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A selection of flavored vaping supplies is on display in the window of a vaping store on March 24, 2018, in New York. 

Teen tobacco use has jumped in recent years after nearly two decades of declines, and nonsmoking advocates say one thing is to blame — electronic cigarettes.

“It is just stunning,” said Laura Smith, spokeswoman for ClearWay Minnesota. “The rates among middle and high school students are so high. Five million kids in the U.S. are now addicted to e-cigarettes. What is going to happen to that generation?”

In 2018, 28 percent of Minnesota high school students and 12 percent of middle schoolers had used tobacco products in the past 30 days. That’s a 4 percentage point increase for high schoolers and nearly double the percentage of middle school students from just three years ago, state survey data show.

Teens’ tobacco preferences also have changed. A record-low 5 percent of 11th-graders smoke cigarettes, the survey found, while 26 percent vape.

The same trend holds for younger students. And flavors — from menthol to “Candy Crash” — are used by the majority of teen smokers, survey data show.

Advocates, community leaders and state lawmakers from both political parties are pushing harder than ever to change laws to help curb teen vaping and other tobacco use. Raising the age to purchase tobacco to 21 and restricting or banning the sale of flavored products are the focus of that effort.

Tobacco giants have gotten behind the “Tobacco 21” push, but have largely opposed bans on flavors. They’ve argued the bans will harm adult consumers who should be allowed to make their own decisions.

That means despite having bipartisan support in the Legislature, big changes in tobacco policy will be challenging — especially when it comes to flavor restrictions. Nevertheless, tobacco is expected to be a top issue during the 2020 legislative session.

Meanwhile, local communities are stepping in where state officials so far have not. Since 2017, 53 communities have raised the tobacco purchasing age to 21 and 13 have put new restrictions on flavors.

St. Paul has done both.

Chris Turner, of the Association for Nonsmokers Minnesota, compared the effort to communities that passed indoor smoking bans more than a decade ago.

“A lot of times, it takes a groundswell from citizens saying, ‘This is what we want,’ ” Turner said. “Our kids can’t wait. Local governments are more nimble.”

Reversing a trend

Nonsmoking advocates point directly to the rise of Juul Labs, one of the leading e-cigarette companies, as the catalyst for what they call a teen vaping epidemic.

Teen tobacco use had fallen to an all-time low in Minnesota when state leaders starting asking youth about e-cigarettes in 2014. Juul came on the market in the spring of 2015.

Teen tobacco use has steadily climbed since then, but students are not smoking cigarettes anymore.

“The rise of Juul really mirrors the rise of teen e-cigarette use,” said Smith of ClearWay. “We had achieved record prevention. … E-cigarettes interrupted and reversed that trend.”

Smith says vaping is attractive to teens for a lot of reasons, but “flavors and the technology” are likely the biggest draws. “You can hide it and it looks cool,” she said. “They market it as stealthy so you can use it without your parents or teachers noticing.”

Advocates note documents and other evidence obtained by the U.S. House Committee on Oversight and Reform in July show Juul “deployed a sophisticated program to enter schools and convey its messaging directly to teenage children … targeted teenagers and children, as young as eight years old, in summer camps, and recruited thousands of online ‘influencers’ to market to teens.”

Juul representatives have promised to change the company’s marketing practices. In October, after the release of a national survey showing a dramatic increase in teen vaping, company CEO K.C. Crosthwaite announced Juul would suspend sales of all non-tobacco flavors except menthol.

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“These results are unacceptable and that is why we must reset the vapor category in the U.S. and earn the trust of society by working cooperatively with regulators, Attorneys General, public health officials, and other stakeholders to combat underage use,” Crosthwaite said in a recent statement.

Teens think it’s safe

But a lot of damage has already been done, says Anna Grace Hottinger, a Shoreview teen who’s been working for the past two years to curb teenage vaping.

Now a high school junior, Hottinger has two older sisters who starting using e-cigarettes when they were teens. That drove her to become active in the Tobacco 21 movement and urge community leaders to put new restrictions on e-cigarettes and flavors aimed at teens.

“I know the effects of being addicted to something and how it impacts people,” Hottinger said. “I don’t want to see other young people go through that.”

Hottinger says vaping has been “all over” since she was a freshman at Mounds View High School — she now attends school online. It was so prevalent that school leaders had to lock some bathrooms during classes and some students went so far as to vape in the back of class.

There are social pressures to vape in order to fit in, Hottinger says, but another big driver among teens is the belief the products are a safe alternative to cigarettes.

E-cigarette companies have made those claims, but they have not been evaluated by federal regulators. Nationwide, there have been more than 2,000 cases of lung injuries related to vaping and 39 deaths, according to the Centers for Disease Control and Prevention. In Minnesota, there have been nearly 100 injuries and three deaths.

“Our whole lives, we’ve heard cigarettes are horrible and you should never smoke them,” Hottinger said. “No one has really said that about vaping.”

Local vs. state policy changes

Edina was the first Minnesota community to raise the tobacco purchasing age to 21 in 2017. Advocates say what followed was a groundswell of support from everyday citizens across the state who began pushing their community leaders to follow suit.

There are now 53 cities and counties that have raised the tobacco age and 13 that have placed restrictions on flavors. To date, just one is being challenged: Arden Hills Tobacco has sued the city over its flavor restrictions.

Last month, St. Paul became the latest city to institute Tobacco 21, adding to restrictions council members put in place three years ago on the sale of flavored products. The move confines flavored products to tobacco stores and keeps them out of gas stations and convenience stores.

Flavored tobacco, including menthol, has long been criticized as a way tobacco companies attract young users. It also has long been targeted toward communities of color, which now suffer disparities in health outcomes related to smoking.

Jeanne Weigum, president of the Association for Nonsmokers Minnesota, says St. Paul was an early leader on restricting flavors and raising the tobacco purchasing age to 21 was a logical next step.

“They were really in the front of the pack,” Weigum said of council members approving the flavor restrictions. “It really was a heavy lift for them.”

Weigum and other advocates now have hopes Tobacco 21 will win legislative approval next year at the state Capitol. Lawmakers also have proposed expanding awareness efforts and new taxes to add to the $600 million raised last year from tobacco.

Cost remains the largest influence when it comes to convincing smokers to quit.

But nonsmoking advocates acknowledge one of their top goals, the fight to restrict flavored products, likely will be the most difficult as tobacco companies step up lobbying efforts to stop it.

“That’s because flavors sell,” Weigum said. “We are trying to get these products not to sell. We are on opposite sides.”

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