With vaping crisis mounting, Illinois legislature weighs in
November 1, 2019

Susan Corbridge.

By Igor Studenkov

Electronic cigarettes have raised controversy from the beginning.

Supporters touted them as safer alternatives to traditional cigarettes and a way to help smokers quit. Opponents questioned just how safe they were and worried about how manufacturers marketed such products to teens.

The debate intensified in recent months, however, after the numbers of hospitalized teens and, worse, teens dying from vaping, increased. The Illinois General Assembly is considering a bill that would ban flavored e-cigarettes. Congress is considering similar legislation. In the meantime, the State is seeking the causes of lung damage from vaping while getting the word out about e-cigarettes’ effects.

An e-cigarette works by heating a liquid to create vapor, which users inhale. The liquid’s exact formula varies but usually includes nicotine, some form of flavoring, propylene glycol, and glycerol sweeteners. In some cases, e-cigarettes include tetrahydrocannabinol (THC), a chemical in cannabis that triggers a high. 

According to the U.S. Food and Drug Administration (FDA), as of 2018, the teen use of e-cigarettes has increased 78% among high-school students and 48% among middle-schoolers. While the number of middle-school students remains relatively low, as of 2018, the percentage of students using e-cigarettes went up from 11.7% to 20.8%.

A survey showed 81% of youth e-cigarette users cited the availability of appealing flavors as the primary reason for use, the FDA report said.

Acute lung injuries

Susan Corbridge, PhD, is executive associate dean at the University of Illinois at Chicago’s College of Nursing and a nurse practitioner who maintains a clinical practice in the UI Health Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine. In that capacity, she regularly sees patients with vaping-related issues. Corbridge explained that what puts people in the hospital are “acute lung injuries,” she said.

“Many need mechanical ventilatory support—the respirator,” she said, noting that, after vaping, serious lung injury “happens quickly. It can lead to death.”

According to the Centers for Disease Control and Prevention, as of Oct. 15, the U.S. posted 1,479 vaping-related lung injury cases, occurring in all states and territories except Alaska, the District of Columbia, and the Virgin Islands. While the CDC did not provide exact numbers by state, it indicated Illinois and California lead the pack, with the number of cases in the 100 to 149 range. The agency also confirmed 33 deaths related to vaping.

The most recent CDC report indicated that, while the exact cause of those injuries remains open to question, in most cases patients used e-cigarettes containing THC. The risk increased if patients obtained the e-cigarette “off the street or from other informal sources (e.g. friends, family members, illicit dealers),” according to the CDC.

Melaney Arnold, spokesperson for the Illinois Department of Public Health (IDPH), indicated her employer’s research paints a similar picture on the State level.

“Young males make up the majority of cases,” she said. “The majority report using THC products. More than half have been admitted to the ICU, and a quarter have needed mechanical breathing assistance.”

Under Illinois law, e-cigarettes are treated the same as traditional cigarettespeople younger than 21 cannot buy them, and smoking bans apply to vaping. That does not prevent teens from buying e-cigarettes online and on the street, however.

Corbridge said that, in addition to lung injuries, her other major concern is how vaping can lead to nicotine addiction, especially among teens.

“There are so many young adults and adults who are using e-cigarettes, and they don’t realize there’s nicotine in there in most of them,” she said. “We know that young adults that vape are more likely to smoke cigarettes and abuse other drugs.”

Corbridge explained that, when manufacturers first introduced e-cigarettes, doctors thought they might have potential to help patients quit smoking, but the data has not borne that hope out.

Photo courtesy American Academy of Family Physicians
Many with vaping injuries need a ventilator, and serious lung problems can happen quickly and lead to death.

Smoking and vaping

“What happens is that [patients] end up smoking and vaping,” she said. “People need to know too that data doesn’t support that it helps people quit smoking.”

In fact, Corbridge said, she worries about vaping’s cumulative effects.

“We don’t have long-term data on how vaping affects the body over a long period of time,” she said. “It took decades to figure out how cigarettes affected the body.”

Gazette Chicago contacted Juul, a major e-cigarette manufacturer based in San Francisco. Although it did not respond to questions, the company issued a statement indicating it suspended sales of “non-tobacco, non-menthol-based flavors (mango, creme, fruit, and cucumber) in the U.S., pending FDA review.” The flavored e-cigarettes have been particularly popular among young people.

The statement indicated Juul sold products only through its website, which, it insisted, “has strict age-verification controls.” While the company said it was committed to preventing sales to youth, it believes its products have medical value.

“We will continue to develop scientific evidence to support the use of these flavored products, coupled with strict measures to combat underage use, as we believe these products can play an important role in helping adult smokers move away from combustible cigarettes,” Juul stated.

State legislation

Two bills before the Illinois General Assembly would ban flavored e-cigarettes.

Rep. Deb Conroy (D-Villa Park) introduced House Bill 3883, and Rep. Grant Wehrli (R-Naperville) introduced House Bill 3887. Unlike Conroy’s, Wehrli’s bill specifically exempts the “tobacco, menthol, mint, or wintergreen” flavors. HB 3883 has 15 co-sponsors, and HB 3887 has three. None of the co-sponsors come from Gazette Chicago’s coverage area. Both bills remain in the Rules Committee.

Corbridge is not sure she would favor an e-cigarette ban altogether, although she said, “I know there are a lot of kids who are addicts, and would they get e-cigarettes on the black market?” She supports banning flavored e-cigarettes.

The IDPH continues its research. Arnold explained the organization is collecting and analyzing medical data and sharing what it learns with local health providers and the CDC.

“These lung injuries are a very serious condition, and no one product, substance, or device has been identified in all cases,” Arnold said. “We continue to see new cases, which means whatever is causing these injuries is still out there. IDPH recommends people not use e-cigarettes or vaping products while this investigation is ongoing.”

IDPH also ramped up public outreach, putting up a website on lung injury caused by vaping and launching social media campaigns through Twitter, Facebook, Instagram, Snapchat, TikTok, and YouTube. IDPH also has talked to students throughout the state “about vaping—what kids are seeing and doing, what they know, and what messages resonate with them,” Arnold said.

Corbridge supports public education, not just in terms of health risks but about what the e-cigarettes look like. She noted they “don’t smell like traditional cigarettes,” and they may look like USB storage devices or pens, which do not catch attention and can be concealed easily.

UI Health and the College of Nursing are doing their part to get the word out.

“We are working on more education, and our pulmonary group has an expert speaker to educate providers,” Corbridge and. “We will continue to do it throughout the campus, and I think we can reach our students as well.”

For the CDC, log on to www.cdc.gov. Contact Corbridge at sjsmith@uic.edu. For the IDPH, log on to www.dph.illinois.gov. More information about Juul is at www.juul.com.