Battery-powered addiction: Vapes may be less harmful than tobacco cigarettes, but prevention specialists say the electronic devices are addicting youth to nicotine

Vapes may be less harmful than tobacco cigarettes, but prevention specialists say the electronic devices are making youths addicted to nicotine

A few years ago, Hattie Bermudes didn't even know what vapes were. Now she asks her kids about them nearly every day.

As a mother of two San Marcos High School students and a member of the Parent Teacher Student Association, Bermudes spends a lot of time on school grounds, and within the past year or so, she started spotting unusual trash in the bushes on campus. 

click to enlarge Battery-powered addiction: Vapes may be less harmful than tobacco cigarettes, but prevention specialists say the electronic devices are addicting youth to nicotine
PHOTO BY KASEY BUBNASH
BATTERIES (AND NICOTINE) INCLUDED: Uriel Chavez, Santa Maria Future Leaders of America youth organizer, holds a poster displaying several vape pens, e-cigarettes, and e-juices that were confiscated from students at high schools in the Santa Maria Valley. Chavez was just one of about 10 representatives of youth advocacy organizations who attended a meeting on Nov. 2 at Foursquare Church, where attendees discussed ways to deter vaping among middle and high school students.

Small devices–rectangular, translucent cases with colorful lids–were littered throughout the school's landscaping. They appeared to be electronic and looked about the right size and shape for a computer's USB port. They looked like flash drives. 

Soon she learned that the devices were emptied e-juice pods, cases containing liquid flavoring and nicotine or marijuana. The pods attach to vapes or e-cigarettes, which she learned are electronic smoking devices that heat e-juice liquids and transform them into vapor that users can then inhale. 

Vapes and e-cigarettes work on essentially the same premise as old-fashioned rolled cigarettes–delivering nicotine quickly to the body through inhalation–but without the tobacco and smelly smoke that comes with it.

The more Bermudes researched vapes and e-cigarettes, the more she learned about how popular they're becoming among teens. She read about the biggest e-cigarette companies and their questionable youth-centered marketing strategies, the still relatively unregulated e-cig market, and the relatively unknown long-term health effects. 

Then she found a vape in her 16-year-old daughter's car. 

"I stayed very calm, even though I was panicking inside," Bermudes said. 

Battery-powered addiction: Vapes may be less harmful than tobacco cigarettes, but prevention specialists say the electronic devices are addicting youth to nicotine
YOUTH VAPING AT A GLANCE: • E-cigarette use rose significantly among U.S. middle and high school students between 2011 and 2017. While only 1.5 percent of high school and 0.6 percent of middle school students reported using e-cigarettes in the 2011 National Youth Tobacco Survey, the 2017 survey found that 11.7 percent of high school and 3.3 percent of middle school students had used e-cigs within the last 30 days before taking the survey. • While more than 98 percent of all e-cigarette products contain nicotine, roughly 60 percent of U.S. teens surveyed in a 2015 study incorrectly reported that e-cigarettes were mostly composed of flavoring. • Unlike traditional cigarettes and other tobacco products, e-cigarettes can be advertised on television and radio. • One brand of e-cigarette, JUUL, has become increasingly popular since its launch in 2015. JUUL’s unit sales increased by more than 600 percent in 2017, and its sales now represent more than 70 percent of the e-cig market share.

She rounded up her daughter and her 14-year-old son, and asked them if they'd ever tried vaping, or worse, if they were using regularly.

She braced herself, "and I just listened."

The vape wasn't her daughter's, it was a friend's. But Bermudes said she was "totally shocked" to hear from her kids that they'd both tried vaping a handful of times, and that many of their classmates were doing it constantly–at parties, during lunch, and even in the bathrooms and locker rooms at school. 

Athletes are doing it, as are the band kids, her kids told her, and the students leading in academics, all the way to those failing every class. Her kids told her that some of their classmates are so addicted, they often leave class to sneak a puff. 

"It's rampant," she said. "My daughter says that it's everywhere." 

She's right. Although modern vapes and e-cigarettes have existed for more than a decade, improved technology, a wider range of flavors, and increasingly sleek devices have made vaping massively popular among teens in recent years. It's become so common that the Food and Drug Administration (FDA) said in a September press release that the trend had reached "an epidemic proportion," and announced a major enforcement operation aimed at reducing sales of e-cigarettes to minors. 

While some camps say vapes simply provide a safer alternative to the deadly carcinogens and tar that come with burning tobacco, tobacco use prevention specialists worry that the devices are getting a new generation addicted to nicotine, and unravelling decades of prevention work on the federal, state, and local levels. 

The last few years have been tough for prevention organizations, which have been fighting to end heavy-duty marketing campaigns and close the many loopholes that exist for e-cigarette manufacturers. But thanks to dramatic statistics and widespread parent and teacher concern, Santa Barbara County's prevention programs are being enhanced and updated, tobacco and nicotine product restrictions are being considered, and local prevention specialists say another lapse in youth nicotine use could be on the horizon. 

'It's not cuul to JUUL in schuul'

Until only recently, Lompoc resident Mustafa Fhaies smoked two packs of cigarettes nearly every day. Eventually he grew tired of enduring all of the most common side effects of smoking–his hair and clothes constantly reeked of tobacco smoke, he struggled to sleep, and he suffered lengthy and intense coughing fits almost every morning. 

He switched to vaping JUULs, a still relatively new but extremely popular brand of e-cigarette, and Fhaies said the severity of his symptoms soon diminished. They haven't returned. 

"I feel way better," he said. "Now I can't even stand the smell of cigarettes." 

click to enlarge Battery-powered addiction: Vapes may be less harmful than tobacco cigarettes, but prevention specialists say the electronic devices are addicting youth to nicotine
PHOTO BY KASEY BUBNASH
SILLY RABBIT, VAPES ARE FOR KIDS: While some say vaping is simply a safer alternative to smoking burnt tobacco, tobacco use prevention specialists argue that the tobacco industry is specifically marketing to teens. E-juice companies like “Juicy AF” package their products in brightly colored boxes reminiscent of juice boxes, and sell flavors that would typically be most appealing to children, including bubble gum, melon candy, and Hawaii berry.

So Fhaies said he can see why vapes in general, and especially JUULs, are such hot ticket items at each of his four tobacco and vape shops in Lompoc, Santa Maria, San Luis Obispo, and Santa Cruz County. 

Fhaies said that while his tobacco sales have dropped off in recent years, vape and e-cigarette sales are only increasing. His vape-related sales have nearly doubled since the beginning of this year, and he said JUUL is one of his best sellers. 

Since JUUL first hit the stands in 2015, it's become a company worth more than $1.5 billion, and it now represent more than 70 percent of the e-cigarette market share. 

JUUL sells a vast breadth of e-juice flavors, ranging all the way from creme brulee and mango to American tobacco, and it uses a unique salt-based nicotine delivery system that allows for a higher absorption of nicotine in the body. Both are features that Fhaies said buyers seem to love, especially those in college towns. 

While the advent of vape culture has been great for his bottom line, Fhaies said he has to be careful. 

"We get a lot of minors trying to buy," he said. "A lot. Especially in San Luis and Santa Maria."

Although vaping is significantly less harmful than smoking tobacco cigarettes, according to data collected by the Truth Initiative, a nonprofit public health organization dedicated to preventing tobacco and nicotine use, there is no evidence that they help adults quit smoking, and nicotine in any form is harmful and extremely addictive. 

That's especially true for kids, according to the Truth Initiative, whose brains and bodies are still developing, and who seem to be most attracted to vapes and electronic cigarettes.

E-cigarette use rose significantly among U.S. middle and high school students between 2011 and 2017, according to data collected by the Truth Initiative. While only 1.5 percent of high school and 0.6 percent of middle school students reported using e-cigarettes in a 2011 National Youth Tobacco Survey, 11.7 percent of high school and 3.3 percent of middle school students reported using e-cigarettes in 2017. 

The 2018 National Youth Tobacco Survey shows an even more dramatic situation. The number of U.S. high school students who reported being current e-cigarette users increased by 78 percent between 2017 and 2018, according to an FDA press release. Numbers among middle school students rose by 48 percent. 

Santa Barbara County is seeing a similar trend. While 6 percent of ninth graders surveyed in the county's 2016-17 California Healthy Kids Survey said they'd smoked a whole cigarette, 22 percent said they had tried a vape or an e-cigarette. Only 2 percent of surveyed ninth graders said they were currently using cigarettes, according to the survey, but 6 percent said they were consistently vaping. Those responses were echoed by surveyed seventh and 11th graders, too. 

It's an issue parents, teachers, and law enforcement agencies across the nation are working to address, and a pattern many feel is no accident. 

With wide ranging fruity flavors sold in brightly colored boxes, youth-centered ads on social media, and easy-to-hide techy designs, e-cigarette manufacturers have been widely accused of purposely targeting teens. 

After the FDA announced its plans to tighten restrictions on e-cigarette manufacturers in September, the agency gave companies like JUUL, Blu, and Logic 60 days to develop plans to keep their products away from teens. 

On Nov. 13, JUUL announced it would stop selling most of its flavored e-juice pods in stores and discontinue its social media promotions. Two days later, the FDA announced plans to officially ban most e-cigarette flavors, flavored cigars, and menthol cigarettes. 

Those are the same kinds of restrictions some organizations on the Central Coast hope to persuade local municipalities to enact, ensuring that children here are safe, regardless of what's happening on the national level. 

Education as a deterrent 

When Edwin Weaver was a kid, his uncle Frank was a frequent babysitter. 

If Frank needed to get somewhere while he was looking after the kids, Weaver said he'd stick the six of them in the back seat of his car–no car seats, no seat belts–and he'd hit the Pennsylvania turnpike, a Scotch and soda in one hand, and a cigarette in the other. 

Frank's behavior, though not all that uncommon at the time, would obviously be considered unsafe and immoral, not to mention illegal, in today's world. 

"So public health strategies changed all of that," Weaver said, adding that thorough research, outreach, and education eventually resulted in laws against driving without wearing a seatbelt, drinking and driving, and smoking in cars where children are present. 

And Weaver said he's confident the same will happen with vaping and e-cigarettes. 

"In a world where there are lots of social problems, this seems like a minor one to many people," Weaver said. "But it's so easy to fix. It really is something we can make a difference in."

Weaver, executive director of Fighting Back: Santa Maria Valley, a nonprofit dedicated to reducing substance abuse and violence in the area, said tobacco prevention efforts appeared to be making major strides just a few years ago. Surveys showed tobacco and nicotine use among local teens to be on a steady decline, even in years as recent as 2014. 

click to enlarge Battery-powered addiction: Vapes may be less harmful than tobacco cigarettes, but prevention specialists say the electronic devices are addicting youth to nicotine
SANTA BARBARA COUNTY VAPE SALES:

Then JUULs hit the shelves, and Weaver said, "it just spiked up." 

Although Fighting Back already offers tobacco use prevention education courses and activities to each of Santa Barbara County's public and charter school districts, Weaver said he felt the dramatically rising prevalence of vaping among teens was a cause for updated and improved prevention materials. 

"We see this as a menace that the tobacco industry has created to get back into the pockets and lungs of our kids," Weaver said, "and we want to stop it."

With approval from the Santa Barbara County Education Office, Weaver hired a full-time tobacco use prevention education specialist this school year, a position that he said is entirely funded by tobacco tax profits. The specialist, Edith Perez, will lead activities and presentations in schools and offer a prevention tool kit, all of which are aimed at teaching parents, teachers, and students about the dangers of vaping and e-cigarettes, free of charge. 

The curriculum includes information on teens' brains and how they develop, on addiction, a history of tobacco and the tobacco industry, flavors, marketing manipulation and demographic targeting, and of course, the health effects of vaping nicotine. 

Perez said despite arguments that vaping nicotine is less harmful than smoking tobacco, teens who vape have higher chances of nicotine addiction, and with that, a greater vulnerability to other drug addictions. Just like tobacco cigarettes, vaping nicotine can damage the lungs and heart tissue, weaken the immune system, and cause chest pain and coughing. 

Although the vape-focused portion of the program is still in its developmental stages, Perez said she's already led four events at schools in the Santa Maria Valley, and her open slots for November and December are quickly filling up. 

At each of the events she has led, Perez said she's been bombarded with questions and comments from parents wanting to know more, and she's had interesting feedback from kids. 

After one presentation, she said two high school students approached her and told her how tired they were of smelling vapes in class, in the halls, in the bathrooms, and outside. Perez said one of the students told her vaping is essentially impossible to avoid at school.

"Then the other student said that they don't like going to the restroom and they pretty much hold it all day because the restrooms are so bad at schools," she said. "Everyone in there seems to be JUULing."

Most kids aren't even aware that vapes and e-cigarettes have nicotine in them, she said. While more than 98 percent of all e-cig products contain nicotine, 60 percent of students surveyed in a 2015 study reported that e-cigarettes were mostly flavored liquid, according to data collected by Truth Initiative.

That, Perez said, makes student education vital to ending the popularity of vaping. Of course, she said, policy change could help too. 

Pushing for policy 

At a meeting in Santa Maria on Nov. 2, Fighting Back staff met with a few representatives of other youth-oriented and tobacco use prevention organizations to discuss possible ways to deter e-cigarette use among local teens. 

Attendees included members of the Council on Alcohol and Drug Abuse; Marian Hospital; Future Leaders of America; and Dawn Dunn, coordinator of the Santa Barbara County Health Department's Tobacco Prevention Program, who gave a rundown of policy changes that could get results. 

One of the first steps, Dunn said, would be to push the Santa Maria City Council to enact a tobacco retail licensing ordinance. Several communities in Santa Barbara County–including Goleta, Carpinteria, and the county's unincorporated areas–already have tobacco retail licensing ordinances, which require retailers hoping to sell tobacco and nicotine products to apply and pay for a license. 

It's similar to the liquor licensing system, Dunn said, and the licensing fees paid by tobacco retailers go toward funding the basic education and training of each retailer, and the enforcement of tobacco sale laws. 

Without a tobacco retail licensing ordinance, Dunn said it can be difficult for communities to regulate tobacco retailers, enforce laws, and ensure that minors are being turned away. And right now, minors in Santa Barbara County are being sold to. 

In this year's undercover buy operations–stings conducted each year by the county's Tobacco Prevention Program, in which underage volunteers attempt to buy tobacco and nicotine products without lying about their ages–about 14 percent were able to buy illegally. Still, areas with tobacco retail licensing ordinances faired just about as poorly as those without.

But Dunn said tobacco retail licensing requirements hold another benefit: Once they're written and passed, it's easy to develop and add new regulations that further impede access to tobacco and nicotine products.

Some of the most common additions to retail licensing ordinances are density restrictions. In Carpinteria, Goleta, and unincorporated areas, new tobacco retailers are not allowed to set up shop within 1,000 feet of any school, Dunn said, an attempt to keep tobacco and nicotine products far away–literally–from children.

Local governments could also prohibit tobacco stores from selling within 1,000 feet of parks, churches, or even other tobacco stores, Dunn said, or place packaging limits and pricing minimums on tobacco products typically sold in large quantities at low prices.

Battery-powered addiction: Vapes may be less harmful than tobacco cigarettes, but prevention specialists say the electronic devices are addicting youth to nicotine
CRACKING DOWN: Three areas in Santa Barbara County have crafted policies thought to be most effective in reducing tobacco/nicotine use. Carpinteria, Goleta, and unincorporated areas in the county all have tobacco retail licensing ordinances that require shops planning to sell tobacco and nicotine products to apply for a license. These areas also prohibit new tobacco retailers from setting up shop within 1,000 feet of schools.

A flavor restriction could also easily be added to tobacco retail licensing ordinances, and Dunn said that because so many young people find flavors enticing, that could be one of the most effective policies. In a study cited by the Truth Initiative, roughly 43 percent of middle and high school students surveyed said they started vaping because of the variety of "appealing" flavors. 

At the Nov. 2 meeting, Fighting Back staff took note, and later announced plans to present information on vaping and e-cigarettes to the Santa Maria City Council at a meeting on Dec. 4. They hope to push for some of Dunn's most highly suggested policy changes. 

But policies don't change overnight, and Dunn said smokers tend to feel directly singled out by tobacco licensing ordinances and restrictions. 

"We aren't anti smoker, we're an anti tobacco industry program," Dunn said, adding that the tobacco industry's marketing clearly targets youth, people of color, and low-income communities, solely to make money on nicotine addicts, who she said become "customers for life." 

So while she said there's still work to be done, including the development of some kind of local nicotine addiction treatment program for Santa Barbara County kids, it's important to jump on the issue in any way possible, as quickly as possible

"It's a social disparity issue," Dunn said. "It's a health equity issue." 

Contact Staff Writer Kasey Bubnash at [email protected].

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