Teen Vaping Is a Public Health Crisis: What You Need to Know

Vaping among preteens and teens has reached a crisis point, according to a 2019 survey, and it threatens to undo years of public health efforts that had led to a decline in nicotine use.

Parents should be concerned because:

• Vaping increases the risk of teens developing an addiction to nicotine.
• Vaping exposes children and teens to harmful metals and toxic chemicals found in e-cigarettes.
• A mysterious, vaping-related illness is on the rise: e-cigarette or vaping product use-associated lung injury (EVALI).

To get an update on the latest data and the dangers associated with vaping and e-cigarettes, we spoke with Brian Jenssen, MD, MSHP, a primary care pediatrician at Children's Hospital of Philadelphia (CHOP) and a researcher at CHOP’s PolicyLab who has worked with the American Academy of Pediatrics (AAP) to shape tobacco policy.

In short: The scope of the problem has widened, and there are many misconceptions out there. Here we share the latest data, and dispel some common myths about vaping.

Vaping is causing an epidemic of nicotine addiction in teens

The 2019 survey shows the rate of vaping among high school and middle school students continues to rise. With more than 1 in 4 high schoolers and 1 in 10 middle schoolers reporting vaping use, the need to educate families about the risks of vaping is critical. 

Tobacco is the leading cause of disease and death in the United States, and its use is entirely preventable. Repeated vaping can lead to the same risk of addiction to nicotine that comes with smoking. 

“There is remarkably clear data showing that teens who try vaping are much more likely to go on to smoke regular cigarettes,” says Jenssen. “Kids who were at low risk for smoking can be drawn to traditional tobacco products through their use of e-cigarettes.”

Children and teenagers younger than 18 years old are especially vulnerable to addiction. “Nicotine can change the biochemical pathways in the body, making paying attention more difficult and priming the brain for addiction,” says Dr. Jenssen.

Harmful chemicals and a new mysterious lung illness

We’ve learned more about the hazards of vaping by identifying some of the chemicals found in the solvents of vapes, sweeteners and flavorings, and how they change when they are heated into an aerosol. We’ve also learned what is in the bodies of teens who vape: heavy metals, volatile organic compounds (VOCs) and nicotine. 

“We are seeing the direct health harms from e-cigarette use, and prevention is the most effective tool,” says Dr. Jenssen.

Those direct health harms include a dramatic rise in acute lung injuries associated with vaping, known as EVALI. It’s unclear what is causing the condition, but the common denominator is e-cigarette use. Across the United States, more than 2,660 cases of EVALI hospitalization or deaths were reported to the CDC, as of Jan. 14, 2020. Sixty deaths related to EVALI were confirmed in 27 states and the District of Columbia during the same time. “These are lung injuries that look like the person worked in a chemical plant for years,” says Dr. Jenssen. 

A public health crisis

As smoking was decades ago, vaping is promoted with enticing advertising but little information about the very real health risks. Even more dangerous: Vaping products are designed to appeal to young people — they come in flavors like cotton candy and sour gummy worms, and with devices styled to appeal to tech-savvy teens.

In the fall of 2019, the U.S. Food and Drug Administration (FDA) issued a warning letter to JUUL Labs Inc. for misleading claims and for marketing specifically to school-age kids. The company is facing several lawsuits for deceptive marketing practices, including one from the New York Attorney General’s Office.

While several states and cities have banned or are considering bans on vaping products, the federal government has stepped in to offer its guidance. In December 2019, a national law was passed restricting all cigarettes, e-cigarette and tobacco products from being sold to anyone under the age of 21.

While this new law is a public health victory, other recent federal action falls short. We know that flavors have fueled use among teens. That’s why the new policy pulling only some flavored e-cigarettes from the market does not adequately protect youth. Allowing menthol-flavored pod devices in traditional retail settings and all flavors in refillable tank-based products sold at vape shops will continue to draw teens to vaping.

What you can do: Dispel the myths

The misleading and unsubstantiated claims made by vaping companies have left lingering myths about the dangers and use of e-cigarette products.

“Many teens — and adults for that matter — don’t know there is nicotine in this product,” says Dr. Jenssen. “They think it’s just flavored water, and that it’s completely harmless. It’s like where we were with smoking 70 years ago.”

Myth: Vaping is a “healthier” alternative to smoking. 

Fact: There is no evidence that supports the claim that vaping is a healthier alternative to smoking. These products are not regulated by the FDA and do not disclose their ingredients.

Myth: Vapes don’t contain nicotine.

Fact: “Because it’s a tobacco product that is not regulated, you can’t tell what’s in the liquid you’re buying or what goes into your body when you use it,” says Dr. Jenssen. “We know that most of the products contain nicotine, which is addictive. It’s particularly addictive and damaging in young people whose brains are still developing.” (This is an issue PolicyLab researchers are watching closely.)

On top of that, recent research on actual e-cigarette users has shown that they are taking in heavy metals like nickel, tin and lead, as well as chemicals known to cause cancer. Some of that is coming from the flavorings and the heating devices, and some is from the tobacco from which the liquids are made.

Myth: Vapes can help smokers quit smoking.

Fact: For adult smokers, Dr. Jenssen explains, there may be some benefit to e-cigarettes as a means of quitting smoking. But the evidence for that is inconclusive. Other means of quitting have been found to be more effective for adult smokers.

Myth: There are no secondhand smoke risks from vaping.

Fact: Like secondhand vapor, secondhand vapor is harmful. When kids are vaping in a school bathroom, others who enter the room inhale the nicotine and the harmful metals and chemicals.

Be informed and talk with your teen

Whether or not you think your child is vaping, Dr. Jenssen encourages parents to open the conversation and create an environment where their teens feel comfortable disclosing their vaping use, asking questions and sharing their worries.

More information and resources to help teens quit vaping

• MyLifeMyQuit. Free help for teens
• This is Quitting by Truth Initiative
• 2018 NYTS Data: A Startling Rise in Youth E-cigarette Use
• Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young Adults
• FDA warns JUUL Labs for marketing unauthorized modified risk tobacco products, including in outreach to youth
• Vaping Illness Tracker by the New York Times