Did you know that over 11% of high school and middle school students vape? According to a 2021 National Youth Tobacco Survey, that’s the percentage of young adults in the US who use e-cigarettes.¹
Since electronic cigarettes generate cool vapors and delicious flavors like bubblegum and watermelon, it can be easy to forget that they still contain highly addictive nicotine.
Many e-cigarettes contain up to 20mg/ml or 2% nicotine. You might even hear e-cigarettes with this level of nicotine touted as a “healthier” substitute — particularly for those who smoke a pack of cigarettes daily.
However, they are far from harmless, especially for young people. Researchers at the University of Michigan found that vaping has reversed nearly two decades of progress in getting teens free of nicotine.²
Juul is an e-cigarette company that was incorporated in 2015, a year after e-cigarette use became the most popular tobacco product used by American youth.³
From there, Juul relentlessly targeted adolescents with its marketing campaigns while not being clear about the nicotine content in its products. Its e-cigarettes contain 20mg of nicotine (the legal limit in the UK) and come in many tasty flavors.⁴
As a big corporation getting children as young as 12 addicted to nicotine, Juul has predictably faced numerous lawsuits since 2015, many of which are ongoing.
Several states have investigated its marketing practices, and in September 2022, Juul was ordered to change its advertising strategies and will pay a $438.5M settlement to cease investigation into its marketing to underagers.⁵ (Most of the money will go toward nicotine cessation and prevention programs).
So, why have these states come down so hard on this company’s marketing, and what are the full effects of vaping on teen health? Keep reading to find out.
E-cigarettes are a type of electronic nicotine delivery system (ENDS). Others include e-pens, e-pipes, e-cigars, and e-hookah.
Typically, e-cigarettes are battery-powered and contain an element that heats the liquid that contains nicotine, other chemicals, and sometimes flavorings. This liquid is called e-liquid.
Vape users may call e-liquid other names, including e-juice, vape liquid, or vape juice. The e-liquid cartridge is usually refillable, making it easy for people to choose their favorite flavors and nicotine quantity.
E-liquid works with the heating element to create the aerosol that vape users breathe into their lungs.
People around the user may also breathe in second-hand vapor when they exhale.
While e-cigarette aerosol typically contains fewer chemicals than cigarette smoke, that doesn’t mean vaping is safer.
Cigarettes contain over 7,000 chemicals and kill half of all long-term users, so they’re hardly a great benchmark for safety.⁶ ⁷
E-cigarette use is concerningly common among young people. The Centers for Disease Control and Prevention (CDC) states that 2.06 million US middle and high school students have used e-cigarettes in the last 30 days.¹ That includes 11.3% of high school students and 2.8% of middle school students.
A 2016 study found that 73% of American adolescents believed e-cigarettes were less harmful than traditional cigarettes, and 47% believed vaping was less addictive.⁸
Unfortunately, researchers found that the perceived safety of vaping correlates with adolescents' increased use.
Meanwhile, e-cigarettes are just as addictive as almost 25% of youth intending to quit found out. A 2020 survey noted that 44.5% of adolescents thought about quitting immediately. 24.9% attempted to quit.⁹
Research indicates that 90% of adult daily smokers start before 18, and teens who use e-cigarettes are 3.6 times more likely to use combustible (traditional) cigarettes later in life.¹⁰ ¹¹ These findings show that e-cigarettes contribute substantially to creating a nicotine-addicted generation. The study did not find evidence of harm reduction benefits that e-cigarette proponents point to — such as the ability to help with cigarette smoking cessation.
While US federal law does not permit the sale of tobacco products to people under 21, e-cigarette companies are finding sneaky ways around the law.
Several companies have started using synthetic nicotine in their products, which falls outside the Food and Drug Administration’s authority. The FDA doesn’t regulate synthetic nicotine, and scientists are just beginning to study its health impacts. Though synthetic, it’s still extremely addictive, like tobacco-derived nicotine.¹²
Part of the concern about synthetic nicotine is that it contains two nicotine compounds: S and R.¹³
S-nicotine is the main form (>99%) in tobacco products, and researchers know a lot about the negative health impacts on those who consume it.
Scientists know far less about the effects of R-nicotine, and unregulated or poor labeling on synthetic nicotine e-cigarette products intensifies concern.
Propylene glycol (PG) and vegetable glycerin (VG) are two of the main ingredients in e-liquid. Another is nicotine, and you know how addictive that is. E-liquid manufacturers can add flavors, which adds even more chemicals to the mix.
While everything is a chemical, some are more harmful than others, especially in uses and levels.
A 2018 study discovered that PG and VG “adversely affected cell viability.” In other words, cells cannot live when we consume these ingredients. The study also found that the more chemicals in e-liquid, the more toxic it will be.¹⁴
In particular, the researchers highlighted the most toxic additional chemicals: Vanillin and cinnamaldehyde. These create vanilla and cinnamon flavors, respectively.
The CDC has reported the danger of inhaling diacetyl, a common e-liquid chemical that creates a butter flavor.¹⁵
Historically, microwave popcorn manufacturers used diacetyl in their products. Researchers linked it to hundreds of cases (and deaths) of popcorn factory workers caused by bronchiolitis obliterans. This earned bronchiolitis obliterans the nickname “popcorn lung.”¹⁶
While the name is almost comical, the obliterans part implies it’s no laughing matter. It causes respiratory symptoms similar to chronic obstructive pulmonary disease (COPD), a form of inflammatory lung disease. A Harvard study discovered that 75% of e-cigarettes contain diacetyl.¹⁷
And while not everyone enjoys tobacco flavor, many enjoy fruity, buttery sweet flavors marketed as so-called cookie dough, pie, or ice cream.
These tactics make e-cigarettes very appealing to young people, and the 2021 National Youth Tobacco Survey (NYTS) discovered that 85% of young vapers use flavored products.¹⁸
Flavors and curiosity are among the most common reasons cited by youth using e-cigarettes, according to the 2016 Surgeon General Report.¹⁹
Secondhand vape aerosol is also a concern. Despite common misconceptions, e-cigarette aerosol isn’t water vapor or harmless. It often contains toxic chemical cocktails of acetaldehyde, formaldehyde, and acrolein, which can cause lung and heart disease.²⁰
Even if teens aren’t vaping themselves, the Chest Journal published findings of a 2019 study in which teens with asthma were more likely to have an attack if they came into contact with secondhand aerosol.²¹
A 2021 study on the effects of secondhand nicotine vape exposure revealed disturbing statistics. Inhaling e-cigarette vapor posed a 53% chance of shortness of breath.²²
It also increased the risk of experiencing symptoms like bronchitis, cough, or phlegm production by 40%.
Many young people use e-cigarettes without knowing what’s in them. The CDC reports that around two-thirds of Juul users aged 15–24 aren’t aware that Juul always contains nicotine.²³ As of 2015, 99% of all e-cigarettes in the US contained nicotine.²⁴
A 2013 study even found that products marketed and labeled “0% nicotine” or “nicotine-free” did contain nicotine.²⁵
The same study also found that almost 20% of the products analyzed had significant discrepancies in nicotine concentration compared to the amount stated on the label.
The researchers tested 91 e-liquids bought in-person or online from the US, Poland, and South Korea.
So, even if you or your teen don’t think there’s nicotine in an e-cigarette, it may contain nicotine and other toxins.
Addiction happens when the brain connects a stimulus, such as vaping, to a response like reduced cravings. The brain learns that the action is pleasurable, and it generates a stronger connection between brain cells. These connective pathways are called synapses, which build faster in teens than adults, putting them at a higher risk of addiction.
As teen brains are still developing synapses, using nicotine permanently impacts their brain circuits, including their reward systems, impulse control, and ability to pay attention and learn.¹⁹
Nicotine also causes the release of dopamine, a neurotransmitter. It’s also known as the “happy hormone” because it produces feelings of pleasure.
Researchers believe dopamine plays a crucial role in nicotine addiction.²⁶ Nicotine also releases adrenaline, causing increased blood pressure, heart rate, and breathing. This combination can create a “rush” feeling.
Our brains have nicotinic acetylcholine receptors (nAChRs), which respond to the neurotransmitter acetylcholine. This chemical activates our muscles and moderates dopamine release. As their name suggests, these receptors are also sensitive to nicotine.
A 2019 literature review noted evidence that nicotine “hijacks” the developing brain and nAChRs and can act as a gateway drug to using other addictive substances, such as cocaine.²⁷
Symptoms of nicotine addiction can appear in teens within days to weeks of starting smoking.²⁸ If they stop using nicotine, they will experience withdrawal symptoms, such as
Feeling anxiety or depression
It’s common for people to keep using nicotine products to relieve these symptoms.
Many young people use e-cigarettes without knowing what’s in them. The CDC reports that around two-thirds of Juul users aged 15–24 aren’t aware that Juul always contains nicotine.²³ Studies have even found that products marketed as 0% nicotine do contain nicotine.²⁹ 99% of all e-cigarettes in the US contain nicotine.
So even if you or your teen don’t think there’s nicotine in their e-cigarette, chances are that it contains nicotine, and they’re experiencing these worrying brain changes. And vaping doesn’t just affect their brains. The effects run even deeper.
With the advent of new nicotine technology also comes a new disease. Researchers discovered a new lung disease, EVALI (electronic-cigarette use-associated lung injury), caused by vaping.
Vitamin E acetate is in many e-cigarette products, particularly those containing THC (tetrahydrocannabinol), the psychoactive compound in cannabis that creates a high.
Even though vitamin E is an antioxidant in food and beauty products, this oil does not belong in the lungs and interrupts their proper function when inhaled.
Its chemical properties also change when heated, and researchers are examing how vaping can turn vitamin E into a highly toxic gas known as ketene.³⁰ ³¹
As of November 30, 2022, the American Association of Poison Control Centers has managed 6,013 e-cigarette device and e-liquid exposure cases.³²
E-liquid is poisonous, and small children and pets can die if they ingest it.
Harmful effects on young children can include:³³
Respiratory arrest (when the child stops breathing)
Cardiac arrest (when the heart stops pumping blood)
E-liquid isn’t the only dangerous part — some defective e-cigarette batteries have caught fire and exploded, causing severe injuries.³⁴
It may be easy to imagine your child is vaping because they think it’s cool or their friends are doing it or pressuring them to try it.³⁵ While that may be the case, there is also a strong relationship between smoking, anxiety, stress, and depression.³⁶
Your child may use vaping to deal with stress and anxiety, but it ends up causing nicotine dependence. According to a 2022 CDC report, the most common reason young people self-reported that they keep vaping is “I am feeling anxious, stressed, or depressed.”³⁷ Some of the perceived benefits include weight loss or coping with stress better.
If your child expects nicotine use to have positive effects, they may choose to smoke or vape because it’s less expensive than traditional cigarettes.
If you smoke or vape, your child is likelier to do so. That’s because parents or peers using tobacco products normalizes their use. So, consider talking with your doctor about developing a quit plan for better health and modeling healthy habits for your teen.
By being tobacco-free yourself, your child can look up to you as a good example. If a parent smokes, it may seem like a completely normal thing to do. It’s also much better for the health of you and your loved ones if you’re not smoking or vaping.
At the least, keep your tobacco product use outside the home, so you’re not exposing your child to secondhand smoke or even just the idea of smoking. This also means keeping tobacco products where they can’t get to them, as children are naturally curious.
Keeping your home smoke-free is important, so ensure guests and family members don’t smoke or vape in the house.
If you’re smoking or vaping, looking to quit is helpful for you and your child. If they’re vaping, too, you can suggest quitting together and checking out a specialized cessation program.
Media is another culprit, whether it’s characters vaping on your child’s favorite TV show or e-cigarette ads.³⁸ Conventional tobacco products aren’t allowed to advertise, but vape products avoid that restriction.
Prevention is the best-case scenario. You have an essential role in preventing your child from vaping. E-cigarettes are very appealing to young people, and with an uptick in their usage over the last seven years, they’re normalized. So what can you do?
Talking to your child from a young age about things like alcohol, tobacco, nicotine, and other harmful products is an ideal way to keep a dialogue open. The sooner you talk about risky behaviors, the better.
While many parents don’t like to think about these things, children start smoking, drinking, and forming other habits earlier than you might think. Understanding the risk of these products may even inspire you to change your ways.
You will also need to talk to your child about the high likelihood of peer pressure, as this is one of the main reasons children vape or smoke. Roleplaying with them could be a fun approach for coming up with great responses to pressure. Helping them prepare responses or snappy comebacks will ensure that peer pressure doesn’t catch them off-guard.
E-cigarettes and other electronic nicotine delivery systems come in various shapes and forms. Hence it’s a good idea to be up-to-date on what they look like.
Learn about the dangers of using e-cigarettes and other tobacco products, especially in adolescents, as nicotine has unique effects on young brains.
Offering a non-judgmental space where you openly talk to your child about their newfound, unhealthy habit is a better approach than punishment.
Making a vice seem even more “naughty” will likely make your child secretive with their habit. (You may miss out on educating them and discovering why they’re vaping). Treating your child like an adult can be a great way to get through to them on a level they understand.
Talking down to your teen isn’t the best approach; it will only alienate them. You may find they’re much more mature than you give them credit for.
It is important to honestly talk to your child about their stressors and bad habits. If your child says they’re stressed, don’t invalidate them. Gently ask them what’s worrying them, and hopefully, they will open up to you. Telling a child, they have nothing to be stressed about because they’re a kid isn’t helpful and will stop them from opening up.
Once you’ve discovered why they vape, you can suggest healthier alternatives to achieve the same results. If they’re using e-cigarettes because their friends do, suggest healthier ways of bonding and the importance of thinking for themself, not following the crowd.
If they’re stressed, suggest talking it through with a therapist or taking up a form of exercise to increase their endorphins and reduce stress.
If they’re vaping to lose weight, discuss healthier approaches with them, such as a balanced diet and various exercise ideas. You can even offer to join in with their new exercise or eating regimen to support them and feel better together.
While companies market vaping as safer than smoking, it comes with many risks. Certain compounds are toxic, and nicotine is a well-known addictive substance. Teenagers are especially susceptible to the addictive effects of these products. Unfortunately, advertisers target children, so it’s a good idea to speak to your children about the risks of vaping from an early age.
If your teen has started vaping, speak to them about the dangers. Rather than lecture, talk to them respectfully — you’re much more likely to make a breakthrough. Nicotine is incredibly addictive, so be prepared that they may struggle with withdrawal symptoms. Speaking to your doctor for additional advice is also a wise idea.
Notes from the field: E-cigarette use among middle and high school students — National youth tobacco survey, United States, 2021 | Centers for Disease Control and Prevention (CDC)
Youth and tobacco use | Centers for Disease Control and Prevention (CDC)
Secondhand smoke | Centers for Disease Control and Prevention (CDC)
What is synthetic nicotine? | American Lung Association
Flavorings related lung disease | Centers for Disease Control and Prevention (CDC)
Popcorn lung: A dangerous risk of flavored e-cigarettes | American Lung Association
Youth e-cigarette use remains serious public health concern amid COVID-19 pandemic | Centers for Disease Control and Prevention (CDC)
Quick facts on the risks of e-cigarettes for kids, teens, and young adults | Centers for Disease Control and Prevention (CDC)
Outbreak of lung injury associated with the use of e-cigarette, or vaping, products | Centers for Disease Control and Prevention (CDC)
Tobacco product use and associated factors among middle and high school students — National youth tobacco survey, United States, 2021 | Centers for Disease Control and Prevention (CDC)
2012 Surgeon general’s report | Centers for Disease Control and Prevention (CDC)
Victoria is a writer from the UK with a keen interest in health and science. She loves writing about mental health, scientific advancements, and dispelling pseudoscience. When she’s not writing sass-laden articles, she walks her rescue dogs, giggles at anxiety memes, eats chocolate, and absorbs useless knowledge for quiz shows.
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