Even in the face of a recent vaping-related death in Montana and warnings from the Centers for Disease Control and Prevention about a national outbreak of injuries and fatalities, the use of e-cigarettes remains commonplace among Montana youth.
“The reception to (it being) proven that it’s actually killing people is a lot less severe than I would expect,” said Nathan Edgarto, a senior at Hellgate High School. “There’s irrefutable proof that it hurts you now, but a lot of people are just doing it anyway. So I feel like they know, but they don’t really care.”
E-cigarettes are the most commonly used tobacco product among all youth, according to the 2019 Montana Youth Risk Behavior Survey. Vaping products are being used as early as middle school, and from 2017 to 2019, the percentage of Montana high school students using the products on a daily basis increased by 263%.
"That's in just two years. It’s rampant," said Ellen Leahy, director of the Missoula City-County Health Department.
According to the risk behavior survey:
- 30% of Montana high school students are vaping regularly,
- more than 58% of high school students have tried vaping products,
- 28% of middle-schoolers reported they have tried e-cigarettes, and
- 16% of middle-schoolers reported they are currently using them.
The University of Montana is seeing an increase as well. The most recent National College Health Assessment in 2018 found the percent of UM students who reported daily e-cigarette use doubled in the past two years from 1.1% to 2.2%. And students who reported using e-cigarettes at least once in the past month more than doubled over the past two years from 3.7% to 9.6%.
Following the death of a Montana teenager last month, Gov. Steve Bullock tried to impose a temporary ban on the sale of all e-cigarette products. But three vape store owners and their association sued, arguing businesses not connected to the outbreak would be forced to shut down.
Ravalli County District Judge Jennifer Lint signed a temporary restraining order to halt the ban and heard arguments Friday on whether to consider a preliminary injunction. The case is pending.
Meanwhile, schools in Missoula, UM and the local health department are working to increase awareness around the epidemic, the dangers of e-cigarettes, and the potential health risks of solvents and flavorings in vaping liquids. But they appear to face an uphill battle.
Mark Monaco, a school resource officer at Sentinel High School, said students aren’t as likely as they were last year to pull out their portable vape pens in class while their teachers’ backs are turned. But he still smells the fruity scent of e-juice in the halls.
“It's not just the kids who you think it is. It's anybody and everybody.”
In response to the nationwide outbreak, the CDC recommended refraining from using all vaping products. The CDC put the related death toll at 37 as of Oct. 29.
But students' understanding of the dangers associated with vaping products is murky, and even the Food and Drug Administration and the CDC have not identified the exact cause or causes of related lung injuries or deaths.
The latest findings suggest that products containing THC — particularly those obtained off the street or from friends, family members or dealers — play a major role in the outbreak because they are linked to most of the cases, according to the CDC.
However, Leahy, with the local health department, said there isn't enough evidence to determine the exact correlation between THC products and vaping-related illnesses or deaths, especially because THC products are not associated with every case.
As of last week, the state Department of Public Health and Human Services counted five cases of vaping-related lung injuries. Although the state health department declined to disclose the location of the teenager who died in Montana, the Missoula City-County Health Department's website reported no injuries or deaths in Missoula.
Local educators are grappling with the best way to talk about the risks, but following the death in Montana, students expressed differing opinions on the dangers of the products — and the information coming from administrators.
"I feel like now they're doing as much as they can with the knowledge that we have, which is not very much," said Adrianna Kuntz, a senior at Willard Alternative School.
Judson Miller, the principal of Hellgate High School, said he thinks talking about vaping as a public health issue, and not just a discipline issue, seems to be working.
"When it's just a discipline issue, it's hard for kids to make the connection as to why they shouldn't use it, because it's just an adult saying 'no,'" he said. “The more that we can link this as a public health issue — in the same way that we have with tobacco and in the same way we've done with drinking and driving —the better off we're all going to be."
Miller and other school administrators said they have caught fewer kids vaping this year than in previous years, but they're unsure if it's less prevalent or if students are doing it off campus.
Several students at Hellgate and Willard confirmed students are more likely vape off campus, in the bathrooms, or on their lunch break. Kuntz, the senior at Willard, said she thinks e-cigarettes are dangerous, but she also thinks they can be an alternative for people looking to quit cigarettes. She said the risks depend on the ingredients or chemicals contained in the vape.
Jakiya Stringer, a senior at Willard, said she sees both vaping and cigarettes as dangerous if the products contain nicotine, but she thinks black market THC cartridges that could contain other ingredients, such as vitamin E oil, are behind many of the vaping-related deaths and injuries.
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"When you buy stuff on the streets, you never know what it is, but if you buy it from a dispensary where they're actually educated about it, then you will probably have a better chance of surviving," Stringer said.
The majority of students the Missoulian spoke with said they think many of the illnesses and deaths are associated with black market products such as THC cartridges that contain other ingredients. Leahy, though, stressed the science is still out.
"My caution would be that simply because one component may have been identified as being related, that does not make other components safe," Leahy said. "There's just too much that is unknown."
Missoula County Public Schools prohibits the use of tobacco products on school property, and in 2019, Montana lawmakers passed a bill that made it illegal for anyone to use a vapor or “alternative nicotine” product on any public school property in the state.
But Jennifer Courtney, principal of Big Sky High School, said she's seen an uptick in students not only using THC products, but filling empty pods and cartridges with substances like meth or heroin.
"We actually see less issue of vaping in the classroom and less overall reports of vaping, but we're seeing an increase in the dangerous products that are contained within the vapes that we do confiscate," Courtney said.
Robyn Nuttall is an instructional coach who helps develop the health and physical enhancement curriculum for the district's middle schools. Nuttall said teachers have addressed vaping in the past, but the district has started to take a comprehensive approach.
"For the past few years, we've had teachers who identified it and added it to their tobacco unit, but last year was the first time that we sat down and evaluated curriculum to be used consistently," Nuttall said.
The district's health teachers start talking about the vaping and e-cigarettes as early as elementary school, Nuttall said. Lessons for elementary school students focus on establishing relationships with trusting adults who they can go to if they are concerned about a friend making unhealthy choices. Middle and high school health and PE teachers now talk about the issue in their tobacco and substance abuse units too.
Courtney said students also learn about the issue through "push-in" lessons or from teachers who incorporate the topic into classroom discussions, and Miller said some student organizations at Hellgate have started creating campaigns about the dangers of vaping.
But some students feel like schools could be doing more. Bernosky, a senior at Hellgate, said he hasn't heard many conversations about it from staff.
"It's more the students that talk about it," he said.
At UM, health providers and students have taken up the issue. Last week, UM even offered prizes to students who turned in their vape pens and e-cigarettes at organized drives at various locations on campus.
“Part of the drive is collecting the e-cigarettes, part of the drive is raising awareness about the negative health effects associated with it and to get people thinking ‘Oh I’ve kind of heard about that in the news. How does that affect me directly?’” said Jessica Vizzutti of the UM Curry Health Center.
UM student Bobby Sonsteng, a senior majoring in community and public health, helped organize the drive with students in the Peers Reaching Out (PROs) program through the UM Curry Health Center. The Center also provides students with free Quit Kits to help students quit all tobacco products.
“Out of my four grandparents, I only have one living,” Sonsteng said. “The three that died have all died due to cigarette-related illnesses and my grandpa still living beat lung cancer.”
Sonsteng said his grandpa told him about how cigarettes were accepted and not seen as "a big deal" when he was younger.
“Fifty years later, we have all these illnesses and diseases associated with cigarette use,” Sonsteng said. “I just feel like history repeats itself too many times, and with e-cigarettes being the new thing, they say one is better than the other. But I disagree and feel that it’s an unknown science."
Last week, Gov. Bullock's health care policy adviser Jessica Rhoades noted large portions of the lawsuit filed in Ravalli County to stop the ban were "lifted word for word" from a complaint filed in Michigan by lawyers from a national firm focused on vapor and tobacco regulation. Said Rhoades: "It's clear that Big Nicotine is pulling the strings in Montana."
Judge Lint pledged to move quickly in the lawsuit. If granted, the injunction would put the governor's 120-day ban on the sale of e-cigarette products on hold until the merits of a lawsuit could be heard.
Meanwhile, tobacco prevention groups, federal, state and local health departments are working to increase transparency around the ways e-cigarette products are marketed toward young users. A recent report by the FDA states that 96% of 12- to 17-year-olds who initiated e-cigarette use started with a flavored product, and 70% report the flavors as their reason for using e-cigarettes.
At UM, Sonsteng said much of his public health work is prevention based, and that he hopes more education can stop a new epidemic from happening. Only a few students turned vapes into the drive, he said, but he spoke with over 50 individuals, and they may hold another drive this school year.
“It’s the first go at this, and we’re just doing our best to educate right now,” he said.