SALT LAKE CITY — States aren’t waiting on the federal government to regulate electronic cigarettes, and at least four have issued all-out bans on the products, while several others are considering similar legislation.

Utah leaders have shied away from pulling e-cigarettes — also called mods, pens, pods and cigalikes — off the shelves, but at least one lawmaker wants the state to head in that direction.

What’s old is new: Kids struggle to quit nicotine

“You’ll see a flavor ban in Utah, for sure,” Rep. Paul Ray, R-Clearfield, said this week. Ray has touted the dangers of tobacco products for years, passing various legislation that is inching Utah closer to prohibition.

His proposed ban would include all flavors, even menthol and mint, which he said are popular among youth, calling it “a good first step.”

Why is Ray so adamantly against the upward-trending nicotine-delivery alternative to smoking?

“People are dying,” he said.

And while experts don’t know exactly what it is about e-cigarettes that is killing people, vaping is wildly popular among teens, with more than a 900% increase in youth use since the devices became available over a decade ago in 2007.

“It’s the latest craze,” Suchitra Krishnan-Sarin, a bio-behavioral scientist and Yale professor of psychiatry, said in June. “It’s also a serious health concern.”

In 2018, more than 3.6 million United States youth — including 1 in 5 high school students and 1 in 20 middle school students — use e-cigarettes, according to an advisory from the U.S. Surgeon General Jerome Adams.

“We must take action now to protect the health of our nation’s young people,” he said.

Krishnan-Sarin said not a lot is known about the long-term effects of vaping or using e-cigarettes; what’s worse is that science can’t keep up with the product’s rapid explosion in popularity.

Use around the world has only continued to increase, with more than 15,000 flavors now marketed and new, compact devices coming out all the time. Krishnan-Sarin said it’s no wonder teens are intrigued.

“It’s perfect for the smartphone generation,” she said, adding that innovative and customizable features fit right into the desires of rising generations.

Andrew Teasley, a salesman at Good Guys Vape Shop, exhales vapor while using an e-cigarette in Biddeford, Maine, on Tuesday, Sept. 3, 2019. | Robert F. Bukaty, Associated Press

That’s not water vapor

At least 13 vaping-related deaths have been reported in the United States, which is prompting consideration, and drawing extra attention to the fact that youth are at particular risk.

“Many teens think these devices produce water vapor and therefore are safe to use, but they could not be further from the truth,” Krishnan-Sarin said.

Electronic cigarettes do not just vaporize whatever is inside a cartridge. The battery-powered heating mechanism creates a chemical reaction and produces an aerosol of finely suspended particles of liquids and gases — including toxic solvents and alcohol — even metals used in device production, which are known to be harmful to the brain and haven’t been studied as inhalants.

“What is produced is definitely not water vapor,” Krishnan-Sarin said.

So why is vaping so bad for teens?

Research has shown that developing teen brains are more sensitive to even low levels of nicotine and other chemicals, causing teens to more easily become addicted and have a harder time quitting — 90% of smokers started before age 18. The changes that nicotine causes in the brain, Krishnan-Sarin says, can lead to decreased learning ability, memory and mental processing issues, cravings and anxiety that is characteristic to behavioral addiction. She said it can also impact other systems of the human body, including potentially impacting the health of future generations.

While e-cigarettes are believed to have been initially created to help curb nicotine addiction in smokers — and more than 10 million American adults have decreased their cigarette dependence with vaping — the unintended consequence of growing youth use is troublesome.

“While there is no doubt that providing smokers with a cleaner form of nicotine is and should continue to be a critical goal, we still do not know if these devices help people quit smoking,” Krishnan-Sarin said. “While trying to solve one huge public health problem — cigarette smoking — we may have created another colossal one.”

She added, “Now is the time for action ... a serious public education campaign.”

But what can be done?

Ray said with the recent death reports, “the awareness level has skyrocketed.” He’s had an influx of emails and comments from parents “who didn’t realize what their kids were getting into.”

“People are seeing that this is impacting kids — their kids,” he said. “And it’s a big deal.”

Current Utah regulations restrict the sale of vape products to anyone under age 19, though that doesn’t seem to be keeping it out of the hands of Utah youth, Ray said. Organizations, too, have called for tighter rules on product advertising, resulting in at least one major vape manufacturer, Juul, pulling its print, digital and TV ad campaigns, amid other issues within the company.

A researcher holds vape pens in a lab at Portland State University in Portland, Ore., on April 16, 2019. | Craig Mitchelldyer, Associated Press

Rates skyrocketing

Ray believes Big Tobacco is only trying to sustain its business, “addicting a new generation” that isn’t so enamoured with smoking.

While smoking rates are down across the country, youth tobacco product use rates increased 38.3% in 2018, according to the U.S. Centers for Disease Control and Prevention. A whopping 1.5 million more youth were using e-cigarettes in 2018 than in 2017.

Teen vaping | Mary Archbold

“This increase — driven by a surge in e-cigarette use — erased past progress in reducing youth tobacco product use,” a CDC Vital Signs report states.

In Utah, which has lower teen smoking rates than many states, fewer than 3% of Utah youth surveyed in grades eight, 10 and 12 reported using actual cigarettes, a local health department study reveals. But use of e-cigarettes has doubled in the past five years, with 11.1% of Utah teens last surveyed reporting they have vaped.

Vaping is considered to be a safer, cleaner method of smoking. It’s discreet and convenient and the flavors are creatively named. All of that, and more, is clinching teens and getting them hooked.

“We live in a technology-crazed world where the latest devices get a lot of attention,” Krishnan-Sarin said. “We need to get out of the habit of automatically celebrating new technology and look with a critical eye, a medical lens, at what it is doing to our health.”

Nicotine, even with the small amounts contained in some e-cigarette cartridges, is extremely addicting — “the most addictive substance on the face of the Earth,” Ray said.

As evidenced in recent reports, it is deadly — perhaps more so in vaporized form, as it can take decades for damages from habitual cigarette smoking to appear yet e-cigarettes seem to already be making a mark.

Smoking, according to a number of health organizations and agencies across the globe, is the leading cause of lung cancer.

And now, vaping is believed to be tied to permanent lung damage and disease.

The vaping-related deaths — in California, Florida, Georgia, Illinois, Indiana, Kansas, Minnesota, Mississippi, Missouri and Oregon — are but a small portion of the more than 530 confirmed and probable cases of lung disease believed to have been caused by e-cigarette use, the CDC states.

‘Urgent epidemic’

No one product or device is to blame, but the American Medical Association has cautioned people to lay off vaping while it is investigated further.

It recommends anyone who has recently used e-cigarette products to seek medical care. Coughing, shortness of breath and/or chest pain can be symptoms of serious health concerns. The American Medical Association “calls on physicians to make sure their patients are aware of the dangers of e-cigarettes, including toxins and carcinogens, and swiftly report any suspected cases of lung illness associated with e-cigarette use to their state or local health department.”

“The e-cigarette-related lung illnesses currently sweeping across the country reaffirms our belief that the use of e-cigarettes and vaping is an urgent public health epidemic that must be addressed,” Dr. Patrice A. Harris, president of the American Medical Association, said earlier this week. “We must not stand by while e-cigarettes continue to go unregulated.”

Adding to the public furor over vaping, U.S. President Donald Trump this month issued his own crackdown on vaping, pushing for a ban on all flavored e-cigarettes.

“We can’t allow people to get sick and we can’t have our youth be so affected,” Trump said.

U.S. Health and Human Services Secretary Alex Azar said flavors will no longer be available.

“The Trump administration is making it clear that we intend to clear the market of flavored e-cigarettes to reverse the deeply concerning epidemic of youth e-cigarette use that is impacting children, families, schools and communities,” he said. “We will not stand idly by as these products become an on-ramp to combustible cigarettes or nicotine addiction for a generation of youth.”

It will take time for federal regulators to work out the ban, though, and the rampant popularity and isolated disease that appears to be related to vaping is enough for some states to act independently.

Leaders in Michigan, New York and Rhode Island have taken matters into their own hands, instituting bans on sales on specific vape products. The most stringent ban, so far, however, is in Massachusetts, where the sale of all vaping products, including those containing THC, is prohibited for the next four months.

Massachusetts Gov. Charlie Baker called it a public health emergency.

“The use of e-cigarettes and marijuana vaping products is exploding, and we are seeing reports of serious lung illnesses, particularly in our young people,” he said this week.

A handful of other states are considering similar action, including Illinois, New Jersey and Delaware. And the governor of California signed an executive order to set an intense education and awareness campaign into motion.

E-cigarette pods are displayed for sale at Good Guys Vape Shop in Biddeford, Maine, on Tuesday, Sept. 3, 2019. | Robert F. Bukaty, Associated Press

‘It’s everywhere’

“The FDA is constantly recalling items — most recently they recalled a blood pressure medication that might cause cancer — but, here we have a substance that is killing people,” Ray said. “It’s at epidemic levels. It’s time we get rid of it.”

Teen vaping | Associated Press

It is estimated that 21% of Utah teens are using e-cigarettes regularly, but Ray said school administrators report much higher numbers to him. Wasatch High School recently installed vape sensors to better enforce its campus vaping ban. Other schools have had to remove bathroom stall doors to keep it from happening there.

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“It’s everywhere,” Ray said, adding that he also intends to bring back a bill that would increase taxes on all vaping products in Utah. He believes it has enough support to pass.

In addition to Ray’s efforts, a legislative working group focused on e-cigarettes has come up with at least four bills intended to curb youth use in Utah. Still, there may even be more focus on the issue during the legislative session that starts in January.

As of Sept. 23, the Utah Department of Health has reported 47 cases of severe lung disease associated with vaping THC, nicotine or both in Utah, with an additional 22 potential cases being investigated. New, increasing numbers are released every week.

“Our health, the health of our children and our future generations is far too valuable to let it go up in smoke, or even in aerosol,” Krishnan-Sarin said.

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