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JAMA Pediatrics Patient Page
February 22, 2021

What Parents Need to Know About Teen Vaping and What They Can Do About It

Author Affiliations
  • 1Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville
  • 2Annenberg School for Communication, University of Pennsylvania, Philadelphia
  • 3Department of Pediatrics, University of Florida College of Medicine, Gainesville
JAMA Pediatr. 2021;175(4):440. doi:10.1001/jamapediatrics.2020.6689

Vaping refers to using e-cigarettes that heat liquids to produce aerosol that users inhale into their lungs.

Vaping among teens has recently skyrocketed, and many believe it is a safe activity. About 1 in 5 high school students vape, exposing them to nicotine, a highly addictive substance found in tobacco. Adults may use vaping to quit a nicotine addiction, but youth often start with vaping and graduate to cigarettes later. Vaping is likely to keep young people hooked for years.

What Are the Risks for Teens Who Vape?

While it might be true that vaping is less dangerous than smoking cigarettes because the vaped aerosols have fewer toxic and cancer-causing chemicals than cigarette smoke, the aerosol from vaping is not harmless. In addition to nicotine, some dangerous chemicals, such as formaldehyde, form when nicotine liquid is heated to high temperatures. Vaping is linked to youth becoming more likely to then try cigarettes, causing more harm. Last year, we learned vaping caused an outbreak of severe lung injuries linked to vitamin E acetate, which is found in vaping devices that deliver tetrahydrocannabinol, the psychoactive ingredient in cannabis. More recently, a study found that vaping in teens was linked to infection with coronavirus disease 2019 (COVID-19). COVID-19 spreads through repeated hand touching to the mouth and face, which is common when vaping, as is sharing of vaping devices, which can spread COVID-19 if devices are contaminated.

How Do I Know If My Teen Is Vaping?

Unlike cigarettes, which come in standard shapes and have a distinct smell, e-cigarettes are harder to detect. Some vaping devices look like everyday objects such as USB drives, watches, pens, and markers. Keep an eye out for parts such as refill pods that contain the vape juice, atomizers, batteries, and chargers. Most children prefer sweet-flavored vapes. Catching fruit or candylike smells could be evidence of vaping. Vaping also makes users’ mouths dry, causing your teen to drink more than usual. If your child is an athlete and starts having trouble breathing, it also could be due to vaping. Other signs of vaping include nosebleeds, unexplained cough, throat clearing, mouth sores, increased irritability, or mood swings.

What Can Parents Do to Help Prevent Teens From Vaping?

If you are a parent of a school-aged child, it is likely that your child has been exposed to youth-targeted vaping ads. Your child is also likely to know someone, even a friend, who vapes. Talk to your child early about vaping and the facts about the harmful chemicals that people breathe in when they vape. You can share resources that are easy to understand, such as the links listed in the box below. You should also continue to talk to your child about other people who vape at their school and how they feel about it.

What Can Parents Do If Their Teen Is Addicted to Vaping?

Quitting vaping is just as hard as quitting smoking. If you are concerned that your teen is addicted to vaping, it is important to know that there are several treatment options. Talk to your pediatrician about counseling from an addiction specialist and medications that can help treat nicotine addiction.

Box Section Ref ID
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Article Information

Published Online: February 22, 2021. doi:10.1001/jamapediatrics.2020.6689

Conflict of Interest Disclosures: None reported.

1 Comment for this article
Aggressive education and awareness campaign targeting adolescents, their parents and care givers, their primary health care providers
Aki Nilanga Bandara, BSc, MSc | Faculty of Medicine, University of British Columbia
With rapidly increasing adolescent’s e-cigarette use in North America and worldwide the balanced review to highlight the parents and caregiver role of preventing e cigarette use of our vulnerable children is utmost important. The article statement “Quitting vaping is just as hard as quitting smoking”(1) is timely. Furthermore, parents and caregiver awareness of this global epidemic is cornerstone for effective prevention efforts. While further evidence has emerged that daily e-cigarette use was independently associated with increased odds of having had a myocardial infarction (OR=1.79, 95%CI=1.20- 2.66), there is still insufficient prevention awareness initiatives to minimize adolescents up taking e- cigarette use (2). More importantly daily dual use (combustible tobacco plus e-cigarettes in combination) is significantly increasing the odds of having MI by almost 3 times (OR 2.72 CI=1.70 - 4.62)(2). Unfortunately, this is the most common use pattern among e-cigarette users. Even though cross-sectional study design would not allow us to make conclusions about causality, accumulating evidence also shows that the short- and long-term health impact of e-cigarettes -use may be more harmful than we know (3). These studies appropriately and timely bring light and the questions regarding its effects on human health.
There is still grossly insufficient evidence, however, tobacco industry sponsored online information are promoting electronic cigarettes as a less harmful tobacco cessation tool. Accordingly, adolescents are more likely to believe that e-cigarettes are less harmful than combustible cigarettes (4, 5). A most recent randomized controlled trial also confirmed that e-cigarette is not a tobacco cessation tool (5, 6). New evidence also shows that injury hazards (explosions and burn injuries) related to e-cigarette use is also increasing (6, 7). More vigorous efforts are needed to disseminate health impacts and injury hazards of electronic cigarettes on adolescents and adults. Aggressive education and awareness campaign targeting adolescents, their parents and care givers, their primary health care providers and the pediatricians with the right information to ensure that there is no sufficient evidence to recommend e-cigarettes as a tobacco cessation tool or harm reduction tool for adolescents(6).
In December 2016, the US Surgeon General released a comprehensive action plan, based on best evidence on how to protect our adolescents from the e-cigarette epidemic. This e-cigarette prevention plan includes implementing comprehensive educational campaigns specifically tailored for young people (8). We need an effective social media campaign to counter the misinformation/common myth that e-cigarettes are risk free and healthier tobacco product:
(a). virtually there are no healthier cigarettes or alternative nicotine delivery system, and it is not a 100 % risk free tobacco product as advertised online
(b). It can be potentially harm developing adolescent brain (especially high nicotine contain products such as Juul)
©. Currently, there is no sufficient evidence to support e cigarette as a evidence based tobacco cessation or harm reduction tool
All new tobacco products including the e-cigarette must carry Health warnings like combustible tobacco. Which could counteract misinformation such as e cigarette is less harmful and safe alternative to combustible tobacco. Adolescents need appropriate and clear guidance on electronic cigarettes and its potential benefits or harm to help them make the right lifestyle decisions.