For decades, schools have been on the front lines in a successful campaign to reduce teenage cigarette smoking. Now, some educators are developing policies to control students’ use of e-cigarettes, devices still unregulated at the federal level that many fear could revive the tobacco habit 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.
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 in April, if passed, would put such devices under the category of tobacco products, allowing them to be regulated as such. The comment period for the proposed rule ends Aug. 8.
Electronic cigarettes’ lure to a young market may be due to several factors. Aesthetically, 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 comes in individual cartridges, often with a flavoring such as chocolate 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. Such flavorings were banned in regular tobacco products in 2009.
Ready Access
Though many “vape shops” will not sell electronic cigarettes to minors, these products are often accessible through sellers like eBay.
“We haven’t had many younger children come into the store,” said Vic Vega, the owner of Vapor Villa in Catonsville, Md., which does not sell to minors. “We are aware that many of them turn to independent sellers.”
Also, because e-cigarettes are not yet considered tobacco products by federal authorities, their marketing is not restricted, as it is for traditional cigarettes. And educators and law enforcement officials have noted that e-cigarette advertisements are using some of the same tactics that once drew teenagers and young adults to conventional cigarettes.
“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, which provides support services for 27 districts and more than 500,000 students in southern California.
The federal government’s slow response is due in part to a lack of sufficient longitudinal data on e-cigarettes’ potential health effects. The product’s popularity began growing around 2009, making it difficult to garner long-term evidence of electronic cigarettes’ health implications. What is known is that nicotine, the addictive ingredient in tobacco products, is a major component of most e-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.”
Some products also contain “potentially hazardous chemicals like metals, low-level nitrosamines, [and] formaldehyde,” said Mr. King.
Phil Daman, the president of the Smoke Free Alternatives Trade Association, in Washington, sees e-cigarettes’ health implications in a different light, noting their benefit for adults hooked on regular cigarettes.
“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.”
Though the SFATA supports federal regulation to prevent the sale of e-cigarettes to minors, Mr. 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—districts and administrators scramble to adjust pre-existing tobacco-free policies to encompass the newer product.
Though most states prohibit e-cigarette sales to minors, districts are left to their own discretion in dealing with students who bring e-cigarettes on campus.
On school campuses in Orange County, Calif., for example, no e-cigarettes are allowed. If students are found with such a 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 warn against the dangers of e-cigarettes. Students also get cessation services.
In February, Orange County’s education and sheriff’s departments hosted an event to raise awareness about the prevalence of e-cigarettes in schools and their known health effects.
Many other districts have adopted rules on e-cigarettes and ends, often after state regulations were passed. Some districts, such as Florida’s Miami-Dade County, did not wait for state guidance.
The 345,000-student Miami-Dade system added specific language to its tobacco-free rules in fall 2013 to adequately cover electronic cigarettes, according to Walter James Harvey, the school board attorney. Now, students caught with e-cigarettes are given an “alternative to suspension” or educational classes on the devices’ effects, he said. Parents and school administrators also worry about electronic cigarettes’ ability to function as drug paraphernalia. Anecdotal evidence from schools nationwide indicates that some students have used e-cigarettes to smoke cannabis, hash oil, and other illegal substances on school campuses.
Ongoing Research
Meanwhile, researchers are working to find more concrete evidence about the effects of e-cigarettes. The Population Assessment of Tobacco and Health, an ongoing FDA and NIH longitudinal study, includes a section on e-cigarettes and is expected to be completed in 2016.
A study published last month in the Journal of the American Medical Association warns of “a major risk that e-cigarettes will revive the popular smoking culture that has taken decades to dismantle” and advises the FDA to move quickly on regulations to prevent their spread among adolescents.
Ms. Deeble-Reynolds concurs. “We don’t want students to be a part of longitudinal studies and be continually smoking these devices,” she said, “then 20 years down the road not be able to do things like play soccer with their kids because they can’t breathe.”
