E-cigarettes, vapes and JUUL: Addicting a new generation

May 31, 2018
E-Cigarettes | Texas Children's Hospital
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Today, which happens to be World No Tobacco Day, an international expert report from the Forum of International Respiratory Societies concludes: “Nicotine in electronic cigarettes poses a great threat to youth, and we must protect them from it.”

E-cigarettes and similar products are now arming themselves with a multitude of attractive flavors (like candy and fruit) and sleek designs for discreet usage (such as pens, lanyards, crayons and flash drives) alongside promotion tactics that market a “cool” factor from usage and a false perception of safety. Because of this, these devices are rising rapidly in popularity among middle and high school students. In fact, many teenagers will now report that “everybody” is doing them. You can’t even walk into many high school bathrooms without recognizing the faintly sweet smell they leave behind. These products are introducing our youth to nicotine addiction, eventually leading to other tobacco use.

The generic term for these devices is electronic nicotine delivery systems (ENDS). Different types of electronic nicotine delivery systems include e-cigarettes, vape pens, e-hookahs, e-shisha, mechanical mods, tank systems and JUUL. For the sake of simplicity, I’ll refer to all of them as e-cigarettes. Even though first generation devices looked like traditional cigarettes, or “cig-alikes,” modern devices can look like almost anything and still deliver aerosols of nicotine and other harmful chemicals to the lung. Today, no regulation or standards exist on content, design or manufacturing of these products. E-cigarettes typically contain propylene glycol and/or glycerin, flavoring agents and nicotine, which are then heated to create an aerosol that can be inhaled. Labels may not accurately reflect these contents.

It’s not “just vapor”

E-cigarettes are not safe. Each month, we learn more and more about the harm they cause. Nicotine itself is highly addictive, and the rapidly developing adolescent brain is uniquely susceptible. It has been proven to cause lung damage, with animal models displaying health changes similar to emphysema caused by inhaled nicotine from e-cigarettes. Nicotine isn’t the only harmful component – heavy metal nanoparticles, including nickel, tin and lead are present, likely coming from the casing and solder used in e-cigarette devices.

In addition, flavoring agents that might be safe to eat are often not safe to inhale, and popular flavors are known to cause lung irritation and damage. Carcinogenic (cancer-causing) chemicals have been found in emissions from these devices, likely originating as contaminants (as nicotine is extracted from tobacco) or generated matter from heating the liquid. Smoking from e-cigarettes reduces lung function, leads to chronic respiratory complications and weakens overall lung defense, all increasing risk for both infections (such as pneumonia) and cancer.

E-cigarettes are addicting a new generation

Adolescents who begin using e-cigarettes are more likely to go on to use other forms of tobacco, including traditional cigarettes, and are less likely to stop tobacco use. Nicotine has been considered a gateway drug to other types of drug abuse. In laboratory tests, rats given nicotine end up finding cocaine rewarding. Most adolescent drug and alcohol abusers mention nicotine as their first drug of abuse. We also know that drug abuse is far less common among adolescents who don’t use tobacco and nicotine products.

The U.S. Food and Drug Administration (FDA) is responsible for regulating the manufacturing, distribution and marketing of tobacco products under the 2009 Family Smoking Prevention and Tobacco Control Act. So far, the FDA has failed to take effective action in protecting our youth.

What can a parent do?

Set a good example. The best way to ensure your child avoids smoking or vaping is to be a non-smoker and non-vaper yourself. If you need help quitting tobacco and/or e-cigarette use, speak with your doctor or consider calling 1-800-QUIT-NOW. Nicotine can be one of the most difficult addictions to kick.

Inform yourself. This way, you’ll be able to identify the devices your children might have in their possession. With the increasing number of products designed for discretion, it can be difficult to recognize if something is an electronic nicotine delivery system or not.

Talk with your children, early and often. Let them know how harmful e-cigarettes and other electronic nicotine delivery systems are, how nicotine changes their brain structure and chemistry, how it puts their lungs in danger and how it impacts their breathing and overall ability to maintain an active lifestyle.  Try to correct the false messages.  They may think e-hookah, e-shisha or JUUL are not types of e-cigarettes, and might assume e-cigarettes without nicotine are safe. 

You can also call out how these industries lie to its consumers in their attempts to make these high-addictive and toxic products seem attractive and “cool.”

Lastly, be sure to speak loudly and often with our politicians and policymakers regarding the critical need to protect our children from e-cigarette promotion and usage. The FDA needs to ban flavors, as mint, fruit and candy flavors attract interest from youth.  On a city and state level, we need to raise the age limit for sale of all tobacco products to 21 years old and enforce sale regulations. On a school level, prohibitions on e-cigarette and tobacco usage should be strictly enforced.  

Image courtesy of Centers for Disease Control and Prevention

Post by:

Harold J. Farber, MD

Dr. Farber’s diverse clinical interests include asthma, respiratory care of children with muscular dystrophy, respiratory care of technology dependent children, the chronic care of children with complex respiratory diseases, and the treatment of tobacco dependence. Dr. Farber’s research...

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