LACONIA — Vape shops abound in the Lakes Region. They are visual extravaganzas much like candy stores: rows and shelves of sleek tools and tasty-sounding products with catchy names that deliver bursts of nicotine while disguising its perils – including during COVID-19.
Simple to use and easy to hide, disposable vape products resemble lipsticks, credit cards, wristwatches, flash drives, Sharpie permanent markers, and disposable pens that write on one end and deliver a nicotine hit from the other. That makes them popular with teens and young adults and enticing to older consumers – a true stealth poison, said Albee Budnitz, a pulmonologist since 1973, and chair of Tobacco Free New Hampshire.
“They come in all shapes and sizes,” Budnitz said.
They’re more discreet, don’t smell like smoking and there’s a perception that they’re safer, which makes them triply seductive, especially to nicotine and habitual tobacco users, said Allyssa Thompson, program director for Breathe New Hampshire, a lung health organization.
And they may be especially dangerous as fall turns to winter.
A recent study that appeared in the Journal of Adolescent Health found that vapers are 7 times more likely to get COVID than non-vapers. Last year, the U.S. experienced its first round of evali – a serious pulmonary disease linked to vaping, and more cases than any other nation. A 17-year-old with evali underwent the first-ever double-lung transplant.
Across the U.S., nicotine poisoning has rocketed since the advent of vaping, which gained a toehold in the U.S. in 2007 and has spread across ages and demographics since. Nicotine poisoning has grown from several hundred cases a year to 3,000 to 5,000 annually, Budnitz said. “Not just nicotine addiction, but nicotine toxicity.”
“There’s no cue with e-cigarettes, the flavors and aerosol are so smooth,” he added. The body doesn’t receive the unpleasant “hit in the back of the throat that they’re getting too much nicotine” and it’s easy to overdose.
And New Hampshire consumers, including those who turn to vaping as a non-carcinogenic alternative to smoking cigarettes, may harbor a false sense of security.
Lung health experts say it’s too early to quantify the long term effects of vaping, which has been billed by marketers as a safe way to ease off cigarettes and a safer vehicle for energizing nicotine, without the cancer risks of inhaling smoke. But, experts contend, the pitches gloss over unseen, persistent dangers. Namely, an express lane to addiction, a gateway to tobacco smoking and a greater and potentially lasting susceptibility to respiratory illness.
For Budnitz, a doctor with a long career battling lung disease, vaping looms as a deadly brain problem, too. Studies show that 88 percent of tobacco product users started before age 25, when the brain is most susceptible to nicotine, which creates brain changes that lead to dependency and addiction, according to researchers at the Centers for Disease Control and the Food and Drug Administration. “Even those who quit will have a huge craving to re-initiate” because of nicotine’s lasting effects on the brain’s frontal lobe, the area of decision making and impulse control, Budnitz said.
“If we kept we kept everyone off addicting substances until age 25, we’d get rid of 98 percent of substance-abuse disorders,” said Budnitz, echoing a summary by Sharon Levy, head of pediatric medicine at Boston Children’s Hospital.
Complicating the vaping proliferation landscape in New Hampshire are that vape products are currently untaxed, unlike cigarettes, and they’re unregulated at the federal level, unlike cigarettes. No one really knows what’s in them – or exactly how many people are using them, or how young they start, according to state health experts.
According to Youth Risk Behavior Surveys collected by the CDC, the percentage of New Hampshire high school students who have vaped in the last 30 days hovers at 33.9 percent, up 10 percent from two years before. That number exceeds the national average of 27.5 percent. In comparison, the state’s high school smoking rates linger below the national level, at 7 to 8 percent.
The National Youth Tobacco Survey just released by the CDC showed a 7 to 10 percent decrease in vaping among middle- and high-schoolers from two years ago. But it was based on 2019 data, and didn’t reflect the recent proliferation of disposable vaping products, such as Puff Bars, which started in January 2020 and has taken off among adolescents, Budnitz said.
Huge inroads have been made to fight teen vaping and tobacco addiction in New Hampshire by schools, public health officials and legislators, and experts hope it will downshift the numbers. At the end of July, with little fanfare, Tobacco 21 became law in New Hampshire, prohibiting the sale of tobacco and e-cigarettes to anyone under age 21, but it’s still too early to determine the effects.
Vape sellers say they are on the lookout for minors posing as qualifying adults. Not selling to people between 19 and 21 has dropped sales slightly, but younger customers were never a big chunk to begin with, said Tom Sloniak, owner of Raven Vapors in Tilton and Laconia, who believes vaping remains a valuable tool for quitting or reducing cigarette smoking.
Sloniak suspects Tobacco 21, while an important milestone, may move determined young people to buy online, where there are no age verifications, and buyers are asked a simple question: Are you over 21?
“There are hundreds of websites where people can order with little or no requirements,” Sloniak said. “Kids will be kids. They’ll get it no matter what.”
In the meantime, schools and communities are trying to keep up the fight against vaping. Peer-to-peer education has been found to be more effective than adult-to-child messaging in steering young people away from adverse behaviors, according to education research. Students in Belmont and Franklin have made public service announcements that have run in school, online, or in Smitty’s Cinema in Tilton, cautioning their peers against starting.
“This is the Guinea Pig generation. If they’re getting hooked on these products and the nicotine, and using for three to five years, we’ll see what the future lung disease looks like for vaping in 15 or 20 years,” said Thompson at Breathe NH.
“I think there’s still a perception of parents, ‘I’d rather have them vaping than smoking, or vaping than doing drugs.’ The kids are 10 steps ahead of us. Parents need to be aware of the dangers, and we need to educate parents,” Thompson said. “It’s not just flavored water vapor. We’ve got decades of data on smoking. Vaping is still too new to know.”
“We need to get people to understand it's an addictive product with the same addictive patterns as smoking,” said Donna Asbury, administrator of Tobacco Cessation and Prevention at the New Hampshire Department of Health and Human Services. “In terms of utilization, it will take another 12 to 18 months to see what the effects are of Tobacco 21.”