E-Cigarettes & Your Teen

While news of hospitalizations and even deaths have been reported over the last several months as a result of EVALI – that is, an e-cigarette or vaping associated lung injury – the investigation is focusing on devices that have most commonly been obtained through illicit sources. However, the investigation has also brought attention back onto e-cigarette use by minors, who are experiencing something of an epidemic in vape usage and nicotine addiction.

What are e-cigarettes?

Since e-cigarettes don’t contain the same components as cigarettes, they are often viewed as healthier alternatives to smoking. However, to better judge how safe an e-cigarette is, let’s break down how they work. The National Center for Biotechnology Information (NCBI) explains it as such: e-cigarettes use heated coils to aerosolize various combinations of glycerol, propylene glycol, flavorings, and nicotine to be inhaled by users.
E-cigarettes began to rise in popularity in 2011 and the number of users has been increasing steadily ever since – up from about seven million users to over 41 million users in 2018, with an estimated user base of 55 million by 2021. As of 2018, the global value of the e-cigarette industry was estimated to be $14 billion and is projected to grow to $29 billion by 2022.

Why are teens using e-cigarettes?

While cigarettes use among minors had gone down in recent years, e-cigarettes and vapes have become popular for their convenience, lack of odor, and potency. Students subtly use their vapes throughout the school day in restrooms, hallways and even in class. The NCBI reports that 20% of high schoolers use an e-cigarette device and view them as far less dangerous to their health as traditional cigarettes.
However, this new demographic of e-cigarette and vape users are choosing products with nicotine, which they otherwise would not use if traditional cigarettes were the method of delivery. Tobacco companies own many of the e-cigarette brands and supply, and as such they rely on youth demographics to increase their lifetime customer base.
By exposing teens and young adults to nicotine-filled e-cigarettes, the users often transition into nicotine addiction and cigarette use as adults. Legislation is in progress in several states to begin regulating these products and the age of purchase, however, the FDA did not gain regulation over e-cigarettes until 2016, so many popular brands – including Juul – launched before that date. The FDA has given manufacturers until May 2020 to retroactively apply for authorization and regulation, to make sure that their products are appropriate for the market.

How does nicotine affect oral health?

Nicotine is the addictive property found in tobacco products and has additional health concerns of its own. Nicotine damages the soft tissues of the mouth and makes it difficult for our bodies to repair. Because nicotine reduces the amount of oxygen that our vital organs and tissues receive, it can lead to complications following oral surgery and extractions.
Current legislation does not require e-cigarette companies to disclose the contents of their products, and as such, many e-cigarettes feature as much nicotine as 20 combustible cigarettes. Additionally, nicotine is more dangerous to children and teens than to adults, as our brains are still developing into our mid-20s and nicotine can harm the parts of the brain that control attention, learning, mood and impulse control.
A 2016 study by Irfan Rahman, Ph. D., of the University of Rochester, showed that the vapor produced by e-cigarettes aggravates cells in our mouths and can lead to various oral diseases, most commonly gum disease. They found that the vapors of e-cigarettes actually change the cells in our mouth, and the degree to which those cells are damaged can increase depending on the flavoring.

What is being done about the teen vaping epidemic?

In December 2018, the US Surgeon General Jerome Adams brought down the hammer on e-cigarette use by teens, calling it an epidemic that demanded better education and legal restrictions to limit teens’ use of e-cigarettes.
“We must take aggressive steps to protect our children from these highly potent products that risk exposing a new generation of young people to nicotine,” Adams said. “To achieve success, we must work together, aligning and coordinating efforts across both old and new partners at the national, state, and local levels. Everyone can play an important role in protecting our nation’s young people from the risks of e-cigarettes.”
Currently, Oklahoma legislation allows people to purchase e-cigarettes at 18, whereas other states have their age of purchase set to 21. Juul, which is the most popular brand of e-cigarettes among teens and young adults, took the brunt of the Surgeon General’s admonishments.
In August 2019, Juul announced plans to provide more than $100 million in “incentives and financial support,” to retailers who adjust their point-of-sale systems to require a valid state ID to be scanned before the purchase can be completed. Additionally, purchases will be limited to one vaporizer and four nicotine pods to try and discourage the resale of their products to minors.
The CDC reports that approximately two-thirds of Juul users aged 15-24 do not know that Juul pods always contain nicotine, nor do they understand how much nicotine is in each pod. Additionally, Juul uses nicotine salts, which allow for high levels of nicotine to be inhaled more easily and with less irritation than other nicotine products.
The FDA, which is currently working the active investigation into the EVALI cases alongside the CDC, has issued regulations on what flavors of e-cigarette cartridges are available – contending that several flavors, such as mint or mango, are especially appealing to teens.

Talk to your teen about e-cigarettes and tobacco

It’s important to establish a dialogue with your child about the consequences of tobacco and nicotine use. Encourage them to stay away from all tobacco products, including e-cigarettes. Utilizing health care providers and free resources like the How to Talk With Your Teen About E-Cigarettes tip sheet or sites such as The Truth. For more information, tips, and resources to help you or your child quit tobacco products – including e-cigarettes – visit the CDC to learn more.

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