Editor:

Many people in Washington County and elsewhere have seen an increase in e-cigarette and vape pen use, especially among youth. The surgeon general issued an advisory on e-cigarette use among youth in December 2018 declaring, “e-cigarette use by youth is an epidemic,” calling for “aggressive steps to protect our children from highly potent products exposing a new young generation to nicotine.”

Nicotine is highly addictive, and exposure during adolescence can harm the developing brain impacting learning, memory, mood, impulse control and attention. Nicotine also impacts the cardiovascular system by increasing heart rate and blood pressure.

E-cigarettes are commonly called vapes and are electronic heating devices that mimic a cigarette by heating liquid containing nicotine. Since 2014, e-cigarettes have been the most commonly used tobacco product among U.S. youth.

Between 2017 and 2018, e-cigarette use by high school students increased 78%, 48% among middle school students. Youth and young adults are particularly attracted to e-cigarettes due to its sweet fruit, candy, cookie, cereal flavors combined with targeted, tested marketing practices.

There are hundreds of brands and thousands of flavors. In 2017, the product Juul gained popularity with unit sales increasing by more than 600%, passing all other companies. In December 2018, Altria, maker of Marlboro, purchased a 35% stake in Juul. It comes in menthol, fruit flavors, and has a USB flash drive design. 

A Juul pod uses nicotine salts that allow high levels of nicotine to be inhaled: about as much nicotine as 20 regular cigarettes.

Vapor from an e-cigarette, or aerosol, is not harmless. Besides nicotine, the aerosol users inhale and exhale contains other harmful substances: heavy metals, formaldehyde, acrolein, cancer-causing chemicals, volatile organic compounds and ultrafine particles that can be inhaled deeply into the lungs.

Nicotine present in e-cigarette aerosol is absorbed not only by users, but also by bystanders. The FDA has just begun to regulate e-cigarettes so there is no mechanism for consumers to know exactly what is in the products or the aerosol.

Currently no studies that show e-cigarettes help people quit smoking, and the U.S. Public Health Service doesn’t recommend it for that purpose. Youth and young adults who use e-cigarettes are more likely to use traditional cigarettes. 

Additional concern for e-cigarettes is its adaptation for use of smoking tetrahydrocannabinol (THC), a chemical found in marijuana that creates a “high” for its users. 

Cartridges for e-cigarettes with a liquid containing THC are manufactured in other states, but Washington County law enforcement found them in the county. The THC cartridges come in colorful packages, named after various types of sweet treats, candies, even children’s cereal like “Fruity Pebbles.”

The higher the level of THC, the greater the high. Usual street-level marijuana contains approximately 8% to 12% THC, the cartridges are as high as 98%. THC can have many effects: paranoia, anxiety, panic attacks, short-term memory problems, learning deficits, chronic stomach pain, lethargy, and coordination and depth perception problems.

Long-term studies on very high levels of THC were not done because the products did not exist until now. Examples of children who ingested a large amount of THC-infused food have experienced vomiting, muscle spasms, either high or low heart rate (depending on strain), and even become comatose. This is THC toxicity. THC vapes look very similar to e-cigarettes, and it has become an issue in law enforcement.

Tobacco use appears similar to other substance use, remaining stable or declining from previous surveys. Among 11th-graders in the county, tobacco use declined greatly in the past eight years, from 35% in 2008 to 17% in 2016. The exception is e-cigarettes. 

Among 11th-grade students 23%reported use of e-cigarettes in the past month (2018 Iowa Youth Survey,) as did 8% of eighth-graders and 2% of sixth-graders. For 11th-graders, it is up from 9% in 2016. More than one in three 11th-graders in 2018 (37%) had tried an e-cigarette. 

The Iowa Youth Survey shows Washington County youth tobacco and e-cigarette use among 11th-graders is consistent with the state average use rate; it is important that evidence-based interventions, including local policy changes, be employed to further reduce the rates.

The county would be among a growing trend of state and local governments in curbing e-cigarette use.

As of Jan. 2, there are 15 state laws and 814 local laws nationally. restricting e-cigarette use in smoke-free venues. In Iowa, state law does not yet prohibit its use and only one county, Story County, has a local ordinance restricting e-cigarette use in smoke-free venues.

Municipalities in Johnson County that enacted ordinances to prohibit of the use of e-cigarettes are Coralville, Iowa City, North Liberty, Solon and University Heights. Local municipalities in Washington County considering a ordinance are Washington and Kalona. 

Adopting ordinances to include e-cigarettes in already existing smoke-free policies on the governmental and business level will address this public health epidemic by reducing e-cigarette use.

It is our recommendation to consider evidence-based population level strategies to reduce e-cigarette use among young people, restricting young people’s access to e-cigarettes in retail settings, licensing retailers, implementing price policies and strategies to curb e-cigarette advertising and marketing appealing to young people, and strategies to reduce access to flavored tobacco products by young people.

THC cartridges look identical to traditional nicotine cartridges, making them difficult to detect. Including e-cigarettes and vapes into existing smoke-free policies will help in addressing the law enforcement issue and send a clear message that our community cares about health and safety.

We hope you will join with us in supporting polices that address these issues.

Danielle Pettit-Majewski

Washington County Public Health Administrator

Jared Schneider

Washington County Sheriff

John Gish

Washington County Attorney

Sarah Smith

Prevention Coordinator for Prelude Behavioral Services

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