North Carolina Lung Injury Cases Related to Vaping Increase
Acute lung injury cases have increased as e-cigarette use by young people rises
The number of North Carolina cases of severe lung injury associated with e-cigarette use or vaping continues to rise with 61 cases in people ranging in age from 13 to 72. The North Carolina cases are among a rising outbreak reported by the Centers for Disease Control and Prevention of 1,604 cases and 34 deaths in the United States and the US Virgin Islands as of Oct. 22. The acute lung injury cases have occurred in the context of a rapid rise of e-cigarette use by young people.
Lung injury cases are being reported in younger adults and teenagers. Approximately 79% of patients are under 35 years of age, 40% are 18-24, and 14% are younger than 18. All patients reported a history of using e-cigarette or vaping products, with most reporting a history of using THC-containing products. THC is the primary psychoactive component in cannabis. Eighty percent of North Carolina cases interviewed reported vaping THC; 75% of North Carolina cases interviewed reported vaping flavors, 70% vaped nicotine, 50% vaped THC and nicotine, and 30% vaped CBD. No single product or source has been linked to all lung injury cases.
NCDHHS has joined the CDC’s efforts to urge people to consider not using e-cigarette or vaping products, especially e-cigarette or vaping products that contain THC.
“Those who use e-cigarettes or vaping products should not obtain them through informal sources and should not modify or add any substances,” said Dr. Zack Moore, State Epidemiologist.
The acute lung illness outbreak is occurring on top of rapidly rising rates of e-cigarette use among youth. The biennial 2017 North Carolina Youth Tobacco Survey found that although cigarette smoking was the lowest ever recorded among high school students at 8.9%, e-cigarette use increased 894% since 2011. E-cigarettes have become the most commonly used tobacco product among youth in North Carolina and 9.6% of high schoolers report having vaped cannabis. This rate is expected to rise.
According to the 2019 Cleveland County Pride Survey, youth e-cigarette use has increased among local high school students, after seeing a decline in 2017. In 2019, 32.8% of Cleveland County high school students reported using e-cigarettes in the past 30 days, up from 10.9% in 2017, a 302% increase. In 2019, 30 day tobacco use among Cleveland County high school students increased for the first time since 2012. Studies show that youth e-cigarette users are four times more likely to start smoking traditional cigarettes. This is particularly alarming because 90% of adult tobacco users start before the age of 18.
“This severe lung disease epidemic and the rise in youth use of e-cigarettes is deeply troubling,” said Dr. Elizabeth Tilson, State Health Director and Chief Medical Officer for DHHS. “As a pediatrician, I know that nicotine can harm areas of the brain that influence attention, learning, mood and impulse control. Nicotine use at a young age can also rewire pathways in the brain, priming it for future addiction – to nicotine and other substances.” Dr. Tilson testified Sept. 25 before a House Committee on Commerce and Energy on the topic.
The North Carolina Division of Public Health (DPH) and Department of Public Instruction (DPI) Healthy Schools initiative have worked together to help implement 100% tobacco free schools policies, considering this new and challenging e-cigarette epidemic, and to increase awareness among youth of nicotine levels in e-cigarette products.
DPI and DPH also promote measures to help students, parents and staff recognize youth e-cigarette use as an addiction and to provide evidence-based prevention and tobacco treatment education and counseling, rather than to suspend students who are addicted to nicotine. CATCH My Breath is an evidence-based tobacco use prevention curriculum that addresses middle and high schoolers’ use of e-cigarettes. The curriculum is available free of charge to NC schools. Fifty-six schools in NC have implemented this curriculum serving more than 17,000 students since 2017, and demand is growing.
Locally, the Cleveland County Substance Abuse Prevention Coalition has been working to address youth e-cigarette use in Cleveland County since 2015. The Student’s Leading a Change youth council was formed to target youth e-cigarette use in local high schools. Through this youth council, the www.EscapetheVapes.com initiative was created to educate peers about the potential risks of e-cigarette use. The Escape the Vapes campaign was nominated for the North Carolina GlaxoSmithKline Foundation’s Child Health Recognition Award in 2017, in recognition for the work towards improving the health of children in the community. Additionally, the Cleveland County Public Health Center’s health education staff facilitates an evidence based substance abuse prevention curriculum in 7th grade health classes and also offers vaping presentations to groups in the community upon request.
The Cleveland County Public Health Center and the Alliance for Health in Cleveland County, Inc. are partnering with Atrium Health to expand tobacco (including electronic cigarette) cessation efforts in the county. With approximately 20% of the county’s adult population continuing to use tobacco products, this partnership aims to expand tobacco cessation services through physician practices and public health providers. Cleveland is one of two NC counties selected by Atrium Health to participate in this initiative primarily due to the rate of lung cancer which is 49.7 per 100,000 population compared to the rate for North Carolina at 44.1 per 100,000 population. Cleveland County is projected to have 98 new cases of lung/bronchus cancer in 2019 with 65 cases ending in death.
This new initiative will train mid-level providers, nurses, social workers, respiratory therapists and health educators in “first-line” treatment of nicotine dependence using assessment, one-on-one and group counseling and pharmacology options to reduce the number of country residents using tobacco products. Health educators will provide group classes at various sites across the county using the “Beat the Pack” curriculum to support the overall cessation effort. Three training sessions are scheduled for Tuesday, November 12, at the Cleveland County Public Health Center and Atrium Health with implementation of the initiative set for February 2020.
Another resource, the Truth Initiative, serves as a further resource and has expanded its quit-smoking resources to include a first-of-its kind e-cigarette quit program. To access TRUTH’s new e-cigarette quit program, users can text “DITCHJUUL” to 88709. QuitlineNC (1-800-QuitNow or 1-800-784-8669) is also available 24/7 with online, text and telephone programs to help young people addicted to any tobacco product, including e-cigarettes.
New clinical guidance for managing acute lung injury from the CDC and NCDHHS also urges people to receive a flu shot to protect against a combination of the flu and lung injury from vaping. NCDHHS will continue to monitor this outbreak and report any new information weekly at www.tobaccopreventionandcontrol.ncdhhs.gov/ecigs.