Child advocates: Raising age for tobacco sales to 21 could help stem tide of youth vaping
By Jennifer Fernandez
Solomon Wynn came down with bronchitis in the spring of his freshman year in high school.
The family doctor tried antibiotics and steroids, but nothing worked. The football player became so weak that he couldn’t even walk to the bus stop, his stepmother said.
A trip to a specialist at Novant Health found the source of his worsening condition — vaping. It had destroyed his lungs and weakened his heart, eventually leading him to collapse on Friday, June 16, 2023. By the time he got to the hospital, he was already brain dead.
“On Saturday evening, once several of our older children came to say their goodbyes, as a family, we sat there together, held hands, held Solomon’s hand and took my son off the ventilator,” Charlene Zorn said earlier this year. “I watched my 15-year-old stepson, who had all the potential in the world, die from something that was completely preventable.”
While cigarette use has generally dropped among North Carolina youth, the number of kids who have taken up vaping has continued to rise. Last year, four in 10 North Carolina high school students reported they had vaped, according to the 2023 state Youth Risk Behavior Survey.
“The most alarming thing last year was discovering that elementary school students were also vaping,” said Tricia Howard, lead nurse for Durham Public Schools.
Child advocates want North Carolina to raise the legal age to buy tobacco products — including vapes — from 18 to 21, matching federal law and the law in 43 other states. They also want North Carolina to create a process for tobacco retailers that mirrors the one for alcohol retailers, who can be inspected and fined for not checking IDs to ensure that customers are old enough for legal purchases.
The Child Fatality Task Force, which is a legislative study committee of volunteer experts in child health and safety, state agency leaders, community leaders and state legislators, has been working to stem vaping among youth since 2017.
“I think it is a horrific epidemic that is just barreling across this country,” Karen McLeod, co-chair of the task force, said at the group’s meeting earlier this year when Zorn shared her story.
“We are just in the beginning of this,” McLeod continued. “And if we don’t nip this in the bud … we’re going to have way too many more stories like we heard today.”
Appealing to kids
E-cigarettes, also called vapes, heat liquid nicotine into a vapor for the user to inhale. Vapes come in exotic flavors like citrus sunrise, nana coconut and watermelon ice. None of these flavors has been approved for sale in the U.S., and children aren’t supposed to be able to buy the 34 tobacco- and menthol-flavored vapes that have been approved by the U.S. Food and Drug Administration.
North Carolina successfully sued e-cigarette maker Juul over its role in the growing nicotine use among the state’s youth, arguing that the company’s marketing and advertising tactics were designed to attract middle and high school students to the flavored pods and other products. Money from the initial $40 million settlement has been paying for e-cigarette cessation and prevention programs, data monitoring, evaluation of programs, a documents depository and litigation costs.
Juul, hamstrung by the settlement, has seen its market dominance fade, but plenty of other vape makers filled the void.
Vapes come in many shapes and sizes, various colors and a variety of flavors, including fruit, candy, menthol and mint, said Teresa Beardsley, tobacco prevention manager at Albemarle Regional Health Services.
“Some vapes look like regular cigarettes or cigars or pipes. They even can look like pens, highlighters, toys, USB flash drives and everyday items,” Beardsley said last month during a virtual town hall on vaping hosted by the N.C. Department of Health and Human Services.
The latest iteration of vapes use smart phone technology to make them more appealing, Sally Herndon, head of the state’s Tobacco Prevention and Control Branch, told Child Fatality Task Force members on Tuesday. The manufacturers are even embedding electronic games into the vape devices.
“The more you vape, the more games you get,” Herndon said. “So they’re gamifying the vape.”
Despite FDA regulatory actions against vaping products, e-cigarette manufacturers continue to launch new products that appeal to youth, researchers with the University of Southern California’s Keck School of Medicine warned in a recent commentary.
“Vaping nicotine and computer gaming are two behavioral addictions that have become prevalent among adolescents in recent decades, and they often co-occur,” the authors wrote.
Nicotine is highly addictive, and vape products can contain really high doses, Kella Hatcher, co-chair of the Child Fatality Task Force, reminded task force members Tuesday as they discussed what action to take on vaping. Every year the group puts together recommendations on preventing child death and promoting child well-being to take to the N.C. General Assembly. Those recommendations can range from seeking funding for a program to asking for new laws to address an issue.
The task force’s biggest success in 2023 — the creation of the Office of Child Fatality Prevention — came after years of lobbying. During this latest short session, legislators provided part of the funding for child care providers that the group recommended.
Push for legislation
In 2019, Congress increased the federal minimum legal sales age of all tobacco products, including e-cigarettes, to 21. The majority of states (43) have increased their minimum age to match federal law, but not North Carolina.
Some of those states just raised the minimum age, but that alone is not effective, said Jim Martin, a Child Fatality Task Force member and director of state-level policy and programs for the state’s Tobacco and Prevention Control Branch.
Another important component is a permitting or licensing system, he said.
The licensing of tobacco retailers has been identified as an evidence-based measure to reduce tobacco sales to youth, according to the U.S. Surgeon General and the National Academy of Medicine.
Martin said North Carolina could set up a permitting system similar to that for retailers that sell alcohol. The Division of Alcohol and Law Enforcement would be able to conduct routine inspections in any location that has a permit. Without that permitting process, ALE can only conduct enforcement operations. A permitting process also would hold retailers more responsible for illegal sales to anyone underage, and it would provide a better mechanism for retailer education, he said.
Several state agencies have been looking at what kind of language should be used to craft a North Carolina law. The agencies have consulted with other states about their laws, Martin said. The idea, he said, is to have “a strong law in North Carolina, one that’s considered evidence-based.”
Pushing for such a law tops the agenda for NC Alliance For Health this year, Executive Director Morgan Wittman Gramann told the task force Tuesday.
McLeod, who often interacts with the General Assembly in her role as a lobbyist, said legislators are seeing their kids vaping too.
“They are upset, and they don’t know how to control it,” she said. “So we’re all feeling this, and I think … the timing is right for us to have this conversation at the legislature.”
The committee voted to recommend endorsing the work of the NC Alliance For Health on increasing the legal age for buying tobacco to 21 and creating a permitting process for retailers who sell tobacco products. The recommendation will be considered by the full task force later this year.
Other groups have been looking at ways to keep vape shops away from areas children frequent.
There’s no state law limiting where vape shops can operate, according to Beardsley, the tobacco prevention manager at Albemarle Regional Health Services. However, she said local governments can use zoning ordinances to decrease the density of retailers in an area and prohibit them from opening near schools, daycares or other areas where young people might be. As of August, three counties and 19 municipalities have adopted such zoning ordinances, she said.
Treating, not suspending
As child advocates work to change state laws to curb youth vaping, parents and educators have to find ways to help children now.
Edgecombe County Schools no longer suspends students who are caught vaping, according to Chanda Battle, the district’s director of student support services.
District officials thought students would change their behavior once they were suspended. But they saw the same students getting suspended again and again, Battle said at last month’s virtual town hall.
“What we found was, if it’s an addiction, you’re going to try to use that [vape] whenever you can and figure out any kind of way you can to use your device,” she said.
Instead of suspension, they now use a combination of interventions, from parent-student conferences to referrals for substance abuse counseling.
Howard, lead nurse for Durham Public Schools, said students have told her that they believe most students turned to vaping as an outlet or coping method to deal with stress, although some students vaped to be cool or due to peer pressure. They also shared concerns that the various flavors of the devices made vaping even more enticing.
She also said students were surprised to hear how bad vaping was for their health, and they asked why it was so easily accessible. They told Howard that the health risks needed to be more widely shared with students and families, and they also said they needed more information on how to effectively cope with stress.
In Edgecombe County Schools, instead of getting suspended, students now can get counseling at school to address the issues that led them to vape, Battle said.
Beardsley said research shows that suspension is “not a helpful way to encourage students to quit” vaping. Suspensions can add to a student’s problems by leading to missed class time, which puts them at greater risk of not graduating and even ending up in the criminal justice system, she said.
Vaping needs to be addressed with elementary age children, as well, said Nnenne Asi, youth and young adult tobacco cessation coordinator with the state’s Tobacco Prevention and Control Branch. They are exposed to vaping through social media just like older children, she said during last month’s virtual town hall.
Prevention for elementary school students can be incorporated into the curriculum, and families can start discussing the dangers of vaping with them, Asi said.
A lot of times, parents don’t know their child is vaping because it happens away from the home, Battle said. So educators and school officials need to make sure they’re talking to parents and kids about it.
“Whether you think students may be vaping or not,” Battle said, “it’s important to have conversations with them about vaping, the risks and … the tools that can help them quit if they need it.”
The post Child advocates: Raising age for tobacco sales to 21 could help stem tide of youth vaping appeared first on North Carolina Health News.
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