Alabama medical experts expressed concerns about the rising use of e-cigarette devices by teenagers. In this April 11, 2018 file photo, a high school student uses a vaping device near a school campus in Cambridge, Mass. Twice as many high school students used nicotine-tinged electronic cigarettes in 2018 compared with the previous year, an unprecedented jump in a large annual survey of teen smoking, drinking and drug use. Findings were released on Monday, Dec. 17, 2018. (AP Photo/Steven Senne, File) (Steven Senne)
Vaping’s popularity among American teenagers is soaring, highlighted by startling national statistics released this week by researchers and an unusual “epidemic” decree on Tuesday by the U.S. Surgeon General.
The news has prompted Alabama pediatricians, researchers and other medical experts to also sound alarms about teenage vaping, and to offer ideas about how to curb its growth.
“It’s not entirely surprising for those of us who have contact with people in this age group,” said Dr. Steven Rowe, professor and director of the Cystic Fibrosis Research Center at the University of Alabama at Birmingham. “But it’s shocking, nonetheless, of the degree of addiction and prevalence of use.”
Said Dr. Curtis Turner, a professor of pediatrics at the University of south Alabama College of Medicine and a pediatrician with USA Health: “What we’re worried about is if you try e-cigarettes for whatever reason, the risk is that it has nicotine and it’s very addictive. They get addicted for life.”
Alabama lawmakers are also setting their sights on the issue ahead of their 2019 spring session. Other states, this week, began rolling out bills intended to take e-cigarette devices from teens’ hands, following Surgeon General Jerome Adams’ call for a crackdown.
“I wouldn’t be surprised if we saw some legislation introduced regulating underage vaping,” said state Sen. Cam Ward, R-Alabaster, chairman of the Senate Judiciary Committee.
The issue was thrust into the media spotlight in the past couple of days following the latest report on teen vaping sponsored by the federal government’s National Institute on Drug Abuse and conducted by the University of Michigan.
The report produced an eye-popping statistic: Never in the survey’s 44-year history had researchers seen such one-year spike in teens’ experimentation with some chemical stimulant or drug. Among high school seniors, 21 percent said they’d vaped nicotine within the past 30 days, up from 11 percent the previous year.
The study prompted Adams to come out with an official warning, only his second in his 16-month tenure. The first, in April, urged people to carry naloxone as a way to respond to opioid overdoses.
Dr. Susan Walley, professor of pediatrics at the University of Alabama at Birmingham who is the chairwoman for tobacco control efforts with the American Academy of Pediatrics, is another who’s disturbed by the data.
A 2016 report by the Center for Disease Control and Prevention, based on an analysis a year earlier,
showed 47.5 percent of high school students admitting to using a nicotine product, and 27.4 percent of middle school students.
The analysis was taken before Juul electronic cigarettes arrived on the market. The sleek devices shaped as USB flash drives are cartridges that contain oils which create vapor when heated. Each Juul pod contains as much nicotine as a pack of cigarettes, according to the Alabama Department of Public Health.
“I think it’s fair to say these numbers are lagging behind,” said Walley. “The statistics of Alabama students using e-cigarettes may be much higher, but we don’t know yet.”
Juul devices are popular among youths. According to one study, teens are 16 times more likely to use Juul than older age groups. Other e-cigarette devices are commonly used by adults to assist in recovering from cigarette addiction.
An Auburn University study, which will be published in the spring, contains preliminary data that suggests an estimated 24 percent of the university’s students use e-cigarettes/Juul at least once per day.
Linda Gibson-Young, an associate professor at Auburn’s School of Nursing, said the study’s release and the surgeon general’s warning will help bring more public scrutiny to the issue.
“Parents need to be more aware of what their children are doing,” said Gibson-Young. “It’s hard. It’s difficult to keep up with. But being aware of what a Juul is or what an e-cigarette looks like and how children use them … just making the public aware of what they are and what they look like.”
Juul devices are the most talked-about of the e-cigarettes because they can be discretely hidden.
Juul, a San Francisco-based company, has defended its products in recent days. The company claims it is taking steps to prevent teens from using them, and has pledged to cease distributing some flavorings to retail stores. Also, the company is taking steps to stop young people from buying devices online.
But the Juul’s “cool” factor causes researchers to wonder whether it’s the new generation’s version the Marlboro Man or Joe Camel.
“It’s what their peers are doing because they are finding their own identities,” said Gibson-Young. “If it comes across as the in-thing, they are more than likely will see the trends and follow it.”
Dr. Alan Blum, director of the Center for the Study of Tobacco and Society at the University of Alabama School of Medicine, said, “It’s almost like we haven’t learned anything from smoking.”
So how to combat the rise of e-cigarettes among teens? Lampoonery, Blum said, could be one way.
“Looking at kids sucking on USB drives is hilarious enough to come up with all sorts of satire and mockery instead of jumping up and down and saying, ‘Oh, you are going to get addicted,’” he said.
Blum said, “The surefire way to get everyone to try it is to tell everyone how dangerous it is.”
Said Rowe, the director of the Cystic Fibrosis Research Center at UAB: “I think we’re behind or getting caught flat-footed.”
He said that UAB researchers have gathered enough date to show there will be harmful effects on how a vaper’s lungs can defend itself from infections.
“It’s only a matter of time before you start to see all sorts of side effects accumulate,” said Rowe. “There is a marketing about the coolness and a mistaken perception that it’s a completely healthy alternative to smoking. It’s not.”
Blum and others are skeptical that in Alabama, much will be done to regulate the industry.
Alabama is one of a dozen states that has not instituted a ban on public smoking of tobacco. All of those states, excluding Wyoming, are located in the South.
Alabama also doesn’t have a tax on e-cigarettes. The state, according to the CDC, had the lowest average monthly sales price for e-liquids in the U.S. at $5.32.
Lawmakers, in 2015, considered a $0.25 per milliliter tax on the liquid products in a move that was backed by Gov. Robert Bentley as a way to generate revenue to patch a budget deficit. The tax failed to advance out of the Legislature, and hasn’t resurfaced since.
Eight states and the District of Columbia have an excise tax on e-liquids, including Louisiana and North Carolina.
Alex Clark, CEO of the Consumer for Smoke Free Alternative Association, said Alabama is a “tax averse state” and he anticipates the issue coming to the fore only if budget deficits need addressing. He said the taxes approved in the Southern states are “not that bad” as compared other states and localities such as Chicago, where a per unit tax of $0.80 is coupled with a per milliliter rate of $0.55.
Said Blum: “Every single legislature is looking at Juul as another source of taxable revenue through sin taxes and getting more revenue into budgets.”
Alabama lawmakers could consider weighing in on increasing the smoking age from 19 to 21. If lawmakers endorse the age increase, it would join six other states – none from the South – in raising the tobacco age to 21.
Another 350 localities, but none within Alabama, have approved ordinances hiking the smoking age. Only one locality in the Deep South, in the unincorporated areas of Adams County, Mississippi – home to Natchez – has increased the smoking age.
State Rep. Chris Pringle, R-Mobile, sponsored legislation last year to have Alabama join the Tobacco21 movement. The measure didn’t go anywhere.
Pringle said he plans to reintroduce the bill this legislative session, and that vaping will be included.
Angi Stalnaker, a Montgomery-based lobbyist representing theBreathe Easier Alliance of Alabama – which consists of approximately 200 e-cigarette businesses in the state – said the organization “feels confident” that 19 is an appropriate age.
“We don’t believe the problem is the law,” said Stalnaker. “It’s the enforcement of the law.”
She added, “In Alabama, it is illegal to purchase vape products or electronic cigarettes if you are under the age of 19. It is illegal for someone to over 19 to purchase them for someone underage. The leadership and members of the Breathe Easier Alliance of Alabama strongly condemns anyone who would sell to those underage or make purchases for those who provide to underage.”
She said that if children under 19 were “punished” for vaping, “you’d see use among teenagers rapidly decline.”
Hoss Mack, the sheriff of Baldwin County, said the concern as he sees it for law enforcement is that the public generally is unaware of the issue.
Mack said that school resource officers have reported to him about vaping becoming a “real problem” inside schools because the devices are concealed.
“If you are out at a ballgame and you see a kid drinking a beer, you think to yourself, ‘that’s not right,’” said Mack. “But if you see a kid out there vaping, they may not necessarily not think it’s right but they don’t know it’s restricted.”
He added, “I don’t think we necessarily need any more laws, but I do think we need an educational thing. I do think this situation has come up that it will need to be addressed in some fashion.”
Dana Vandiver, spokeswoman with the Alabama Association of School Boards, said existing policies on cigarettes, alcohol and other drugs at school districts throughout Alabama already apply to vaping.
“However, we will be reminding our members to review those policies to determine if any updates are necessary to include specific terms/language addressing vaping/e-cigarettes,” she said. “Our role with respect to this issue largely focuses on ensuring that school board members have awareness about the problem and are prepared to address it through their district policies.”