One in five high schoolers and one in 20 middle schoolers in the U.S. used e-cigarettes in 2018, according to a U.S. Food and Drug Administration (FDA) youth tobacco survey. The rates are an increase of 78 percent and 48 percent, respectively, from 2017.
E-cigarette, or vaping, devices, such as the popular Juul brand products, are by far the most used tobacco product among youth, the survey indicated. The devices can look like thumb drives or pens and have tanks which can be filled with liquid containing nicotine or other chemicals, though some liquid is marketed as containing no nicotine.
A U.S. Center for Disease Control fact guide on its website said e-cigarettes have fewer harmful chemicals than traditional cigarettes, but they are still unsafe for youth because nicotine could harm parts of the brain that control attention, learning, mood and impulse control.
Safety concerns, along with companies' marketing, have spurred action by government organizations and Nebraska school districts to address e-cigarette use.
Blair Community Schools, Arlington Public Schools and Fort Calhoun Community Schools have had prohibitive tobacco policies in place for some time, but since the devices began gaining popularity over the past few years, updates to policies have included terminology related to e-cigarettes.
"We went from cigarettes to e-cigs to vaping, just keeping up with terminology," Fort Calhoun High School Principal Jerry Green said. "We've done a little (training) with the staff. You get these vaping sticks and they look like thumb drives, so just sharing material with my staff to kind of know what they're looking for."
Blair High School Principal Tom Anderson said tobacco, including e-cigarettes, are not allowed on school property, with vaping language added during the 2017-18 school year. BCS' policy listed on the district website states that violations could result in suspension or expulsion.
Anderson said the district has started educating students and parents on the harm e-cigarettes can cause.
"We communicated with parents via the school messenger system several times, we communicated with the students through an assembly, guest speakers, freshmen seminar and have implemented it into our health curriculum," he said. "Our hope is that our education of parents and students will help stop an epidemic that could potentially have serious health effects in the future."
Officials from APS did not respond to request for comment, but the APS school board discussed its nicotine policy during its July school board meeting. APS policy prohibits all tobacco use by students on school grounds which includes cigarettes and e-cigarettes.
During the meeting Supt. Dawn Lewis said she would prefer not having the word "nicotine" in the policy because it leads to questions about how a vaping device is used, but the word needs to be included to be in compliance with state law.
"I almost wish they would take out the word nicotine because you could have a kid who says there's not nicotine in my vape, it's just water vapor with flavor, and some are putting other things in there now too," she said.
At least in the case of Juul, the vaping liquid is more than water vapor or nicotine. Added flavorings — which vary from fruity such as mango to traditional tobacco tastes — can be toxic and cause inflammation or fibrosis of the lungs, according to a Nebraska Medicine article about the company's devices written by physician assistant Jill Selzle.
The discreet look, fruity flavors and advertising images of Juul, Blu, MarkTen and other e-cigarette products have led to concerns the devices could be marketed to younger users.
In May, Gov. Pete Ricketts approved a bill introduced by Sen. Dan Quick of Grand Island to raise the legal age to purchase tobacco products to 19. The bill also requires e-cigarette sellers to be licensed the same as other tobacco sellers.
"Although many people may think that the use of vaping and e-cigarettes is primarily as a smoking cessation device for adults, the reality is that many teenagers and children are accessing e-cigarettes with nicotine and using them at alarming rates," Nebraska Sen. Dan Quick of Grand Island said in a January press release announcing the bill.
The FDA announced in September that it would enact stricter regulations as part of an attempt to crack down on companies whose marketing might appeal to kids.
Juul's website says it's devices are for adults who are seeking a safer alternative to traditional combustible cigarettes or who are hoping to use them as a smoking cessation aid. Juul devices can be purchased online after putting in a name, birthdate, address and social security number or I.D. to verify age.
But e-cigarette marketing might not be the only thing that appeals to students.
Green said he knows there are videos online showing kids how to get away with vaping in school, such as blowing the vapor down their hoodie sleeve, so it's good for teachers to know about those techniques.
FCCS doesn't currently have school-wide educational programming for students that specifically addresses e-cigarette use, Green said. There have been a few instances of students vaping, he said, but the high school handles those situations as they occur with talks with school officials and parents, activity suspensions and school suspensions.
"Part of my concern with that is how much attention do we want to bring to this," Green said said, adding he's concerned about bringing the idea of vaping up to every student if there's a chance educational programming could actually lead more kids to it.
"You know, do you talk to seventh graders about it, or by the time they're in high school, they've probably heard about it whether they've decided to use or not," he said. "We're kind of waiting to see what other districts are doing ... I'm in contact with other principals, and we share articles about it, which is the material I give to staff."