An estimated 119,000 kids younger than 18 in Kentucky today will ultimately die prematurely from tobacco use. This estimate may actually be low given that we are now in the middle of a youth tobacco epidemic, driven largely by the increase in e-cigarette use.

More than one in four Kentucky 12th-graders and one in seven eighth-graders used e-cigarettes in 2018. These rates are double what they were in 2016. Cigarette smoking has decreased somewhat, but the rate for Kentucky 10th graders still ranges as high as 17.1 percent in some areas of the state.

Individuals in these age groups are more easily addicted to nicotine, and exposure to nicotine before age 25 changes the brain structure, priming youth and young adults for other addictions, hindering their attention span and impulse control. There is a misperception that vaping is a safe alternative to cigarettes; in fact, a single JUUL pod, a popular e-cigarette product, has as much nicotine as a pack of cigarettes. In recent days there have been reports of otherwise healthy teens with acute respiratory illnesses resulting in hospitalization and even deaths attributed to vaping. Youth exposure to secondhand smoke and e-cigarette aerosol raises the risk of respiratory infections, middle ear disease, asthma, and even slowed lung development.

Smoking remains the leading cause of preventable death and disability in the U.S. Adults in Kentucky smoke at a rate almost double the national average and given that 90 percent of adult smokers began smoking before age 18, it is imperative that our youth never pick up a cigarette or tobacco product of any kind, particularly in our schools, a place where their health and well-being should be the highest priority.

Recognizing these facts, the Foundation for a Healthy Kentucky, the Kentucky Medical Association and the Kentucky Foundation for Medical Care joined hundreds of Kentucky organizations in advocating for statewide tobacco-free schools. We thank the Kentucky legislature for passing the tobacco-free schools law, including the requirement that schools post signage to notify staff, students and visitors. Prominently displayed tobacco-free signs will help establish a new norm where everyone understands that tobacco use has no place at school. They're a tool for schools to help improve community health by reducing smoking and e-cigarette use, preventing youth initiation of tobacco use, and protecting students, staff and visitors from the dangers of secondhand cigarette smoke and e-cigarette aerosol.

Signage isn't free, however, and the new law did not include funding to cover new signs. And many school districts in Kentucky are struggling to balance their budgets against a host of competing needs.

The Foundation for a Healthy Kentucky, the Kentucky Medical Association and the Kentucky Foundation for Medical Care are stepping in to address that need. We have launched the "Tobacco Free for Students" program to provide signage absolutely free of charge to every school district that passes a policy in compliance with the new law after April 9, 2019. We are offering districts metal signage for school property entrances and athletic fields, and window stickers for exterior building doors and school buses. We are offering the signage on a first-come, first-served basis and we've already received dozens of orders.

It will take time for some communities to get used to the idea that tobacco products can no longer be used at school. That's why we're also offering free "perhaps you didn't know" cards that can be passed, without an uncomfortable confrontation, to people who are violating the policy.

Kentucky has languished at the bottom of health rankings for long enough, and far too much of that is the result of our high rate of tobacco usage. We look forward to seeing these signs posted on school campuses across our state, but more importantly, to witnessing fewer young people struggle with the devastating health consequences of tobacco use.

Ben Chandler is president and CEO of the Foundation for a Healthy Kentucky; Bruce Scott, M.D., is president of the Kentucky Medical Association; and Shawn Jones, M.D., of Paducah, is President of the Kentucky Foundation for Medical Care.

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