Students are vaping — in school bathrooms, between classes and after school — and at the crux of the crisis is the spread of misinformation.

Last week, an Illinois district filed a lawsuit against Juul Labs, a leading e-cigarette company that holds more than 75% of the market, for allegedly glamorizing the product on social media to market to teens and young adults. What was meant to be a harm-reduction alternative for adults addicted to nicotine is becoming increasingly popular among teens, and school administrators now face the dilemma of how to discipline students and address misinformation.

According to a survey conducted by the CDC in 2017, 42.2% of students have used an electronic vapor product. Superintendent Mikkel Storaasli of Grayslake Community High School District 127 in Illinois said that while districts are now witnessing an “explosion” of vaping, administrators should avoid punitive disciplinary responses and alternatively respond through an educational lens.

“Simply punitive measures don’t do a whole lot,” Storaasli said. “We want to start conversations with students and parents instead.”

Elizabeth D’Amico, a senior behavioral scientist at the RAND Corp. and a licensed clinical psychologist, agrees detention and zero-tolerance policies, which some districts have put in place as a response to vaping, do not serve as a good deterrent or intervention. “Teens will find a way to do it and brush off the detention,” she noted.

Programs that yield better results

Implementing early prevention and later intervention techniques — like establishing afterschool programs, incorporating it into a comprehensive health education curriculum beginning in middle school, and educating school staff and parents on its use and effects — could yield better results.

According to Jeanie Alter, executive director of the American School Health Association (ASHA), evidence-based prevention programs are shown to work. D’Amico suggested part of the prevention and intervention approach should include providing normative feedback, which gives students a better idea of the bigger picture.

“Teens tend to overestimate how many other teens are actually using, whether it’s e-cigarettes, marijuana or alcohol,” she explained. “In reality, the rates of teen usage are much much lower.”

Any health curriculum or after-school program, she said, must include demonstrating to students through statistics that not vaping is more common than doing so, which could normalize abstinence.

Another part of the problem that must be addressed, both Storaasli and D’Amico said, is that students and parents falsely believe vaping is not as harmful or addictive as combustible cigarettes. While vaping began as a healthier alternative to traditional cigarettes for addicted adults, they do not serve as a harm-reduction technique for young adults who vape — 50% of teens who begin to use e-cigarettes go on to use combustible cigarettes in one year — and can lead to students adopting even more harmful habits.

According to a recent internal district health survey in Grayslake High School District 127, numbers showed that as students got older, they perceived less of a risk associated with vaping and increased their use. Results showed 60% of the district's 10th-grade students saw vaping as dangerous. By 12th grade, that number was down to 49%.

To address this, schools can partner with county health departments and other local health organizations to develop educational programs. In Storaasli’s district, schools offer a reduced penalty for vaping if the student agrees to complete such a program. Partnering with middle schools to get the message out early works as a good prevention technique.

Barriers for minority and low-income students

In an afterschool program D’Amico developed, schools that offered it and teens who attended reported less use of marijuana and alcohol. The same concept, she said, applies to vaping.

However, it is important when building any afterschool program to ensure attendance barriers for minority students, those from lower-income backgrounds and at-risk youth — all of whom are less likely to attend highly-structured afterschool programs than white students from more affluent backgrounds — are mitigated.

Districts can do this by building programs in conjunction with school staff, students and parents. Collaborating with the communities districts serve to get feedback on program content, keeping sessions brief, and tailoring them so they are culturally and developmentally relevant will all make uptake more likely.

Experts like Alter foresee the trend only increasing until schools begin to respond in a “comprehensive and coordinated way.”

“We have to start rethinking how we talk to teens about this,” said D’Amico. “Prevention, intervention and disciplinary action go hand-in-hand.”