Vaping Rates Increasing among Teens

In 2016, the Centers for Disease Control and Prevention (CDC) released survey data stating that the use of cigarette smoking among middle school and high school students continued to follow a two-decade decline, falling to the lowest level ever recorded. But the survey also revealed that a new tobacco product is rising in popularity among teens — the electronic cigarette.

Nationally, e-cigarette use among teens tripled from 2013 to 2014, surpassing the use of other tobacco products, including cigarettes. According to the most recent Texas Youth Tobacco Survey (2016), 12.7 percent of middle school students and 35.6 percent of high school students reported ever using e-cigarettes, compared to 12.8 percent of middle school students and 31.6 percent of high school students using cigarettes. Although those numbers don’t seem far off, data suggests that once teens start using products with nicotine, it usually leads to trying other tobacco products, with many teens citing e-cigarettes as the first tobacco product they ever used.  

E-cigarette users are more likely to take up cigarettes, at a rate of 30.7 percent, versus 8.1 percent for non-users, and teen boys are twice as likely to use e-cigarettes as their female classmates. The Surgeon General’s website “Know the Risks” explains that nearly three in five high school students who smoke also use e-cigarettes.

Compounding the issue, the National Institute on Drug Abuse (NIDA) reports that many teenagers don’t even know what they are actually inhaling, as 66 percent say their e-cigarettes only contain flavoring, while 13 percent say they contain nicotine and another 13 percent admit they aren’t sure. Nicotine is particularly harmful to teens, as their brains continue to grow and develop until around the age of 25. Synapse formation in the brain is negatively affected, which can damage parts of the brain that control attention and learning.

Early exposure to nicotine increases the risk of nicotine addiction, addiction to other substances, mood disorders and a permanent decrease of impulse control. NIDA points to a study that shows nicotine use activates the brain’s reward system, putting e-cig users at a higher risk for addiction to other drugs.

Elizabeth Leon, M.D., a pediatrician and physician on the medical staff at Texas Health Plano, says the amount of nicotine varies widely between manufacturers of e-cigarette liquid — or “juice,” as many teens refer to it — making it difficult for teens to know how much they are actually receiving and elevating the danger of accidental ingestion.

“The main ingredient in e-cigarette liquid is nicotine, and it is packaged in vials that range between six milligrams per milliliter to 36 milligrams per milliliter,” she explains. “A typical vial size will contain five milliliters of liquid, which means it can deliver 30 to 180 milligrams of nicotine per vial.”

To put that into perspective, the average cigarette delivers anywhere between .5 and 1.6 milligrams of nicotine. Many cigarette packs contain 20 cigarettes, meaning one vial of e-cigarette liquid can deliver more than a pack’s worth of nicotine.  

“If the vial is ingested by a child under the age of six years, the lethal dose of nicotine can be as small as 10 milligrams,” Leon says. “With even as little as one to two milligrams of nicotine, there may be nausea, vomiting, increased heart rate, and eye irritation.”

Although e-cigarettes are age-restricted items, many manufacturers still target teens and young adults with often times misleading and colorful packaging. Research published in the journal Pediatrics found that product marketing to teenagers touts that e-cigarettes don’t contain the cancer-causing chemicals in traditional cigarettes. And while they may not include the same toxins, scientists found that e-cigarettes do still contain various chemicals and solvents that form carcinogenic compounds during the heating and vaporizing process. In addition, some researchers believe certain flavors of e-liquids create higher levels of toxins, which is particularly troublesome since many teens say they use e-cigarettes because they prefer the availability of flavors.

Experts warn that while e-cigarettes may not have the old familiar chemicals in them as regular cigarettes (arsenic, carbon monoxide, formaldehyde, tar, etc.), they still contain carcinogens and toxic chemicals, including metals like nickel, chromium and cadmium. The American Lung Association states that e-cigarettes also can contain formaldehyde and diacetyl, a flavoring that causes lung disease.

Leon says teens should avoid tobacco in all forms and recognize the danger of inhaling e-cigarettes, even if they look harmless.

“The current packing and flavorings offered with e-cigarettes are targeted to appeal to the younger adolescent population, which may lead to nicotine addiction and subsequent conventional cigarette smoking,” she says. “Once an adolescent tries and uses legal drugs, there is evidence suggesting that nicotine may prime the brain for illicit drug use. Most worrisome is the lack of regulation on the production of e-cigarettes and the potential harm from inhalation and/or ingestion of nicotine and its toxic by-products.”


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