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Youth vaping is on the rise, although fewer cases of EVALI are being reported. Getty Images
  • New cases of vaping-related lung injuries are on the decline, but cases of youth vaping remain high.
  • Deaths from EVALI have reached 60 with more than 2,600 people hospitalized.
  • Black market products with THC are suspected as the cause for the lung injuiries.

The death of a 15-year-old in Texas marks the youngest fatality linked to the current outbreak of vaping-related lung injuries in the United States.

This comes as new cases of e-cigarette, or vaping, product use-associated lung injury (EVALI) are on the decline.

As of January 16, 2020, a total of 2,668 hospitalized EVALI cases, including 60 deaths, have been reported to the Centers for Disease Control and Prevention (CDC).

However, there are signs that we may be through the worst of it. Data published last month suggests that the number of new cases peaked in September and have been declining since then.

Visits to the emergency room due to possible vaping-related lung problems have also declined since September. But they haven’t returned to their pre-outbreak level.

Black market or other informally obtained THC-containing vape products remain the primary suspect in these EVALI cases.

THC, or tetrahydrocannabinol, is the compound that produces the high feeling in cannabis.

A new study this week by CDC researchers found that 82 percent of people hospitalized with EVALI reported using THC-containing products. This was out of almost 2,000 cases where data on vaping products used was available.

However, 13 percent of people reported using only nicotine-containing vape products.

Of those who provided information on where they obtained the THC vape products, 78 percent said they got them informally such as from family, friends, dealers, or online.

This “reinforces CDC’s recommendation to not use e-cigarette, or vaping, products that contain THC, especially those acquired from informal sources,” wrote the authors of the study.

Cristine Delnevo, PhD, MPH, director of the Rutgers Center for Tobacco Studies, said the drop in EVALI cases is “likely attributed to efforts to shut down the illicit supply chain of THC oil, and cannabis users avoiding vaping.”

The 2019 National Youth Tobacco Survey found that 27.5 percent of high school students and 10.5 percent of middle school students are current e-cigarette users. This is a sharp increase from 2018.

Steven H. Kelder, PhD, MPH, Beth Toby Grossman Distinguished Professor in Spirituality and Healing at UTHealth School of Public Health in Austin said recent policy changes may help slow this rise in youth vaping.

One of these is the increase in the age of sale for tobacco products in the United States from 18 to 21. Kelder said this may interrupt the informal e-cigarette distribution chain in high schools.

“Now we’ve put up an age barrier,” he said. “There’s no reason for a 21-year-old to be hanging around on a high school campus.”

Another policy move came with the Food and Drug Administration’s announcement earlier this month that it will take certain unauthorized flavored e-cigarettes off the market.

Although this applies only to cartridge-based e-cigarettes and exempts tobacco and menthol flavors, Kelder said it’s still a “step in the right direction.”

Other experts are concerned that anything short of a total flavor ban won’t be able to curb youth vaping.

“It’s highly plausible that [young people] will simply migrate to menthol- or tobacco-flavored pods — which will do little to reverse the high rates of youth e-cigarette use,” said Delnevo.

She added: “The appeal of JUUL and other pod-mods extends beyond flavors, and includes the products’ very high nicotine concentrations as well as the devices themselves.”

Given the rise in youth vaping, many researchers are also developing and testing youth vaping prevention programs.

One of these is the CATCH My Breath campaign, part of Kelder’s ongoing research at the Michael & Susan Dell Center for Healthy Living at the UTHealth School of Public Health.

According to data presented at the 2018 American Public Health Association Conference, middle school students enrolled in this program were 46 percent less likely to start vaping compared to those not in the program.

“A lot of schools are using this program,” said Kelder. “The teachers say they enjoy teaching it and they report that the kids are also liking it. So that’s a positive sign.”

He hopes to expand the program to include sixth through ninth grades, and also follow a larger number of teens to see how many in the program say no to vaping.

These programs can help keep youth from starting to vape, but Kelder said more is needed to help current young vapers quit.

Some ‘quit vaping’ programs for youth exist, but Kelder said there’s still not an effective treatment for children and teens addicted to nicotine — which he estimates may be as many as 3 to 4 million in the United States.

He said another unknown is what will happen to youth who aren’t able to stop vaping.

“There’s a whole range of things that could happen,” said Kelder, “but we’ll have to wait and see.”

One concern is the “gateway effect” — that teens who start with e-cigarettes will move onto combustible cigarettes.

Right now, the research on this is mixed.

Also, cigarette smoking among adults and youth are at all-time lows. But the recent popularity of e-cigarettes — and their high-nicotine content — could change this.

“Due in large part to JUUL, we have a new generation of nicotine addicted e-cigarette users,” said Delnevo. “Ironically, [the current] policy environment is primed to now promote gateway to cigarette use.”