For decades schools have been on the front lines in a successful campaign to reduce teenage cigarette smoking. Now, some educators find themselves developing policies to control students’ use of e-cigarettes, devices which are still unregulated at the federal level that many fear could revive smoking among adolescents.
Otherwise known as “vape pens,” “cloud pens,” and by other names, e-cigarettes are undoubtedly catching the eye of teenagers, and of even younger children. The Centers for Disease Control and Prevention reported in 2013 that the percentage of students in grades 6-12 who had tried e-cigarettes more than doubled between 2011 and 2012, growing from 3.3 percent to 6.8 percent. About 160,000 of the 1.78 million students who had experimented with electronic cigarettes as of 2012 had never used conventional cigarettes.
Thirty-eight states prohibit the sale of the product to minors, but e-cigarettes and other Electronic Nicotine Delivery Systems (ENDS), aside from those marketed for therapeutic purposes, are unregulated by the U.S. Food and Drug Administration. A rule proposed by the FDA on April 24, if passed, would include devices like electronic cigarettes under the category of tobacco products, allowing them to be regulated as such. The comment period for the proposed rule ends August 8.
Appeal for Youth
Electronic cigarettes’ attractiveness to a young market may be due to several factors. Solely based on aesthetics, the sleek battery-operated cigarette, which houses an atomizer that vaporizes a liquid form of nicotine and other chemicals, is a far cry from its tar-and-ash predecessor. The liquid inside e-cigarettes comes in individual cartridges, frequently with a flavoring such as chocolate, peppermint, or piña colada.
“We know from past experience with other tobacco products that flavoring can mask the harshness of these products and make them appealing and enticing,” said Brian King, a senior advisor in the CDC’s office on smoking and health. “In 2009, the Food and Drug Administration banned characterizing flavors in regular tobacco products, but e-cigarettes can still be sold with flavors.”
Though many specialty “vape shops” will not sell electronic cigarettes to minors, independent sellers like eBay make it possible for children under 18 to purchase these products.
Vic Vega, the owner of Vapor Villa in Catonsville, Md., maintains that his store does not sell to minors, but acknowledges that children buying e-cigarettes online is a reality.
“We haven’t had many younger children come into the store,” Mr. Vega said, but “we are aware that many of them turn to independent sellers.”
Also, because e-cigarettes are not yet considered tobacco products by federal authorities, marketing campaigns for the devices are not restricted, unlike those of traditional cigarettes. And educators and law enforcement officials have noted that e-cigarette advertisements, often featuring celebrities and even children’s characters, are using some of the same tactics that once drew teenagers and young adults to smoking.
“It’s kind of a wild, wild West in terms of regulations. Big companies can have a billboard with Santa Claus on it, or other child-friendly characters, promoting e-cigarettes,” said Stacy Deeble-Reynolds, the prevention coordinator for the Orange County Department of Education, an agency that provides support services for 27 school districts and over 500,000 students in southern California. “Hopefully, with more restrictions on ads, that will curb some of the appeal for young people.”
Gathering Evidence
The federal government’s slow response is due in part to a lack of sufficient longitudinal data on e-cigarettes’ potential health effects. Usage of the product began gaining momentum in the United States around 2009, making it difficult to garner long-term evidence of electronic cigarettes’ health implications. What is known, however, is that nicotine, the addictive ingredient in tobacco products, is a major component of most electronic cigarettes.
“We know that nicotine has adverse health effects on the adolescent brain,” Mr. King said. “A lot of these products are advertised as containing no nicotine, but laboratory testing has shown that they actually do.”
Nicotine may not be the only chemical an e-cigarette user inhales. Besides nicotine, some contain “potentially hazardous chemicals like metals, low-level nitrosamines, [and] formaldehyde,” according to Mr. King.
Others see the health implications of e-cigarettes in a different light. Phil Daman, the president of the Smoke Free Alternatives Trade Association, based in Washington, said that he has seen the positive impact of the devices in the lives of some adult smokers.
“I saw this as a really transformative product because a lot of my family died from smoking traditional cigarettes,” Mr. Daman said. At the same time, he added, “we don’t think it’s appropriate to have minors using a product that is really for adults. We’re on the conservative side there, and we don’t think kids should be puffing on these devices.”
Though SFATA supports any federal legislation that would prevent minors from purchasing e-cigarettes, Daman does not view vaporizers as simply tobacco products, but rather as a “product category” of their own.
School Regulations
As more adolescents start using electronic cigarettes—often on school property—school districts and administrators scramble to adjust pre-existing tobacco-free policies to encompass the newer product. Though many states prohibit the sale of electronic cigarettes to minors, no specific guidelines are provided for districts to follow in dealing with students who bring e-cigarettes on campus, leaving schools to use their discretion in deciding the appropriate punishment.
On school campuses in Orange County, Calif., for example, no types of ENDS are allowed on the premises. If students are found with this type of device, it is confiscated and further measures are taken. Most likely, the school will put the student, and frequently the parents, in informational classes that caution against the dangers of e-cigarettes. Cessation services are also provided to help students quit.
This past February, the Orange County education department and the Orange County Sheriff’s Department also hosted an event to raise educators’ awareness about the prevalence of e-cigarettes in schools and their known health effects.
Information about e-cigarettes is crucial for all age groups, according to Ms. Deeble-Reynolds; she said students as young as 5th grade have been found on school grounds with e-cigarettes in some of the districts with which she works.
“We want to educate and help [children caught with e-cigarettes] understand that they are going against school policy,” Ms. Deeble-Reynolds said.
Many other schools across the country have adopted new rules on e-cigarettes and ENDS, often following suit after state regulations were passed. Some school districts, such as those in Florida’s Miami-Dade County, did not wait for their state to provide guidance; instead, they worked pre-emptively to augment their own policies to include e-cigarettes.
Miami-Dade, the nation’s fourth largest school district with 345,000 students, added specific language to its tobacco-free rules in fall 2013 so as to adequately cover electronic cigarettes. Walter James Harvey, the school board attorney for Miami-Dade, is confident that their policies are now comprehensive enough to include existing ENDS and “products of this type that may become popular in the future.” Under the revised policy, students caught with e-cigarettes are given an “alternative to suspension,” or educational classes on the effects of the devices, according to Mr. Harvey.
Another aspect of electronic cigarettes that worries parents and school administrators is their ability to function as drug paraphernalia.
“We have heard reports from states and localities that youths are putting other psychoactive substances into these products,” Mr. King said. “The most prominent we’ve heard is THC, the active ingredient in marijuana.”
Anecdotal evidence from schools nationwide indicates that some students have used e-cigarettes to smoke cannabis, hash oil, and other illegal substances while on school campuses.
“I work closely with the Orange County Sheriff’s Department, and a lot of the e-cigarettes with illegal substances in them that the department confiscates are right from middle schools or high schools,” Ms. Deeble-Reynolds said.
Moving Forward
Meanwhile, researchers work toward finding more concrete evidence about the effects of electronic cigarettes. The Population Assessment of Tobacco and Health, an FDA and NIH longitudinal study currently in progress, includes a section on e-cigarettes and is expected to be completed in 2016.
In a study that was published June 30 in the Journal of the American Medical Association, researchers warn that there is “a major risk that e-cigarettes will revive the popular smoking culture that has taken decades to dismantle.” It advises the FDA to move quickly and pass regulations that can prevent the spread of e-cigarette use among adolescents.
However, Mr. Daman predicts that vaporizers’ continuing popularity will spur innovation in the safety of these products.
“We want to make sure that this technology isn’t the type that kills you, it’s the kind that helps people,” he said.
Until further evidence on electronic cigarettes is released or federal regulations are passed, many schools seem to be treating the devices with caution. Said Ms. Deeble-Reynolds: “We don’t want students to be a part of longitudinal studies and be continually smoking these devices, then 20 years down the road not be able to do things like play soccer with their kids because they can’t breathe.”
