Vaping epidemic: How Sonoma County agencies, public schools are tackling the problem

Some kids vape in response to peer pressure. Ralph Manalac had a different reason.

“I liked this girl, and she was doing it,” said Manalac, an 18-year-old freshman at Santa Rosa Junior College.

Two years ago, Manalac was a junior at Windsor High School. To spend more time around the young woman he fancied, he took up vaping. After about six weeks, he recalled, he quit. While his crush remained unrequited, his times in the 300-meter hurdles improved dramatically.

Since then, Manalac has mentored fellow students on the dangers of vaping and served as an undercover tobacco purchaser for the Center for Well Being, a Santa Rosa nonprofit organization. He has seen both sides of an issue that has lately been all over the national news.

Last week, in response to some 400 cases nationwide of lung illness apparently linked to vaping - 36 of them since June in California - the Trump administration unveiled plans to ban most flavored e-cigarettes. That news came a day after Kansas authorities announced the sixth U.S. death related to inhaling vapor from the battery-powered devices, also known as e-cigs and vape pens.

Last month, Dr. Celeste Philip, Sonoma County's health officer, issued a health alert warning against lung injuries related to vaping. The local alert came on the heels of a similar statewide warning by the California Department of Public Health.

While vaping-related illnesses only recently emerged as a national issue, county health officials and educators have been fighting this battle for years. At the tip of the spear is Impact Sonoma, the county health department's designated tobacco and nicotine prevention team, which received a two-year grant of $156,000 from the California Department of Justice in October 2018.

To better reach the youth the team seeks to educate, it has a strong presence on Instagram - @ImpactSonoma - and Facebook. Because research shows that scare tactics don't work, said Terese Voge, the program's manager, “We believe in just giving kids the facts” that vaping products “are full of toxins and chemicals like formaldehyde that you don't want in your body.”

Among the first things her team did with that grant money was conduct a comprehensive survey of county schools. The survey revealed, among other things, that administrators in half the county's high schools consider vaping their number one disciplinary problem.

And it's on the rise. While 11.7% of Sonoma County ninth graders reported having used an e-cigarette at least once in the previous 30 days in the 2015-2016 California Healthy Kids Survey, that number climbed to 21.7% in the 2017-2018 survey. To counter that trend, the state justice department has awarded additional multiyear grants, totaling $3.2 million, to the Petaluma City, Santa Rosa City, and west county school districts.

Dealing with students vaping is “a daily occurrence,” said Connie Marx, assistant principal at Healdsburg High School, which has partnered with Impact Sonoma, the Center For Well Being and the city's Police Department to educate students on the health risks.

“But sometimes,” Marx said, “with the bombardment of messages they get on social media that vaping is safe, it's cool, it feels like we're fighting a losing battle.”

Like Manalac, Cameron Olson is a member of Windsor High School's class of 2019, and volunteered as an undercover tobacco purchaser as part of a senior project. Four years ago, as a ninth grader at Windsor, he knew vaping existed, “but I didn't see that much of it,” said Olson, now a freshman at Sonoma State University. By the time he was a senior, “every time you went to the bathroom people were passing around a Juul or Suorin” - widely used vape pens.

Nor was it unusual for him to see students taking covert pulls on e-cigarettes in class.

Long touted as a less addictive way to consume nicotine, vaping was deemed a safer practice. But there was a paucity of research supporting those claims, “and the initial research was biased,” said Julia Chang, a Santa Rosa pediatric nurse practitioner with the Sutter Medical Group. A 2015 graduate of the University of California at San Francisco School of Nursing, Chang wrote her thesis on vaping.

E-cigarettes work by heating an oil and turning it into vapor, which is then inhaled. If vapers are mixing different oils, “it's like a different chemistry experiment every time,” Chang said.

According to the Centers For Disease Control and Prevention, most of the 400 recently hospitalized vaping patients reported a history of using e-cigarette products containing THC, the main chemical in marijuana. Many used THC and nicotine, while some used only nicotine products.

Regardless of the combination, Chang said, “we know that aerosolized oils don't mix well with lung tissue.”

Dr. Brian Prystowsky is a Sutter Health pediatrician in Santa Rosa who has had a surge of vaping-related health issues with patients in his practice “over the last two or three years. It's become a mainstream thing. By ninth or 10th grade, almost everybody's tried it.”

During a recent checkup, one young man told Prystowsky that he couldn't stop vaping. Another, who had vaped a combination of nicotine and THC, described an out-of-body experience, “almost the way people talk about flashbacks with acid,” the physician said. Months later, the young man was still experiencing fallout from that episode, having moments “where he just spaces out.”

Juul Labs, the San Francisco-based company now dominating the e-cigarette space, received a warning letter on Sept. 9 from the U.S. Food and Drug Administration. The agency informed Juul that it had been illegally marketing its products as a healthier alternative to traditional cigarettes. In addition to its vaping pen, which resembles a USB drive, Juul sells “pods” of vaping juice that come in flavors including mango, fruit, crème and mint.

Innocuous as those flavors sound, one pod can contain 41 milligrams of nicotine. That's 41 cigarettes' worth, according to the popular Stanford University Tobacco Prevention Toolkit.

“The flavored ones taste good” to teens, Cox said, “but they're highly, highly addictive.”

Students “tell us they want to stop,” she said, “because it doesn't feel good. Especially when they get ‘nic sick': the headache, the nausea. Sometimes we have to send them home.”

Teens with vaping issues aren't necessarily best helped by detentions and suspensions, according to educators. Using funds from its grant, Petaluma City schools has hired a team of mental health specialists who work with students on a variety of issues, including targeted interventions for teens who may be addicted to tobacco or using THC, said Liz Chacon, the district's superintendent of student services.

The Santa Rosa City school district is considering diverting offenders to its Elevated Academy, a four-hour Saturday morning program during which they would meet with counselors to discuss their life choices, and participate in smoking-cessation workshops, said Patricia Turner, the district's director of student and family engagement.

At Healdsburg High, principal Bill Halliday designed a diversion program, featuring 10 hours of counseling, plus community service.

“They're not bad kids,” said Marx, the Healdsburg assistant principal. “They need help.”

You can reach Staff Writer Austin Murphy at 707-521-5214 or austin.murphy@pressdemocrat.com. On Twitter @Ausmurph88