Depression, anxiety and wanting to fit in are what Olivia Ridl, 17, says drew her to begin vaping when she was a freshman at Chatfield High School. “I wasn’t a popular kid,” she said. “I was …
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27 percent — of Colorado high school students are users of e-cigarettes
7 percent — of Colorado high school students smoke traditional cigarettes
44.6 percent — of JeffCo high school students have ever used an electronic vapor product
16.2 million — JUUL devices sold in 2017, up from 2.2 million in 2016
Source: Colorado Department of Public Health and Environment; 2017 Healthy Kids Colorado Survey; JUUL
Vaping: The act of inhaling an aerosolized liquid from an electronic device. The devices used to vape go by many different names such as e-cigarettes, e-cigs, smokeless cigarettes, vaporizers, vape pens, mods, tanks, cigalikes, JUUL, e-hookah and hookah pens.
E-cigarettes: E-cigarettes come in many shapes and sizes. Most have a battery, a heating element, and a place to hold a liquid. E-cigarettes produce an aerosol by heating a liquid that usually contains nicotine, flavorings and other chemicals that help to make the aerosol. Users inhale this aerosol into their lungs. Some e-cigarettes are made to look like regular cigarettes, cigars or pipes. Some resemble pens, USB sticks and other everyday items. Larger devices such as tank systems, or “mods,” do not resemble other tobacco products.
E-juice, e-liquid or vape juice: The liquid used in vape devices to make a smoke-like vapor.
Pod: A cartridge filled with a liquid used in a device.
JUUL: A brand of electronic cigarette. They look like a USB flash drives and can be charged by a computer. They are popular with teenage users, who often refer to the activity of using one as JUULing rather than vaping.
Tanks: The component of a vaping device that includes a reservoir to hold additional vape juice and the coil to fire and create the vapor.
Mods: Bigger, bulkier, more complicated e-cigarettes.
Sources: Colorado Department of Public Health, smokefree.gov, U.S. Department of Health and Human Services
• Tri-County Health Department: www.tchd.org
• Tobacco Free 303: www.tobaccofree303.org
• Tobacco-Free Colorado: www.tobaccofreeco.org
• Children’s Hospital Colorado: www.childrenscolorado.org
• Colorado Quit Line: call 1-800-QUIT-NOW
• American Lung Association: www.lung.org
The following tips can help when talking to teens, according to Tobacco Free Colorado. More information can be found at www.tobaccofreeco.org.
Make then feel heard. Consider their opinions and keep the conversation going. Even if you’ve talked about this topic before, their issues and opinions change all the time. Plus, as youth get older, they can feel more pressure from friends and classmates.
Set clear rules
Make family, school and sports team rules clear and stick to them. Let them know what will happen if they don’t follow them.
Focus on positive messages
Encourage them to make choices that help them achieve their goals.
Learn how teens are vaping
Because of the wide array of discreet vape devices, it is easier than ever to hide them and vape at school or during school activities. Get a sense of what vaping devices look like. Many teens don’t consider JUULs to be vapes or e-cigarettes.
Share the science
Despite what teens may hear, vaping is not just water vapor. Most vapes contain nicotine, artificial flavoring and other chemicals. Stress the fact that teens who JUUL or vape nicotine and THC — the compound that is the main active ingredient of cannabis — have trouble learning and memory issues, as both nicotine and THC have negative effects on adolescent brain development.
What to ask teens
Have you ever used a vape pen, vaporizer, e-cig or a JUUL with nicotine? How much? How often?
Depression, anxiety and wanting to fit in are what Olivia Ridl, 17, says drew her to begin vaping when she was a freshman at Chatfield High School.
“I wasn’t a popular kid,” she said. “I was eating lunch in my teachers’ classroom or in the library.”
But vaping with her new friends made her feel like she fit in somewhere, and the nicotine buzz allowed her to cope with and numb unwanted feelings, she said.
By her sophomore year at the school in unincorporated south Jefferson County, Ridl said she couldn’t go a day without her vape, using it at school, in class — sometimes going through a pod or two a day.
The discrete products — often marketed by manufacturers as a healthier alternative to cigarettes, one that can help adults quit smoking — have exploded among today’s youth. The Colorado Department of Public Health and Environment says Colorado is first in the nation for the number of teenagers who use vaporizers or e-cigarettes, calling the trend a public health crisis.
Local public health officials agree that high school students are vaping or using e-cigarettes at alarming rates.
MORE: Consequences of vaping within the Douglas County School District
Vaping is the act of inhaling a vaporized liquid from an electronic device. The devices used to vape go by many different names, such as e-cigarettes, e-cigs, smokeless cigarettes, vaporizers, vape pens and JUULs. There is no smoke as with a traditional, or combustible, cigarette, but there is the addictive chemical nicotine — which is concerning to health officials.
But many people, both teen and adult, don’t connect vaping with nicotine.
Zac Hess, director of health, wellness and prevention at the Douglas County School District, said his department is taking a well-rounded approach to the problem of youth vaping by communicating that connection with school administrators, students and parents. His department is also collaborating with county resources, including the Douglas County Sheriff’s Office, Tri-County Health Department and other health organizations.
“It can’t be just the school district,” Hess said. “I’m optimistic — I think everybody is coming on board.”
Data from the most recent Healthy Kids Colorado Survey — an in-depth look at the health and well-being of young people conducted by the state every two years — concluded that 44.2 percent of Colorado high school students have ever used a vapor product. That’s only slightly higher than Douglas County’s average of 41.1 percent of high school students. About 27 percent of Colorado high school students had vaped in the past 30 days — more than twice the national average of 13 percent, the Centers for Disease Control and Prevention, or CDC, reports.
Ridl’s school district, Jefferson County Public Schools, and other districts in the Denver metro area have seen similar numbers of students using vaping products.
While the rate of teen smoking of traditional cigarettes has dropped 30 percent since 2013, according to the Colorado Department of Public Health and Environment, vaping and e-cigarette use represent something of a new frontier for health, school and law officials.
E-cigarettes hit the market in the United States in the early 2000s. The battery-powered products deliver nicotine in the form of an aerosol, which generally contains fewer toxic chemicals than the 7,000 chemicals in smoke from regular cigarettes, the CDC says. But the aerosol can still have potentially harmful substances like heavy metals and cancer-causing agents, according to the CDC.
Dr. Stanton Glantz, director of the University of California, San Francisco Center for Tobacco Control Research and Education, says vaping devices expose people to a much higher level of heavy metals than combustable cigarettes do.
While vaping refers to the actual act of inhaling and exhaling vapor from a device, an e-cigarette is a specific type of device, created to feel and look like a traditional cigarette. Statistics show that vaping has increased in the past three years with the emergence of kid-friendly flavors and trendy products, such as the JUUL, which hit the market in 2015.
JUUL sales increased more than 600 percent in one year, from 2.2 million in 2016 to 16.2 million in 2017, according to the company.
Popular among teenagers, the JUUL looks like a small flash drive. It is sold at gas stations, convenience stores and online. On its website, the company states that anyone who purchases a JUUL must be at least 21 years old. The legal age to purchase vape products throughout the country ranges from 18 to 21. In Colorado, the minimum age is 18.
The JUUL rings up at about $40 a device and $5 a pod, which contains the liquid used in the device. The device does not produce a big cloud and is easy to hide.
“We know that ease of access is a risk factor that leads to increased usage,” said Maura Proser, chronic disease, injury and prevention manager at Tri-County Health Department, which serves Douglas, Arapahoe and Adams counties.
Fruity flavors and the use of social media have made vaping appealing to youths, experts say.
“Ultimately, it’s undermining all the progress we’ve made in reducing youth tobacco use,” said Susan Westhof, who is part of the tobacco health team at Jefferson County Public Health. “Now a lot of kids are trying this new trendy way of using nicotine and they are getting addicted.”
The liquid in some vaping products comes in a variety of popular, kid-friendly flavors, like bubble gum and cotton candy.
Pink lemonade and strawberry daiquiri were the favorite flavors of Ridl, who is now one year clean from vaping. Mango, she said, was the most popular flavor among her classmates.
“A lot of kids use the fruit flavors,” she said, adding that she didn’t know any teens who used the plain tobacco flavor.
Ted Kwong, spokesperson for JUUL, said the company is committed to preventing youth access to JUUL products, and that no young person or non-nicotine user should ever try JUUL.
“We cannot fulfill our mission to provide the world’s one billion adult smokers with a true alternative to combustible cigarettes if youth use continues unabated,” Kwong said. “As we said before, our intent was never to have youth use JUUL products. We have taken dramatic action to contribute to solve this problem.”
After a Federal Drug Administration crackdown in late October, JUUL announced it will stop taking retail orders for mango-, fruit-, creme- and cucumber-flavored pods. Those flavors will remain available online at the company’s own website through age-verified purchases. In November, JUUL also made its Facebook and Instagram accounts inactive, and says it is developing new technology to further limit youth access and use.
In 2018, 20.8 percent of high school students and 4.9 percent of middle school students across the U.S. reported using e-cigarettes in the past 30 days, according to the CDC. That accounts for about 3.6 million young people.
Reasons for picking up the habit vary, public officials say. But most agree that young people view it as “cool” and “trendy,” and disregard the potential health risks.
A 16-year-old student at Valor Christian High School in Highlands Ranch, who asked that his name be withheld due to the topic’s sensitivity, started vaping last year, when a friend offered him a hit from a JUUL while they were hanging out, playing video games, in his family’s basement.
The Valor student, a friendly teen, an athlete who loves math and biology, said he gave in to peer pressure. He would continue to vape for the next eight months.
“If someone would have told me it was destroying my family and my lungs, I would have stopped,” the student said. “But no one ever told me that.”
The Valor student recalls feeling a brief head rush and burst of energy after using his JUUL. Over the period of eight months, when he was vaping most days, his parents said their otherwise sweet and social kid acted moody, tired and secretive. He spent more time in the family’s basement, where he hid his JUUL and pods in couch cushions and drawers. He lied about needing money for food so he could purchase the nicotine-filled pods from friends’ older siblings.
“He’s a really good student — a sophomore in pre-calculus,” the student’s mother said. “Sometimes he would be focused, other times aloof.”
Vapes have a cartridge, otherwise known as a pod, that is filled with a liquid often times with as much nicotine as one pack of cigarettes. That’s about 200 puffs worth.
The vaping trend concerns public health officials and medical professionals due to the known and unknown health risks. Vaporizers and e-cigarettes contain nicotine, among other, unregulated ingredients, said Robert Valuck, professor at the Department of Clinical Pharmacy at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences.
“People don’t realize nicotine is just as problematic with vaping as with cigarettes to the young brain, pre-age 25,” Valuck said. “This use of nicotine — anything that is an addictive substance — actually changes brain chemistry and rewires somebody to be a more dependent person on substances for the rest of their life.”
Dr. Tista Ghosh, interim chief medical officer at the Colorado Department of Public Health and Environment, said data suggests vaping may be an indicator for other high-risk behaviors, such as binge drinking, using marijuana and misusing prescription pain medications.
Nicotine is especially problematic for young people, whose brains are still developing. Areas of the brain associated with risk and decision-making don’t fully form until age 25, Valuck said. He added that the younger the consumer of nicotine is, the more likely he or she will continue use.
“It’s biology,” Valuck said. “We should keep people safe until they are old enough to make a rational decision.”
Each puff of the chemical delivers a small amount of dopamine, a neurotransmitter in the body associated with reward and pleasure, Valuck explained. When nicotine is inhaled regularly, the consumer’s natural production of dopamine begins to shut down.
“If you stop inhaling nicotine, you feel like crap. You have no dopamine inside,” Valuck said. “This is why people don’t want to quit (smoking).”
Nicotine addiction is linked to agitation, aggression and anger, and can escalate existing anxiety or depression. It can disrupt sleep cycles and appetite. Some people report suicidal thinking when the substance is removed, Valuck said.
Unlike traditional cigarettes, which have been around for centuries, vaping products are relatively new to the market and studies are ongoing as to long-term health impacts.
“We know that we have been able to link cigarette smoking to every cancer and heart disease and lung disease,” said Taylor Roberts, product disease prevention coordinator at Tri-County Health. “Unfortunately, vaping devices haven’t been around as long. We don’t have as clear of a link.”
Glantz, who has been researching the health risks associated with vaping at his center in San Francisco, said although it could be another 20 years before scientists know the potential cancer risks associated with vaping, heart and lung disease are already being linked.
Efforts to decrease the use of e-cigarettes and other vaping products are taking place at the county, state and national levels.
In January, legislators introduced a bipartisan bill that would prohibit the use of e-cigarettes in indoor public spaces and workplaces, essentially imposing the same rules that smokers of traditional cigarettes face. The goal, in part, is to eliminate youth exposure to the products.
“The recent rise in popularity of electronic smoking devices has pointed out a glaring loophole in current law that must be closed in order to keep these products out of the hands of children,” said state Rep. Colin Larson, a Republican representing parts of unincorporated Jefferson County and co-sponsor of the bill.
This comes on the heels of a statewide health advisory on vaping and nicotine addiction issued by the Department of Public Health and Environment last November. Then-Gov. John Hickenlooper signed an executive order to double the number of compliance checks on businesses that sell vapor products and ban the use of vaping products in state buildings.
In 2015, Douglas County expanded its existing ordinance prohibiting minor possession of tobacco to include e-cigarettes, vapor pens or any other alternate devices of ingesting nicotine. Parker and Castle Rock have made similar changes to town ordinances.
Along with the health advisory, Hickenlooper launched Vape-Free November, a prevention initiative aimed at increasing awareness about the dangers of e-cigarettes and vaping. He also recommended that the General Assembly pass legislation on existing tobacco policy, including raising the minimum sales age for tobacco and e-cigarrette products to 21 years old.
With the initiative, came more discussion.
Public health officials are working with schools and brainstorming new ways to reach today’s youth, such as social media campaigns. It’s uncharted territory, Tri-County officials say.
“We have been doing such a good job of getting people to quit smoking. This is just something so new,” Proser said. “The messages that we know work for cigarette smoking are not going to work for this generation and this product.”
Douglas County School District has a department dedicated to students’ physical, social and emotional needs. The Health, Wellness and Prevention Department offers programming and lessons to prevent or change behavior associated with substance use. The elementary level, for example, utilizes a “Lifeskills Tobacco and Nicotine Prevention” class. Middle and high schools use an e-cigarette and vape pen prevention curriculum created by Stanford Medicine.
The school district’s nine middle schools have a counselor whose sole job is to work on prevention, thanks to a $2.4 million, three-year grant from the state.
“In school, we work to help kids build resiliency and refusal skills,” said Hess, the DCSD director of health, wellness and prevention. “Those two things go hand-in-hand.”
In partnership with Douglas County Sheriff’s Office, the district’s Youth, Education and Safety in Schools program, or Y.E.S.S., brings deputies into middle schools to educate students on relationships, Internet safety and substance abuse. Instructors host seminars on similar topics for parents.
DCSD’s school resource officers are using humor to deter students from using vaping products. Some schools, for example, have signs of a guinea pig holding a vaping product with the words, “Don’t be this generation’s guinea pig.”
Ridl, the Chatfield student, said she hid her vape addiction from her father. Now, she wants to encourage other teens to quit vaping, too.
“Telling yourself you are addicted and knowing how bad it is for you is the first step,” said Ridl, who largely credits a 10-week, voluntary group program at the school for enabling her to kick the habit.
Hess said when talking about youth vaping, it’s important to note that it’s impacting kids across the board, starting as young as middle school.
“Administrators get frustrated because they don’t know what to do,” Hess said. “We realize we are not dealing with a kid just making a poor choice. It is so prevalent in schools.”
Students agree that they see kids throughout all social groups vaping.
Abby Hoerler, a junior at ThunderRidge High School in Highlands Ranch, is involved in several extracurricular activities. She often sees students in band or choir vape at school or afterward in their cars.
“I had friends that would say, `I can’t stop taking this, I don’t know how to stop this,’” Hoerler, who does not vape, said.
Vaping, Hoerler said, is everywhere.
“They hide them and they share them,” she said of the devices. “No kid wants to tell a teacher, because then, you’re called a tattler.”
Hoerler serves on the Douglas County Youth Initiative Board, which falls under the Douglas County Youth Substance Abuse Prevention Coalition, made up of agencies with a stake in youth substance abuse prevention or treatment.
Established in 2016, the coalition is part of the Douglas County Mental Health Initiative, comprising more than 40 organizations from the public and private sectors to address the county’s mental health needs.
The Douglas County Youth Initiative Board, comprising students ages 13 to 18, studies and educates the community on issues facing teens.
Vaping is at the top of the list.
“It’s definitely scary,” he said, adding, “I think the community is ready to get engaged.”
— Colorado Community Media reporter Shanna Fortier contributed to this report.
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