Protecting Youth From e-Cigarettes: 5 Things to Know

Brian A. King, PhD, MPH; Brenna VanFrank, MD, MSPH


March 02, 2020

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Did you know? More than 1 in 4 high school students use e-cigarettes. Even kids in middle school are using these products at epidemic levels, with over 10% reporting use in 2019. If you have not identified kids in your own practice who are using e-cigarettes, you may not be asking the right questions.

Here are five things that can help you talk to young patients about e-cigarettes.

1. Most e-cigarettes contain nicotine.

E-cigarettes are battery-powered devices that heat a liquid that typically contains nicotine, flavorings, and other chemicals to produce an aerosol that is inhaled into the lungs. Nicotine, which is found in all tobacco products, is highly addictive and drives the chemical dependency component of tobacco use disorder. Young people who use e-cigarettes may be more likely to go on to use regular cigarettes.

The brain continues to develop through about age 25, and being exposed to nicotine during youth and young adulthood can harm the parts of the brain responsible for attention, learning, mood, and impulse control and increase the risk for future addiction to other drugs.

2. The aerosol from e-cigarettes is not harmless.

In addition to nicotine, e-cigarette aerosol may contain other harmful substances, including volatile organic compounds, ultrafine particles, heavy metals, and cancer-causing chemicals that are inhaled deep into the lungs. This aerosol exposes both the user and bystanders to these harmful substances.

3. E-cigarettes are marketed to youth.

E-cigarette advertising is widespread, including on television, where advertising for cigarettes has been prohibited for many years. In 2019, about 70% of US middle and high school students said they had seen e-cigarette advertising in retail stores, newspapers and magazines, movies and TV, and online.

E-cigarettes also appeal to youth for many other reasons:

  • They come in many shapes and sizes and can be easily concealed because they can look like USB flash drives, highlighters, pens, or car keys.

  • They come in a variety of kid-friendly flavors, including fruit, candy, and menthol/mint. In 2019, about 7 out of 10 middle and high school students who currently used e-cigarettes reported using flavored e-cigarettes.

  • The nicotine in certain types of e-cigarettes (eg, JUUL) is in a new form known as "nicotine salts." This allows particularly high levels of nicotine to be inhaled more easily and with less irritation than the nicotine in other tobacco products and older types of e-cigarettes.

  • Youth are exposed to e-cigarettes in social settings, including by friends and family who use these products.

4. Using terminology that young patients understand is important.

Knowing the e-cigarette terminology that youth use can help you have a more honest conversation and better screen and counsel your patients about risk. Youth commonly refer to use of these products as "vaping" or "JUULing," and the devices may be called "e-cigs," "e-hookahs," "mods," "vape pens," "vapes," or "tank systems." The Centers for Disease Control and Prevention has a fact sheet for healthcare providers with more information to help you have this conversation.

5. Resources are available.

If your patients are using e-cigarettes, you have an opportunity to counsel them to quit. In addition, resources are available to help youth and young adults quit, including:

  • This Is Quitting, a free text-messaging program developed by the Truth Initiative that sends young people evidence-based tips and strategies to quit e-cigarette use;

  • quitSTART app, a free smartphone app developed by the National Cancer Institute (NCI) that provides tailored tips, inspiration, and challenges to help people quit tobacco product use;

  • SmokefreeTeen, an NCI website with tools and resources to help young people quit using e-cigarettes;

  • SmokefreeTXT for Teens, a free text-messaging program developed by NCI for youth; and

  • 1-800-QUIT-NOW for free, confidential cessation counseling with a trained quit coach.

Brian A. King, PhD, MPH, is the deputy director for research translation in the Office on Smoking and Health within the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention.

Brenna VanFrank, MD, MSPH, is a pediatrician with a particular interest in pediatric chronic disease and prevention. She is currently a senior medical officer in the Office on Smoking and Health within the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention.

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