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Doctors, educators tackle teen vaping issues

December 31, 2018

West Lebanon, N.H. (AP) — Cake batter, blue slushy, bubble gum and fruit punch are among the flavors of vape juice available for sale behind a counter at Un-Dun, the tobacco, beer and novelty shop in West Lebanon.

People inhale these juices, which carry varying amounts of nicotine, using battery-powered electronic cigarette devices that heat the fluid and produce vapor. Though ostensibly intended as products to help established smokers quit smoking, a major national survey indicates teenagers who have never smoked are increasingly picking up “vapes” and related devices and unintentionally becoming dependent on nicotine.

It is the wide-range of flavors that appeals to 18-year-old White River Junction residents Brianna Boyce and Zach Moote, who visited Un-Dun on Thursday to check out the selection. Boyce said she recently took up vaping as a form of stress relief and because her friends were doing it.

Moote, who has asthma, said he would never consider smoking cigarettes, but feels that vaping nicotine-free juice is safe and not addictive.

“I don’t vape that often,” he said.

Though vaping has not been shown to carry the same risks of cancer, cardiovascular disease and stroke as cigarette smoking, clinicians and public health advocates say it’s unhealthy for young people to use e-cigarettes. Nicotine dependency alters developing brains.

And because e-cigarettes are relatively new, there have not yet been long-term studies on the effects of vaping on health, meaning that it’s not yet known what effect breathing in these flavors and other ingredients may have on people’s health.

“These are not without risk,” Dartmouth-Hitchcock Medical Center pediatrician Susanne Tanski said in a phone interview. Just because there’s “not a lot of long-term research yet does not mean that they’re safe.”

Though these products are only legally sold to people over 18 in the Twin States, younger teens are getting them through older friends and online. In New Hampshire, 24 percent of high school students have used an e-cigarette in the past 30 days, according to the 2017 Youth Risk Behavior Survey. In Vermont, about 12 percent of high school students have used the devices in the past 30 days and roughly a third have ever tried them.

This use appears to be on the rise. Nationally, from 2017 to 2018, there was a 78 percent increase in e-cigarette use among high school students and a 48 percent increase among middle-schoolers, according to the 2018 National Youth Tobacco Survey.

A national study by the University of Michigan found similar results, as the number of teens who had vaped in the 30 days leading up to its survey doubled between 2017 and 2018.

Though the rates of e-cigarette use in the Twin States look a bit lower than national numbers, Tanski said that may just be because the local data is a year behind.

“We’re conducting this grand experiment (and we) don’t know what kind of harm we’re doing,” Tanski said, noting that she is especially concerned about teens’ exposure to ultra-fine particles created when the flavored juice is vaporized.

Though none of Tanski’s patients who vape have come to her seeking assistance with tobacco or nicotine cessation, some of them acknowledge that they cannot make it through the day without using their vaping device, she said.

“It’s a real issue,” Tanski said. “The kids may not recognize that they’re becoming highly dependent.”

Tanski’s patients’ parents are becoming concerned, especially when they confiscate their children’s device only to see new ones appear.

The devices also are increasingly on the minds of Upper Valley educators.

Because e-cigarettes do not give off the acrid odor of cigarette smoke and leave very little residue, Hartford High School principal Nelson Fogg said administrators have trouble determining when students are vaping.

“It’s really chasing a pretty insidious ghost,” Fogg said.

The vapor emitted by the devices, which can be as small as flash drives, is fruity or pleasantly scented and most of the vapor is not visible, making the devices easy to hide.

Hartford administrators first began hearing about the issue of vaping last year, Fogg said. They began finding some students with vaping devices, but over the summer Fogg speculates that students had more time to use their devices and “they came back to school with an addiction.”

One pod of vape juice for the popular vaping device known as Juul can contain as much nicotine as a pack of cigarettes, according to the website of the Truth Initiative, a Washington D.C.-based nonprofit devoted to ending tobacco use.

The increasing rates of vaping among high school students has administrators like Fogg scrambling to educate students and their parents about the potential risks of the products, he said. Information about vaping now is part of the school’s health curriculum. The athletic trainer also is spreading the word to student athletes, Fogg said.

When school staff do find vaping paraphernalia they try to take the opportunity to teach the students about the products, Fogg said.

But “that stuff, to be honest with you, has a very limited impact,” he said of warning about the hazards of vaping.

The rates of vaping are increasing at the same time that the number of young people picking up cigarettes is declining. In 2017, about 8 percent of New Hampshire high school students smoked cigarettes, which is down from 21 percent in 2009. About 9 percent of Vermont high school students smoked cigarettes in 2017, down from 18 percent in 2007.

Vaping does not carry with it the social stigma that cigarette smoking does. Many of the students who are now vaping find cigarette smoking to be “gross,” Fogg said.

“The anti-tobacco folks have done a good job of making sure that young people know that tobacco is unhealthy,” he said.

Some studies, however, have shown that using these e-cigarettes may increase the likelihood that teens will start using cigarettes.

One such study was led by Samir Soneji, an associate professor at The Dartmouth Institute. That study, published in the journal PLOS One in March, used 2014 census data, published literature and surveys on e-cigarette use to create a model that found that about 2,070 cigarette-smoking adults in the U.S. quit in 2015 with the help of the devices. The model also estimated that during that same time — after first using e-cigarettes —168,000 young people who had never smoked cigarettes began smoking and then became regular cigarette smokers.

There are a variety of reasons why young people who had previously been uninterested in smoking take it up after first using e-cigarettes, Soneji said in a phone interview. For example, cigarettes are an effective way of delivering nicotine to people who are addicted to it and once kids begin vaping, they may begin to spend time with smokers.

“Vaping has co-opted the same social aspect,” he said.

Because the motions of bringing a cigarette and a vaping device up to the mouth and inhaling are similar, the behaviors may be transferable, he said.

Since long-term studies defining the health consequences of vaping have not yet been completed, that can make it harder for educators to convince students that they are taking a risk.

But Fogg said we do know that nicotine is addictive and alters developing brains. And, once a habit is developed, students can find they are paying to maintain it.

A Juul starter kit costs $50 and two pod refills cost about $10 online.

Hartford students caught vaping are subject to punishment, usually starting with an in-school suspension, Fogg said. That punishment, however, doesn’t help students to address their nicotine dependence, he said.

Though Hartford High employs a student assistance professional to help students address addictions of all kinds, Fogg said in the case of vaping this can be tricky because there is not a clear protocol for vaping cessation.

Though Tanski said she has not yet had a young patient come to her seeking assistance with quitting, if one did, she would consider prescribing a nicotine-cessation aid such as gum, lozenge or a patch. But these tools usually are used to help adults quit smoking and their effectiveness at helping young adults quit vaping still is unknown, she said. She also would recommend behavioral therapy, she said.

“What we’d love to do (is) see some actual research done as quickly as humanly possible,” Tanski said. “How do we help the kids?”

Public health officials and regulators at state and federal levels are raising alarms and proposing changes in hopes of curbing the rise in teen use of e-cigarettes. In November, FDA Commissioner Scott Gottlieb said his agency will restrict sales of many flavored e-cigarettes to brick-and-mortar outlets that have either age-restricted entry or areas inside stores that are not accessible to customers under 18. The agency also will require stepped-up age verification for online sales.

“I will not allow a generation of children to become addicted to nicotine through e-cigarettes,” Gottlieb said in November. “We won’t let this pool of kids, a pool of future potential smokers, of future disease and death, to continue to build.”

Locally, some are pushing to increase the age at which people can purchase tobacco products, including vaping equipment, to 21. Some New Hampshire communities, including Dover and Keene, already have made this change.

“The longer you can hold people off from trying things, the better for their overall health,” Stephanie Winters, deputy director of the Vermont Medical Society, said in a phone interview.

At its annual meeting this fall, the medical society passed a resolution aimed at reducing youth use of e-cigarettes, including a recommendation to increase the age to purchase tobacco products to 21.

Both Soneji and Tanski said that raising the age limit would prevent older teenagers from buying vaping supplies and reselling them to their younger friends.

Rob Carrier, who owns Valley Vape on the Miracle Mile in Lebanon, said he would welcome raising the age to 21. He also would welcome a cap of the amount of nicotine in vape juice.

Such changes “wouldn’t hurt me,” Carrier said.

His business, which he formed after taking up vaping following 25 years of cigarette smoking, is based on a model aimed to help adults quit smoking, he said. He does not sell Juuls or other products that cannot use his house-made juice.

Though the jury still is out on whether e-cigarettes are an effective smoking cessation tool — the FDA has not yet approved them for that purpose — vaping has helped Carrier give up what was a pack-a-day habit when the patch and gum didn’t work. With vaping, he still gets the “satisfaction of exhaling (and) seeing something.”

Quitting smoking has enabled Carrier to smell things better, stop smelling like cigarette smoke himself and increased his lung capacity. It’s also saved him money, he said.

“It’s the only way I could quit,” Carrier said. “If it helped me, chances are I could help somebody else.”

Similarly, behind the counter at Un-Dun, 35-year-old Chris Wentworth said he started smoking at 13, but now has gone four years without a cigarette since switching to vaping.

Un-Dun doesn’t let anyone under 18 in the door, Wentworth said. The in-person interactions and an ID card reader prevent underage people from making purchases, he said.

“We want to send an image of responsibility,” Wentworth said.

Even so, Wentworth said he had mixed feelings about raising the age limit to 21. He noted that 18-year-olds can join the military.

That said, however, Wentworth said, “We are prepared for whatever.”

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Online: https://bit.ly/2Sv47nE

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Information from: Lebanon Valley News, http://www.vnews.com

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