The New Mexico Department of Health is investigating eight suspected cases of severe electronic cigarette- or "vaping"-associated lung disease among residents from Santa Fe, Los Alamos and Bernalillo counties. The patients, age 17 to 46 years old, include five males and three females, all of whom reported vaping tetrahydrocannabinol (THC), an active ingredient in cannabis, according to health department spokesman David Morgan.

All eight were hospitalized since June for symptoms that included difficulty breathing, chest pain, cough and fatigue. Four were admitted to the University of New Mexico Hospital intensive care unit in Albuquerque, a UNM Health Sciences Center official confirmed.

"In light of this disease, we discourage vaping of any cartridges with THC," New Mexico Department of Health Cabinet Secretary Kathy Kunkel said in a written statement. "People who have trouble breathing or experience chest pain after vaping in the weeks or months prior to the development of these symptoms should seek immediate medical attention."

As concerns over the dangers of vaping grow, Taos is in the bull's-eye as the county with the highest rate of teenagers in the state that use e-cigarettes. Nationwide, at least 215 suspected cases of the vaping-associated illnesses have been reported in at least 25 states since June, according to an Aug. 27 bulletin released by the U.S. Centers for Disease Control and Prevention in Atlanta, Georgia. One patient in Illinois died in August.

The CDC and U.S. Food and Drug Administration are assisting state health departments with testing vaping devices, fluids and the vaping fluid cartridges or "pods" that are inserted into vaping devices, for contaminants. Federal officials confirmed that among other substances, scientists are testing patients' vaping fluids for pesticides and other potentially toxic chemicals, including flavoring chemicals that can be toxic to lung tissue.

"The liquid in the cartridges used for vaping not only contains nicotine or substances like THC, but also other chemicals and preservatives that damage lung tissue, and are sometimes carcinogenic," said Dr. Veronica Parker, a pediatrician with Taos Clinic for Children and Youth. "There have been some recent reports that kids are getting unknown types of pneumonia with different types of bacteria."

Nicotine is highly addictive and can affect teens' "still developing" brains, Parker noted. But local teens frequently do not understand the dangers of vaping, said Taos Alive school substance-abuse preventionist Monica Trujillo. There is a widespread misconception among young people that vaping is safer than cigarettes and that the vapor is "harmless," she said.

High school students in Taos County have the highest vaping rates in New Mexico - 54 percent, followed by Río Arriba County, where 48 percent of high schoolers reported vaping, according to 2017 Youth Risk and Resiliency Survey, data provided by the New Mexico Department of Health. The survey is conducted every other year and will be administered at both middle and high schools, this and next month.

"It is very disturbing how high the usage was," said Lynn Brashar, Taos Municipal School District director of Exceptional Programs, of the 2017 figures. "I'm very concerned. Overall, smoking is going down but yet vaping is going up. There is not nearly as much information about the longterm effects from vaping and I'm afraid students think it's a safe alternative to smoking. Vaping is not safe."

Statewide, nearly a quarter of New Mexico high schoolers reported e-cigarette use in 2017. Rates across New Mexico were highest among boys (35.6 percent statewide) and Hispanic students (34 percent). The survey does not ask about vaping of THC oils.

"It's a super-complicated issue," said Taos High School Principal C.J. Grace. "One thing we've seen with what's going on around the country is that students may not know what it is they're using and how it affects their physiology," she explained. "All of this is so new that really, we're seeing our kids experimenting with something about which we don't have any longterm information or understanding, in terms of the health risks. People were not talking about vape-related lung illnesses until very recently. And now, as students and people are experimenting more, and potentially delivering more nicotine or whatever substances they're inhaling through these devices, we're seeing things emerge that we couldn't have predicted or anticipated because they're just completely new scenarios.

"It's really shocking to contemplate that people are so unaware of the quantities of chemicals they're ingesting," she said. School faculty and staff find discarded vape cartridges dropped around campus, Grace noted.

"Taos High is a tobacco-, vape- and drug-free campus," Grace said. "Those things are not allowed on school grounds."

When students are caught with vaping devices, school administrators confiscate them, contact students' parents for meetings and alert the Taos Police Department, Grace said. "We're notifying the police if they are caught with vape materials because we're not able to judge what the contents are that the students are consuming," Grace explained.

Police have already been called to the school twice this semester, she confirmed. She would not go into details about those incidents.

Students are not taken into custody when they're caught with vaping devices but they are suspended and referred by the police department to the state's juvenile probation system, which is administered by the state Children, Youth and Families Department. The Taos Police Department and CYFD did not immediately respond to a request for information and vaping-related incident reports.

"Everyone's goal is to help the kids be safe and part of that is confiscating materials when we find them," Grace said. "But we're working on how to get better at supporting kids to stop engaging in the behaviors and what kind of prevention programs we can put in place to support them. That would be the next step for us."

Identifying effective prevention programs will involve both assessing the needs of Taos students and evaluating what evidence-based prevention research suggests "would work best for us," Grace said. "There are high schools around the country piloting different programs and some of them are proving effective. I think we'd say it is not strictly a disciplinary issue and that we need to be proactively providing students with the tools they need to be healthy."

Because vaping devices are small and some are designed to resemble innocuous items like pens or USB drives, detecting their use is not always easy for parents or school officials.

"I recall one student [who] expressed that e-cig devices are compact enough to hide and use in class without being suspected," said Taos Alive's Trujillo. "It's as easy as hiding it in your sleeve."

The biggest concern about e-cig use in adolescence is addiction, Trujillo said. She encourages students to scrutinize how e-cigarette companies appeal to youth and why they target youth. She also tries to get them to think about vaping's dangers to their development and health, noting that the human brain does not stop developing until well into the 20s.

"What exactly are people inhaling deep into their lungs?" she asked. "Pretty much a bunch of chemicals, dyes, metal and organic compounds heated up by a battery that also poses risks."

The New Mexico Poison Center at the University of New Mexico had received 40 calls through August 2019 for e-cigarette-related exposures, including 25 involving THC vape fluids and 15 including nicotine fluid exposures. None of those reports involved callers from Taos County.

Last year, the federal government began cracking down on the marketing and sale of vaping products to youth, demanding that manufacturers stop selling products with cookies, candy or cartoon figures on packaging. In what FDA officials called the "largest coordinated enforcement effort" in the agency's history, regulators also fined and sent warning letters to more than 1,300 retailers who had illegally sold e-cigarette products to children.

In December, the U.S. Surgeon General declared teen vaping to be a national "epidemic," after the CDC reported that more than 3.6 million U.S. middle and high school students had reported current e-cigarette use that year--an increase of more than 1.5 million students from the previous year.

To learn more about vaping and its dangers, Parker recommended parents and students visit the American Academy of Pediatrics website and type "vaping" into the search bar.

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