In just the past couple of years, a public health crisis has emerged affecting youth across the U.S. and in Kentucky: the rapidly rising rates of e-cigarette use. From 2017 to 2018, according to the Surgeon General’s Advisory, e-cigarette use among high school students rose from 11.7 percent to 20.8 percent, a 78 percent spike. This increase coincided with the growing popularity of Juul e-cigarette products.

E-cigarette use continues to make national headlines. A growing number of respiratory illnesses – over 800 as of Sept. 27 – and several deaths have been linked to vaping, with most of those occurring among people who use products containing THC, the compound in marijuana that creates euphoria. Although a specific chemical cause of these health problems has yet to be identified, the increase in health problems has led the Trump Administration to call for a national ban on flavored e-cigarette products, which are marketed to youth.

Dr. Patrick Withrow, a retired cardiologist who is director of outreach at Baptist Health Paducah, has made it his new mission to educate adolescents all throughout the Jackson Purchase about the dangers of e-cigarettes.

“This Juuling, or e-cigarette epidemic that we have down here, it sort of caught folks by surprise, it’s taken off like a rocket,” Withrow said. “Since the release of their fifth-generation e-cigarette, Juul has got about 75 percent of the market share right now. And the kids, they love it.”

In recent years, Withrow has traveled through western Kentucky and to other parts of the commonwealth speaking out about emerging health crises involving drugs such as methamphetamine and various forms of opioids. A member of the Coalition for a Smoke-Free Tomorrow, he’s modified his prior speaking format to address the addictive qualities of e-cigarettes, which may lack many of the carcinogenic additives of traditional, combustible cigarettes, but are now being linked to a growing number of negative health effects as more research is released.

Dr. Withrow recognized the insidious marketing strategies used by Juul and other manufacturers early on, such as certain companies’ production of sweet flavorings, and Juul’s use of social media (which the company ended in September 2019 along with other advertising).

“The nicotine level in this – especially the Juul (pod) – is the equivalent of one or two packs of cigarettes, of combustible cigarettes,” Withrow said. But, he added, a person who vapes for the first time doesn’t get the same harsh effect as lighting up and inhaling a traditional cigarette.

“What the Juul company has done is, they’ve used small leaf tobacco, and they make the liquid into a nicotine salt, which is really smooth,” he explained. “I mean, it’s very bland, it’s smooth, it’s mild, and the kids, they don’t get this noxious sensation of smoking a regular cigarette right off. And of course, you can take lots and lots of nicotine in with these things.”

Kids who would never consider smoking have become addicted to using e-cigarettes, Withrow said, and many parents are totally in the dark. A lot of them may be unaware that their children are using the products, and for those that are aware, they may be uneducated about the health effects of nicotine addiction. Withrow’s presentations make it clear: using nicotine inhibits brain development in young people and it can also serve as a gateway to using other, even more harmful, substances.

Withrow pointed out that the human brain does not reach full maturity until around age 25, and the last part to develop is the frontal region – the prefrontal cortex controlling judgment and decision-making.

“If your adolescent brain does not mature until you are 25 years old and you put an addictive substance in your brain when you are 13 years old, likely the maturity of that brain is going to stop or slow down right there,” he said. “You might be playing with Legos until you’re 50.”

Armed with that information, Withrow mainly targets middle schoolers for his presentations to reach kids at a younger age, but he also speaks at high schools. He said that nicotine has taken the place of alcohol as the substance of first use among many of the young people he encounters.

“One of the risks of addiction is age of first use – the younger you are when you try an addictive substance, the more likely you are to become addicted, not only to that substance, but to other things in the future,” he said.

Withrow’s speaking appearances mix information, anecdotes, and visual aids, and they’ve been well received across the region during the previous school year – and also last summer. In July, Withrow set up a booth during the registration for Paducah City Schools displaying information discussed during his tour. The booth also had information from Four Rivers Behavioral Health in Paducah and the Paducah Health Department, and the response was positive from both students and parents.

Since e-cigarette use has become so rapidly prevalent among young people in such a short period of time, there is currently no consensus, FDA- or CDC-approved method of treating addiction to these products. Withrow said that he has spoken with some pediatricians who’ve attempted to implement a treatment program for young people addicted to vaping, but they are basically modifying earlier models suitable for adults using traditional cigarettes.

That makes prevention even more important, according to Withrow. His final message for teenagers is simple, and one he’ll return to during this current school year armed with even more up-to-date information about e-cigarette addiction taken straight from the headlines: “Don’t think it can’t happen to you, because it’s very insidious, and it sneaks up on you.”

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