The sharp increase in the use of e-cigarettes among my young patients has me worried. Many young people—and their parents—believe that e-cigarettes are relatively harmless. But this couldn’t be further from the truth.
That’s why, when I ask my patients about smoking, drugs and alcohol use, I also now ask if they use e-cigarettes. Whether they answer yes or no (many say no the first time I ask them) I emphasize why it’s important that they are honest with me. I explain that there can be some pretty scary side effects of e-cigarette use, specifically with e-cigarettes that use liquids containing nicotine.
These side effects include high blood pressure, brain damage, lung damage, tachycardia (abnormally fast heart rate), seizures, cancer and coma. And I make sure their parents are aware of these risks, too.
Unfortunately, there is a lot of misinformation out there. Considering that e-cigarette use among U.S. high schoolers jumped 77 percent between 2017 and 2018, and 50 percent among middle schoolers, it’s more important than ever that young people and their parents know the facts.
What are e-cigarettes?
Electronic cigarettes are battery-operated devices that heat liquid and turn it into vapor instead of smoke, which is why using them is often called “vaping.” They are sold under many brand names—over 460 are currently on the market. They come in a range of shapes and sizes, with some resembling pens and flash drives. Those that look like everyday items make it easier for teens to bring them to school undetected.
Liquids used in e-cigarettes, called e-liquids, are often flavored. Many, but not all, contain nicotine and other chemicals. Some people use e-cigarettes to vape CBD oil, an extract from the buds and flowers of marijuana or hemp. CBD oil is sometimes touted as treatment for various health concerns, including anxiety, insomnia and even seizures, but it’s not yet regulated by the Food and Drug Administration, meaning it ranges in quality and may have negative, unintended side effects.
Advertisements are often targeted to teens and they are marketed as being safer than cigarettes, with lots of flavors. E-cigarettes are also relatively inexpensive: between $9–$10 for a disposable device, $25 and up for rechargeable models and $8-plus for e-liquid refills.
E-cigarettes are used by some, including adults, as a way to quit smoking, since they don’t contain tobacco. However, they aren’t an FDA-approved method for smoking cessation. Research shows that using a combination of medication, like nicotine replacement therapy, which many use in the form of gum or a patch, and support is the best way to quit smoking.
While most teens only think they are inhaling flavoring, that may not always be the case. Because e-cigarette manufacturers aren’t required to report what ingredients are in their devices, it’s unlikely that users know what’s in them.
Some people use them for “dripping,” an alternative use of e-cigarettes where e-cigarette liquid is put directly onto the device’s hot coils to produce thicker, more flavorful, stronger smoke. This also means a stronger hit of nicotine in e-liquids that contain it.
The devices have a myriad of health risks, particularly for teens. Most e-cigarettes have nicotine in them, which is highly addictive and can hurt brain development; impair the parts of the brain responsible for attention, learning, mood and impulse control; change the way the brain’s synapses are formed; increase teens’ future use of cigarettes; and can lead to nicotine dependence.
A study of some e-cigarettes found that devices may produce vapors with cancer-causing carcinogens and toxic chemicals in them. Carcinogens can also result in coughing, asthma, lung inflammation and irritation, allergic reaction and nausea.
Because e-cigarettes are still quite new and are being used in increasingly different ways, their safety hasn’t been fully studied yet. Based on the studies that have been done so far, though, the potential for harm is concerning.
In 2016, the FDA passed a ruling that said all tobacco products, including e-cigarettes, cannot be sold to anyone under the age of 18, and the devices cannot be sold in vending machines except in adult-only establishments. In November 2018, the FDA said it plans to ban the sale of most flavored e-cigarettes in retails stores and gas stations. The ban has yet to go into effect, however.
Helping teens quit
Talk with your children about e-cigarettes, whether or not they use them. It’s important to explain why the devices are harmful and what risks and side effects can result from their use.
For young people who do use e-cigarettes and need help quitting, consider practicing mindfulness through activities like yoga, meditation and tai chi; nicotine replacement therapy, such as gums or patches; online programs, such as the American Lung Association’s Freedom From Smoking; and counseling or therapy.
If you’re concerned that your child is using e-cigarettes or you have questions about vaping, contact your child’s pediatrician, who is one of your best resources to help your teen make healthy choices now and in the future.
For more information on e-cigarettes and vaping, visit the National Institute on Drug Abuse’s website.
Carol Forster, M.D., is board certified in pediatrics by the American Board of Pediatrics. She sees patients at the Mid-Atlantic Permanente Medical Center in Reston.