Vaping devices come in many shapes and colors, as well as 1,550 flavors. Jason McCoy, tobacco prevention coordinator with Clay County Health Department, displays some of those most popular with teens and young adults. (Photo/Nancy Hanson)

Nancy Edmonds Hanson

“We were almost there – close to raising a tobacco-free generation,” Jason McCoy observes. “The smoking epidemic was nearly over.”

Then came vaping. Today, beneath the radar of most adults, smoke-free tobacco – vaping, or inhaling a vaporized cloud of flavored nicotine mist – has grown into a major health risk among teens and young adults.
McCoy, the tobacco prevention coordinator with Clay County Public Health, notes that the 20-year campaign against smoking cigarettes has largely succeeded in persuading most young people to reject it. Only about one in 20 admits to smoking today, down from nearly half at the turn of this century. That’s due to early education about health risks, he suggests, as well as bans on cigarette advertising on TV and in print and other measures – increased taxation, for one, and laws like Tobacco 21 that have raised the age for legal sales from 18 to 21.
But Big Tobacco has found another way to reach its prime target, the youth who must take up consumption to keep the industry alive. The proportion of teens and young adults who vape has risen astronomically, even as the devices have shown only modest appeal among older ages. Heavily advertised on targeted social media and endorsed by celebrities and online “influencers,” vape products like Juul are attracting legions of youthful users.
Jason cites the Minnesota Youth Risk Survey, which polls students every three years. From 2016 to 2019, vaping more than doubled among 8th graders, to about 11%. Ninth grade use rose from 9 to more than 16%. High school juniors’ use of vaping devices rose from 17 to more than 26%. And the numbers vary from school to school; he points to one unnamed Clay County high school in which 44% of 11th graders reported the practice.
The first vaping devices resembled regular cigarettes … thus, “e-cigarettes.” Today, though, they’re far more varied and harder for the uninitiated to recognize. Many resemble computer thumb drives or small mouses. Others are even more subtle. When he talks to invariably shocked parents and grandparents, Jason brings along several examples of “vapewear.” They look like regular hoodies. The hood, though, hides a connection where the device can be attached; the wearer inhales the cloud through a tube camouflaged as an everyday drawstring.

‘Not Safer than Smoking’
“Vaping is not safer than smoking,” he emphasizes. “It eliminates the tars that come from smoking. But vaping juice (the liquid that’s aerosolized) contains as much or more nicotine, along with heavy metals, volatile organic compounds and a whole bunch of chemicals in the liquid itself. When it’s superheated as the vapor kids inhale, those turn into a whole bunch of other chemicals.” Next to nothing is known about the health effects of most of those countless compounds, but some stand out. When superheated, propylene glycol – one of the most common, used in the base – becomes formaldehyde.
Vaping is considered safe and cool among most young people. Its biggest appeal is the vast universe of flavors, from cotton candy and apple pie to blue raspberry slushee and the mysterious “unicorn poop.” Unlike tobacco, the scents are pleasant. But – like tobacco – almost all vape juices contain a heavy dose of pure nicotine, the most addictive of all drugs.
Paraphrasing the old saying about leading a horse to water, Jason says, “The flavors lead the kids to vape, but the nicotine makes them drink it.” The nicotine content of one juice pod is comparable, he says, to one or two packs of cigarettes. “Most users go through one a day. When they’re partying with their friends, they might do three. That’s as much as three and six packs.”
Tobacco prevention efforts have long focused on nicotine’s damaging effect on youth brains, which aren’t fully formed until around the age of 25. Besides addiction, it may lead to mood disorders and permanent lowering of impulse control. Nicotine also changes the way synapses are formed, which can harm the parts of the brain that control attention and learning.

Damage to Lungs
The cloud of vapor that users inhale has been shown to injure their lungs, sometimes drastically. Last year the CDC reported a rash of cases of hospitalizations and deaths among young vapers. (From 100 to 149 were reported in Minnesota, and up to 49 in Minnesota.) The condition was dubbed EVALI, an easier mouthful than “e-cigarette or vaping product use-related lung injury.” While news reports tied it to vape juice containing THC, the marijuana component that creates a high, Jason points out that not all of the victims used THC fluids. The common tie between all of them is believed to be Vitamin E acetate.
Jason explains that inhaled vapor, though cooled before it enters the lungs, causes damage and scarring to the tissue. Along with EVALI, it causes a pneumonia-like condition known as “wet lung.”
The greatest risk right now, though, may be the connection between vaping and susceptibility to COVID-19. Young people who vape have seven times the risk of contracting the coronavirus. Once infected, they are twice as likely to develop severe symptoms. “We can’t say the explosion of COVID-19 is all due to poor social choices,” he says. “Vaping certainly plays a part.”
It’s hard to know exactly what you’re inhaling, Jason says, because the industry is barely regulated. Though nicotine is refined from tobacco, and though Big Tobacco owns all or a portion of most companies producing the products, the Food and Drug Administration has only recently classified it as a form of tobacco.
That has opened the doors to some measures to control its spread. Jason hails Minnesota’s new Tobacco 21 law, which took effect Aug. 1, to limit sales to those over 21. “We know high school students get their vape equipment from older friends. This puts it a little farther out of reach,” he notes.
Two states and a number of cities, including 16 in Minnesota, have taken a different tack to limit vaping’s appeal. They’re outlawing the sales of flavored vaping juices, just as Congress banned flavored smoking tobacco (except for menthol) in 2009. Other possible steps include barring the free samples and coupons that are often used to lure new users.
“Public health departments are freaking out about vaping,” Jason concedes. Battling this risk has more than a little in common with the decades-long quest to eliminate smoking – the one that, not so long ago, they seemed to be winning. Big Tobacco is spending vast amounts to bring young people into their orbit – $110 million a year in Minnesota alone. The lion’s share is invested in social media messages that target teens but their parents never detect.
Few of those teens realize its darker side at this point. The most recent state youth survey revealed that three out of four think vaping is perfectly safe, unlike the regular cigarettes that turn them off.
Even fewer may recognize that second-hand vapor is just as dangerous as second-hand smoke. Third-hand – the residue left on surfaces – carries substantial use as well. “Some of these chemicals have a half-life of 100 years,” Jason says. “If you’re smelling it – no matter how fruity or pleasant it may seem – you’re breathing it, too.”
Jason frequently speaks to community groups and service clubs. To arrange a program, call him at (218) 299-7180 or email jason.mccoy@co.clay.mn.us.