LA SALLE COUNTY – It began with an invitation from a nearby school that wished to give students a medical perspective to the dangers of using e-cigarettes. Jennifer Kelsey, Pediatric Advanced Practice Registered Nurse with OSF Medical Group-Ottawa, accepted the invitation and from there, began taking that message to numerous middle and high schools in the LaSalle County area.
Kelsey first spoke to students at Washington Junior High in Oglesby, where Principal Merritt Burns began to proactively address the issue at the start of the school year. At that time, they began to see a concerning uptick in vaping among its students – some in 6th grade. Burns believed that having a medical professional from OSF reinforce their efforts would add more weight to the issue.
“It’s one thing for us to talk to the kids,” Burns said. “At some point, I feel, we all fall on deaf ears. So, to have an outside agency come in to preach that same message, we were thrilled to have OSF come and just reinforce some of the things we were saying.”
A recent study, sponsored by the National Institute on Drug Abuse, found the number of high school vapers rose by 1.3 million from 2017 to 2018. Administrators at all the schools where Kelsey has made her presentation say they are seeing increases in vaping use. That coincides with what she is seeing among her pediatric patients.
“Definitely a huge problem, especially in the younger kids,” Kelsey noted. “And we’re surprised at how young they are starting to vape. As early as 5th and 6th graders have tried it.”
At Northbrook School in Mendota, Principal Paula Daley agreed that vaping is a concern. She said at this point, they are discussing it as a health issue during P.E. “Every generation has their thing. This is so new and it’s happening so fast, I think next year we’ll be able to do more to address it,” she said. “I think it’s great that OSF is going around and doing that.”
Like many habits adopted by adolescents and teens, Kelsey believes curiosity, peer pressure and experimentation are at the core of the increase in vaping. She also points out that e-cigarette flavors are attractive and geared to kids, plus there is the misconception that it is safer than regular cigarettes.
“We talk a lot about how vaping is kind of a new and upcoming trend,” Kelsey explained. “And there hasn’t been a lot a research and science of what the long-term side-effects on their body will be. But I do talk a lot about the chemicals that are in the vaping and we do know the side-effects of those chemicals.”
Kelsey says students often come away shocked by what she tells them – particularly that one of the chemicals in e-cigarettes is formaldehyde, used to preserve dead bodies.
Additionally, Burns says the students come away enlightened and he is already seeing a positive effect. “They’ve reacted positively as to what they are now knowing or what they are seeing, where they’re getting things,” said Burns. “They’re more pro-active in their conversations to me, if they hear about kids that might be doing it or might be selling it. So overall, it’s just generated conversation as opposed to just kicking it under the table.”
The E-cigarette epidemic among youth
In a recently released report on vaping, the U.S. Surgeon General noted that considerable progress had been made in reducing cigarette smoking among youth but that is being offset by a variety of tobacco products, including e-cigarettes, which are designed to deliver nicotine, flavorings and other additives to the user via an inhaled aerosol.
The report continued, stating that e-cigarettes first entered the U.S. marketplace around 2007, but since 2014, they have become the most commonly used tobacco product among U.S. youth. E-cigarette use among U.S. middle and high school students increased 900 percent from 2011-2015, before declining for the first time from 2015-2017. However, current e-cigarette use increased 78 percent among high school students during the past year, from 11.7 percent in 2017 to 20.8 percent in 2018. In 2018, more than 3.6 million U.S. youth, including 1 in 5 high school students and 1 in 20 middle school students, currently use e-cigarettes.
E-cigarette aerosol is not harmless, the report emphasizes. Most e-cigarettes contain nicotine, which is an addictive drug. Nicotine exposure during adolescence can harm the developing brain until about age 25. Nicotine exposure during adolescence can impact learning, memory, and attention. Using nicotine in adolescence can also increase risk for future addiction to other drugs. In addition to nicotine, the aerosol that users inhale and exhale from e-cigarettes can potentially expose both themselves and bystanders to other harmful substances, including heavy metals, volatile organic compounds, and ultrafine particles that can be inhaled deeply into the lungs.
Recently, a new type of e-cigarette has become increasingly popular among youth due to its minimal exhaled aerosol, reduced odor, and small size, making it easy to conceal. Many of the new e-cigarettes look like a USB flash drive, among other shapes. One of the most commonly sold of these, JUUL, experienced a 600 percent surge in sales during 2016-17, giving it the greatest market share of any e-cigarette in the U.S. by the end of 2017. Other companies are also starting to sell e-cigarettes that look like USB flash drives.
All JUUL e-cigarettes have a high level of nicotine. The Surgeon General states that the typical JUUL cartridge, or “pod,” contains about as much nicotine as a pack of 20 regular cigarettes. These products also use nicotine salts, which allow high levels of nicotine to be inhaled more easily and with less irritation than the free-base nicotine that has traditionally been used in tobacco products, including e-cigarettes. This is of particular concern for young people, because it could make it easier for them to initiate the use of nicotine through these products and also could make it easier to progress to regular e-cigarette use and nicotine dependence. However, despite these risks, approximately two-thirds of JUUL users aged 15-24 do not know that JUUL always contains nicotine.
E-cigarettes and youth: a public health concern
An article released by OSF last March outlined the ingredients used in vaping. They include:
Vaping and e-cigarettes are still fairly new, and scientists are still learning about their long-term health effects. Here is what is known now:
Besides nicotine, e-cigarette aerosol can contain substances that harm the body. This includes cancer-causing chemicals and tiny particles that reach deep into lungs. However, e-cigarette aerosol generally contains fewer harmful chemicals than smoke from burned tobacco products.
E-cigarettes can cause other unintended injuries. Defective e-cigarette batteries have caused fires and explosions, some of which have resulted in serious injuries. Most explosions happened when the e-cigarette batteries were being charged.
In addition, acute nicotine exposure can be toxic. Children and adults have been poisoned by swallowing, breathing, or absorbing e-cigarette liquid through their skin or eyes.
E-cigarettes are not currently approved by the FDA as a quit smoking aid. The U.S. Preventive Services Task Force, a group of health experts that makes recommendations about preventive health care, has concluded that evidence is insufficient to recommend e-cigarettes for smoking cessation in adults, including pregnant women.
Because most tobacco use starts during adolescence, actions to protect our nation’s young people from a lifetime of nicotine addiction is critical. Both Burns and Kelsey know that talking to students is not a “one-shot” deal. The education and messaging needs to continue, even if it takes convincing one student at a time.