‘Game of Whack-a-Mole’: NC authorities face new challenges in effort to end youth vaping

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Just after noon on a Monday, John Motley Morehead High School principal Jason Tuggle’s laptop dings with the notification of a new email. Assistant principal Landon Kimrey’s phone vibrates at the same time.

“Vape event detected,” the subject line reads. A detector has gone off in the boys’ bathroom.

Tuggle checks the time stamp on the email and heads over to a TV monitor in his office to check the hallway cameras. Just minutes before the vape alert was sent, the recording shows six boys walking into the bathroom. Crude “NO VAPING” signs — made with laminated pieces of printer paper — are tacked to either side of the doorway. After some time, the boys meander back out of the bathroom one by one.

Tuggle and Kimrey recognize it as the typical signs of a group vaping session. Later, they’ll call the boys into their office to talk with them about the incident. If they find an e-cigarette, it’ll be confiscated, and the students could face suspension. Somewhere hidden in the administrators’ office is a box full of confiscated vapes.

Kimrey estimated that he receives about 10 “vape alert” notifications on a typical day at the 800-student school in Eden, a small town 40 miles north of Greensboro close to the Virginia border. After Rockingham County Schools received a grant several years ago to install vape detectors in all of their high schools and middle schools, Morehead was chosen to pilot the program.

The HALO Smart Sensor devices that the school has in nearly every bathroom detect changes in the atmosphere in order to identify vapor from e-cigarettes, THC and even masking agents like perfume or body spray. Tuggle said the detectors have been a useful tool for addressing instances of vaping during school, although some students remain undeterred.

“We think [e-cig usage among students] has been steady,” Tuggle said. “And, you know, the market has increased. The size of them has gotten smaller. The power of them has gotten stronger.”

The men’s bathroom at Morehead High School, pictured on April 15, 2024, is one of several student restrooms at the Eden school equipped with vape detectors.
 
The men’s bathroom at Morehead High School, pictured on April 15, 2024, is one of several student restrooms at the Eden school equipped with vape detectors.

Vape detectors are one example of how schools are attempting to address the youth vaping epidemic. However, researchers and public officials have struggled to keep up with a global vape market that is constantly adapting to new trends and technologies.

Ilona Jaspers, a professor at UNC’s Gillings School of Public Health, has conducted significant research on popular e-cig flavorings. She likened the effort to curb youth vaping to a “game of Whack-a-Mole.”

“We’re always chasing something that by the time we actually have it set up in our lab and do controlled experimental designs, do the research to understand causality, dosing, toxicity, all of these things, it’s either off the market because they got shut down or something else is a shinier object and really has taken the market by storm,” Jaspers said.

The newest concern for regulators is the rise in popularity of disposable e-cigarettes — devices packed with nicotine that are designed to be thrown away after a short period of use. Popular disposable brands like Elf Bar are cheap and widely available at convenience stores and vape shops despite being illegal to sell in the U.S., making them a favorite among young people.

One 19-year-old student at Appalachian State University — who asked to remain anonymous — said she’s used vapes on and off since she first tried e-cigarettes as a sophomore in high school. She called the habit “embarrassing” and “gross” but admitted that she likely wouldn’t be quitting any time soon, partly because of how accessible vapes are on college campuses.

Right now, her brand of choice is Lost Mary, a popular disposable vape manufactured in Shenzhen, China.

The legal age to buy tobacco products, including e-cigarettes, under federal law is 21, but the student said “everyone knows” which stores in Boone don’t check IDs. Sometimes she shares devices with her underage friends.

“You’re always gonna find somebody who has something,” she said. “It’s not hard.”

How did we get here?

Electronic nicotine delivery systems — more commonly known as vapes or e-cigarettes — were first introduced to the U.S. market in 2007 as a safer alternative for adult cigarette smokers. However, youth e-cigarette use exploded in the mid-2010s as brands like JUUL introduced flavored e-liquid cartridges and used influencer marketing tactics that appealed to young people.

Facing pressure from the federal government, academics and activists, JUUL discontinued certain pod flavors like fruit, cucumber, creme and mango in 2019.

After losing several high-profile lawsuits, including one brought by North Carolina Attorney General Josh Stein that settled for $40 million, JUUL’s once-powerful vaping empire has shrunk into relative obscurity.

In its place, disposable products have flooded the market and become the preferred e-cigarette of school-age users. According to the latest National Youth Tobacco Survey, more than 2.1 million middle school and high school students currently use e-cigarettes. Of those students, nearly 57 percent reported using Elf Bar vapes.

These products are appealing to young people because they come in dozens of flavors with names like Blue Razz Ice and Malibu. They’re packaged in bright colors, are easily concealable and guarantee 5,000 puffs per device — the equivalent of about 20 packs of cigarettes in terms of nicotine delivery.

FDA crackdowns threaten disposables

In December, the Food and Drug Administration and U.S. Customs and Border Protection seized 41 shipments containing approximately 1.4 million illegal e-cigarettes, including Elf Bar, all of which originated from China. The estimated retail value of the seized e-cigarettes was more than $18 million.

The manufacturers of these devices smuggle them into the United States by mis-declaring them as toys or shoes, according to the Food and Drug Administration.

“Those shamelessly attempting to smuggle illegal e-cigarettes, particularly those that appeal to youth, into this country should take heed of today’s announcement,” Brian King, director of the FDA’s Center for Tobacco Products, said in a press release following the operation. “Federal agencies are on to their antics and will not hesitate to take action.”

There isn’t an explicit ban on disposable vaping devices or flavored e-cigarettes, but no fruit- or mint-flavored e-cigarettes have been authorized by the FDA to date. That’s because, according to the FDA’s premarket tobacco product application, e-cigarette vendors must prove that marketing their products would be “appropriate for the protection of the public health” before they can be approved.

The agency has ramped up its efforts to penalize retailers that sell illegal e-cigarettes, issuing at least 80 warning letters to brick-and-mortar stores across the country for selling unauthorized products, including Elf Bar, since February. Retailers who are found to still be operating out of compliance after being issued a warning letter may be served a civil money penalty upwards of $20,000.

Last year, the FDA fined six North Carolina retailers $19,192 each for selling Elf Bar products. However, that’s just a tiny sliver of the total number of North Carolina retailers who sell unauthorized e-cigarettes.

For example, there are at least six retailers in downtown Chapel Hill — a college town of 60,000 people — that currently sell Elf Bars and other unauthorized disposable e-cigarettes.

Disposable e-cigarettes line the shelves of a Chapel Hill convenience store on April 25, 2024.
 
Disposable e-cigarettes line the shelves of a Chapel Hill convenience store on April 25, 2024.

In an attempt to curb the sale of these products, some states have taken regulations and enforcement into their own hands. Last year, Louisiana passed a law prohibiting the sale of e-cigarettes that aren’t on the FDA’s regulated list of vapor or alternative nicotine products. Businesses that do not adhere to the law are subject to fines and penalties from the Louisiana Office of Alcohol and Tobacco Control.

North Carolina has no such law targeting the sale of illegal e-cigarettes. And state Rep. Maria Cervania, a Democrat from Wake County, said the legislature doesn’t seem interested in making it a priority. Cervania co-sponsored the Youth END Act, a bipartisan bill that would establish a fund to “prevent the use of new and emerging tobacco products, including electronic cigarettes, especially among youth and people of childbearing age.”

That bill, which was filed concurrently in both chambers, passed first readings in the House and the Senate but never made it out of committee. It’s uncertain if it — or any other vaping-related bills — will be picked back up in the near future.

“There’s no legislation, and in fact I think if anyone’s going to put anything forward, it’ll probably be me,” Cervania said.

While the state is, at least for the meantime, turning a blind eye to retailers who sell illegal e-cigarettes, it has been using the JUUL settlement money to fund media campaigns and cessation programs aimed at young people.

The N.C. Department of Health and Human Services spent $730,000 in the 2022 and 2023 fiscal years on these efforts, according to the latest JUUL settlement progress report submitted to a legislative oversight committee in February.

The NCDHHS Division of Public Health is also working with schools across the state to offer education on vaping prevention and cessation as an alternative to suspension, NCDHHS spokesperson Hannah Jones said in an email.

The Rescue Agency has a vaping cessation program that assigns youth — aged 13-17 — to Instagram groups where they work for five weeks with an adult facilitator,” Jones’ email said. “Members of the group also help each other in their efforts to quit vaping.”

What are the health risks of e-cigarettes?

While e-cigarettes may not have the same carcinogens as combustible tobacco products, a growing body of research shows that heavy use can cause decreased lung function, shortness of breath and other asthmatic symptoms in otherwise healthy young people.

“It’s this different manifestation of kids who have never smoked a cigarette at all — have started with e-cigs — [and] are now coming down with potentially something that’s unique to e-cigs that we would have not seen in cigarettes,” Jaspers said.

Jaspers said that part of the difficulty in determining the risks of e-cigarettes is that the ingredients found in vapes are always changing.

In 2019, researchers determined that the vitamin E acetate, which used to be found in some vaping products, was associated with EVALI, a serious lung condition that could lead to hospitalization or death. Jaspers’ past research also found that vaping cinnamaldehyde — a flavoring agent used in cinnamon-flavored vapes — causes damage to lung cells. Currently, she is looking into the effects of the synthetic coolants used in “ice”-flavored e-cigarettes, although that research is still ongoing.

Because e-cigarettes are a relatively new phenomenon, it’s still unclear what the long-term health effects of vaping could be.

The Appalachian State student said she sometimes experiences shortness of breath, nausea and shakiness after she vapes. Still, the side effects she’s experienced haven’t been severe enough to deter her from vaping.

“The only thing that would convince me [to quit] is if somebody close to me had a bad experience with it,” she said. “Because we see things all the time on social media about popcorn lung, about people’s (expletive) collapsing, diseases. And that’s not me. Hasn’t happened to me yet.”

Unless that kind of serious health event happens, she said she’ll continue to frequent the vape shop near her that doesn’t check IDs.

UNC Media Hub is a collection of students from the various concentrations in the Hussman School of Journalism and Media working together to create integrated multimedia packages covering stories from around North Carolina and beyond.