Students at Boulder Creek High School in Arizona, like kids across the country, have no trouble getting e-cigarette devices or the addictive vape juice pods that are packed with nicotine and other dangerous chemicals—even formaldehyde—and sugar-coated with appealing names like mint, mango and creme.
“I can call up anyone I know who is 18 and give him $40 for a Juul and a pack of pods, and if I can, so can any kid who is under 18,” said John, a 17-year-old at the school, in this suburban neighborhood at the northern edge of Phoenix. (John is not his real name — he asked not to be identified).
When I spoke with him in October, John figured about 40 percent of the student body vapes. Another student at the school put the figure higher. “Some kids do it just to fit in,” John told me, “and others do it because they like the buzz.”
FDA Commissioner Scott Gottlieb is well aware.
On March 13, Gottlieb announced a crackdown on the sale of flavored e-cigarettes in an effort to tamp down the soaring rate of vaping among young people, including children as young as 11.
“Evidence shows that youth are especially attracted to flavored e-cigarette products, and that minors are able to access these products from both brick-and-mortar retailers, as well as online, despite federal restrictions on sales to anyone under 18,” he said.
More than 3.6 million U.S. middle and high school students had vaped in the past 30 days, according to the latest data (from 2018), Gottlieb said. “This is a dramatic increase of 1.5 million children since the previous year,” he said. “The data also showed that youth who used e-cigarettes also were using them more frequently and they were using flavored e-cigarette products more often than in 2017.”
Perhaps most alarming: Among middle school students (grades 6 to 8), “current e-cigarette use increased from 0.6 percent in 2011 (60,000 students) to 4.9 percent (570,000 students) in 2018,” according to the latest data from the CDC.
That’s 1 in 20 kids as young as 11—at least one in every class, on average, sucking on nicotine and, well, as you’ll see below, we don’t know exactly what.
The FDA is “putting all manufacturers and retailers on notice: you may be subject to FDA enforcement for selling certain flavored ENDS [electronic nicotine delivery system] products without authorization,” Gottlieb said. The planned tighter oversight will also include online sales, sales in locations where minors can enter freely (such as convenience stores), and the quantity of these products people can buy at one time, he said.
The action comes six months after Gottlieb announced an undercover operation that resulted in issuing 1,300 warning letters and fines to retailers known to have illegally sold e-cigarettes to minors.
What Gottlieb and some who purvey the products know is exactly what most kids don’t. And this is the part parents need to learn.
Kids Don’t Realize the Risks
About 80 percent of youth say they don’t see great risk of harm from regular use of e-cigarettes, according to the FDA. Other research has found two-thirds of teens who vape said their e-cigarettes contained “just flavoring.”
The reality is much different.
E-cigarettes use a battery to heat a pod of liquid (commonly called vape juice) that produces an aerosol (the vapor). Some devices resemble regular cigarettes. Others look like a standard pen or a portable USB drive. Larger devices with tanks are called “mods” and look different still.
The pods can be bought separately and can deliver other liquid drugs, including marijuana.
By far the most popular e-cigarette brand among youth is Juul. Its sales grew more than seven-fold from 2016 to 2017, according to the CDC. (The top cigarette manufacturer and parent of Philip Morris, Altria, invested $12.8 billion in Juul in December, for a 35 percent stake in what it saw as a growing competitor.)
“Most e-cigarettes contain nicotine,” according to the CDC. In fact, based on a CDC report citing the manufacturer, “a single Juul pod contains as much nicotine as a pack of 20 regular cigarettes.”
Lead, Nickel and… Formaldehyde?
Juul and other e-cigarettes can be especially dangerous for young people “because these products contain extremely high levels of nicotine, which can harm the developing adolescent brain,” Corinne Graffunder, director of the CDC’s Office on Smoking and Health, said in October.
Also, the CDC says the vapor can contain everything from hazardous ultrafine particles to a flavoring called diacetyl — a chemical linked to a serious lung disease — plus other cancer-causing chemicals, and even heavy metals like lead and nickel. Studies find some flavorings break down into formaldehyde and other dangerous chemicals.
“Significant amounts of cancer-causing chemicals such as formaldehyde are absorbed by the respiratory tract during a typical vaping session,” according to a study published last year in the journal Toxics.
“It is difficult for consumers to know what e-cigarette products contain,” the CDC says. “For example, some e-cigarettes marketed as containing zero percent nicotine have been found to contain nicotine.”
Still, in the United States and in the UK, the risks and benefits of e-cigarettes has become a great debate. On the one hand, if vaping helps people stop smoking regular cigarettes, that presumably means fewer harmful chemicals entering their bodies (though very little study has been done on this). But the FDA, CDC and others argue e-cigarettes, particularly when flavored, are a gateway to nicotine addiction — itself harmful to young brains — that many children would otherwise avoid.
“E-cigarette use among youth and young adults is strongly linked to the use of other tobacco products, such as regular cigarettes, cigars, hookah, and smokeless tobacco,” according to the Surgeon General. “Some evidence suggests that e-cigarette use is linked to alcohol use and other substance use, such as marijuana.”
The non-governmental National Academies of Sciences, Engineering, and Medicine recently completed a comprehensive review of e-cigarette science. Among the report’s conclusions:
“Use of e-cigarettes results in dependence on the devices, though with apparently less risk and severity than that of combustible tobacco cigarettes. Yet the implications for long-term effects on morbidity and mortality are not yet clear.”
‘These Kids are Guinea Pigs’
At Deer Valley Unified School District, which includes Boulder Creek, John’s high school, a crackdown started last fall.
“We have noticed a significant increase in the use of e-cigarettes by students on our campuses this year,” Curtis Finch, the district’s superintendent, said in an October letter to parents, announcing new drug enforcement policies.
It’s against DVUSD rules for any student, including those who are 18, to possess or use tobacco products on campus. E-cigarettes are considered tobacco products. While the problem is most prevalent in high schools, “vaping is occurring” in the district’s middle schools, too, said Scott Warner, the district’s director of school operations and athletics.
Meanwhile, students have brought vaping from the bathrooms to the classrooms, using small electronic devices teachers and parents may not even notice.
“I see kids vaping in class every now and then,” John told me back in October. “Just a couple days ago, I saw a kid do it when the teacher turned their back.”
“We know anecdotally that it’s occurring in classrooms,” Warner said. “The kids are just holding it in. And there are all kinds of poisons that are supposed to be released in the vapor. These kids are guinea pigs. We don’t know what the long-term health effects are going to be.”
The vaping problem extends beyond traditional public schools, of course. Some students at Anthem Prep, a high-performing charter school near Boulder Creek that’s known for its strict discipline on everything from haircuts and gum-chewing to shoe brands, are partaking, too.
Jane (not her real name) is a 18-year-old at Anthem Prep. She estimated about 5 to 10 percent of students there have their own vape device and use it often. She’s never seen anyone vaping in class. “Most people don’t vape as often at school as they do outside of school, Jane told me. “It varies from person to person and often depends on how afraid they are of being caught.”
A recent grad confirmed seeing students vape in the Anthem Prep bathrooms last year.
“Students who are caught ‘vaping’ at school will be suspended, and most schools are now referring possession of e-cigarettes by students to law enforcement for prosecution,” DVUSD’s Finch wrote in the October letter. “Fines for minors in possession of nicotine delivery systems can range from $200 to $500 depending on the jurisdiction.”
Drug-sniffing dogs can now be used “for random searches in common areas like student parking lots, locker rooms, or hallways,” Finch wrote.
The minimum suspension for first-time vaping offenses is three days, Warner said.
Meanwhile, teachers have become “the first line of defense” in spotting e-cigarettes and reporting to administrators, Warner told me. And teachers have needed some education since the vaping craze took off about three years ago. “A lot of teachers didn’t realize what they were looking at when they saw them,” he said.
Before it’s latest crackdown, the FDA had developed anti-vaping health campaigns aimed at youth via social media. This summer, it will run the first TV ads to educate children on the risks of e-cigarettes.
DVUSD plans to include vaping education into its health curriculum, Warner said, but to date, the focus has been on deterrence through increased detection and threat of suspensions and fines.
It may all be having an effect, along with some students simply deciding vaping isn’t for them.
“Way more people try it and decide they don’t want to do it all of the time than those who end up vaping often and getting addicted,” Jane said.
“I feel like it is kind of getting better,” said John, the Boulder Creek student. “More kids are quitting because they know the health risks, but other kids, especially younger kids, are much more susceptible to getting into it because it’s ‘trendy’ or because all their friends are doing it.”
Does the FDA Have Enough Teeth?
Gottlieb, the FDA commissioner, isn’t banking on the problem going away on its own, and not given current laws.
His new proposed guidelines—not yet new laws—would require convenience stores, gas stations and other establishments open to all ages to sell e-cigarettes “only in a manner that prevents youth access. And he expects some flavored e-cigarettes, particularly appealing to kids, will come off the market.
“The FDA will continue to use our enforcement tools to ensure manufacturers comply with the law,” he said. “We’ll continue to hold retailers accountable for illegally selling tobacco products to minors. Manufacturers have the means to control the distribution and sale of their products to retail customers by, for example, including or requiring terms, conditions, or controls in their contracts with downstream distributors (wholesalers, distributors, importers and/or retailers) to prevent youth access.”
It’s not certain whether the FDA has the teeth to accomplish these goals, and its clear from Gottlieb’s statement that the wheels of regulation change will churn slowly. Already, conservative groups, vaping trade associations and the National Association of Convenience Stores are claiming government overreach.
The outcome will depend also on whether the next FDA commissioner agrees with the crackdown. Gottlieb recently announced his resignation and is expected to leave the post in a few weeks.
Portions of this article were first published in Luminate’s sister publications, In&Out Magazine and North Phoenix News.