A student enters the bathroom as the bell signaling the start of lunch rings overhead. She pulls a USB-shaped device out of her pocket. Drawing it towards her lips, she begins to take short puffs, inhaling and holding in the vapor. Seconds pass and she exhales, suddenly overcome with satisfaction. The gratification received from the act has proved worth the venture. Little does she know the health implications that await her in the future.

In the United States alone, upwards of 3 million middle and high school students currently use e-cigarettes, as reported by the National Youth Tobacco Survey, which is conducted by the Food and Drug Administration and Centers for Disease Control. While this is an increase from the 2.55 million students found vaping in 2021, the rate has substantially declined in comparison to that which was reported in 2019, at 6.2 million students.

The epidemic of youth vaping across America, however, is nowhere near over. Vaping rates throughout the U.S. are still far above what health organizations have dictated that they should be. Therefore, it perseveres as a problem within the nation, the state of Florida and MSD.

Vaping is defined as the inhalation and exhalation of the aerosol, or vapor, produced by the heating of e-liquids that occurs within a vape. E-liquids often contain flavoring and nicotine, as well as substances that help facilitate the creation of the vapor. Yet, it may sometimes contain heavy metals and dangerous chemicals such as Tetrahydrocannabinol, commonly known as THC, and diacetyl.

In an anonymous survey consisting of 355 students at MSD, only 4% of students admitted to vaping. Although, according to the Florida Department of Health in Broward County, 16% of high school students have at the very least tried an electronic vapor product at some point in their lives.

Currently, it is not legal to purchase or possess a vape in the U.S. until one turns 21. Therefore, all students vaping at MSD are doing so illegally, since they are underage. As a result of this, many students are also not purchasing vapes themselves. Out of the students who admitted to vaping in the survey, 36% of them acquire their vapes from a friend and 29% of them acquire them from a parent.

Presently, there is no shortage in the variety of different vaping devices, most of which are made up of the same basic parts: something to hold the liquid, a heating element and a battery. While some vapes are disposable, others can be recharged, refilled and reused.

Common types of vapes include cig-a-likes, vape pens, vape mods and pod systems, all of which vary in size, shape and the smoking experience they provide. Cig-a-likes and vape pens are exactly as their names imply, e-cigarettes designed to look and feel like traditional cigarettes and e-cigarettes designed to resemble pens. On the other hand, a vape mod is a power source. It uses rechargeable batteries to power a vape’s heating element, called an atomizer. Finally, pod systems are ultra-compact vaping devices that use pods instead of atomizers, although they serve the same purpose. Pods are just detachable or a self-contained unit.

The JUUL, an extremely controversial product, was once the most highly used vaping device amongst teens. Discrete and simple, with high concentrations of nicotine per pod, this type of vape pen soared in popularity. However, the company has faced significant backlash over their marketing, which appeared to be targeting teens as consumers. Further aggravating this controversy was the fact that the flavors they were producing had become popular with adolescents.

According to the NYTS, nearly 85% of teens who vape reported using flavored e-cigarettes, with fruit flavors being the most popular, followed by candy and other sweets. This is consistent with the findings at MSD, as the most popular flavors included Blue Razz, Mango and Strazz, a strawberry and raspberry combination flavor.

In 2020, the FDA ordered nearly all flavored vape pods off the market via the Enforcement Priorities for ENDS and Other Deemed Products on the Market Without Premarket Authorization policy, yet the order did not apply to disposable devices. These devices are not cartridge-based, and therefore do not have a pod; instead, they contain everything in one unit. This order, paired with the 2022 JUUL ban and subsequent administrative hold, caused JUUL’s popularity to decline, as the brand does not make a disposable device. Now, brands that produce disposable vapes, like Puff Bar, Elf Bar and Vuse, are much more common and their fruit flavors remain extremely popular.

“I like any of the fruity Elf Bar flavors,” junior Nathan Brown* said. “They have a stronger taste, but it is not too overpowering, like just enough to not be breathing in straight-up air.”

At MSD, vaping is a common occurrence. In the survey, it was established that 74% of students have at the very least witnessed one of their peers vaping on campus. Additionally, the School Environmental Safety Incident Reporting Data for MSD, from Aug. 16, 2022 to Jan. 31, 2023, reports a total of 36 tobacco-related incidents, which includes vaping.

Of the students who vape on school grounds, the locations where they do so vary. The most popular vaping location is the bathroom, followed by public, outdoor spaces–such as the courtyard, the parking lot or a sports field–and then the hallways.

“It’s sort of easy to get away with vaping in school and the bathroom and stuff,” sophomore Alexa Smith* said. “Most students don’t care or don’t bother to report it, so I’m not worried of being tattled on by anyone if they happen to see it. Plus, they’re easy to hide, and most people seem kind of oblivious to it or just go with it anyways, so I feel like being caught is just a wrong place, wrong time situation.”

In the past, vaping in MSD bathrooms has even caused schoolwide plumbing issues and backups, with students flushing empty cannabis cartridges and disposable vapes down the toilet.

“We constantly have to close down bathrooms and put emergency work orders in to get those things [plumbing issues caused by vaping] resolved,” Assistant Principal Anna Koltunova said. “It is something that impacts school activities directly, like the cafeteria and the making of lunches. One time we had that and we had to serve lunches outside because students had flushed so many vapes down [the toilet] it blocked the system, which created backup issues, preventing us from using the cafeteria in the back.”

Despite the fact that many students continue to get away with vaping on campus, security measures have increased over the years in response. Currently, the school monitors the bathrooms twice every period and has security constantly tracking it on the cameras.

Vaping is also thought to be the cause of many of the school’s false fire alarms. Therefore, when one occurs, cameras are immediately checked to see if any students ran out of the bathrooms, and then security looks to clear out any students remaining in the bathrooms at the time.

If caught, school policy dictates that the consequences of one’s first offense are one or two days of in-school suspension, along with a referral to the District Substance Abuse Case Manager and required intervention assignments. Upon a second offense, students will receive a six-day suspension with the same additional consequences. If a student continues to commit offenses, they will receive a 10-day suspension, a recommendation for expulsion and a referral.

While some users choose to vape alone, vaping can also serve as a social activity. This factor differs from person to person, varying in accordance to a vaper’s personal preferences. The survey of 355 MSD students determined that 50% of the students who vape do so both alone and with friends.

“I vape with friends and alone,” freshman Sally Johnson* said. “I don’t really have a preference, but when I vape with my friends it’s not like it’s planned or anything. It just sort of happens, but we all do it and enjoy it and depending on the day, it makes it more fun. Other times though, I prefer to just be alone, do it when I feel like it and be in my own world.”

The majority of surveyed MSD students who vape reported having started between the ages of 11 and 14. For most, this means that they began in middle school. Among the students interviewed, it was found that many chose to try vaping simply because they had a friend or family member who did it or were curious and wanted to see what it was like.

“I first tried vaping when I was 13,” Smith* said. “My dad did it, and I had a few friends who did, and eventually I just decided I wanted to see what it was like. I had been around it for a while, so it’s not like it was a spur of the moment thing. I think it was sort of bound to happen at some point because of how often I saw other people doing it, but regardless, I wanted to try it so I did.”

For a great deal of these teens, the decision to try vaping was then followed by a decision to continue. However, in deciding this, many teens had already been made aware of the dangers it may pose. These dangers include being at an increased risk for developing asthma and other lung conditions, developing heart disease or its symptoms and harming their brain development.

In spite of this, daily vape use is still extremely common. The NYTS found that more than a quarter of youth e-cigarette users vape on a daily basis. This is consistent with the survey results at MSD, where it was revealed that 50% of the students who admitted to vaping do so daily.
Among the students who offered a reason for why they continue to vape, the most common responses were that it was enjoyable and helped them cope with depression and anxiety.

“[I vape] because it’s fun or more so like I just don’t really care to quit right now,” Brown* said. “I’ll quit when my lungs hurt… I’m aware [of the health problems vaping may pose]. I stay healthy. Besides vaping, I like to exercise and eat well. I just don’t really care right now, I’ll deal with the problems later.”

Furthermore, students appear to be vaping both marijuana and nicotine, although nicotine is more common. According to the National Institute on Drug Abuse, in 2022, 21% of 12th graders reported having vaped marijuana in the past year. Nicotine is found in tobacco plants and is an extremely addictive compound. Marijuana is found in the plants Cannabis indica and Cannabis sativa. These plants contain THC, which is considered a psychoactive and mind-altering chemical.

Nicotine has a tranquilizing effect when one takes deep drags and a stimulating effect when one takes short puffs. Vapes do not have to contain nicotine, but according to the CDC, 99% of those sold in U.S. venues do. Additionally, some vaping products fail to disclose on their labels the fact that they contain nicotine, while others claim to contain 0%, but have been found to contain it as well.

Both the nicotine and other particles found within the aerosol produced by vapes pose serious health implications. In 2019, there was a nationwide outbreak of e-cigarette or vaping product use associated lung injury, known more commonly as EVALI. Currently, vitamin E acetate is thought to be its primary cause. Vitamin E acetate is a chemical found in the aerosol of some vaping products that also contain THC. By February 2020, 2,800 hospitalizations and 68 deaths caused by the condition were recorded, as reported by Yale Medicine.

Another chemical potentially found in the aerosol is diacetyl, a flavoring linked to popcorn lung. This condition causes the smallest airways in the lungs, the bronchioles, to become inflamed, damaged, and scarred, resulting in reduced lung function. Popcorn lung has no cure, proving fatal in some instances in which an individual does not undergo treatment.

E-cigarette users are also at a higher risk of developing cancer and heart disease, as the aerosol contains cancer-causing chemicals and ultrafine particles that are prominent cardiovascular toxins.

Additionally, there is nicotine addiction. Nicotine reinforces the behavior of vaping, as it increases dopamine levels. Consequently, when the effects of nicotine begin to wear off, an individual will face withdrawal symptoms that make it much more difficult to quit.

As previously stated, one reason teenagers may continue to vape is to help deal with anxiety or depression; but what starts out as a form of relief, develops into a dependency. Yet, this dependency will frequently come to be something that serves as another source of stress. Many studies have proven that with the increased frequency of vape use comes a higher likelihood of reporting depression. One specific study by the National Institutes of Health found that depression occurred in about 17% of all e-cigarette users, as opposed to 5% of those who have never used an e-cigarette.

A dependency on nicotine is only further enhanced by the concentration of nicotine in vapes, as many contain the equivalent of, if not more than, a pack of cigarettes. High nicotine concentrations can be found in many of the vapes most popular among teens. For example, an Elf Bar typically has a level that is equivalent to 65 cigarettes, and a Puff Bar and HQD Tech USA Cuvie Bar have about the equivalent of 100 cigarettes.

This high concentration is a result of the use of nicotine salts, which allow for the easier inhalation of higher amounts of nicotine, along with less throat irritation than with the nicotine found in most tobacco products. This then serves as an instigator for increased dependency, particularly when it comes to young adults.

Despite their consequences, vapes were initially developed to help people quit smoking; however, they have now created a new generation of smokers. While many of the effects of vaping remain unknown, the ones unearthed thus far have only incited panic among health organizations. This has led to a resulting demand for government intervention, a pressing request backed by educators, parents and other individuals across the globe.

Anti-vaping campaigns are common worldwide, including The Real Cost E-Cigarette Prevention Campaign created by the FDA. This campaign was designed to specifically target youth vapers by advertising on social media and other online platforms and partnering with youth-centered content, like Marvel Comics.

Still, among the interviewed MSD students who admitted to vaping, it is the general consensus that they are not looking to quit. Instead, these particular students see the act of vaping as something that tastes good and feels good, providing a sensation that is well worth whatever consequences may occur. For the most part, this select group of teens does not seem to be as oblivious to vaping’s health implications as everyone has made them out to be. As they expressed the sentiment that their decision to vape was not for a lack of knowledge, but rather a lack of concern for their future well-being, favoring the present over any prospective complications.

Despite the decrease in teen e-cigarette use between the years 2019 and 2022, vapes are not yet diminishing in relevance or demand. Market analysis by Grand View Research states that the global market size for vapes and e-cigarettes is expected to grow by almost 31% from 2022 to 2030. Therefore, the likelihood of teens continuing to vape remains high.

Actions have already been implemented to aid in decreasing this extortionate rate. E-cigarettes have been made harder to obtain, many flavored, non disposable vapes have been taken off the market and the minimum age of possession and purchase has been raised to 21. Still, these changes have not proved impactful enough. Consequently, health organizations such as the FDA, have developed plans to further dissuade teens from vaping.

The FDA’s Youth Tobacco Prevention Plan focuses on three key areas: preventing youth access to tobacco products, curbing the marketing of tobacco products aimed at youth and educating teens on the dangers of tobacco and e-cigarette use, as well as educating retailers on their key role in protecting youth. It is recognized, however, that such plans will not succeed overnight. Changes need to occur not just within retailers, manufacturers and the government, but within teens and their attitudes toward vaping.

*Names indicated were changed to protect the students’ anonymity