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% of adolescents in grades 9-12 who use e-cigarettes

26%2019

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Story Behind the Curve

Last Updated: January 2020

Authored by the Tobacco Control Program

To aid monitoring use of e-cigarettes and electronic vapor products, several questions were added in 2015 to Vermont’s Youth Risk Behavior Surveillance System. The e-vapor products asked about included e-cigarettes, e-cigars, e-pipes and e-hookahs, vape pipes, vaping pens and popular brands like JUUL. While there had been a decrease reported from 2015 to 2017, there was a sharp increase from 12% to 26% from 2017 to 2019. This is attributed to the rise in market share of JUUL which is easy to use and conceal including in school environments.  Vermont's vaping rates are similar to the national rate of 27% (National Youth Tobacco Survey).

In addition to 30-day use increasing is the frequency of use. 57% of youth who reported using an electronic vaping product in the past 30 days indicated using 10 or more days a month. More than three in ten high school youth indicated using every day. Lifetime use has also been increasing every survey: 30% in 2015, 34% in 2017 with a dramatic increase to 50% in 2019.

Also, electronic vapor product use increases with each grade level. For present use, 17% of 9th grade students reported vaping and increased to 34% in 12th grade. For lifetime use, the rates are substantially higher. In 9th grade the reported use was 37% and increased to 58% for ever tried an e-vapor product. White, non Hispanic students and LGBT students are significantly more likely to report ever vaping. Male youth continue to report significantly higher rates of current and lifetime use than their female counterparts.

Concerning flavors, 27% of high school students have ever tried flavored tobacco products including vanilla, cloves, alcohol, mint, menthol among others. Similar to current use, lifetime use of flavored tobacco products increases with each grade.

 

E-vapor products are increasingly popular among youth given their wide array of flavors (mint, candy, fruit), design and accessibility through social connections. Vaping among youth is shown to increase risk of smoking in the future. While e-vapor products are often promoted as a safer alternative to traditional cigarettes, which may be the case for adults, the Surgeon General cautions youth, young adults, those who are pregnant and non tobacco users not to vape. Although e-vapor products do not produce tobacco smoke, they still contain highly addictive nicotine and other potentially harmful chemicals. Testing of some e-cigarette products found the vapor to contain known carcinogens and toxic chemicals (such as formaldehyde and acetaldehyde), as well as potentially toxic metal nanoparticles from the vaporizing mechanism. The health consequences of repeated exposure to these chemicals are not yet clear (National Institute on Drug Abuse, 2016)

 

Partners

Vermont Agency of Education: The Vermont Agency of Education also funds school-based tobacco prevention activities, including OVX and VKAT, and is committed to raising awareness and reducing youth use of e-cigarettes.

Youth Groups: OVX and VKAT youth are instrumental for educating and engaging decision makers and local stakeholders on the harms of e-cigarettes.

Community Coalitions: Coalitions support OVX and VKAT youth by connecting them to local and statewide policy initiatives, providing them with the resources they need to communicate to decision makers, and creating opportunities for education around the diverse issues surrounding tobacco prevalence in Vermont.

VYAN: The Vermont Youth Action Network builds relationships and provides training to implement prevention of risk behaviors among youth.

Rescue: the media and youth engagement contractor of the VTCP. Rescue specializes in peer crowd segmentation, behavior change and addressing tobacco use among youth and young adults.

What Works

Innocent sounding flavors (watermelon, cotton candy) and a low perception of harm could be contributing for the alarming rise in the number of youth using other tobacco products, particularly e-cigarettes. The national 2013-2014 Population Assessment of Tobacco and Health (PATH) study found that 81% of 12-17 year olds who had ever used tobacco, began with a flavored product. In Vermont, 21% of high school students reported ever trying a flavored tobacco product (YRBS 2017) and 6 percent reported trying a flavored tobacco product before the age of 13 (YRBS 2015).

E-cigarettes come in over 7,000 flavors and continue to be the most popular tobacco product among youth, surpassing conventional cigarettes. The 2016 Report of the Surgeon General, E-Cigarette Use Among Youth and Young Adults, concluded that e-cigarettes are marketed by promoting flavors and using a wide variety of media channels and approaches that have been used in the past for marketing conventional tobacco products to youth and young adults. Nicotine use poses a greater risk to the developing adolescent brain and can impact attention, learning, and likelihood of addiction.

The Surgeon General Reports also states there are studies showing that non-smoking youth who use e-cigarettes are more likely to try conventional cigarettes in the future than non-smoking youth who do not use e-cigarettes. And among high school students and young adults who use tobacco, more use both e-cigarettes and combustible tobacco products than use e-cigarettes alone.

The Tobacco Control Program and Partners are working to:

  • Educate communities and stakeholders on the harms of e-cigarettes including exposure to dangerous particulates, toxins and nicotine.
  • Limit access to e-cigarettes by requiring locked containers for self-service displays, which are often used for e-cigarettes by tobacco retailers.
  • Inform on how flavors are used to attract and appeal to youth and young adults. Flavors make the tobacco milder and appear less harmful.
Strategy

Preventing tobacco use among youth is critical to ending the tobacco epidemic, reducing likelihood of use of other addictive substances, and decreasing future health care costs.

  • By end of February 2019, holding an Our Voices Exposed youth rally at the statehouse to educate legislators on how flavors work to attract youth to tobacco.
  • During FY19, provide technical asistance to community tobacco grantees on local strategies including zoning to reduce youth access and exposure to flavored and other tobacco products including e-cigarettes.
  • By October 2018, the Tobacco Program will have started its 4th campaign year of CounterBalance to educate and engage on flavors in e-cigarettes and other tobacco products, making them appealing and popular among youth. The Program monitors annual progress using a set of Metrics of Success for community and media engagement.
Why Is This Important?

Tobacco use is the #1 preventable cause of death. In Vermont, smoking costs approximately $348 million in medical expenses and results in an estimated 1,000 smoking-related deaths each year. 10,000 kids now under 18 and alive in Vermont will ultimately die prematurely from smoking. Countless other lives, including those of friends and family members, are impacted by the negative effects of tobacco use and secondhand smoke exposure. Reducing tobacco use and the chronic disease and mortality it causes is one of CDC's Winnable Battles.

Reducing smoking and other tobacco product use is part of Healthy Vermonters 2020 (the State Health Assessment) that documents the health status of Vermonters at the start of the decade and the population health indicators and goals that will guide the work of public health through 2020. Click here for more information. This indicator is also part of the State Health Improvement Plan (SHIP), a five-year plan that prioritizes broad Healthy Vermonters 2020 goals: reducing prevalence of chronic disease, reducing prevalence of substance abuse and mental illness, and improving childhood immunizations. The SHIP is a subset of HV2020 and details strategies and planned interventions. Click here for more information.

Act 186 was passed by the Vermont Legislature in 2014 to quantify how well State government is working to achieve the population-level outcomes the Legislature sets for Vermont’s quality of life. It will assist the Legislature in determining how best to invest taxpayer dollars. The Vermont Department of Health and the Agency of Human Services report this information annually. Click here for more information.

Notes on Methodology

Data is updated as it becomes available and timing may vary by data source. For more information about this indicator, click here.

This indicator is age-adjusted to the 2000 U.S. standard population. In U.S. data, age adjustment is used for comparison of regions with varying age breakdowns. To remain consistent with the methods of comparison at a national level, some statistics in Vermont were age adjusted. In cases where age adjustment was noted as being part of the statistical analysis, the estimates were adjusted based on the proportional age breakdowns of the U.S. population in 2000. For more detailed information on age adjustment visit /www.cdc.gov/nchs/data/statnt/statnt20.pdf.

Due to BRFSS weighting methodology changes beginning in 2011, comparisons between data collected in 2011 and later and that from 2010 and earlier should be made with caution. Differences between data from 2011 forward and earlier years may be due to methodological changes, rather than changes in opinion or behavior.

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