To Vape or Not to Vape? That is the question many youths are asking themselves. But, often they don’t know what they need to know to make that decision. Nor do their parents or teachers have the expertise to guide them in that decision process. Let’s take a test:
1. True or False. 6 out of 10 youth believe that occasional use of E-cigarettes causes little or some harm?
2. Which of the following is a risk to youth and young adults who use nicotine?
a. Depression, anxiety, and other mood disorders
b. Nicotine addiction
c. Difficulty paying attention and concentrating
d. Reduced impulse control
e. All of the above
3. Your brain continues to develop until what age?
4. Which of the following tobacco products is most commonly used by U.S. high school students?
c. Little cigars
5. Which of the following are reasons youth and young adults use E-cigarettes?
a. Availability of E-cigarettes in candy, fruit, and alcohol flavors.
b. A belief that E-cigarettes are safe
d. All of the above
Answer key: 1:True; 2:e; 3:d, 4:b; 5:d
Let’s answer some basic questions. When did E-cigarettes enter the market and when did its use spread to middle school, high school, and college students? E-cigarettes entered the U.S. marketplace around 2007, and since 2014 have been the most commonly used tobacco product among U.S. youth. Student use of E-cigarettes increased by 900% between 2011-2015. In 2018, more than 3.6 million U.S. youth, including 1 in 5 high school students and 1 in 20 middle school students, used E-cigarettes.
How do people use E-cigarettes? In the twelve years since E-cigarettes entered the market, the delivery system has rapidly changed. There are e-pipes, e-cigars, large vaping devices, rechargeable e-cigarettes. They are known as e-cigs, e-hookahs, mods, vape pens. Recently a product called JUUL that looks like a USB flash drive was introduced into the market. It has become increasingly popular among youth due to its minimal exhaled aerosol, reduced odor and small size, making it easy to conceal. It experienced a 600% surge in sales during 2016-2017, giving it the most significant market share of any E-cigarette in the U.S. market. JUUL comes in a variety of colors and flavors and can be connected to a USB port to recharge the battery for use.
What drugs can be used in E-cigarettes? All E-cigarettes contain nicotine (except as listed below). A JUUL cartridge or ‘pod’ contains about as much nicotine as a pack of 20 regular cigarettes. Most people use a ‘pod’ per day. The nicotine salts allow an unusually high level of nicotine to be inhaled more efficiently and with less irritation than the free-base nicotine in regular cigarettes. Despite this, approximately 2/3’s of JUUL users aged 15-24 do not know that JUUL always contains nicotine. In addition to nicotine, liquid marijuana, bath salts (a synthetic drug with mood-altering and stimulant properties), Flakka or ‘gravel’ is a more potent form of bath salts, Hash Oil that contains a higher concentration of THC (ingredient in marijuana, Spice or K2 (a synthetic form of marijuana), and psychedelics like DMT that gives hallucinations like LSD can be used in E-Cigarettes.
Why do people use E-cigarettes? They were initially introduced for adults to use to quit smoking regular cigarettes. It works for some adults, but a majority use both E-cigarettes and regular cigarettes depending on where they are. In surveys of youth, they use E-cigarettes for curiosity and wonder what it would be like to use them. Some use it because you can get ‘super buzzed’ off of it. The advertisements for E-cigarettes are not regulated and contain all of the same tactics the regular tobacco companies used for years. E-cigarette packaging and design come in bright colors with flavors like fruit, candy, and alcohol. Many advertisements include sexuality and popularity in their content to appeal to youth. Nine of ten youth who use E-cigarettes used flavors as their choice of product. There is also the belief that E-cigarettes cause little or no harm. 3 of 5 youth think they cause little damage. And, 1 of 5 youth thinks they cause no harm.
The truth is, they do cause harm. Flavoring chemicals in E-cigarettes may induce genetic changes in the bronchial epithelial cells. In test-tube experiments, hundreds of genetic variations were induced in the cells impairing their ability to function correctly. All E-cigarettes contain nicotine. And, it is easier to become addicted to it since the adverse effects of smoking, like smell, cough, and nausea, are not present with the aerosol form of nicotine. The nicotine and other chemicals affect the way the brain develops, leading to impacts on learning, memory, and attention. It also leads to increased risk for future addiction to other drugs. There is moderate evidence that E-cigarette use increases the frequency and intensity of regular cigarette smoking in the future. The aerosol also includes harmful substances, including heavy metals, volatile organic compounds, and ultrafine particles that can be inhaled deeply into the lungs. E-cigarette products have also been found to be contaminated with bacterial and fungal toxins. There is emerging evidence that E-cigarettes can lead to alcohol and other drug use and dependence.
So, despite the risks, who uses E-cigarettes? Since JUUL was introduced, high school students who have ‘ever’ used E-cigarettes went from 11% in 2013 to 37% in 2015. At the same time, Middle school students’ use went from 3% to 11% during the same time frame. High school students who ‘regularly’ use E-cigarettes went from 4% to 16% during those two years. Middle school students went from 1% to 4%.
Where do youth use E-cigarettes? Because of their sleek design and resemblance to USB drives, JUUL products are natural for students to conceal and use in school—sometimes even in the middle of class. They are used in restrooms and hallways because the aerosol quickly evaporates and there is minimal smell. The youth also use E-cigarettes when gathered together. YouTube videos are showing how to do tricks, like blowing rings and ‘ghosting,’ slang for exhaling a plume of vapor and quickly drawing it back in the mouth. Tips are shared about how to conceal JUULs like sleeves, hoodies, and even hollowed-out markers. There are unique Vaprwear hoodies where the device is built into what would typically be the strings of the hoodie.
To vape or not to vape. It is an important question. The surgeon general said, “I, Surgeon General of the United States Public Health Service, VADM Jerome Adams, am emphasizing the importance of protecting our children from a lifetime of nicotine addiction and associated health risks by immediately addressing the epidemic of youth e-cigarette use. The recent surge in e-cigarette use among youth, which has been fueled by new types of e-cigarettes that have recently entered the market, is a cause for great concern. We must take action now to protect the health of our nation’s young people.”
What can you do? Have a frank and open conversation with the youth around you. Give them the facts. There is an organization called ‘Catch My Breath’ that developed a ‘Youth E-cigarette and JUUL Prevention Program.’ It is a series of modules that can be used in classrooms, church groups, or families to spread this information. 7 of 8 students said they were less likely to use E-cigarettes after taking the classes. It is designed so that it could be incorporated into health classes in the schools. Be aware: “E-cigarette use poses a significant—and avoidable—health risk to the young people in the United States.”
Tracy Frandsen, MD
Canyon View Family Medicine