“Everyone else is doing it”: A Breakdown of Vaping, the Dangerous Trend Among Teens

Make no mistake, vaping – the inhaling of a vapor produced by an electronic cigarette (e-cigarette) or vaping device – is becoming increasingly more common in our society.  So much so, medical professionals believe it’s caused a deadly outbreak of lung-related illnesses across the country. Among all the different age groups, adolescents are the most susceptible to developing an addiction to vaping. If you aren’t familiar with the dangers of vaping, here’s what you need to know:

What is vaping, in the teenage cultural sense?
Vaping is considered to be the new “behind the dumpster” – and, for that matter, in front of the dumpster, in the car, in the classroom, at the football game – favorite teen activity.

The Facts

• Vaping is associated with using electronic vaping products (EVPs) or electronic nicotine delivery systems (ENDS), like e-cigarettes (e-cigs), vape pens, e-hookahs, tanks, mods, and dab pens (devices used solely for vaping THC, the ingredient in marijuana that makes people high).
• What is JUUL? JUUL is the most popular brand of battery-powered e-cigarette among young people. It’s shaped like a USB flash drive, so teenagers who use them can be very discreet. People who vape JUUL products commonly refer to vaping as “Juuling.”
• A JUUL “pod” has the same amount of nicotine as a pack of 20 regular cigarettes.  
• E-cigarettes work by heating a nicotine-containing liquid to produce an aerosol that is inhaled.
• E-cigarette aerosol is NOT harmless “water vapor.” It can contain: nicotine, ultrafine particles, flavorings such as diacetyl (a chemical linked to a serious lung disease), volatile organic compounds, cancer-causing chemicals, and heavy metals such as nickel, tin, and lead.

The Stats

• According to the Centers for Disease Control and Prevention (CDC), more than 1 in 4 high school students (27.5%) in 2019 have used an e-cigarette in the past 30 days.
• From 2017 to 2018, use of vapes and e-cigs increased 78% among high school students and 50% among middle schoolers.
• Approximately two-thirds of JUUL users aged 15 to 24 do not know that JUUL always contains nicotine.
• Nearly 97% of users aged 12 to 17 choose fruit, mint, or menthol-flavored products.

The Attraction of Electronic Vaping Products

• EVPs are considered by users as a trendy way to smoke. Cigarettes are now considered unfashionable.
• Electronic vapor products are sleek and inconspicuous.
• They are available in many flavors, including fruits, menthol, and mint. 
• They’re taxed at a lower rate compared to conventional cigarettes. 
• Advertising companies easily target and manipulate youth by using celebrity promoters to fulfill powerful psychological needs like popularity, peer acceptance, and a positive self-image, while marketing EVPs as products to help people quit smoking, a claim the FDA has dismissed. 
• Young people have described the feeling after smoking as a “little head high” or “little buzz.”
• These devices also can be used to vape THC liquid and other drugs.

The Catch

• Vaping is just a new, easier way of becoming addicted to nicotine. It makes teens statistically more likely to go on to use real cigarettes and increase the risk for addiction to other drugs.
• Surprise! Nicotine harms adolescent brain development, which continues into the early to mid-20s. This is a crucial time for development of brain synapses related to attention, learning, mood, and impulse control. 
• Users may not know what is in the vaping solutions. Many of the products and substances can be modified by suppliers or users. They can be obtained from stores, online retailers, from friends and family, or “off the street.”    
• There is not enough vaping history for scientific evidence regarding what will happen in 10, 20, or even 50 years – which makes the dangers of vaping all the more concerning.

The Impact 

• New outbreak of pulmonary (lung) disease related to THC-containing vape products. 
• As of Nov. 20, 2019, there have been 2, 290 cases of lung injury (EVALI) associated with use of e-cigarettes or vaping products, reported to the CDC.
• Forty-seven deaths have been confirmed in 25 states and the District of Columbia.
• As of Nov. 5, 2019, 15% of these patients are under 18-years-old and 38% of patients are 18 to 24 years old.
• On Nov. 8, the CDC identified vitamin E acetate – a compound used in many foods, supplements, cosmetics, and vaping products – as a “potential toxin of concern” after it was found in 29 patients from ten different states. The CDC says it will continue investigating other substances and products because there could be more than one cause of this outbreak. A new report released by the CDC points to more evidence vitamin E acetate is a factor in the EVALI outbreak and why the illnesses are appearing in 2019 specifically.
• Extremely high levels of the chemical vitamin E acetate have been found in many cannabis-containing vaping products. 
• The outbreak is occurring as the popularity for e-cigarette products rises. Companies are producing and marketing EVPs with a mix of ingredients, complex packaging and supply chains, and with that, potentially including illicit substances.

The Federal Government Steps In
What’s the government doing?

• The Trump Administration is considering raising the age to purchase vaping products in the U.S. to 21. On Nov. 19, the House Energy and Commerce Committee passed a measure that would raise the purchasing age to 21, ban all flavored tobacco products, and ban online sales.  Senate Majority Leader Mitch McConnell has proposed a similar anti-tobacco bill, but if passed, the federal government would not restrict tobacco product sales.
• The U.S. Food and Drug Administration (FDA) proposed to pull all non-tobacco-flavored e-cigarettes off the market until their safety can be reviewed. However the Trump Administration recently announced it will no longer pursue a ban. On Nov. 22, President Trump met with representatives of the vaping industry and medical professionals to develop a solution to the youth vaping epidemic.
• In September, 2019, the FDA issued a warning letter to JUUL for illegally marketing its products as a safer alternative to smoking cigarettes, among other claims. The agency ordered the company to respond within 15 working days with corrective actions and its plan to comply with federal law. In October, JUUL Labs announced it would temporarily halt sales of fruit-and dessert-flavored e-cigarettes online and to retailers. In November, the company said it would stop selling mint-flavored pods, another popular flavor among teens. 
• Acting FDA Commissioner Ned Sharpless, MD, released a statement: "To combat the epidemic rise in youth use of e-cigarettes, we're aggressively enforcing the law and investing in campaigns to educate youth about the dangers of e-cigarette use. Our educational efforts include youth-focused prevention messages on TV, digital platforms, posters in high school bathrooms, and lesson plans developed with Scholastic for educators." 

What can parents do?

• Set a good example by avoiding nicotine-containing products. 
• Learn about the different types of e-cigarettes available and the risks for using them.
• Talk to your children openly and without judgment. 
• Refer to this Tip Sheet for Parents, published by the CDC. 

How are physicians and other health care providers getting involved?

• As physicians educate themselves about the different types of e-cigarettes, vapes, and substances, they may warn all patients, especially young ones, about the risks of all forms of tobacco product use, including vapes. 
• A primary care physician might ask if you’ve used e-cigarettes or similar devices and ask about symptoms when screening for the use of tobacco products.
• If patients admit to using any of these products, a physician may ask: The type of vaping they do (nicotine, THC, or both); Source of the product (location purchased and whether its commercial or homemade or otherwise); and the type of device used.
• Doctors may encourage patients who use these products to avoid buying from informal sources or “off the street,” and advise against modifying or adding any substances to these products that are not intended by the manufacturer.
  A physician could consider vaping-related lung disease for any young patient complaining of coughing, shortness of breath, or chest pain. Often these symptoms are also accompanied by nausea, vomiting, or other stomach-related concerns.
• Physicians will report any case of confirmed vaping-related pulmonary disease to your local or state health department.

Resources for further reading and guidance for parents:
INFORMATION FOR PARENTS, EDUCATORS, AND HEALTH CARE PROVIDERS 

“The Real Cost” Campaign 

Safer ≠ Safe