E-Cigarettes and Teen Smoking

By Tarah Damask. Medically reviewed by Tom Iarocci, MD. May 7th 2016

Protecting your teen from smoking is a common task that has most parents concerned about the longevity and quality of their child’s life.

Fortunately, FDA regulations regarding the sale and marketing of conventional cigarettes to minors contributes at least partial support to the prevention of teen smoking.

Unfortunately, the same cannot be said for e-cigarettes. As of 2014, the sale and marketing of e-cigarettes, or e-cigs, is unregulated. The electronic device, more formally called an electronic cigarette, heats up nicotine-containing e-juice, turning it into vapor inhaled by the user. Vaping storefronts are popping up across the nation.

Supporters of e-cigarettes hail the devices for assisting adults in the effort to quit the use of conventional cigarettes. For teens, however, these devices may have the opposite effect, and might actually act as a gateway to the use of traditional cigarettes.

Are Manufacturers Marketing E-Cigarettes to Minors?

Research continues to point to significant e-cigarette marketing targeted at teens and children. While much of the vaping world is clearly geared toward adults, the lack of regulations means not all manufacturers advertise with your teens’ best interests at heart.

Although e-cigs are often marketed as a smoking cessation aid, a variety of e-devices target a younger market. “The e-cig/tobacco companies are aggressively reaching the youth market,” says Stanton A. Glantz, MD, professor of medicine and director of the Center for Tobacco Control Research and Education at the University of California, San Francisco,  

Though individual states have placed bans on the sale of e-cigarettes to minors, and the FDA has plans in the works to treat e-cigarettes like tobacco products to reduce nicotine use, the current lack of regulation gives e-cig companies free reign when it comes to attracting new consumers.

What are the concerns regarding targeting of youth? Manufacturers are creating e-cigarettes, among other devices, such as e-hookahs, in bright colors and a multitude of flavors, including candy-flavored cartridges, available online and in shopping malls, all of which is potentially attractive to a younger audience. 

Teens fall under the impression that e-cigarettes offer a safe alternative to cigarettes, often failing to realize the impact of the consequences.

Do E-Cigs Protect Teens from Nicotine Addiction?

Highly addictive, nicotine can set the stage for a lifelong struggle with addiction. The increasing saturation of the market with e-cigarettes is leading to an equally quick increase in teen nicotine use. One in five high schoolers who identify as smokers “vape,” rather than smoke, and may be on the road toward an addiction that may lead to conventional smoking, according to the Center for Disease Control and Prevention (CDC).

This problem extends into middle-school-aged students, among whom smoking of both e-cigarettes and conventional cigarettes increased during 2011 to 2012, according to the CDC.

While proponents of e-cigarettes praise the devices for their clean secondhand vapor and lack of toxins, even limited research has proven these supposed benefits false. Teens who choose to vape expose themselves to both nicotine, and a medley of other toxins, often carcinogenic, known to cause lasting adverse health effects.

The Dangerous Power of Nicotine Addiction

Because humans in adolescence are still in the process of developing, e-cigarette use may pose additional threats to minors. Nicotine can have a poor effect on both brain development and behavior. Toxins like nickel and formaldehyde make the list of additional toxins commonly found in e-cigarettes.

Glantz expresses his worry regarding e-cigarette use among teens, saying, “I am very concerned that e-cigs are a gateway to smoking cigarettes for teens. Even if they do not lead to smoking cigarettes, e-cigarettes are a gateway to nicotine addiction, which is a bad thing, especially for adolescents, whose brains are still developing.  Nicotine also has important toxic effects on its own, in addition to being an addictive drug.”

In a study performed by the Center for Tobacco Control Research and Education at the University of California San Francisco, researchers looked at a cross-section of Korean high school students, finding that though marketed as a means of quitting smoking or a cigarette alternative, 9.4 percent of Korean adolescents have used e-cigarettes, and a small handful of this group actually began their nicotine addiction through e-cigarettes, having never smoked before. What’s more, e-cig use was strongly associated with current and heavier cigarette smoking in this study.

Because adolescents who have not previously used tobacco are considered a low-risk group (compared to those who have already been exposed to nicotine or tobacco products) the data illuminates an unsavory fact: e-cigarettes may act as a gateway to nicotine addiction for teens.

Next Steps

For Patients and Family Caregivers

  • Speak openly with your teen about the effects of smoking, and explain that e-cigarette use may result in the same devastating health and developmental consequences as conventional cigarettes.
  • If you are a teen addicted to e-cigs or cigarettes, speak with a parent, guidance counselor or help line for assistance with quitting. Programs like SmokeFreeTxt offer free daily support.
  • If you are a caregiver of a smoker, speaking with a doctor or counselor about methods for quitting nicotine is an important step in stopping the cycle of addiction comfortably, while promoting healthy habits.
  • Explain to your teen the extreme danger of handling e-juice, which contains liquid nicotine, and may result in poisoning through ingestion, inhalation or absorption; a simple spill may result in serious illness or death.

Sources

Glantz, SA, Ph.D., professor of medicine at director of the Center for Tobacco Control Research and Education at the University of California, San Francisco (UCSF) School of Medicine. http://profiles.ucsf.edu/stanton.glantz Interviewed June 2014
Dutra L., ScD and Glantz S, PhD.  “Electronic Cigarettes and Conventional Cigarette Use Among US Adolescents.” JAMA Pediatrics. March 2014.  http://archpedi.jamanetwork.com/article.aspx?articleid=1840772&resultClick=3. Accessed June 2014.
Lee S., PhD, Grana R., PhD, Glantz S., PhD. “Electronic Cigarette Use Among Korean Adolescents: A Cross-Sectional Study of Market Penetration, Dual Use, and Relationship to Quit Attempts and Former Smoking.” Journal of Adolescent Health. November 2013.  http://www.jahonline.org/article/S1054-139X(13)00748-9/abstract. Accessed June 2014.
American Academy of Family Physicians. “Electronic Cigarettes.” http://www.aafp.org/about/policies/all/e-cigarettes.html. Accessed June 2014.
Centers for Disease Control and Prevention. “Notes from the Field: Electronic Cigarette Use Among Middle and High School Students – United States, 2011-2012.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6235a6.htm. Accessed July 2014.
Gaudette R. Yale School of Medicine, Psychiatry. “Blumenthal, DeLauro: E-hookahs Attractive, Dangerous, and Marketed to Children.” March 2014. http://psychiatry.yale.edu/newsandevents/archive/article.aspx?id=7079. Accessed June 2014.
Morbidity and Mortality Weekly Report “Notes from the Field: Electronic Cigarette Use Among Middle and High School Students — United States 2011–2012.” 2013; 62 (35); pages 729-730. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6235a6.htm. Accessed June 2014.
U.S. Food and Drug Administration. “FDA Proposes to Extend Its Tobacco Authority to Additional Tobacco Products, Including E-Cigarettes.” Updated April 2014. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm394667.htm. Accessed June 2014.  

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