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Jun. 10—A return to normalcy could bring a pre-pandemic crisis — youth vaping — back to a boiling point, experts fear, even as conflicting studies paint different pictures of how coronavirus affected everyday usage during lockdowns, particularly among teens.
Data from the United States Centers for Disease Control and Prevention released last December that e-cigarette use among American youths was down 25 percent during state-imposed shutdowns has been presented in public-health circles as a tiny silver lining to come out of a pandemic that ranks in the top 10 among human history's worst plagues.
But 3.6 million youth in the United States still use e-cigarettes, the CDC reports, and as schools have opened back up, summer has kicked off, and a full return to normalcy is visible, usage could return back to where it was pre-pandemic — or even skyrocket.
It's an alarm-sounding reality upon which public health experts and officials are again focusing.
"I would like for there to be some momentum [coming out of the pandemic] and I'm not being pessimistic, I'm just being realistic, but I believe the issue will prop up again," said Bradley Fevrier, an assistant professor of public and allied health at Bowling Green State University who studies drug prevention and the dangers of tobacco use.
"I don't think it ever went away," Mr. Fevrier said. "Kids being at home and all those habits were kind of kept in check. When individuals branch out and everything gets back to normal, I think there is a great tendency for individuals to get back to their old habits."
Before the pandemic, teen vaping dominated headlines and airwaves, as legislators weighed options about how to address a growing issue that turned into a public-health crisis.
Since 2019, states, municipalities, and even the federal government have taken steps to curb youth vaping, assailing flavors they argue target children and banning certain vape products from online shipment. On Dec. 21, 2019, former President Trump signed a spending package that also raised the federal legal age for purchasing tobacco products from 18 to 21.
By Feb. 18, 2020, the CDC had recorded 2,807 cases throughout all 50 states of individuals being hospitalized for lung injuries associated with e-cigarette or vaping product use, which was first recognized in Wisconsin and Illinois in April of 2019. Then the public health focus quickly shifted to the global pandemic, leaving a crisis that had been spiraling on the backburner for the time being.
The CDC's dedicated website that tracks cases and hospitalizations related to vaping injuries, identified by the acronym EVALI, has not been updated since February of 2020.
A national, cross-sectional survey performed by Bonnie Halpern-Felsher, a professor of pediatrics at Stanford University, during the pandemic held in line with reports from the CDC that suggest e-cigarette usage was down among youth during the months of shutdown.
The study — done by Ms. Halpern-Felsher, who specializes in adolescent medicine, and a number of her colleagues — revealed that of 2,125 samples involving individuals ages 13 to 24, 1,198 reported participants changed usage amount during the pandemic, 388 quit, and 422 reduced their amount of nicotine intake.
The decline reported by Ms. Halpern-Felsher's study and a number of other studies can be directly related to the effects of the pandemic and teen access, said Tavis Glassman, a professor of public health at the University of Toledo who studies risky behavior, particularly involving tobacco and alcohol use.
"If you're a teenager and you can't do it in front of your parents, and you don't have access, and you can't go out and get it, it's a little bit easier to quit when you're a youngster," he said.
Other reports, however, paint a different picture. A study published last month in the Journal of American Medical Association found teens in Northern California kept up their daily usage even during the state's stay-at-home order.
Furthermore, Brian Jenssen, a researcher and primary care pediatrician who specializes in tobacco use at the Children's Hospital of Philadelphia, reported to The Philadelphia Inquirer that he and his colleagues still saw a prevalent number of cases of EVALI during the pandemic.
"Anecdotally, my colleagues are seeing cases where teens come in [with COVID-19 symptoms], test negative for COVID, and we realize they have a textbook case of EVALI," he said.
Local public health officials have their eye on the crisis too, as kids branch out for the summer, return to normal life, and potentially pick up on old habits.
Before the pandemic, the Toledo-Lucas County Health Department engaged with every school nurse in the county about vaping's dangers, and county initiatives to curb youth e-cigarette use ramped up, said spokesman Shannon Lands, who is involved in the department's smoking cessation outreach and programs.
Those efforts were mostly put on hold as the virus continued to spread throughout Lucas County, but Ms. Lands anticipates picking the outreach back up soon.
"We're going to start back down that road come later this summer into the fall," she said. "It's something that unfortunately we weren't able to do a ton with during the pandemic."
Eric Zgodzinski, the county's health commissioner, said e-cigarettes are not quite "the healthy alternative that people originally thought," and efforts to end bad habits, regardless of the product, is a focus for the county.
"I think the overarching story is that whether it's e-cigarette, or smoking tobacco, or excessive alcohol use, all those addictions are not healthy, and we need to find ways to make sure we're doing the healthiest thing we can for ourselves," he said.
Nicole McKenzie, the director of UT's respiratory care program, conducted a survey of 423 young people ages 18 to 25 about e-cigarette usage, particularly with marijuana, during the pandemic, and found a mixture of results on usage.
"Some of them said they were using it more often because they were doing less, they were kind of bored," she said. "And a number of people said they were kind of using it less because they weren't socializing, and it was more of a social thing."
For the survey, Ms. McKenzie also interviewed 22 participants, and an overwhelming majority of users told her it was used as a coping mechanism for struggles with mental health, something she says gives youths and young adults a "false sense of security."
"E-cigarettes aren't going to solve mental health," she said. "You're just compounding your own mental health."
First Published June 10, 2021, 10:00am