that doesn’t necessarily mean use has gone down, she said. They may just be getting better at hiding it and more careful about when and where they vape, she said.
Still, Bennett, one of three anti-vaping enforcers at South Portland High, says she’s encouraged that some seniors are starting to talk about quitting and they’re angry at the vaping industry for manipulating them into using in the first place.
Mitchell, a South Portland senior who didn’t want his last name published, is one of them. He said he’s been trying to stop for more than a year. He no longer vapes on weekends, he said, but he can’t resist when somebody offers him a hit in the school bathroom.
“Everybody’s just walking around ‘fiending,’” Mitchell said. “They go from bathroom to bathroom looking for a ‘shred’. They’re just like crackheads.”
Adults have had limited success in using scare tactics to dissuade adolescents from engaging in risky behavior such as smoking, drinking and using drugs. But a combination of other strategies has been shown to work.
In addition to state and local bans on the sale of nicotine and other substances to young people, research has demonstrated the effectiveness of readily available addiction treatment and counseling, restrictions on youth-targeted marketing and drug-free recreation.
Nearly all 30,000 U.S. high schools are grappling with an explosion of adolescent vaping. Most are combating it by suspending kids who are caught doing it and by educating them on the dangers of nicotine addiction.
"Everybody’s just walking around ‘fiending,’” Mitchell said. “They go from bathroom to bathroom looking for a ‘shred’. They’re just like crackheads."Mitchell, a senior SOUTH PORTLAND HIGH SCHOOL IN MAINE
But South Portland High School has an advantage.
In 2016, the city of South Portland received one of roughly 700 federal grants that have been distributed nationwide to help communities combat youth substance abuse, including nicotine vaping.
South Portland is using most of its money — a five-year, $625,000 drug-free community grant from the U.S. Substance Abuse and Mental Health Services Administration and the White House Office of Drug Control Policy — to pay for staff and services at the high school. The goal is to help kids avoid the social pressures that lead to vaping and support them when they decide to quit.
Lee Anne Dodge, a substance use prevention professional, is employed by the city to oversee the grant program. She spends most of her time at South Portland High School. The school also has contracted with a substance use and mental health counselor from an outside treatment organization who is available four days a week.
Another one of South Portland High School’s strategies for preventing youth vaping is a school club called SoPo Unite. Founded in 2017, more than 60 of South Portland’s 900 students are members.
Participants spread their anti-vaping message in the community and in school — and they’re looking for recruits.
Maggie Whitmire, a senior who’s on the group’s leadership team, said she tells her friends, their younger siblings, middle-schoolers and anyone else who will listen not to waste their money on vaping, because it can ruin their health and result in addiction. “It’s definitely not worth it,” she says.
Whitmire and others in the group stressed that they’re not “narcs” or “snitches.” Many of them have tried vaping and learned the hard way that it wasn’t for them. The group wants as many kids as possible to join, and members are trying to ensure that anyone who vapes as a social activity can find alternative ways to socialize.
Maine’s new school vaping ban applies to everyone — students, school employees, parents and visitors — and it aims to create a vape-free environment for kids, at least while they’re at school.
But the same statute that raised Maine’s legal smoking age to 21 did away with civil penalties for kids.
The idea was to shift the penalties to stores that sell vaping products to minors rather than punishing the kids, said school resource officer Al Giusto. But he said stores in South Portland weren’t selling vapes to kids in the first place — adults were buying the products for them.
And police have lost leverage, he added. In the past, he said the underage smoking law allowed police to issue a summons to a kid caught smoking and offer them the choice of paying the fine and having it on their record or attending an eight-hour anti-smoking class called Smokeless Saturday.
“I guarantee you nobody ever paid the fine,” he said. “And we had no repeat offenders.”
Research shows that adolescent use of nicotine “primes” the brain for addiction to other substances, including marijuana, cocaine and methamphetamines. It also increases the likelihood of binge drinking.
Among the most highly addictive substances of abuse, nicotine in cigarettes and other tobacco products has hooked more than 50 million Americans. And addiction experts maintain that using the stimulant, which also can have a calming effect, is among the hardest habits to break.
An estimated 480,000 Americans die of smoking-related illnesses each year, according to the Centers for Disease Control and Prevention. Since 1965, when the agency started keeping records on smoking, the rate of smoking among adults has dropped from about 42% to less than 15% and continues to decline.
Teen smoking declined during the same period, and middle- and high-school attitudes about the substance were consistently negative until vaping started becoming popular in 2016, according to the National Institute on Drug Abuse.
Teachers can’t prohibit students from going to the bathroom, but since they tend to prefer vaping in groups, most South Portland teachers now allow only one student at a time to take a bathroom break. But with 50 classes going on at a time, that’s a lot of kids who can text each other and meet up in the bathrooms, Bennett said.
If students go too long without inhaling nicotine, Dodge explained, they typically get sick and vomit. When they’re trying to quit, they tend to vomit so much they start to lose weight, she said.
South Portland’s two assistant principals regularly patrol student bathrooms to check for vaping. Bennett has a bag full of confiscated Juuls as well as other brands of e-cigarettes and the pods or “juice” to refill them.
An Alabama high school reportedly took the doors off student bathroom stalls to prevent kids from hiding while vaping. And a New Jersey school has installed electronic vaping detectors in student bathrooms that set off an alarm in administrative offices when vaping is detected, according to news reports.
Although vaping is most prevalent in high schools, a growing number of seventh- and eighth-graders reported vaping in the most recent national survey. Even the elementary schools in South Portland are starting to worry about vaping, Dodge said.
The good news, she said, is that “we’re starting to see some signs, at least among seniors, that interest in vaping may be fading. In fact, many of them are angry.”
They didn’t know they were inhaling nicotine at first, and when they found out, they weren’t clear on whether it really was addictive. Now some of them say they feel like they’ve been duped by the industry, Dodge said.
Until 2018, e-cigarette-makers didn’t have to disclose on the packaging that nearly all of their products contain nicotine. All Juul pods have nicotine in higher concentrations than any other products — equivalent to a pack of cigarettes.
Kids were inhaling an entire Juul pod in a few hours, Dodge said. “They felt light-headed and sick. They had no idea what they were putting in their bodies.”
The American Academy of Pediatrics discourages the use of nicotine patches and nicotine gum for adolescents, because research shows the drug can be permanently damaging to young brains and is not more effective than abstinence at helping kids quit. In South Portland, though, some pediatricians are reportedly starting to rethink that policy.
“We’re concerned that some kids are so addicted that they’re not coming to school,” Dodge said. “I understand that one doctor helped a kid get nicotine gum to help him quit.”
Michael, another senior who didn’t want his full name to be published, said he quit vaping six months ago. For him, he said, the cure was thinking about his mother’s father, a smoker who died young from emphysema. “She lost her father. I couldn’t let that happen to my mother again,” he said. “I just kept telling myself that over and over.
“Part of me is a little OK with the fact that I vaped,” Michael said. “There’s no mystery. I know what happens. I know how it feels. I’ve felt it, and I physically know I don’t like it.”