‘Kid-friendly’ e-liquids at a vape shop in Berkeley. Experts say flavors attract teens, and the FDA is now targeting e-cigarette manufacturers who label or advertise these products. Photo: Annette Choi
‘Kid-friendly’ e-liquids at a vape shop in Berkeley. Experts say flavors attract teens, and the FDA is now targeting e-cigarette manufacturers who label or advertise these products. Photo: Annette Choi

Skyrocketing e-cigarette use in teens has cities across the nation baffled. Including Berkeley.

Kieran Rok, dean of students at Berkeley High School, said e-cigarettes have been wreaking havoc for a few years now.

“It was unexpected,” he said, of the new cigarettes’ popularity. There have been 15 incidents of vaping at BHS so far this year that have occasioned school administrator intervention. “This represents less than one half of 1% of our students,” Rok said, “but we know the behavior is more widespread.”

E-cigarettes – handheld electronic devices that heat up cartridges (or pods) of flavored, nicotine-containing liquid, forming vapor to be inhaled – have many names, like vapes (short for vaporizers) or e-hookahs. Typical e-cigarettes are made up of three components: a rechargeable battery, a vaporizing chamber, and a cartridge. They deliver nicotine just like a traditional cigarette, but without the tar, tobacco, or smoke.

The “cigarettes” took off about five years ago, said Stanton Glantz, Professor of Medicine and Tobacco Control at UCSF, whose research on tobacco control and the effects of secondhand smoke has recently expanded to include e-cigarettes and marijuana.

E-cigarettes’ popularity has soared in part because people can use them in places where traditional cigarettes have long been banned. “Students smoke walking around hallways and blow it down their shirt,” said Berkeley High sophomore Damian Burke.

The discreet design of some e-cigarettes, like Juuls – one of the most popular brands – makes them look shockingly like the flash drives most students already carry to class.

The smell is inconspicuous, too. Cartridges come in flavors like “Skittles” and “Kool-Laid.” “It might smell like cotton candy,” Rok said. “Or fruity flavor, sweet flavor.”

And the scent evaporates quickly. It doesn’t linger on fingertips, breath, or clothing, like traditional cigarette smoke does.

Rok said Berkeley’s High’s biggest challenge is a “generational divide.” Parents and staff don’t really know what they’re looking for as they try to identify teens using nicotine in its newest form.

Rok said the school is working on educating adults, but the process is time-intensive. The first step is to help adults identify the sweet smells that linger in the halls between classes.

“I’d had conversations where I’ve had to explain to staff members that that is actually the byproduct of someone vaping,” he said.

In an effort to get ahead of the problem here in Berkeley, in 2015 City Council passed an ordinance that created Berkeley Tobacco Retail Buffer Zones of 1,000 feet around grade schools of 50 students or more. Retailers in the zones are prohibited from selling flavored tobacco products (including menthol) and nicotine-containing e-liquid.

Rebecca Day-Rodriguez, health services program specialist with the City of Berkeley, said the buffer zones aim to decrease youth consumption of tobacco products, particularly flavored and electronic ones. At Berkeley High, it’s unclear what impact that buffer zones have had.

FDA declares ‘epidemic’ of youth e-cigarette use

The Center for Disease Control and Prevention found that more than two million U.S. middle and high school students have used e-cigarettes in the past 30 days. According to the California Department of Public Health, the Bay Area makes the top five counties with the highest tobacco smoking prevalence among high school students, meaning Berkeley students live in an area with the highest teen smoking rates in the state.

Most youth who use tobacco products today use e-cigarettes. And last month, the Food and Drug Administration officially declared youth e-cigarette use a nationwide “epidemic.”

FDA Commissioner Scott Gottlieb said the word “epidemic” was chosen with great care. “The disturbing and accelerating trajectory of use we’re seeing in youth, and the resulting path to addiction, must end,” he said in a press announcement.

“The problem has gotten so big so fast that [the FDA] couldn’t continue to ignore it,” Glantz said.

In one study, Glantz and a colleague found that U.S. e-cigarette marketing expenditures rose from $3.6 million in 2010 to $125 million in 2014, and that that expenditure translated to “rapid increases in youth e-cigarette use.” Between 2016 and 2017, Juul sales alone grew 641%.

Teens are the foundation of the e-cigarette market, Glantz said. Which is why the FDA is now targeting manufacturers who label or advertise “kid-friendly” e-liquids that come in flavors like strawberry ice cream or glazed donut. The FDA is seizing company documents and analyzing marketing practices. And in September, the FDA demanded five major e-cigarette companies present a plan to address youth access to such cigarettes within a 60-day deadline.

“I applaud what they’re doing,” Glantz said. “Because they previously have been doing nothing, and now they’re doing something.”

San Francisco-based Juul has been a particular target of enforcement efforts. The FDA recently conducted a surprise inspection of Juul’s headquarters in San Francisco and collected thousands of documents outlining company sales. Buzzfeed News recently reported that Juul offered a number of schools payments of up to $20,000 to adopt a “vaping curriculum” taught by Juul consultants. None of the schools accepted the funding or the program.

One of the most common reasons youth use e-cigarettes is a low perceived level of harm.

Teenagers know cigarettes are “bad.” They’ve been taught since kindergarten to look out for distinct indicators—bad breath, pungent clothes, gray ashes. But with e-cigarettes, all those indicators go out the window.

The Truth Initiative, a Washington, DC-based nonprofit tobacco control organization, also found that 63% of young Juul users surveyed did not even know the product contained nicotine.

San Francisco became the first city to ban sale of flavored vaping products this year. Berkeley has yet to follow suit

Earlier this year, San Francisco became the first city in the U.S. to ban the sale of flavored vaping products entirely. No council member has introduced such a ban to the Berkeley City Council as yet.

Day-Rodriguez said the public health department is working with the Berkeley Unified School District’s Tobacco Use Prevention Education Program to try to cut back on teen vaping. Berkeley High is also updating its curriculum. The required freshman semester course “Social Living,” which covers healthful living, will soon include more extensive education on vaping and dangers of nicotine.

But it may take more than curriculum to deal with a growing epidemic of addiction.

In an article published in the Berkeley High Jacket last year, students said they pool their money to buy cartridges, love the “headrush,” and spend their days seeking out nicotine breaks,.

“Kids smoke together in the bathroom all the time,” said Berkeley High sophomore Juliette Labadie. “Or when they go off campus for lunch.”

“My addiction to nicotine has gotten so bad that I find myself going to the bathroom to Juul and finding others doing the same,” another student told a reporter at the school paper.

When a student is caught vaping on campus, school administrators confiscate the e-cigarette. Then follows the typical phone call to the parent and detention. First-time offenders have to take a four- to six-session Alcohol Tobacco and Other Drugs, or ATOD, class with a counselor or intervention staff member.

“It’s an alternative to suspension,” Rok said.