Understanding the rise in youth vaping
Analyzing the reasons behind the climbing numbers and its effects.
May 21, 2023
It’s compact enough to keep in your pocket or purse –– to take with you everywhere you go. It’s eye-catching and comes in a multitude of different colors and shapes, ranging from rectangular to cylindrical. The flavors pull you in with your sense of taste and smell, ranging from fruity to menthol. But, is this little device misconceiving?
E-cigarettes, or vapes, have the nation’s youth fixated, as 2022 has marked the ninth consecutive year of the product being the most commonly used tobacco product among middle school and high school students.
Vaping is a past time familiar to many college students. According to the American College Health Association’s Fall 2022 National College Health Assessment, vapes were the leading used tobacco product.
21-year-old Kittie describes her first time vaping nicotine at around the time JUUL products were at their peak popularity in 2017. After her first vaping encounter, Kittie’s sister gifted her a vape that she didn’t care for anymore. This led to Kittie wanting more.
“I bought another one and then I got addicted,” Kittie said. “I always thought [vaping] was wild before the people close to me were doing it, and then I realized it wasn’t that crazy.”
Her personal normalization of vaping led to Kittie developing a reliant sort of paranoia, where she thinks it’s fine to vape, but knows it isn’t because of its negative aspects — including becoming addicted.
“It just cost a lot of money,” Kittie says. “I quit a few times but whenever shit gets real I always go back to it.”
The evolution of vapes
According to the Consumer Advocates for Smoke-free Alternatives Association, a nonprofit organization that raises awareness about smoking and tobacco usage, Chinese pharmacist Hon Lik was the first person to successfully develop and commercialize a vape in 2003. Lik did this after his father, who was a heavy cigarette smoker, passed from lung cancer.
Vapes have only evolved since, according to the CDC’s E-Cigarette, or Vaping, Products Visual Dictionary, there are now four generations of vaping devices.
The first generation of devices includes disposable e-cigarettes, or “cigalikes,” which were initially introduced in 2007. Cigalikes take on the appearance and feel of cigarettes. They are designed for one-time use – once the e-liquid is out, the device would have to be thrown away as it isn’t rechargeable or refillable.
The second generation gave way to vape pens. These devices are e-cigarettes with prefilled or refillable cartridges and designed for multiple uses. Once the e-liquid runs out, users can either get a new cartridge to attach to the device or refill the previous one.
The third generation of devices is modifiable batteries. Tanks or mods are a type of vape system designed for multiple uses and allow for customized substances. Sub-ohm tanks are attached on top, which allows one to inhale the e-liquid. The tanks are designed for stronger hits of nicotine, ultimately creating larger vapor clouds.
The fourth generation of devices come in the form of pod systems, or “pod mods.” These devices use prefilled or refillable pods with a modifiable battery and allow the user to inhale higher levels of nicotine. Popular pod mod brands include JUUL, SMOK and Suorin, and come in a variety of shapes and styles.
Today, a new generation of disposable vapes has hit the market and may be the most popular yet. These vapes come pre-charged and have a certain amount of puff amounts before the e-liquid runs out. This can vary from hundreds of hits to even thousands. These vapes are available in a variety of flavors and nicotine levels. Popular brands include Flum, PUFF BAR and ELFBAR.
Kimberlee Vagadori, project director for the California Youth Advocacy Network, “1000%” believes that the evolution of vaping devices plays a role in youth and young adult consumption.
“The original devices used a freebase nicotine solution which was difficult to deliver with smaller devices,” Vagadori said. “Thus, we saw e-cigarettes transition in size from cig-a-likes to pens, to mods and tanks.”
According to Vagadori, JUUL changed the course of vaping by creating a device that best replicates smoking cigarettes. The company incorporated a salt-based nicotine solution pod and a “small, sleek and discrete device.”
“Salt-based solutions deliver higher levels of nicotine in less aerosol. This has resulted in people using vaping devices more often,” Vagadori said. “The more you vape and the higher the nicotine, the greater the dependency.”
Today, many companies have taken on the salt-based nicotine approach for their products, though it may not be for the better.
“The vaping devices on the market today have a high level of a salt-based nicotine solution that is linked to higher levels of addiction in youth and young adults. These products negatively impact an individual’s lung health as these devices include an assortment of chemicals and heavy metals, all found in the e-cigarette aerosol,” Vagadori said. “Use may lead to long-term, long-lasting effects on a young person’s brain such as nicotine addiction, mood disorders, and permanent lowering of impulse control.”
Behind the rising numbers
According to Richard Harvey, SF State holistic health studies professor and former research fellow at the UC Irvine Transdisciplinary Tobacco Use Research Center, individual health habits and behaviors contribute to the rise in vaping.
General health behaviors can include one’s diet, sleeping habits and how they decide to relax. These categories then break into smaller subcategories and include what people use and do to fulfill these habits.
“Some people use meditation versus medication. Some people use alcohol, tobacco and other drugs,” Harvey said. “Tobacco and nicotine products are a part of the [latter] category.”
Vagadori elaborates, reiterating that vaping can be a coping mechanism for some users.
“When we vape or smoke, we are associating that action with another behavior, and we use the substance to deal with stress, anxiety, depression, boredom, etc.,” Vagadori said. “It’s really hard to take away something we are using to cope without replacing it with something healthy.”
Smoking is considered an appetitive behavior, which is exactly what it sounds like – a behavior one has an appetite for. Once smoking becomes a consistent part of your lifestyle, you can end up craving more.
“When we think of appetite we think of food, but it’s anything, any substance that we put into our body, including tobacco, alcohol and other drugs,” Harvey said. “Appetitive behaviors even go so far as anything we become dependent on.”
According to Harvey, shifts in information availability, material accessibility and emotional support are technical factors contributing to the rise of youth vaping.
He connects information availability to what’s currently being talked about in connection to vapes, whether it be casual conversation or advertising. He offers the rhetorical example of someone saying that vapes are cheaper and more accessible. This shift goes in hand with material accessibility.
“While this is information that may or may not be true, it’s informational support,” Harvey said. “When we want to do things we need to provide not only information, but we also need to provide access to equipment, a vaping pen for example, or the money that goes in to buy these things.”
Harvey associates emotional support with a certain level of encouragement. For instance, if someone were to say that vaping isn’t as strong or it’s a good way to quit. Whether it’s factual or not, a sense of encouragement is brought about because the device is being projected in a positive light.
Vapes have painted themselves to appear as a better alternative to smoking ever since its emergence. However, the American Heart Association states that “e-cigarettes should not be promoted as a safe alternative to smoking.”
“Nicotine vaping devices have not been approved to support individuals in quitting tobacco nor is there sufficient evidence to show that they do help people quit smoking cigarettes,” Vagadori said. “The FDA has approved pharmaceutical nicotine products to help people quit using tobacco. The vaping devices on the market today have a high level of a salt-based nicotine solution that is linked to higher levels of addiction in youth and young adults.”
The FDA states, “To date, no e-cigarette has been approved as a cessation device or authorized to make a modified risk claim and more research is needed to understand the potential risks and benefits these products may offer adults who use tobacco products.”
Compared to cigarettes, vapes are generally less physically damaging, but still hold health risks.
“The vaping pen is not quite as hot when the vapor comes out of the end of it, however, the fact that the chemistry was changed, [the vapor] is actually heated up and chemically altered. Those chemical damages can still occur even if you’re not getting the heat damage in addition,” Harvey said. “It is less physically damaging, at least in the heat-superheated column of air sense. It’s potentially as damaging in terms of the toxic chemicals.”
Prevention & reduction at SF State
The California State University has a smoke and tobacco-free policy across all universities.
According to Hazel Kelly, CSU strategic communications & public affairs manager, former Chancellor Timothy P. White pioneered the process for a systemwide smoking and tobacco policy in 2013.
“Although most of the CSU’s 23 campuses were already smoke-free or had tobacco restrictions in place, a workgroup was created to explore the creation of a new policy that would serve as a basis for the system while providing the flexibility to adopt additional provisions appropriate to each campus community,” Kelly said.
Former Chancellor White implemented CSU Executive Order 1108 in April 2017, which went into effect in September that year.
“In addition to banning the use and sale of all tobacco products, the policy also initiated tobacco cessation programs and outreach campaigns to the campus communities,” Kelly said.
The American College Health Association conducted the National College Health Assessment III, Spring 2021. Tailored for SF State students, the survey received over 2 thousand respondents. During the Spring 2021 semester, the university had over 25 thousand undergraduate and graduate students enrolled.
In the survey, the highest used tobacco or nicotine delivery product in this category was vapes.
Although the smoke and tobacco-free policy is in place, SF State has taken on a harm reduction approach to address smoking and vaping among the campus community.
“Nicotine is highly addictive, and once it becomes a habit, it can be hard to seek support, however making the community aware of the resources out there can be the first step,” said Elizabeth Nunez Gandara, health promotion & wellness substance use education coordinator. “We don’t want to shame users but provide education.”
Health Promotion & Wellness is a part of SF State’s Student Affairs & Enrollment Management office, which focuses on health education in areas such as alcohol, drugs and personal health. The group has been actively educating the campus community about smoking and vaping.
According to the Health Promotion & Wellness Impact Report from Fall 2018 to Spring 2020, the group implemented the SF State Smoke and Tobacco Free Task Force as well as pursued smoking cessation programs and events.
Within the period, the task force consisted of 16 members and formally met seven times. They also held 20 smoking cessation events, gathering the attention of over 600 students. BREATHE advocates, who push for clean air and lung health, were able to educate over 550 students and faculty on smoking cessation.
The SF State Smoke and Tobacco Free Task Force stopped their meetings during the pandemic due to a low campus population. However, there are still advocates ready to educate the repopulating campus community.
“Now that we are all back, we have a group of stakeholders from across campus to continue having conversations around alcohol, tobacco and other drugs on campus,” Gandara said. “This group talks about programming, events, resources, and policy and is composed of staff/faculty, and student representatives.”
Throughout the current academic year, Health Promotion & Wellness continued to host events and workshops regarding smoking and vaping.
“The Substance Use Education team tabled at the Food & Housing Fair in support of the Great American Smoke Out event which happens on the third Thursday in November every year,” Gandara said. “This event hopes to raise awareness on cessation and moderation management of smoking/vaping and provides awareness on the disproportion of communities who are impacted by vape/tobacco marketing and use.”
Another event the group put on was the Earth Day clean-up event towards the end of April. According to Gandara, the event not only allowed them to pick up trash around campus, but also helped spot potential smoking spots. By doing this, Health Promotion & Wellness will be able to know where they can go to raise awareness about the no-smoking policy.
“Smoking and vaping are legal and for many a way to cope with stressors. However, we also do not want it to infringe on other people’s ability to clean air, so making sure it does not happen in buildings or on campus is important,” Gandara said. “If we see it happening on campus, we simply let the user know that they are more than welcome to step out to the sidewalk, away from campus.”
There are on-campus resources to support the members of the SF State community looking to cessate their smoking and vaping habits. The Student Health Services Pharmacy offers nicotine replacement therapy, through gum or a patch, for under $20. Health Promotion & Wellness is also partnered with CYAN, which provides “quit kits” for those interested.
Addressing youth vaping in San Francisco
In a garbology study, two UCSF researchers, Jeremiah Mock and Yogi Hendlin, went to 12 high schools across different Bay Area counties, including San Francisco, to collect e-cigarette waste.
“Our garbology study, while conducted during the era of the youth JUUL epidemic, is still one of the very few on this topic,” Mock said.
Their findings included 893 disposed smoking products, including 172 JUUL pods and caps. Nearly all of the JUUL products weren’t tobacco flavored.
“It is important to recognize that the manufacturers who make all of these products are ultimately responsible for producing them in the first place,” Mock said.
At the time, JUUL devices were seen as a silent, rapid threat among San Francisco youth. So much so that the San Francisco Unified School District filed a lawsuit against the company in December 2019.
According to the initial press release, the lawsuit sought damages for targeted marketing and advertising.
“It’s very important for us to help teach students about the dangers of using Juuls, but JUUL has continued to relentlessly target their product to minors, undermining our efforts to teach children how to live healthy lives,” said Dr. Vincent Matthews, SFUSD Superintendent of Schools, in the press release.
The SFUSD reached a settlement in December 2022. The unidentified amount is said to go towards additional resources regarding youth vaping and nicotine usage.
“The settlement will make a significant difference in the public health fight against youth e-cigarette use, and will further advance SFUSD’s established health education work by providing meaningful resources to support prevention efforts and education around youth e-cigarette use,” said Jenny Lam, SF Board of Education President, in the press release.
SFUSD did not reply for further comment.
The San Francisco Tobacco-Free Project, a program part of the city’s public health department, works to reduce secondhand smoke among residents and limits youth access to tobacco products by strengthening established policies. The project also monitors youth tobacco use, vaping data, developing news and new research.
“The Coalition is where change happens. It’s a network of strong advocates against tobacco who tirelessly work toward a tobacco-free San Francisco,” said San Francisco Tobacco-Free Coalition Co-Chair Chakoma Haidari. “It’s an honor to be part of the Coalition and advocate for a healthy generation and community.”