Fall 2019

Trump moves to ban flavored e-cigarettes | ABC News

The FDA said the move would mean "clearing the market of unauthorized, non-tobacco-flavored e-cigarette products."

The Student Vaping Crisis: How Schools Are Fighting Back

By Denisa R. Superville and Arianna Prothero with EdWeek/August 27, 2019

With reports of at least one death linked to vaping and dozens of cases of teens and young adults recently hospitalized, school leaders are starting the new academic year even more anxious about the “epidemic” of e-cigarettes. They are vowing to intensify prevention and treatment.

Many administrators were caught flat-footed as the vaping trend started to take off several years ago—including stealth use of the sleek products in class—and tried to stem the problem with a hodgepodge of approaches, from strict zero-tolerance policies that came with mandatory suspensions for students caught vaping or with vaping paraphernalia on campus, to programs that teach high school and middle school students the dangers of vaping.

But educators had already started to reconsider their disciplinary approach before the rash of new medical concerns.At Arrowhead Union High School in Hartland, Wis., about 27 miles from Milwaukee, administrators installed devices in the bathrooms over the summer that detect vaping and automatically send email alerts to the associate principal. And high school students trained in prevention education will be deployed to the middle schools to talk to younger students about the dangers of vaping, according to Principal Gregg Wieczorek.

"I would rather convince a kid to not start, than to ever have to convince them to stop," Wieczorek said.

The Boulder County, Colo., district has moved from letting individual schools decide how to handle such incidents to developing a community-wide approach that now stresses prevention efforts, including education for students about the risks and how to make good decisions, and informational parent nights that feature the county's public health department, law enforcement, local doctors, and experts. They are also working with local physicians to ask screening questions during regular check-ups.

About 33 percent of Boulder Valley high school students vape.

The district is backing a series of measures before the Boulder City Council that would ban the sale of flavored nicotine and tobacco products, increase the minimum age to buy nicotine and tobacco products from 18 to 21, and push a voter-approved city sales tax on such products.

"It's really much more of a coordinated community effort," said Stephanie Faren, the director of health services at the Boulder Valley school district. "[W]hether it's parents, or providers, or community businesses, we want to do what's best for the youth in our community. We have to think about this rationally and thoughtfully and we have to put something together that's coordinated and collaborative."

It's a tricky balance for school districts as they weigh sending a strong message to students that vaping and nicotine use will not be tolerated on campus, while also recognizing that students need help to understand the potential health consequences and available treatment options if they become addicted.

Looming Health Effects

Educators and health experts worry about the long-term effects of nicotine on students' developing brains. And there are added concerns in states where marijuana has been legalized that students may now have easier access to the drug, which can be used with easily concealed vape devices. Educators are not as likely fooled by the products as they were a few years ago, but still feel they are playing catchup.

"It's been a challenge for us administratively in all of education, and it's a challenge in society," said J. Eric Diener, the principal of Eisenhower High School in Yakima, Wash., where tobacco or marijuana use more than doubled between 2017 and 2019 and the confiscation of illegal devices like vapes went from just four in the 2017-18 school year to 36 in 2018-19.

Experts agree that vaping is harmful to students' bodies and brains. There are toxic chemicals and metals in many e-cigarettes, and vaping can cause respiratory issues, and potentially cardiovascular problems, and even seizures. The nicotine itself is much more concentrated in e-cigarettes than traditional ones.

"Nicotine will actually alter the structure of a developing brain, and we have no idea what that will do in the long run," said Robert Klesges, a professor at the University of Virginia Cancer Center. "[A]ll the adverse health consequences that we know about in e-cigarettes are short-term health consequences, and it will be 30 to 40 years before we know how dangerous e-cigarettes are."

But many teens are not aware of the hazards of vaping. Sixty-six percent of teens believe their e-cigarettes contain just flavoring, according to the National Institute on Drug Abuse.

"They may not know that they contain harmful substances such as nicotine, lead, and cancer-causing chemicals," said Ashley Merianos, an associate professor at the University of Cincinnati. "They have been marketed to youth as fun [with] cool flavors such as bubble gum or candy."

Counseling vs. Fear Tactics

Another thing that has health and addiction researchers worried is that a significant number of teenagers who start vaping—30 percent according to the National Institute on Drug Abuse—progress to traditional cigarettes within six months. "We don't know why exactly," said Alison Breland, a research professor in Virginia Commonwealth University's psychology department.

But scaring students off that path doesn't work, said Faren.

"I am a firm believer that fear tactics [like] 'If you do this, you are going to be doing heroin next week.' Kids … they'll just laugh at you," said Faren.

For Merianos, who specializes in adolescent substance use prevention, education and counseling, at least in conjunction with discipline, are important tools.

"The reason why is, if students are suspended and they aren't being educated, I'm not sure if they're not going home and Juuling, for example, if their parents are off at work," she said.

But educating today's teens on the harmful effects of vaping may be more complicated than that of regular cigarettes and chewing tobacco—which are unequivocally bad for everyone. E-cigarettes are generally believed to be better than smoking regular cigarettes for adults, and as a pathway to quitting. That contradiction—that e-cigarettes are bad for some but may be good for others—makes messaging around e-cigarettes difficult, say Klesges and Breland.

Parents are key allies and have to set the tone at home that there’s a zero-tolerance policy for drugs, school officials say.

“This is not a one-time lecture and then it’s done,” Wieczorek said. “This has got to be ongoing, because kids are going to be tempted. Kids do what their friends do, we know that.”After hearing from principals that they need help dealing with “blatant” incidents of vaping, including an instance where students had videotaped themselves vaping on campus, the Horry County school district in South Carolina will have a mandatory three to five days out-of-school suspension for the first offense if they are found with e-cigarettes or smoking-related devices.

Tobacco violations in the district, which include using e-cigarettes, more than doubled over two academic years, jumping from 427 incidents in the 2017-18 school year to 1,030 in the one recently completed.

“They [principals] wanted more teeth” to the policy, “and a little bit more flexibility,” said Lisa Bourcier, a district spokeswoman, who added that education and cessation have always been part of the district's response.

And last month, Florida's Hillsborough school district and the sheriff's office launched a public service campaign called "Put Down The Pen" to urge students to stop vaping. It highlights some of the consequences they could face if they are caught.

In addition to suspension, students face a possible felony charge if the liquid in the vape pen includes a banned substance like tetrahydrocannabinol (THC), an ingredient in cannabis.

"We want to educate them so that all of the students know the discipline they may face in school, but, also if it rises to the level, how it can affect their futures if law enforcement gets involved," Hillsborough spokeswoman Tanya Arja said.

But not all educators think that heavily punitive measures like suspension alone are the right way to deal with this issue.

In the Arrowhead district in Wisconsin, for example, even the threat of being suspended from school sports did not prevent athletes from vaping on campus.

Diener, the principal in Yakima, Wash., also tried a largely punitive approach: mandatory suspensions, locking bathrooms students congregated in, and setting up an anonymous tip line for students to report others who had vapes or who were selling them on campus.

"I do believe that that system is not effective," said Diener, who noted that suspensions did not reduce the number of vape-related incidents in his school as it had with fighting and other infractions. "We need to look at how we educate our kids at a younger age and how we get them help and treatment."

This fall, he plans to work with the district's drug and alcohol counselor to help students who are addicted get treatment, including connecting them to off-campus facilities if necessary. He will also focus more on parent and student education. And the harms of vaping will be included in the school's advisory course, which generally focuses on helping students prepare for life after high school.

"If you are not healthy, you are not going to meet your goals after high school," Diener said.

Parent Support Needed

That's the kind of comprehensive approach that Faren and school nurse Elizabeth Blackwell have been developing in Boulder Valley over the last two years.

When Blackwell started as a nurse at Fairview High School, she was met with an "explosion of vaping incidents" and a dean who wanted to know what they were going to do about it.

They started with informational letters to parents—a simple but important step because many parents did not know about the prevalence of vaping, were not talking to their children about vaping, or did not know the most effective ways to do so.

They organized professional development for nurses, school counselors, and teachers. A lot of it was simple and basic, such as explaining the types of devices, how students are able to conceal them, and the vocabulary that students use. But they also delved into the health effects and how to refer students for treatment.

At the time, Fairview had a three-day out of school suspension policy for students caught with e-cigarettes.

Blackwell introduced a screening, intervention, and referral program to reduce the time students were out of school. Suspensions for nicotine infractions were moved to Saturday school, and students were able to take an online course to learn about nicotine products and addiction.

Students were not always receptive or were dismissive of the concerns over vaping.

That start at Fairfield evolved into a collaborative district approach to develop both prevention and awareness strategies that included the school community and the city.

This spring the prevention program was expanded to the elementary school level, where students are taught about making good decisions, how to question advertising for e-cigarettes, and how to say no to vaping.

"There is a perceived notion that that risk is less than … 'snorting cocaine or heroin,'" Blackwell said. Students argue, " 'Yes, I am young, and yes, I know there are dangers associated [with it], but I get to make my own choices.' "

But it was from students that they learned that high school is too late to start talking about vaping, and that parents were not talking about it at home.

It will be another year before Boulder Valley obtains data from the Healthy Kids Colorado Survey to know the full impact of their efforts. But they are confident that their collaborative approach with the city and community groups is having an impact.

"Certainly the amount of awareness for staff and the teachers and the students and the parents increased from when we started," Blackwell said. "I do think that knowledge is power, and I do think that information is important."

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An Illinois patient’s death may be the first in the U.S. tied to vaping

The individual was among 193 people who have reported lung injuries linked to e-cigarettes

By Aimee Cunningham / AUGUST 23, 2019 AT 6:24 PM / Science News

The death of an Illinois resident may be the first in the United States linked to vaping, state health officials announced August 23. The adult was among 193 patients who have been hospitalized nationwide with severe lung injuries. Although investigators don’t know the cause of the illnesses, which have been reported in the last two months, all of the patients had vaped.

All of the patients had reported using e-cigarettes before developing symptoms, such as shortness of breath and chest pain (SN Online: 8/22/19). Most of the cases have been among adolescents and young adults. Many of the patients also said that they had used products containing tetrahydrocannabinol, or THC, the psychoactive ingredient in marijuana, in the lead-up to their illnesses.

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Vaping is suspected in a fifth death and hundreds of injuries

It’s unclear what e-cigarette device or product may be driving the growing number of cases

By Aimee Cunningham / SEPTEMBER 6, 2019 AT 6:16 PM
Federal and state officials can’t yet point to one substance or device that’s behind a rising number of severe lung injuries and deaths tied to vaping.

U.S. health officials have now reported five deaths from severe lung illnesses tied to vaping, with 450 possible cases of these lung injuries reported in 33 states and one U.S. territory. That’s more than double the 215 cases reported a week ago.

It’s unclear whether a particular substance vaped or a type of vaping device is behind the illnesses, federal and state health authorities announced September 6 in a news conference. “So far, no definitive causes have been established,” said Dana Meaney-Delman of the lung injury response group at the Centers for Disease Control and Prevention in Atlanta.

For now, federal health officials are urging people not to use e-cigarettes, and say that vaping is especially harmful to youth, young adults and pregnant women.

The New York State Department of Health is eyeing one possible suspect substance, saying on September 5 that high levels of vitamin E acetate had been found in some vape products containing cannabis. Vitamin E acetate is a dietary supplement and ingredient in some skin care products, but could be toxic when inhaled.But it is still too early to focus on any one substance, federal officials cautioned in the news conference. The Food and Drug Administration is testing more than 120 samples from vaping products for a broad range of chemicals, including nicotine and tetrahydrocannabinol — the psychoactive ingredient in marijuana known as THC — as well as various diluents and additives and even pesticides and opioids. “The samples we’re continuing to evaluate show a mix of results, and no one substance or compound, including vitamin E acetate, has been identified in all of the samples tested,” said Mitch Zeller, director of the FDA’s Center for Tobacco Products in Silver Spring, Md.

The severity of the cases — including the deaths in Illinois, Oregon, Indiana, California and Minnesota — has caused alarm within the health community (SN: 8/23/19). The deaths in Indiana, Minnesota and Los Angeles County were all reported September 6.

The New York State Health Department announced September 5 that they were focusing their investigation of severe lung injuries related to vaping on vitamin E acetate, found in samples from some analyzed products, including these pictured.

The same day, doctors and health officials from several U.S. states also released a series of new studies sharing information about some of the patients and their symptoms. In Wisconsin and Illinois, 53 cases of severe lung illness reported as of August 27 largely involved young people who were otherwise healthy before falling ill. The vast majority of those patients — 83 percent — were male, and nearly a third were younger than 18. Almost all of the patients were hospitalized (SN: 8/2/19), with about a third needing ventilator support to breathe. Of 41 patients who gave detailed interviews, 61 percent had used nicotine products in their e-cigarettes, and 80 percent had used THC products. Nearly half had used both, the officials report in the New England Journal of Medicine.

In North Carolina, five patients with illnesses potentially linked to vaping developed a noninfectious form of pneumonia, researchers report in the CDC’s Morbidity and Mortality Weekly Report. All five said that they had used THC concentrates or oils purchased on the street in their e-cigarettes. Clinicians diagnosed lipoid pneumonia in the patients, which occurs when oils or fat-containing substances enter the lungs and provoke inflammation.

Lungs aren’t designed to handle the onslaught of chemicals and toxicants that can be inhaled while vaping, says Illona Jaspers, who studies inhalation toxicology at the University of North Carolina School of Medicine in Chapel Hill. And substances that are considered safe to eat, such as vitamin E acetate or the flavors added to vaping liquids, can pose risks to the lungs. “When you change the route of exposure, you are changing the potential for toxicity,” she says.

Even if vitamin E acetate were identified as a culprit in these lung injury cases, there are other substances inhaled during vaping that could harm lungs, Jaspers says. “Heavy vapers who got scared by all of this may now have this false sense of security, saying ‘oh, I’m not doing the vitamin E stuff, so I can continue.’ ” That, she says, “is a bad idea.”

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