Why Everyone Should Be Concerned About Adolescent Vaping

What we know is bad, but what we don't know could be scarier.

Posted Jul 01, 2019

In 2019, it seems that e-cigarettes and vaping have fallen in the crosshairs of schools and local and state governments, all of whom are considering how to approach vaping among adolescents and young adults. The city of San Francisco is set to institute a ban on e-cigarette sales; Aspen, Colorado, has banned flavored liquids to be used in e-cigarettes; and school administrators are struggling with whether to treat vaping either as a substance use or as a disciplinary problem (to be clear, it should be treated as a substance-use problem).

Vaping remained under the radar for many years, but evidence continues to accumulate about its potential harm in adolescents. Nationwide surveys illustrate the trend: from 2017 to 2018, vaping in U.S. high school seniors jumped from roughly one in six users (16.6 percent) to more than one in four (26.7 percent). Also notable is what they’re vaping. High school seniors aren’t just vaping nicotine, though over 20 percent have done that in the past month. Compounds in marijuana can be vaped as well, with 7.5 percent of high school seniors having vaped oils containing THC, cannabidiol (CBD), and other marijuana compounds.

Significant research also indicates that adolescents who use e-cigarettes are more likely to begin smoking traditional cigarettes than teens who do not vape, compounding the harm potentially caused by vaping, which has been linked to heart and blood vessel damage. Perhaps the long-term risks of e-cigarette use in adolescents are best summarized by Dr. Daniel Conklin, a professor at the University of Louisville Medical School, who said “…we just don’t know what the health risks are,” giving medical professionals and the general public all the more reason to be concerned.

Moreover, researchers at Stanford University have produced strong evidence that Juul, one of the leading e-cigarette manufacturers, intended to target teens in early advertisingThis research found that Juul’s ads from 2015 to 2018 contained striking similarities to traditional cigarette advertising aimed at teens, including the use of social media influencers and pictures of younger people in fashionable clothes.

Another leading reason why e-cigarettes (including Juul) are popular among teens and adolescents is that these manufacturers tap into, and appeal to, the user behavior of this demographic by selling sweet-flavored e-cigarette liquids, like mango or mint. A great deal of research indicates that teens not only prefer sweeter flavors, but the majority who initiate use also do so with a sweet flavor. Roughly 70 percent of adolescents who are current e-cigarette smokers have used a flavored liquid, and those adolescents said they were more likely to try traditional cigarettes than those who didn’t use flavors.

Juul’s decisions to make sweet flavors available and potentially market their products to teens (among other factors) led the state of North Carolina to sue the brand earlier this year, setting up an interesting and impactful challenge to the evolving e-cigarette industry. 

Many researchers believe that e-cigarettes could be a useful “harm reduction tool” for adults by promoting their transition from traditional cigarettes (which are extremely harmful) to e-cigarettes.  Indeed, it is very, very likely that e-cigarettes are less harmful than traditional cigarettes, and helping adults who smoke combustible cigarettes transition to vaping is a public health good.  The problem is the harms that come from adolescents initiating vaping. Because we do not know what the long-term health risks of vaping in adolescents are, it’s imperative we put careful regulation in place to reduce adolescents’ access to the products.  

If e-cigarettes are a better alternative for adult traditional smokers, perhaps we should focus our efforts on policy changes that would label them as a medical device or cessation aid that could help regular smokers stop, provided that we also prevent the costs to adults from being high. In doing so, we could potentially decrease the level of e-cigarette exposure among teens and adolescents. Ultimately, as the need to prevent adolescents from vaping becomes increasingly important, the movement toward stronger regulation must become even more front-and-center.