County officials warn of e-cigarette use, especially among youth

Many people in Washington County and elsewhere have seen an increase in e-cigarette and vape pen use, especially among youth. The Surgeon General issued an advisory on e-cigarette use among youth in December 2018. He declared 'e-cigarette use among youth is an epidemic in the United States,” and called for 'aggressive steps to protect our children from these highly potent products that risk exposing a new generation of young people to nicotine.” Nicotine is highly addictive, and exposure during adolescence can harm the developing brain impacting learning, memory, mood, impulse control and attention. Nicotine also impacts the cardiovascular system by increasing heart rate and blood pressure. E-cigarettes are commonly called vapes and are electronic heating devices that mimic a cigarette by heating liquid containing nicotine. Since 2014, e-cigarettes have been the most commonly used tobacco product among U.S. youth. From 2017 to 2018, e-cigarette use among high school students increased 78%, and 48% among middle school students. Research shows that youth and young adults are particularly attracted to e-cigarettes due to the sweet fruit, candy, cookie and cereal flavors combined with targeted marketing practices known to attract kids.

E-cigarettes go by many names; there are hundreds of brands and thousands of flavors. In 2017, a product named JUUL gained popularity with unit sales increasing by more than 600%. JUUL sales surpassed all other companies and in December 2018, Altria, maker of Marlboro, purchased a 35% stake in JUUL. This product comes in menthol and fruit flavors, and has a USB flash drive design. A JUUL cartridge or pod uses nicotine salts which allows for high levels of nicotine to be inhaled. These pods contain about as much nicotine as an entire pack of 20 regular cigarettes.

Contrary to what many believe, the vapor from an e-cigarette, or aerosol, is not harmless. In addition to nicotine, the aerosol that users inhale and exhale from e-cigarettes contains other harmful substances including heavy metals, formaldehyde, acrolein, cancer-causing chemicals, volatile organic compounds and ultrafine particles that can be inhaled deeply into the lungs. The nicotine present in e-cigarette aerosol is absorbed not only by users, but by bystanders as well. The FDA has just begun to regulate e-cigarettes so there is no mechanism for consumers to know for sure what is in the products or the aerosol.

Additionally, there are currently no studies that show e-cigarettes help people quit smoking, and the US Public Health Service doesn't recommend it for that purpose. Unfortunately, youth and young adults who use e-cigarettes are more likely to also use traditional cigarettes.

An additional concern for e-cigarettes is its adaptation for use of smoking Tetrahydrocannabinol (THC), which is a chemical found in marijuana and affects the brain, creating a 'high” for its users. Cartridges for e-cigarettes are being manufactured in other states with a liquid containing THC, but law enforcement in Washington County have found them here in Washington County. These THC cartridges come in colorful packages, and are named after various types of sweet treats, candies, and children's cereal like 'Fruity Pebbles”. The level higher level of THC, the greater the high. Traditional street level marijuana contains approximately 8-12% THC, but these cartridges are as high as 98% THC. THC can cause many different effects including paranoia, anxiety, panic attacks, short-term memory problems, learning deficits, chronic stomach pain, lethargy, and coordination and depth perception problems. Long-term studies on very high levels of THC have not been done because those products have not existed until now. There have been examples of children who have ingested a large amount of THC infused food who have experienced vomiting, muscle spasms, either high or low heart rate (depending on strain), and even comatose. This is called THC toxicity. THC vapes look very similar to e-cigarettes, and this has become an issue in enforcement.

Tobacco use appears similar to other substance use, remaining stable or declining from previous surveys. Among 11th graders in Washington County, tobacco use has declined greatly over the past 8 years – going from 35% in 2008 to 17% in 2016. The exception to this is e-cigarettes. Almost one-quarter of 11th grade students (23 percent) reported use of e-cigarettes in the past month on the 2018 Iowa Youth Survey, along with 8 percent of eighth graders and 2 percent of sixth graders. For 11th graders, this is up from 9% in 2016. More than 1 in 3 11th graders in 2018 (37%) had ever tried an e-cigarette.

The Iowa Youth Survey shows Washington County youth tobacco and e-cigarette use rates of 11th graders are consistent with the state average use rates, and it is important evidence-based interventions, including local policy changes, are employed to further reduce these rates.

Washington County would be among a growing trend of state and local governments in curbing e-cigarette use. As of January 2, 2019, there are 15 state laws and 814 local laws in the U.S. restricting e-cigarette use in 100% smoke-free venues. In Iowa, the State law does not yet prohibit its use and there is one county, Story County, with a local ordinance restricting e-cigarette use in 100% smoke-free venues. The following local municipalities in Johnson County have enacted ordinances related to the prohibition of the use of e-cigarettes: Coralville, Iowa City, North Liberty, Solon and University Heights. The following local municipalities in Washington County are considering similar ordinances: Washington and Kalona.

Adopting ordinances that include e-cigarettes in already existing smoke-free policies on both the governmental and business level can address this public health epidemic by reducing e-cigarette use. It would be our recommendation to consider additional evidence-based population level strategies to reduce e-cigarette use among young people: restricting young people's access to e-cigarettes in retail settings, licensing retailers, implementing price policies and strategies to curb e-cigarette advertising and marketing that are appealing to young people, and strategies to reduce access to flavored tobacco products by young people. Furthermore, THC cartridges look identical to traditional nicotine cartridges, making them difficult to detect. Including e-cigarettes and vapes into existing smoke-free policies would help in addressing the law enforcement issue as well as send a clear message that our community cares about health and safety. We hope you will join with us in supporting polices that address these issues.

Sincerely,

Danielle Pettit-Majewski, Washington County Public Health Administrator

Jared Schneider, Washington County Sheriff

John Gish, Washington County Attorney

Sarah Smith, Prevention Coordinator for Prelude Behavioral Services