Community forum in Louisville addresses teen use of e-cigs

Claire Ramsey of Henry County led the discussion at Manual.
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By Melissa Patrick
Kentucky Health News

Kentucky students led a community forum about the epidemic of electronic cigarette use among teens at DuPont Manual High School in Louisville Nov. 6.

“Many students and their parents think that e-cigs or vapes are safe, but they are not, especially for students and young adults. And there just isn’t enough research yet to know whether they’re safer than cigarettes for adults,” said Claire Ramsey, a Henry County seventh-grader who led the discussion.

Ramsey gave the audience a short lesson about the different e-cigarette products and accessories on the market, including a special hoodie designed to hide the device and allow the person to inhale the aerosol through what appeared to be the hoodie draw-string.

A panel of experts presented a range of e-cigarette topics as they related to youth, including some that addressed the specific health dangers to youth, marketing tactics that target youth, an update on vaping-related lung disease, and policies to decrease youth use of e-cigs.

Dr. Aruni Bhatnagar of the University of Louisville told the group of about 70 that nicotine is especially harmful to teens and young adults because it can harm developing brains. He said it is associated with a decrease in impulse control, affects attention and learning capacity, changes the chemistry of their brains and can prime adolescent brains for addiction to other drugs. Research also shows, he said, that teens who use e-cigs are more likely to start smoking regular cigarettes.

E-cigarette use among Kentucky’s teens nearly doubled between 2016 and 2018, with more than one in four high school seniors and one in seven 8th graders reporting use in 2018, according to the Kentucky Incentives for Prevention study.

One Juul Labs pod has as much nicotine as a whole pack of cigarettes and many teens go through several pods a day. Juul is one of the most popular brands of e-cigarettes among teens.

Ben Chandler, CEO of the Foundation for a Healthy Kentucky, which hosted the event, listed several policy measures that it will support in the legislative session that begins in January, including taxing e-cigarettes just like cigarettes; raising the age to buy tobacco products and e-cigs to 21; and increasing state funding for smoking prevention and cessation to $10 million, up from $3.8 million.

Asked about cessation products for teens, the panelists said there are no validated cessation programs and protocols for teens who are using e-cigarettes, and a great need for them.

Some resources for teens who are looking to quit include:

Dr. Sara Moyer, Louisville’s director of health, noted that the Louisville health department has no age restrictions on its smoking-cessation classes.

Vitamin E acetate may be the culprit

The Centers for Disease Control and Prevention said Nov. 8 that vitamin E acetate, an additive sometimes used in e-cig products, may be to blame for the national outbreak of related lung injuries.

The CDC found vitamin E acetate in all of the samples taken from 29 patients who were sickened by e-cigs in 10 states. THC, or tetrahydrocannabinol, the psychoactive ingredient in marijuana, was detected in 82% of the samples, and nicotine was detected in 62% of the samples.

“This is the first time that we have detected a potential chemical of concern in biological samples from patients with these lung injuries,” says the CDC. “These findings provide direct evidence of vitamin E acetate at the primary site of injury within the lungs.”

Several other studies have linked cases of EVALI, which stands for “E-cigarette or Vaping product-use Associated Lung Injury,” to vitamin E acetate in products containing THC.

That said, the CDC says it’s not able to attribute all of the cases of the lung injuries to one compound or ingredient, and there may be more than one cause of the outbreak.

“While it appears that vitamin E acetate is associated with EVALI,” CDC said, “evidence is not yet sufficient to rule out contribution of other chemicals of concern to EVALI.”

As of Nov. 5, 2,051 cases of lung injury related to electronic cigarettes had been reported to the CDC, and 39 deaths had been confirmed in 24 states.

Of the 1,364 patients on which the CDC has age data, 14 percent were under 18 years old; 40% were aged 18 to 24; 25% were 25-34; and 21% were 35 and older.

The CDC reports that among 867 patients who reported e-cigarette use in the previous 30 days, 86% reported using products with THC; 34% reported exclusive use of THC-containing products; 64% reported using products with nicotine; and 11% said they used only nicotine-containing products.

In Kentucky, 33 cases are under investigation, with three of them confirmed and 11 of them considered probable. Seven reported cases have been ruled out.

The CDC recommends that for now at least, no one should use electronic cigarettes or products containing THC; no one should buy any e-cigarette products off the street, particularly those with THC; and no one should modify or add any substances to e-cig products that are not intended by the manufacturer. It also says that because the cause or causes of these lung injuries is unknown, the only way to assure that you are not at risk is to refrain from use of all e-cigarette or “vaping” products.