Education and pricing are strategies to fight high vaping use by isle youths

Lola Irvin is a long way past her middle- and high-school days, but not so long that she has forgotten the importance of a teacher-student bond. She had one such relationship, and that helped her through those tricky adolescent years.

Irvin administers the state Health Department’s division on chronic disease prevention and health promotion, now focusing on a developing campaign to counter the state’s electronic cigarette crisis, especially among Hawaii’s youth. In the continuing debate over how best to fight what’s known simply as “vaping,” she believes strongly that casting teachers as enforcers is the wrong way to go.

That would never have worked when she was a kid, when her special teacher was there to give her an ear, not slap her with a penalty.

“She was the adult listener, when I didn’t have an adult listener at home,” Irvin said. “That wouldn’t have happened if a teacher had turned me in to the judicial system.”

What school officials and other “adult listeners” should be doing is finding a way to relay the following message to their young charges: Vaping can do terrible damage to young bodies, striking hard with little warning.

The state Health Department is putting out some media messaging through digital advertising and plans to expand outreach through training of educators and community organization leaders who work with adolescents.

Hawaii has some of the worst statistics for vaping among its student population, with roughly one-fourth of high-schoolers having used the products. The use of “e-cigs” for the inhalation of vapor, generally tinged with nicotine, has become a rampant practice on school campuses — among middle-schoolers, too.

Now the state is in the throes of constructing its own defense against vaping. The 2019 legislative debate over strategies is sure to be resurrected this year.

It’s already illegal to sell vaping products to anyone under 21, and school authorities can already confiscate the vaping supplies if used on campus. But a bill passed last year sought to strengthen that by increasing fines from $10 to $100.

Even though Gov. David Ige vetoed that bill, it’s likely to be reintroduced in some form for the 2020 session, Irvin said.

What she and many other stop-vaping advocates prefer — strongly — are efforts to restrict sales and marketing aimed at kids. Some of them made that point recently in a legislative briefing, prefaced by some scary descriptions of how the vaping liquid affects the lungs when inhaled.

That presentation was by pediatrician Dr. Bryan Mih, medical director of Kapiolani Smokefree Families. Some of the formulations involve “nicotine salts,” a variant making it easier to inhale deeply and get addicted more readily, Mih said. E-cigs have never been proven effective as a smoking- cessation alternative.

“The chemicals used for flavors and the solvent, they are also harmful, not recommended at all as a cessation device, and was never introduced as such,” he said. “They just put it on the market and allowed whatever happens to happen. And that’s what we’re seeing now.

“The severe harm from it is not just mild lung damage, but it can be very severe lung inflammation that lands you in the ICU.”

From the front lines of the battle against vaping came Samantha Domingo, a Farrington High School senior and member of the Coalition for Tobacco-Free Hawaii’s Youth Council that works with the Health Department to counter smoking and vaping among the young.

Domingo told the lawmakers at the briefing that many of her classmates believe vaping is safer than cigarettes, an impression enhanced by a multitude of sweet flavorings in the fluids (“e-juices”) marketed to teenagers.

“This issue is very personal for me because I know people my age who sell e-cigarettes and e-juices and they have connections with people who are willing to sell to kids, even if it’s illegal,” Domingo said. “And I also know some of the kids who actually purchase from them. I see the effects that their nicotine addiction has, and it’s not good.”

Domingo is outnumbered on campuses by children and teens who have found ways to conceal their habit: Devices now sold can be as small as a flash drive, said Anthony McCurdy, lead teacher for the academy of creative media at Campbell High School.

It’s become so commonplace, he added, that some kids don’t try very hard to conceal anything.

“My first year teaching was really the first time I had run into it,” McCurdy said. “I had one student who had some type of device that he plugged into the wall.

“I said, ‘What is that?’ He said, ‘Oh, Mister, it’s for my phone.’ And I said, ‘No, no, it’s not.’

“Another student last year, as he was walking in he was blowing out a big puff of vapor. I was like, ‘Dude, I’m right here — you’re not even trying to hide it,’” he added.

The realities of campus management make confiscation somewhat ineffectual as a strategy, said Mitzie Higa, government relations specialist for the Hawaii State Teachers Association: They’re hard to spot, and when they can be seized, the school is burdened with piles of what amount to hazardous waste it can’t discard.

The union has lobbied for a law that bans the sale of flavored vaping liquids because these are the elements that attract new users, Higa said.

“Our teachers are extremely worried about the students,” she said. “Even though they are confiscating more and more, it’s still on the upswing. … Confiscating? I’m sorry, it’s not working.”

Higa said HSTA also favors the idea of taxing e-cigarettes, an initiative that’s aimed more as a disincentive for the young customers than as a revenue enhancement. Frank Chaloupka, a health research and policy professor at the University of Illinois at Chicago, concurred.

He told legislators at the briefing that teens are particularly cost-sensitive, so anything that raises the price should drive down sales.

“We’ve taken everything that we’ve done on traditional tobacco product taxation and started to look at what would happen with vaping product taxes,” he said. “What we see is that, if anything, the demand for these products is much more sensitive to price than what we see with traditional tobacco products.”

A 10% price increase for cigarettes tends to cut the demand by about 4%, Chaloupka said; the same price hike cuts vaping demand by 10%. Kids were about three times as sensitive to vaping prices as they were to prices of cigarettes, he added.

Higa maintained that attacking the problem at the point of sale was the approach with the best chance of success. Students might tend to wave off any coaching about the ill effects of vaping, she said — especially if it comes from parents.

However, Christine Russo, a freshman science teacher at Campbell, said some kids are plainly misinformed and think their parents are just pointlessly panicking.

“One of my good friends, her son, who is an eighth-grader, admitted to vaping,” Russo said. “And when she got upset, he said, ‘Mom, it’s only Zeros,’” referencing a brand labeled as having zero nicotine.

“In his mind, it’s not even bad.”

McCurdy’s view is that “there won’t be any magic bullet,” and so the state needs to throw everything at the problem: regulations, teacher training, educational advertising — everything.

Kids have found every workaround imaginable, he said, relating one story of a girl who runs a virtual store on Instagram. She posts ads on the platform, her customers give her money, she buys a credit-type gift card and goes online to buy the product.

This is a plague that will be hard to stamp out, Irvin acknowledged. That said, if an anti-vaping program works even partly as well as the state’s stop-smoking advertisements of the 1990s, it will be worthwhile.

“We reduced smoking 71 percent between 1997 and 2017,” she said. “And that was done without penalizing youth.”

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INJURIES AND DEATHS

According to a Thursday update of vaping-harm cases from the U.S. Centers for Disease Control and Prevention:

>> As of Oct. 29, 1,888 cases of e-cigarette (vaping) product use associated with lung injury have been reported — from 49 states (all except Alaska), D.C., and one U.S. territory.

>> There have been 37 deaths in 24 states and D.C. (none yet in Hawaii). The median age of deceased patients was 53, and ranged from ages 17 to 75. More deaths are under investigation.