By Elizabeth Shane, Martin B. Gonzales and Shawn S. Sidhu

What's With Teen Vaping?

Tackling the E-Cigarette Epidemic in Youth

The Oxford English Dictionary officially introduced "vape" into the lexicon in 2014, when it was named word of the year.

It is defined as the act of inhaling and exhaling the vapor produced by an electronic cigarette or similar device that come in many different styles and looks. The mechanism consists of a removable cartridge containing nicotine liquid, which is heated by a battery and produces a vapor that is inhaled by the user.

E-liquids commonly come in concentrations of 24 mg, 18 mg, 12 mg, 6 mg - or no nicotine. The first e-cigarettes were introduced to the American market in 2007 and it has since grown into an $11 billion industry. Initially developed to help smokers quit traditional cigarettes, e-cigs deliver nicotine without burning tobacco.

E-cigs eliminate a lot of the harmful chemicals and carcinogens, like carbon monoxide and tar, which are created by burning a traditional cigarette. However, because e-cigarettes and e-liquids are currently unregulated, the actual nicotine content and concentration in e-liquids often is different from what is stated on the labels. Cartridges can also be infused with flavorings, or can contain other drugs like marijuana or wax (concentrated marijuana).

Much like cigarette companies in the second half of the twentieth century, e-cig producers have promoted relaxation, travel, cool factor and sex appeal. Vaping has been popularized on social media, by users who post pictures of themselves vaping and share these posts with their friends. E-cig companies use appealing colorful packaging and flavoring, such as bubble gum, cotton candy, mango, crème brulee, and cool mint, to promote teen usage.

Many teens are unaware that e-cigs contain nicotine and believe they are just ingesting flavored vapor, contributing to e-cigarette use among youths reaching epidemic proportions.

According to data from the 2011-2018 National Youth Tobacco Survey, the number of middle school and high school students who currently vape is 3.6 million. The survey also reports that teenagers who use e-cigs are more likely than non-users to start smoking, so that 30.7 percent of teens who used e-cigs started smoking cigarettes, cigars, and hookahs within six months, as opposed to 8.1 percent of non e-cig users. The FDA has called e-cig companies to account for their direct-to-youth advertising and launched programs to reduce teen use.

The most popular e-cig device on the market today is the JUUL, which resembles a USB device and is often referred to as "the iPod of e-cigs." A single pod provides about 200 puffs and contains as much nicotine as a pack of 20 regular cigarettes. Nicotine is found naturally in tobacco and is what causes a lot of the addictive properties associated with tobacco products but e-cig vapor can also contain heavy metals and harsh chemicals.

There is some evidence that nicotine may lead to changes in adolescent brain development, especially the areas associated with attention, learning and memory. Nicotine also lowers impulse control, can worsen depression and anxiety, and can prime the adolescent brain for addiction to other drugs.

While we can't say for sure that nicotine causes cancer, cells exposed to nicotine have thousands more mutations than non-exposed cells, and nicotine promotes tumor growth in lung cancer, gastrointestinal cancer, pancreatic cancer and breast cancer. It can also lead to hypertension and diabetes.

Additionally, nicotine is dangerous during pregnancy, as it crosses the placenta and can harm the developing fetus. Nicotine also affects blood flow to teeth and gums, causing bacterial buildup, dry mouth and tooth decay. The end result is bad breath, red, irritated bleeding gums and loss of teeth.

Certain vaping flavors in particular are linked to lung inflammation, lower immune response in the lungs and possible clot formation and tightening of blood vessels that feed the heart.

While e-cigarettes may be less dangerous than smoking tobacco, they do carry some risk to consumers. It is important for parents to start the conversation with their children about e-cigs (see "How to Talk to Your Kids About Drug Use").

You might ask your child what he or she thinks about a situation you witness together, such as someone using an e-cig. Know who your kids' friends are and what they do, start by taking an interest and being inquisitive. Educate your kids about the harms of nicotine including things kids care about such as tooth decay.

If you have difficulty starting the conversation ask your health care provider or another trusted adult, like a teacher or coach, to talk to your child about the risks of e-cigarettes. If your child is using vaping to self-medicate anxiety or depression, they should be referred for mental health treatment or medication management.

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