Shortly after that meeting, Higginbotham said, Texas set a record by becoming the state with the youngest vaping-related death. A Dallas County 15-year-old had died due to vaping-related complications Dec. 31, according to the Centers for Disease Control and Prevention.
Through her work with the Young Men’s Service League Cavalier Chapter, Higginbotham distributed an anonymous survey to a number of the Lake Travis ISD High School students, asking them to estimate how many of their fellow students they believe have tried vaping.
A majority said they felt at least 50% of students have used e-cigarettes, and some guessed that number could be as high as 70%. Higginbotham said she was not shocked by their responses. Regardless of the informal nature of the survey, Higginbotham said their opinions mirrored those of LTISD administrators.
Because local data sets on vaping behaviors among students for the most part do not yet exist or are not readily available, Higginbotham’s informal survey and other similar inquiries are serving as a baseline barometer for how newly formed groups such as her task force are preparing to deal with what she sees as a growing trend.
Cigarette smoking rates have been decreasing over the past 10 years, with Texas seeing a 19.55% decline, according to the CDC. The National Institute on Drug Abuse also reports a nationwide decline in illicit substance use among teens.
At a time when nationwide use of cigarettes and illicit drugs is declining among teenagers, data on vaping shows the behavior in the same demographic is growing.
Parents, educators and community members such as Higginbotham are working to curb the use of e-cigarettes. Private testing facilities, local school districts, community leaders and health officials are developing a plan to gather more meaningful data on vaping trends in order to prevent children in the Lake Travis-Westlake area from becoming addicted.
“It’s definitely something that kids are talking about,” Higginbotham said. “It’s prevalent.”
Evaluating the epidemic
Dr. Steve Kelder, an epidemiologist and health educator, has been following the trend of vaping for several years. In 2015 he worked with the CDC to develop a general report on the health implications of e-cigarettes.
“At that time I thought, ‘Yeah this is going to be a problem,” Kelder said, adding he immediately recognized the need to provide children, parents and school officials with more information. That was the origin of CATCH My Breath, a program utilized by Eanes ISD that distributes vaping-prevention curriculum to communities at no cost.
Vaping is considered by health officials to be a relatively new epidemic that only caught the public’s attention roughly six years ago, Kelder said. Consequently, there is not yet sufficient data to truly understand the long-term health implications.
Kelder explained that doctors can only speculate on the implications of the chemicals found within e-cigarettes, some of which are carcinogenic. While the potential exists to show vaping could lead to cancer, cardiovascular disease and other chronic illnesses, it could require years to prove, Kelder said.
An evolving catalogue of products
The market for electronic nicotine-delivery systems is rapidly changing with new generations of vaping products emerging every few years, according to a report from Texas Health and Human Services Commission. Local leaders have said this has made it difficult for parents and school officials to stay informed on the substances their children might be ingesting.
“There’s so many different kinds of e-cigarettes, and people [use] them different ways,” Kelder said. “Things are changing rapidly.”
Along with the evolution of devices, nicotine levels have increased in the e-liquids the devices vaporize, and new flavor options are also more prevalent now than they have ever been. Device aesthetics have also changed to become more sleek. They now have more compact designs that often resemble thumb drives or other office supply items, according to Kelder.
The modern e-cigarette was released in 2003 and contained a similar nicotine level to that of a regular cigarette, which is around 10 to 15 milligrams per milliliter. A 2018 report by Texas HHSC states that today’s most popular e-cigarette brand, Juul, contains around 59 milligrams.
For professionals tasked with making sure children do not engage in self-destructive behaviors, the vaping industry presents a set of challenges that differ widely from other illicit substances, according to EISD Associate Superintendent Linda Rawlings. Vaporized liquid is odorless and will not present itself on an individual’s hair, skin or clothing. And, unlike other substances, there are no signs of immediate impairment.
“Vaping is one of those things that sometimes the parent doesn't even know [their child is engaging in],” Rawlings said, adding that while she believes the rates of teen vaping have likely increased within EISD, compiling the data would be challenging.
EISD does not implement a drug- or nicotine-testing program, and according to Rawlings the logistics of doing so are complicated. After speaking to neighboring districts, Rawlings said EISD officials felt there was a lack of evidence in the effectiveness of campuswide drug testing.
“I’m not sure that your numbers would even tell the whole story,” she said, adding that the district is focusing on prevention through education.
The troubles of testing
Timing plays a critical role when testing for nicotine use, according to Sarah Toney, owner of Westlake-based testing facility Any Lab Test Now. Unlike substances such as marijuana, which can stay in a user’s system for 30 days or longer, nicotine is a faster metabolite, meaning the body processes and excretes the substance more quickly, Toney said.
According to Toney, there are three certified tests for nicotine: a urine test, a hair follicle test and a blood test. All three tests are equally accurate; however, they’re capable of varying detection periods.
Toney said the hair follicle tests are among the company’s most popular for parents and employers, who call them the gold standard. The test has a 90 day dedication period, compared with a urine sample that can detect nicotine use after 24 to 48 hours.
“[The hair follicle test is] a more comprehensive test ... especially for the parents that say, ‘Hey, I want to find out if my teenager is using nicotine as far back as three months,” Toney said, adding that unlike a urine sample, a hair follicle cannot be manipulated.
LTISD utilizes urine samples in its randomized drug testing program, which tests a percentage of the student body in six sessions per year. The district does not test for nicotine, though the topic has been extensively discussed by school officials during board of trustees meetings.
At a Jan. 15 school board meeting, Superintendent Dr. Brad Lancaster stated that including nicotine in the testing program would add an extra $6,200 to the program’s annual cost.
“$6,200 is not cost-prohibitive,” Lancaster said. “What we’ll see is an increase in students being penalized. Do we punish children for an addiction?”
Despite the looming questions centered on the disciplinary challenges of such a policy implementation, Lancaster also said he would be curious to see the results.
At the same meeting, trustee Jessica Putonti stressed the importance of gaining a better understanding of the issue and argued that the purpose of the testing program was never to penalize students but to identify and aid those kids struggling with an addiction.
Toney said testing will hold teenagers accountable and can provide them with the necessary tools to combat peer pressure, and for some parents, these tests are a lifesaver.
Cracking down on vaping
Both EISD and LTISD officials have amended their student codes of conduct to include e-cigarettes in the list of prohibited devices. LTISD has also discussed making penalties more stringent for vaping and smoking.
Higginbotham said added restrictions are a necessary step toward decreasing the rates of underage vaping. Similar to the methods used to curb cigarette use, it is not enough to simply inform teenagers of the health risks.
Combating vaping rates will require efforts of city officials, school districts, parents and law enforcement, and restrictions are required in order to make it more difficult for people to continue the use of e-cigarettes, she said.
Higginbotham led a Lakeway City Council discussion on the issue prior to officials voting Jan. 21 to amend the city’s smoking ordinance to include a ban on vaping in public places where smoking is restricted.
Changes are also taking place at state and federal levels with officials cracking down on e-cigarette companies. On June 7, the state of Texas increased the legal age to buy cigarettes and e-cigarettes from 18 to 21, but Higginbotham said the law has not kept nicotine products out of teenagers' hands.
She and numerous health officials are hoping for a ban on e-cigarette flavors due to the fact that a common argument for opponents of vaping is that flavors such as bubblegum, vanilla and pineapple are intentionally marketed to children.
“[In] early February there should be a conclusive statement from the FDA that manufacturers can't produce flavors anymore except the tobacco flavor and menthol flavor,” Kelder said, adding the ban will not entirely solve the problem.
Higginbotham stressed the importance of community involvement and said vaping rates will require a comprehensive education system, stricter ordinances, support from law enforcement and the vigilance of parents.
“It's a big problem that is going to take a lot of different solutions,” she said. “Because it's just rapidly escalating, and because it's so easy to conceal.”