Tobacco's Toxic Shadow

My grandfather died cruelly of emphysema when I was a boy. In our last conversations I remember long, wheezing breaks as he coughed gobs of phlegm into tissues. Like many nicotine addicts, tobacco grabbed him as a teen and never let him go.

Teens today are less apt to smoke cigarettes, but they are becoming addicted to nicotine nonetheless through vaping, a stealthy and cheap alternative. In addition to nicotine, vaping devices can be used to inhale other drugs.

A rash of vaping-related deaths has jolted school leaders and parents awake. Many are realizing how little they know about all of this, much less what to do about it. This post points you toward some answers — but first it makes sense to take a step back.

The History of Tobacco

Tobacco has a long history in America, with its original roots in native American cultures. It was an important cash crop for the Jamestown colony. At terrible human cost, great fortunes have been amassed in its production, distribution and sale worldwide.

'Til Death Does Them Part

Tobacco marketers have always enjoyed a huge advantage: their product quickly delivers a fast-acting dose of nicotine, a tremendously addictive substance. The marketers' job is straightforward: if they can get people to try a nicotine product, after the first few coughs repeat sales are easy. Before long, it's hard to quit. Start the habit early, they learned, and you can have a customer for a long time — perhaps 'til death does them part.

Tobacco was once marketed as an over-the-counter pharmaceutical product for calming the nerves, staying alert and curbing appetite. Over time, however, an important drawback became obvious: it causes cancer. Smoking kills.

The US Surgeon General declared smoking a health hazard in 1964, marking the peak in per-capita tobacco consumption in America. Anti-smoking campaigns and taxes on tobacco products gradually succeeded in driving down consumption. Laws banished smoking from offices and restaurants.

A market opened for less-obtrusive, cheaper and hopefully less-deadly ways to serve the cravings of nicotine-addicted smokers.

What Is Vaping?

Although cigarettes remain the world's main delivery vehicle for nicotine as of 2019, there are now many electronic nicotine delivery systems (ENDS), known by many names: e-cigarettes, pods, e-cigs, vape pens, and other evolving names, including the brand name Juul. These products were initially developed and marketed as a healthier alternative for smokers trying to quit, but at this point it's clear that they also play a role in getting new customers to start, including children.

The decline of smoking is being matched by a rapid rise in "vaping," a less-obtrusive system for inhaling vapor spiked with nicotine. Vaping companies position these products as safer than tobacco — a claim now under investigation by the FDA. (Vaping tools can be used to deliver other substances, too, but let's stick with nicotine for now.) The best-known vaping brand, Juul, is substantially owned by Altria, the tobacco conglomerate that owns Phillip-Morris.

The Center on Addiction describes a vaping device as consisting of "a mouthpiece, a battery, a cartridge for containing the e-liquid or e-juice, and a heating component … which turns the contents of the e-liquid into an aerosol. The e-liquid in vaporizer products usually contains a propylene glycol or vegetable glycerin-based liquid with nicotine, flavoring and other chemicals and metals, but not tobacco."

Heating a mixture of water and goo to make an aerosol isn't rocket science — it's the trick behind Halloween fog machines. Vaping devices are basically handheld heaters that raise the temperature of the liquid to vaporize it. Users suck the heated vapor into their lungs, absorbing the chemical payload into their bloodstream. When exhaling, the vapor passes into the nasal cavity, where added "flavors" are sensed as aromas. Sometimes the vapor is a thick, obvious fog, but it can also be thin and almost invisible.

How Dangerous Is Vaping and Nicotine?

Nicotine-laced vapors have been presumed to be less toxic than tobacco smoke, which is why people trying to quit cigarettes have found them of interest. But they are not benign, especially for children, including teens. Nicotine interferes with brain development. Vaping devices degrade with use, adding toxic metal nanoparticles to the haze.

Nicotine interferes with brain development.

Concentrated nicotine is a deadly neurotoxin. The amount of nicotine in a cigarette varies, and the process of smoking one can deliver a varying dose of nicotine absorption depending on the tobacco variety and how it is inhaled.

The amount of nicotine delivered by vaping can easily exceed the amount delivered by smoking. Vaping companies aim to differentiate their "juice" products by altering the chemistry of the nicotine, for example by adding sodium benzoate for faster absorption and a stronger "hit." Added flavors and aromas deemed safe as food additives may also come with unknown risks when heated and inhaled.

Is Vaping Just For Nicotine?

The trick of suspending a chemical in a vapor doesn't work only for nicotine, of course. Adding other chemicals to the "juice" isn't technically complicated. Companies quickly started adding flavors, beginning with traditional flavors like tobacco, mint and menthol, to appeal to smokers. Some companies even started selling products with added vitamins.

In 2019 demand for flavored vaping products boomed, including demand for flavors like bubblegum that were clearly designed to appeal to kids. It is possible to vape these flavor products alone, without nicotine or other active ingredients. There is evidence that some teens use vaping products in this way, at least at first. The flavor is part of the attraction, along with the weird novelty of blowing steam out of your nose.

Cannabis businesses jumped into the market, too, developing vaping products to deliver CBD and THC, the active ingredients of marijuana, with less odor than smoking it.

A Boom in Teen Vaping

Since 1975 the National Institute on Drug Abuse (NIDA) at the National Institutes of Health has measured drug and alcohol use and related attitudes among adolescent students nationwide through a huge annual study called Monitoring the Future. The 2018 report revealed that teen vaping had spiked. Suddenly, it was common: nearly one in five eighth graders surveyed said they had used a vaping device in the last year, and nearly two in five twelfth graders had done so.

Source: Monitoring the Future, 2018. Data from monograph page 573. In the chart on the left, the hexagonal shapes and dots do not represent data. They are meant to resemble Juul pods, a popular vaping device.

Some of the reported vaping activity is "just flavoring," but the survey suggests that in the last year over a quarter of high schoolers in America have vaped nicotine, and about half that many have vaped marijuana-derived products. And the rate has been going up.

Stealthy Vapor

The survey findings took many parents and educators by surprise. How could they have missed this?

The "innards" of a vaping device are simple and inexpensive, so there are many manufacturers competing for a piece of the market. Devices come in a huge range of designs, many with stealth in mind. It makes sense for parents to be on the lookout for unexplained expenses, but vaping is cheap.

Most vaping tools include a battery that is charged with a USB cable. When parents or teachers search a backpack or bedroom for vaping contraband, they often don't even know what they are looking at.

In 2016, Proposition 64 legalized cannabis in California for adults 21 and over. The measure triggered a boom in cannabis products of all kinds, including vaping products that deliver the active ingredients in marijuana with less detectable odor. It still smells, but a bag of fresh popcorn or a sheet of fabric softener can cover it up.

Smoking and vaping aren't the only ways kids are getting high on cannabis, either. Cannabis "edibles" including youth-friendly gummy candies and cookies are stealthy, popular, cheap and dangerous. Vaping supplies and edibles are easy to order online, where age verification methods can consist of as little as uploading an image of an ID — or even just checking a box.

What's Being Done to Reduce Teen Vaping?

Perhaps it seems obvious that inhaling hot fog laced with chemicals is risky, but the risks weren't widely appreciated until people started dying. Government leaders have scrambled to raise awareness about it. In late 2018 the US Surgeon General issued a warning to highlight the hazard to children. In September of 2019 the Trump administration announced that it would direct the FDA to clear the market of "unauthorized, non-tobacco-flavored e-cigarette products."

Enforcement is weak. Here's the data.

If history is any guide, it could take a while for laws and policies to go into effect in a way that meaningfully reduces kids' access to vaping products. Tobacco products are sold just about everywhere, especially in convenience stores, which make a lot of their money from impulse purchases. Tobacco companies are using their distribution prowess and retail incentives to ensure that vaping supplies are there, too. Enforcement is weak; in the whole state of California from January 1 through September 15, 2019 there were exactly 93 enforcement reports related to sale of vaping products to minors; all but five resulted in warnings. With so many outlets to choose from, underage customers find it easy to get what they want.

On the other hand, pressure from parents and other voters could prove decisive. San Francisco's board of supervisors has already voted to ban the sale of e-cigarettes, period, even though Juul Labs is headquartered in the city.

The first step in reducing childhood demand for vaping products is to build awareness of the significance of the problem. Governments in America and elsewhere are experimenting with anti-vaping campaigns to help spread the message through media. These campaigns will probably get bigger (and hopefully more effective) as government representatives respond to the pressure to do something quickly.

What Can School Boards Do?

The Association of California School Administrators (ACSA) has collected model policies for school districts to help them consider alternatives. Additional draft policies are available from the California School Boards Association. Boards and administrators are faced with the challenge of balancing demands for "zero tolerance" enforcement with the reality that some of their students and faculty may be struggling with addiction.

What Can Parents Do?

"Was there part of you, like a voice, saying not to do that?"

Parents can play a vital role through their relationship with their kids. Counselors and psychologists with expertise in addiction tend to encourage calm, informed conversations rather than heated threats or punishment. Ultimately, people make their own decisions at any age, and for adolescents a sense of independence tends to be pretty important. Vaping is a pretty dumb habit, and kids tend to know it, but there can be many reasons why quitting could be hard. The blog Empowering Parents has some useful verbage to help parents prepare, so that a conversation can be helpful.

When kids do something foolish, the best parenting advice I ever heard was to help them think about why it happened. For example, a parent could ask, "Was there part of you, like a voice, saying not to do that?" Usually the answer will be some version of yes, which is an invitation: "What do you think made you not listen to that voice?" That question can lead in all kinds of insightful directions, and it positions you to be helpful instead of punitive.

Schools, PTAs and other community organizations can help prepare parents by providing information about vaping, along with guidance about how to talk with kids about vaping. As advocates, parents can do even more. The National PTA urges action at the national, state and local levels to protect children.

Is your school doing something smart to combat vaping? Drop us a comment!