Treating your taste buds with flavors like blueberry muffin, chicken and waffles, chocolate chip cookie and caramel frappe? Sounds great. Blasting your lungs with nicotine in an aerosol that contains chemicals including arsenic, lead and acetone? Not great.
But that’s the reality of vaping, a small audience of mostly parents, along with a few students, was told last week in Modesto. The “Teen Vaping” presentation was offered at Beyer High School by Charmaine Monte, TUPE (Tobacco Use Prevention Education) planning coordinator with the Stanislaus County Office of Education.
Nicotine is a highly addictive drug even in cigarettes and other tobacco products, Monte said. It goes right away to pleasure centers of brain and latches onto the receptors there, she said. But manufacturers make it far more potent in vaping liquids and the devices that deliver them.
She shared research from Stanford University’s Tobacco Prevention Toolkit that one pack of 20 cigarettes contains 20 mg of nicotine, while one e-liquid pod for a Juul brand e-cigarette delivers nicotine equivalent to 41 cigarettes. A Phix brand pod is equal to 75 cigarettes, and a Suorin pod equals 90.
But often, Monte said, people don’t vape they way they’d smoke. “There’s time taken with a cigarette. To inhale, to exhale, it takes about seven to nine minutes” to smoke one, she said. “With a Juul, they can get 200 puffs from one of those pods, and someone can just sit there and keep going, keep going , keep going. They could be done with it in a matter of an hour, done with it all at once.”
That’s about 41 cigarettes. About 41 mg of nicotine. In as little as an hour.
And beyond the nicotine, there’s so much more in the e-liquid aerosol — because it’s not a “harmless” water vapor so many youth think they’re sucking down — Monte said. Researchers have found that the compositions of the aerosols delivered by vape devices include oils, extracts and, among many other ingredients:
- Propylene glycol — found in antifreeze
- Acetone — found in nail polish remover
- Ethylbenzene — found in paints and pesticides
- Formaldehye — found in embalming fluid
- Rubidium — found in fireworks
That’s only what’s been discovered, Monte said. There’s still a lot more that’s unknown. For example, while the common e-liquid ingredients glycerin and propylene glycol have been OK’d by the FDA for consumption, they’re not FDA-approved for inhalation.
The chemicals that go into the e-liquids, or “juices,” aren’t meant to be consumed at the temperatures vaping devices bring them to, so they’re volatile, said Dr. Anna Song, an associate professor at the UC Merced Health Sciences Research Institute whose area of expertise includes e-cigarettes and tobacco use.
“You’re talking about a lot of compounds, a cocktail of compounds that users are consuming,” she said. “So now we are finding out that a lot of these chemicals have unintended effects.” They are “converted when you vape and are irritants, so we can expect pulmonary issues.”
Even if just looking at the nicotine, Song said, there is no question about its addictive nature. “And we know it has neurological effects and teens’ brains are still developing. That continues into the mid-20s. So when they’re consuming nicotine, that’s introducing a substance that will affect that development.”
Whether teens or adults, those who vape are being used as Guinea pigs, Monte said. Back in the 1920s, ‘30s and ‘40s, she said, doctors were advertising smoking as a way to lose weight, because no one knew what the dangers were. “Now here we are again with a new product that people are inhaling, and things are coming out now that people are having issues,” she said.
Among the problems are lung, nose and throat irritation, coughing, wheezing and shortness of breath, Monte said. Some users experience skin irritation, too, because they get e-liquids on their hands when filling their vaping devices.
An article this week in California Healthline, citing the Centers for Disease Control and Prevention, said that as of Aug. 22, potential vaping-related illnesses have been reported in 22 states. “California is investigating 22 cases,” the article says. “Wisconsin, which first put out an alert in July, has at least 16 confirmed and 15 suspected cases. Illinois has reported 34 patients, one of whom has died. Indiana is investigating 24.”
The Illinois case is the first reported death in the U.S. that’s been tied to vaping. The Illinois Department of Public Health said little about the death, primarily that it was of “an individual who had recently vaped and was hospitalized with severe respiratory illness.”
At a news conference held by the CDC, the FDA and the state of Illinois, “Health officials did not say what product the patient had used, whether an e-cigarette or other vaping device; nor did they specify what substance was vaped,” The New York Times reported.
Even the CEO of Juul Labs is urging nonsmokers not to vape. In an interview on “CBS This Morning,” Kevin Burns said, “Don’t vape. Don’t use Juul. Don’t start using nicotine if you don’t have a pre-existing relationship with nicotine. Don’t use the product. You’re not our target consumer.”
Early this month, the California Department of Public Health issued an alert because since June 7, seven cases of severe acute pulmonary disease requiring hospitalization and respiratory support among previously healthy adults have been reported to the Kings County health officer. “This number of cases greatly exceeds the number otherwise expected since June,” the alert says. “A reported common exposure among these patients is that they have been vaping cannabis or cannabidiol (CBD) oils.”
How widespread is it?
Last fall, the U.S. Food & Drug Administration said e-cigarette use was at an epidemic proportion because in a year, it increased alarmingly among middle and high school students, “with over 3.6 million kids currently using e-cigarettes in 2018.”
From 2017 to 2018, “current” e-cigarette use — defined by use on at least one day in the past 30 days — by high school students increased 78 percent, from 11.7 to 20.8 percent, the FDA said. Among middle schoolers, there was a 48 percent jump.
Monte shared with the Beyer audience some results of the California Healthy Kids Survey of ninth- and 11th-graders at the start of the 2018-19 school year. Countywide, 23 percent of the respondents said they’d smoked or vaped tobacco/nicotine at some point. Ten percent said they were current users, and 5 percent said they currently used at school.
The survey also asked about marijuana use. Countywide, 22 percent of the students said they’d used it at some point, and 12 percent said they were current users.
A Beyer sophomore said vaping is so common in the boys restrooms that you come out smelling of the products even if you’ve not done it yourself.
Two other Modesto high school students who asked to remain anonymous provided some insight on vaping.
An Elliott Alternative Education Center senior said he quit after about two years of doing it daily. He began, like a lot of teens do, because he saw tons of other people doing it and was intrigued.
The variety of flavors and the nicotine buzz — he described it as not a particularly good feeling, but not a bad one — kept him vaping. On the flavor, he said, “you can taste it going down into your throat. It stings pretty strong at first,” but that goes away.
Despite the regularity of his vaping, he never felt addicted and said it “wasn’t that hard” to quit. He did so because he saw a lot of news reports and YouTube videos on the dangers of vaping and “it hit me pretty hard.” Thinking of his goals and the career he wants to have, he decided vaping wasn’t worth it, and said he’d tell that to anyone he knows who’s taking up the habit.
A Beyer High senior said he vapes occasionally. He doesn’t have his own kit, but if he’s around someone who’s vaping, he’s inclined to partake. “I used to be really against it, but one of my friends had it and I thought, ‘Why not? One time’s not going to hurt me,’” he said, estimating that he vapes maybe once a month.
On what he gets out of it, the student said, “There’s obviously some good flavors, but the main thing is the act of doing it. It’s not like it’s necessarily cool, but I can’t really explain it. You’re just chillin’.”
He’s seen some YouTube videos on the side effects of vaping, but most of them focus on people who do it regularly, he said. As an infrequent vaper, he’s not concerned about harming himself.
Dr. Song countered that “there is no safe amount of smoking” or vaping. “Every time you consume nicotine, you’re increasing your risk of addiction,” she said. “I think it shows that people don’t really understand the nature of addiction.”
What schools are doing
The program Monte presented at Beyer is available to parents and staff at all county high schools, she said. She’s spoken with staff at 10 schools but really wants to get more parent meetings like Tuesday’s.
Most or all of the information shared at the meeting will be presented to all Stanislaus junior high and high school students as part of their health curriculum, Monte said. SCOE is scheduling expert speakers and is working with Victor DeNoble, a former Philip Morris cigarette researcher turned whistleblower whom The San Diego Tribune called “one of the nation’s most prominent anti-smoking campaigners.”
SCOE has written a grant through the Department of Justice to get sensors put in bathrooms and locker rooms. They do not have cameras but have sensors that detect noise — a tool to prevent bullying — and vapors. “We hope to hear next month if we’re funded,” she said.
The county office also works with the Health Services Agency on tobacco and vaping “shoulder tap” operations. In those stings, minors are sent into stores to see if they’re carded when trying to buy products that legally can be sold only to people 21 and older. A couple of years ago, 41 percent of the stores visited sold to minors, Monte said. But in the most recent survey, 92 stores were visited in the 2018-19 school year and the percentage that sold was down to 18.
Schools have a powerful force in students, too, Monte said. Teens, including those in the PHAST (Protecting Health and Slamming Tobacco) program are trained to present to their peers. Because let’s be real, she said: “They don’t listen to us (adults).”