As e-cigarettes gain in popularity among teenagers, many South Carolina school districts have not updated policies to discourage their use.
More than 100,000 minors in South Carolina will one day die prematurely from a smoking-related disease, research shows. Eighty-three percent of South Carolinians who smoke started before they turned 18.
Despite the consequences, 33 school districts in the state lack a policy prohibiting the use of "alternative nicotine products" on campus, according to the South Carolina Tobacco-Free Collaborative.
"If we want the best future for our kids, that involves establishing the most healthy environment for our kids," said Ian Hamilton, deputy director of the Tobacco-Free Collaborative.
Nearly 100 percent of schools have policies in place that ban tobacco, according to the Department of Education. But using information from the Department of Health and Environmental Control, the collaborative highlighted that many schools have not updated those policies to address alternative nicotine products, like e-cigarettes.
Meanwhile, 2017 was the first year when the percentage of students who use e-cigarettes — 13 percent — surpassed the percentage who smoke conventional cigarettes.
Research is more clear about the harms of conventional, or combustible, cigarettes, but the battery-powered devices come with their own dangers.
E-cigarettes were introduced to the American market in the mid-2000s, and they have grown in popularity in recent years. A state amendment passed in 2013 made it illegal to sell these products to minors. It passed with near-unanimous support.
Rep. Bruce Bannister, a Greenville Republican and a sponsor of the amendment, said it wasn't aimed at addressing school policies. Still, he said he would expect school districts to have them in place.
The South Carolina Tobacco-Free Initiative advocates for smoke-free communities, school districts, universities and colleges. The group would like to see school districts take the cue from the change in state law and adopt their own policies.
Horry, Beaufort, Greenville and Richland counties are among the districts that don't have a comprehensive tobacco-free policy in place, according to DHEC.
Some Lowcountry districts have updated their rules following the new 2013 state law.
The Charleston County School District's code of conduct addresses e-cigarettes. There are greater penalties in place for selling the products rather than simply using them. The Charleston County School Board put a new policy in place to ban e-cigarettes in March 2015, a spokesman said.
In Dorchester 2, the district revised its policy in 2014 to do the same. The school board discussed it again in February, a spokeswoman said, and they reaffirmed then that the best instruction on tobacco use happens in a tobacco-free environment.
The rate of high schoolers who smoke is half of what it was seven years ago, according to a press release from the initiative. But the use of e-cigarettes is increasing steadily.
Authors of a congressionally mandated report on e-cigarette use said early this year the devices shouldn't be categorized as either good or bad. There is some hope e-cigarettes could help people who smoke combustible cigarettes quit.
But there is also now conclusive evidence that e-cigarettes lead teenagers toward the combustible variety.
About 30 percent of South Carolina students have used, or have seen someone using, a tobacco product on school property within the past month, according to DHEC.
Increasingly, those products have the look and feel of a flash drive.
JUUL devices, for example, deliver more nicotine than the average e-cigarette, and they deliver the addictive product faster. They are slick, with a slim and compact design and smoke that doesn't give off much of a smell. They were introduced in 2015.
And JUULs are cutting deeply into the e-cigarette market, according to an April report from the Public Health Law Center. In March, JUUL represented 55 percent of the dollar share.
Hamilton said there is no directive that school districts should change their policies. South Carolina could establish a state-level rule, he suggested.
"The longer we can keep young people from ever starting, the better chance we have of saving lives and saving money," he said.
Despite widespread concern about the rising popularity of e-cigarettes, decades worth of evidence shows combustible cigarettes are harmful to teen health. Twelve percent of South Carolina students still smoke the traditional type. Experts agree the single-most effective way to keep teens from accessing nicotine would be to raise the price of a pack of cigarettes.
South Carolina is one of the cheapest states to buy cigarettes, at about $4 to $5 a pack.