Vape, Juul use increasing in adolescents; no amount of nicotine is safe

Junior+Parker+Boone+exhales+amidst+a+cloud+of+colored+smoke%2C+the+outlines+of+his+features+barley+visible+in+the+dark.+In+December+2018%2C+the+Surgeon+General+issued+an+advisory+on+e-cigarette+use+among+youth%2C+declaring%0Athe+growing+problem+an+epidemic.+Featured+image+by+Sophia+Eaton.

Junior Parker Boone exhales amidst a cloud of colored smoke, the outlines of his features barley visible in the dark. In December 2018, the Surgeon General issued an advisory on e-cigarette use among youth, declaring the growing problem an epidemic. Featured image by Sophia Eaton.

Will Cover

Vaping related illnesses have been popping up nationwide with 530 reported cases according to the Center for Disease Control and Prevention (CDC). Missouri just experienced its first death due to vaping, the eighth nationwide. The Missouri Department of Health and Senior Services (DHSS) concluded it was a vaping-related lung injury from the patient’s lung samples. According to a DHSS press release, the patient developed acute respiratory distress syndrome, a severe lung condition that limits the amount of oxygen that can enter the bloodstream due to fluid buildup in the lungs. This led to heart failure and near cardiac arrest, ultimately leading to the patient’s death. Although specific causes are unknown, harmful chemicals present in vape juice and bootleg and street vaping products are suspected. As a result, the CDC recommends refraining from using e-cigarettes and vaping products.

Vape use has skyrocketed in the past few years, driven by booms for businesses such as Juul. A 2018 survey on vape use, conducted by the National Institute on Drug Abuse, which is part of the National Institutes of Health, found a dramatic increase in teen use of vaping devices in just a single year. Thirty-seven percent of high school seniors reported “any vaping” within the past 12 months, compared with just 27.8 percent in 2017. 

Reported use of vaping nicotine also increased. The amount of high school seniors who vaped nicotine 30 days prior to the survey nearly doubled from 11 percent in 2017 to 20.9 percent in 2018. 

RBHS senior James Glaser conducted a similar survey for the Youth Advisory Council last school year looking into substance abuse among Columbia Public Schools high schoolers, with a focus on vaping. Glaser said the council investigated “vaping specifically because of how new it is. Many teachers still can’t recognize a vape, and we felt that we could help most by investigating what adults aren’t as familiar with.” 

The survey, which had 570 student responses, 304 of whom were RBHS students, found that 22.5 percent of students had tried nicotine at least once, and of those students who had tried it, 74.8 percent had used nicotine in the past month. This number was significantly higher than groups who had tried alcohol and marijuana, a fact that surprised Glaser.

“People always say that it’s easy to get hooked,” Glaser said, “but that’s really evident when basically three quarters of everyone who uses nicotine once has also used it within the past 30 days.”

RBHS Studies and Psychology teacher Brian Larsen attributes some of this increase to vapes often coming with flavorings that appeal to younger audiences. 

“You’re not allowed to sell cigarettes that are flavored outside of Menthol, so you can’t buy, like, mango cigarettes,” Larsen said. “There’s a reason for that: to discourage kids from smoking. Because it’s available in flavors that are appealing to kids, that gets kids started, and once they start they don’t realize how easily they get addicted and how hard it is to stop.”

Larsen is particularly worried about the lack of information available about vapes as they are still an emerging product, and uses this as a way to facilitate conversations with his students in hopes of preventing them from vaping. 

“I ask my AP [Psychology] kids, ‘What is vape juice? Like what is it even?’” Larsen said. “You don’t even know what’s in it, let alone what the health implications are for you. I personally take it upon myself to talk about it in Psychology because it’s appropriate to our course. I think when you deal with high schoolers, especially with 17, 18 year olds that are on their way out of the door, it’s appropriate for us to have adult conversations about it, real conversations not trying to scare kids, [not trying] to talk down to kids who are already doing it because, chances are, if you are a kid that vapes at school, you are probably already addicted to nicotine, and me admonishing you doesn’t serve any purpose other than alienating them.”

RBHS sophomore Zachary Willmore tested vaping in eighth grade on a school trip, but because he was worried about the consequences of nicotine he used Kool-Aid in place of vape juice. Willmore was caught and punished but said regardless of that he would not have vaped again. 

“I tried it because it was like all the really cool kids,” Willmore said. “And I was like, ‘You know what? Yes. Like, I’m gonna try this.’ [But] I think it was too much risk and not enough, like, benefit. I didn’t feel anything. I think that to each his own, some people like it and I respect that. And I just think that for me, it’s not really worth the health risks in there.”

Although the Surgeon General’s website explains vapes are less harmful than cigarettes when used in replacement, it cautions that any amount of vape use by teens is harmful, no matter how limited. 

The website continues, “The aerosol from e-cigarettes can contain harmful and potentially harmful chemicals; ultrafine particles that can be inhaled deep into the lungs; flavoring such as diacetyl, a chemical linked to a serious lung disease; volatile organic compounds such as benzene, which is found in car exhaust; and heavy metals, such as nickel, tin and lead.”

In order to study the potential for harmful chemicals in vapes, Dr. Mark Rubenstein of the University of California, San Francisco, analyzed the levels of toxic chemicals in teenagers who had and had not vaped. Dr. Rubenstein’s research revealed that the teenagers who vaped had a three times higher concentration of toxic compounds in their bodies than the non-vaping subjects.

Regardless of whether or not a vape is well regulated and avoids these dangerous chemicals, the nicotine in vapes will always have adverse effects on the teenage brain’s development. Dr. Natalia A. Goriounova of Vrije University in Amsterdam, one of the top 100 global universities, details the risks to the brain associated with nicotine as one grows older. Goriounova writes the prefrontal cortex, the part of the brain responsible for executive functions, is still developing during adolescence. Thus, nicotine use during high school increases the risk of cognitive impairment in later life, as well as attention deficits.  These dangers are also higher for high schoolers as the brain is still in the adolescent stage and has not yet fully developed. 

These effects have been exacerbated in recent years, as the particular type of vape that is becoming popular among high school students, pod mods, has a higher nicotine concentration than other e-cigarettes. Pod mods have a battery powered atomizer, which creates the vapor from the liquid in a disposable or refillable pod. The most common examples of these is Juul, which controls a whopping 72 percent of the entire e-cigarette market.

This delivery system, however, is far more dangerous than the alternative as they typically have a higher nicotine content. Dr. Jessica L. Barrington-Trimis and Dr. Adam M. Leventhal, both of the University of Southern California, explain in the New England Journal of Medicine that pod mods deliver higher levels of nicotine than other e-cigarettes because of how they derive nicotine. Pod mod advertisements typically claim a nicotine concentration two to 10 times higher than in most other e-cigarette products. Juul’s website indicates a level of nicotine equivalent to 20 cigarettes a pod. 

The authors concluded that given the high nicotine concentrations in pod mods, nicotine-related health consequences would be worse, particularly because many users of pod mods are unaware of the amount of nicotine actually present. A 2018 survey conducted by Truth Initiative, a tobacco control non-profit, discovered that 63 percent of Juul users did not know that Juul always contains nicotine.

Although Willmore was concerned about the potential health side effects that vaping carried, he was skeptical of any measures to curtail vape use. 

“I think that once you go start going over like one [pod] a day, that’s kind of like when you realize that you’re, like, addicted. And I think that even if there are new laws, new regulations, people are going to get around it. I think that’s up to each person to kind of just decide, I guess, like when they’re addicted.”

Larsen finds the lack of information on vaping particularly concerning, as it can lead to a higher nicotine use than would otherwise occur. 

“I think vaping is particularly dangerous compared to other nicotine products simply because it’s been marketed as a safe alternative,” Larsen said. “I think, because of that marketing and because of a lack of awareness by students as to how nicotine affects the brain and how addictive it is, kids fall into this trap where they try it, and then they get addicted to it, and then they can’t stop.”

A study of the correlation between e-cigarette use and cigarette use of 11,046 youths by Dr. Kaitlyn Berry of the Boston University School of Public Health found that vaping substantially increased the likelihood that one would become a smoker later in life, particularly among those who would otherwise be unlikely to smoke cigarettes.

Berry discovered that those who vaped were more than three times more likely than their non-vaping peers to actively use cigarettes during the next two years. More notably, the study found this rate was even higher among those who posed a low-risk for cigarette use.

Berry concludes the report by warning of the drastic effects popular vaping products can have in the fight against smoking. 

“This study supports the view that e-cigarettes represent a catalyst for cigarette initiation among youths,” Berry said. “The association was especially pronounced in low-risk youths, raising concerns that e-cigarettes may renormalize smoking behaviors and erode decades of progress in reducing smoking among youths.” 

Larsen knows of the dangers of vaping because, as a young adult, smoking negatively impacted his life, and he wants to prevent a similar thing from happening to his students. As a high schooler, Larsen started smoking, which he attributes largely to the social pressures. Reflecting on his cigarette use; however, Larsen realized just how potentially dangerous it would have become had he not been able to quit. 

“After I quit I realized exactly that these tobacco companies got me,” Larsen said. “They got me for hundreds and hundreds of dollars. They got me unable to run, unable to feel good. They got me when I was nervous, looking to a cigarette to calm me down rather than my own sort of tool chest to deal with that sort of stuff. Vaping likely will lead many kids into cigarettes, and we know how bad cigarettes are for us, but that addiction overrides everything. I think the more that I can talk about it in passing, in class using, if I can get through to just one kid, I think I’ve done my job in trying to educate.”