Teens are turning to an easy-to-conceal illicit substance to achieve a dopamine high.
Something’s in the air in high schools across America, and it’s not love, asbestos, or COVID. Instead, it’s vapor from e-cigarette emissions. Whether or not you vape, you have likely been exposed to it in some form. Whether from friends, family, the internet, a substance abuse unit in advisement, or even a school-wide evacuation caused by a tripped fire alarm, it seems like vaping is everywhere. But to understand why vaping has become so popular, it is crucial to understand how e-cigarettes work and how they differ from the product they intend to replace: traditional cigarettes.
The contents of e-cigarettes are not harmful as individual components. At their core, e-cigarette pods contain three fundamental elements: flavors, sweeteners, and solvents. The solvents dissolve either nicotine or marijuana-based substances, including THC or CBD, into an aerosolized form inhaled at the press of a button. The most common solvents are vegetable glycerin and propylene glycol. The former, vegetable glycerin, derived from vegetable oil, creates a cloud of visible aerosol seen when vaping. The latter is a clear, slightly syrupy liquid that is colorless and odorless. A wide variety of sweeteners are available, which may include sucralose and ethyl maltol. The FDA (Food and Drug Administration) recognizes these ingredients as safe, but only for consumption. Some, when superheated and vaporized, become toxic when inhaled.
E-cigarettes made it to U.S. markets in 2006, but they have found great success, not among the target demographic – cigarette smokers looking for ways to quit, but rather with teenagers who have never smoked before. The Centers for Disease Control found that E-cigarettes are now the most commonly used tobacco product among youth. In 2022, 17.4% of U.S. middle and high school students reported using e-cigarettes in the past 30 days. By contrast, in 2020, 3.7% of U.S. adults were using the devices.
At Thomas Jefferson High School, Megan Miccio is one of the school health professionals tasked with addressing student vaping. For the school administration to effectively respond, they first must learn what percentage of students are engaging in this form of substance abuse. “[In] the 2021 Healthy Kids Colorado survey, there’s a question that asks ‘how many of you have vaped in the past 30 days,’ and students here at TJ reported 16.4%,” Miccio said. This statistic also means that 84% of students are not engaging in vaping. The perceptions of the harms of vaping have also increased significantly after educational substance use prevention modules were introduced in Colorado school curriculums during the 2017-2018 school year. Initially, 43% of students viewed vaping as harmful. Two years later, in 2019, that number jumped to 74%. In 2021, it was 78%. And for the first time since 2015, current e-cigarette usage among high school students has significantly decreased (down from 26% in 2019).
A commonly asked question among school administrators, parents, and teachers is why students choose to use e-cigarettes, and it tends to be a combination of three factors. First, students generally perceive vaping as less harmful than other substances. “When we ask students… [what] substances they think are harmful, cigarettes are always number one, alcohol is usually behind that, then marijuana, then vaping. Vaping is usually at the bottom of the list,” Miccio said. Smoking a traditional cigarette involves inhaling smoldering materials, causing immediate irritation in the user’s throat. With vaping, there is no combustion, and breathing aerosol is not as harsh a sensation for the user. The widespread availability of flavor cartridges for e-cigarettes, which make vaping feel like eating candy, contributes to the belief that it is less harmful than smoking. However, Miccio said the long-term effects of vaping are unknown, especially for adolescents. The only proven facts thus far are that the way it delivers nicotine to the body is not the same as traditional cigarettes and that nicotine is harmful to adolescent brains.
Secondly, many students claim they vape because of the positive psychological effects. “When I work with students individually and ask why they’re using, [I] get a lot of answers around, ‘it helps my anxiety,’ ‘it helps my stress,’ it helps me sleep better,’” Miccio reported. When nicotine enters the body, it binds to receptors in the brain within 10 seconds, causing the user to immediately feel the rush of dopamine, which invokes a feeling of pleasure. “The problem here is that we can get that feeling from other things. If someone really likes skiing, or ‘runner’s high–’ there are other things we can do to release dopamine… but it’s pretty immediate when you’re using a vape device,” she said. Despite student claims, though, studies have found that vaping doesn’t reduce anxiety on a physiological level, and may even increase depression symptoms when the rush of dopamine wears off and the brain is left chemically unbalanced.
And third, there is a social aspect to vaping, especially in groups. Recently, school administrators have caught more groups of students vaping instead of individuals. When students are referred to Miccio, they fill out a 90-minute psychoeducational module regarding their substance use. Many students have said vaping in groups helps them meet new people, relaxes them in a social setting, or helps them fit in among their friend groups. However, she says peer pressure is not the leading cause of e-cigarette usage. When the module asked if reducing their substance use would negatively affect friendships, many students said it would not. Instead, Miccio claimed vaping largely stems from anxiety and students using it as a coping mechanism.
Student vaping also affects student behavior and performance in class. One issue school administrators have seen recently is students abusing class passes to vape in restrooms. “That’s obviously taking away from class time, so then they’re not getting the academic content they should be getting,” Miccio said. As a result, grades may slip, and incomplete assignments may pile up. Students who feel overwhelmed by their workload may turn to vaping as a coping mechanism for stress rather than addressing the work. TJ also has strict grade requirements for participating in sports, and students falling behind in class due to vaping may be barred from playing their favorite sports. Bathroom vaping has also set off the new fire system multiple times, which is now more sensitive to aerosol. “[One] week alone we had three fire alarms go off, which is a huge interruption to our day,” she said. (Two alarms were tripped by aerosol, and the third was a possible malfunction.)
In response, many restrooms across the building have been locked, leaving only two open on every floor for all students to use. While the intent is to deter on-campus vaping, particularly during class time, it negatively impacts students who legitimately need to use the restroom. Rather than a short walk, they may need to trek across the building, or perhaps to another floor, to find an open restroom.
As a school health professional, Miccio said her job involves two main functions: prevention and intervention. Prevention involves Miccio (or any other student health professional) going into classrooms, getting in front of as many students as possible, and educating them about the dangers of vaping. The critical part of prevention is continuing the conversations regularly so the information sticks. “Effective prevention is doing multiple weeks [of discussions] at a time, going into classrooms, and building relationships with students,” she said, and “admin has been really supportive of me going into classes, talking with students… and a lot of teachers have invited me into their classrooms.” She believes prevention modules are critical for all students, even those who don’t vape, because it gives them useful information that may deter them from starting. The modules may also help them support a friend struggling with nicotine addiction.
An intervention involves school administrators meeting with students who are getting caught vaping on campus or who have been reported to the restorative justice staff. Miccio works closely with administrators Emily Lupo and Andrew Skari to put together a triage system that outlines for students and families how the school will address a student’s substance abuse. For first-time offenses, administrators will pull students into an office and have them complete a psychoeducational module, which varies based on the substance used. For tobacco and vaping, they must complete the Second Chance program, which addresses tobacco laws in schools and communities and asks about a student’s home life. For a second offense, students are referred to either Miccio or another school health professional, Annie DePoy, to complete a more intensive, one-on-one counseling program called Teen Intervene. A counselor will meet with the student for four to six weeks to discuss the root cause of their substance abuse and work with them to set realistic goals to reduce it. In the past, schools would immediately suspend students for substance use, which Miccio believes was a problematic response. “DPS as a district is really trying to put together, in their discipline matrix, finding alternatives to suspension. Because we feel like… if students are using a substance, and we’re just suspending them, we’re not supporting them.” Taking students out of school also forces them to miss instruction, causing them to fall further behind.
While student vaping may seem like an unsolvable problem, Miccio says much of it is exaggerated by student perception and media. The 2021 Healthy Kids Colorado survey showed that while 45% of students believed at least five out of every 10 of their peers were vaping, the percentage of students who vaped was less than half that. “The media does a really good job of this… we see a lot of the ‘doom and gloom,’ and it’s hard to see all of the good things that are happening,” Miccio commented. But to keep that number low, Miccio says they must continue educating students on the harms of substance abuse, especially the effect of nicotine on the developing brain. “Your brain is still developing, let it develop!” Miccio implored.
High school is a unique experience that is often pivotal in many people’s lives. It’s where many start to branch out and realize who they are as people. But as a result of branching out, some will encounter situations that make them uncomfortable or morally conflicted, including being faced with the choice of vaping. Should a student encounter such a situation, the student support team at TJ hopes to provide them with the facts about substances well in advance, with a reality check that it rarely has any benefits, to allow them to make the best choices possible. And over the past five years, more students seem to be getting the message. More are seeing e-cigarette use at a young age as an inherent harm, and fewer are reporting using them in the past month.
The root causes that push some students to vape regardless still exist, but many are realizing the importance of finding healthy coping mechanisms. In January 2021, at the height of the COVID-19 pandemic, the CDC published an article outlining healthy ways of coping with stress. Rather than turning to drugs or alcohol, which may worsen stress as the effects wear off, they recommended eating healthy, exercising, sleeping well, making time to unwind, and talking to others to foster a sense of community. We’ve heard these things repeated many times, but they’re better than the alternative, which may put you on a difficult path.