E-cigarettes have grown in popularity, particularly in younger populations such as high schoolers. Vaping is inhaling an aerosol created by a battery-powered electronic device. The aerosol is typically made from a liquid that contains nicotine, flavorings, and other chemicals. It was initially marketed as a less harmful alternative to smoking, but recent studies have shown that the risks are hardly less harmful than their traditional cigarette counterparts. How did this come to be?
Background
As early as 1930, electronic cigarettes were mentioned, with Joseph Robinson filing a patent for the first e-cigarette. The development of these devices began in the 1960s, but they have yet to be commercialized. Up until the 1990s, both tobacco companies and individual inventors continued to submit patent applications for other vaping devices. 2003, the first e-cigarette was commercially successful. Hon Lik developed this version of the device after his father, a heavy smoker, passed away from lung cancer. The goal of the vape advertisement was to market the product as a smoking cessation aid. Vapes became established in the U.S. A couple of years later, the World Health Organization proclaimed that, despite companies’ efforts, vapes are not considered a legitimate smoking cessation aid. Over the next few years, several countries banned vaping devices, and several pieces of legislation were passed to prevent their distribution. However, its popularity persisted, and a case between Smoking Everywhere v. FDA in 2010 ruled that the FDA can only regulate e-cigarettes as a tobacco product. Vapes have since been distributed around the world, including within the U.S., despite efforts to ban their production and distribution. Further information about the history of vapes can be found on the Consumer Advocates for Smoke-Free Alternatives Association website[2].
Flash forward to 2024; e-cigarettes are now the most commonly used tobacco product in not only high school students but middle school students as well. A recent study found that 1.63 million students vape, 410,000 middle school students, and 1.21 million high school students. Of those who use e-cigarettes, 87.6% use a flavored device, 55.6% use disposable vapes, 15.6% use prefilled or refillable pods/cartridges, and 7% use tanks/mod system. A demographic breakdown of middle and high school students who vape shows that certain groups have high rates of e-cigarette use[4] :
- Non-Hispanic multiracial students: 20.8%.
- Non-Hispanic White students: 18.4%.
- Hispanic or Latino students: 18.2%.
- Non-Hispanic American Indian and Alaska Native students: 15.4%.
- Non-Hispanic Black or African American students: 12.9%
Elf Bar, Breeze, and Mr. Fog are the most commonly used brands. The study also reviewed attempts and desire to quit. 63.9% of students in 2020 reported wanting to quit, and 67.4% reported trying to quit in the last year[4].
Wht Teenagers Vape
Several factors contribute to the teen vaping epidemic. Starting with tobacco companies, advertising for e-cigarettes has been heavily aimed at teens[10]. The billboards, packaging, and products are all made to be appealing to teens. Indeed, 78% of middle and high school students have been exposed at least once to a vape advertisement[10]. The pods are made to be colorful and come in appealing flavors such as gummi bear or mango. Vaping devices are also designed to be discrete, modeled after USBs, pens, and inhalers.
Social influences also contribute to teen vaping. A study in 2021 demonstrated that out of the middle and high school students who use e-cigarettes, 32.3% got them from a friend, 31.1% bought the product themselves, 28.7% had someone else buy it for them, and 21.7% had someone offer the products to them[5]. With vape use being so normalized in social settings, youth are being exposed more frequently to this habit, making it more likely that they will also want to participate.
Nicotine is the primary substance in e-cigarettes. Being an addictive substance, continued nicotine use can lead to dependence on nicotine-containing products. Adolescents using e-cigarettes puts them at significant risk of nicotine addiction due to their brains still developing; addiction can sometimes start before the start of regular or daily use. Even just social experimentation with vapes can lead to addiction, and with the average nicotine content of a vape being 5%, they are exposed to higher doses of nicotine compared to regular cigarettes. Nicotine dependence can have significant effects, such as not being able to stop smoking, giving up social activities because one will not be able to smoke them, and withdrawal symptoms when you try to stop. Symptoms include intense cravings, anxiety, irritability, restlessness, difficulty concentrating, depressed mood, frustration, anger, increased hunger, insomnia, and constipation or diarrhea[11]. These symptoms make it hard to stop smoking, causing many people to go back to smoking to feel “okay” again, feeding the addiction further.
Health Effects
Although e-cigarettes have fewer chemicals than traditional cigarettes, they still pose a significant health risk to teens and adults alike. The aerosol that comes from vaporizing products contains substances that are harmful or potentially harmful. Firstly, they contain nicotine, which is harmful to adolescent brain development. Heavy metals such as tin, nickel, and lead are also used in these products. High enough doses of heavy metals can lead to lower energy levels and can cause damage to the brain, lungs, kidneys, liver, blood composition, and other vital organs[9]. Vape products also contain tiny particles that can be inhaled deep into the lungs. These exposures can lead to bronchiolitis obliterans, also known as popcorn lung. Popcorn lung is a respiratory condition affecting the bronchioles of the lungs. Airways become inflamed, damaged, and then scarred due to the inhalation of toxic substances found in vape products [6]. Substances associated with popcorn lung, such as acetaldehyde, formaldehyde, and diacetyl, are found in e-cigarettes.
The mental effects of vaping are also an area of concern. Nicotine use in adolescence can harm parts of the brain that are still developing and control attention, learning, mood, and impulse control[7]. Because of this and the addictive nature of nicotine in general, teens are put at risk for current and future addiction to other drugs[7]. Mental health effects due to vaping include an increased risk of depressive symptoms. Teens who use e-cigarettes are more likely to have a history of depression, which increases with more frequent use of e-cigarettes[1]. These effects can cause teens to continue using e-cigarettes as they try to cope with stress and anxiety, leading to a cycle of nicotine dependence. Furthermore, continued use of e-cigarettes can lead to acute lung injury, heart disease, lung disease, COPD, asthma, and lung cancer[1].
Laws in Smoking and Vaping
There has been movement on both federal and state levels to reduce the amount of teens using e-cigarettes. As early as 2009, the Family Smoking Prevention and Tobacco Control Act aimed to address the teen smoking epidemic. This act gives the Food and Drug Administration authority to regulate the manufacture, distribution, and marketing of tobacco products[8]. This restricts tobacco marketing and sales to youth, requiring warning labels on smokeless tobacco products and disclosure of ingredients in tobacco products, and preserves state, local, and tribal authority. Schools have also stepped their strategies up: campuses have begun to install vape detectors in their bathrooms and other areas where teens could be found vaping[12]. School administrators will then determine disciplinary actions should a student be caught vaping. Some schools have gone as far as to fine students for vaping at school.
What is Being Done?
Multiple organizations work towards smoking cessation and prevention in teens. Coordinated Approach to Child Health, or CATCH My Breath, works to empower students with the knowledge and skills needed to make informed decisions about vaping and resist social pressures to do it.. Their advisory board is informed by tobacco youth prevention researchers, practitioners, and youth[3]. This program approaches this issue via peer-led teaching, and it is the only school-based program to prevent vaping that has proven to reduce the likelihood of vaping among youth.
Conclusion
Vapes pose a public health threat to youth and adults alike. Youth are susceptible to the adverse health effects associated with vape use. It is essential to emphasize the risks of vaping to teens both in school and at home, and parents should educate themselves on how to prevent their children from vaping and how to help them quit should they start. Legislation needs to continue to place regulations on vape products and restrict who can purchase them. Reselling of vapes should also be banned to prevent youth from being able to purchase them in hopes of reducing the number of teens who smoke. Working together as a community to advocate for our teens to stop vaping will be what helps make a meaningful impact on this epidemic.
