Rubiner & Mendonca: Schools and Parents Alone Can’t Stop Kids from Vaping. To Head Off This Epidemic, the FDA Must Ban All Flavored E-Cigarettes

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After more than a year of online learning and social distancing from friends and peers, many teens are finally returning to school and their social circles this fall. But as students make plans for the new school year, we could also see the resurgence of another health crisis that was bad even before the COVID-19 shutdown: the youth e-cigarette epidemic.

In the early months of 2020, teen vaping was rampant in schools; 3.6 million kids, including 1 in 5 high school students, used e-cigarettes. Now, as students head back to school, they could again face the conditions that caused the vaping epidemic in the first place: the powerful influence of peer pressure and the widespread availability of e-cigarette products that lure kids with fun flavors and can quickly addict them with massive doses of nicotine. The industry knows full well that 83 percent of youth vapers use flavored products.

The return to school coincides with another critical date on the calendar: The Food and Drug Administration faces a Sept. 9 deadline for deciding which e-cigarette products can remain on the market. To truly protect kids and end the youth e-cigarette epidemic, the FDA must eliminate the flavored and high-nicotine products — including the popular menthol flavor — that have driven this crisis. Parents, educators and health advocates are counting on the FDA to take them off the shelves.

The evidence is clear that as long as any flavored e-cigarettes remain on the market, kids will get their hands on them. Last year, the FDA banned flavors other than menthol in cartridge-based products like Juul but left other flavored e-cigarettes widely available. What happened next was completely predictable: Kids migrated to the flavored products that were left. Use of disposable e-cigarettes like Puff Bar soared by an alarming 1,000 percent among high school students, and there was also a notable shift to menthol products, with over 1 million kids using them in 2020.

Those of us working in schools and caring for students’ health and well-being remember what it was before classrooms were shuttered. Juul and other e-cigarettes were everywhere, and traces of mint- and fruit-scented aerosol lingered in hallways and bathrooms as teens attempted to discreetly satisfy their dangerous nicotine addictions. Educators even smelled it in classrooms. Nurses, teachers and administrators were constantly confiscating devices, with piles of Juuls filling their desk drawers. Some schools had to take the doors off bathroom stalls to stop kids from trying to vape in secret. The percentage of high school e-cigarette users reporting frequent or daily use has risen steadily, to a high of nearly 39 percent in 2020. That’s not surprising, because e-cigs like Juul contain as much nicotine as a whole pack of cigarettes.

The U.S. Surgeon General has found that nicotine use in any form by young people is unsafe, causes addiction and can harm the developing adolescent brain, impacting learning, memory and attention. Studies indicate that young people who use e-cigarettes are more likely to go on to smoke regular cigarettes, and nicotine use during adolescence can increase risk for future addiction to other drugs.

With COVID-19 cases surging once again because of the Delta variant, it is more important than ever to keep kids’ lungs healthy by preventing young people from smoking or vaping. For school nurses, that means this academic year will bring even more challenges. On top of navigating COVID-19 and the mental health fallout from the pandemic, they will have to redouble their efforts to educate teens about the risks of vaping.

Teachers and parents will also need to learn anew how to recognize the signs of e-cigarette use and addiction. E-cigs can be hard to identify because of their sleek and inconspicuous designs that resemble flash drives or pens. If teens are spending more time alone than usual, coming up with excuses to step away frequently or have a sweet smell on their clothes or in their rooms, these could be signs of vaping. Others include an unexplained cough or increased thirst, increased irritability and mood swings.

But nurses, educators and parents alone cannot combat youth vaping. More than anything, we need the support of the FDA and other policymakers, who are the only ones with the power to eliminate the flavored products driving this epidemic.

As the new school year begins, we’d all like to start fresh. But until the FDA takes action, we will face more of the same. It’s time for the agency to stop playing whack-a-mole and eliminate all flavored e-cigarettes.

Laurie Rubiner is executive vice president, domestic programs, at the Campaign for Tobacco-Free Kids. Linda Mendonca is president of the National Association of School Nurses and an assistant professor at the Rhode Island College School of Nursing. She was a school nurse for two decades.

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