*All student names in this article have been changed.
The scent comes first—sweetly intoxicating, enticing and pervasive. But it’s a dangerous lure. Stepping foot into any East restroom, smoke billows from students’ mouths in plumes.
Skipping class, they gather in empty stalls to inhale the insidious vapor deeply into their lungs. The source: small, inconspicuous devices appearing similar to a USB flash drive, easily hidden in pockets or backpacks. These battery-powered gadgets heat a liquid and produce an aerosol that sends a temporary buzz through the nervous systems of users.
It’s the highly addictive qualities of e-cigarettes—also known as “vape pens” or “e-cigs”—that ensnared nearly 3.6 million youth in 2020 in a vicious cycle of nicotine-based flavorful fantasies, producing one of the most serious health crises plaguing adolescents today: the youth vaping epidemic.
Vaping doesn’t stop during class, nor does it stop during a pandemic. Nationally more than two million middle and high school students reported using e-cigarettes in 2021, with nearly 85 percent using flavored e-cigarettes, according to the CDC.
“It’s hard sometimes to think beyond ‘I’m looking cool with my friends,’ and to conceptualize that if you keep doing that, then you may get addicted to it,” said school nurse Quinn Campbell, who also works as a clinical oncology nurse at UNC Medical Center. “Nobody ever intends to get addicted. But it happens over time. And it can become very, very hard to stop. And that whole time, the damage is real.”
While touted as a safer alternative to smoking, emerging research demonstrates that the inhaled vapors contain harmful elements not found in traditional cigarettes, including heavy metals, volatile organic compounds and ultrafine particles.
Whether as a coping mechanism or a result of social influences, vaping has gained a sustained presence on campus.
“I certainly think we have a real problem at East with vaping,” one sophomore said. “Especially because there’s so many students just accustomed to doing it, and most of them are underclassmen… It’s just continually getting worse.”
Students’ dependency on e-cigarettes is apparent.
“My friends are all addicted,” sophomore Maddie Lucas said. “They literally whip out their vapes in front of the teacher, like in my chemistry class. I’ve seen them try to hide it beneath their sleeves, and I’m just like, ‘Are you okay?’”
In the girls’ bathroom, two students recently exchanged comments about vaping between taking drags on their vape pens.
“Maybe [teachers] think it’s a little weird there is smoke coming out of their [students’] mouths, but they don’t care or do anything about it,” one student said.
Her friend added, “Maybe teachers are like, ‘No way kids are actually doing it in class.’”
In addition to the harmful effects common to all vapes, marijuana, which has many known adverse health effects, is gaining in popularity as an additive to vapes, according to a 2019 survey conducted by Monitoring the Future. This study also found that teenagers who use e-cigarettes often end up smoking regular cigarettes. The chemical ambiguity of many vaping products further compounds their potential risks.
“One of the biggest challenges that our students face every day is making good decisions. ‘What do I put in my body? If I’m going to smoke, what type of smoke? If I’m going to take pills, is it ibuprofen or is it something else?’” Campbell said. “The big variable that I’m seeing with our students is that when you buy something from Joe at the park across the street, you don’t know what you’re buying. And then you get a ‘bad batch.’ What did Joe put in that? Is it laced with something to make it go further, or is it synthetic? You just don’t know what you’re getting.”
Originally marketed to adults seeking to quit cigarettes, vaping presents a unique public health conundrum, forcing physicians and policymakers to reconcile competing concerns. While adults with lung disease from decades of smoking may benefit by replacing traditional cigarettes with e-cigarettes, adolescents are increasingly exposed to the dangers posed by this new nicotine delivery mechanism. Research studies have shown multiple pernicious effects of vaping, including impaired neurological development that can impact attention, learning, and mood and impulse control.
In 2019, an outbreak of acute lung disease among previously healthy adolescents, several of whom required lung transplants, baffled doctors until it was finally determined to be a serious new disease linked to e-cigarettes—e-cigarette or vaping use-associated lung injury, or EVALI. The CDC identified the vitamin E acetate commonly found in THC-based vape fluids as a main culprit.
In addition to its potentially lethal effects, vaping can cause symptoms such as shortness of breath. School social worker Melissa Breaden, who serves as East’s facilitator for the Student Assistance Program (SAP), which supports students with vaping and other substance abuse-related issues, recalls helping a student athlete who had started vaping due to peer pressure. After several sessions together, the student stopped vaping.
Breaden said that the student recognized that “vaping affected their lungs and their athletic performance” to the extent that “when the student started to work out again, they realized that they had to build back that lung capacity.”
“There are a lot of different reasons students vape,” Breaden said. “First we look at why they vape and then we look at what else is going on in their life. What other stressors are occurring? How is vaping an escape? And then we ask, ‘How do we replace those behaviors with something else?’”
Decades ago, Big Tobacco advertised to their parents and grandparents, but today, youth are the primary targets for vaping companies like Juul and Puff Bar, which capitalize on their vulnerability to reap billions of dollars in revenue each year. Mimicking the allure of candy, Puff Bar and others advertise sweet and fruity flavors like “Cool Mint,” “O.M.G” (Orange, Mango, Grapefruit) or “Pink Lemonade.” A JAMA survey of youth aged 12 to 17 years found that most used a flavored product, indicating the industry’s targeting of youth was effective.
“We know that a lot of the adults who smoke cigarettes today or vape started in high school,” Campbell said. “In my day, it was smoking cigarettes that somebody stole from their parents in the bathroom or behind the school bleachers, and 30 years on, things haven’t changed a lot. But the variety and the intensity of what’s available to high school students today is different from what was available to me as a high school student.”
Last summer, amid a spate of lawsuits filed by states, municipalities and school districts nationwide, North Carolina was the first to reach a settlement with Juul, a breakthrough case that could set a precedent for future agreements. Even still, the $40 million settlement, which forces Juul to stop its deceptive advertising and funnel profits toward youth e-cigarette prevention programs, must be accompanied by vigorous FDA enforcement, public health experts emphasize.
“Not until 2018 did vaping products actually gain the label ‘Warning: Nicotine is an addictive chemical.’ For many years, e-cigarettes had no warning messages at all that were required from the FDA. On current products, there’s no warning about the effects upon your lungs,” said UNC Hussman School of Journalism and Media professor Dr. Seth M. Noar, who studies health communication and messaging to prevent youth vaping. “I don’t think youth are as informed as they should be. Many messages should be out there, yet there are hundreds that shouldn’t be.”
Funded through grants from the National Institute on Drug Abuse and the FDA, Noar’s research determines the types of messages used to prevent youth vaping, paying close attention to the effects of vaping on teenage mental health and brain development.
“We know a lot about what kinds of messages discourage cigarette smoking, but there have not been that many studies on messages to discourage youth from vaping,” Noar said. “We’re really trying to understand what kind of messages resonate with youth and discourage vaping. The more that we can synthesize evidence, the more that we can develop messages and programs to educate young people about vaping, the better that we can ensure teens are well-informed, with sufficient information to make the best choice for themselves.”
Tobacco use remains the leading cause of preventable disease and death in the U.S., according to the Department of Health and Human Services and Office of Surgeon General and Smoking Cessation. CDC data indicates that if smoking continues at current rates, 5.6 million of today’s children—1 out of 13—will die prematurely from a smoking-related illness.
For Nurse Campbell, who lost her father to lung cancer and whose sister suffers from smoking-related lung issues, the dangers posed not only by smoking and vaping, but by using any addictive substance, are top of mind as she reflects upon the vaping epidemic at East.
“Maybe for some students, the events this year would help serve as a wake-up call,” Campbell said, referring to the emergency transport of two students to UNC Medical Center earlier this year for substance abuse, although unrelated to vaping. “One instance is already one too many—if we can prevent a death, if we can save a young life, that’s action we need to take. The need for prevention is imminent, but change will only come if we do something here and now.”
Photo courtesy of Vaping360/Flickr
