THE WORD ON DRUGS: The Kids Are Not All Right—Wyoming Teens Vaping Dangerous E-cigarettes at Twice the National Rate

By Ernest Beck

Special to the Wyoming Truth

As the nation grapples with several drug crises, including the fentanyl-fueled overdose epidemic, surging use of methamphetamines and the fallout from marijuana legalization, another critical public health issue has been sidelined: America’s youth vaping epidemic.

Nearly a decade after the first e-cigarettes entered the market, purportedly as a way for traditional tobacco smokers to quit, recreational vaping is still widespread among young people despite it can be addictive and lead to serious health problems.

Just ask any high school or even middle school student about school bathrooms that have become hangouts for vaping not only tobacco but even marijuana.

While the teen vaping rate has fallen since the height of its popularity in 2019, over 2.5 million young people in grades six to 12 in the United States reported using e-cigarettes in 2022, accounting for 14% of high school students and 3% of middle school students nationwide, according to the Centers for Disease Control and Prevention.

An effort to reduce tobacco smoking, which still causes some 480,000 deaths annually in the U.S., has been remarkably successful over the past decades, especially for youth. Smoking for this group fell to an all-time low of 2.3% in 2021 from nearly 23% in 2000, according to a University of Michigan study. Today, however, nearly 40% of all e-cigarette users nationwide are 25 or younger.

“It’s a huge problem,” said Guanglong He, an associate professor of medicinal chemistry with the University of Wyoming’s School of Pharmacy, who has studied the health impacts of e-cigarettes. His recent research shows that in addition to causing pulmonary damage by inducing fibrosis in the lungs, vaping any type of e-cigarette device can also lead to cardiac failure.

We already know that nicotine is highly addictive. E-cigarettes deliver a wallop too although without the tar: one liquid cartridge of a Juul e-cigarette, once the market leader, is roughly equal to smoking an entire pack of cigarettes, or some 200 puffs of a regular cigarette.

Nicotine exposure during adolescence can harm the developing brain and affect memory, concentration, learning, self-control, attention and mood, the American Lung Association reported. E-cigarettes can also irritate the lungs, throat and eyes. And young people who vape are more likely to eventually try traditional cigarettes because, as He put it, “the habit is built into the system.”

According to the Campaign for Tobacco-Free Kids, despite the sale, purchase and possession of e-cigarettes by anyone under 21 being prohibited by law in the state, nearly 30% of Wyoming high school students use e-cigarettes (about twice the national rate).

How did e-cigarettes become so popular among teens? “Young people think it’s cool,” He explained in a telephone conversation about the root causes of the epidemic. “They have no idea what the real harm is. They like the fruity flavors and are influenced by the advertisements. They get hooked right away.”

Many critics of the e-cigarette industry blame Juul for making and marketing a product in ways that young people would come to crave, as the new Netflix documentary Big Vape: The Rise and Fall of Juul points out.

Created by two Stanford University product design students and launched in 2015, the Juul e-cigarette resembled a USB flash drive as slim as an iPhone and was relentlessly promoted as hip. Ads featuring playful 20-something models having a good time vaping were blasted out on social media and other youth-oriented channels. Flavors included mint, fruit, and candy varieties that would be attractive to young people.

Before long, Juul had become a Silicon Valley darling. With $12 billion in annual sales and 75% of the market, it was valued at nearly $38 billion when Marlboro-maker Altria acquired a third of the company for nearly $13 billion in 2018. Meanwhile, Juul spawned a booming e-cigarette industry. Today there are dozens of players and alluring brands while Juul is faltering as it fights off bankruptcy and regulators and settles lawsuits accusing the company of marketing to underage consumers.

Federal authorities were slow to step in until a vaping-related lung illness—later named EVALI—led to over 2,600 lung injuries and at least 60 deaths; two-thirds of those who became ill were between 18 and 34, according to the CDC.

The Food and Drug Administration (FDA) is trying to stay ahead of the fast-growing market and keep consumers safe. It has banned many flavors, increased inspections of retailers and manufacturers, and cracked own on disposable devices and synthetic nicotine products designed to evade FDA regulations.

With such quirky names as Elf Bar, Juicy Bar and Lost Mary, the new brands follow the “get-them-addicted” playbook. They have ramped up the nicotine volume to as much as 6,000 puffs per cartridge and added flavors such as birthday shake and watermelon. The CDC reported that flavored vape sales have surged 60% over the past three years to 18 million per month, up from just 11 million in 2020.

Warnings, injunctions and fines, as well as public service messaging in many states including Wyoming about the dangers of e-cigarettes, have only marginally dented their appeal. One 2022 survey found that 60% of 15 to 24-year-old users want to stop for health cost, and/or social reasons, but find it difficult—much as older generations have struggled with quitting cigarette smoking.

Overcoming any addiction can be a challenge, especially for impressionable and vulnerable young people who think e-cigarettes are fashionable. In my opinion, we must send a clear message through public health education in schools and communities, along with parents, that e-cigarettes are nothing more than a nicotine delivery device but without the tar. At the same time, the FDA must get its act together and act quickly to provide stricter oversight of the industry.

Equally important is to pursue more long-term clinical trials to better understand the mental, physical and psychological consequences of vaping. As He noted, “We have to act boldly and have the entire society involved so we can find a solution.”

Ernest Beck writes about drug policy. He is the former communications lead for the Rosenthal Center for Addiction Studies in New York.