If you are a parent or work with teens, you know that they are vaping –
using battery-operated e-cigarettes that deliver nicotine and other
additives in the form of an aerosol – at an alarming rate. In 2016, the
U.S. Surgeon General called vaping a “major public health crisis,” noting
that teen use of e-cigarettes had jumped an astonishing 900 percent in just
the four years between 2011 and 2015. In the wake of that report, the U.S.
Food and Drug Administration (FDA) announced that it would begin to
regulate these previously unregulated devices.
Yet the FDA has been widely criticized for being slow to act on its promise
to protect teens – earning an “F” for its efforts from the American Lung
Association in late January. What sparked this outrage, and has all of us
in the medical community alarmed, were numbers released late last fall.
These numbers, so startling that the FDA released them early, show that
teen vaping jumped 78 percent in a single year, according to a survey
conducted by the Centers for Disease Control and Prevention. In 2017,
roughly one in 10 teens said they were vaping. Last year it was 20.8
percent, or one in five.
Some attribute this sharp increase to sleek new devices on the market
described as “pod mods” that use nicotine cartridges or “pods” that come in
a variety of flavors.
Pod mods are especially attractive to teens because they are compact,
elegantly designed and easy to use. They look like a flash drive and can be
charged on the USB port of a computer and concealed in the palm of the
hand. Also, the liquids come in child-friendly fruit and candy-like
flavors. Teens say the flavors are one of the main reasons they started
using e-cigarettes, according to the FDA. And young people tend to think of
pod mods as harmless. One survey of teen users found that nearly two-thirds
had no idea their favorite pod mod contained nicotine.
While not all e-cigarettes contain nicotine, researchers have found that
mislabeling and lack of regulatory enforcement are common. So it can be
difficult to know for sure just what you are vaping. Also, some ingredients
in e-cigarettes approved by the FDA as safe to ingest have not been
approved as safe to inhale.
As a result, the FDA commissioner, who had been reluctant to regulate pod
mods because of their popularity with adults who have quit or are trying to
quit smoking, declared teen vaping an “epidemic” last year and announced a
crackdown on retailers selling to children. He also threatened to ban
flavored liquids – something the American Lung Association and other
advocates are demanding – unless pod mod manufacturers come up with a plan
to keep their products out of the hands of teens.
There are a number of reasons I worry about teen vaping. Many teens have
reported experimenting with cannabis oil in e-cigarettes. And many report
that they have tried “dripping” – placing e-liquid drops directly onto
heated atomizer coils for a more potent vaping experience. And, though it’s
generally agreed that e-cigarettes are less dangerous for adult smokers
than traditional “combustible” cigarettes, there is no safe level of
nicotine for anyone under age 25. Health professionals don’t even recommend
nicotine patches and other nicotine delivery systems for young smokers
trying to quit (we focus on behavioral treatments) because it’s so
dangerous for the developing brain.
Nicotine is at least as addictive as heroin and cocaine, and, like those
drugs, it actually rewires the young brain, changing its reward system.
Ninety percent of adult smokers became addicted to cigarettes before they
turned 18; and some 98 percent before they were 25.
Nicotine also affects the development of brain circuits that control
learning, memory and the ability to concentrate. Teens who use nicotine can
develop mood and attention disorders as well as problems with impulse
control. And researchers have found contaminants in e-cigarette aerosols,
including carcinogens and heavy metals like lead, which also causes brain
damage. Contaminants in the aerosol can also damage lung tissue and
exacerbate asthma, even in children who are exposed to it secondhand.
Even more alarming: Some pod mod manufacturers claim that their use of
nicotine salts, a potentially more potent form of nicotine than is used in
other e-cigarettes, means that their products contain a higher and more
fast-acting dose of the drug.
We already know, unfortunately, that teens who vape are more likely to
start smoking traditional cigarettes. That is why we are now asking
teenagers during their annual physical, “Do you smoke or vape?” What keeps
doctors like me up at night is not only the fact that a new generation is
becoming addicted to nicotine, but that we have no idea what the health
consequences of vaping will be 20 years down the line.
For more information on e-cigarettes and vaping, visit the
website of the National Institute on Drug Abuse:
For tips from the Surgeon General about talking to your teens about
e-cigarettes, read this
tip sheet
