The Alarming Increase in Vaping among Youth

Can you imagine a teenager spending $150 per week for his vaping habit? This disturbing report appeared during a recent nightly television news broadcast, along with the announcement of an upcoming conference of the Food and Drug Administration focused on an alarming vaping epidemic, especially among our youth. The Surgeon General of the United States has called on states to increase taxes on vaping materials and to pass laws banning the practice of vaping indoors (O’Donnell, 2018, December 28).

Let me back up and explain what vaping is, for readers outside the USA who may not be familiar with it. We are talking about electronic cigarettes (battery-powered devices that vaporize liquid nicotine) that were originally promoted as a way for smokers to ingest nicotine in a less harmful way than smoking cigarettes. Vaping was even promoted as a way to stop smoking, although we now know that vaping itself is addictive and that young people who vape are more likely than non-vapers to progress to cigarette smoking later (National Academies of Sciences, Engineering, & Medicine 2018).

Sales of electronic cigarettes rapidly increased after a plethora of advertisements featuring glamorous celebrities. Desirable flavors such as watermelon were very attractive to adolescents and masked the danger of nicotine. For middle- and high-school students, vaping (also called JUULing because JUUL is the most popular brand), was perceived as really “cool” and “not at all harmful” (as shown in a large study by Cooper, Harrell, Perez, et al, cited in Modesto-Lowe & Alvarado, 2017). Hiding the evidence of vaping was facilitated by devices that look like USB flash drives or pens, making it easy for students to “vape” in school bathrooms. In the latest federal data, 3.6 million middle- and high-school students use e-cigarettes (21% of high school seniors) (O’Donnell, 2018, December 28).

As popularity of vaping grew, medical professionals did begin to express concern about the long-term consequences (which have not yet been established). Federal agencies, however, were slow to take action, not banning the sale of e-cigarettes to persons younger than 18 until 2016 (FDA News Release, 2016, May 5). Even lacking data about long-term consequences, it is logical to conclude that having high nicotine levels in the bloodstream cannot be healthful—and nicotine is one of the most addictive substances on the planet. Reports about withdrawal from vaping parallel typical accounts of smoking cessation, including unpleasant symptoms such as headaches, nausea, agitation, anger, and cravings (O’Donnell, 2018, December 28).

A man who recently tried to quit his vaping habit described the withdrawal as “hell,” including depression and a sense of a void in his life (O’Donnell, 2018, December 28). He had begun vaping to stop a smoking habit acquired at age 17, but like many other smokers have found, quitting vaping can even harder. A doctor who had recommended vaping to her patients to “step down” from cigarettes, admitted to a reporter that only one patient was able to quit vaping (thus, one addiction was merely substituted for another).

A pediatrician acknowledges that most of his middle- and high-school patients find withdrawal from vaping so difficult, they abandon their efforts to quit (O’Donnell, 2018, December 28).

Nurses must become involved in educating the public, especially adolescents and their parents, about the dangers of vaping. Parents could be advised to review “quick facts on the risks of e-cigarettes for kids, teens, and young adults” on the CDC website (http://www.cdc.gov). Physicians have expressed concern that exposure to nicotine during adolescence may induce persistent changes in neural connectivity among the regions of the brain involved in cognitive maturation, which will not be complete until the 20s (Modesto-Lowe & Alvarado, 2017). Motivational interviewing has been recommended to promote teen readiness to modify early vaping behavior before the addiction has become severe, or the teen has progressed onto smoking combustible cigarettes (Modesto-Lowe & Alvarado, 2017). Beyond expertise in motivational interviewing, nurses have considerable experience with evidence-based modalities for smoking cessation, including nicotine replacement patches and oral medications, physical activities, relaxation, and imagery. We need to conduct research regarding the efficacy of these modalities for vaping. I welcome articles from researchers and clinicians that address this latest and very dangerous form of addictive behavior.