Historically, inhaling nicotine-laced air was difficult to do furtively. Cigarettes have an obvious stench when smoked indoors; yet e-cigarettes, most of which are smaller and more nondescript than a traditional cigarette, are practically designed to be clandestine.
The ease with which one can vape subtly, and without leaving the noticeable stench of cigarettes on one's breath or clothes, has led to the proliferation of e-cigarettes in high schools. The Food and Drug administration and the Centers for Disease Control and Prevention estimate that, in 2022, 14.1% of all American high school students used e-cigarettes actively (meaning in the past 30 days).
And unlike cigarettes, their use by teens often happens in plain sight. Many teens have mastered the so-called "stealth vape" in school stairwells, hallways, bathrooms—or even in class. While schools are doing their best to try to curb underage nicotine product use, it is a struggle for them — as well as parents — given how easy to hide e-cigarettes typically are. Many parents and other older people who did not grow up with them are unable to even correctly identify many "disguised" e-cigarette or vape products.
Caroline, 18, a first-year-college student at Texas A & M University, and anti-vaping advocate, has spoken on some peer panels on the topic. While Caroline has close friends and family who avoid e-cigarettes like herself, Caroline often feels like she's in the minority. In fact, a lot of people she knows at school think nothing about vaping, and don't even seem to understand the risks of nicotine addiction or paying attention to what's in their e-cigarette.
"They couldn't go a full school day without going to get a vape. It was shocking to me. It kind of became a big issue with my school."
A few years back, when Caroline started high-school in West Central Texas, she said it was shocking to her just how many classmates and school acquaintances just all started casually vaping at their high school all of the time. In classes, at the cafeteria, in the school stairwells, in the bathrooms, outside of school and during student athletic games. None of the teens seemed to see a problem with how frequently they were taking in nicotine, Caroline said. At the time, flash drive-shaped vape products were extremely popular.
"They couldn't go a full school day without going to get a vape. It was shocking to me. It kind of became a big issue with my school. It is such a common problem. I do my best to discourage my friends and acquaintances," she said. "They are usually a vape pen, Puff Bars — it is mainly any type of nicotine vape, most of the time," that she would see around the campus.
Many smokers don't believe that secondhand vape smoke is real.
In the rare instances when a high school student was "caught" chain-vaping at school, the student would be suspended, including in-school suspensions, for up to two weeks. Unfortunately these high school students did not get any kind of social work support or referral to substance use counseling services, Caroline said. Since then, things have slowly started changing at her high school, she noted.
Now that Caroline is in college, she says that while most college student vape users try to refrain from using in college classes, many don't believe that secondhand vape smoke is real. "Many vapers on my college campus don't seem to understand that we really don't want to walk through their super huge vape clouds, for lack of better terminology," she said. "The smell is kind of rough."
"Most of the time if you ask them, 'don't do that near me,' most—but not all—of them will stop and put the vape away," she added.
E-cigarettes started being sold to American consumers in 2005, but they didn't become mainstream with teens until fairly recently, around five years ago. Then, in the early days of the pandemic, teen vaping fell off the radar as a public health issue for obvious reasons. While some experts believe that fewer teens were vaping during lockdown, research shows that teen vaping rates are now rising again.
According to the National Youth Tobacco Survey (NYTS), an annual public health report that measures self-reported data from middle school (6-8) and high school (9-12), vaping rates among teens decreased during the 2020-2021 lockdown. Yet it is possible that virtual data collection (as opposed to in-person data collection) methods may have skewed the research results. In contrast, more recent data from the 2022 Survey shows an increase in vaping and e-cigarette use among the same age group.
Organizations like Parents Against Vaping e-cigarettes have done work in raising awareness. Based in New York, PAVe is one of the only organizations nationwide dedicated specifically to teens and vaping prevention.
Some experts believe that e-cigarette companies — many who are actually owned by old-school Big Tobacco corporations — are easily lapping the combined efforts of schools, parents, public health agencies, nonprofits and substance abuse prevention organizations, who are fighting collectively to raise awareness regarding e-cigarette use and its health effects.
Part of the problem comes down to marketing. Vapes and e-cigarettes appear in many TV shows popular with teens, including "Euphoria"; it is unclear if this is paid product placement or organic. Anti-vaping education organizations, including the Truth Initiative, a national public health foundation that fights to stop youth smoking, are working on catching up.
The Truth Initiative believes that youth vaping is driven by advertising and marketing. As they write: "Youth prevalence of e-cigarette use is nearly four times that of adults, driven in large part by the broad availability and appeal of flavored products which are used by 84.9% of youth who vape and the growing popularity of disposable products used by 55.3% of young e-cigarette users. Disposable products with flavors like'"Cheesecake,' 'Bubble Gum,' and 'Strawberry Ice Cream' now make up 35% of the vape market."
Marketing experts have railed against the candy-like flavors, which they see as clear signs that these products are meant to appeal to teens and youth. Indeed, e-cigarette maker Juul recently was forced to pay $438 million in order to settle an investigation into its marketing practices that, regulators and states said, targeted youths.
"The companies know they benefit from youth getting addicted."
Meredith Berkman, a co-founder of Parents Against Vaping E-cigarettes, (PAVe), turned into an advocate back in 2018 when her son Caleb, then 16, told his mother about a troubling school-sponsored event at his Manhattan high school. Branded as a mental health/addiction prevention program, students were expected to participate in an "ask me anything Q & A" where all teachers and school staff and other adults were asked to leave the room for student confidentiality purposes, Berkman said.
An adult speaker spent a portion of this "off-the-record'"Q & A telling the teens in the group about Juul in glowing terms. According to Berkman, one of the things the teens learned from this person was that "Juul was the iPhone of vapes." While the individual told the teens the device was for adult use only, the representative falsely claimed the FDA had already approved the product. Even further, this individual told the teens the Juul was "totally safe." Last but not least, the apparent Juul representative actually took out his own Juul device and showed the group of teens how easy it was to use.
Berkman's son Caleb, now a college student, told his mother that the high school speaker also never disclosed himself as a Juul employee or representative. Not only was this information undisclosed to students, but teachers, school staff and members of the anti-addiction group were apparently all in the dark. Once she found out, Berkman went on to testify publicly about the incident, prompting systemic changes.
Nonetheless, these kinds of subtle insidious marketing and "influencer" events are not isolated incidents. Direct marketing to teens still happens often — not in person, but typically through social media platforms, online videos and other online methods. Pre-pandemic, Juul representatives leaned hard on social media youth-oriented presence, which is partly what resulted in the hefty settlement that the company is being forced to pay.
"The companies know they benefit from youth getting addicted... These companies are making more money targeting kids. No company is going to come out and say, 'we are targeting kids,' but these companies are very strategic in their marketing campaigns," said Dr. Ijeoma Opara, PhD, LMSW, MPH, who is a Yale Assistant Professor of Social & Behavioral Sciences, at the School of Public Health and founder and head of the Substance Abuse and Sexual Health Opara Lab.
"Greenwashing" vapes
Dr. Robert Jackler, M.D., is an expert on tobacco and media and advertising and the principal investigator of an interdisciplinary research group, the Stanford Research Into The Impact of Tobacco Advertising. According to Jackler, one trend in the industry is "greenwashing" — the false claiming that vaping and e-cigarettes have health benefits, or are at least "healthy" in some vague way.
"Winston-Salem (the R.J. Reynolds American Tobacco company and subsidiaries like Vuse) calls their cigarettes and vape products, 'natural,' 'additive-free', and organic. Any way to suggest that their product is 'healthy' is a lie," said Jackler, noting that all vaping and e-cigarettes have nicotine, other chemicals and substances that are detrimental to health.
Greenwashing could include claims that a vaping or e-cigarette product is "additive-free," "all-natural," "organic" and has other supposed health benefits, he said. Yet the exact opposite is true. According to Jackler, it wasn't until a few years ago that Juul started complying with the federal regulations requiring warning signs on both their products and advertising. Jackler says many vaping and e-cigarettes still try to get aways with dodging these regulations, especially on social media product placement and online promotions.
The negative health effects of e-cigarette use are indisputable, said Jackler. Not only does vaping injure the lungs, but vapers may have chronic inflammation and respiratory issues in the long run, he said. A recent study linked e-cigarette consumption with brain inflammation. Decades ago, Jackler watched his mother, a lifetime cigarette smoker pass away from lung cancer. The same sophisticated tactics Big Tobacco used to try to convince Americans that smoking was safe back in the 1940s, 1950s and 1960s are being duplicated again with vaping, often with the same old-school tobacco companies, Jackler said.
Besides being unhealthy, vape products typically contain toxic e-waste — something that Jackler said that adults should point out to environmentally-conscious teens. Vapes typically contain lithium-ion batteries, heavy metals, plastic, and residue from liquid nicotine, which is hazardous waste.
Medical experts like Jackler and Dr. Michael K. Ong, M.D., Ph.D. professor of general internal medicine and health services research at the David Geffen School of Medicine at UCLA and of health policy and management at the UCLA Fielding School of Public Health, say that health risks to teens are overwhelming. Research shows that when teens start vaping at a young age, this invariably may lead to the likelihood of nicotine addiction. Teens who vape are more likely to start cigarette smoking once they are adults as well, research shows.
Some may brush off these claims, particularly adult vaping advocates who use the product to help with smoking cessation. Many adult ex-smokers swear that vaping helped them kick their smoking habit. Hong, who also serves as chair of the State of California Tobacco Education and Research Oversight Committee, says that e-cigarettes became prominent in part because of the confusion over whether they were sold as smoking cessation tools or as a vice akin to cigarettes.
"These products continue to change because they have been unregulated … These products fell into a loophole," he said. "That led to the unregulated rise of teen vaping in the United States and elsewhere."
At the end of the day, it's a group effort. Schools, parents, community groups, substance use prevention experts and others have to collectively work to educate teens on the risks of vaping.
While Dr. Anu Ebbe, Ed.D, deputy associate superintendent of Middle Schools at the Madison District in Madison, Wisconsin, notes that while she does not believe that vaping is currently at a problem level within the middle schools she oversees, she strongly believes it's definitely important to have a "restorative justice" approach to dealing with vaping students, rather than be strictly punitive.
"Vaping can happen in any demographic," Ebbe told Salon. "The punitive approach of keeping kids out of the school doesn't work as punishment for vaping or any other substance use. Our students are our children. We need to provide appropriate services and figure out what the underlying issue is."
