Health workers are concerned that electronic nicotine products are undoing decades of prevention of smoking and nicotine addiction among North Dakota youth and adults.
The Food and Drug Administration released its 2018 youth tobacco survey early because of concern for a 78 percent national increase in e-cigarette use among high school students and a 48 percent increase among middle school students, said Nancy Neary, director of tobacco prevention at Central Valley Health District in Jamestown. The U.S. Surgeon General has declared youth e-cigarette use an epidemic, and the FDA has now asserted authority over the products to require disclosing ingredients, she said.
The North Dakota survey showed an increase from 19 to 21 percent in e-cigarette use while smoking rates dropped to 12.6 percent, she said. The concern is that youth who start vaping are more likely to continue or switch to smoking.
"The only thing that needs to go into your lungs is air," Neary said.
Vaping is the use of electronic cigarettes, or e-cigarette devices that heat liquid into an aerosol that is inhaled, she said. The products often contain higher nicotine levels than labeling indicates, she said.
The products are illegal to sell or provide to someone under age 18 but are marketed with candy flavors that appeal to youth, and e-cigarette devices are sometimes modified for marijuana use, Neary said. The devices look like inhalers, USB drives, remote keys and cellphones to make it difficult to spot them, and the lithium ion batteries can explode when damaged, she said.
In March, a Jamestown High School administrator became ill after his hand came in contact with vaping liquid confiscated from a student. The level of nicotine was poisonous and highly addictive, she said.
The school district added vaping products to its substance use policies years ago, but there still is an increase in use locally, said Adam Gehlhar, principal of Jamestown High School. Central Valley Health provides the school district with awareness training.
Adolescents are neurologically more prone to making risky decisions that include use of unhealthy substances, said Robert Lech, superintendent of Jamestown Public School District.
"The accessibility, relative lack of awareness of the inherent dangers and novelty (of vaping) has resulted in increased usage by lots of different groups," Lech said. "If we want to combat the issue, we truly need an all-hands-on-deck approach together by students and parents, educators and policymakers and the business community."
Nicotine products are dangerous for brain development in people under age 25, Neary said. Addiction can lead to behavioral issues later on in life, and the brain is susceptible to addiction to other substances, she said.
Surveys show that 66 percent of kids don't even realize that vaping products contain nicotine, Neary said. The nicotine in one pod (liquid container) can be equal to a pack of cigarettes, she said.
"The level of nicotine someone ingested depends on how of often they use it," Neary said. "A pod could last a week, a few days or even one day."
Other dangers include diacetyl, heavy metals and nano particles that get deep into the lungs, she said. People who are trying to quit smoking should use FDA approved nicotine replacement therapies, she said.
The effect of nicotine on the brain is the same, whether it is delivered with cigarette smoke or an electronic device, said Irina Stepanov, an associate professor with the School of Public Health and the Masonic Cancer Center of the University of Minnesota. But during adolescence, nicotine affects the reorganization of brain regions necessary for mature cognitive function such as memory, emotional regulation and behavioral functions, she said.
"Nicotinic acetylcholine receptors are key players in regulating brain maturation, so when nicotine interacts with these receptors during adolescence — there are unique negative consequences," she said.
The amount of exposure to nicotine from an e-liquid varies depending on how much nicotine is present, the type of the electronic device, the power setting and frequency of use, she said.
"An example of a product that delivers very high levels of nicotine is JUUL, which is also the most popular among youth," Stepanov said.
Stepanov's lab researches the chemistry and toxicology of tobacco products and she said the aerosol from heating propylene glycol and glycerin in e-cigarettes produces toxic byproducts and a complex chemistry.
The long-term risks of e-cigarettes are not yet well understood, but a recent finding was that e-cigarette users can form a potent carcinogen called N-Nitrosonornicotine in the oral cavity, which is believed to contribute to esophageal and oral cancer in tobacco users, Stepanov said.