Vaping on the rise in teens
Was it really a coping mechanism during the pandemic?
How do you get kids addicted to what you’re selling? Make it taste like fruit or candy. That’s according to the National Youth Tobacco Survey conducted by the Centers for Disease Control and Federal Drug Administration.
Their findings were unsettling. More than 2.5 million adolescents in middle and high school are current e-cigarette users with 85 percent favoring use of disposable flavored brands like Puff Bar, Vuse, Hyde, and SMOK.
Vaping brands such as these peaked in 2019 and then saw a dip during the pandemic. More recently, vaping frequency among teens is creeping back up to pre-pandemic levels despite government crackdowns.
Those government crackdowns mainly centered on JUUL. In 2020, the FDA banned the selling of non-disposable brands, which specifically targeted the e-cigarette company. JUUL appealed and a stay was granted this past June. Since that time, the ban on their products has been on hold because they are suing the FDA for not disclosing documents that justify the e-cigarette ban.
While the FDA was honing in on JUUL, the organization neglected other brands–which opened the flood gates for disposable e-cigarettes.
Ari Kirshenbaum, Ph.D, is a professor of psychology at St. Michael’s College in Vermont. He was interviewed by Vermont Public Radio in September about a recent settlement of the $8 million Vermont will receive as a result of JUUL’s aggressive marketing on young people. (Vermont was one of 33 states suing the company for a combined total settlement of $438 million.)
Kirshenbaum spoke at length about its impact. Acknowledging that the initial purpose of the e-cigarette was to get smokers to quit, he put JUUL’s marketing plan in perspective.
“Why on earth should these e-cigarettes come in bubblegum flavor or blueberry flavor or cotton candy flavor? It just doesn’t seem to make sense to me,” he said. “So, I think that these flavors are really there to sort of introduce nicotine to a new population of users.”
Sherin Panacherry, MD, MPH, is an assistant professor of clinical pediatrics in the section of Respiratory, Allergy-Immunology and Sleep Medicine at the Yale School of Medicine. She agreed with Kirshenbaum that the only reason to market with sticky sweet flavors is to get kids addicted.
“There is no other reason for a product like that to be so marketed to children with bright colors and candy flavors,” she said. “I don’t think any of this is okay. It affects the brain, which continues to form until they are in their 20s. [Adolescents] are more prone to addiction. Their neuro systems are flexible and more plastic.”
She added there may be an increased risk in children smoking if their parents smoke. But it’s more likely if their peers are the smokers. It’s a lot easier to hide at school with opportunities to sneak a puff in between classes.
Ari Kirshenbaum, Ph.D, is a professor of psychology at St. Michael’s College in Vermont.
In an email exchange, Kirshenbuam discussed how children get hooked on e-cigarettes, or ENDS as an acronym for electronic nicotine delivery system. Basically, nicotine enhances sensory experiences and “commandeers” neural circuitry in the brain to sensitize the satisfaction of the sweet taste.
He said because nicotine activates the pathways involved in memory, the sensory experience is “encoded” more easily and is retrieved more readily. In other words, the smoker has a positive memory of the experience which only encourages further use.
Part of the problem is that many people, adolescents in particular, believe ENDS are harmless. But are they? Not according to the American Lung Association. The Association highlights the damage that can happen to the lungs, called E-cigarette or Vaping Use-Associated Lung Injury (EVALI).
The symptoms that occur from vaping include shortness of breath, fever and chills, cough, vomiting, diarrhea, headache, dizziness, rapid heart rate, and chest pain. Some kids have even died from vaping. What is most often blamed for the onset of EVALI symptoms is the vitamin E acetate liquid in the vaping device. Children have no idea what they’re inhaling but think it is fine because it’s not a “real” cigarette.
Panacherry pointed out it may be difficult to know if a child vapes because he or she may not necessarily exhibit any outward symptoms. Some kids may develop a cough, but an otherwise healthy child may not have any issues.
She noted that children with pre-existing conditions like asthma may be more likely to cough. Then, there are kids who end up diagnosed with EVALI.
“It’s the worst-case scenario,” she said. “There can be a cough and even GI upset. You may see CAT scan changes in the lungs. But cases vary depending on what they’re taking, like Vitamin E acetate. The data is lacking. It’s not really regulated, what’s going in an e-cigarette. It’s just a noxious combination of ingredients.”
Kirshenbaum echoed that point when he talked about synthetic nicotine products. “ENDS are less toxic than combustible tobacco, but there are ingredients in the aerosols that have been linked to cancers,” he said. “There is also evidence that in teens, exposure to ENDS increases the odds that those youth will move on to combustible tobacco cigarettes.”
Panacherry said unlike cigarette smoke, which you can smell, with e-cigarettes, there is more of a sense of a sickly-sweet smell. Any obvious changes are more likely in behavior; children who vape can become more secretive or hide things.
In an article published in the June issue of “Journal of Preventive Medicine,” researchers claimed vaping during the pandemic was a coping mechanism in young adults for mental health issues.
“Increased vaping may have been a form of coping with pandemic-related stressors, which increases risk for future substance use problems.” Certainly, there have been a number of reports over the past two years pointing out the increase and severity of mental health issues in children, adolescents, and adults.
Kirshenbaum reacted this way to the possible link between ENDS and mental health: “I’m unsure about whether ENDS were used as a way to solve mental health issues in youth,” he explained, “but depression, schizophrenia, and ADHD are all correlated with tobacco dependence, presumably because nicotine is used to self-medicate symptoms.”
Panacherry acknowledged there needs to be more research into the data from 2020. She feels it is likely vaping was a way to cope with pandemic-related mental health issues. “Rates of anxiety and mental health issues skyrocketed during the pandemic, so this would be a coping mechanism.”
This publication has covered the topic of vaping multiple times. In one 2019 article, Suchitra Krishnan-Sarin, Ph.D., professor of psychiatry at the Yale School of Medicine, gave her feedback. “We need to find a way to regulate these compounds and make them only available to adults to be used when they want help to quit smoking cigarettes. Education is going to be key,” she noted.