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To Vape or Not to Vape — Is That the Question?
Tuesday, May 16, 2023 3:37 PM

To Vape or Not to Vape — Is That the Question?

Tuesday, May 16, 2023 3:37 PM
Tuesday, May 16, 2023 3:37 PM

What should you do if your kids have been vaping? Learn all you can about it and then start the conversation with them.

If you ask kids in middle or high school about vaping, you’ll probably hear them say that it goes on all around them. Some may also say that they have tried it. And you may even get a “What’s the big deal?” pushback.

What, in fact, is the big deal? Why is the Centers for Disease Control and Prevention sounding alarms about the use of e-cigarettes? Why is the Food and Drug Administration seeking to regulate how, where and to whom they are sold?

What, in fact, is the big deal? Why has the Centers for Disease Control and Prevention (CDC)sounded alarms about the use of electronic cigarettes (e-cigarettes for short) over the past several years? Why does the Food and Drug Administration (FDA) regulate (as much as possible) how, where, and to whom they are sold?

Using e-cigarettes, also known as “vaping,” appears to be a safer alternative to smoking or chewing tobacco, at least for those who are struggling to quit using tobacco. But for those who aren’t tobacco users — especially kids and teens — vaping is definitely a bad idea. For some adolescents and young adults, vaping may actually be an onramp to a tobacco habit. 

A Dangerous Addiction

 

Smoking tobacco products holds the dubious distinction of being extremely harmful to just about every part of the body. The facts are dismal. The latest (2014) version of the Surgeon General’s Report on the consequences of smoking noted:

 

Cigarette smoking is responsible for more than 480,000 deaths per year in the United States, including more than 41,000 deaths resulting from secondhand smoke exposure. This is about one in five deaths annually, or 1,300 deaths every day.

Worldwide, more than 7 million deaths per year are attributed to cigarette use. This habit is also linked to cancer (of the lungs, mouth, throat, vocal cords, and esophagus), clogging of arteries, chronic lung disease and a wide assortment of other ailments.

If cigarettes are so harmful, why are they so hard for smokers to give up?  Because along with the many products of combustion sucked into the body with every puff, cigarettes also deliver nicotineto the bloodstream with spectacular efficiency. This substance has the unique ability to be both relaxing and stimulating, at least for adults. It is also incredibly addictive, both physically and psychologically. Those habituated to its effects will crave it, sometimes desperately, within a few hours after their last dose.

Smokers who are trying to quit will typically try various methods of delivering nicotine in order to stave off withdrawal symptoms. You no doubt have seen nicotine patches, gum and lozenges for sale. These can be helpful to varying degrees. But they don’t deliver the “hit” of nicotine delivered from cigarette smoke.

These delivery systems don’t supply the ritual of inhaling and blowing smoke that most users find calming and enjoyable.

Enter the E-Cigarette

A “smokeless, non-tobacco cigarette” was patented in the United States in 1965, but the version that has more recently taken the world by storm was developed and introduced in China in 2004 and arrived in the U.S. not long thereafter. A variety of devices and brands of e-cigarettes have entered the marketplace since 2010 and have spread like (smokeless) wildfire.

E-cigarettes originally looked like cigarettes, but they have morphed into dozens of shapes and sizes. They all consist of a battery, a heating element, and a liquid that is vaporized and inhaled. The liquid is water that normally contains flavoring, vegetable glycerin and propylene glycol (both of which disperse the other ingredients and create vapor when heated) — and variable amounts of nicotine. Variations in these components — along with different features, colors and styles — can dramatically impact the appeal, sales and health impact of e-cigarette devices. As we will see, the vaping landscape changes at a breathtaking pace, and keeping up with it can be a challenging task. 

Some Statistics

The 2022 National Youth Tobacco Survey (NYTS), an annual study conducted by the FDA and CDC, found that 14.1% of high school students (approximately 2.14 million) and 3.3% of middle school students (about 380,000) reported current e-cigarette use. Of these, more than one in four reported using an e-cigarette product every day. Ask the administrators at your local high school and you will almost certainly hear that dealing with student vaping — in class, in the rest rooms, inside and outside school grounds — is a challenging issue.

What’s Hot, What’s Not With kids?

The e-cigarette brand Juul not long ago was the iPhone of vaping devices. Started by two Stanford University graduate students, Juul burst out of the blocks in 2015. Within 2 years its sales represented 29% of the US market, rising to a whopping 73% in 2018. By the end of 2018, Juul had 1,500 employees, and in 2019 its revenue hit the $3 billion mark. By the end of the decade, the word Juuling had become synonymous with vaping. 

Juul’s success in such short order was largely due to its appeal to kids. The Juul device was slick and sleek, closely resembling a flash drive and very easy to conceal. It emitted only a modest amount of vapor or aroma, and thus was easier to use without being detected. Juul’s liquid “pods” originally came in a variety of flavors that were appealing (or at least not threatening) to kids: Creme Brulee, Cool Mint and Fruit Medley, among many others. Last, but definitely not least, Juul’s creators spent considerable time and effort to make their device highly efficient at delivering nicotine. In so doing, it replicated the “hit” that keeps tobacco users hooked on cigarettes.

Juul’s founders stated repeatedly and adamantly that their sole purpose was to create a device that would allow smokers to quit. But their initial advertising campaigns and aggressive use of online marketing pushed all the right buttons to attract kids, presenting images of attractive/hip people, slick and sleek like their product, having a great time using it. And therein were planted the seeds of Juul’s downfall.

As of 2023, Juul and its sales have nearly vaporized. It has paid hundreds of millions of dollars to settle thousands of lawsuits arising from the early marketing of its highly addictive products to teens. It has been stripped by various governmental agencies of most of its capacity to sell its products. Juul’s website is now distinctly uninviting to teens (or anyone else). Colorful screen images have been replaced by stark verbiage that Juul is intended to help smokers quit–period. 

But guess what?  Into Juul’s vapor void raced a variety of disposable (i.e., use and toss, rather than refill) vape brands that picked up where Juul left off. There has been a marked increase (to more than 50% as of 2022) in the use of disposable e-cigarettes such as Puff Bar and Vuse as the preferred product among middle and high school students. Prefilled devices using refillable pods or cartridges now run a distant second at 25%, and Juul, which once dominated the latter category, has all but disappeared from the playing field. 

Sadly, the disposable brands cheerfully work from Juul’s old playbook, with colorful products and websites, and plenty of appealing flavors to choose from. The 2022 National Youth Tobacco Survey found that nearly 85% of current middle and high school vapers use flavored e-cigarettes. Fruit flavors are the most popular, followed by candy or other sweets. Puff Bar options, for example, include Peach Ice, Blueberry and Pink Lemonade.  In addition, online vendors offer a host of colorful wraparound “skins,” decals for the Vuse device designed to “show off your style.”  

Finally, in an attempt to do an end-run around regulators (and thus avoid limitations that might be placed on their sales efforts), some disposable e-cigarette manufacturers claim that their products contain “synthetic nicotine” not derived from tobacco. The American Lung Association has issued a blunt response: “Synthetic nicotine is still nicotine,” and thus both highly addictive and harmful to adolescent brain development, as we will see momentarily.

So what’s wrong with kids vaping? Let us count the ways.

Exposure of Young Brains to Nicotine

Remember that e-cigarettes were originally designed to help tobacco users shift from inhaling dangerous and toxic clouds of smoke to inhaling water vapor (and a few other odds and ends) as a safer means of managing their nicotine addiction. In other words, their purpose was to migrate nicotine addiction from one delivery format to another, while otherwise perpetuating it. For someone not already using tobacco–especially teenagers–e-cigarettes create nicotine addiction, and once that chemical train has been boarded it is very difficult and unpleasant to get off. 

The last thing that adolescents need during their critical physical, psychological, and social transition to adulthood is to be chained to a distracting and destabilizing chemical tyrant. Indeed, a number of organizations have raised concerns that nicotine can impair adolescent and young adult brain development and cause other harms as well:

  • Young people who have never smoked but take up vaping have a significantly higher likelihood of becoming cigarette smokers later in life.
  • Vaping is associated with increased symptoms of attention deficit disorder (ADD), anxiety and depression.Depending on the duration and intensity of a nicotine habit, withdrawal from this substance can provoke irritability and even agitation – which then drives the user to seek another dose, in whatever format might be available to deliver it efficiently.
  • The adolescent/young adult brain is still growing and maturing until about age 25. Not only does this affect judgment and risk-taking, but it also means that teenagers and young adults are prone to addiction than older adults. Among young people a nicotine dose of 5 mg. per day – roughly one fourth of the amount in the majority of disposable vapes–is enough to establish an addiction to nicotine. For a real-world check, ask any long-term smoker (especially one who has had difficulty quitting) when he or she got started. You will invariably hear that it was during their teen years — or earlier. Very few people start smoking when they are 35 years old and have a spouse, kids and a career well under way.

Long-term Impact on Lungs

While inhaling flavored water vapor is generally recognized as less harmful than inhaling smoke, no one really knows what may be the long-term impact — on airways, lungs, and the overall body — of repeated exposure to the compounds emitted by e-cigarettes.

Kids and adults with asthma are likely to have their symptoms aggravated by inhaling e-cigarette vapor, for example, but that may be the tip of an iceberg whose size and destructive potential will not be recognized until decades have passed.

Other Potential Harms

  • Nicotine exposure poses a health risk both to pregnant mothers and their developing babies.
  • Though rare, fires, and explosions involving e-cigarettes, usually while devices with lithium batteries are being charged,have caused burns (but thus far no deaths). E-cigarettes with lithium batteries are not allowed in checked bags on aircraft for this reason, and may not be used or charged by passengers who bring them into the cabin.

Talk About Vaping

What should you do if you think your kid might be vaping? In a nutshell, find out.

This has two components:

  • Ongoing big-picture efforts at home, including building and maintaining a loving relationship through the teen and young adult years, open and transparent communication, creating a family culture that makes drug use (of all kinds) unattractive, transmission of values, and a whole lot of prayer.
  • Opening specific dialogue about vaping in particular: Is it going on around you at school? Has anyone offered a vaping device to you? Have you tried it? Interrogation will be less effective than genuine interest, and some candid (and hopefully well-informed) discussion of the risks will go a lot further than a lecture.

  • If Your Kid is Vaping

    What should you do if your kid has been vaping? You’ll need to help her take this bull by the horns, which first requires understanding how big the bull really is.

    Again, without shaming and lecturing, try to find out what substance she’s using, how much and how often, and for how long she’s been using it. On one end of the spectrum, you may be dealing with experimentation and dabbling, which hopefully can be curtailed with some conversation about risks to be avoided.

    Perhaps by now she’s endured enough clouds of vapor in the lavatory, or seen some agitated behavior from a habituated vape user, and is now ready to steer clear of this product in the future.

    If your adolescent or young adult is already a steady consumer of vaporized nicotine, you (and he) may have a bigger challenge ahead. Remind him that this substance is highly addictive, and that the original idea of the e-cigarette was to wean smokers to a (theoretically) safer product–because they couldn’t successfully quit using nicotine gum, lozenges, or patches. But once aboard the vaping train, how does one get off?

    Withdrawal Strategies

    The skyrocketing use of vaping devices among adolescents has created a daunting public health challenge: How to help untold thousands of teens and young adults become free from nicotine addiction.

    While one size definitely does not fit all, for now it would appear that behavioral approaches – specifically (and not surprisingly) utilizing digital and text-messaging support – can be effective.

    The nonprofit Truth Initiative, which has mounted an active campaign to end both tobacco and vaping for more than two decades, has created a text-messaging based program called “This is Quitting” that teens can access by texting “DITCHVAPE” to 88709. “Become An EX” (EX for short), a free online program developed by Truth Initiative in collaboration with the Mayo Clinic Nicotine Dependence Center, offers a multi-faceted approach that includes quitting plans for all forms of nicotine dependence, including support for parents want to help their kids stop vaping. (Access at becomeanex.org.)

    Withdrawal Symptoms

    If anxiety, depression, headaches, or other problems surface, visit your teen’s physician. Keep in mind that underlying anxiety and depression can contribute to a nicotine addiction rather than result from it, and these factors must not be ignored. Your teen’s doctor may or may not have an inside track on the latest approaches to nicotine withdrawal, but at the very least medical conditions such as iron deficiency or a thyroid malfunction — though rarely the primary problem, but simple to assess — can be ruled out.

    You may need a referral to a professional who is qualified to provide medical management for depression and anxiety. Counseling, both for the addicted individual and his or her family, is definitely a good idea. Support from your pastor, as well as a trusted friend or relative who has had to navigate an addiction in the family, would be highly advisable. Last (but really first) and certainly not least, prayer should bathe the entire process.

    Stay Informed

    The story on vaping and nicotine addiction continues to unfold. For updates, continue to check websites such as:

By Dr. Paul C. Reisser

Published on Tuesday, May 16, 2023 @ 3:37 PM EDT

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