We are hard pressed to open a newspaper or turn on the news and not hear the latest statistics on vaping. It is hard to imagine that more than 5 million young people are currently using electronic-cigarettes or vaping, and 1 million are using these products daily. The growth of e-cigarette use among Kentucky middle and high school students has also skyrocketed, for instance, with 14% of our eighth-graders and 27% of our high school seniors reporting current, past 30-day e-cigarette use.
These products are setting up future generations for a lifetime of dependence and health risks if we do not implement innovative higher ed institution-, school- and community-based prevention and treatment efforts immediately.
If young people are using e-cigarettes, support is essential to understand how their dependence may affect their life now and in the future.
According to the Centers for Disease Control and Prevention, there have been 2,668 cases of e-cigarette, or vaping, product use-associated lung injury (EVALI) from 50 states, the District of Columbia and two U.S. territories (Puerto Rico and the U.S. Virgin Islands). Of these cases, 60 resulted in death. Even though much of the focus has been on products containing THC (the active ingredient of cannabis), the risk for those using e-cigarettes with nicotine cannot be overlooked.
E-cigarettes and dependency
Many people are unaware that e-cigarettes are considered a tobacco product, although they are regulated as such by the Food and Drug Administration. Vaping is the use of an e-cigarette product that works by heating e-liquids to form an aerosol, which is then inhaled. It is not water vapor, but aerosolized particles, which can also exacerbate respiratory symptoms among nonusers who are exposed to secondhand aerosol, similar to secondhand smoke. E-cigarettes can contain various substances, including flavorings, toxic chemicals and high levels of nicotine.
A young person’s exposure to substances like nicotine can easily cause dependency and affect many parts of the brain, including the areas responsible for impulsive decision-making, logical thinking, learning, memory and attention. In addition, use of e-cigarettes has been associated with future use of other tobacco products. According to the surgeon general, current youth e-cigarette users are four times more likely to use combustible cigarettes. This increased risk of dual use is problematic considering the potential for increased risk of dependency—not to mention risk for morbidity and mortality.
Higher ed administrators, faculty and staff play an integral role in combating the youth e-cigarette epidemic, including watching for signs of use, providing a supportive environment for those who are already dependent, and keeping up with the times. E-cigarettes can be found in a variety of forms, some of which look like traditional cigarettes or cigars, while more recent generations look like pens or USB drives.
Many young people are now switching to disposable e-cigarettes, which are taking advantage of a loophole in the recent flavor legislation, selling fruit and candy flavors that are known to attract young people. That attraction is often fueled by catchy advertising that aims to reinforce the social appeal of these products. Advertising has often been used to recruit “replacement” smokers over the years, targeting teenagers specifically, so we have seen this before.
Prevention is critical. We cannot assume that a one-day presentation, for instance, is going to reverse this epidemic. Prevention needs to be supported by:
- integrating evidence-based, skills-based substance use (including tobacco and e-cigarettes) prevention on campus
- creating open lines of communication and support systems
- engaging (and educating) parents, advisory councils, administrators, health care providers, and all others who interact with young people in the conversation
- empowering students with opportunities to learn more about the issue, problem-solve and develop action projects on campus to make a difference
If young people are using e-cigarettes, support is essential to understand how their dependence may affect their life now and in the future. Put them in touch with relatable quitting resources and be a shoulder to lean on when needed. This is not the place for judgment or blame, but the time to practice empathy and open dialogue. What makes it difficult for them to quit? What can you do to support them? How can higher ed institutions create an environment that is conducive to quitting?
More information on available resources can be found through the KY State Tobacco & Prevention Program, for instance. Kentucky has also invested in My Life, My Quit that will connect young people to a “quit coach,” who will provide free, confidential and real-time support.
The risks posed with youth e-cigarette use are unnecessary and avoidable, and it is time to do our part in stopping this epidemic. We have a chance to speak up for our young people and advocate for strong flavor policies, comprehensive smoke-free community policies that include e-cigarettes, and funding for prevention and treatment.
Melinda Ickes is associate professor of health promotion at the University of Kentucky College of Education. Jim Pauly is on the faculty at the University of Kentucky College of Pharmacy. Beth Magner holds a Doctor of Pharmacy degree and is a University of Kentucky College of Pharmacy community resident.