Vaping’s growing popularity spurs action

State, local officials tackle what some call a public health crisis

Posted 2/26/19

Depression, anxiety and wanting to fit in are what Olivia Ridl, 17, says drew her to begin vaping when she was a freshman at Chatfield High. “I wasn’t a popular kid,” she said. “I was eating …

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Vaping’s growing popularity spurs action

State, local officials tackle what some call a public health crisis

Posted

Depression, anxiety and wanting to fit in are what Olivia Ridl, 17, says drew her to begin vaping when she was a freshman at Chatfield High.

“I wasn’t a popular kid,” she said. “I was eating lunch in my teachers’ classroom or in the library.”

But vaping with her new friends made her feel like she fit in somewhere, and the nicotine buzz allowed her to cope with and numb unwanted feelings.

By her sophomore year at the school in unincorporated south Jefferson County, Ridl said she couldn’t go a day without her vape, using it at school, in class — sometimes going through a pod or two a day.

MORE: Consequences for vaping in Jeffco schools

The discreet products — often marketed by manufacturers as a healthier alternative to cigarettes, one that can help adults quit smoking — have exploded among today’s youths. The Colorado Department of Public Health and Environment says Colorado is first in the nation for the number of teenagers who use vaporizers or e-cigarettes, calling the trend a public health crisis.

Local public health officials agree that high school students are vaping and using e-cigarettes at alarming rates.

Vaping is the act of inhaling an aerosolized liquid from an electronic device. The devices used to vape go by many different names such as e-cigarettes, e-cigs, smokeless cigarettes, vaporizers, vape pens and JUULs. There is no smoke like a regular, or combustible, cigarette, but there is the addictive chemical nicotine — which is concerning to health officials.

In August, the Jefferson County Board of Health signed a resolution declaring youth vaping a public health crisis in Jefferson County. El Paso County did the same in January.

The declaration followed the release of data from the most recent Healthy Kids Colorado Survey, an in-depth survey on the health and well-being of young people conducted by the state every two years. The 2017 survey found that 44.2 percent of Colorado high school students have used a vapor product at some time — 27 percent of them using within the last 30 days. That’s roughly the same rate as in Jefferson County and more than twice the national average of 13 percent reported by the Centers for Disease Control and Prevention (CDC).

While the rate of teen smoking has dropped 30 percent since 2013, according to the Colorado Department of Public Health and Environment, vaping and e-cigarette use represent something of a new frontier for health, school and law officials.

What’s vaping?

E-cigarettes hit the market in the U.S. in the early 2000s. The battery-powered products deliver nicotine in the form of an aerosol, which generally contains fewer toxic chemicals than the 7,000 chemicals in smoke from regular cigarettes, the Centers for Disease Control and Prevention says. But the aerosol can still have potentially harmful substances like heavy metals and cancer-causing agents, according to the CDC.

Dr. Stanton Glantz, director of the University of California, San Francisco Center for Tobacco Control Research and Education, says vaping devices expose people to a much higher level of heavy metals than combustible cigarettes do.

While vaping refers to the actual act of inhaling and exhaling vapor from a device, an e-cigarette is a specific type of device, created to feel and look like a traditional cigarette. Statistics show that vaping has increased in the past three years with the emergence of kid-friendly flavors and trendy products, such as the JUUL, which hit the market in 2015.

Popular among teenagers, the JUUL looks like a small flash drive. It is sold at gas stations, convenience stores and online, and its sales increased from 2.2 million in 2016 to 16.2 million in 2017, according to the company.

On its website, the company states that anyone who purchases a JUUL must be at least 21 years old. The legal age to purchase vape products throughout the country ranges from 18 to 21. In Colorado, the minimum age is 18.

The JUUL rings up at about $40 a device and $5 a pod, which contains the liquid used in the device. The device does not produce a big cloud and is easy to hide.

Fruity flavors and the use of social media have made vaping appealing to youths, experts say.

“Ultimately, it’s undermining all the progress we’ve made in reducing youth tobacco use,” said Susan Westhof, who is part of the tobacco health team at Jefferson County Public Health. “Now, a lot of kids are trying this new trendy way of using nicotine and they are getting addicted.”

The liquid in some vaping products comes in a variety of popular, kid-friendly flavors, like bubble gum and cotton candy.

Pink lemonade and strawberry daiquiri were the favorite flavors of Ridl, who is now one year clean from vaping. Mango, she said, was the most popular flavor among her classmates.

“A lot of kids use the fruit flavors,” she said, adding that she didn’t know any teens who used the plain tobacco flavor.

Ted Kwong, spokesperson for JUUL, said the company is committed to preventing youth access of JUUL products, and that no young person or non-nicotine user should ever try JUUL. 

"We cannot fulfill our mission to provide the world’s one billion adult smokers with a true alternative to combustible cigarettes if youth use continues unabated," Kwong said. "As we said before, our intent was never to have youth use JUUL products. We have taken dramatic action to contribute to solve this problem."

After a Federal Drug Administration crackdown in late October, JUUL announced they will stop selling mango-, fruit-, creme- and cucumber-flavored pods at retail stores. Those flavors remain available online at the company’s own website through age-verified purchases. In November, JUUL also made its Facebook and Instagram accounts inactive, and say they are developing new technology to further limit youth access and use.

“That was a big deal,” Westhof said. “But we still have the mom-and-pop small companies selling their fruity flavors.”

Westhof added that her organization would like mint and menthol flavors to also be taken off the shelves.

MORE: State bill would limit public vaping indoors

In 2018, 20.8 percent of high school students and 4.9 percent of middle school students across the U.S. reported using e-cigarettes in the past 30 days, according to the CDC. That accounts for about 3.6 million young people.

‘Risk taking’

Reasons for picking up the habit vary, public officials say. But most agree that young people view it as “cool” and “trendy,” and disregard the potential health risks.

Jen Bolcoa, health education specialist for Jefferson County Public Schools, says there are several factors that play into the popularity of the products, including the social connection vaping creates among youths.

“These students have never gone to school when smoking was allowed or teachers had a smoke break,” Bolcoa said. “They’ve always lived in a tobacco-free schools environment. I think a lot of times they don’t connect the device they are using with tobacco. But they certainly do connect with the social, the fun flavors and the risk taking.”

Lakewood High School senior Tasmin Duncan said she sees vaping everywhere at her school.

“You’ll catch someone in class sneakily doing it, or you’ll see it in the bathroom every time you walk in there,” said Duncan, who is part of the Jeffco Tobacco-Free Youth Breathe Easy team, a high school club focused on preventing tobacco and substance use in their schools and communities.

In class, students blow their vape clouds into their hoodies, or they “ghost it,” Ridl said, explaining that students inhale and hold their breath. After a couple seconds, there is no vape cloud.

Health concerns

Vapes have a cartridge, otherwise known as a pod, that is filled with a liquid often with as much nicotine as one pack of cigarettes. That’s about 200 puffs worth.

The vaping trend concerns public health officials and medical professionals due to known and unknown health risks. In addition to nicotine, vaporizers and e-cigarettes deliver other, unregulated ingredients, said Robert Valuck, professor at the Department of Clinical Pharmacy at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences.

“People don’t realize nicotine is just as problematic with vaping as with cigarettes to the young brain, pre-age 25,” Valuck said. “This use of nicotine — anything that is an addictive substance — actually changes brain chemistry and rewires somebody to be a more dependent person on substances for the rest of their life.”

Dr. Tista Ghosh, interim chief medical officer at the Colorado Department of Public Health and Environment, said data suggests vaping may be an indicator for other high-risk behaviors, such as binge drinking, using marijuana and misusing prescription pain medications.

Nicotine is especially problematic for young people, whose brains are still developing. Areas of the brain associated with risk and decision-making don’t fully form until age 25, Valuck said. He added that the younger the consumer of nicotine is, the more likely he or she will continue use.

“It’s biology,” Valuck said. “We should keep people safe until they are old enough to make a rational decision.”

Each puff of the chemical delivers a small amount of dopamine, a neurotransmitter in the body associated with reward and pleasure, Valuck explained. When nicotine is inhaled regularly, the consumer’s natural production of dopamine begins to shut down.

“If you stop inhaling nicotine, you feel like crap. You have no dopamine inside,” Valuck said. “This is why people don’t want to quit (smoking).”

Nicotine addiction is linked to agitation, aggression and anger, and can escalate existing anxiety or depression, experts say. It can disrupt sleep cycles and appetite. Some people report suicidal thinking when the substance is removed, Valuck said.

Unlike traditional cigarettes, which have been around for many years, vaping products are relatively new to the market and studies are ongoing as to long-term health impacts.

Glantz, who has been researching the health risks associated with vaping at his center in San Francisco, said that while it could be another 20 years before scientists know the potential cancer risks associated with vaping, heart and lung disease are already being linked.

What’s being done

Efforts to decrease the use of e-cigarettes and other vaping products are taking place at the county, state and national level.

In January, Colorado leaders introduced a bipartisan bill that would prohibit the use of e-cigarettes in indoor public spaces and workplaces. If it passes during this legislative session, which ends in May, it would essentially put in place the same rules that smokers of traditional cigarettes face. The goal, in part, is to eliminate youth exposure to the products.

“The recent rise in popularity of electronic smoking devices has pointed out a glaring loophole in current law that must be closed in order to keep these products out of the hands of children,” said state Rep. Colin Larson, a Republican representing parts of unincorporated Jefferson County and co-sponsor of the bill.

This comes on the heels of a statewide health advisory on vaping and nicotine addiction issued by the Department of Public Health and Environment last November. Then-Gov. John Hickenlooper signed an executive order to double the number of compliance checks on businesses that sell vapor products and ban the use of vaping products in state buildings.

Similarly, the City of Lakewood recently adopted a mandatory licensing system for retailers who sell non-cigarette tobacco products and devices.

In January, the Lakewood City Council unanimously voted in favor of a new tobacco-licensing system ordinance designed to halt youth tobacco use. The ordinance will require retailers who sell non-cigarette tobacco products to pay a licensing application fee — something that is a proven strategy to prevent illegal sales and youth tobacco use, according to Jefferson County Public Health.

Products like e-cigarettes, chewing tobacco, snus (moist powder tobacco), pipe tobacco, cigars and cigarillos fall under the category of non-cigarette products. Additionally, non-cigarette tobacco products will be required to be put behind counters in stores. Golden and Edgewater have similar laws in place.

Along with the health advisory, Hickenlooper launched Vape-Free November, a prevention initiative aimed at increasing awareness about the dangers of e-cigarettes and vaping. He also recommended that the General Assembly pass legislation on existing tobacco policy, including raising the minimum sales age for tobacco and e-cigarette products to 21 years old.

With the initiative came more discussion.

“I think that really helped create a sense of urgency that helps us feel like people were ready to listen and learn about the problem and how to address it locally,” Westhof said. “Vape-Free November created a nice platform for us to better educate the community.”

The initiative also brought attention to the need for better communication between parents and their kids.

“What we’ve realized is that adults don’t understand it, they don’t know how to talk about it,” Westhof said. “We want to help adults feel armed and have the facts and be able to help youth.”

Jeffco Public Schools is working to educate school faculty and staff as well as coaches, parents and mentors. Late last year, the district started partnering with Jeffco Public Health to hold workshops on how to start the conversation about vaping. Teen Breathe Easy Teams focused on preventing tobacco and substance use in their schools and communities are also working to educate their peers at Jefferson, Lakewood and Wheat Ridge high schools about vaping and other tobacco products.

Additionally, six Jeffco schools offer a Not-On-Tobacco (N-O-T) group — a 10-week voluntary group to help students quit tobacco.

The NOT group at Chatfield High is what Ridl said helped her kick her nicotine and vaping addiction.

“When you’re in school and you see people doing it, it’s all fun and games,” Ridl said. “But when you’re in an actual group where people want to stop, it feels like you have that support.”

In the fall of 2018, the Chatfield High NOT group had 22 members — the most ever — with all of them trying to quit vaping or marijuana.

Don Daniels, a Chatfield teacher who leads the group, said he hasn’t had a traditional cigarette smoker in the group in four years.

In nearby Douglas County, the district’s school resource officers are using humor to deter students from using vaping products. Some schools, for example, have signs of a guinea pig holding a vaping product, stating “Don’t be this generation’s guinea pig.”

‘Not a type of kid’

Ridl, who hid her vape addiction from her father, wants to encourage other teens to quit vaping too.

“Telling yourself you are addicted and knowing how bad it is for you is the first step,” she said.

Daniels is in the process of putting together a program on vaping education to be presented and taught at all Jeffco high schools.

Bolcoa said when talking about youth vaping, it’s important to know there’s not a type of kid who vapes — the trend is impacting youths across the board.

“I think there is a perception in the community of the kinds of kids that smoke,” Bolcoa explained. “And a lot of our parents are really clueless. They say, ‘not my kid because my kid’s on the volleyball team.’ Or, ‘not my kid, he’s an honors student.’”

Students agree that they see classmates throughout all social groups vaping.

Parent Ann-Marie Marquis, of Lakewood, said most parents don’t realize how big the issue of youth vaping is.

“Every bit of information I learn,” she said, “I share with my kids.”

— Colorado Community Media reporter Alex DeWind contributed to this report.

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