The Dangers of Concentrated Nicotine Vaping Liquid on the Health of Children and Young People

Concern is increasing among healthcare professionals that the use of so-called e-cigarettes might lead to a whole generation of young people in many countries who become like their forefathers of yesteryear addicted to nicotine. Recent media coverage of the problem among children and young people suggests that they are able to obtain illegal vaping devices with up to 12.5% nicotine, which is in context more than six times above the legal limit currently set at 2% nicotine (Das & Ungoed-Thomas, 2022).

Data from Action on Smoking and Health, a UK public health charity that aims to eliminate the harm caused by tobacco, show that among 11–17-year olds who have tried vaping, a greater proportion have never smoked (40.1%) than smoked (35.6%) (Action on Smoking and Health, 2022).

As a student nurse in the late 1960s, I remember that a significant proportion of older adult patients were given fresh enamel sputum cups on a daily basis. This was because so many of them were smokers with productive coughs irrespective of their actual admission diagnosis. Chronic obstructive pulmonary disease (COPD) among older smokers was commonplace then and carried a high risk of mortality in addition to respiratory disability, which profoundly impacted daily life. Sputum production in the heyday of cigarette smoking ensured that most pubs, taverns, and bars would have featured a spittoon in the corner for the use of customers. The spittoon scene in the movie Back to the Future 3 where Marty McFly empties the full spittoon over Buford “Mad Dog” Tannen is a humorous reminder of how common spitting receptacles were in public places throughout the 19th and early parts of the 20th century. The damage to public health caused by smoking tobacco as the medium to get a dose of nicotine was profound.

Lum et al. (2008) discuss how tobacco companies during the period 1927 to 1951 were able to promote smoking as an acceptable and pleasurable adult pastime through the medium of Hollywood movies where famous stars such as Al Jolson, Bob Hope, and Clark Gable were financially rewarded for promoting certain brands of cigarettes. Ironically, the Hollywood stars themselves were not immune from diseases associated with smoking tobacco – John Wayne, Humphrey Bogart, and Patrick Swayze, among many others, died as a result of their addiction to nicotine in tobacco.

31 May 2022 was designated by the World Health Organization (WHO) as “World No Tobacco Day.” WHO points out that tobacco still causes in excess of 8 million deaths per year (World Health Organization, 2022). It is not surprising that the replacement of tobacco products but primarily cigarettes with electronic cigarette devices in 2003, which administered nicotine without the harmful chemicals found in natural tobacco smoke, was widely embraced as a method of reducing both mortality and morbidity associated with smoking, especially among older adults.

There is no doubt that nontobacco nicotine supply devices, such as e-cigarette vaping pens, are playing a major role in reducing the incidence of smoking related diseases such as COPD and the health burden it causes in society, especially among adults. However, it should be stressed that vaping products cannot be legally sold in the UK to anyone under the age of 18 years although there continue to be violations of this law. In the United States, a federal law enacted on 20 December 2019 raised the federal minimum legal sales age for all tobacco products, including e-cigarettes, from 18 to 21. Worryingly, the British government has acknowledged that there is a loophole in the current legislation, which allows free samples of vaping products to be given to people of any age (Public Health England, 2022).

Leventhal et al. (2016) have shown that young people who vape higher doses of nicotine are more likely to become regular tobacco smokers and importantly that high levels of nicotine are harmful to the developing adolescent brain. This study has also revealed that the e-cigarette device known as JUUL appears to be associated with the current e-cigarette smoking epidemic among the young exacerbated by their addictive nicotine content and appealing flavors such as mango, mint, and berry.

Every children’s nursing student undertaking an assessment of a child or young person fully understands the need to explore potential alcohol, drug, and cigarette use. Thus far, they might not explore vaping within the context of cigarette use, but that needs to change in light of the growing use of e-cigarettes among the young. Hence, when asked the specific question “Do you smoke?” some children and young people might not link vaping with smoking. Undoubtedly, vaping among the young is potentially a serious health hazard. Jones and Salzman (2020) highlight the growing trend by the manufacturers of e-cigarettes to specifically target young people in their advertising campaigns.

In addition to the high nicotine content, e-cigarettes contain other substances such as propylene glycol and/or vegetable glycerin. These are constituents used to produce stage or theatrical fog, which have been found to increase lung and airway irritation after concentrated exposure. One of the other chemicals found in some of the nicotine flavors is diacetyl, which has been linked to a serious lung disease, bronchiolitis obliterans, that results in obstruction of the bronchioles due to inflammation.

Lyzwinski et al. (2022) are adamant that e-cigarettes expose children and young people to unnecessary health risks such as provoking exacerbations of asthma and other respiratory health problems. Additionally, the nicotine in e-cigarettes is linked to cognitive impairment and neurodevelopmental problems. Furthermore, e-cigarettes may also be the gateway to real cigarette smoking and cannabis use. Young people who have never smoked previously and began using e-cigarettes are more likely to smoke cigarettes in the future with one study finding that young adults who used e-cigarettes had a seven-time higher chance of becoming tobacco smokers one year later compared with those who had never vaped.

Conclusion

The use of e-cigarettes is dangerous for children and young people, and parents who themselves “vape” should be aware that a very small amount of liquid nicotine used to refill e-cigarettes can kill a child. In December 2014, the first death of a 1-year-old child was recorded in the United States. It is imperative that parents treat vaping fluid in the same way as any other poisonous substance (Healthy Children.org, 2021).

Metcalf et al. (2022) reinforce the need for health professional training to address this global issue. Children’s and young people’s nurses need to be very aware that vaping and e-cigarette use has the potential to harm the health of their young patients and require skills training to help families more openly deal with this evolving health problem.

Disclosure statement

No potential conflict of interest was reported by the author(s).