Recently, Annahbella McLaughlin, an 11th grade student at Baldwinsville High School, went into a neighborhood grocery store for a sugary treat.
“They have a ton of snacks, mainly like snacks that you see on TikTok,” McLaughlin said. “I went in there to get ice cream.”
But when a man at the check out counter asked McLaughlin if she wanted a vape, she was surprised. At 16 years old, McLaughlin is five years away from being able to legally buy nicotine products. It was a reminder to her and her friends just how accessible and predatory the nicotine industry is to teenagers.
“He was not even like a young adult,” said Fayth Sims, McLaughlin’s friend who accompanied her. “It was a 50 year old man. I think it's just crazy that he doesn't even care. And it’s so illegal.”
McLaughlin and Sims are two of dozens of local students enrolled in Reality Check, a Department of Health program that teaches New York youth about the dangers of smoking and the tobacco industry’s manipulative marketing tactics. Originally founded to prevent young people from smoking cigarettes, the program has changed focus as alternative nicotine products like vapes and nicotine pouches have flooded schools and communities throughout the state and across the country.
The program’s youth coordinator for Central New York, Camryn Chaffee, travels to schools throughout Onondaga, Oswego and Cayuga counties teaching 6-12th grade students about the deceitful tactics the nicotine industry uses to hook young people, particularly through social media.
Public health data show that the amount of youth vaping has declined to the lowest in a decade, Chaffee and her students see a different story in schools throughout Onondaga County.
“They do end up getting to a majority of these kids our age,” said Sims, who is an 11th grade student at Liverpool High School. “Probably 80 percent of my school has smoked or vaped at least one time. It's crazy to me.”
That's why Chaffee sees its mission as urgent, since “everybody's gone into a bathroom at some point in school and there's been someone vaping.”
The youth nicotine crisis
The Department of Health started the Reality Check program in 2001, three years after the Tobacco Master Settlement Agreement, a major legal settlement between the four largest tobacco companies and states across the country. Some of Reality Check’s original funding came from the lawsuit, which required the tobacco industry to pay $206 billion over a period of decades, some of which went to fund anti-smoking initiatives.
The New York State Department of Health did not respond to questions from WAER for this story.
Cigarette smoking in New York plummeted in the two decades that followed the Master Settlement; between 2000 and 2021, the Department of Health reported that the number of adult smokers in New York fell from 23.2 percent to 12 percent.
During that time, New York State and the Onondaga County legislature cracked down on cigarettes, passing laws restricting smoking in indoor public spaces and raising the age to buy nicotine products to 21.
But the rise of vaping in the 2010s created a new nicotine-related public health threat for New York youth, and a renewed need for education about nicotine addiction. In 2018, 27.4 percent of New York’s high schoolers reported using e-cigarettes at a time when high school smoking cigarettes was 4.8 percent, according to the Department of Health.
Herself 25, Chaffee remembers going to high school in 2018 and 2019 when vaping was at its peak. Although federal, state and local governments have tightened laws surrounding the legal sale of nicotine products, many young people end up with nicotine products obtained illegally or through the black market, Chaffee said.
“There's kids in sixth and seventh grade that are selling them in the bathrooms, like dealing vapes,” Chaffee said.
Unlike cigarettes, new nicotine products have proportionately higher amounts of the drug. According to the Center for Tobacco Control Research and Education at the University of California, the average vape can have up to 600 cigarettes worth of nicotine in them.
“These products really pack a punch as far as how strongly the nicotine hits them,” said Dr. Eric Soule, a health professor at Eastern Carolina University who researches the health impacts of nicotine and tobacco.
Since vapes and nicotine pouches have higher amounts of nicotine, “we're seeing a lot of younger people that vape just constantly, basically. They really — especially people that are really strongly addicted — don't go very long without puffing on their vape.”
Between 2019 and 2020, an outbreak of pulmonary illnesses attributed to vaping made national headlines. Despite recent reports that vaping in New York schools is at the lowest level in a decade, Sims said vaping is so frequent at her high school that going to the bathroom as a non-smoker is an uncomfortable experience.
“Last year it was really so bad,” Sims said. “[Students] would just be out of the class for 30 minutes and they'd be in the bathroom smoking. You would walk by, not even close to the bathroom, and you could just smell it for so long. It was so bad.”
Countering nicotine misinformation
The tobacco industry markets vaping and nicotine pouches as safer alternatives to smoking. This claim has been circulated widely, including among young people in the schools that Chaffee visits.
“That's what they're hearing,” Chaffee said. “They might not know what's true and what's not.”
But claiming that vapes and nicotine pouches are safer than cigarettes is misleading, according to Soule, a health professor at Eastern Carolina University who researches the health impacts of nicotine and tobacco.
“Cigarette smoking is so bad, it's the most deadly consumer product ever created,” said Soule. “So to compare harms from something like that is not always an appropriate thing.”
There is still much to be revealed about the health impacts of vapes and nicotine pouches, Soule said. That’s because the nicotine market typically stays far ahead of the science, he noted, as well as the regulators.
While cigarette smoking contains the danger of smoke and tar, both vaping and smoking expose users to carcinogens like formaldehyde, arsenic, benzene, and heavy metals like lead and cadmium.
“I would not feel comfortable telling somebody that vaping is just drastically safer than cigarette smoking,” Soule said. Unlike smoking, Soule noted, vaping requires using a battery to heat up a coil that creates vapor. “That's where you start to see some of these degradations of those compounds that are both in the liquid and the coils, and where people are being exposed to some of these chemicals, metals and carcinogens.”
One of Chaffee’s strategies to counter the claim that vaping and nicotine pouches are safer than cigarettes is to show them how the tobacco industry once advertised low-tar cigarettes as healthy. These advertisements appeared despite a surgeon general report in 1964 directly linking smoking to lung cancer.
“They get to dig deeper into the tobacco industry and their tactics,” Chaffee said, describing a recent trip with a group of students to the Washington, D.C. headquarters of Altria, a major tobacco and nicotine company. “Once they start really getting into that, they definitely are more invested in it and are even stronger advocates for change because of all the terrible things that the tobacco industry does.”
One of these tactics includes flavors that appeal to children, like green apple, watermelon and cotton candy. In August, the FDA approved Zyn Ultra, a new high concentration nicotine pouch that comes in flavors like peppermint, citrus, and arctic mint.
Sims said she was shocked to learn about how the tobacco industry has misinformed young people about the safety of nicotine products.
“Scary is an okay word for it,” Sims said. “We're not even necessarily close to legal age, and we're being targeted so much as teenagers and as kids.”
Media literacy and advocacy
Social media has become the latest frontier for the tobacco industry’s advertising. That’s why media literacy has become a key part of the Reality Check program, Chaffee said.
This involves having students sleuth through social media with a critical eye to find the sources of nicotine advertisements and influencers who promote nicotine products.
“I scour social media for all of the different advertisements, rewards programs, all of those things,” Chaffee said. “I've even had the kids go through TikTok and find different creators that are using different products and promoting them on their page.”
According to the tobacco industry watchdog Stopping Tobacco Organizations and Products (STOP), the industry has pivoted to social media to market its next generation of nicotine products to young people.
“What we've seen is those products making their way into very, very well established marketing and distribution machines that have been built over hundreds of years,” said Jorge Alday, STOP’s director. “All those things together, that can create rapid acceleration of uptake in a market, particularly among young people who want to try something new and have all these messages coming at them from digital environments.”
This includes getting social media influencers to promote their products, Alday noted.
“They're often on the cutting edge of how to target consumers, they're trying things out, they're seeing what works and they're figuring out how to get people on their products as quickly as possible,” Alday said.
Chaffee plans to expand this part of the program by creating a TikTok page where students can upload videos about the dangers of smoking and vaping.
“It's everywhere,” said Chaffee, who sees on her own social media feed how influencers and paid advertisements normalize nicotine addiction. This allows Chaffee to keep her finger on the pulse of the tobacco industry’s marketing arm, which spends billions on advertising every year, according to the Federal Trade Commission.
“I save it to show my coworkers, so then it thinks that I like that content," Chaffee said. "
But it's really just informational for me to see what people are doing and what's popular.”
The mental health connection
The program’s focus on vaping and nicotine pouches has found support and relief from Central New York parents who want to keep their kids away from nicotine, Chaffee said. One father, himself a lifetime smoker who has struggled to quit, thanked Chaffee for teaching her daughter.
“He was just like, ‘I'm so glad she's doing this, I want her to stay involved because I don't want her to have to deal with anything like this that I have,’” Chaffee said.
In seeking to prevent nicotine addictions before they happen, the Reality Check program has helped prevent young people like McLaughlin and Sims from getting addicted in the first place. However, they say larger support is needed in schools for children, particularly for those struggling with mental health.
“A lot of these kids do it because they're depressed or anxious or something,” McLaughlin said. “They just have a lot going on so then they start doing that and then they just get addicted.”
According to the CDC Foundation, young people who vape are twice as likely to have symptoms of depression.
“A lot of the kids just feel like they have to vape or something to fit in, so that's why a lot of them do it,” McLaughlin said. “They don't even want to do it. They just want to fit in and have friends.”
