A new Minnesota Department of Health (MDH) issued survey shows that, for the first time since 2000, overall youth tobacco use has increased in the state with 26.4 percent of high school students using some form of tobacco or nicotine, up from 24.6 percent in 2014. Simultaneously, youth cigarette smoking has reached an all-time low, with less than 10 percent of high school students smoking cigarettes, a 70 percent drop since 2000.
The rapid uptake of e-cigarettes and other vaping devices has reversed a long-term trend of declining teen tobacco use in Minnesota, according to new results from the Minnesota Youth Tobacco Survey.
According to the new data, one in five high school students use e-cigarettes, a nearly 50 percent increase since the data was last collected in 2014. In Itasca County, one out of three eleventh graders are using e-cigarettes, while 25 percent of eighth graders believe there is little or no health risk in smoking.
The rise in the use of e-cigarettes is one that Kelly Chandler, Itasca County Public Health Division Manager, said emerges from the narrative that e-cigarettes are “safer” than traditional tobacco products.
“The perception of harm of these products is not significantly present,” said Chandler. “The truth is, we do not know the long-term negative effects of e-cigarettes, because they have not been around long enough to have been tested.”
What experts do know, said Chandler, “is that persons are inhaling nicotine, a highly addictive substance that affects the cardiovascular system in our body, in these devices.”
Products such as e-cigarettes and vape pens typically contain liquid forms of nicotine and are currently unregulated.
It is more than just nicotine, however, which causes concern for public health officials.
According to a MDH press release, one in three high school students who use e-cigarettes report using the device with recreational marijuana.
“We know that illicit drugs are being inhaled in these products, i.e. marijuana and methamphetamine,” said Chandler. “Basically anything you can make into a liquid you can inhale in an e-cigarette.”
Even though overall traditional tobacco use is declining, from a public health standpoint, said Chandler, the rising use of e-cigarettes is alarming because “we seem to be trading in one addiction for another.”
As e-cigarettes attract more youth into tobacco use, they create a disturbing cycle of addiction and harm to adolescents, reported the MDH press release. In fact, according to the study, one-fifth of Minnesota youth using e-cigarettes have never smoked or used conventional tobacco such as cigarettes or chewing tobacco.
“The latest research shows teens who try e-cigarettes are almost twice as likely to start smoking cigarettes as teens who do not try them,” continued the release.
It is the use of e-cigarettes and similar devices which “threaten to reverse our success in preventing youth from using tobacco products,” said Minnesota Health Commissioner Jan Malcolm.
“Just as we successfully reduced cigarette use to under 10 percent of high school students, giving us the hope that a smoke-free generation was within reach, the industry responded with new products designed to get youth addicted to nicotine,” continued Malcolm.
The use of e-cigarettes is also “especially dangerous for youth,” said Dr. Peter Dehnel, Pediatrician and Medical Director with Twin Cities Medical Society.
“It provides a platform for illicit drugs and for nicotine, which we know is highly addictive and can harm brain development as teens grow, impairing learning, memory and attention,” continued Dehnel.
What makes vaping particularly challenging to reign in, said Chandler, is that “vaping devices look like everyday items.”
“The most recent I have seen and heard about is a vaping device that looks like a jump drive for a computer,” explained Chandler. “The cartridge containing the ejuice looks (to me) like a fuse you would use in your vehicle or motor home, or like the attachment for your mouse on your computer. They also look like pens, or writing utensils.”
Itasca County is not immune to the state-wide trend. According to Chandler, Itasca County, in general, has the highest tobacco use in the Northeast region of the state, for all ages.
Anecdotally, Chandler said, “two of our four school district administrators have reported an increase in vaping in their kids – not necessarily violations for using on campus – but an increase in use in general.”
“According to data collected by the American Lung Association, Itasca County has the highest percentage of adult tobacco users in Northeastern Minnesota,” said Chandler, who noted that Itasca County’s rate of adult tobacco users is 25.5 percent.
“The next highest counties (Cook and Carlton) are at 21.6 percent, and in Minnesota, the tobacco use rate of adults is 14.4 percent,” said Chandler.
As for the percentage of teens in Itasca County using various forms of tobacco, in 2016 the Minnesota Student Survey revealed that 30 percent of females in grade 11, and 28 percent of their male peers, were using e-cigarettes or hookah.
A survey of Grand Rapids revealed that, during the past 30 days, 29 percent of females and 26 percent of males in eleventh grade have used e-cigarettes or hookah. Similar results emerge in surrounding areas, including Nashwauk-Keewatin (28 percent of ninth graders), Greenway (31 percent of eleventh graders) and Deer River (39 percent of eleventh graders).
Hill City, in Aitkin County, witnessed the lowest use, with six percent of eighth graders reporting they have used e-cigarettes or hookah products within the last 30 days.
The trend, when compared with other forms of traditional tobacco use such as cigarettes, cigars and smokeless tobacco, more readily affects females, with more young girls selecting vape products over traditional tobacco. (Twenty-two percent of females in grade 11, and 28 percent of males reported using traditional forms of tobacco use in 2016.)
According to the results of the Minnesota Student Survey, females in eighth, ninth and eleventh grades had higher use of e-cigarettes than their male peers in all three grades, said Chandler.
“This is certainly alarming from a Public Health standpoint,” continued Chandler. “Females, generally speaking, have less rates of tobacco use than males. These products have an appeal to females.”
Many communities are already taking action to protect youth from the harmful effects of underage tobacco use.
Cities and states across the nation, including many in Minnesota, are working to reduce youth access to these products through policies such as increasing the minimum tobacco sales age to 21, restricting where menthol and flavored tobacco are sold, raising the price of tobacco, and strengthening compliance and enforcement efforts.
For Itasca County, these measures include continuing annual tobacco compliance checks.
According to Public Health Nurse Kimberly Johnson, who provided the Itasca County Board of Commissioners with an update concerning tobacco compliance statistics at a board meeting on Tuesday, Feb. 13, 2017 witnessed an increase in compliance check failure rates, a result the department is currently investigating.
Tobacco-related disease remains the number one cause of death in Minnesota and the nation.
While the United States has taken great strides in the area of tobacco and indoor air quality, there is still more to do in order to keep up with new and emerging products such as e-cigarettes.
“I will be very interested in the data that comes from the next round of the student survey in 2019,” said Chandler.
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