ENDS (Electronic Nicotine Delivery Systems), commonly known as E-cigarettes, were introduced in 2007 as a “safer” means for current adult smokers to stop smoking, but as recent news headlines are bringing to light, they’re not as safe as they perhaps once seemed.

 

Their perceived safety and many appealing flavors – up to 7000 varieties – make these devices attractive to adolescents, and now an important concern for parents. ENDS are widely available in large retail stores, pharmacies, convenience stores, gas stations, vape shops and online.

 

Due to increased availability, lack of regulation and what appears to be marketing to the young, the use of ENDS has skyrocketed in the past three years and far surpassed use of any other tobacco product or device among youth. According to the 2018 National Youth Tobacco Survey, one in five high school students and one in 20 middle school students reports that they vape (the term for inhaling vapor from an E-cigarette or similar device) on a regular basis.

 

These devices consist of a battery that heats metal coils in a vaporization chamber and a replaceable or refillable cartridge or tank that contains nicotine in a solution. When heated, the nicotine solution becomes a vapor to be inhaled. The solution includes a solvent/liquid base such as glycerol or propylene glycol, natural oils, extracts and flavorings, all considered to be generally safe in liquid form but known to release potentially harmful chemicals when heated.

 

Almost all E-cigarettes contain nicotine, but the amount can vary greatly. “Dripping,” dropping the solution directly on the hot coils, produces a thicker vapor with even higher nicotine content and more rapid intake into the body.

 

JUUL, a more recent product, is the size and shape of a USB flash drive which makes it easy to hide in a pocket, backpack or purse. It produces little vapor, making it easy for students to use anywhere, even in a classroom. JUUL pods contain double the nicotine content of any E-cigarette, equal to the amount of nicotine in one pack of 20 cigarettes. The term “juuling” may be used to mean any vaping.

 

Note: Teens typically “microdose” with JUUL or E-cigarettes, taking small “hits” frequently throughout the day and not realizing how much nicotine they’re inhaling. Some may end up using one or more pods or cartridges a day, equal to a pack or more of regular cigarettes.

What to watch for

The following are possible signs a child may be vaping/juuling:

• Suspicious-looking devices or packaging in your home, garage or yard
• Unexplained online purchases on your credit card
• A scent (from a flavoring) with no obvious source
• Mentions of vaping in your child’s text messages or social media exchanges
• Bloodshot eyes, frequent nose bleeds, increased thirst, increased appetite and/or changes in mood or behavior

Talk with your child’s pediatrician or other primary care provider if you have concerns. 1-800-QUIT-NOW and drugfree.org/helpline are also helpful resources.

How can parents discourage vaping?

• If you’ve never used tobacco products or quit in the past, don’t start using these while raising children. If you already smoke, make every effort to stop. Any adult role modeling of smoking or vaping increases the risk of teens thinking it’s a safe and desirable “adult” thing to do. Also, research has shown that adolescents tend to associate with peers whose beliefs and behaviors are similar to that of their own parents – in other words, children whose parents don’t smoke tend to have friends who don’t smoke.
• If you’re trying to stop smoking, do not use ENDS as a way to help you quit because they have limited success compared with other methods. If your adolescent or young adult smokes, do not recommend or provide ENDS for them to stop smoking.
• Share information about the dangers of vaping and juuling with your child, using articles from print media or online. Express your concern if and when children or adolescents are exposed to advertising that appears targeted to the young and misleading about the safety of these products.
• Keep up with the rapidly changing state and federal regulations that will affect the availability of ENDS to youth and the required package information describing the risks. Share this new information with your adolescent or young adult as soon as you learn it.

Positive role modeling, sharing accurate information and honest discussion of your concerns and expectations are the best ways to help the young people in your life choose healthy behaviors. This approach also can be an effective way to help them avoid unhealthy risk-taking, whether trying E-cigarettes, alcohol, or the many other temptations they may face in this stage of life.

Helpful resources

For additional information, go online to American Academy of Pediatrics, Centers for Disease Control, Partnership for Drug-Free Kids, Surgeon General and/or U.S. Food and Drug Administration and search for E-cigarettes or vaping.

By Dr. Richard R. Brookman, adolescent medicine specialist