They’re vaping in bathrooms, lunchrooms and hallways. They’re even vaping up the sleeves of their sweatshirts in the middle of class — and most of the time, it’s undetectable.
In 2016, former Surgeon General Vivek Murthy declared vaping, or electronic cigarette use, by young adults as a nationwide epidemic. As its popularity skyrockets, public health advocates are scrambling to spread the word about the nastier truths of the drug trend.
“With the internet and the advertising of these e-cigarettes, it doesn’t matter if you’re living in a rural or urban community. It’s here. Every school we work with is having problems. Kids are using them at an alarming rate,” says Tobin Lee, regional tobacco prevention manager at Western North Carolina nonprofit MountainWise. “The problem with vaping is that it doesn’t have the same social barriers that cigarettes did. There’s not a special type of kid that’s vaping. Everyone is doing it.”
High school students have witnessed vaping’s popularity firsthand. “It’s like 90% of the school. In the bathrooms, even in class. Some will do it right in front of their teacher. It’s getting really popular,” says an A.C. Reynolds High School senior named Bella, who asked Xpress to use her first name only.
“I have friends that are addicted to nicotine and vape all the time. And now, it’s almost not a big deal to be addicted. It’s so prevalent,” says Sawyer Taylor-Arnold, a senior at Asheville High School.
“There’s a lot of people who can’t focus in class, and they’ll have to go to the bathroom to use it,” adds another Asheville High senior, John Kelly Douglas. “I mean like every period, constantly throughout the day. It’s pretty disruptive.”
From 2011-2017, the use of e-cigarettes by North Carolina students has increased 894% for high schoolers and 430% among middle schoolers, according to the 2017 North Carolina Youth Tobacco Survey. In contrast, the number of traditional cigarette smokers who have used within 30 days has decreased or remained largely unchanged over the same period. Moreover, the National Youth Tobacco Survey found that the number of high school students who had used e-cigarettes at least 20 of the last 30 days rose from 20% to 27.7% from 2017-18.
The most popular device on the market is the Juul, whose manufacturer, Juul Labs Inc., ended 2018 with over 75% of the e-cigarette market and more than $1 billion in revenue. Its sleek and unassuming profile, no larger than a thumb drive, allows users to hide it in plain sight.
Juul pods, the disposable cartridges heated to create inhalable vapor, have some of the highest levels of nicotine among e-cigarettes. Fragrant flavors such as mango and creme have also helped the brand attract underage consumers, although as of November, Juul has removed most flavors besides mint, menthol and tobacco from physical stores.
“I hate to say it, but I don’t think it’s going anywhere anytime soon,” says Ryan Stevens, a physical education instructor and baseball coach at A.C. Reynolds. “At least once a day in the gym, there’s vapor that’s not caught but smelled. As teachers, we have to roam around and make sure they’re not getting a quick hit or puff in the stairway.
“I’ve heard kids say it’s not as bad as smoking a cigarette. I think that’s the stigma with our students. It’s easier to hide, and they’ve been told it’s not as bad,” Stevens adds.
Because the average Juul pod contains roughly the same amount of nicotine as a pack of cigarettes, users with developing brains are at a high risk of becoming addicted. The surgeon general reports that nicotine use at a young age can result in reduced impulse control, deficits in attention and cognition, mood disorders and a higher likelihood of using other addictive substances. Aerosol inhaled from e-cigarettes can also include diacetyl, a chemical linked to serious lung disease; heavy metals such as nickel, tin and lead; and benzene, which is found in car exhaust.
“We probably won’t know for 5-10 years the more long-term effects of the chemicals in the cartridges. But you can take a good guess,” says Lee. “Early data is showing it’s irritating lungs on a cellular level. There’s the risk of abnormal growth … developing chronic diseases like emphysema and heart attack and stroke. All these products have the potential to do that.”
The federal Food and Drug Administration has cracked down on e-cigarette manufacturers and retailers by restricting the availability of flavors in brick-and-mortar locations, enforcing more stringent labeling and holding retailers more accountable. State Attorney General Josh Stein also recently announced a lawsuit against Juul Labs that cited the company’s “youth-focused business strategy.” However, much of the responsibility to fight youth vaping still falls into the hands of regional organizers and educators.
“I think there’s a lack of education on both sides. Teachers don’t know how to recognize it, and students don’t necessarily know what they’re putting in their body,” says Taylor-Arnold, who collaborates with Douglas at Youth Empowered Solutions, a statewide youth-led advocacy group that has worked to inform young people about the dangers of vaping.
The story is all too similar to the battle against Big Tobacco — which perhaps makes it unsurprising that Altria, the company behind Marlboro cigarettes, owns 35% of Juul, giving it a minority stake in the dominant e-cigarette supplier.
Lifting the cloud
In March, the Asheville cohort of YES! created an Advocacy from Afar toolkit that includes sample social media posts, graphics, templates for calling and emailing representatives and tips for adult allies. The campaign’s hashtag, #TobaccoTargetsMe, aims to highlight how tobacco companies exploit youths of different races, sexual orientations and other backgrounds.
“Education is the most important part. You can add harsher disciplinary actions, you can change the signs and rules, but it doesn’t matter if students aren’t educated about what they’re doing,” says Taylor-Arnold.
Students at Western Carolina University have taken a similar approach, developing a campaign that uses video, augmented reality and campus spaces to spread information to first-year college students, many of whom are vulnerable to picking up the habit or have already been vaping since high school. The campaign, developed in partnership with MountainWise and Candler-based tech company WNC Digital, is part of a public relations course taught by Betty Farmer, WCU professor of communication and public relations.
“One of the big things the campaign covers is the fact that vaping is not as cool or clean as you think it is,” says Shaina Clark, communications and development coordinator at MountainWise. “And not to be a test dummy or guinea pig because you don’t know all that’s happening.”
A video produced by WCU students highlights the unattractive realities of vaping from the perspective of onlookers. At a recent Clean the Air event hosted by WCU Residential Living, students also gave out T-shirts with a Zappar code produced by WNC Digital that, when scanned with a smartphone, links to an augmented reality experience that includes the video, a student-made infographic addressing e-cigarette misconceptions and other helpful information.
“We’re competing now in the marketplace of ideas, from individuals who are not informed, to e-cigarette marketers and advertisers, to people like MountainWise who have information to share. To be able to cut through those competing messages is challenging for people. That’s one of the reasons we thought the augmented reality would be particularly engaging to college freshmen,” says Farmer.
“The idea that any one entity working alone is going to be able to solve this or any other public health issue is probably naive,” Farmer continues. “So we need to coordinate, collaborate and communicate.”