JUULs in Schools: Colorado and Minnesota Public Health Efforts

August 07, 2019

Tobacco use remains the leading cause of preventable disease and death in the United States, with the majority of tobacco use beginning in youth and young adulthood. Following encouraging declines in tobacco use over the past decade, the popularity of e-cigarettes among high-school and middle-school students has increased considerably in the United States, with twenty percent of high school students and 1 in 20 middle school students currently using them.

This increasing epidemic of youth e-cigarette use can largely be attributed to the popularity and brand recognition of JUUL, which accounts for nearly half of the e-cigarette market share. The product particularly appeals to youth through marketing practices, an assortment of flavors, inconspicuous appearance, and the ability to purchase online.

Attempts to reduce JUUL use among youth and young adults have focused on schools. This brief highlights two efforts in Colorado and Minnesota to reverse trends around JUULs in schools.

Colorado

Colorado youth are using e-cigarettes at twice the national average, with high school students in the 11th and 12th grade having the highest e-cigarette use. The lack of tobacco retailer licensing policies in Colorado largely contributes to youth access. According to the 2017 Healthy Kids Colorado youth survey, e-cigarettes are the second most tried substance among Colorado youth after alcohol. Only half of the youth surveyed believe vaping is “risky.”

The youth risk behavior survey also found that Colorado had the highest rate of youth vaping compared to other states. The state saw a decrease in youth combustible cigarette smoking while the use of e- cigarettes increased. Colorado has taken strides to reduce the use of e-cigarettes in youth through media campaigns, formative research, and focus groups. Many policies applied to traditional combustible cigarettes in the state are not applied to e-cigarette products, increasing their prevalence. For instance, the state places an excise tax on cigarettes but not on e-cigarettes, as they are not included in the Clean Indoor Air Act.

To address the issue, the Colorado Department of Public Health and Environment (CDPHE) is working with schools to implement a comprehensive tobacco free school policy that includes vaping products. CDPHE provides technical assistance training to help school staff understand vaping and applicable policies. CDPHE provides a series of resources and an alternative suspension method, the Second Chance program, which helps students understand the impact that tobacco products can have on their lives. Additionally, quitline staff have been coached to assist children as young as 12 years of age and Colorado Gov. Hickenlooper instituted a vape free November, which includes a health advisory through the health department. CDPHE hopes that the Healthy Kids Colorado survey, scheduled for publication in fall 2019, will identify reductions in youth tobacco use rates.

Minnesota

According to the 2017 Minnesota Youth Tobacco Survey, e-cigarette use is two times higher than cigarette use. More than 1 in 5 high school students who have tried e-cigarettes have never used any other tobacco products and 1 in 4 middle- and high-school students reported having tired e-cigarettes. Of the students who currently use e-cigarettes, more than half reported using menthol or other flavored e-cigarettes. Use of e-cigarettes is highest among 11th and 12th grade students. In 2017, 50 percent of high school seniors had tried e-cigarettes. Minnesota has taken strides to reduce e-cigarette use in youth by requiring retailer licensure for e-cigarettes. Minnesota is also incorporating e-cigarettes in their clean indoor air acts at the state level.

To help address the issue, the Minnesota Department of Health (MDH) and Department of Education (MDE) sent a joint letter to every superintendent, principal, and school nurse in the state offering information about JUULs and providing information on how to address the issue in schools. To address student use of e-cigarettes and other vaping products in schools, MDH released a toolkit highlighting how school administrators and nurses can strengthen and review current policy, promote health messaging, and provides resources for parents. Currently, there is a statewide grant program working to create health improvement partnerships with the school districts across the state. Through the grant program, MDH can funnel information through local coordinators who will ensure the school administration and teachers have proper training to address e-cigarettes, as well as health and technical assistance for school performance.

Conclusion

The JUUL epidemic in schools is affecting youth all around the country. A multi-tiered approach is needed to reduce youth tobacco use rates. To address the issue, both Colorado and Minnesota are using a coordinated approach involving the departments of education, shared policy language, and targeted training for school administrators and faculty. Further research is needed to identity what options exist for youth tobacco cessation and which will be most effective among youth.