Credit: Courtesy of Breathe Pennsylvania
The teens gathered at the store counter to select a favorite flavor from the colorful wall display—bubblegum, banana, chocolate, pink lemonade. But they weren’t purchasing candy. They were buying electronic cigarettes.
Commonly called vapes, vape pens and pens, they are used by more than 11 million people in the United States, the most of any country. (The United Kingdom is a distant second, with 4.3 million.) Sales in the U.S. have increased nearly 50% over the past three years; global sales are expected to reach $40 billion by the end of 2023.
Despite a 2019 federal ban on sales of tobacco products and e-cigarettes to those under 21, an estimated 3.1 million users are between 18 to 24. One in seven high school seniors vape (that’s 2.1 million teens); so do one in every 30 middle school students (380,000 children). Only 0.5% of smokers over 65 prefer e-cigarettes.
Student vaping declined during the Covid outbreak, in part because kids weren’t able to buy e-cigs from friends at school, but it has climbed back to pre-pandemic levels. Underage users also go to online websites (strict proof of age is rarely required) and convenience stores or gas stations are known to be lax about checking IDs.
The simple device consists of a battery, heating element, mouthpiece and a place to hold e-juice, a flavored liquid nicotine mix derived from the tobacco plant that is converted to vapor. Vapes can be mistaken for USB flash drives, lipstick, erasers or small cell phones, making them easy to smuggle into school.
Credit: Courtesy of the CDC
E-cigarette makers target young people. There are hundreds of fun flavors to choose from, and many kids mistakenly think they’re only inhaling water and flavoring. The packaging often uses words like “pure” or “tobacco free,” but nearly all e-cigs sold in the U.S. contain up to 5% nicotine—even those marked as having none! Vapes are just as addictive as cigarettes because of their similar nicotine content, and a standard pen provides 200 puffs, the equivalent of a pack of smokes.
Developed in 2003 by a pharmacist as a way to kick the smoking habit, e-cigs have instead compounded the problem: Thirty percent of adult tobacco users smoke and vape. A ninth grader who vapes is seven times more likely than a non-vaper of the same age to start smoking after one year. Many teens use e-cigs to relieve anxiety and depression. Some like the buzz from nicotine, or the social aspect of vaping.
According to the CDC, e-cigs have fewer harmful chemicals than the smoke from tobacco products, but they still pose serious health risks. In addition to nicotine, they contain chemicals used in flavoring like diacetyl, which can cause severe lung inflammation. Byproducts of vaporization produce volatile organic compounds such as benzene and heavy metals, which are carcinogens.
Vitamin E acetate, added to thicken vape liquids, is the presumed cause of E-cigarette or Vaping use-Associated Lung Injury (EVALI), a potentially fatal obstructive respiratory disease. In 2019, EVALI caused 2,800 hospitalizations in the U.S.; over half of the victims were 24 or younger. Of the 68 who died, 10 were children under the age of 18. Thanks to increased public awareness, EVALI cases have declined. Many states have banned the use of Vitamin E acetate in e-cig products, but users must remain vigilant and read labels.
Vaping can lead to the development or exacerbation of asthma. Nicotine increases the risk of heart disease, arrhythmias and high blood pressure. It is toxic to fetuses and harms brain development in teens. Two thirds of U.S. youths report wanting to quit, tired of the side effects: coughing, eye irritation and headaches.
Credit: Courtesy of the CDC
Secondhand vapor produced by e-cigs contains carcinogens, a potential danger to those nearby. Chemical residue from vaping settles on household surfaces (“third-hand aerosol”) and is unsafe for toddlers, who transfer it from fingers to eyes or mouth. The incidence of young children poisoned by ingesting vape liquid is on the rise: Containers can look like Legos, and the vape liquid smells like candy. In a recent 12-month stretch the National Poison Data System reported more than 7,000 cases of poisoning from exposure to vaping products. Of those cases, 90% involved children under the age of 5. Vape supplies must be locked safely away to protect toddlers (and pets).
The ways to stop vaping and smoking are similar. First, toss out the vape pens! Try a change of routine: exercise, meditate (free classes are available in local libraries), take up a new hobby. Call a friend or family member when you have the urge to vape. Check with your medical professional to consider an OTC nicotine replacement therapy. Adults may need prescription medications (Chantix, Zyban) to help kick the habit. Many benefit from counseling to address underlying emotional issues.
Those aged 13 to 24 can text “DropTheVape” to 88709 and receive age-appropriate assistance in quitting, including text messages to motivate and support this effort. This service is sponsored by the New York State Department of Health.
From health.ny.gov: “The free and confidential New York State Smokers’ Quitline assists thousands of New Yorkers every year in their attempts to break free from smoking and other tobacco use by providing information, expert quit coaching, support, and free starter kits of nicotine replacement therapy. Call 1-866-NYQUITS (1-866-697-8487), text 716-309-4688, or visit the New York State Smokers’ Quitline at https://www.nysmokefree.com/ for more information or to chat with a Quit Coach.”
Mary Jenkins recently retired after nearly 40 years as a family practice physician in New York state.