In early November, Lauren Williams, a teacher from McCracken High School, and several students decamped to the offices of Kentucky state senator Danny Carroll to tell him about the vaping problem in the district. As an indication of the problem, Williams procured photos of backpack contraband: pods, e-cigarettes, chargers, the rare pack of cigarettes, nicotine-coated toothpicks, and individually wrapped pieces of nicotine gum.
“Either the students are using that to get the nicotine—what small amount of nicotine is in it—or they’re trying to curb their cravings until after school where they can use their Juuls,” Williams says.
The biggest fallout so far from the rise in vaping among teens is that many may now be addicted to nicotine. In the first week of December, the CDC released findings that roughly 27.5% of high school students and 10.5% of middle schoolers used an electronic cigarette in the past 30 days. “Importantly, more than half of current youth tobacco product users reported seriously thinking about quitting all tobacco products in 2019,” the report said. (Electronic cigarettes are considered tobacco products.)
With a growing number of restrictions around having vapes at school, students may be turning to patches and gum just to get through the day. Data from IQVIA, a data analytics firm for healthcare companies, notes that Nicorette sales in the U.S. and U.K. grew 5.3% between June 2018 and June 2019. The year prior it only grew 1%.
One of the reasons that kids are getting addicted to e-cigarettes is because they often contain a lot more nicotine than an average cigarette. “One 5% strength Juulpod is designed to replace one pack of cigarettes in nicotine strength,” the company’s website says. Another way to quantify it: One Juulpod can last for about 200 puffs. Before Juul emerged, e-cigarettes had less nicotine, with typical concentrations between 1.5% and 3%, according to a study that pegged Juul as the instigator in rising nicotine levels in e-cigarette liquids. Teachers are concerned that kids are ripping through pods quickly, going from being nonsmokers to ingesting pack-a-day levels of nicotine.
To address this, the FDA originally sought to limit the amount of nicotine legally permissible in vapes, but it has since pulled that item off its agenda. U.S. Representative Raja Krishnamoorthi is hoping to cap nicotine levels in vapes through legislation.
But there are still other health concerns. Researchers currently studying vaporizers have found carcinogenic metals in the vapors of e-cigarettes. There’s also the lung illness that’s been associated with cigarette or vaping products—the most publicized public health problem linked to vaping this year. So far, it has caused 2,409 hospitalizations and 52 deaths, according to the CDC. However, this condition has largely affected adults, not teens.
As lawmakers decide what to do about these health risks, schools are on the frontlines of the vaping problem. In hallways and classrooms, students surreptitiously sneak puffs while teacher’s backs are turned, the scentless vapor vanishing before they can catch a glance.
Spotting students vape is difficult enough, but containing the source is even harder. Williams says that throughout the day, kids will send out pleas for pods on Snapchat while others sell $5 to $10 hits on their dab pens, which are vaporizers that contain concentrated amounts of THC. Dab pens are causing a separate issue at schools. “They lose control of their bodies—they’re flopping around, they’re wailing—it’s very scary,” says McCracken High School principal Michael Houser. “It’s because they’re super high. What we’ve been told is one drag off the dab pen is equivalent to a joint.”
Looking for a fix
Houser and his colleagues are trying to solve this issue by creating a coalition of students, faculty, parents, and medical professionals to try and find the best way to curb vaping and help kids kick their nicotine habit. It is somewhat uncharted territory, made complicated by loose tobacco laws around schools. Only 19 states have strict rules against having tobacco on school grounds. This year, Virginia banned tobacco products (including e-cigarettes) from schools and raised the legal purchasing age for tobacco products from 18 to 21. The laws came after a campaign called 24/7 , which sought to make all schools in Virginia tobacco-product-free.
They lose control of their bodies—they’re flopping around, they’re wailing—it’s very scary.”
The new laws and school policies mean bigger consequences for students. But at McCracken High School, these harsher punishments are not curbing use. “We’ve increased the consequence for getting caught with tobacco from three days of detention to five days and it really hasn’t slowed anything down,” Houser says.
As for cessation products like Nicorette, the school doesn’t have a specific policy. “It’s kind of a case-by-case basis for those types of products,” he says. Per the Food and Drug Administration’s Center for Drug Evaluation and Research, a person must be at least 18 to purchase nicotine replacement therapies such as nicotine gum, lozenges, and patches. Children under 18 years old must go through a physician to get access to cessation products.
While the FDA has been campaigning for more than a year to quell the tide of vaping use among teens, there are not many federal guidelines on how to help already addicted kids quit. The U.S. Preventative Services Task Force does not currently have recommendations for how to help teens with nicotine addictions. It does suggest that primary care physicians offer counseling or educational talks as a means of intervention, while acknowledging that such efforts may only have mild to moderate impact. The National Cancer Institute has launched a program called Smokefree Teen, which provides educational resources on vaping and tips for quitting. There may be more guidance on the way. In May, the FDA launched a scientific workshop called “Youth Tobacco Cessation: Science and Treatment Strategies,” devoted to understanding how drug treatment could be employed to help kids kick vapes.
In the meantime, other organizations have already started providing tools. National Jewish Health has launched My Life, My Quit, aimed specifically at helping teens give up vaping. The Truth Initiative has a program called This Is Quitting, which links teens and young adults (ages 13 to 24) over text to people who have quit. Schools can also reach out to the American Lung Association for training in their two vaping cessation programs Not On Tobacco and Intervention for Nicotine Dependence: Education, Prevention, Tobacco and Health, a curriculum that focuses on supporting kids in their recovery rather than punishing them. There are also quitlines, a generic term for hotlines that provide over-the-phone counseling for people battling addiction. According to the organization Tobacco Free Kids, a number of quitlines have made their age eligibility requirements younger in recent years.
McCracken High School is exploring a more grassroots approach to solving its vaping problem. The school is in the process of putting together its first meeting between parents, students, anti-vaping advocates, and medical professionals to foster a collective conversation about how to curb vaping.
Williams is hopeful that students will want to quit once they understand the health hazards. She says she has heard from students that they often start vaping because they think it’s a safer alternative to cigarettes that still looks edgy.
“I think that there are students out there that will always be the risk-takers,” she says. “But there are some, if they’re educated about the dangers, they won’t, and it will draw down the numbers.”