Behind the Smoke Screen

Teen vaping is on the rise. Here’s what every parent needs to know.

Introduced to the U.S. market in 2007, electronic cigarettes were designed to help smokers kick the habit by gradually reducing their intake of nicotine. But a few years ago, addiction experts like Douglas S. Collier ’99M began to notice an alarming trend. While the number of middle and high schoolers smoking traditional cigarettes continued to plunge, the percentage of teens smoking e-cigarettes (or “vaping”) was increasing rapidly, and there was evidence that the new cigarettes weren’t as benign as many believed.

Collier, who worked as a special agent and, later, as a drug demand reduction coordinator and public information officer for the U.S. Drug Enforcement Administration, is an adjunct professor and director of professional outreach and engagement in Monmouth’s Department of Criminal Justice. To help stem the tide of teen vaping, he’s spent the past three years educating parents and adolescents about its potential dangers in a program he calls “The Smoke Screen.”

How prevalent is vaping among teenagers?

In my field, we use an educational tool called Monitoring the Future, an ongoing study of adolescent behavior, including drug use. The jump in vaping it recorded from 2017 to 2018 was the single biggest annual increase in the use of any drug by teens since 1975, when the study began.[1] I can tell you anecdotally that when I talk to kids in high school and middle school and ask them to raise their hands if they or someone very close to them has ever vaped, 98% of the hands go up.

Is it accurate to say that e-cigarettes today are marketed mainly to young people?

Absolutely. Flavors like mango, orange, and bubblegum are deliberately aimed at teens, and vaping is promoted as “cool.”[2] It’s also being sold as safer than cigarettes.

What are some of the common misconceptions people have about vaping?

I call my program “The Smoke Screen” because those e-devices[3] produce a lot of smoke, metaphorically. A couple of years ago, when we saw the uptick in use, vaping was completely unregulated with regard to adolescents. There was no age requirement because, back then, the Food and Drug Administration (FDA) didn’t consider the e-cigarette a smoking product.[4] And even though the FDA recently required vaping products to carry a black box warning stating that they contain nicotine and that they’re addictive, most adolescents remain uneducated about vaping.

The most common myths among kids and many of their parents are that vaping is harmless—it’s not, especially to young people, whose brains and bodies are still growing—and that e-cigarettes don’t contain nicotine—most of them do. A lot of parents buy e-cigarettes for their kids, and when I ask them why, they say, “At least it’s better than smoking, right?” What they don’t understand is that vaping is smoking.

A lot of parents buy e-cigarettes for their kids, and when I ask them why, they say, ‘At least it’s better than smoking, right?’ What they don’t understand is that vaping is smoking.

What specific dangers does vaping pose to adolescents?

As I said, most e-cigarettes contain nicotine. In fact, the vaping system marketed as Juul comes with a pod that contains the same amount of nicotine as a pack of cigarettes, and some of these kids are smoking three to five pods a day. Even when adolescents know that e-cigarettes contain nicotine, they don’t always understand that it can be toxic. A lot of vapes, for instance, come with gauges that allow you to regulate the amount of nicotine they deliver, starting at a higher number and going down to a lower number. Often, kids will say, “Give me the higher number—I can deal with it.” Nicotine, of course, is addictive, but too much of it can also cause headaches, nausea, increased blood pressure, and tachycardia, a rapid heartbeat.

It’s not just nicotine: E-cigarettes contain unregulated flavors and other substances—usually either propylene glycol or vegetable glycerin, which help disperse the vapor—and diacetyl, a chemical flavor enhancer, all of which may affect the lungs.[5] Another danger is that so-called “open-container” vapes can be customized with the addition of contraband like butane hash oil, flakka, and MDMA, all of which we’re now seeing.

For parents who are concerned that their kids may be vaping, are there any signs they should be aware of?

There are many signs. One is scent: Because kids tend to use the flavored vapes, they may smell like mango, orange, cherry, or bubblegum. Another involves the devices themselves: They often look like pens or USB drives—you actually charge the Juul in your computer, so keep in mind that a pen isn’t always a pen. Then there’s excessive thirst. Propylene glycol is hygroscopic, which means it attracts moisture; it dries out the mouth and the nasal passages. If young people suddenly complain of dry mouth or start sipping water constantly, or if they suffer from nosebleeds, they could be vaping. Another sign is reduced consumption of caffeine. Teens who normally drink coffee or energy drinks like Red Bull may cut back on them because caffeine can intensify the headaches and nausea caused by nicotine. Look out, too, for unrecognized charges on your Amazon or other internet account. A lot of vapes and the e-liquids that go into them are sold over the internet, but the charges don’t always identify the products ordered.[6]

What should parents do if they know or suspect that their child is vaping?

It’s important to have an open conversation about the perception of vaping versus the reality. The perception among teens is that it’s not a big deal—they may tell you that lots of their friends are doing it and a few are even getting it from their parents. So the job of a parent is to discuss the perception and then the reality: that there’s nicotine in e-cigarettes, that nicotine carries health risks and is addictive, and that there are other substances in e-cigarettes that can be toxic. The idea is to arm teens with accurate information so that they can make an informed decision.

Is there a role for schools in this?

Unfortunately, the schools are being reactive right now because vaping wasn’t on their radar screen—it came on so quickly, especially in middle schools.I’m doing a lot of outreach with the schools, including parent presentations and student presentations. The role of schools should be to facilitate this kind of education, so kids understand the risks of vaping. When I’m done talking to these kids, I put up a slide that asks “E-cigarettes: Safe?” The majority get it. They tell me: “I didn’t know.”

Notes

1. According to Monitoring the Future, between 2017 and 2018, vaping increased by 17.6% among eighth graders, 32.3% among tenth graders, and 37.3% among twelfth graders.

2. In a 2018 study, researchers at the Centers for Disease Control and Prevention concluded that Juul was largely responsible for the steep rise in teen vaping, stating, “Juul’s high nicotine concentration, discreet shape, and flavors could be particularly appealing to, and problematic for, youths.”

3. Most so-called “vapes” consist of a mouthpiece, a container for the e-liquid (usually comprising, among other things, flavors; synthetic substances like propylene glycol, or the oil derivative known as vegetable glycerin and diacetyl; plus nicotine), and a battery-powered heating element that turns the liquid into inhalable vapor. “Open-container” vapes must be filled manually with e-liquid; “closed-container” vapes, like Juul, are sold with prefilled (and closed) pods.

4. As of August 2019, nine states, including New Jersey, have passed laws restricting the sale of e-cigarettes to those 21 and older.

5. Propylene glycol (PG) is a synthetic liquid used in cosmetics, medicines, and food products and in the manufacture of polyesters and deicers. The FDA has classified it as “generally recognized as safe” when ingested, but there is no FDA judgment as to its safety when inhaled. There are indications that inhalation of PG may contribute to “wet lung,” a serious inflammation that causes scarring and symptoms similar to those of chronic obstructive pulmonary disease. Animal studies have found that inhalation of diacetyl can damage the airways, and the CDC notes that airborne diacetyl likely contributed to lung disease in workers at a microwave popcorn manufacturing facility (hence the name “popcorn lung”).

6. None of these signs guarantees that a child is vaping, says Collier. Parents should be aware of their child’s baseline behavior and watch out for deviations.

// //