Vaping, E-cigarettes, and JUULing: What Parents of Teens Need to Know
Vaping was initially marketed as a safe alternative to cigarettes and a smoking cessation method—but there is little evidence that either claim is true. Here's what you need to know about the effects of e-cigarettes on kids, including the vaping-related disease called EVALI that's affecting young people nationwide.
It should come as no surprise that teenagers sometimes make bad decisions. Asserting their independence, pushing boundaries, and taking risks are hallmarks of the teen years, as anyone who has parented a teen knows well. Sometimes, however, their penchant for personal revolution results in self-destructive or dangerous behavior.
Over the last decade, teen smoking has been on the decline, with fewer teens saying they smoke regularly—8.1 percent in 2018 down from 15.8 percent in 2011. On the rise, however, is the use of e-cigarettes or vapes. And it can be dangerous for teens.
The Centers for Disease Control and Prevention issued a warning urging consumers to stop using e-cigarettes while an investigation is ongoing into deaths related to vaping. Reports of the disease, named EVALI for "e-cigarette or vaping product use associated lung injury," have skyrocketed to 2,758 cases and 64 deaths.
Last year, JUUL stopped advertising on social media after criticism that the ads targeted teen Instagram users. In July 2019, the then-CEO of Juul apologized to the parents of teen JUUL users. “I’m sorry that their child’s using the product,” former Juul CEO Kevin Burns told CNBC (who recently stepped down as CEO due to widespread backlash to e-cigarette marketing and health risks). “It’s not intended for them. I hope there was nothing that we did that made it appealing to them. As a parent of a 16-year-old, I’m sorry for them, and I have empathy for them, in terms of what the challenges they’re going through.”
Even so, a House subcommittee claims that Juul went after youth with a “sophisticated program” surrounding messaging on school grounds, according to The New York Times. They mention, for example, how a Juul representative told New York City-based students that the products were “completely safe” during an April 2017 visit (no teachers were in the room at the time). Juul also sponsored a summer camp about healthy lifestyles with a charter school organization in Baltimore last year. The House subcommittee also states that Juul marketed products to teens through online influencers—although Juul denies targeting youth.
This has become such an epidemic, in fact, that Congress passed a law in December 2019 raising the legal smoking age to 21. The law will go into effect in 2020, and it covers both cigarettes and e-cigarettes.
The Food and Drug Administration (FDA) also announced in January 2020 that it's banning mint and fruit e-cigarette flavors, which teens are typically drawn to. Companies that refuse to follow the ban within 30 days will be punished.
Here's what every parent of a teen needs to know about the vaping trend.
What is Vaping or JUULing?
An e-cig is a battery-operated smoking device that contains cartridges filled with a nicotine-based liquid that, when heated, emits a vapor that is inhaled. The act of using e-cigarettes is called vaping or JUULing. Vape liquid is also sold in a wide variety of flavors that increase the appeal for teens. (Juul took many—but not all— flavored liquid off store shelves, and they can only be bought through online sales with age verification).
Although more teens are vaping than ever before, a study released by the NYU School of Global Public Health in January 2020 found that over 86 percent of middle and high school students don’t vape at all. Only a small percentage vape regularly.
Physical Health Effects of Teenage Vaping
Touted as a less dangerous alternative to cigarettes, vaping gained popularity among high- and middle-schoolers who once believed the practice is safe. But according to Yale Medicine pediatrician, Deepa Camenga, the jury is still out on how e-cigarettes affect teen bodies. Several investigations are underway by the CDC and the U.S. Food and Drug Administration after dozens of deaths from lung diseases related to vaping (EVALI).
"We don't know much about what the long-term health effects are because the teen body is still growing, and these are relatively new types of products, so we haven't seen what the long-term effects of using them for years and years would be." Effects of continuous vape use by teens isn't the only questionable issue we face. says Dr. Camenga. She explains, "We also don't know what potential long-term effects there could be if a young person uses them—even if they stop. What does it mean if a young person who is still growing is exposed to the chemicals inside the e-liquids? We don't know that yet."
Riley Children's Health Pulmonologist Nadia Krupp echoes the sentiment. "What we do know is that the e-liquid contained in e-cigarettes includes chemicals that are known to irritate lungs in other settings. What we don't know is how much irritation is happening. There haven't been enough studies done yet to really understand the lasting health effects of vaping."
Research on long-term effects of JUULing is scant due to the limited amount of time products have been available, however, a meta-analysis released in 2018 by the Academies of Science, Engineering, and Medicine found unequivocal evidence that inhaling the vapor from e-cigs is harmful. Vapor can contain toxic chemicals that are linked to respiratory and cardiovascular disease.
The liquid inside vape cartridges is also dangerous on its own. Accidental exposure, by ingestion, ocular, or dermal contact, can cause seizures, brain injury, and death. Vape pens, especially when modified, used improperly, or that have bad batteries, "can explode and cause burns and projectile injuries."
Mental Health Risks for Teens Who Vape
While the long-term effects of vaping specifically have yet to be determined, we do know that the nicotine contained in vape cartridges is not benign. Nicotine is highly addictive and teens who use nicotine can become addicted in just days. Dr. Camenga explains that nicotine affects teens differently than adults because "teens are just more vulnerable than adults are to developing an addiction to nicotine. As a result, it may be harder for teens to stop because their brain is still growing and developing."
Studies have shown that teens who use nicotine may be more prone to mood disorders, due to the drug's effect on how the body uses and processes serotonin, a "happiness hormone." Early use of nicotine effects the areas of the brain associated with serotonin and the damage persists into adulthood. The above-mentioned study, published in the Journal of Physiology reports that products "containing nicotine may have potentially severe consequences for teen addiction, cognition, and emotional regulation. Thus, not only tobacco but also e-cigarettes must be considered as serious threats to adolescent mental health."
Nicotine use also puts teens at risk for further addiction. Researchers from Yale showed high schoolers who reported vaping were 7 times more likely to report cigarette use 6 months later. Despite its popularity among teens, JUULing "can also be a dangerous, seamless transition to cigarettes and other drugs," warns California pediatrician Gina Posner. Due to changes in adolescent brain development caused by nicotine, there is also evidence that teens who use nicotine products are at higher risk for developing addictions to harder drugs, like cocaine. Dr. Posner reminds parents to "be aware that vaping is very addictive and since we don't know its long-term consequences, it is really important to discourage their teen's use."
What Parents Can Do About Vaping
When it comes to teens and vaping, Dr. Camenga recommends starting the conversation early, before it becomes a problem.
"I think starting conversations early with your kids about your expectations of them when making choices around tobacco products and as they get older with alcohol and other drugs is important." Parents should never underestimate the power of peer pressure and keep in mind the influence teens face to fit in and conform. "It's good to have your kids come to you with those questions and seek your advice because so many kids around them are using. I think keeping open lines of communication is important, so you can support them when they're trying to make difficult choices around not using e-cigarettes when everyone around them is."
Dr. Krupp adds, "We know the developing parts of a brain are more susceptible to addiction – making teenagers easy targets for vaping companies' marketing strategies. Seeing these companies target young people with their advertising is very concerning to me and it should also be very concerning to parents."
Open, honest, and direct conversation around the dangers of JUULing and tobacco use should start early and continue. If a parent discovers their teen is using e-cigarettes, support in quitting is of paramount importance. Parents should also consider contacting their physician to discuss successful cessation techniques.