If Ky. teenagers’ use of e-cigarettes continues at its current pace, look for a new generation of adult smokers, conference is told

By Melissa Patrick
Kentucky Health News

Kentucky teachers have plenty to keep up with in the schools, which can cause an issue like teenagers’ vaping of electronic cigarettes to get lost in the shuffle, but health advocates warn that if we don’t get in front of this uptick in e-cigarette use, a new generation of adult smokers is on the horizon — along with all of the health issues that come with it.

Eric Kennedy of the Kentucky School Boards Association ( Foundation for a Healthy Kentucky photo )

At a Dec. 10 Coalition for a Smoke-Free Tomorrow conference in Louisville, Eric Kennedy, chief lobbyist for the Kentucky School Boards Association, said KSBA offers districts a model policy for 100 percent smoke-free schools that includes e-cigarettes, and encourages them to adopt it. However, despite the e-cig epidemic in schools, it hasn’t offered any specific guidance on the topic of e-cigs or Juul, a wildly popular e-cig that looks like an oversize USB drive and comes in popular flavors.

“I think there is a lot coming at classroom teachers on this and every issue, and it’s not as streamlined as it needs to be, and that is a big part of what the coalition is working on,” he said. “We’re almost at a level of being overwhelmed, if not already beyond that point. . . . It’s unfortunate that it’s easy for an issue like this to get lost in the shuffle of the massive amounts of information coming at classroom teachers and superintendents and everyone else in the district. So I think that’s something that we will keep working on, but that’s always going to be part of the problem.”

Many new school board members will take office in January.

Ben Chandler, president and CEO of the Foundation for a Healthy Kentuckyand chair of the coalition, told the conference, “The enormity of this . . . surge is a recent phenomenon, so I don’t think anybody has realized just how dire this issue is and how quickly it has become so.”

Some may question the use of the word “dire,” but teen use of e-cigarettes has become so prevalent that the U.S. Food and Drug Administration has called it an epidemic. Federal research shows that high-school students who reported being current e-cig users increased 78 percent between 2017 and 2018, exceeding 3 million. The same report showed use by middle schoolers increased 48 percent.

In Kentucky, about the same number of high-school students smoke cigarettes as use e-cigs, 14 percent. But health advocates at the conference warned that e-cig use is likely much higher among the state’s youth because the survey was taken before the introduction of Juul and Juul-like products.

To get a more current understanding of what is going on in Kentucky, the foundation and Kentucky Youth Advocates conducted focus-group discussions in October with 35 Kentucky teens in Campbell, Clay, Jefferson, McCracken and Monroe counties about their knowledge, perception and usage of e-cigarettes in their schools.

“The kids asserted educators and parents were clueless about their use,” said Terry Brooks, executive director of KYA. “And checking with parents and educators, they confirmed they were clueless. So, we’ve got a real adult/kid knowledge gap.”

Catie Kelly, senior at Martha Layne Collins High School, talked about e-cig use by teens. (Foundation for a Healthy Kentucky photo)

Catie Kelly, a senior at  Shelby County’s Martha Layne Collins High School, who was not part of the focus groups, told conference attendees that the flavors were the main reason kids are using e-cigarettes, and that most kids don’t realize they are harmful or have nicotine in them. In fact, a Juul can have as much nicotine as a pack of cigarettes.

“It is so easy to use in school because it’s so small and is really easy to hide. Most of my friends, they’ll just put their head down and put it under their sleeve and then blow the smoke into their sweatshirt,” she said. “People you wouldn’t think would use a Juul would use a Juul.” The device has 75 percent of the e-cigarette market.

Chandler offered four policy suggestions toward decreasing e-cigarette use among teens, including making sure e-cigs are included in all local ordinances and school policies; an excise tax parallel to regular cigarettes; the prohibition of flavors in e-cigs; and allowing cities and counties to enact stricter tobacco control policies than at the state level.

Asked why a statewide smoke-free school law wasn’t listed as a policy priority on the news release, Chandler said it had inadvertently been left off. “One hundred percent smoke-free schools is what we intend to do,” he said. “This whole boom of e-cigarette use I think has made this tobacco-free schools issue much more important and timely right now.”

As of July, 72 of the state’s 173 school districts (42 percent) have 100 percent smoke-free schools, covering 57 percent of the state’s students. However, many of these districts still need to update their policy to meet new standards for e-cigarettes.

Rep. Kim Moser, R-Taylor Mill, said she also thought the surge in e-cigarette use among Kentucky’s youth could spur the passage of a statewide tobacco-free school bill this year. Moser is the new chair of the House Health and Family Services committee and said she plans to file a bill for such a law.

But Sen. Ralph Alvarado, R-Winchester, new chair of the Senate Health and Welfare committee, said he wasn’t so sure the epidemic would change things. “It’s not a guarantee, but I’m hoping that with the new leadership in the House this coming year that this will loosen the tobacco policy up a little bit,” he said.

Alvarado’s tobacco-free school bill passed the Senate in 2017 but died in the House. Two such bills were introduced in the last session, but were not called up in the legislature’s education committees.

Alvarado, a physician, said he will file the legislation again, but added that no matter how much science and data he has presented in the past to show the harms of smoking, it hasn’t outweighed the philosophical argument for many that the government shouldn’t be telling people what to do.

The KSBA’s Kennedy said parental support for such policies to include e-cigs is vital, because many parents still “don’t think they are a big deal” and often ask that their child not be reprimanded for using them. He said the problem is so rampant that it’s not possible to suspend all student violators.

He said, “It’s almost in some ways too late to get out in front of it, but of course that can’t stop us from trying to do everything that we possibly can.”

Other points from the conference:

• 80 percent of children are exposed to e-cigarette advertising.
• 85 percent of youth who use e-cigs report using flavored varieties.
• 40 percent of 18- to 24-year-olds who vape report never smoking a regular cigarette.
• One-third of youth who have ever used e-cigs report also using marijuana.
• Nine out of 10 adult smokers started smoking before they turned 18.
• 99 percent of e-cigs have nicotine; the rest are typically found in vape shops.
• The adolescent brain is “uniquely vulnerable” to nicotine addiction, meaning youth become addicted more quickly and smaller amounts of nicotine can create addiction.
• Nationwide, nearly 3 percent of adults use e-cigarettes and 21 percent of youth do; adult e-cig use in Kentucky is higher, 5.9 percent; 24.6 percent of Kentucky adults smoke.
• Research has not proven that e-cigs help smokers quit smoking.
• Research shows that kids who use e-cigs are more likely to smoke.
• E-cigs create secondhand aerosols with potentially harmful ingredients, including volatile organic compounds, ultrafine particles, heavy metals and potential cancer-causing agents.