DES MOINES -- As the number of vaping-related illnesses continues to climb -- 23 in Iowa as of Friday -- state leaders are trying to determine what steps should be taken to address the issue.

Uncertainty and a lack of data are undermining the discussion, some state officials say.

Public officials across the country are dealing with health issues related to vaping, a form of smoking that uses an electronic device that produces an aerosol from a liquid that contains nicotine but no tobacco. Some people use the devices to vape THC, the chemical in marijuana that produces the high effect.

Iowa’s public health department on Friday afternoon announced its latest tally: 23 cases of severe respiratory illness associated with vaping. While the patients skew young, they range in ages from 17 to 60, and most have been males. No deaths have been reported in Iowa, although 12 have been reported nationwide.

Of those 23 cases of severe respiratory illness in Iowa, 18 reported vaping with THC.

Even more alarming, state officials say, is a spike in the use of vaping products, which they fear could cause those numbers to also increase exponentially. The abuse of e-cigarettes among sixth-, eighth- and 11th-graders jumped from 4 percent in 2016 to 10 percent in 2018, according to the Iowa Youth Survey, a poll conducted jointly by myriad state departments.

The survey also found the number of young Iowans who reported using e-cigarettes more than doubled from 2016 to 2018 among eighth-graders (from 3 percent in 2016 to 8 percent in 2018) and 11th-graders (from 9 percent in 2016 to 22 percent in 2018).

In Cerro Gordo County, 14 percent of eighth-graders -- or nearly twice as many as the statewide average of 8 percent -- reported they were currently using e-cigarettes. That grew to 22 percent among 11th-graders, the same as statewide.

But despite the increased use and the potential for harmful impact, health officials say the cause of vaping-related illness remains a mystery and data is still preliminary and scarce, making it difficult for them to advocate for specific public policies.

“Unfortunately at this point in the investigation we just don’t have a lot of information,” Dr. Caitlin Pedati, the state public health department’s medical director, said Friday at a meeting of the state commission on tobacco use prevention and control. “I fully appreciate that that’s frustrating. We’re working pretty hard to try and gather some additional data to help narrow the focus of things. But at this point, unfortunately, I’m not sure if we can narrow it further.”

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Jay Jenkins holds a Yolo brand CBD oil vape cartridge alongside a vape pen earlier this year at a park in Ninety Six, S.C. Jenkins says two hits from the vape put him in a coma and nearly killed him in 2018. 

Pedati said she hopes Iowans with vaping-related illnesses report their ailments and that medical professionals work with the state in order to achieve a more complete picture of the issue.

Meantime, despite that uncertainty and lack of data, the state public health department is suggesting Iowans not use vaping products.

“Iowans should not use vaping and e-cigarette products since the cause of this outbreak is not yet clear and the long-term health impacts of these products are unknown,” read a department press release announcing the latest vaping-related illness figures.

George Belitsos, chair of the state tobacco use prevention and control commission, said the lack of data is hindering health officials’ efforts to address vaping-related health issues. The commission at its meeting Friday voted to produce a public statement urging state and federal lawmakers to enact myriad policies designed to reduce vaping, including raising the legal age to 21 and ban flavored vaping products.

Multiple members of the commission -- which is comprised of medical professionals, myriad state agency representatives and members of the public -- spoke passionately at Friday’s meeting about the need for state action designed to reduce vaping.

“A lot of the concerns that we have been talking about for years about vaping have suddenly become a very big public concern. Kids are dying,” Belitsos said. “We’ve known about this problem for health (issues) from vaping, and why did it take this before the public wakes up. So this is a springboard for us to take action, and I think that’s what we did today.”

Some states have taken myriad actions to address the budding issue. According to data compiled by the Public Health Law Center at the Mitchell Hamline School of Law in Saint Paul, Minnesota:

  • 21 states have included e-cigarettes in their legal definition of tobacco products, making them subject to the same regulations. Iowa does not.
  • 15 states tax the sales of e-cigarettes. Iowa does not.
  • 29 states have laws that require product packaging of e-cigarettes. Iowa does not.
  • 24 states, including Iowa, require state licenses for the sale of e-cigarettes.
  • 49 states restrict youth access to e-cigarettes. In Iowa, an individual must be 18 years old to purchase an e-cigarette, matching the lowest threshold in the U.S. Four states set the bar at 19 years old, and 16 set the threshold at 21.

Two state lawmakers who are non-voting members of the commission said Friday that the prospects for vaping legislation are uncertain. State lawmakers return to work for the 2020 legislative session in January.

Herman Quirmbach, a Democrat from Ames, said he is “cautiously optimistic” state lawmakers will address vaping in 2020. He has introduced legislation that would raise the legal age for purchasing vaping products to 21 with no exceptions.

Charles Schneider, a fellow Republican from West Des Moines, this past session introduced legislation similar to Quirmbach’s, although Schneider’s bill carved out an exception for military members.

The nuances of the debate create more issues in getting legislation passed. For example, the American Cancer Society’s lobbying arm supports legislation that aims to reduce vaping, but advocates specifically for including vaping products in the legal definition of tobacco products. A representative for the organization attended Friday’s meeting and made that case to the commission.

State officials pledged to continue to work on the issue while also attempting to collect more information.

“I wish we had more information. ... We have a dearth of data on this,” said Dale Woolery, with the governor’s drug control policy office.  

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