What Parents Need to Know about Youth Vaping

Photo: Isabel Wang @ Up and Better

In a household where no one smokes or uses vaping products, I once thought vaping was rare and had no direct connection with our family and friends. However, in Michigan where we live, today about one in four high schoolers did vaping in the past 30 days. Middle schoolers are vaping too, although to a less extent.     

            On Nov 26, 2019, Michigan Department of Health and Human Services (MDHHS) reported the second case of death related to vaping in Michigan. So far, 56 cases of vaping related lung injury have been reported in Michigan. The age of patients ranged from 15 to 67.

            It is critical for parents to be more aware of this epidemic. It is as important for us to share our knowledge with our children.

What is vaping?

            Electronic cigarettes (E-cigarettes), or vaping products, are battery-powered devices that heat up liquid and generate aerosol for users to inhale. The use of E-cigarettes is called vaping.

            Although most of the E-cigarettes contain nicotine, many of them are nicotine-free. Some vaping products contain THC (tetrahydrocannabinol) or CBD (cannabidiol) oils. THC is the chemical that gives the sense of “high” in marijuana users.

            JUUL is a vaping device that has got increasingly popular among youth. It comes with at least eight flavors that are attractive to children, such as mango, mint and creme. JUUL “pods” are small and resemble the shape of a USB drive, which makes it easy to carry and use in classrooms.

How prevalent is vaping among youth?

            Nationwide, rate of vaping in high schoolers and middle schoolers has doubled since 2017. In Michigan, vaping in 7, 9 and 11 grades has been investigated in the MiPHY survey led by Michigan Departments of Education and Health and Human Services.

            The rate of youth vaping in Michigan is similar to the national level. As mentioned above, in 2018, an average of 25% of Michigan high-schoolers and 7% of middle-schoolers used e-cigarettes in the previous 30 days. The reports in 2019 are only available for a few counties, but it appeared that vaping among youth continued to rise in 2019.

            In comparison, less than 4% of high schoolers smoked cigarettes in the previous 30 days according to the same survey.

Many of us were led to believing vaping is safe or safer, but it is not

            Until very recently, vaping products were thought to be safe and beneficial in helping smokers quit smoking cigarettes. Such notions were backed up by earlier scientific studies and advertisements by industry. However, professionals and government agencies now have more evidence showing vaping products are doing more harm than good, for both adults and youth.

  • Lung injury and death

            EVALI (E-cigarettes or Vaping Associated Lung Injury) is a new disease defined earlier 2019 after initial lung injury cases were reported in New England Journal of Medicine.

            Patients with lung injury have a wide range of symptoms, such as cough, short of breath, chest pain, vomit or fever. Actual cause of EVALI is unknown. There is no specific cure either. 

            As of Nov 20 this year, 2,290 cases of EVALI and 47 deaths have been reported in the US. The investigation led by Centers for Disease Control and Prevention (CDC) is still ongoing. Current research reported last week linked Vitamin E and DHC oil in the vaping products to lung injury. I recently published an article on what we have known about EVALI.

  • Potential carcinogenic compounds in vapor

            Aerosols generated by E-cigarettes contain various concentration of compounds that potentially cause cancers. E-cigarettes contain solvents such as glycerin and propylene glycol, both of which produce carcinogenic chemicals during vaping process. However, the actual concentration of these chemicals and their long-term effects are still unknown.

  • Chronic effects of inhaled nicotine at higher dose

Nicotine patch or other forms of nicotine replacement therapy have been considered safe. However, nicotine is not safe in youth as it is highly addictive and may impair brain development in children.

In addition, vaping may introduce higher dose of nicotine into body, depending on the devices and personal experience. For instance, one JUUL pod contains nicotine that is equivalent to a pack of cigarettes.

  • Vaping at a young age may lead to more smoking later in life

            Much fewer youth or young adults smoke conventional cigarettes. This could be attributed to several reasons:

            It is more difficult for minors to get cigarettes; smoking cigarettes is banned at almost all public locations; in the past decades, harm of cigarette smoking has been well-known to adults and children; use of conventional cigarettes has been stigmatized.

            As expected, over 80% of Michigan youth reported that they consider smoking even one cigarette to be of risk and wrong, according to the MiPHY survey.

            In contrast, vaping has been promoted by businesses as an effective tool to help quit smoking and improve health in smokers; vaping has not been banned from public locations; advertisements led children and adults to thinking vaping products are safe.

            Is vaping just a harmless recreational activity for youth? According to the study by researchers at Boston University, youth who use vaping products are 4 times more likely to smoke cigarettes in the following 2 years.

Top three reasons why youth vape

            The National Youth Tobacco Survey of United States in 2016 showed the most common reasons are the following: influence from family and friends, availability of flavors and belief that they are safe.

Chart based on data from National Youth Tobacco Survey 2016

Where do students get vaping products?

            I looked at the data on Wayne, Oakland and Washtenaw counties reported in the 2018 MiPHY survey. The sources of vaping products are very similar across counties. Nearly half of students get vaping products by borrowing from others. This is concerning as CDC reported majority of EVALI cases were associated with products obtained from informal sources. These products are more likely to contain chemicals that have not been approved for vaping use.

Resources available to parents

       CDC recommended that vaping products should not be used in youth, young adults or pregnant women; THC vaping products should not be used either.

            In September 2019, Michigan became the first state in the nation that banned flavored E-cigarettes. However, this act encountered resistance.

            Meanwhile, to parents, it is never too early or too late to have an open discussion with our teens and preteens.

About the Author Isabel Wang, MD/PhD

I received my MD from PUMC in Beijing China and my Ph.D. in Biochemistry from Stony Brook University on Long Island. Over the years, I have worked in the fields of genetic research and clinical medicine in different parts of the US, including PA, MO, CT, FL, NY and MI. My research has been published in multiple scientific journals. Currently I live in Ann Arbor, MI with my husband and our children and Mango the orange tabby. I love hiking, running, baking, cooking and biking.

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