SHERIDAN — When Sheridan County Sheriff’s Office Deputy and school resource officer Boot Hill presented a Drug Abuse Resistance Education training to fifth-graders at Sagebrush Elementary School Sept. 5, one hand shot up.

“What is vaping? Is it safer than smoking?” the student asked.

Hill said many fifth-graders are aware of and curious about what vaping is — described by the Centers for Disease Control and Prevention as an electronic delivery system for nicotine, flavoring, marijuana or other substances.

Several local and national organizations are working to counteract advertisements and prevent teens and adults from vaping under the belief that it is a safer alternative to smoking.

The CDC released a health advisory Aug. 30 claiming there is a link between severe pulmonary disease and e-cigarette product use.

The report said as of Aug. 27, an investigation is ongoing into 215 possible cases of severe pulmonary disease linked to e-cigarette use.

All patients in the suspected cases used e-cigarette products and symptoms started to appear within a days to weeks of e-cigarette use, the advisory said.

E-cigarette products can contain heavy metals, volatile organic compounds and cancer-causing chemicals, according to the CDC.

DARE training is one way for Hill to dispel the myth that vaping is safer than smoking cigarettes early on, he said.

Almost twice as many teens used e-cigarettes last year than the year before, according to the National Institutes of Health.

“We know our high school kids countywide are vaping,” Hill said.

In Sheridan County School Districts 1 and 3, Sheridan County Sheriff Allen Thompson said vaping has been an increasing problem, as it is among youth across the country. He rarely hears of a report about tobacco in schools, it’s all vaping.

Hill said part of the training he offers to school staff is how to identify vaping devices, as some of them can be cleverly disguised. The CDC said vaping devices can look like USB drives, pens or flashlights.

Ann Perkins, Sheridan County community prevention manager, said vaping is a problem facing all Sheridan County districts, but it’s hard to identify statistics about the number of students who use e-cigarettes.

Vaping devices are easily concealable, hard to detect and not all parents and teachers recognize vaping paraphernalia.

“It’s very easy to get away with,” Perkins said.

The information Perkins has gleaned from students and parents indicates that many students in Sheridan County, especially high school students, are vaping.

Teens are more likely to use e-cigarettes than traditional cigarettes and more than three times more likely to start smoking cigarettes within six months of using e-cigarettes, according to the National Institute on Drug Abuse.

Seven in 10 teens are exposed to advertisements for e-cigarettes. According to the CDC, teens are particularly vulnerable to vaping ads that push the idea that vaping correlates to independence and rebellion. Many ads show vaping devices in bright colors and patterns and e-juices in a variety of flavors like candy or fruit.

Reports from several of the 25 states included in the CDC investigation said patients had respiratory symptoms like a cough, shortness of breath or chest pain. Some had gastrointestinal symptoms like nausea, vomiting or diarrhea, while others had symptoms like fatigue, fever or weight loss. Patients from one state were diagnosed with lipoid pneumonia.

“Regardless of the ongoing investigation, e-cigarette products should not be used by youth, young adults, pregnant women, as well as adults who do not currently use tobacco products,” the advisory said.

The CDC said e-cigarettes do have the potential to help adult smokers transition away from traditional cigarettes, but research is inconclusive about its effectiveness and it is not approved as a means of quitting smoking by the Food and Drug Administration.

Charles Auzqui, superintendent of Sheridan County School District 3, said vaping hasn’t been identified as a problem in their schools, but he isn’t blind to the fact that students are exposed to vaping ads and media.

Arvada-Clearmont schools’ health classes address the health risks associated with vaping, but as a small school, Auzqui hasn’t seen it become a problem on campus.

Similarly, Tongue River Middle School principal Jeff Jones said he hasn’t seen a vaping incident at the school in his two years there. He said the six-to-one student-to-teacher ratio is critical to maintaining positive relationships with students and observing any potentially risky behaviors.

TRMS teaches overall wellness, awareness of media influence on decision-making, ways to reduce health risks and understanding of the short- and long-term health problems associated with tobacco use and vaping, Jones said in an email.

Perkins said she is working closely with local organizations and schools to increase education and awareness about the health risks of vaping among teens in Sheridan County.

The Sheridan County Prevention Coalition is preparing to educate students and parents at schools this fall about the effects of nicotine on the brain and vaping on the lungs. It’s important to have honest conversations about vaping with everyone involved, Perkins said.

Juul is the most popular brand of e-cigarettes for teens and one Juul pod has as much nicotine as one pack of cigarettes, Perkins said. Some students are vaping multiple pods per day. Sharing pods and selling individual puffs from a device are also problems for teens who vape, as sharing saliva can have additional health implications, she said.

Nationally, the number of teen smokers has gone down. Now, the task is communicating to students how unhealthy e-cigarettes are for their bodies, Perkins said.

Students know about black lung associated with smoking cigarettes, but Hill said he is now teaching students about popcorn lung and vaper’s tongue associated with using e-cigarette products.

Many students believe e-juice is just water vapor, or that they have been vaping safe, food-grade juice. However, vapers also intake chemicals and hard minerals from the heating element in the pod, Perkins said.

“It’s not food-grade for the lungs,” she said.

Last year, the Sheridan County Prevention Coalition presented information at parent conferences and sports meetings, so parents could see what devices and e-juices look like and understand the associated health risks. Perkins plans to present the information at conferences again this year.