Bruce Barcelo

I looked forward to writing the November article to fit the “Thanksgiving” theme. The CDC’s “Tobacco Product Use Among Middle and High School Students-National Youth Tobacco Survey, United States, 2024”, Morbidity and Morality Weekly Report, /October 17, 2024, certainly gives us reason to be thankful. It shares that youth use of nicotine products has continued to decline yet adds that comprehensive and sustained evidence-based tobacco control strategies are needed. That is what I was planning to focus on. However, I recently received an email from a young man I had the privilege of formally working with. He emailed me asking if I could help or give him any direction in his time of need. He mentors and is the “Big Brother” of a young man who finds himself in a difficult situation. He was caught at school with a vape and then a vape was found in his car on school property. He is now facing expulsion.

As a former school administrator, I appreciate that schools are the “front lines” of our youth’s substance use and are uniquely positioned to identify and support students who may be addicted to nicotine or at risk of addiction. Schools can design their education and disciplinary practices to help prevent youth from starting and offer supportive approaches when students are caught using nicotine products. The CDC said, ” The most effective approaches to help students quit tobacco use are through counseling and education. “We must move away from the old mindset of zero tolerance policies and adopt appropriately structured “alternative-to-suspension” programs that incorporate cessation strategies and guide students toward quitting nicotine products while remaining in school.

The use of expulsion and suspension is shown to increase the likelihood of negative educational outcomes. These outcomes include lower test scores, higher dropout rates, and reduced likelihood of postsecondary education.  It is important to understand that according to the U.S. Department of Education, there is a significant difference in the use of punitive discipline based on race and ethnicity of students. Black students are much more likely to be suspended and expelled. Moving away from punitive discipline and focusing on supportive approaches will have the benefit of supporting student academic achievement, improving health, and decreasing inequities.

It’s time for a change.

I remember so well when I was an elementary school principal. I would love to drop by classrooms as students worked together with their teachers on math problems. Sometimes, a problem was a bit tricky, and the teacher had to help the students add it. Let me give you a problem, and let’s see if it adds up. First, I need to give you the structure of our problem. Commercial tobacco products must submit to the FDA a Premarket Tobacco Product Application for every product they wish to have on the market. The FDA has received millions of applications and only approved 27. Only 4 of them are flavored products. The FDA provides “authorization” for these products not “approval” as it does for food, drugs, and devices. None of the 27 authorized e-cigarettes have been authorized as a modified-risk tobacco product. It’s important to note that companies did not apply for a modified risk either. Why? They do not have the evidence to prove that e-cigarettes are a safe alternative to combustible cigarettes or that they are an effective tool for quitting smoking.

None of the 27 authorized e-cigarettes are “disposable” or “single-use” vapes. This is an important concern not only for public health but for environmental reasons as well. With six disposable vapes being sold every second in the United States, the discarding of these products presents a significant environmental challenge. Once the e-liquid runs out, these devices contain a lithium-ion battery glued to them, which makes them nearly impossible to safely remove or recycle. The environmental toll of these products is a major concern.

Now, understanding all this, let’s solve this math problem. The FDA has approved only 27 e-cigarettes, and of those, 4 are flavored. Today there are over 9,000 flavored e-cigarettes available in the United States, sold in gas stations, corner stores, grocery stores, vape shops, and bars, all illegally.

How does that add up?

There have been multiple iterations of vaping devices over a relatively short span of time. The first commercially successful electronic cigarette was developed by Hon Lik, a pharmacist from China in 2003. The first generation of commercially successful electronic cigarettes were the “cig-a-likes”. The second generation of e-cigarettes were “box” or “mods” because you could modify your device. The third, and most impactful generation, was the pod. This is when in 2015, the Juul e-cigarette was introduced. The fourth generation and where we currently are, is the disposable e-cigarette. Within this generation, we have the development of synthetic nicotine, and now, 6-methyl synthetic nicotine the FDA doesn’t yet have authority to regulate.

I have gone through the iterations because it is important to see how this industry is always evolving. Sometimes, it is to evade the federal government and sometimes to keep consumers engaged and curious. They know youth are always looking for the next big thing to try and post on social media. That is where this newest evolution is coming from.

I give you the interactive disposable vape. These products have touch screens, animated displays, and built-in games. One company sells a disposable vape that has three retro games, one being Pacman. Another has a roulette wheel that the owner spins. They can earn points that can be submitted for prizes. So now we need to be concerned about a youth having a nicotine addiction and a gaming addiction. There is now the first Bluetooth disposable vape being sold. I purchased one to see if it works as advertised. I was able to name the device, “BAB”. Put a picture of myself on BAB. Put BAB in another room and track it. The last one I will mention does several things. Every time you puff, you earn food to feed your virtual pet. In another game, count your puffs so that you can submit your score on social media for rankings and win prizes. (Does this concern anyone?)

Friends, this is just the beginning. Interactive devices that have addictive substances in them. They could not be targeting youth, could they?

July is a month that we think of our nation’s independence. We cannot do that without thinking of how through the years the sacrifices young Americans in military have given. But have you given pause to consider not only war hazards but the tobacco addiction and disease addiction history that was created by the tobacco industry and politicians and has diminished our militaries readiness.

In 1917, before World War 1, cigarettes (a four pack) became a standard in K-ration boxes which meant soldiers received 12 cigarettes per day. If a soldier wanted more, they were a nickel a pack or 50 cents a carton. As a result, tobacco consumption skyrocketed during the war.  At that time, tobacco was considered so important for soldiers’ morale and fighting boredom, General Pershing said “You ask me what we need to win this war. I answer tobacco as much as bullets. Tobacco is as indispensable as the daily ration; we must have thousands of tons without delay”.

Even when the military decided to stop supplying cigarettes to servicemen and women, big tobacco began sending free cigarettes to the military. When the military declined their offer, politicians from states where tobacco was produced intervened.

Years ago, I was working with our local V.A. Hospital to become a Tobacco-Free Hospital. That’s not possible because by U.S. law, every V.A. must provide a heated and airconditioned facility for veterans in which to smoke. I visited this site. It was a very large greenhouse-like building at the back of the V.A. Hospital.  Some vets would walk back there with their oxygen tanks, park them outside, and go inside to smoke. I talked to some who had gone through heart surgeries, those who had COPD, and several who had amputations.  I spoke to one of the maintenance workers and he told me that they had to change the air filters every month.

If we are addicted, we are never free. May freedom ring.

We’re in trouble when Big Tobacco is writing to the FDA, complaining that the government must do something about a vape product coming from China, Metatine or 6-methyl nicotine.

Let me back up a little bit. On April 14, 2022, the FDA was authorized to regulate tobacco products containing nicotine from any source, including synthetic nicotine. Some companies had begun producing vaping products with synthetic nicotine stating they didn’t have “tobacco” in them, so the FDA had no authority to regulate them. Congress corrected that. Around October 2023, vape stores in the U.S. started selling a product named Spree Bar. Spree Bar was sold claiming it was FDA premarket tobacco product application (PMTA) exempt. This product, and now others coming from China are marketed as containing “Metatine”, a trademarked name for 6-methyl nicotine, a synthetic nicotine analog. So again, manufacturers have, for the time being, found a way to work around the system until the FDA can decide whether 6-methyl nicotine can be regulated as a drug under the Federal Food Drug and Cosmetic Act (FDCA).

As of now, there is at least one vaping product on the U.S. market as well as several oral nicotine products that are using some derivative of 6-methyl nicotine. There are projections that this will be a billion-dollar market. Others are skeptical. Metatine is said to give users the same satisfaction a nicotine product does, and it comes with a lower price point, but the critical point is, for the time being, it isn’t hindered by the FDA’s authority over nicotine products.

Let me return to the letter Altia Group, the maker of Marlboro cigarettes, wrote to the FDA. In speaking of the warning vaping products that had 6-methyl nicotine in them, warning they posed a “new threat”.  “The introduction and growth of chemicals intended to imitate the effects of nicotine, if left unchecked, could present unknown risks to U.S. consumers and undermine FDA’s authority,” the letter said.

Who loses in this story? Our kids do.

In recent years, vaping among adolescents has become a major concern for educators and parents alike. The rise of e-cigarette use among teenagers has prompted schools to take proactive measures to address this issue. One important measure many schools are looking to is the implementation of vape detectors within school premises.

To begin with, vape detectors serve as a deterrent to vaping on school grounds. By installing these devices in restrooms, locker rooms, and other common areas, schools send a clear message that vaping is not tolerated. The mere presence of vape detectors acts as a reminder to students of the rules and regulations surrounding substance use, discouraging them from engaging in such behavior.

Something I believe is even more important, vape detectors enable schools to identify and address vaping incidents promptly. With real-time monitoring capabilities, these devices alert school administrators to potential vaping activity, allowing them to intervene before the situation escalates. By detecting vaping early on, schools can provide support to students who may be struggling with nicotine addiction or peer pressure.

Additionally, vape detectors contribute to overall campus safety by reducing the risk of fire hazards associated with vaping. Many e-cigarette devices use lithium-ion batteries, which have been known to malfunction and cause fires. By detecting vaping activity, these detectors help mitigate the risk of accidental fires, safeguarding students, staff, and school property.

Installation of vape detectors underscores the school’s commitment to promoting a healthy lifestyle. By creating a vape-free environment, schools encourage students to make positive choices for their well-being and resist peer pressure to engage in harmful behaviors. In doing so, they foster a culture of responsibility and respect for oneself and others.

In recent surveys, the majority of Americans feel that inhaling marijuana smoke is safer than inhaling smoke from tobacco. Most Americans also believe that there is less harm to both adults and children who are exposed to secondhand marijuana smoke than cigarette smoke.

Does science back up these growingly popular concepts? Nope, we are learning more about the risks of marijuana use at an amazing rate. The fact is, when you burn tobacco or cannabis, it creates carcinogens which are toxic as well as particulate matter that is harmful to one’s health.  There is a growing concept that because cannabis is “natural”, inhaling or burning it is fine. Again, that is simply not true.

It is a ridiculous concept to debate if smoking cannabis is safer than smoking cigarettes. That is no more useful than asking, ‘Is eating a box of cookies healthier than eating a cake?’ NO added smoke is safe for our health.

There were surveys analyzed from 2017, 2020, and 2021. They showed that American’s positive perception of marijuana increased each year. The last year of the survey, 2021 shows that over 44% thought cannabis was somewhat or much safer than cigarette smoke. How about the harm of secondhand marijuana smoke?  Over 40% thought smoke from marijuana was safer than cigarette smoke.

Friends, we have so much work to do. As health professionals, educators, parents, or grandparents, we need to have conversations about facts like these. It’s not preaching about how using these products is going to ruin our teen’s lives. It’s about taking advantage of organic conversations about what they are seeing at school and in their community. What their friends may or may not be doing. And always, with an open mind, have conversations where there is an opportunity to drop some knowledge.

Before Christmas, I had a mom tell me about this situation with her teenage daughter. Her daughter had asked her if she could have a personal diffuser.  Thinking it was something she would plug in and make her room smell like strawberries, Mom told her “Sure.” In a few days, the mom found her daughter in her room vaping what we now call “wellness vapes”.

Wellness vapes or “nutritional supplement diffusers” allow a user to inhale ingredients like vitamin B12, melatonin, caffeine, and many other options. These are usually slim, colorful cartridges, and names like Inhale Health and NutriAir. These products claim to do many things. There are options to help with sleep, give you energy, help with anxiety, and even fight ADHD. The fact of the matter is these products do not live up to their claim.  Here is the kicker, wellness vapes do not need FDA approval to be on the market. Why? They don’t contain nicotine, so the FDA has no control over these products.

The number and options for wellness vapes keep growing. They arrived on the market about four years ago. These products certainly hold something alluring and helpful to teens and undermine the efforts to encourage youth not to vape.

The FDA has warned that wellness vapes might well be dangerous. They may even trigger severe coughing and cause airways to tighten which could make breathing difficult. The simple truth is, it’s not ok to put anything unknown into our lungs.

Flavorings used in these products can cause lung damage and the propellants that send them into the lung will usually be propylene glycol and glycerin into the lungs and that is a medical concern.

Let’s be sure to include these products when talking to our youth about healthy choices. Help them understand that these products make many claims, but they are ineffective and at the worst, are likely to be harmful.

As we turn our eyes toward a new year and all it will bring. Let’s spend a few minutes looking at something relatively new, vaping cannabis. Unfortunately, we cannot go into depth explaining all the differences between CBD, THC, Deta-9, dabbing, blunts, chasing, and many other terms and important details to look at when discussing cannabis but we do need to understand several basic things.

How it works. Just like nicotine vaping devices, cannabis vapes work by heating a liquid or oil that becomes a vapor the user inhales. It is often difficult to tell a nicotine vape from a cannabis vape. Also, kids know how to hack them. I talked to a youth not long ago and he told me that he had a watermelon vape, used it till about half the vape was gone then opened it up and filled it with a THC liquid (he was very proud of himself). There are tons of YouTube showing how to do this.

We do need to know the difference between THC and CBD. THC is the psychoactive chemical compound in cannabis while CBD is non-psychoactive. There is also Delta-8 THC that can be sold as CBD. One thing all caregivers need to understand is this. Today’s cannabis is not the cannabis of the 60’s and 70’s. At the very least, 1 joint today is 10 times stronger than a joint in 1970. That means that for every 1 joint, you or your grandparent may have smoked, your child or grandchild would be smoking 10. Then you look at something like “dapping” where the cannabis is cooked down to a wax and is 80% stronger THC than a joint from the 1970s.

This brings us to the realities of the risks. I will highlight two of the vital organs at risk: the brain of the young person and their developing lungs. The brain of a young adult continues to grow into their early 20s and is busy developing critical skills related to problem-solving, impulse control, anticipating consequences, and more. Cannabis can get in the way of this critical development.

Several thousand lung injuries and deaths have been associated with an illness linked to vaping devices containing THC. Even though the CDC has stopped collecting this data, cases are still being recorded. Some symptoms to watch for are shortness of breath, fatigue, weight loss, and gastrointestinal problems.

In months to come, we will look at how we can address this issue with our youth.

This time of the year can certainly mean the weather is changing outside. There are songs like, “Baby It’s Cold Outside” or maybe “Colder Weather” by Zac Brown that remind us of cold weather.  But actually, I’m thinking of the efforts Big Tobacco is going through to keep the “cooling agent” in cigarettes and vapes on the market: MENTHOL.

See, the FDA, in October of this year, sent the White House final regulations to eliminate menthol nicotine products like e-cigarettes, cigarettes, and cigars. But Big Tobacco won’t give these products up without a fight. Menthol cigarettes reap more than a third of all annual cigarette sales from menthols and US sales of “ice” e-cigarettes have been increasing at an alarming rate, with US sales growing by more than 10 times from 2017-2021. What is even more alarming, in 2023, almost 58% of US kids who vape, use ice e-cigarettes.

Big Tobacco put up a major fight as California passed its flavor ban that included menthol. Now, they have multiple front groups like “Alliance for Fair and Equitable Policy” to post advertisements opposing the federal ban on menthol and placing them on popular podcasts and local targeted radio and social. These ads prompt their target audience to call the White House in protest of the FDA proposal.

So now, it’s time for all of us to use our voices. I encourage you to call the White House’s comment line and leave a message for President Biden. Support the FDA’s recommendations on eliminating the sale of menthol products. The phone number is: 202-456-1111.

May your days be merry and bright.