Boone County health educator Claire Haughton holds an e-juice product containing nicotine (left) beside a pack of gum. The FDA believes tobacco companies package nicotine products to look like candy and other food products to appeal to minors. Staff photo by Maria Flora
Boone County health educator Claire Haughton holds an e-juice product containing nicotine (left) beside a pack of gum. The FDA believes tobacco companies package nicotine products to look like candy and other food products to appeal to minors. Staff photo by Maria Flora
The percentage of high-schoolers who admitted to vaping nearly doubled last year to 20%, according to the U.S. Food and Drug Administration.

The jump alarms health officials who say teens mostly don’t know what’s in the products they are ingesting, nor how powerful the e-juice is, and that nicotine is especially aggressive in teens’ developing brains.

To compound the problem, tobacco companies are forbidden from marketing vaping products to children but package e-juices with nicotine to resemble candy, gum, breakfast cereal and in fruit flavors that appeal to children.

Mango is the favorite among Boone County students, Boone County health educator Claire Haughton said.

CAMOUFLAGE

The companies also design innocuous looking vapor delivery products, called e-cigarettes or vapes, that look like USB sticks, pens, highlighters, watches, or necklaces, to name a few.

Students would normally have these things, and their appearance is not immediately alarming to teachers or parents, who often remain in the dark about their children’s use of nicotine products, Haughton said.

Some hooded sweatshirts come with a tube woven through the drawstring through which the wearer can vape. “It’s like tubing you would find in an aquarium,” Boone County health educator Claire Haughton said. Vaping hoodies are available for less than $30 online, but children also make their own.

They pull up the hood, cross their arms on the desk and put their heads down, pretending to sleep when they are actually vaping in class and blowing the vapor into their arm undetected, Haughton said.

Haughton visits area high schools and middle schools to educate students and staff about e-cigarettes and vaping and nicotine addiction.

A basic e-cigarette is the shape of a cigarette or pen. It has a battery to power a heating element that vaporizes an e-liquid contained in a cartridge that fits in the device. The user inhales the vapor.

A vaporizer, or vape, has the same elements except it has a larger refillable tank instead of a cartridge to hold e-liquid.

E-cigarette cartridges are disposable and the user just snaps another into its place.

But some users, including entrepreneurial teens, buy e-liquid in bulk online and refill cartridges or vape tanks and sell hits to their classmates between classes, Haughton said.

NO IDEA

Some teens spend more than $1,000 a year to feed their nicotine addiction, and their parents don’t think they are using tobacco products because they aren’t smoking traditional cigarettes, authorities say.

Asked what is in their e-juice, 66% said just flavoring, 13.7% didn’t know, 13.2% said nicotine, 5.8% said marijuana, and 1.3% answered other, according to the National Institute on Drug Abuse.

Manufacturers don’t have to report e-cig ingredients, so users don’t know what’s actually in them, according to the NIDA.

One manufacturer that especially appeals to minors, Juul, has claims on its website that one 5% strength Juulpod replaces one pack of cigarettes in the number of cigarettes, 20, puffs, 200, and the amount of nicotine strength.

But Haughton read the label and did the math and said one Juulpod is closer to one and a half to two packs of cigarettes, and the nicotine used hits children’s brains harder and faster than cigarettes.

“Today’s tobacco products are a lot stronger than these children’s parents or grandparents would have had,” Haughton said.

Some e-juice does not contain nicotine, but most does have nicotine and any number of chemicals that are not always listed on the label, including THC, the intoxicating element in marijuana.

The FDA and Centers for Disease Control and Prevention warn that THC cartridges represent a higher percentage of patients in an epidemic of lung injuries that both agencies are investigating. Other patients used only nicotine products, while some patients used both.

SHOPPING

Although 18 is the federal legal age to buy tobacco products, younger teens can easily buy e-liquids online, and many of those come from overseas and are unregulated and improperly labeled, authorities say.

Sixteen- and 17-year-olds bought e-juice with their own debit cards online for a study conducted by Dmitriy Nikitin, a University of California, Irvine, researcher, in 2015.

The teens bought e-liquid containing nicotine from vendors in 34 states. Only four sellers rejected purchases because of their age.

The majority of orders included free samples of e-liquid and 15 came with promotional freebies, including playing cards, Mike and Ike candy, Laffy Taffy candy, Sweet Tarts candy, bracelets, B’loonies Plastic Balloons and stickers, according to the study.

Teens found it just as easy to buy vaping devices and other related products online, according to a report published in the journal Nicotine and Tobacco Research indicated.

EPIDEMIC

The use of e-cigarettes, vapes and e-juice is directly connected to the recent declaration of a national epidemic of lung injury and illness declared by the CDC and FDA.

As of Tuesday of this week, the CDC reported 805 confirmed and probable cases of lung injury associated with vaping among 38 states and one territory. That’s up from 530 reported Sept. 19.

No one chemical or component and no particular practice has been determined as the cause, and authorities ask that everyone stop using e-juice products.

The FDA forensic chemistry center is analyzing about 150 samples of products collected from victims for the presence of a broad range of chemicals, including nicotine, THC and other cannabinoids, along with opioids, cutting agents or dilutants and other additives, pesticides, poisons and toxins.

Nearly 75% of the cases of lung injury are among males, according to the CDC. Two thirds of reported victims are aged 18-34, with 16% being younger than 18 and 17% being 35 or older.

Authorities are concerned because a large majority of patients were otherwise healthy people before the onset of lung injury, Haughton said.

MOVE TO 21

Organizations around the country are campaigning to raise the legal age to buy tobacco products to 21 in the wake of vaping’s popularity among teens.

Students who are 18 or older legally buy the products at gas stations, convenience stores, groceries, department stores and drugstores and sell them to their younger friends at school, Haughton said.

Raising the age to 21 makes it less likely that students that age will still be in high school to sell them to younger peers, she said.

Juul is the most popular brand of e-cigarettes among teens and is advertised on signs in local gas stations windows. Juuls look like USB sticks and even plug into a USB port to recharge. And Juul offers loads of flavors like mango and mint that children favor.

Jacob Kingery of Indianapolis owns KC Vapor Studios stores in Lebanon, Crawfordsville and Lafayette and offers mint, mango and other fruity flavors but does not sell Juul products because they appeal to children, he said, adding that his clients are mostly ages 25 to 65.

Kingery said teens are easy to spot in vape stores, and most vape store owners are leery of being fined for selling to a minor, so they are careful to check identification of younger customers.

He believes vaping products are safer than cigarettes for adults who are trying to stop smoking, although not completely safe.

He supports raising the legal buying age to 21 and banning online sales to everyone because minors find it so easy to buy vaping products online.

Kingery thinks minors find it far easier to buy e-cigarettes at a gas station than at a vaping store.

Haughton stopped into a Zionsville gas station recently and found Juul and other brands there. The store had a $15 coupon on e-cigarettes that day, and she was able to buy an e-cigarette for $5 after the coupon.

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