Vaping, Cigarettes, and Teens

There has been a good deal of newspaper coverage recently on  the use of e-cigarettes, particularly the JUUL brand, which is shaped like a USB flash drive and is popular among teens. Like other e-cigarettes (also called vaping devices), these are battery powered and heat a liquid containing nicotine to produce an aerosol that is inhaled by the user.

Why the focus on JUUL? As explained by Dr. Howard A. Zucker, the New York State Health Commissioner, in a recent communication to health care providers throughout the state, this brand of e-cigarettes is almost odorless and is small enough to be used discretely almost anywhere. Students have been reported using them in school bathrooms (no surprise there) and even in classrooms and hallways. The liquid in JUUL devices is contained in a small pod, each of which may have the same amount of nicotine as a pack of cigarettes. What makes JUUL especially attractive to teens is the flavoring added to the liquid in the pods. These flavorings -- by some counts as many as 15,000 different ones, including fruit and candy flavors -- are highly appealing to young users.

What these young users don't consider is that no matter what flavor they may choose to use, each pod of liquid also contains nicotine, which is highly addictive. As Dr. Zucker notes, nicotine in any form can impair adolescent and young adult brain development, particularly those functions affecting impulse control, mood disorders, and attention and learning. Furthermore, while the vapor from the e-devices seems to be just harmless water vapor, it actually contains toxic chemicals and ultra-fine particles that enter the lungs.

Some adults have noted that all e-cigarettes can be used to help smokers quit, but evidence has shown that many adults use both regular cigarettes and e-cigarettes in different situations. There can, however, be no question at all that e-cigarettes pose a danger to young people and that parents need to be aware that they are not just a harmless fad or novelty device. They are a gateway to smoking cigarettes and they are a danger on their own.

Current data from the CDC on smoking and its effects on health is something to share with your teen. As the CDC notes, each day, more than 3,200 people younger than 18 years of age smoke their first cigarette and, each day, an estimated 2,100 youth and young adults who have been occasional smokers become daily cigarette smokers. Your pediatrician or family doctor can be a valuable resource on both the dangers of e-cigarettes and smoking and ways to help users quit.

Youth Tobacco Use

The dangers of tobacco use are well documented and widely understood. A recent article in PLoS Medicine adds just one more data point to the argument against cigarette smoking: in Asia, where smoking is more widespread than in the United States, approximately two million premature deaths in recent years can be attributed to cigarette use. Victims generally died of cancer, cardiovascular disease, or respiratory disease. Men who had a history of smoking were nearly twice as likely to die from cancer as men who had never smoked and were fifty percent more likely to die from respiratory diseases.

According to the Center for Disease Control , cigarette use among youth in the United States has seen encouraging declines in recent years. It is particularly important to track rates of tobacco use among young people because nearly all adult smokers begin using tobacco during their youths. CDC surveys show that nine of out ten adult smokers began using cigarettes by the time they were 18 years old, and 99% of smokers had begun smoking by age 26.

Cigarette smoking among youth declined between 2000 and 2011, which is certainly a positive trend. However, the use of electronic cigarettes, a product whose advisability is hotly debated among health care professionals, and which are often manufactured in China without oversight as to safety issues, doubled between 2011 and 2012. During that same period, hookah use among high school-aged youth increased as well. In 2012, the most recent year for which data were available, 6.7% of middle school students and 23.3% of high school students used tobacco products.

Declines in cigarette use are certainly good news, but the risks that accompany tobacco use are frightening enough that parents, teachers, and mentors must continue to work with physicians to ensure that teens understand them. Resources are available through the Surgeon General, including conversation cards for parents and doctors to guide talks with young people about tobacco. Adults can also help by reporting sales of tobacco to underage customers, which is illegal in every state; consumers who witness an illegal tobacco sale in New York, which includes sale of tobacco products and electronic cigarettes to minors or sale of loose cigarettes, should call 1-800-458-1158.

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