Editor’s note: This is the first article in a two-part series about e-cigarette usage in Minnesota and Brown County and local response to the problem.

NEW ULM — It’s not just harmless water vapor.

Minnesota teen tobacco and nicotine use are on the rise, and experts and public health officials believe it’s because of the growing popularity of electronic cigarettes – considered a hazardous trend amongst children, teens and young adults.

According to the Minnesota Department of Health’s 2017 Minnesota Youth Tobacco Survey, one in four middle school and high school students in the state had tried e-cigarettes, which are small, battery-powered devices that heat e-liquid, or “e-juice,” to produce a vapor that’s inhaled.

The survey also found that nearly 20 percent of high schoolers used e-cigarettes in the past 30 days, compared to more than 9 percent who used regular cigarettes. Since 2014, e-cigarette use in Minnesota has increased by nearly 50 percent among high school students, and their use is now double the conventional cigarette use.

In 2018, the U.S. Food and Drug Administration (FDA) listed youth e-cigarette use as a public health threat, and FDA Commissioner Scott Gottlieb called teenage vaping an “epidemic.”

“Once they start, they’re addicted,” Statewide Health Improvement Partnership (SHIP) and Brown County Public Health (BCPH) registered nurse Melissa Hoffmann said. “You can’t buy a new brain.”

Hoffmann said SHIP and other health officials are concerned about what nicotine does to adolescents’ developing brains. She said early nicotine use in teens and children changes brain chemistry, making youth more susceptible to addiction. Because the brain is still developing well into the mid-20s, adolescents can become addicted to nicotine more easily than adults. The use of nicotine in adolescents may also affect learning, memory and cognitive abilities.

What draws kids in?

“The most common reasons why kids use the e-cigarettes is from friends or family members, and then the flavors,” Hoffmann said. “And then thinking that they’re less harmful and not knowing exactly what’s in them.”

According to the American Lung Association and information compiled by SHIP, 39 percent of teens who use or have used e-cigarettes acquired the devices from friends or family,. Thirty-one percent said they have used them because of the variety of flavors, and 17 percent believe “they are less harmful than other forms of tobacco such as cigarettes.”

According to the 2016 Minnesota Student Survey, 17.4 percent of 11th grade students in Brown County had used nicotine-based products in the past thirty days compared to the state average of 12.7 percent.

Hoffmann said the enticing flavors that e-juices come in is a large factor that may contribute to the rise of teenage vaping. With flavors that taste and smell like candy, fruit, mint, coffee and even alcoholic beverages, the appeal to kids and teenagers is substantial, she said.

A quick search on the internet may also procure unique e-juice names such as hawaiian pog, sunrise pressed, carnival cali steam and jamaican rum.

Hoffmann said many e-juice flavors and brands contain harmful chemicals or compounds that have been linked to diseases and illnesses. Some flavorings contain diacetyl, a chemical that can scar lung tissue after prolonged use; volatile organic compounds such as benzene, which is found in car exhaust; and heavy metals, such as nickel, tin and lead, according to information compiled by SHIP from the FDA and Centers for Disease Control and Prevention (CDC).

Hoffmann said the colorful designs of e-juice bottles and the appealing smell the liquid gives off is also a safety concern for small children who may consume it thinking it’s candy.

“It’s a safety thing too,” Hoffmann said. “You don’t know what’s in these things. [Kids] have been poisoned from swallowing these things some of which look like candy.”

Brown County Underage Substance Abuse Coalition (USAC) Program Director Abigail Schwab said teens often believe e-cigarettes aren’t as hazardous as traditional tobacco products.

“They may say it’s better than a cigarette, but it’s not,” she said. “They’re starting to get addicted to this.”

How do kids

get e-cigarettes

According to the 2017 Minnesota Youth Tobacco Survey, 62.4 percent of high school and 57.4 percent of middle school e-cigarette users got their e-cigarettes from friends. 32.2 percent of underage high school students who use e-cigarettes received or bought their e-cigarettes from retail outlets with the most common source being vape shops.

The survey also found that 88.4 percent of students had seen ads promoting e-cigarettes in the past 30 days, down slightly from 90.1 percent in 2014.

50.9 percent had seen ads in convenience stores and other stores in the past 30 days, up from 47.5 percent in 2014. 39.6 of students had seen ads on the internet, 38.6 percent on television, and 6.8 percent on the radio.

E-cigarettes are also available for purchase on the internet from manufacturers’ websites and even Amazon. While the websites do ask for age verification to ensure customers are at least 18 years old, underage teens can bypass this by simply clicking the +18 verification tabs on the websites. However, some websites have strengthened age verification software to ensure underaged persons can’t purchase e-cigarette-related products.

Hoffmann said e-cigarette starter kits can also be obtained by completing vape trick challenges that can be found on Youtube. Similar to traditional cigarette smoking tricks, the large amount of vapor produced by some e-cigarettes allows for intricate vape tricks. One of the vape tricks called “the tornado” allows for a cloud of vapor to be manipulated into a small cyclone that spins on table tops or the floor. Many other tricks and their tutorials may also be found on the internet.

‘Hidden in Plain Sight’

Shwab said USAC partners with SHIP to help prevent teens from using e-cigarettes by educating parents and the community. The two organizations also visit schools and community events to hold educational presentations with educators or the community.

Schwab said USAC visited the 2018 New Ulm Home Show and set up a booth with a mock teenager’s room that contained standard decor, hidden compartments and concealed items. Called “Hidden in Plain Sight,” the goal of the setup was to show and help parents determine whether their child may be experimenting with or using drugs or alcohol.

One of the items in the mock room was a JUUL, an e-cigarette shaped like a USB flash drive that uses disposable e-juice cartridges and also the most commonly used tobacco product amongst youth in the United States.

“People couldn’t find it,” Schwab said. “We had it plugged right into a computer and people said, ‘this is it?'”

Schwab and Hoffmann said many e-cigarettes can look like common household items or school supplies such as USB drives or pens and can be easily disguised or hidden in plain sight.

Hoffmann said a SHIP colleague of hers in Waseca had recently held a community presentation about teenage vaping, and the colleague was hearing anecdotally from teachers that students were saying they could easily disguise the use of e-cigarettes by holding the vapor in their lungs long enough until it would dissipate and they could exhale little to no smoke.

“It’s so hidden,” Hoffmann said. “Anecdotally, I’m hearing from some schools that there’s a big worry about that. They’re making sure that their policies are up to date and including e-cigarettes in their language. And they’re worried about kids vaping in the bathrooms or just even vaping in class.”

Schwab said USAC continues to partner with SHIP to provide resources to schools, teachers, parents and the public to combat and prevent teen use of e-cigarettes.

Unprecedented

challenge

Legislators and government officials across the United States have also taken measures to combat teen and underage tobacco use with laws and regulations.

Hoffmann said the implementation of Tobacco 21 laws that raise the legal age limit to buy tobacco products may help reduce the rise in teen vaping.

Some believe if the legal age to purchase tobacco was raised to 21, it could make it more difficult for underage teens to obtain e-cigarettes from friends who are 18.

Minnesota has 34 cities and counties with Tobacco 21 ordinances. Mankato passed a Tobacco 21 city ordinance May 13.

“As from a public health standpoint, we do look at those kinds of policies that kind of inform and support better health too,” Hoffmann said. “So that’s something that some communities have been passing.”

Hoffmann said the teenage vaping epidemic has caused the creation of new programs that have previously never existed.

“Unfortunately, because of this epidemic, there is now quit lines just for teens,” Hoffmann said. “That never had to be something.”

Teens ages 13 through 17 can call these tobacco quit line numbers to receive information and support on tobacco cessation.

Hoffmann and Schwab said USAC and SHIP are awaiting the updated data and results from the 2019 Minnesota Student Survey that releases later this year. She said questions about vaping and e-cigarette use on the survey are relatively new, and more data can help public health officials combat the potential spread of e-cigarette use.

“In 2019 we’re hoping we’re going to have a lot more information,” Schwab said. “In 2016 they were just starting to ask about it, but if you look, Brown County, we were above the state of Minnesota with the 11th graders.”

Gage Cureton can be emailed at gcureton@nujournal.com.