For years, the use of tobacco products among middle and high school students has been on an overall decline. But the Food and Drug Administration is reporting a reverse of that trend in 2018. The reason? A sharp rise in the use of e-cigarettes.
That rise is creating problems in schools across the country, including Maine, because e-cigarettes are easy to use, easy to hide and highly addictive.
As a vice principal at South Portland High School, Kimberlee Bennett has a stash of items confiscated from students. And when it comes to e-cigarettes, she's got a whole bag.
E-cigarettes, also known as vape pens, are a problem that erupted only recently in the 7 years since Bennett has been at South Portland High.
"My first few years here, I'd say we didn't see any vape pens. And I would say the last 3 or 4, it's exponentially increased," she says.
E-cigarettes entered the U.S. market about a decade ago. Marketed, in part, as an alternative for adults trying to quit smoking, e-cigarettes provide nicotine through aerosol instead of smoke. They're battery-operated devices filled with a flavored liquid that vaporizes when the user sucks on the mouthpiece.
It's that liquid, which comes in flavors like mango, bubble gum and cotton candy, that's appealing to teens. And unlike smoking, it's easy to vape discretely.
The bathroom is the hotspot for vaping at South Portland High School, says senior Grace Rende.
"Usually some girls go into the stall together to share, or pass over the stall. It's also really easy — since there aren't like, doors, you can hear people coming. So they're like, you can hear someone coming, like, 'Quick, hide it,'" Rende says.
The vapor dissipates quickly, making it hard to catch students. And e-cigarettes can be so small and disguised so well — some look like USB flash drives or stylus pens — that students sometimes hide them in the bathrooms for others to use.
Many teens think vaping is harmless, says Emily Spencer of the Maine Center for Disease Control.
"Youth don't always realize what they're inhaling, and that's kind of shown in our numbers. Almost no e-vapor products are just flavoring, yet more than half of high school students who use e-vapor products think they're just inhaling flavoring," she says.
The aerosol from e-cigarettes emits fewer harmful chemicals than the burning tobacco in cigarettes, but it can contain cancer-causing chemicals and high amounts of nicotine. In some brands, one pod of liquid contains the same amount of nicotine as a pack of cigarettes.
What starts as recreation, says South Portland High School social worker Kara Tierney-Trevor, easily becomes an addiction.
"For a lot of students, school is stressful. Life is stressful. And so when they're able to get that quick hit, then they can get that head rush, they get that buzz, that can kind of make them feel they can handle life," she says.
E-cigarettes have grown so popular that the FDA recently sounded the alarm about a spike in use among teens nationwide: 78 percent from 2017 to 2018. About one in five high school students now vape. Maine's numbers are slightly lower, but the latest data were collected just as popularity of a particular e-cigarette product - Juul - was on the rise.
The FDA is concerned that e-cigarettes could reverse the decadeslong trend of reduced tobacco use among teens, because teens who use e-cigarettes are more likely to transition to conventional cigarettes.
"When people argue about, well, what's the gateway drug? Everyone wants to know. Well, really it is nicotine in the brain," says Lee Anne Dodge, program director of SoPo Unite, a federally funded Drug-Free Community program. "It primes the brain for other substances. It doesn't make me use other substances, but if I do, I'll become more addicted."
The problem of vaping is prompting schools such as South Portland High to reevaluate policies on substance use. Bennett says in the past, students caught with substances were automatically suspended, which, she says, didn't go very far in helping them stop.
The group SoPo Unite suggested the school instead use a restorative strategy, in which students are encouraged to do a risk-assessment about their substance use.
"So we try to go more intervention-based route with it than the consequences," Bennett says.
The more than 100 middle and high school students who are in SoPo Unite also intervene with peers at the individual level. The group hosts social events, including potlucks and movie nights, to give students something to do that will hopefully steer them away from e-cigarettes and other substances.
Senior Cooper Mehlhorn, one of the leaders of SoPo Unite, says a lot of parents are still in the dark about vaping.
"I think that adults really just don't understand how easy it is to get this stuff. You can make one text to a friend and have it in 30 minutes. I don't think a lot of parents and adults realize that," he says.
The FDA has launched a prevention campaign and says it's cracking down on illegal sales. The agency is also proposing rules that would require e-cigarettes to be sold only in age-restricted in-person locations, and better age verification for online sales.