Updated: August 8, 10:05 a.m.
U.S. Surgeon General Jerome Adams, in Honolulu for a medical convention, raised alarms earlier this week about the heavy use of e-cigarettes by Hawaii’s youth. The U.S. Centers for Disease Control and Prevention ranks Hawaii number two among states for children grades 6 to 12 who are vaping. Hawaii's e-cigarette usage by its youngsters is double the average for the country as a whole.
For those not in the health field or working in island schools, the statistics are startling.
Teachers report finding children as young as second and third-graders using e-cigarettes at school. They have asked the state Department of Health to begin prevention education programs starting in kindergarten to combat the growing health problem.
According to the Health Department, the high rate of use stems mainly from heavy vaping among children and teens in Kauai, Maui and Hawaii counties.
In 2017, about 25 percent of Hawaii teens reported using an electronic vapor product in the past 30 days, according to the Hawai'i Youth Risk Behavior Survey. Among the counties, Hawaii Island had the highest rate at 34% and a third of Maui County teens surveyed had used e-cigarettes.
Even young kids are regularly vaping -- rates among Hawaii middle-schoolers are similar to that for high-schoolers. Sixteen percent of all Hawaii middle-school students surveyed reported using e-cigarettes while 23% of students in Hawaii County said they did the same. For Kauai County, 19% of middle-schoolers reported vaping while on Maui, 18% said they smoked e-cigs, both rates higher than the state average.
“We’re losing a lot of our progress with reducing cigarette use by youth with just this rise in adoption of e-cigarettes,” said Lola Irvin, administrator of Chronic Disease Prevention and Health Promotion Division at the state health department.
Irwin said in 1999, youth cigarette smoking rates stood at 29%. Now, 20 years later, the rate of youth usage of e-cigarettes is almost the same.
SMOKING IN SCHOOL
As public schools resume next week, Hawaii's state policies on e-cigarettes have failed to match the need for youth prevention. One reason: smoking remains a popular social habit that elevates the attraction of e-cigarettes.
Two years ago, Madeleine McCurdy went to the bathroom during a freshman-year math class at Kapolei High School and ran into another student breathing out clouds of smoke. She returned to the bathroom with a teacher, but the student had left, taking her vaping device with her.
It was the first time Madeleine had encountered a student using an electronic smoking device. However, it would not be her last.
“I’m not really around people who do that, but it’s definitely a big social thing,” said Madeleine, now a rising junior. Vaping, she said, can take a student higher up the social ladder in high school.
Increasingly, smoking devices and electronic cigarettes are a common accessory for teens. In the 2017 youth risk behavior survey, about 42% of teens admitted to trying electronic smoking devices at least once and 44% reported their closest friends use e-cigarettes.
Irvin believes Hawaii’s rates are high due to the online marketing of e-cigarette products to youth by companies.
“These companies were really advertising their products like the flavored e-juice and various products like JUUL and Suorin Drop through social media,” Irvin said. “In fact, JUUL did use social influencers to post their products online, and our youth have access to that.”
In a statement to HPR, JUUL said that they've never marketed to anyone underage, and they're goal is to appeal to adult smokers trying to quit regular cigarettes. They also said they do not use social media channels to advertise to anyone, and their current campaign targets smokers ages 35 and up.
SERIOUS HEALTH EFFECTS
Apart from the social aspects of vaping, what makes e-cigarettes particularly addicting for youth? Lila Johnson, program manager for the state health department’s Tobacco Prevention Education Program, says the type of nicotine in e-cigarettes is the cause.
“E-cigarettes use a different form of nicotine in pods or cartridges called nicotine salts, which are far more addicting and smoother. So, it’s a little easier for [youth] to inhale or use,” Johnson said.
“It’s just really scary, and it’s most unfortunate that we don’t have any regulation in the state for these products.”
Irvin raises other health concerns about nicotine and youth. She said the brain does not fully develop until the age of 25, and e-cigarette use could stunt key cognitive developments such as memory retention. Pediatricians around the state have also reported to the health department that nicotine addiction disrupts teenagers' sleep schedules.
Irvin adds that youth who use e-cigarettes are more likely to move into regular cigarette products. Nationally, 45,000 new, habitual smokers in the U.S. were e-cigarette users.
HAWAII POLICY BATTLES
State lawmakers tried to impose more regulations on the $2.5 billion e-cigarette industry as it targets youngsters. But few of the proposals aimed at protecting the health of younger students have become law.
In July, Gov. David Ige vetoed Senate bill 1405 that would have allowed public school teachers or educators to confiscate e-cigarettes or electronic smoking devices from students.
S.B. 1405 also called for a program under the state Department of Health to dispose of electronic smoking devices. The measure further would have imposed fines of $100 to $2,000 for any person under the age of 21 who violates laws relating to electronic smoking devices.
Ige said the bill failed to define exactly what qualifies as an electronic cigarette. He also said a disposal program could hinder investigations into where students bought the devices, and he cited unknown costs and implementation concerns as other reasons for his veto.
State Rep. John Mizuno, chair of the House Committee on Health, said the bill would have allowed teachers to confiscate e-cigarette without legal confusion. Had the measure become law, Mizuno said, students could not claim that confiscating their e-cigarettes violated their rights to personal property.
“E-cigarette addiction, in America, is pure devastation,” said Mizuno. “It’s already hurting our schools and our students, as well as our teachers. They’re trying to have a good learning environment, and that’s not happening.”
Mizuno also said the governor's concern about using confiscated devices to track down illegal distributors should not be an issue as many vendors operate online.
Madeleine and her twin sister, Paige, said they’ve heard of students using VISA gift cards and posing as adults online to purchase electronic smoking devices. In some cases, they say students make a large purchase of e-cigarettes or e-cigarette products and distribute them to their peers.
The Senate bill would have only covered public elementary, middle and high school students.
A law banning electronic smoking devices and tobacco products from all University of Hawaii campuses passed in 2017. And, according to the Public Health Law Center, Hawaii is one of the few states that has a minimum legal age of 21 for e-cigarette sales. The majority of states have set their minimum legal age at 18.
Still, some anti-vaping proponents feel the state needs to do more to end what they call an epidemic.
Anthony McCurdy, father to Madeleine and Paige, teaches at Campbell High School in Ewa Beach. He sees first-hand the explosion of youth e-cigarette use at his school. According to McCurdy, students are often vaping around campus, sometimes even during classes.
In 2018, 3.62 million middle and high school students across the country were users of e-cigarettes, according to the U.S. Food and Drug Administration. The FDA also reports that e-cigarette use among high school students increased by 78% from 2017 to 2018.
While McCurdy believes the tobacco industry should be subject to more regulations to protect youth, he felt lawmakers missed the mark during this year's legislative session.
“There was enough discussion over [S.B. 1405] where it kind of turned teachers and administrators into law enforcement officials,” McCurdy said. “And that’s not really our role. I don’t think that’s where we should be going.”
Instead of putting the enforcement burden on teachers, McCurdy wants lawmakers to stop youth vaping at the source, and impose more rules on how the products are sold.
“The reality is kids are pretty smart. They know how to get around these things,” said McCurdy. “We can say, ‘Yeah, we’re going to take this from you.’ But it’s not going to stop them from going out and getting it again. Then it becomes punitive as opposed to preventative.”
Johnson agrees and says too much of the bill’s focus was on penalizing students and not tacking the problem at its source, the e-cigarette producers.
Irvin says what Hawaii’s lawmakers really need are parity laws. She’s urging the state to place the same regulations on e-cigarettes that are imposed on ordinary cigarettes.
“We don’t have equality between the way we treat regular cigarettes and the way we treat e-cigarettes,” Irvin said.
Unlike e-cigarettes, it is illegal to purchase regular cigarettes online, flavor the products, and distribute or sell them without a license or permit. Hawaii also charges a $3.20 tobacco excise tax on cigarette packs. The state currently applies the second highest tax on cigarettes in the country.
State lawmakers tried to address some of these disparities earlier this year. In March, Hawaii became the first state to consider banning flavored tobacco products.
The bill attempted to curb the industry's marketing to teens for such flavored vaping products as Maui Mango and Cookie Monsta. Sixty-eight percent of e-cigarette users in high school use flavors, according to the CDC.
The state House Finance Committee chaired by Rep. Sylvia Luke, however, killed the proposed local ban on flavored tobacco, noting that teenagers could still buy the products online.
Despite the governor's rejection of the Senate bill, Mizuno remains optimistic that more regulations are coming.
“With all due respect to everyone, we can still craft this bill and deal with concerns for 2020. All parts that [Ige] has concerns about we can answer them. It’s not rocket science, and at the end of the day, this is just to protect our students and their learning environment.”
Parents of children and teens seeking counseling for e-cigarette or nicotine addiction can visit the Hawaii Tobacco Quit line or call/text (808) 784-8669.