What Parents Should Know About E-Cigarettes
As of Dec. 3, 2019, the Centers for Disease Control and Prevention (CDC) reported that there have been 2,291 lung injury cases that have been associated with the use of e-cigarettes or vaping products. The CDC also reported that while the number of cases has been declining, hospitals are still reporting cases to the CDC.
The use of electronic nicotine delivery systems (ENDS) has reached epidemic levels among youth in the US. From 2017 to 2019, there was a 78% increase among high school students and a 48% increase among middle school students. ENDS emit toxic substances and their use leads to nicotine dependence and increased risk of cigarette smoking initiation among young people.
To prevent these percentages from continuing to rise, Taghrid Asfar, M.D., M.P.H., a research assistant professor at the Department of Public Health Sciences, wants parents to learn more about the products. Dr. Asfar, who has extensive experience in tobacco control research, spoke to parents at The Cushman School on all there is to know about e-cigarettes.
She delved into the history and basics of e-cigarettes, its common misconceptions, and what parents should do if their child uses the device. Dr. Asfar also spoke more about the CDC’s e-cigarettes and youth toolkit for parents, which suggest tips on how to talk to teens about e-cigarettes, how to start the conversation if they do use the device, the importance of answering their questions, how to keep the conversation going, as well as the messages that schools should send to students about ENDS. During the presentation, Dr. Asfar also shared resources on where to get support for helping students to quit ENDS.
E-Cigarettes History
In 2003, Hon Lik, a Chinese pharmacist, created the first commercially successful electronic cigarette. At the presentation, Dr. Asfar said that Lik had a simple concept when he created the device, which was to separate nicotine delivery from the carcinogens in cigarettes. Instead of burning tobacco, she explained to parents, this new device would vaporize a nicotine-containing liquid, thus creating a smoke-like vapor that could be inhaled. It was in 2006 that e-cigarettes were introduced in Europe and in the United States. Since then, uptake has been rapid, particularly among youth and young adults.
E-cigarettes come in many shapes and sizes. Some e-cigarettes look like regular cigarettes, cigars, or pipes. Some look like USB flash drives, pens, and larger devices, such as tank systems. Interchangeable names for e-cigarettes are known as “e-cigs,” “e-hookahs,” “mods,” “vape pens,” “vapes,” “tank systems,” and “electronic nicotine delivery systems (ENDS).”
E-cigarettes are electronic devices that heat a liquid and produce an aerosol in the air. Most have a battery, a heating element, and a place to hold the aerosol of e-cigarettes. The liquid often contains nicotine and flavorings. Users inhale e-cigarettes aerosol into their lungs. Bystanders can also breathe in this aerosol when the user exhales it into the air.
The e-cigarette aerosol contains nicotine, ultrafine particles that can be inhaled deep into the lungs, flavorings, such as diacetyl, a chemical linked to a serious lung disease known as the popcorn lung, volatile organic compounds, cancer-causing chemicals, and heavy metals, such as nickel, tin, and lead.
In 2019, JUUL, an e-cigarette brand, accounted for 75 percent of the U.S. e-cigarette market. One JUUL pod contains 20 cigarettes worth of nicotine. There is currently 60 percent of JUUL users aged 15 to 24 that do not know that JUUL contains nicotine. JUUL comes in fruity flavors, which make it more attractive to youth and especially dangerous.
There is a myriad of possible reasons why youth use e-cigarettes. Dr. Asfar shared that a few of the many reasons are that a friend of a family member uses them, the availability of flavors, such as mint, candy, fruit, or chocolate, and the belief that e-cigarettes are less harmful than other forms of tobacco, such as cigarettes. They are also less expensive than other tobacco products, easy to use in areas where tobacco products, such as cigarettes, are not allowed, help in quitting other tobacco products, as well as because famous people, a shown in movies or TV, use them.
Approximately 75 percent of youth obtained JUUL at a store or retail outlet, 50 percent received JUUL from a social source, a friend or family member, and six percent received the product through an online transaction.
At the federal level, e-cigarettes are regulated. In August 2016, the regulatory authority of the Food and Drug Administration (FDA) was extended to cover e-cigarettes through the agency’s “deeming rule.” Through the authority granted by the Family Smoking Prevention and Tobacco Control Act, the FDA has the authority to develop regulations that address the manufacturing, marketing, and sale of e-cigarettes.
Generally, e-cigarettes are less toxic than traditional cigarettes, but they are still addictive and not without their own health risks. On the one hand, some researchers argue that e-cigarettes are an obvious “win” to public health by helping smokers quit smoking. On the other hand, some researchers argue that e-cigarettes are a gateway to traditional cigarettes, especially youth and young people. Their controversy is surrounded by three principal issues, which include whether they help or undermine attempts to quit, whether e-cigarettes are safe, whether they expand the nicotine market by attracting youth who otherwise might not ever use the products, thus functioning as a gateway to traditional cigarettes.
So does using ENDS help attempts to quit? Evidence suggests that the odds of quitting cigarettes are 28 percent lower for smokers who used ENDS than for those who did not. Most adults who use e-cigarettes to quit continue to smoke conventional cigarettes. These users are referred to as dual users. In 2016, 93 percent of ENDS users continued to smoke cigarettes.
Are e-cigarettes safe? E-cigarettes deliver the tobacco-specific nitrosamine and potent lung carcinogens, such as NNK and bladder carcinogens. E-cigarette aerosols contain ultrafine particles that cause cardiovascular disease and inflammation in the lungs, leading to increased risk of respiratory infections and severe asthma. Acrolein can cause irreversible lung damage, as well as burns.
Are e-cigarettes a gateway to traditional cigarettes? Among youth, e-cigarettes increase the risk for nicotine addiction, seizures after high doses of nicotine, the mysterious lung disease known as popcorn lung, the use of other tobacco products, as well as the use of alcohol and other drugs, such as Marijuana, cocaine, and methamphetamine.
Common Misconceptions
Approximately 63 percent of teens and young adults do not believe that JUUL e-cigarettes contain nicotine. A recent CDC study found that 99 percent of the e-cigarettes sold in the U.S. contained nicotine. Some e-cigarette labels do not disclose that they contain the chemical and some e-cigarette marketing that is labeled as containing none have been found to contain the chemical.
Most of the e-cigarette advertisements are targeted to youth, making the design aspect more sleek and attractive.
In 2016, approximately 30 percent of U.S. middle and high school students who have ever used an e-cigarette reported using marijuana in the device. Teens who used e-cigarettes but not marijuana had double the likelihood of using marijuana one year later. Vaping devices are being used to vaporize marijuana or have oil (THC) – the chemical responsible for most of marijuana’s mind-altering effects – often through cannabis-infused oils in place of e-liquids. The vaporized marijuana smoke has little smoke, which makes it hard to detect.
The use of e-cigarettes is unsafe for kids, teens, and young adults. Nicotine is an addictive drug and can harm the developing adolescent brain, as the brain keeps developing until the age of 25. Using nicotine in adolescence can harm the parts of the brain that control attention, learning, mood, and impulse control. It can also increase the risk of future addiction to other drugs.
What Parents Should Do?
Throughout Dr. Asfar’s presentation, she advised parents that they should become informed of all there is to know about e-cigarettes, that they should talk to their kids about them, as well as to advocate to elected officials about better laws to protect children. She also advised speaking to schools, as well as to the community about potential education and outreach efforts.
Knowing the signs of vaping is also key for parents to know. Some of them include unusual items, as some devices look like USB drives and pens, sweet smells, changes in thirst and taste in users, nosebleeds, expressing less of a need for caffeine, as well as an unexplained cough, throat-clearing or mouth sores.
Dr. Asfar also provided parents with tips on how to talk to their teens about e-cigarettes. Before having the talk, for example, she shared that parents should know the facts, be patient and ready to listen, as well as set a positive example by being tobacco-free.
When starting the conversation, she said that finding the right moment is key and to ask for support if needed. Answering their questions, keeping the conversation going, connecting and encouraging, reminding and repeating, as well as sharing facts and resources is also key.
In terms of the role that schools have in the fight against e-cigarettes, Dr. Asfar said that adding anti-smoking policies could be beneficial, as well as educating parents, teachers, and coaches about the risk of e-cigarettes. Distributing handouts, factsheets, posters and involving students in those activities can also help.
Smartphones can also be an important resource, as there is a lot of information on the topic online, such as countries that have banned e-cigarettes, toxic chemicals in e-cigarettes, such as nicotine and vitamin E acetate, popcorn lung, and more.
Where To Get Support
There are various resources online on smoking cessation. A few include:
Take-Home Messages
E-cigarette use is very common in adolescents and rates are increasing. E-cigarettes carry important risks for teens’ health, and they should not be used as a smoking cessation tool among adolescents. Other important reminders are that parents, schools, and health providers can help in attempts to prevent the use of e-cigarettes, as well as quit.
Written by Amanda Torres
Published on December 11, 2019
