A report on vaping by Columbia/Boone County Board of Health concluded that the health effects on teens are so harmful and far-reaching that the city needs to restrict its use within the adolescent age group.
The report was submitted by the Board of Health to the City Council on Monday night and includes three recommendations: ban flavored vaping products, prevent retail vape shops from operating near high schools and middle schools and consider a higher tax on e-cigarettes.
The report follows at least two years of investigation into the health effects of e-cigarettes on youth. The council had requested more information about the effects of vaping in October 2019 after community members expressed concern about the increasing number of teens using vapes and e-cigarettes.
“It was a time when there was a lot of discussion that flavoring was a gateway for teens,” said Mahree Skala, who chairs the board.
Two years ago, Skala said the board saw a need to take steps locally, but the council wanted more information before making a decision.
An ordinance in Columbia and Boone County already prohibits the sale of e-cigarette and tobacco products to anyone under the age of 21.
But the board’s report noted that while Columbia and Boone County have implemented policies to reduce youth access to tobacco and vaping products, youth are still using products purchased by adults. There is also a robust market online, with lax procedures for age verification.
The board gathered information from university researchers, anti-tobacco advocates, Columbia/Boone County Public Health and Human Services, school administrators and members of the Columbia Youth Advisory Council.
The vaping recommendations by the board are intended to be broad enough that public entities, including Columbia Public Schools, could provide additional interventions Skala said.
In its report, the board found that youth vaping is a significant problem in Missouri and Boone County.
A 2020 Missouri student survey showed that 11.7% of students in grades 6-12 reported using e-cigarettes in their lifetime, and 3.6% reported using them in the past 30 days.
Nearly 90% of Boone County survey respondents were in middle school, but statewide and national data show that e-cigarette usage rates are higher among high school students.
Flavors are a key factor in enticing youth to start vaping, the report noted. E-cigarettes are sold in over 15,000 flavors, and a 2020 national survey found flavored e-cigarettes were preferred by 85% of high school users and 74% of middle school users.
Skala said many people have been concerned about the retail vape shop directly opposite Hickman High School. The board’s report also said advertisements close to schools tend to “normalize and signalize availability of e-cigarette for teens.”
“While teens are not allowed to purchase it themselves, it stills conveys that it is acceptable,” Skala said.
In recent years, the federal government and some local communities have imposed more restrictions of e-cigarette products. The Food and Drug Administration banned flavored pre-filled cartridges in 2019.
However, the ban did not include flavored refillable vape tanks or disposable e-cigarettes. Flavored cigarettes were preferred by 85% of high schoolers, according to the board’s report and a 2020 National Youth Tobacco Survey.
Missouri does not have any additional e-cigarette tax, so vapes are taxed only by sales tax. Skala said of all tobacco users, the board learned teens were the most susceptible to price increases.
Serious health implications for teens include negative influences on brain development, mood disorders and increased anxiety and depression. In the brain, the prefrontal cortex, which is responsible for cognitive behaviors like planning and reasoning, is significantly impacted by long-term cigarette use or e-cigarette use. The report said the prefrontal cortex is not fully developed until a person is 25.
The report explained that nicotine found in e-cigarettes exposes users to the potential of psychological dependence and long-term addiction.
“A number of us were pretty shocked at the mental and physical health implications, and many people see it as harmless,” Skala said.
Campaigns in Boone County explaining the negative health effects of vaping through social media platforms like Snapchat and Instagram have been successful, the report noted.
Social media advertisements were targeted at people age 13-24 and reached a total of 80,729 individual social media users in 2019 and 104,985 in 2020, according to the report. Fewer Boone County middle and high school students reported recent use of e-cigarettes after the campaign (3.6% in 2020) than before (9.6% in 2018).
The board recommended that this type of social media campaign be funded and resumed with the addition of messages targeted to parents.