Vaping and Teen E-Cigarette Addiction: Will Conventional Harm Reduction Programs Work?

The prevalence and use of electronic cigarettes has increased rapidly over the past decade, particularly among youth.  The extraordinary growth of e-cigarettes has also raised significant public health concerns about the emergence of a new generation of teens with nicotine dependency.  Changes in the design and marketing of vaporizers with the introduction in 2015 of more stylish, sleekly-designed, discreet high-tech devices, known as JUUL, have proven irresistible to teens and become the latest ‘nightmare’ for today’s high school principals and teachers.

School authorities in Canada as well as the United States are coming rather late to the challenge of combating vaping and its associated health risks.  Advance promotion of e-cigarettes as a smoking cessation device may have contributed to the initial ambivalent, almost helter-skelter, response.  A May 2019 Ontario Tobacco Research Unit report confirms that schools were caught off-guard by the surge of vaping among never-smokers and responded with interventions once used to combat smoking or imported from the United States, where the craze is far more advanced among youth.

Five years after the arrival of JUUL, public concern has reached a panic stage with the spread of fear over a recent spate of lung-disease cases involving teen users of e-cigarettes. Breathing in flavoured aerosol that contains nicotine was already a worry of doctors, parents and schools.  Over the past few months, some 380 people in 36 different American states have been struck by a mysterious lung infection linked to chemicals inhaled through e-cigarettes, and seven of those affected died.  Shortly after Health Canada issued a September 6, 2019 advisory, a London, Ontario, hospital disclosed that a local high school student suffering from vaping-related illness had been placed on life support before recovering and being sent home. It could become worse in mid-December 2019 when the sale of vaping liquids containing cannabis compounds becomes legal in Canada.

Schools are on the front lines of the current teen health scare. Since entering the Canadian retail market in 2009, e-cigarettes have morphed from a smoking-cessation aid to a full-blown health concern among today’s youth. Ten years ago, Health Canada greeted e-cigarettes with an advisory warning of the dangers of the new nicotine delivery devices, expressing concern over the lack of scientific research to support claims that they were safe for adults and teens. More recently, Canadian health authorities monitoring the spread of e-cigarette use have been echoing the U.S. National Academies of Science, Engineering and Medicine research finding that ” e-cigarettes are not without biological effects on humans” and, rather than aiding in cessation, can lead to further dependency.

Vaping devices and products containing nicotine are now flooding the Canadian market and readily available in local convenience stores and gas stations. Since September 1918, JUUL, the San Francisco-based company that controls over 50 per cent of the market, has been selling its sleek devices that look like a computer flash drive and are re-chargable at a USB port. They have proven more popular that the Imperial Tobacco brand Vype, released Canada in the Spring of 2018, and Japan Tobacco‘s Logic brand released in early 2019.

First introduced by Juul Labs in mid-2015 as a smoking-cessation device, JUUL became the so-called “iPhone of e-cigarettes.” The extraordinary sales growth of the product was driven by a variety of effective, wide-ranging and engaging campaigns reaching youth through social media, particularly on You Tube, Twitter, and Instagram. Five million Canadians, mostly aged 15 to 34, had tried e-cigarettes by 2017 and 300,000 reported using it every day. One more recent study, published in the British Medical Journal, reported that the proportion of Canadian teens (aged 16 to 19) vaping rose from 8.4 per cent in 2017 to 14.8 per cent in 2018, a 74 per cent increase. 

The Ontario Tobacco Research Unit conducted an environmental scan of current harm reduction programs and quickly recognized that there were, as of the Spring of 2019, no studies of the effectiveness of such interventions. Most intervention programs were public education and school-based efforts, typically aimed at teaching children and youth about the dangers of vaping in the hope of reducing or eliminating the practice. Three of the programs reviewed were E-Cigarettes: What You Need to Know (Grades 6 -12, Scholastic), CATCH My Breath (Ages 11-18, CATCH), and School E-Cigarette Toolkit (Grades 6-12, Minnesota Department of Health).  The report also examined interventions outside of schools, including community-based initiatives, public health efforts, health-care programs, and public policy strategies such as advertising and promotion restrictions, age restrictions, labelling and health warnings, flavouring restrictions, and safety requirements.

Most of the actual school-based interventions were embedded in existing tobacco control programs and sought to counter the marketing messages of companies claiming it is a safe, smoking cessation activity. The Ontario Tobacco Research Unit recognized the scattered approach being taken and recommended considering interventions that proved successful at reducing rates of regular cigarette smoking among youth. They also identified the need for a more coordinated and planned anti-vaping strategy.

Vaping has overtaken smoking as the favoured health-risk behaviour of high school students.  Some 15.8 per cent of Ontario Grade 9 students vaped in 2017, and only 6.2 per cent smoked cigarettes. As many as one out of every three high schoolers may now be regular users of vaporizers with nicotine-laced fluids. The recent health scares may have jolted users and curbed the growth in usage, but it remains the biggest, mostly unaddressed health issue in our high schools.

Why have health agencies and school authorities been so slow off-the-mark in combating the spread of vaping among adolescents? What more can be done to regulate and curtail the marketing of e-cigarettes among the youth market segment?  Where are the research initiatives aimed at identifying the real health risks for teens of vaping nicotine and cannabis products?  Should vaping cessation programs simply mimic smoking control strategies and programs?  What can be done to develop more effective student-centered vaping cessation programs? 

 

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Vaping in Schools: Is ‘Juuling’ a Passing High School Craze or a Worrisome Trend?

Smoking in and around high schools has become ‘cool, once again. Over the past year, vaping has overtaken cigarette smoking as the surreptitious habit of choice among teens as well as undergraduate university students. While smoking e-cigarettes is officially outlawed on school property, that has not stopped a dramatic rise in the popularity of vaping among high schoolers. In the case of Ontario, a 2017 provincial survey revealed that more students in Grades 7 to 12 self-reported vaping (18 per cent) than smoking tobacco cigarettes (12 per cent).

The latest vape innovation, the Juul, now dominates the United States teen market and is beginning to spread into Canada. Inhaling multi-flavoured vapors with nicotine is now much harder for school administrators and teachers to detect. The small, sleek device, or juul, which can be easily mistaken for a portable USB drive has cornered the market for e-cigarettes and vaping products, particularly in affluent school districts where students can afford the latest gadgets and stimulants. Concealing bulging vaporizers was tough, but these low-profile, sleek designs allow students to easily conceal their habit and to escape detection not only in in the usual spots (bathrooms, back hallways, and under stairwells), but even in classrooms.

Like most teen crazes, vaping and ‘julling’ caught on far faster than school officials realized and became well established before authorities saw the scale of the problem. School principals are scrambling to contain the practice and trying to stamp it out.  “I think it’s everywhere, and my school is no different, ” Connecticut principal Francis Thompson recently told Education Week. Then he added, “I think it’s the next health epidemic..”

Vaping with the stealth devices, while less prevalent, is reportedly rising in and around Canadian high schools. “Everybody’s doing it, ” a Grade 9 student in Windsor-Essex County told Windsor CBC News in early April 2018.  Teens in Ottawa high schools featured in a May 2018 Canadian Press news story confirmed that it was now “cool” to smoke again, albeit with vaporizers and in well-known hiding spots. In Sydney, Cape Breton, students at Sydney Academy were well-aware of students vaping in class undetected, and fellow students suspended for smoking who were actually vaping on school grounds.

The new federal legislation, the Tobacco and Vaping Products Act, passed in May 2015, may help to clarify the legal position of school principals trying to cope with the latest craze. Bill S-5 (2018) may improve the quality and regulation of  vaping products and it does restrict use to adults. Federal regulations, expected within six months, will reduce the number of flavours used in e-cigarettes, banning those designed to mimic ‘confectionary,’ cannabis, or energy drinks, and designed to hook young people on these devices.

Defenders of e-cigarettes continue to maintain that they are a safer alternative to tar-producing tobacco cigarettes. Tobacco experts at Public Health England tend to support such claims, as confirmed in a February 2018 UK government report. Whether vaping is effective in promoting smoking cessation is far from clear in studies to date.

School policies banning smoking have been updated to include vaping, but the new stealth devices are making it harder than ever to enforce, especially when the juul looks so much like a USB stick and can be easily concealed by student users. The latest fear expressed by school principals and teachers is the prospect of vaporizers being used to deliver cannabis, circumventing school detection and regulations. When cannabis is legalized across Canada, October 17, 2018, we shall see whether it further complicates the job of policing and eliminating vaping on school grounds.

Why is vaping replacing tobacco smoking as the nicotine product of choice in and around schools?  Will the American juul craze become more widely accepted and entrenched among teens here in Canada? Should we be focusing so much on stamping out vaping or on convincing students to stop smoking, whatever the substance? Will the legalization of marijuana only compound this problem for teachers and school administrators? 

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