Montana Youth & E-cigarettes

Know the Facts

What are E-cigarettes?

E-cigarettes can be called a lot of things: e-cigs, vapes, mods, e-hookahs, vape pens, tank systems and JUULs.

Using an e-cigarette is sometimes called "vaping." E-cigarette devices heat a liquid into an aerosol that is inhaled into the user's lungs.

These devices can be used to deliver nicotine, marijuana and other drugs like meth and fentanyl.

 Video source:  TobaccoFreeCA.com  

Disposables Are Becoming More Popular.

Since the FDA placed flavor restrictions on pod-based e-cigarette products, like JUUL, disposable products, like Elf Bar, have increased in popularity. 

Disposable e-cigarette use among current U.S. high school e-cigarette users increased by about 1000% during 2019-2020. 4 

 Image source: Truth Initiative 

E-cigarettes are becoming bigger and badder.

Between 2017 and 2022, disposable e-cigarettes sold in the United States:

  • Nearly tripled in nicotine strength;
  • Quintupled in e-liquid capacity; and,
  • Dropped in price by nearly 70%, making it easier for kids to buy.

As a result, the amount of nicotine in some disposable e-cigarettes is now comparable to several cartons of cigarettes. 5 

Montana Facts

E-cigarettes are the MOST commonly used tobacco product among Montana's teens.

  • Nearly HALF of Montana high school students have tried e-cigarettes. 1  
  • One-in-four Montana high school students currently use e-cigarettes. 1  

Montana ties Louisiana for the second-highest prevalence of current e-cigarette use among high school students.

  • The use of e-cigarettes among Montana's high school students and young adults is 4x that of Montana adults 25+. 1, 2  
  • Frequent and daily e-cigarette use among Montana high school students both increased by almost 200% from 2015 to 2023. 3 

E-cigarette use is higher among female, American Indian and Hispanic/Latino students.

Racial disparities exist among e-cigarette users. Current e-cigarette use among American Indian youth (40%) and Hispanic/Latino youth (35%) is significantly higher than other racial groups. 1 

More female high school students use e-cigarettes than male high school students in Montana. 1 

E-cigarettes cannot be sold to anyone under 21 and cannot be used on school property.

Federal law prohibits the sale of any tobacco product, including e-cigarettes, to individuals under the age of 21. If a retailer is suspected of selling e-cigarettes to someone under the age of 21, it can be  reported to the FDA .

According to Montana law, use of all tobacco products, including e-cigarettes, is prohibited in school buildings and on school property. In some communities, e-cigarette use is prohibited in all indoor public places and workplaces. Check if your community is protected in the "What Can I Do?" section.

What are the Risks?

E-cigarette aerosol is not "harmless water vapor."

The e-cigarette aerosol that users breathe and exhale from the device can contain harmful and potentially harmful substances, including:

  • Nicotine
  • Ultrafine particles that can be inhaled deep into the lungs
  • Flavoring such as diacetyl, a chemical linked to a serious lung disease
  • Volatile organic compounds
  • Cancer-causing chemicals
  • Heavy metals such as nickel, tin, and lead 6 

 Image source: Centers for Disease Control and Prevention 

Nicotine is addictive.

Almost all (99%) e-cigarettes sold in U.S. convenience stores contain nicotine. 7 

Nicotine, in any form, is unsafe for youth. Nicotine is highly addictive and can prime the brain for addiction to other drugs in the future.

Nicotine harms brain development.

Youth are uniquely at risk for long-lasting effects of nicotine exposure because the brain continues developing until about age 25.

Nicotine exposure during adolescence harms the parts of the brain that control attention, learning, mood, and impulse control.

E-cigarette use can be a gateway to other tobacco product and drug use.

E-cigarettes use among youth is strongly associated with use of other tobacco products, like conventional cigarettes.

Teens that use e-cigarettes are 4x more likely to start smoking cigarettes in the future and 20x more likely to vape marijuana than teens who do not use e-cigarettes. 8, 9 

 Image source: New York State Department of Health 

Big Tobacco Targets Kids

Big Vape is Big Tobacco.

Big Tobacco continues to adapt its portfolio to attract new users and replace those who have quit or died from tobacco-related diseases. 

In 2018, the top 25 e-cigarette manufacturers brought in more than $2.5 billion in sales and 96% of these sales were from brands owned in whole or part by Big Tobacco. 10  

In December of 2018, around the same time the U.S. Surgeon General declared youth e-cigarette use an epidemic, the tobacco giant Altria purchased a 35stake in JUUL. 10 

 Image on the left: 1994 congressional hearing in which tobacco industry executives falsely claimed under oath that nicotine is not addictive. Image on the right: 2020 congressional hearing in which e-cigarette CEOs admitted under oath that they do not know all of the harmful health effects of nicotine. Image source: Truth Initiative 

Big Tobacco targets kids with...flavors.

E-cigarettes come in over 15,500 different flavors, like cotton candy, skittles, O.M.G. and unicorn puke. 11 

Flavors mask the harshness of tobacco products, making it easier for kids to start and become addicted. Most (96%) youth e-cigarette users started with a flavored product. 11 

Among Montana high school students who used e-cigarettes in 2023, 99% reported using non-tobacco flavored products. 12 

Image source: Truth Initiative

The tobacco industry needs to replace their dying customers.

The tobacco industry spends $29 million each year in Montana promoting their products. 13   

E-cigarettes are advertised using celebrity endorsements, cartoon characters, sport and event sponsorships and social media influencers.

In 2021, 76% of U.S. middle and high school students had been exposed to e-cigarette marketing. 14 

New looks and new gimmicks attract new, young users.

Disposable e-cigarette products have a sleek, high-tech design and are easy to conceal.

Some e-cigarettes can be dressed up and customized with colorful sleeves and accessories. Others are designed to resemble school supplies or toys. E-cigarette companies have even come out with products that are disguised as sweatshirts and watches.

 Image source: U.S. Federal Food and Drug Administration 

Signs of Vaping

 Adapted from Partnership to End Addiction's  Vaping Guide for Families . 

The following are some indicators that a child may be vaping:

  • Equipment: You may find devices that look like flash (USB) drives, e-liquid bottles, pods/cartridges (that contain e-juice) or product packaging.
  • Fruity scent: You may smell something sweet, minty, or fruity without an obvious source like candles, lotion, food, or gum. E-cigarettes containing marijuana can produce a skunk-like smell.
  • Increased thirst or nosebleeds: Some of the chemicals used in e-juices dry out the mouth and nose. As a result, some kids drink more liquids and develop frequent nosebleeds.
  • Appearance and behavior changes: Vaping nicotine may lead to anxiety, irritability, difficulty concentrating and loss of appetite. There may be a noticeable change in friends and a decrease in activities that were once enjoyed.
  • Social media and vaping slang: Look for pictures or references to vaping on the child's social media accounts and take note of  vaping terms  in text messages.

How to Talk with Youth

 Adapted from American Lung Association's  Vaping Conversation Guide . 

Prepare before you talk.

  • Know the facts. Misinformation about vaping is everywhere. Get credible information from the  Centers for Disease Control and Prevention .
  • Be open. Start a conversation with open-ended questions and without judgement. Understand that the child may be addicted and addiction is a disease.
  • Find the right time. Did you drive by a vape shop or see someone vaping in a movie? Use these moments as an opportunity to start a conversation. Asking about vaping when it is already top of mind gives you a non-confrontational way to begin.

Have the conversation.

  • Start with questions.
    • "I saw something on Facebook about vaping. Do you know what vaping is?"
    • "Do you know anyone at school who vapes?"
    • "How do you feel about vaping?"
    • "Have you seen any vape videos pop up while you're on social media?"
  • Acknowledge independence and appreciate honesty. Express trust in the child to make good decisions for themselves. Be ready to hear that the child is vaping. Make sure you thank them for being honest, then follow-up with concern for their health.
  • Blame Big Tobacco, not the kid. Nine out of ten current smokers started before the age of eighteen. This is the result of Big Tobacco's tactics to allure new life-long users.

Provide support after you talk.

  • If the child is not vaping, equip them with refusal skills. Talk about what to do if their friends want them to try vaping:
    • Say a simple “No, thanks,” or “Nah, that’s not my thing.”
    • Change the topic (“Hey, are you going to band practice today?”).
    • Walk away and do something else.
    • Talk with a friend, parent, or trusted adult.
  • If the child is vaping, get them quit help through  My Life, My Quit  if they are showing signs of addiction:
    • Cravings to use e-cigarettes or other tobacco products
    • Feeling anxious or irritable
    • Continuing to vape despite negative consequences
    • Going out of one’s way to get e-cigarettes
  • Help the child manage stress. Talk with the child about developing  positive coping skills .
  • Keep up and follow up. Leave lines of communication open and stay up to date on vaping so you can share new information with the child when it's available.

Help Quitting

My Life, My Quit™

My Life, My Quit™ is a specialized program for youth who need help with quitting e-cigarettes and other tobacco products! Text "Start my Quit" to 36072 or visit  mylifemyquit.com  to sign up!

 My Life, My Quit™ offers:

  • Free live texting, chatting or phone calls with coaches dedicated to work with youth
  • Confidentiality
  • Free personalized quit plan and quit materials

What Can I Do?

Set an example by living tobacco-free.

Reach out to Quit Now Montana for free help with quitting all forms of tobacco! Enroll by calling 1-800-QUIT-NOW or visiting  quitnowmontana.com .

Quit Now Montana offers:

  • Free tobacco cessation coaching
  • Free personalized quit plan
  • Free nicotine replacement therapy (patches, gum or lozenges)
  • Free cessation medications
  • Free educational materials

Make your home tobacco-free.

Set a healthy example for children and protect family members, guests and pets by keeping your home free of commercial tobacco products, including e-cigarettes. Secondhand smoke and e-cigarette aerosol contains chemicals that can harm your health and increase the risk for heart disease, lung disease and cancer. 

Steps to creating a tobacco-free environment:

  1. Don't allow smoking or vaping inside your home or vehicle.
  2. If you live in a building that allows smoking,  ask your landlord to adopt a smokefree policy. 
  3. If you smoke or vape,  get help to quit .

Understand the importance of policies that protect kids' health.

Cities and counties across the nation are limiting kids' exposure to e-cigarettes and other tobacco products by:

  •  Banning the sale of flavored tobacco  products.
  •  Prohibiting the use of e-cigarettes  in workplaces, indoor public places, parks, and other community venues. Ten localities in Montana have already taken this important step to protect public health!
  • Requiring all tobacco products, including e-cigarettes, be placed behind the counter and out of reach of children.
  • Adding a tax to e-cigarettes and banning discounts.

Resources

Fact Sheets

Infographics

Outside Resources


Sources:

1. Montana Youth Risk Behavior Survey, 2023.

2. Montana Behavioral Risk Factor Surveillance System, 2022; Montana Youth Risk Behavior Survey, 2023.

3. Montana Youth Risk Behavior Survey, 2015-2023.

4. Wang TW, Gentzke AS, Neff LJ, Glidden EV, Jamal A, Park-Lee E, Ren C, Cullen KA, King BA, Hacker KA. Disposable E-Cigarette Use among U.S. Youth - An Emerging Public Health Challenge. N Engl J Med. 2021 Apr 22;384(16):1573-1576. doi: 10.1056/NEJMc2033943. Epub 2021 Mar 16. PMID: 33725431.

5. Diaz MC, Silver NA, Bertrand A, et alBigger, stronger and cheaper: growth in e-cigarette market driven by disposable devices with more e-liquid, higher nicotine concentration and declining pricesTobacco Control Published Online First: 03 August 2023. 

6.Centers for Disease Control and Prevention. About Electronic Cigarettes.  https://www.cdc.gov/tobacco/basic_information/e-cigarettes/about-e-cigarettes.html  Accessed May, 2019.

7. Marynak KL et al. (2017) Sales of Nicotine-Containing Electronic Cigarette Products: United States, 2015. American Journal of Public Health. 107(5):702-705.

8. Sonjeli et al., Soneji S., Barrington-Trimis, J.L., Wills, T.A., Leventhal, A., Unger, J.B., et al. (2017). E-Cigarette Use and Subsequent Cigarette Smoking Among Adolescents and Young Adults: A Systematic Review and Meta-Analysis. JAMA Pediatrics.

9. Kreski et al. (2023). Nicotine Vaping and Co-occurring Substance Use Among Adolescents in the United States from 2017–2019. Substance Use and Misuse. 58(9):1075-1079.

10. Truth Initiative. Spinning a new tobacco industry: How Big Tobacco is trying to sell a do-gooder image and what Americans think about it.  https://truthinitiative.org/research-resources/tobacco-industry-marketing/spinning-new-tobacco-industry-how-big-tobacco-trying . Accessed June, 2020. 

11. Hsu, G., Sun, J. Y., & Zhu, S. (2018). Evolution of Electronic Cigarette Brands From 2013-2014 to 2016-2017: Analysis of Brand Websites. Journal of Medical Internet Research, 20(3). doi:10.2196/jmir.8550.

12. Montana Youth Risk Behavior Survey, 2023.

13. Campaign for Tobacco-Free Kids. The Toll of Tobacco in Montana.  https://www.tobaccofreekids.org/problem/toll-us/montana  Accessed November, 2022.

14. National Youth Tobacco Survey, 2023.

 Image source: Centers for Disease Control and Prevention 

 Image source: U.S. Federal Food and Drug Administration