In recent years, the use of e-cigarettes has surged among teens and young adults across the country and in Virginia, drawing concern from public health experts that increases in e-cigarette use could be offsetting longstanding progress in decreasing cigarette use among teens.

According to 2018 survey data from the Centers for Disease Control and Prevention, around 5 percent of middle school students nationwide reported using e-cigarettes in the past 30 days, up from less than 1 percent in 2011; and 21 percent of high-schoolers reported using e-cigarettes in the past 30 days, compared to 2 percent in 2011.

That has occurred as cigarette use has decreased — from around 4 percent of middle schoolers in 2011 to 2 percent in 2017, and from 16 percent of high schoolers in 2011 to 8 percent in 2017.

According to Meredith Bloomfield, middle school coordinator with the Warren County Public Schools, nicotine vapor products have largely replaced cigarettes in Warren County's schools.

"Predominantly, we're dealing with vapes and e-cigs when it comes to high school students now," Bloomfield said. "There's not a whole lot of them that use the traditional tobacco."

Bloomfield added that when she speaks with ninth-graders about nicotine vapor products in a class she teaches about drugs and addiction, they are often unaware of the risks of using the products.

David Hinegardner, director of administrative services at Shenandoah County Public Schools, said that Shenandoah County has also seen students shift from paper cigarettes to e-cigarettes, although he added that he has not seen an overall change in the number of students using tobacco products.

"I don't know that it's anything really different," Hinegardner said. "The bottom line is as it's always been for eons, that you can't have cigarettes in school."

As that rise has taken place, local school districts and the Virginia General Assembly have taken action.

Since 2015, Bloomfield said that she has included instruction about e-cigarettes and vapor products in a broader lesson about nicotine as part of her class.

She said she hopes that her students understand the risks and uncertainty surrounding e-cigarettes. Research about them is relatively new, so the exact benefits and drawbacks of the products are not yet clear. But e-cigarettes do pose a health risk, particularly to nonsmokers.

In her course, Bloomfield said she likes to stress the state of research on e-cigarettes.

"I don't want to lie to them and say this is going to kill you; I don't know that," Bloomfield said. "I know it's going to change your respiratory cells. It's going to alter them. Do we know long-term what it's going to do? We don't know that yet."

By focusing on the facts and uncertainty surrounding e-cigarette and nicotine vapor use, Bloomfield said she hopes that students will have enough information to make smart decisions on their own.

"The more that they know, I genuinely believe, that they will make better choices for themselves," Bloomfield said. "I think that everyone wants them to be healthy in that regard."

In addition to coursework about e-cigarettes, Michael Hirsch, director of special services at the Warren County Public Schools, said that Warren County is set to hold a conference in August designed to instruct teachers about the products so they can become more aware of specific issues related to e-cigarettes.

"We're having someone from the state that will teach teachers as well as other human services professionals how to recognize the tools, how to understand the lingo, understand the terminology, and understand what e-cigarettes one, look like, and then some of the issues that we're having with them," Hirsch said.

Hinegardner said that he believed that Shenandoah County Public Schools also offered specific instruction about e-cigarettes.

"I'm very confident that in our health instruction teachers included that, especially since it's pretty popular in the media and all that," Hinegardner said.

Hinegardner said that as more students have been shifting from using paper cigarettes to using e-cigarettes, the district has not changed its overall approach.

Soon, schools across Virginia may be required to instruct students specifically about e-cigarettes. A house bill that Del. Michael Webert, R-Marshall, co-sponsored would require the Virginia Department of Education to develop materials concerning nicotine vapor products like e-cigarettes, and that would require public schools to teach about the risks of those products.

Webert has not responded to requests for comment.

Correction: This article has been corrected to reflect the spelling of David Hinegardner's name.

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