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Back to School: Addressing the Evolving Landscape of E-cigarettes

by Jim Martin, Director of Policy and Programs, NC Tobacco Prevention and Control Branch

In 2020, the U.S. Food and Drug Administration (FDA) eliminated flavors for only cartridge-based e-cigarettes, like JUUL, but exempted menthol flavors and disposable e-cigarettes. Within a year, following this policy change, disposable e-cigarette use among U.S. high school students increased dramatically.


Disposable e-cigarettes, which come in wide variety of fruit, candy, and dessert flavors, have increased in nicotine strength. The average nicotine concentration has increased from below 2% to 5%. This alarming trend of increasing nicotine strengths in disposable e-cigarettes places youth at greater risk of addiction, lower motivation to quit, and amplified symptoms of anxiety and depression.


As kids around the country head back to school, we know that schools play a central role in confronting and addressing youth tobacco use. Surveys show that NC school staff express concern about students’ e-cigarette use. Discussions with students and school administrators suggest many students use e-cigarettes and other tobacco products to self-medicate for depression, anxiety, and other mental health concerns


Learn more about our upcoming Tobacco Treatment in Adolescent and Young Adult Populations CE Short Course on December 12, 2023!

Tobacco-free school policies regulating the use and possession of commercial tobacco products, including e-cigarettes, often rely on punitive measures for student violations. Suspension and expulsion are sometimes used to enforce these policies. However, suspensions are counterproductive and harmful. According to the CDC, the most effective approaches to help students quit tobacco use are counseling and education. Rather than punitive discipline, appropriately structured “alternative-to-suspension” programs that incorporate cessation strategies can guide students toward quitting tobacco use while remaining fully engaged in their education. The focus of these programs is on recovery from, and reduction of, nicotine addiction.

Through various partnerships, the North Carolina Tobacco Prevention and Control Branch (TPCB) recommends two vaping cessation programs proven to help teens in NC and across the US, aged 13-17, quit vaping for good. Live Vape Free is a text and online program that uses games, videos and other engaging content to help young people quit. Quit the Hit is an Instagram group program that allows young people to interact with other teens who are trying to quit, while working with an adult group facilitator. Learn about these programs and more here.

Find information on youth vaping, including school programs and curricula here.


In North Carolina, the Tobacco Prevention and Control Branch partners with the Research Triangle Institute (RTI) on an e-cigarette sales database called the ENDS Tracker. ENDS stands for electronic nicotine delivery systems. It’s a customized online dashboard developed by RTI that allows states to monitor and track commercial tobacco product marketing and sales trends in real time. The dashboard includes statewide commercial tobacco product sales data by brand using Nielsen retail scanner data; advertising expenditures by media type and brand for the nation and specific media markets; internet search trends for the nation and specific media markets; and social media activity from top ENDS marketers. This data will help NC identify and address new and emerging tobacco products in a rapidly changing commercial tobacco product landscape.


In the last report, RTI showed that 10 of the top 12 most frequently sold e-cigarettes in N.C. are disposable e-cigarettes. The research, published in Nicotine and Tobacco Research by the Centers for Disease Control and Prevention (CDC) in partnership with Truth Initiative, also finds that the price of e-cigarettes with high nicotine levels has either decreased or has not changed, while those with lower nicotine levels are more expensive.


The US Surgeon General warns that nicotine exposure during adolescence may harm brain development and impact learning, memory and attention. Additionally, brain changes induced by nicotine exposure can make youth more susceptible to addiction to other substances. As the tobacco product landscape continues to evolve, it is crucial that school personnel are equipped to help prevent and intervene on youth tobacco use.


To learn more about how to combat the epidemic of youth tobacco use, register now for our Tobacco Treatment in Adolescent and Young Adult Populations CE Short Course on December 12!


About the Author

Jim D. Martin, M.S., is Director of Policy and Programs with the NC Tobacco Prevention and Control Branch (TPCB), Division of Public Health, NC Department of Health and Human Services. Jim’s major responsibilities include providing statewide leadership and expertise on tobacco use prevention and control policy and programmatic solutions. He has also served on multiple national committees including the ASSIST National Strategic Planning Subcommittee and the Tobacco Control Network. Jim is a native of Virginia. Jim received his Master’s (1986) and Bachelor’s degrees (1984) in Community Health Education from Virginia Tech. He worked as a Director of Worksite Health Promotion with the Virginia Department of Health, Mount Rogers Health District from 1986 – 1989, before relocating to North Carolina.


About Duke-UNC TTS


The Duke-UNC Tobacco Treatment Specialist Training Program is a collaboration of three leaders in tobacco treatment, education, and research--the Duke Smoking Cessation Program, the University of North Carolina Tobacco Treatment Program, and the North Carolina Division of Public Health--and has been making TTS education accessible to medical, behavioral and public health professionals in North Carolina and beyond since 2016.


The primary aim of the program is to train health professionals to provide evidence-based treatment for tobacco use and dependence. Our comprehensive tobacco treatment specialist training and CE Short Courses provide impactful education experiences for a wide variety of professionals, including clinicians, nurses, pharmacists, social workers, public health policy-makers, and more.


Duke-UNC TTS is nationally accredited by the Council for Tobacco Treatment Training Programs. CE credit is provided by Duke Continuing Education.

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