Applying an Equity Lens to Policies Designed to Decrease Youth Vaping: A Student Perspective 

October 18, 2024 Update: The youth e-cigarette use rates cited for the United States and North Carolina have been corrected.

In one week, my Raleigh, North Carolina, high school had four false fire alarms, all triggered by smoke from e-cigarettes in the bathrooms. Walking into a bathroom filled with the sickeningly sweet stench of vapor is an unsettling norm for many high school students. Despite the well-documented health risks of vaping, students continue to use e-cigarettes. At my former high school, as in many others around the country, this usage partly reflects the high density of vape outlets near schools, particularly lower-resourced schools and schools in racial and ethnic minority neighborhoods.  

A Public Health Crisis  

Over the last decade, vaping has evolved from a niche alternative to smoking into a national public health crisis, especially among teenagers. Fortunately, recent data from the Centers for Disease Control and Prevention show a significant drop in vaping among middle and high school students nationally, a promising sign that public health interventions, such as Tobacco 21 legislation and increased awareness campaigns, are making an impact. However, youth rates vary widely from state to state. Data from North Carolina’s 2023 Youth Risk Behavior Survey (YRBS) show progress, with current e-cigarette use among high school students decreasing to about 21.4% in 2023, down from a peak in 2019. However, North Carolina’s rate is still higher than the national average of 16.8%, highlighting that the benefits of public health initiatives may not be equally experienced across all states and communities. 

E-cigarettes pose severe health risks ranging from nicotine addiction to lung damage, particularly at young ages, and even increased susceptibility to other substance abuse. Yet a false sense of safety, combined with the appeal of flavored e-liquids and deceptive advertising, has led to its normalization among youth, especially in vulnerable areas.  

The proximity of vaping outlets to students is a contributing factor to their use of e-cigarettes. Within two-and-a-half miles of my former high school, there are 86 vaping outlets. A student can walk around the corner before or after school and purchase a harmful vape product. Unfortunately, this is a widespread problem throughout Raleigh, and similar trends have been observed nationwide. Research in Texas, for instance, found 40% of vape shops within 0.5 miles of schools, and studies in other areas have demonstrated a clear link between outlet proximity and increased youth e-cigarette use.  

Moreover, many high schools in Wake County are situated in low-income areas, so there is also a correlation between the density of outlets and Wake County’s most economically vulnerable areas. These areas are often populated by low-income families and communities of color, which already face significant barriers to health and wellness. The saturation of vape shops in low-income areas not only perpetuates a cycle of poor health outcomes but also highlights the systemic inequities present in the availability and marketing of harmful substances. Addressing these disparities is essential to ensuring all communities benefit from progress in reducing teen vaping rates.  

Policy Implications and Recommendations  

To effectively address the issue of vape outlet density near schools, state and local health policymakers need to take decisive action. While North Carolina’s preemption laws restrict local governments from enacting their own regulations regarding the sale, distribution, display, or promotion of tobacco products, regulation through zoning and land use is still permitted. This means municipalities can use zoning laws to limit the density and location of vape shops near schools by utilizing mechanisms like the Unified Development Ordinances. This approach allows local governments to implement community-specific zoning restrictions, even within the constraints of state preemption laws, to better protect public health. 

For example, some municipalities in Wake County, where Raleigh is located, have started to enact ordinances that prohibit the establishment of tobacco retailers within 1,000 feet of a school. While this is a significant step forward, more must be done at the state level to support these local efforts. Here are a few examples of implementations that could be considered:   

1. Support local ordinances. Local ordinances can have a role even in states with significant pre-emption barriers. Wake County passed a Unified Development Ordinance Amendment- to establish distance requirements from schools, as did other local municipalities in North Carolina. Encouraging local municipalities can lead to other communities following suit. This could be achieved through grassroots efforts such as community members emailing local leaders, participating in city council meetings, or organizing public forums to raise awareness. Public health advocates can also partner with local organizations to educate and listen to communities, creating a network of local policies that protect youth from the risks of tobacco and vaping products. Tennessee underwent an extensive community listening campaign in all 95 counties in 2018, resulting in an understanding of which tobacco and vaping policies were of most interest. This local engagement ultimately resulted in the first dedicated, permanent state funding for youth prevention and pregnancy cessation programming, generating the outcomes communities wanted.  

2. Raising the minimum age to purchase. While Congress changed the Tobacco Control Act in December 2019 to prohibit the sale of tobacco products to individuals under the age of 21, states must follow the implementation of their own “Tobacco 21” laws. Only eight states — Alaska, Arizona, Mississippi, Missouri, Montana, South Carolina, North Carolina, and Wisconsin — have not passed a Tobacco 21 law. State legislation is necessary to ensure penalties are placed on retailers, not youth, and to ensure clarity and consistency with enforcement, especially in rural or under-resourced areas.   

3. Regulate flavored products, including menthol. Flavored e-cigarettes, especially menthol, attract young users and are disproportionately marketed to minority communities. Banning flavored products at the state level could significantly reduce youth vaping. San Francisco implemented such a ban, leading to a decline in youth e-cigarette use. 

4. Increase the price of vaping products. Raising taxes on vaping products reduces affordability, decreasing youth access. Like tobacco taxes, higher prices have been shown to deter young people from purchasing e-cigarettes. Implementing state-level excise taxes on e-cigarettes could discourage youth consumption and fund public health initiatives.  

Building on Success

While we have made strides in reducing youth vaping, the high density of vape outlets near schools and in vulnerable communities continues to pose a threat to public health. Building on the successes of public health interventions and extending them to underserved communities will be essential to closing the remaining gaps. By enacting targeted policies and providing the necessary resources, we can ensure that all residents of Wake County — and beyond — benefit from this progress. The time to act is now, so that we can continue moving forward and prevent the vaping epidemic from regaining ground.