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The Youth VAPING Epidemic
https://eds.b.ebscohost.com/eds/pdfviewer/pdfviewer?vid=11&sid=ec9ce6c8-6e8a-437b-ac68-d5a2453d1227%40sessionmgr4006

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Centers for Disease Control and Prevention

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The use of e-cigarettes is unsafe for kids, teens, and young adults.

Most e-cigarettes contain nicotine. Nicotine is highly addictive and can harm adolescent brain development, which continues into the early to mid-20s.1

E-cigarettes can contain other harmful substances besides nicotine.

Young people who use e-cigarettes may be more likely to smoke cigarettes in the future.

Find Data on E-cigarette Use Among Youth

E-cigarettes are electronic devices that heat a liquid and produce an aerosol, or mix of small particles in the air.

E-cigarettes come in many shapes and sizes. Most have a battery, a heating element, and a place to hold a liquid.

Some e-cigarettes look like regular cigarettes, cigars, or pipes. Some look like USB flash drives, pens, and other everyday items. Larger devices such as tank systems, or "mods," do not look like other tobacco products.

E-cigarettes are known by many different names. They are sometimes called "e-cigs," "e-hookahs," "mods," "vape pens," "vapes," "tank systems," and "electronic nicotine delivery systems (ENDS)."

Using an e-cigarette is sometimes called "vaping."

Some e-cigarettes look like regular cigarettes, cigars, or pipes.
Some look like USB flash drives, pens, and other everyday items.

E-cigarettes produce an aerosol by heating a liquid that usually contains nicotine, flavorings, and other chemicals that help to make the aerosol.

The liquid used in e-cigarettes often contains nicotine and flavorings. This liquid is sometimes called "e-juice," "e-liquid," "vape juice," or "vape liquid."

Users inhale e-cigarette aerosol into their lungs. Bystanders can also breathe in this aerosol when the user exhales it into the air.

E-cigarette devices can be used to deliver marijuana and other drugs.

News outlets and social media sites report widespread use of JUUL by students in schools, including classrooms and bathrooms.

JUUL is a brand of e-cigarette that is shaped like a USB flash drive. Like other e-cigarettes, JUUL is a battery-powered device that heats a nicotine-containing liquid to produce an aerosol that is inhaled.

All JUUL e-cigarettes have a high level of nicotine. According to the manufacturer, a single JUUL pod contains as much nicotine as a pack of 20 regular cigarettes.2

JUUL is one of a few e-cigarettes that use nicotine salts, which allow particularly high levels of nicotine to be inhaled more easily and with less irritation than the free-base nicotine that has traditionally been used in tobacco products, including e-cigarettes.

News outlets and social media sites report widespread use of JUUL by students in schools, including classrooms and bathrooms.

Approximately two-thirds of JUUL users aged 15 - 24 do not know that JUUL always contains nicotine.

Although JUUL is currently the top-selling e-cigarette brand in the United States, other companies sell e-cigarettes that look like USB flash drives. Examples include the MarkTen Elite, a nicotine delivery device, and the PAX Era, a marijuana delivery device that looks like JUUL.

Additional information about USB-shaped e-cigarettes and actions that parents, educators, and health care providers can take to protect kids is available at CDC's Infographic [PDF - 1.2MB]

Most e-cigarettes (vapes) contain nicotine-the addictive drug in regular cigarettes, cigars, and other tobacco products.

A CDC study found that 99% of the e-cigarettes sold in assessed venues in the United States contained nicotine.1

Some vape product labels do not disclose that they contain nicotine, and some vape liquids marketed as containing 0% nicotine have been found to contain nicotine.

Nicotine can harm the developing adolescent brain.2 The brain keeps developing until about age 25.

Using nicotine in adolescence can harm the parts of the brain that control attention, learning, mood, and impulse control.2

Each time a new memory is created or a new skill is learned, stronger connections - or synapses - are built between brain cells. Young people's brains build synapses faster than adult brains. Nicotine changes the way these synapses are formed.

Using nicotine in adolescence may also increase risk for future addiction to other drugs.2

When a person is dependent on (or addicted to) nicotine and stops using it, their body and brain have to get used to not having nicotine. This can result in temporary symptoms of nicotine withdrawal.

Nicotine withdrawal symptoms include irritability, restlessness, feeling anxious or depressed, trouble sleeping, problems concentrating, and craving nicotine.3 People may keep using tobacco products to help relieve these symptoms.4

Youth may turn to vaping to try to deal with stress or anxiety, creating a cycle of nicotine dependence. But nicotine addiction can be a source of stress.

What may start as social experimentation can become an addiction.

The most common reason U.S. middle and high school students give for trying an e-cigarette is "a friend used them." 5

The most common reason youth give for continuing to use e-cigarettes is "I am feeling anxious, stressed, or depressed." 5

Youth e-cigarette and cigarette use have been associated with mental health symptoms such as depression.9, 10

Yes. As long as a person stays quit, withdrawal symptoms will fade over time as the brain gets used to not having nicotine.

Scientists are still learning about the effects of quitting vaping on mental health. Quitting smoking cigarettes is associated with lower levels of anxiety, depression, and stress, as well as improved positive mood and quality of life.9

Scientists are still learning about the long-term health effects of e-cigarettes.

Some of the ingredients in e-cigarette aerosol could also be harmful to the lungs in the long-term. For example, some e-cigarette flavorings may be safe to eat but not to inhale because the gut can process more substances than the lungs.1

Defective e-cigarette batteries have caused some fires and explosions, a few of which have resulted in serious injuries.

Children and adults have been poisoned by swallowing, breathing, or absorbing e-cigarette liquid through their skin or eyes. Nationally, approximately 50% of calls to poison control centers for e-cigarettes are for kids 5 years of age or younger.

E-cigarette aerosol is NOT harmless "water vapor."

The e-cigarette aerosol that users breathe from the device and exhale can contain harmful and potentially harmful substances, including:

Nicotine

Ultrafine particles that can be inhaled deep into the lungs

Flavorings such as diacetyl, a chemical linked to a serious lung disease

Volatile organic compounds

Cancer-causing chemicals

Heavy metals such as nickel, tin, and lead1

The aerosol that users inhale and exhale from e-cigarettes can expose both themselves and bystanders to harmful substances.

It is difficult for consumers to know what e-cigarette products contain. For example, some e-cigarettes marketed as containing zero percent nicotine have been found to contain nicotine.3

E-cigarettes come in various flavors, including fruit, candy, mint, and menthol.

A study from 2013-2014 showed that most youth who use e-cigarettes first start with a flavored variety, and flavors are the primary reason youth report using e-cigarettes.⁶

In 2023, most youth who reported using e-cigarettes used flavored varieties (89.4%). Among middle and high school students who currently used any type of flavored e-cigarette in 2023, the most commonly used flavors were fruit (63.4%), candy, desserts, or other sweets (35%), mint (27.8%), and menthol (20.1%).¹¹

On January 2, 2020, the U.S. Food and Drug Administration (FDA) finalized an enforcement policy that prohibits the sale of prefilled cartridge e-cigarettes in any flavor other than tobacco or menthol, unless authorized by FDA. FDA has since taken additional steps to prohibit certain companies from selling youth-appealing, flavored disposable e-cigarettes and flavored e-liquids without authorization.⁷

Several states and communities have restricted the sale of flavored tobacco products, including menthol-flavored products.⁸

E-cigarettes are also advertised using the same themes and tactics that have been shown to increase youth initiation of other tobacco products, including cigarettes. In 2021, approximately 76% of students reported exposure to tobacco product marketing through traditional sources and approximately 74% of students who used social media had seen e-cigarette-related posts or content.¹²

Widespread advertising for e-cigarettes, including via media for which advertising for conventional tobacco products is prohibited (e.g., TV), and the lower costs of some e-cigarettes relative to regular cigarettes has contributed to use among youth.¹

Many youth also report using e-cigarettes because they are curious about these products.¹

Many young people who use e-cigarettes also smoke cigarettes.1 There is some evidence that young people who use e-cigarettes may be more likely to smoke cigarettes in the future.

Specifically, a 2018 National Academy of Medicine report found that there was some evidence that e-cigarette use increases the frequency and amount of cigarette smoking in the future.4

E-cigarettes also can be used to deliver other drugs, including marijuana; in 2016, approximately one-third of U.S. middle and high school students who have ever used an e-cigarette reported using marijuana in the device.

But e-cigarette use among young people is still unsafe, even if they do not progress to future cigarette smoking.

E-cigarettes expose users to fewer harmful chemicals than burned cigarettes.1

But burned cigarettes are very dangerous, killing half of all people who smoke long-term.

The use of any tobacco product, including e-cigarettes, is unsafe for young people.

Yes. In August 2016, the regulatory authority of the FDA was extended to cover e-cigarettes through the agency's "deeming rule."

Through authority granted by the Family Smoking Prevention and Tobacco Control Act (FSPTCA), FDA has authority to develop regulations that address the manufacturing, marketing, and sale of e-cigarettes.

There are some strategies that the FDA does not have authority to implement, such as including e-cigarettes in smoke-free policies or increasing the minimum legal sales age for these products, unless directed to do so by Congress. However, the FSPTCA does not prevent states and communities from including e-cigarettes in smoke-free policies or from regulating the sale and distribution of e-cigarettes. These types of strategies can include further raising the minimum legal sales age, licensing retailers, implementing price policies, and restricting or prohibiting the sale of tobacco products.

Yes. In 2018, the FDA expanded its successful youth tobacco prevention campaign, "The Real Cost," to reach the more than 10 million youth aged 12-17 who have used e-cigarettes or are open to trying them. The campaign educates youth about the potential risks of using e-cigarettes.

The "Real Cost" reaches teens where they spend most of their time: in school and online. The campaign is also placing e-cigarette prevention materials in high schools across the nation, both in school bathrooms and on educational digital platforms accessed by students during the school day.

Heated tobacco products (HTPs) like IQOS and Eclipse, sometimes marketed as "heat-not-burn" technology, represent a diverse class of products that heat the tobacco leaf to produce an inhaled aerosol. They are different from e-cigarettes, which heat a liquid that can contain nicotine derived from tobacco.

HTPs are available in at least 40 countries and several have been authorized for sale in the United States by the FDA. In 2018, few U.S. adults (2.4% of all surveyed, including 6.7% of people who currently smoke surveyed) had ever used HTPs. In 2023, 1.0% of U.S. middle and high school students, combined, reported having used heated tobacco products in the past 30 days.¹¹

Scientists are still learning about the short-term and long-term health effects of HTPs, but the available science shows they contain harmful and potentially harmful ingredients. Youth use of any tobacco products, including heated products, is unsafe.

It is important that we continue to modernize proven tobacco prevention and control strategies to include newer products entering the market such as HTPs.

Talk to your child or teen about why e-cigarettes are harmful for them. It's never too late.

Set a good example by being tobacco-free and ensure that your kid is not exposed to the secondhand emissions from any tobacco products, including e-cigarettes.

If you use tobacco, it's never too late to quit. For free help, visit smokefree.gov or call 1-800-QUIT-NOW.

Talk to your child or teen about why e-cigarettes are harmful for them. It's never too late.

Get the Talk With Your Teen About E-cigarettes [PDF - 5.2MB] tip sheet for parents. Start the conversation early with children about why e-cigarettes are harmful for them.

Let your child know that you want them to stay away from all tobacco products, including e-cigarettes, because they are not safe for them. Seek help and get involved.

Set up an appointment with your child's health care provider so that they can hear from a medical professional about the health risks of tobacco products, including e-cigarettes.

Speak with your child's teacher and school administrator about enforcement of tobacco-free school grounds policies and tobacco prevention curriculum.

Encourage your child to learn the facts and get tips for quitting tobacco products at Teen.smokefree.gov.

Fact Sheet for Educators:

Conversation Card for Educators:

1. U.S. Department of Health and Human Services. Smoking Cessation: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2020 [accessed 2022 April 4].

2. Truth Initiative Mental Health x Vaping Headline Survey Internal Data - August 2021.

3. Gentzke AS, Wang TW, Cornelius M, et al. Tobacco Product Use and Associated Factors Among Middle and High School Students - National Youth Tobacco Survey, United States, 2021. MMWR Surveill Summ 2022;71(No. SS-5):1-29. DOI: http://dx.doi.org/10.15585/mmwr.ss7105a1.

4. U.S. Department of Health and Human Services. The Health Consequences of Smoking-50 years of Progress: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

5. Birdsey J, Cornelius M, Jamal A, et al. Tobacco Product Use Among U.S. Middle and High School Students - National Youth Tobacco Survey, 2023. MMWR Morb Mortal Wkly Rep 2023; 72(44);1173-1182.

6. Cooper M, Park-Lee E, Ren C, Cornelius M, Jamal A, Cullen KA. Notes from the Field: E-cigarette Use Among Middle and High School Students - United States, 2022. MMWR Morb Mortal Wkly Rep 2022;71:1283-1285. DOI: http://dx.doi.org/10.15585/mmwr.mm7140a3

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Quick Facts on the Risks of E-cigarettes for Young People

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Learn quick facts on the risks of e-cigarettes for kids, teens, and young adults, including how they work, why nicotine is unsafe, what is in e-cigarette aerosol, and resources for parents to prevent their child from using e-cigarettes or help them stop.

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Article weighs out the use of electronic smoking with tobacco smokes only saying that nicotine is almost the only bad thing that comes with vaping, making ECIGS sound more safe to use

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SOURCES:

CDC: "Cigarette Smoking among U.S. High School Students at an All-time Low, but E-cigarette Use a Concern."

FDA: "FDA Takes Significant Steps to Protect Americans from Dangers of Tobacco Through New Regulation," "Retailer Overview of FDA Regulations for Selling Tobacco Products."

American Cancer Society Cancer Action Network: "The Wild, Wild, West of E-cigarettes."

National Institute on Drug Abuse: "Drug Facts: Electronic Cigarettes (e-Cigarettes)."

The Nemours Foundation: "What Are E-cigarettes?"

Cleveland Clinic: "E-Cigarettes: Tobacco-Free, But Your Heart May Still Be at Risk."

American Lung Association: "E-cigarettes and Lung Health."

Erika Sward, assistant vice president for national advocacy, American Lung Association.

Neal Benowitz, MD, a nicotine researcher and professor of medicine, bioengineering, and therapeutic sciences, University of California at San Francisco.

Kenneth Warner, tobacco policy researcher and Avedis Donabedian Distinguished University Professor of Public Health at the University of Michigan.

Public Health England: "E-cigarettes: an evidence update: A report commissioned by Public Health England."

Caren Kagan Evans, e-cigarette user, Washington DC.

American Heart Association: "American Heart Association Issues E-Cigarette Recommendations."

Barrington-Trimis, J. Pediatrics, July 2016.

Leventhal, A. Journal of the American Medical Association, August 2015.

YouTube: American Vaping Association President Gregory Conley CNN interview May 5, 2016.

American Academy of Pediatrics: "AAP Statement on FDA Rule Regulating E-Cigarettes and Tobacco."

Michael Felberbaum, FDA spokesperson.

CNN: "Man Says E-cigarette Battery Exploded In His Pocket." February 25, 2016.

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SOURCES: CDC: "Cigarette Smoking among U.S. High School Students at an All-time Low, but E-cigarette Use a Concern." FDA: "FDA Takes Significant Steps to Protect Americans from Dangers of Tobacco Through New Regulation," "Retailer Overview of FDA Regulations for Selling Tobacco Products." American Cancer Society Cancer Action Network: "The Wild, Wild, West of E-cigarettes."

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This article makes it CLEAR that they are promoting the use of ECIGS over traditional cigarette smoke.

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CLOSE

Vaping makes it easier to quit smoking than patches or gum, and it's a lot less dangerous than smoking. Americans should be encouraged to switch.

Public health officials' goal should always be to build awareness of the risks associated with smoking and educate the public on the products that can help smokers quit. Yet the public health community has failed to build awareness of how switching to e-cigarettes can reduce the harm associated with smoking by as much as 95 percent, according to the Public Health England and multiple independent reviews.

This is a public health tragedy. Currently 38 million Americans are addicted to traditional combustible cigarettes, which puts them at higher risk for cancer as well as heart and lung disease. A new study shows e-cigarettes are nearly twice as effective as other methods in helping people quit smoking - and thereby significantly improve improve their health prospects. But many people simply don't know of the e-cigarette option and its benefits.

In fact, when asked whether e-cigarettes are less harmful than traditional cigarettes, 53 percent of Americans in a new nationally represented poll of likely voters conducted by McLaughlin and Associates incorrectly responded "no," and another 23 percent weren't sure. A 2016 study published in the American Journal of Preventative Medicine found that even current smokers believed e-cigarettes to be equally or more harmful than traditional cigarettes, a misperception that could dissuade many of them from switching to less harmful e-cigarette products.

Using an e-cigarette (Photo: Eva Hambach/AFP/Getty images)

FDA limits on menthol and teen vaping are more than just smoke

Don't let fearmongering guide vaping debate

We're pushing age verification for e-cigarettes: FDA Commissioner Scott Gottlieb

Clearly, American smokers and non-smokers are unfamiliar with the differences between e-cigarettes and traditional smoking, and misunderstand how traditional smoking causes harm. Both smoking and using e-cigarettes, also called vaping, are nicotine delivery systems. But traditional cigarettes burn tobacco, which causes the release of thousands of chemicals that are inhaled in the process of delivering the nicotine. It is this combustion process and the inhalation of these chemicals - not the tobacco or nicotine - that leads to cancer.

E-cigarettes contain no tobacco. Instead, e-liquid (which is made up of propylene glycol and glycerin - two substances the FDA recognizes as safe - along with water and flavorings) is warmed, creating a far less harmful vapor. If the e-liquid contains nicotine (not all e-cigarette liquids do), when the vapor is inhaled, it delivers nicotine to the user.

People are misguided on e-cigarettes

Yet a whopping 79 percent of respondents in the McLaughlin poll thought it was the nicotine itself that caused cancer and other cardiovascular and lung diseases. Another 12 percent were unsure. Only 9 percent of respondents knew the correct answer - that nicotine is not linked to cancer or cardiovascular and lung diseases. While not harmless (in particular, nicotine can affect adolescent brain development) and certainly addictive, nicotine itself is not linked to increases in cancer or any major diseases. Nicotine also increases adrenaline, which can cause a faster heartbeat and spikes in blood pressure - similar results after drinking a cup of coffee.

Currently, the FDA approves three other nicotine delivery systems - gum, lozenges and patches - to help people quit traditional cigarettes. Yet, according to the new study in the United Kingdom, e-cigarettes are much more effective at helping people quit traditional cigarettes than patches and gum. In fact, doctors in the UK now encourage current smokers to switch to vaping. The American Cancer Society also acknowledges that vaping is safer than traditional cigarettes and recognizes the efficacy of e-cigarettes in helping smokers quit.

E-cigarette positives outweigh negatives

Despite this, the FDA refuses to approve e-cigarettes as a smoking cessation product and instead is working to make it harder for current smokers to access these products.

The goal of those discouraging vaping seems to be to prevent teens from vaping. Certainly that's a worthy goal: No one wants teens, or anyone else, to take up any form of smoking or become addicted to nicotine. Yet teen vaping should also be kept in perspective, rather than positioned as a dire public health emergency.

Public health officials should consider how to discourage teens from habit-forming behaviors, but they shouldn't mislead the public by calling teen vaping an epidemic or use it as an excuse to ignore e-cigarettes' potential to end the use of traditional cigarettes among adult smokers and dramatically improve Americans' health.

In a perfect world, no one would smoke anything, eat junk food, have unprotected sex, drink alcohol or stay up too late. Yet policymakers and public health officials have long recognized that rather than wishing for the end of a vice, it is more effective to find ways to educate about the risks and mitigate the harms associated with it. There is no reason to abandon that principle now.
Julie Gunlock runs the Center or Progress and Innovation at the Independent Women's Forum. Follow her on Twitter: @JGunlock (Editors' note: IWF has received funding from JUUL Labs and Altria.)

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E-cigarettes are much safer than smoking but few know it. That's a public health tragedy.

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CLOSE Vaping makes it easier to quit smoking than patches or gum, and it's a lot less dangerous than smoking. Americans should be encouraged to switch. Public health officials' goal should always be to build awareness of the risks associated with smoking and educate the public on the products that can help smokers quit.