By KARA HAMMES, guest columnist
When you read the words, “e-cigarette,” “vaping” or “Juul,” do you know what they mean?
It’s likely you have heard these words on the news, seen them on a sign at the gas station, know someone that uses these products, or may even use them yourself. Based on data from the Centers for Disease Control and Prevention (CDC), Indiana has the third-highest rate of vaping, or e-cigarette use, in the nation, with 6 percent of all Hoosiers reporting that they have used e-cigarettes. Only Oklahoma and Kentucky report higher rates.
This ranking in and of itself is a serious health concern. But combine that with skyrocketing rates of e-cigarette use among youth and a nationwide outbreak of a serious vaping-related lung illness being investigated by the CDC, and you can see why there is renewed focus and energy on curbing the spread of e-cigarette use.
According to a 2019 study published by the Journal of the American Medical Association (JAMA) earlier this month, approximately 1 in 4 (28 percent) of high school students nationwide report using e-cigarettes in the past month. Three years ago, this was at only about 1 in 10 high school students. This number continues to increase significantly each year and, according to the 2018 Indiana Youth Survey, Indiana youth in Grades 7 to 12 are nearly three times more likely to report monthly use of e-cigarettes versus traditional cigarettes. At the time that study was published, Indiana youth of all races and ethnicities reported rates of e-cigarette use at more than double the nationwide average (in 2018, this was at 21.7 percent for Indiana youth in Grades 9 to 12, compared to 10.5 percent nationally).
So, given the serious health concerns and widespread use among Hoosiers, what do you need to know about e-cigarettes and the issues faced by youth in Indiana?
What are e-cigarettes?
E-cigarettes are devices that produce an aerosol vapor by heating a liquid inside the device. These devices are known by a variety of names (e-cigs, e-hookahs, mods, vape pens, vapes or Juuls) and can look like everyday items, such as pens or USB drives, or like regular cigarettes, cigars or pipes.
Along with the variety of names, e-cigarettes come in many different forms, but usually have four components:
cartridge used to hold a liquid solution that consists of nicotine, flavorings, and other chemicals;
heater or vaporizer;
power source (generally a rechargeable battery); and
mouthpiece from which users inhale the vapor.
Are e-cigarette products regulated?
It may be surprising to know that e-cigarette products, including the devices themselves and nicotine-containing e-liquids, have not been regulated or standardized by the Food and Drug Administration (FDA).
However, in response to a court order issued earlier this summer, the FDA published a proposed rule in September that outlines the potential standards that the agency will use to evaluate a tobacco or vaping product’s “components, ingredients, additives, constituents, toxicological profile and health impact, as well as how the product is manufactured, packaged and labeled.”
The lack of regulation and knowledge of ingredients in specific products has made it especially difficult for the CDC to investigate more than 2,000 cases of vaping-related lung illness, including at least 39 deaths that have occurred since March of this year.
Although e-cigarette manufacturers claim that their products “exist solely to help adult smokers find an alternative to combustible cigarettes,” e-cigarettes are not currently approved by the FDA as a quit-smoking aid. Available research is insufficient to show whether e-cigarettes are a good option to support smoking cessation in adults.
According to the CDC, among current e-cigarette users aged 45 years and older in 2015, most were either current or former regular cigarette smokers, with only 1.3 percent reporting having never been cigarette smokers. In contrast, among current e-cigarette users aged 18-24 years, 40 percent had never been regular cigarette smokers.
E-cigarettes are the most commonly used tobacco product among youth. This is in spite of the fact that it is illegal in all states for people under 18 to purchase e-cigarettes, and some states have raised that age to 21.
Several states are considering banning some or all e-cigarette products. In response, some manufacturers have voluntarily agreed to stop producing and selling the majority of their flavored products. These flavors include everything from cinnamon toast to cotton candy, and are considered by many to be specifically targeted for use by youth.
However, these manufacturers still intend to market and sell mint, menthol and tobacco flavors. Studies have shown that mint and menthol are actually the most popular flavors, especially among youth.
Why are e-cigarettes harmful?
In addition to nicotine, e-cigarette aerosol can contain other harmful or potentially harmful substances, such as volatile organic compounds, ultrafine particles, cancer-causing chemicals, heavy metals (nickel, tin, lead, etc.) and flavorings such as diacetyl, a chemical linked to serious lung illness (although not the same serious illness the CDC is currently investigating, which is likely due, at least in part, to the presence of vitamin E acetate).
Users inhale the aerosol into their lungs through the device, and bystanders can also breathe in this aerosol when the user exhales into the air. Although e-cigarette aerosol generally contains fewer toxic chemicals than smoke from regular cigarettes, safer does NOT equal safe.
Although it varies by manufacturer, each Juul pod contains a concentration of nicotine equal to a pack of 20 cigarettes. E-cigarette liquids have been formulated to reduce the irritation caused by inhaling high levels of nicotine, which allows users to comfortably inhale more of the vapor per puff.
There’s evidence emerging that all e-cigarette users, but especially teens, get addicted to nicotine faster by vaping than by smoking cigarettes. This is mainly due to the fact that a much higher dose of nicotine is inhaled with each puff, which can make it harder to kick the habit.
Support for youth who want to quit
Brown County Schools is already actively involved in efforts to prevent e-cigarette use in our schools and support students in quitting. You can read more about their initiatives elsewhere in this issue.
In August, Gov. Eric Holcomb announced a $2.1 million social media awareness campaign to help curb the use of vaping products among teens. Meanwhile, various state agencies are working on developing educational materials on vaping for students, parents and educators.
Youth, and parents of youth who vape, can also text DITCHJUUL to 88709 to enroll in the Truth Initiative’s text-to-quit program, which offers age-appropriate recommendations about quitting e-cigarettes.
Numerous resources and more information are also available through the CDC, the Purdue Extension Brown County office and publication HHS-840-W, and NPR’s “Shots — Health News” blog has thorough, regularly updated coverage.
Kara Hammes, MPH, is the Brown County Purdue Extension educator for health and human sciences and agriculture and natural resources. She can be reached at 812-988-5495 or [email protected].
