In the United States, it is illegal for people under the age of 18 to purchase e-cigarettes. However, this has not stopped underage individuals from using this product. In fact, according to a 2021 survey conducted by the National Institute on Drug Abuse, 13.4% of eighth grade students, 22.8% of tenth grade students, and 31.4% of twelfth grade students reported using e-cigarettes last year.
The increasing proportion of children and teenagers using e-cigarettes is a trend causing serious public health concern. In 2019, the American Medical Association and other public health organizations issued a statement urging the US government to remove all flavored e-cigarettes from the market. In June 2022, the US Food and Drug Administration (FDA) pulled popular brands of e-cigarettes and e-cigarette pods, such as Juul, from store shelves for teenagers (the order is currently on hold, while safety studies are conducted on the brand).
What is an electronic cigarette?
Dr. Ke from Providence Mission Hospital in Southern California explained that electronic cigarettes are battery-powered devices that contain a liquid which is heated and then inhaled like regular cigarettes. This liquid contains nicotine, flavorings, propylene glycol, vegetable glycerin, and other ingredients, which form an aerosol when heated. Many smokers believe that switching to electronic cigarettes, also known as electronic nicotine delivery systems (ENDS), is a healthier alternative because they inhale water vapor instead of tobacco smoke. However, this concept is incorrect.
Dr. Kri stated that the US Food and Drug Administration has not yet evaluated the components of e-cigarette aerosol. Therefore, it cannot be considered a safer way of consuming tobacco.
What is in an electronic cigarette?
The electronic cigarette liquid, or e-liquid, is made up of nicotine, propylene glycol (a colorless, odorless liquid with a sweet taste), and other flavorings and chemicals. According to Krebs, "Electronic cigarettes come in a variety of shapes and sizes, and can look like traditional cigarettes, pipes, pens, and cigars.
Many electronic cigarettes use flavorings to attract young people. According to a recent study by the Centers for Disease Control and Prevention, e-cigarette flavors range from fruity to candy or dessert-like, chocolate and even mint. While these "fun" flavors may make e-cigarettes seem harmless, their content is far from it. In addition to nicotine, e-cigarettes typically contain ultrafine particles (which can be inhaled deep into the lungs), chemicals such as diacetyl (linked to lung disease) and heavy metals such as nickel, tin, and lead, as well as carcinogens.
What is JUUL?
David, the medical director of the Connecticut Children's Medical Center Network in Hartford, stated that JUUL is an extremely popular electronic cigarette brand among young people. He explained that the battery-powered device has a shape similar to a USB flash drive and contains approximately the same amount of nicotine as a pack of 20 cigarettes. While the legal age to purchase JUUL is 18 years old (in some places it is 21), many underage individuals still manage to obtain the product from physical stores, friends, family, or online sources.
Dr. David explained that in June 2022, the FDA issued a Marketing Denial Order (MDO) to JUUL Labs Inc. for all of its products in the United States. These orders require the company to stop selling and distributing its JUUL electronic cigarette devices and several electronic pod products.
However, on July 5th, the FDA suspended orders and conducted additional research on the safety of the product. During this review process, JUUL products can still be purchased, as well as other e-cigarette brands that are not affected by the orders.
What are the health risks of electronic cigarettes?
Similar to traditional cigarettes, prolonged use of electronic cigarettes can pose serious health risks.
Dr. Krebs stated that research has shown smoking can cause significant harm to the lungs and heart. For example, he explained that nicotine is a potent vasoconstrictor or blood pressure raiser. Due to the rapid delivery of nicotine into the body through e-cigarettes, vaping may pose a serious risk to the lungs and heart.
In addition, e-cigarette liquids contain ingredients and compounds that pose health risks. According to a doctor, inhaling e-cigarette vapors also increases the risk of certain diseases, including:
The use of electronic cigarettes is causing respiratory irritation and lung disease. This is an alarming trend that doctors are witnessing, with a growing number of young people being hospitalized in the pulmonary disease department due to e-cigarette use.
The risk of developing heart disease increases. According to Dr. Cree, this is due to the inhalation of ultrafine chemical particles, which include acrolein, formaldehyde, and acetaldehyde, all of which are deadly cardiovascular toxins. Inhaling carcinogens such as acrolein, lead, and formaldehyde also increases the risk of developing cancer.
There is an increased risk of blood clots, especially in individuals who use certain types of birth control measures.
Chronic respiratory issues. According to Dr. Kroll, there is a significant link between the use of electronic cigarettes and an increase in chronic cough, bronchitis, and asthma in teenagers.
Nicotine addiction
According to a study published in the American Journal of Public Health in 2017, up to 99% of e-cigarettes sold in the US contain nicotine, but this ingredient is not disclosed on the product label. Nicotine is highly addictive due to the increase in endorphins or feel-good chemicals it produces. It also increases dopamine levels, a neurotransmitter that can lead to stronger dependence on nicotine.
As the effects of nicotine gradually dissipate, withdrawal symptoms such as irritability, anger, difficulty concentrating, restlessness, insomnia, depression, anxiety, and increased appetite may occur, making quitting smoking even more challenging.
Teen Smoking
Electronic cigarettes were initially developed as a tool to help people quit smoking, but in reality, they may be creating new smokers altogether. According to the 2021 National Youth Tobacco Survey, over 2 million American high school students reported current use of electronic cigarettes.
Dr. Kroll explained that electronic cigarettes contain the same psychoactive elements as regular cigarettes (nicotine), often in higher doses. "Nicotine has neurotoxic effects on the developing brain, which is rapidly developing during adolescence. If someone uses products containing nicotine, such as electronic cigarettes, during early childhood, the addiction becomes stronger and quitting smoking becomes more difficult," continued the doctor.
According to Dr. Cruel, young people who use e-cigarettes are at a higher risk of transitioning to traditional cigarettes compared to those who do not. In fact, a study published in 2020 in Mobile Medicine Education showed that young people who use e-cigarettes are 3.6 times more likely to use traditional cigarettes later in life.
Is vaping safer than smoking traditional cigarettes?
Dr. Kroll stated that using electronic cigarettes is not safer than traditional smoking. "We are still learning about how heating the vapor liquid affects overall health. Additionally, the e-cigarette liquid that you inhale and exhale can have negative effects on the health of friends, family, and other loved ones," he explained.
In simple terms, smoking any type of cigarettes poses a risk to your health. If you're looking to quit smoking, there are better options than e-cigarettes. Doctors recommend working closely with your physician to develop a cessation plan, which is a highly recommended choice.
How to talk about e-cigarettes with children.
Dr. Kroll emphasizes the importance of educating oneself about the dangers of e-cigarettes before discussing them with children. It is also important to consider the social pressures that children may face, as many parents may have faced similar pressures during their own upbringing.
Experts suggest starting a dialogue with children about cigarettes and e-cigarettes early on, sharing facts about the harmful effects of smoking. Dr. Kroll advises parents to remain calm, non-judgmental, open, and honest, answering their questions or exploring answers together, if possible.
After your initial conversation about smoking with your child, encourage them to have an open dialogue with you. When they share their experiences, be sure to listen to their opinions.
Ask for their opinions on the topic and be prepared to hear if they may have tried e-cigarettes before. If they have, thank them for their honesty, and place any blame or anger towards the e-cigarette company, not your child," advised Dr. Kroll. Then, share your concerns for their health and how e-cigarettes may impact things they care about such as their overall health and physical abilities.
If your child is addicted to e-cigarettes, you can reach out to your pediatrician or other trustworthy resources to help them quit. Dr. Kroll suggests setting a good example by not smoking or using e-cigarettes yourself, and making your home a smoke-free environment.
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