The e-cigarette industry, while relatively unknown about 10 years ago, has seen a rapid increase in popularity and use, with the Center for Disease Control estimating that there are around 9 million e-cigarette users in the United States. Early data suggests that teens and young adults are the fastest growing group to elect use of electronic nicotine delivery devices over conventional cigarettes, with the 2015 Surgeon General Report on E-Cigarette Use indicating that more than a quarter of middle and high school students have tried e-cigarettes.
Initially marketed as a smoking cessation tool, e-cigarettes do not contain tobacco, which has been linked to significant risk for cancer and other health related diseases in conventional cigarette smoking. E-cigarettes are marketed as a safer alternative, delivering nicotine (of varying doses that can be tapered over time similar to other smoking cessation tools), flavorings, and other additives in a battery powered device that heats the liquid into an aerosol which can be inhaled by the user. Of concern among the addiction treatment community, is the difficulty in determining whether e-cigarette use works as a safe form of tobacco harm reduction. Specifically the e-cigarette may function as a replacement habit and provides opportunity to continue the rituals and habits associated with smoking instead of finding ways to eliminate smoking related behaviors.
The popularity of e-cigarettes or ‘vaping’, as is often referred to by youth and young adults, indicates that teens are not using these devices as a way to quit, but for a multitude of other reasons. A study published in the 2018 journal Drugs: Education, Prevention and Policy,interviewed 50 youth between the ages of 16 and 26 to identify common views young people have around e-cigarette use, including how they were introduced to vaping, judgements about risk of harm, similarities with traditional cigarette smoking and what they like most and least about vaping. Consistent with other studies on smoking behavior among adolescents, most young people are introduced to vaping in social settings with friends who had been using e-cigarettes. Youth discussed curiosity and perception of e-cigarettes as being less harmful than traditional tobacco cigarettes as factors in willingness to experiment. Many youths interviewed also mentioned the variety of flavors (ranging from cotton candy to crème brulee), less stigma, increased acceptability to vape in public, the ability to blow large clouds of thick smoke, and the lack of smell as determining factors as reasons to continue using e-cigarettes.
Public health officials and educators are becoming increasingly alarmed at the rates of youth and young adults using e-cigarettes. The perceived lack of risk associated with the use of e-cigarettes is a dangerous view given the limited short and long term research associated with the health effects of e-cigarette exposure. Prior research on cigarette smoking has shown that approximately 90% of adult smokers initiate tobacco use prior to the age of 18, making youth today particularly susceptible to similar trends related to continued e-cigarette use into adulthood. Of concern is the potential impact of aerosol exposure to the lungs and heart, due to the variety of chemicals and lack of regulations of the liquid contained in e-cigarettes. Other concerns related to e-cigarette use focus on exposure of the adolescent brain to high levels of nicotine. A 2015 study published in the Journal of Physiology highlighted concerns related to adolescent nicotine exposure including alterations in the neurochemistry of the brain (particularly as it relates to serotonin and dopamine), reduced attention span and enhanced impulsivity in adults exposed to nicotine as adolescents, and difficulties related to emotion regulation, including higher reports of anxiety, fear and increased symptoms of depression.
The most popular e-cigarette product among youth today is a vape called the Juul. While the company reports that they are not marketing their product specifically to teens, the sleek design (it looks like a USB that can fool most unknowing adults), the ability to recharge it through a laptop, the low cost of replacement pods (which contain the liquid), and the variety of flavors have gained popularity among middle and high school students across New Jersey. Also of concern with this product, is the high level of nicotine, as smoking one Juul pod is equivalent to smoking 1 pack of cigarettes. While there may be support for e-cigarettes as a harm reduction tool, among our youth, it appears that many have taken up vaping as a replacement for cigarette smoking. Unfortunately there is not enough long term research on the possible consequences of e-cigarette use on the brain and body to indicate that this is a safer alternative.
Jenica Siniscalco is an LCSW who has her masters in social work from Fordham University. She currently works as the Student Assistance Coordinator in the Guidance Department at Don Bosco Prep and can be reached at firstname.lastname@example.org for any further questions you might have. References are available upon request.