At Fairbury Junior-Senior High School in southeast Nebraska, school administrators have noticed an alarming increase in students sneaking puffs of e-cigarettes: in locker rooms, restrooms and elsewhere on school grounds.

In an effort to reverse the vaping trend, the school district is taking a drastic step. Starting in the fall, all students who participate in extracurricular activities will be subject to random nicotine testing.

"It's a huge problem, and right now, I think it's new enough that we're being very naive to think that more kids aren't doing it," the Fairbury public schools superintendent, Stephen Grizzle, said of vaping. "We want to provide a safe, substance-free school as best we can, and we're just hoping that through the implementation of the policy, that we're helping students make the best decision."

The uptick in e-cigarette use in Fairbury echoes a national epidemic of teen vaping, according to public health experts. A 2018 Centers for Disease Control and Prevention survey found that 3.05 million high school students and 570,000 middle school students had used e-cigarettes within 30 days. The authors attributed the popularity to "e-cigarettes shaped like a USB flash drive, such as JUUL; these products can be used discreetly, have a high nicotine content, and come in flavors that appeal to youths."

Once a month, 20 to 25 kids at Fairbury will be randomly selected to be tested for nicotine through a urine test, Grizzle said. If they are found to have nicotine in their system, the student must sit out for 10 participation days of their extracurricular activity. If there is a second offense, they have to sit out for 45 days, and see a certified substance abuse counselor or licensed mental health provider for an evaluation or treatment at their own expense, he said. Third-time offenders cannot partake in their extracurricular for 12 months.

"Our main concern is that No, 1, it's unhealthy. No. 2, it's against the law: They are not supposed to be able to purchase cigarettes and vaping and all that," Grizzle said. Plus, he added, "I think it would stand to reason that it would get in the way of opportunities and educational experiences if they're focused more on when they can vape as opposed to what's going on in the classroom."

The rural school district of Fairbury has about 900 students, 383 of whom are enrolled at the junior-senior high school. In the 2017 to 2018 school year, there were seven disciplinary incidents involving vaping at the high school; in the 2018 to 2019 school year, that number jumped to 30, Grizzle said.

Many states have moved to tamper teen vaping, with at least a dozen raising the tobacco and vaping device purchase age to 21. In Nebraska, e-cigarettes are legal for users 18 and up, but lawmakers are trying to raise the age to 19.

Dr. Sharon Levy, a pediatrician and director of the Adolescent Substance Use and Addiction Program at Boston Children's Hospital, said most teenagers have no idea how dangerous vaping can be.

"The active ingredient in vapes is nicotine, but they're really different than cigarettes in the way that they deliver nicotine. They can deliver a much higher dose much faster," she said. "The worst part is, we really don't know what the long-term effects of such high doses of nicotine on the teenage brain are."

Smoking of any sort is prohibited on school grounds in Fairbury. Grizzle said he believed his school district will be the first in Nebraska to test for nicotine. The district already does random drug tests for students involved in extracurriculars, which encompasses somewhere to 60 to 65 percent of the student body: For the past two years, it has tested them for illegal or performing-enhancing drugs.

Adding nicotine to the existing drug tests will cost $5 per test, at an estimated cost of $900 per year, Grizzle said.

The test will be quantitative, not qualitative, meaning those who inhale secondhand smoke will not have high enough levels of nicotine to register as positive, he said.

The testing is done by Sport Safe Testing Service, a Powell, Ohio-based student drug testing company that works with more than 100 school districts around the country. Grizzle said the company does not collect students' names, and instead assigns them a random identification number. The test results will only affect extracurriculars, which range from sports to speech clubs, and will not go on students' records, he said.

The policy was approved by the local board of education last month. Grizzle said the reaction from the community has been "predominantly" positive.

"Obviously you're going to have some that are against it, and think it's an intrusion, but overall, it's been positively received," he said. "We're focused on trying to be proactive the best we can."