Braden Brown, a junior at the University of Wisconsin-Eau Claire, knows the risks of using e-cigarettes and abstains during the week.
But on Friday and Saturday nights, or during a "Sunday Funday" of drinking, he'll go through a Juul – a popular type of e-cigarette – or two, even if it makes him feel funny at hockey practice the next day.
"Breathing wasn't harder, but it felt like something was up," said the 22-year-old junior from Plano, Texas.
As health officials across the country scramble to understand what exactly is causing the lung injuries related to e-cigarette and vaping use, they're waging a multipronged battle when it comes to getting young users to quit. They're facing indifference and feelings of invincibility – as most parents of teens can relate – but also physiological addiction in some cases.
School, health and government officials also say they're struggling to turn young people away from vaping and e-cigarettes at the same time that marketing campaigns present the products as safer than regular cigarettes.
The medical community hasn't had enough years to study the long-term health impacts of the products, health experts say.
"There’s a campaign of misinformation when you use the word 'safe,' " said Panagis Galiatsatos, a pulmonologist and tobacco treatment specialist at Johns Hopkins University. "Even compared to the relative risk of using regular cigarettes, that doesn't tell us the actual risk to you, and to someone who has never smoked a cigarette."
Christy Sadreameli, a pediatric pulmonologist at Johns Hopkins, put it more bluntly in a webinar for the American Lung Association on Wednesday:
"These products were designed to appeal to teens and to go undetected by adults," she said. "According to the Surgeon General, there's no safe level of exposure to nicotine."
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Vaping-related illnesses and deaths continue to rise
At least eight people have died in the recent outbreak and the Centers for Disease Control and Prevention last week confirmed 530 cases of vaping-related lung illness in 38 states and one U.S. territory.
The U.S. Food and Drug Administration is studying more than 120 vaping product samples submitted by states associated with cases of patient lung injury. The samples are being studied for the presence of chemicals such as nicotine, THC and other cannabinoids, along with cutting agents and other additives, pesticides, opioids, poisons and toxins, FDA spokesman Michael Felberbaum said Wednesday.
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The FDA plans to soon release a plan to take popular flavored e-cigarette varieties such as menthol and mint off the market. And the CDC is warning young people to refrain from vaping.
Rates of teen nicotine vaping more than doubled nationwide between 2017 and 2019, according to a report released Wednesday by the New England Journal of Medicine.
"Current efforts by the vaping industry, government agencies, and schools have thus far proved insufficient to stop the rapid spread of nicotine vaping among adolescents," the report said.
More than 1 in 4 12th graders and more than 1 in 5 10th graders reported vaping in 2019, according to data in the report compiled by researchers at the University of Michigan.
"New efforts are needed to protect youth from using nicotine during adolescence, when the developing brain is particularly susceptible to permanent changes from nicotine used and when almost all nicotine addiction is established," the report said.
Punishment or treatment? School districts must decide
Officials at K-12 schools, where e-cigarette and vaping use has soared, are struggling with how to balance discipline for using tobacco products on school grounds with treatment and counseling.
Districts have started installing vaping censors in bathrooms to catch students using the products at school. Other districts have hired additional staff to better patrol bathrooms and hallways.
Some districts are designing new forms of discipline to deal with the rise in offenders — many of whom are first-time users drawn to the products because, well, everyone is doing it.
In Fort Myers, Florida, the Lee County School District saw tobacco and drug offenses on school grounds soar in the 2017-18 and 2018-19 school years. Tobacco use or possession offenses in the 95,000-student district increased almost five-fold; drug use offenses more than doubled.
Much of that was due to kids being caught vaping at school, said district spokesman Rob Spicker.
In August, the district opened a new center where students suspended for such offenses are sent for 20 days. At the center, the students essentially complete their studies online, under the supervision of staff, for the four weeks, but they also receive mentoring and drug-treatment counseling.
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Outside Rochester, New York, the West Irondequoit Central School District adopted an education and treatment model, hoping to understand why teenagers are vaping rather than simply punishing them for it.
Lindsay Snyder, a substance abuse counselor, said students have been some of the greatest advocates for the school to address the issue. She recalled what one young woman said at an open forum: “I feel like we should be afraid, because we’re being treated as guinea pigs.”
“They have the understanding that we don’t know what this is going to cause long-term, but in the teenage brain that’s not deterring them from the risk,” Snyder said. “And (others) are saying, ‘I don’t want my friends getting hurt and sick.’ ”
Surveys in the district of about 3,500 students showed almost half of students had vaped at least once and 10% were chronic/potentially addicted.
The first time students in the district are caught vaping, they must take an educational course online and then create a poster or public safety announcement reflecting what they learned. The second offense triggers what Snyder called a “therapeutic intervention,” differing based on the situation.
Overall, however, district-sponsored listening groups made up of kids who vaped produced a lot of shoulder shrugs.
“They didn’t think it was an issue," Snyder said. "They were seeing it as, we were making too big of an issue by installing consequences. And they didn’t think there was anything we could do to them to make them think of it differently."
Meanwhile, kids who don't vape in schools have a hard time going into a bathroom without it happening.
College students choosing not to vape
At the college level, some students say they are increasingly nervous about vaping. Some even say they are quitting as a result of government reports.
University of Pittsburgh junior Shannah Stone heeded the warnings. She decided to quit using a Juul after hearing that hundreds of people who vaped were falling ill.
Even though Stone said she vaped less frequently than many of her friends, she did not want to risk serious illness.
“I want to make sure this stupid habit doesn't kill me," she said.
Back in Eau Claire, Wisconsin, Brown said some of his friends had thrown away their Juuls and vaping products, especially after a few friends were hospitalized for vaping-related illnesses.
"When I started seeing all these things, it was a huge incentive not to do it anymore," he said.
Still, the allure of the products is strong, which is why Brown still indulges in a Juul or two on the weekend, when it's time to party.
"If flavored pods are banned, I might just quit all together – I wouldn't go out of my way to get it as much," he said. "I’m just a little weak when I'm intoxicated."
Contributing: Pamela McCabe of the Fort Myers News-Press.
Education coverage at USA TODAY is made possible in part by a grant from the Bill & Melinda Gates Foundation. The Gates Foundation does not provide editorial input.
This article originally appeared on USA TODAY: Vaping lung disease: Battle against teen vape use not easily solved