E-Cigarette Use: A Troubling Trend

More teens using vaping devices
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Teens and their parents face a growing challenge unique to the digital age as electronic cigarette use climbs among adolescents.

Between 2013 and 2014, the number of middle and high school students who reported using an e-cigarette in the past 30 days tripled, according to an April 2015 press release issued by the Centers for Disease Control and Prevention. The popularity of electronic cigarettes and other “vaping” devices is rising faster than the data collected about their associated risks.

“We’re still waiting on a lot of data to come in about how teens are using e-cigarettes and what sorts of implications that might have for their health going forward,” says Joseph McClernon, a professor of psychiatry and behavioral sciences at Duke University School of Medicine. While e-cigarettes are increasingly considered less harmful than traditional cigarettes, he says, that does not mean they are safe — especially where teenagers are concerned.

What are e-cigarettes and vaping devices?

Vaping devices don’t necessarily resemble cigarettes, says Jessica Pepper, Ph.D., a postdoctoral fellow at the University of North Carolina’s Center for Regulatory Research on Tobacco Communication. This can lead to confusion. “You’ll talk to people who say, ‘Oh, I don’t use e-cigarettes, I use a vape pen,’” she says.

While early e-cigarettes were roughly the size and shape of traditional cigarettes and came in limited flavors, second and third generation vaping devices can be modified by the user; look like a pen, phone or other gadgets; and allow users to choose from thousands of flavors, Pepper says. All of these devices — whether they’re called an e-cigarette, hookah pen or vape pen — use the same fundamental technology: a power source, heating element and e-liquid that transforms into the aerosol users inhale. E-liquid generally has three components: a humectant to keep it moist, nicotine and flavoring.

Why are teens drawn to vaping devices?

Flavored vaping devices targeting young people may offer one explanation. E-liquid in a Skittles flavor, cotton candy flavor and other flavors have popped up that might “appeal to teenagers more than they might adults,” McClernon says.

While state law prohibits the sale of e-cigarettes to anyone under the age of 18, one recent study by the UNC-Chapel Hill Lineberger Comprehensive Cancer Center suggests that teens found few obstacles when trying to buy them online.

Advertising and other media, including ads that feature celebrities, might also play a role, says Vivek Anand, a clinical assistant professor at East Carolina University’s Brody School of Medicine. Furthermore, he says, teens frequently misjudge the risks of using e-cigarettes.

Anand conducted research in North Carolina a few years ago that suggested more than six out of 10 teens surveyed did not know what was in e-cigarettes. Many failed to realize they contained nicotine, and 26 percent of surveyed high school students believed they

contained only water. Additionally, 51 percent of the students surveyed believed e-cigarettes could help people quit using traditional cigarettes, a belief Anand says is contrary to the available research about teens, tobacco use and e-cigarettes.

What are the risks?

“Nicotine alone could potentially alter how (a teen’s) brain develops, which could have implications for them in later life in terms of cognitive and emotional functioning,” McClernon says. Furthermore, there is no regulation of e-cigarette liquids at the current time, so “there’s a lack of any sort of certainty or accountability about what goes into these products, and that’s concerning.”

Formaldehyde and other potentially detrimental compounds and agents have also been found in e-cigarette vapor, Anand says, adding that researchers don’t know yet whether, for example, “inhaling a mango flavor or a peach flavor” repeatedly over a long period of time will affect users’ lungs.

What should parents do?

The first line of defense for parents is to communicate with their teens about e-cigarettes. Pepper encourages parents to incorporate e-cigarettes into the conversations they’re already having about other risky behaviors and to emphasize that even if e-cigarettes taste like bubble gum, they can result in an unhealthy nicotine addiction and other problems. According to WebMD’s feature, “E-Cigarettes 101,” e-cigarettes can also harm arteries over time and pose risks to people who already have heart problems.

There is also some evidence that second-hand vapor can harm those exposed to it. A recent study conducted by the Johns Hopkins Bloomberg School of Public Health revealed that exposing mice to e-cigarette vapor compromised their immune system.

North Carolina’s teens are really smart, Anand says, but “when there’s no education, no discussion,” they may make the wrong choice.

Laura Lacy is a freelance writer based in Chapel Hill.