Mango, fruit and crème are just a few of the nicotine flavors that may be drawing kids and teens to electronic cigarettes and vaping. In recent years, rising rates of youth in the United States using e-cigarettes has grown into a public health epidemic.
According to the U.S. Centers for Disease Control and Prevention (CDC), e-cigarette use jumped 78% among high school students from 2017 to 2018. Last year, more than 3.6 million middle school and high school students in the U.S. used e-cigarettes. The products’ surge in popularity led the Food and Drug Administration to restrict fruit and candy flavored e-cigarettes at gas stations and convenience stores in 2018.
“I have absolutely seen an increase in teens using e-cigarettes, and so have hospitals and schools across the country,” said Dr. Yolanda Evans, associate professor of pediatrics in adolescent medicine at Seattle Children’s. “With these highly addictive products becoming more popular and readily available, it’s important for parents to know what e-cigarettes are and how to discuss vaping with their children.”
An addictive trend
Also known as vapes, vape pens, mods and tanks, e-cigarettes come in a variety of shapes and sizes. The handheld devices include a rechargeable battery, heating element and mouthpiece. They can appear as inconspicuous as a pen or flash drive, and can also be used to deliver marijuana. A new brand, Suorin, has devices shaped like a tear drop.
Vaping is a social group activity for teens, without the stigma of smoking traditional cigarettes, Evans said. Many teenagers that Evans sees in her practice know that smoking is unhealthy, but they don’t view e-cigarettes with the same risk. This may be because vape products are marketed to help adults quit smoking and involve inhaling aerosol vapor instead of tobacco smoke.
“Unlike cigarettes, vape products aren’t associated with a foul odor, bad breath and other cosmetic drawbacks,” Evans said. “The products’ numerous flavors can also be really appealing for teens.”
In certain states, including Washington, it is illegal for people under age 21 to purchase vape products. However, recent research found that almost half of tobacco and vape shops illegally sold nicotine products to teens.
Understanding the risks
Despite the misconception that e-cigarettes are safer than cigarettes, Evans said vapor products are not safe for teens. According to the CDC, e-cigarette aerosol contains harmful and potentially harmful substances, including nicotine, ultrafine particles, flavoring, volatile organic compounds, cancer-causing chemicals and heavy metals such as nickel, tin and lead.
In some vapor products, the amount of nicotine can be dialed up or down depending on the concentration and how much teens use it each day, Evans said. Teens might not recognize that they could inhale more nicotine with an e-cigarette than a traditional cigarette if they increase the concentration or take multiple puffs per day.
“A hit off of an e-cigarette or vape may contain more nicotine than a cigarette,” Evans said. “Some teens think they can stop vaping anytime, not recognizing that the nicotine is addictive.”
The popular e-cigarette brand JUUL has a pod-type system that delivers a high concentration of nicotine, according to the National Cancer Institute. A study found that young people who used pod-type e-cigarettes had higher levels of nicotine in their body than have previously been found in adolescents who regularly smoked conventional cigarettes.
The study results are concerning to experts like Evans not only because of the high potential for nicotine addiction, but also because nicotine exposure can lead to other short and long-term health issues.
Teens addicted to nicotine might experience significant withdrawal symptoms. Nicotine exposure can also harm teens’ brain development, affecting areas that control attention, learning, mood and impulse control, according to the CDC. E-cigarettes may not have the same carcinogens as a traditional cigarette, but nicotine has cardiovascular effects, Evans said. The drug can raise blood pressure, lead to heart disease and put people at risk for a heart attack or stroke.
In addition, e-cigarettes can lead to the use of tobacco products. Vaping is an expensive habit. If a teen who becomes addicted to e-cigarettes is unable to buy refills, they might transition to less expensive cigarettes.
“Although e-cigarettes are marketed as an aid to help adults stop smoking, studies show that adolescents who vape are more likely to start using traditional tobacco products,” Evans said. “For teens, e-cigarettes seem to be more of a gateway into using nicotine and tobacco instead of a way to help with cessation.”
Talking to teens about vaping
Parents can play an important role in preventing their kids’ e-cigarette use by setting expectations about substance use.
“I recommend parents have a set of expectations, and have clear consequences if these expectations are not met,” Evans said. “I encourage parents to get input from their teens about what they think an appropriate consequence would be.”
Parents should also be prepared to discuss the risks of e-cigarettes with teens.
“You don’t have to explain yourself completely, but it helps to have a valid reason for setting guidelines for their behavior,” Evans said.
If a teen is already using e-cigarettes and is interested in cutting back, Evans recommends parents say that they can provide support and help them quit. Teens should also see their primary care provider to create a plan for cutting back and quitting. Additional resources include smartphone apps and the national tobacco quit line.
She also suggests asking teens about when they use an e-cigarette and who they use it with. Social capital and peer influence are important for teens, depending on their stage of development, and can be important factors to consider when helping a teen quit.
“If their entire friend group is going out at lunch to use the vape pen, it could be really hard to cut back,” Evans said.
It’s helpful for families to have these conversations when not in a moment of crisis, Evans said. Teens will be more likely to follow through with the expected behavior and understand the reason for the consequences.
“It’s important to let them know you’re there to support them,” Evans said. “For teens, having support and clear boundaries can make a difference in their e-cigarette use and have a positive impact on their health.”
- Escape the Vape
- Prevention Works in Seattle
- Vaporizers, E-Cigarettes, and other Electronic Nicotine Delivery Systems (ENDS)
- King County: E-cigarettes and Vapor Products
- The Teen Vaping Trend – What Parents Need to Know
- Washington State Department of Health How to Quit Self-Help Materials
- The Truth Initiative E-cigarette Quit Program
- With the Jury Out on Vaping, Clinicians Pause to Identify the Cons of E-Cigarettes