The U.S. Surgeon General has declared the use of e-cigarettes among teenagers as an epidemic, which is to say that it is widespread and dangerous.

That may come as a surprise to some parents, who haven’t noticed such behavior among the teens in their lives, but the reality is, if they don’t know what to look for, they could easily be missing it happening right under their noses, said Julie Hook, program director of the HOPE for Franklin County Coalition, a nonprofit organization that strives to empower young people to make positive decisions and lead healthy, drug-free lives. HOPE stands for Healthy Outcomes through Prevention Education.

Parents who aren’t familiar with e-cigarettes or terms like vaping and “JUULing” can learn more about this new trend, see the devices that teens are using and ask questions about all of it during a free presentation, “Up in Smoke,” being held next Wednesday, March 20, from 5:30 to 6:30 p.m. at the Foundations for Franklin County office, 3033 Highway A in Krakow. The information, presented by HOPE for Franklin County Coalition, will include facts from the Centers for Disease Control (CDC), the U.S. Surgeon General, National Institutes of Health and other premier public health resources.

The presentation is free, but people are asked to register because space is limited. Call 636-239-7652, ext. 318, or 636-485-4104.

“The big problem with this subject is that people don’t have the information, and they’re reacting to media attention, whether it’s good or bad, and they don’t know where to go for information,” said Hook. “There is a lot of information out there.”

Know the Terms, Risk

E-cigarettes is the generic name for battery-powered devices that heat up a liquid substance until it forms an aerosol or vapor that can be inhaled, said Hook. The process of inhaling those vapors or aerosols is called “vaping.”

The term JUUL refers to a brand name of e-cigarette devices and flavored pods. The brand has become so popular that the name is now used as a verb, “JUULing,” interchangeably with “vaping.”

E-cigarettes and the vapor pods can be purchased at gas stations, convenience stores and typically anywhere tobacco products are sold.

“These are nicotine delivery items,” said Hook, noting most e-cigarette vapor pods contains nicotine, the same highly addictive drug found in traditional cigarettes and tobacco products.

Some of the liquid pods contain as much nicotine in a single pod as an entire pack of 20 regular cigarettes, Hook said. That is part of what makes this trend so dangerous, particularly among teens, whose brains are still developing.

“The brain isn’t fully developed until mid-20s, and we know that nicotine or any addictive substances have a bigger impact on the developing brain,” said Hook. “And there are other concerns about brain development with regard to nicotine that are even beyond addiction.”

The Surgeon General has stated that e-cigarette aerosol/vapor is not harmless. In addition to nicotine — which can impact learning, memory and attention — the aerosol/vapor that people inhale and exhale can potentially expose themselves and bystanders to other harmful substances and carcinogens, including heavy metals, volatile organic compounds and ultrafine particles that can be inhaled deeply into the lungs.

The packaging for e-cigarettes and the liquid pods does state that they contain nicotine. The FDA has begun implementing regulations that include this requirement, said Hook, but these products are not yet receiving the same kind of regulations as combustible tobacco regarding flavorings and marketing.

Vaping Has Increased 78 Percent Among High School Students

E-cigarette manufacturers say their products are designed as alternatives to cigarettes, and that they are intended only for adults, said Hook. “Except one in five students have seen them in school.”

For decades, teenagers who were drawn to smoking used the bathrooms as a common place to light up, except the smoke and smell easily gave away their behavior.

Today with e-cigarettes, there is no smoke, often no visible vapor at all and very little if any smell. So now teens can still use a bathroom stall for easy cover if they want to inhale, but they also may be able to get away with it during class or just walking the halls at school.

“Someone can be using an e-cigarette or vaping and there wouldn’t be any signs,” said Hook.

E-cigarettes come in a variety of shapes and sizes that are easily concealed or look like something else entirely. The popular JUUL devices, which have a USB port so you can charge them on a computer, look like a flash drive, Hook said.

“That’s one reason we want to educate people in the community is to be on the lookout for this,” she said.

E-cigarettes have been around for more than 10 years and since 2014 they have been the most commonly used tobacco product among American youth, the Surgeon General reported. Use among middle and high school students increased 900 percent between 2011 and 2015 before declining between 2015 and 2017. However, that trend was reversed last year:

“Current use of e-cigarettes has increased 78 percent among high school students during the past year, from 11.7 in 2017 to 20.8 percent in 2018, and a 48 percent increase among middle school students, from 3.3 percent in 2017 to 4.9 percent in 2018.

“In 2018, more than 3.6 million U.S. youth, including one in five high school students and one in 20 middle school students currently use e-cigarettes.”

Hook believes that is likely due to the flavors the liquid is available in, flavors like cool mint, mango and creme brulee.

“They are flavored to make it smooth, so there’s no bitter taste from the nicotine,” said Hook. “And we know that 85 percent of kids who use these are buying the flavored kind.”

A 2018 Missouri Student Survey of Franklin County students found that 22.6 percent of students had used an e-cigarette in the last 30 days and that 34.6 percent of them said their peers believe using e-cigarettes and vaping would make them “pretty cool” or “very cool.”

Many didn’t see any danger in using e-cigarettes. More than 45 percent of Franklin County students surveyed said there was no risk or just a slight risk in vaping.


The cost of e-cigarettes can range between $8 or so for a disposable device that only allows one use to $50 for a kit that includes a reusable e-cigarette device and a four-pack of the flavored liquid pods.

Some teens also share their e-cigarettes and pods, selling “a hit” off of their device for as little as $2.

What is different about e-cigarettes compared with traditional cigarettes is that an e-cigarette can be used as long as it takes to empty the pod. A traditional cigarette is designed to be smoked all at once. E-cigarettes don’t have to be.

Although Hook noted that there have been cases of e-cigarettes malfunctioning and exploding, causing physical injuries and even death. The e-cigarette device doesn’t have an on-off switch, she said.

What You Can Do . . .

At the “Up in Smoke” presentation next week, Hook will go into detail on these points as a way to educate parents and adults about what the teens in their lives are facing, if not experiencing first hand. The goal, she said, is to help teens make positive choices.

“One way is for us as adults to understand these products and go forward with some action steps,” said Hook.

These include raising the age for purchasing them from 18 to 21 and eliminating the flavor choices.

But one of the best things parents can do right now is just talk to their kids about this, said Hook.

“We as adults need to have a bigger voice and start to educate each other about this so we all understand what it’s doing to our young people . . . The biggest protective factor is us. Kids listen to adults they care about.”

Parents can find the Surgeon General’s tip sheet to “Talk With Your Teen About E-Cigarettes” at https://e-cigarettes.surgeongeneral.gov/.

The National Council on Alcohol and Drug Abuse (NCADA) also has a program that focuses on addiction in general. Those downloadable talking points are available at http://ncada-stl.org/talk-about-it-campaign/.

The NCADA also gives presentations in classrooms and for adults. For more information on that, people should contact Hook.

There is room for as many as 50 people at the “Up in Smoke” presentation next week. Several people already have registered. If more than 50 people express an interest in the program, Hook said she will gladly schedule a second presentation.

“The key is to get the information out there,” said Hook.

To register to attend the “Up in Smoke” presentation March 20, call 636-239-7652, ext. 318, or 636-485-4104.