Adolescents and e-Cigarettes

An Alarming Trend

Vaping is the practice of inhaling an aerosol comprising propylene glycol, nicotine, flavorings, and other substances. It has gained popularity among adult smokers in recent years as an alternative to cigarette smoking, but public health groups like the American Heart Association do not officially recommend vaping as a method for quitting smoking.1 In addition to use among hopeful adults looking to quit cigarettes, e-cigarettes have become increasingly popular among adolescents with no history of cigarette smoking, presenting a public health issue that grapples
with questions of how e-cigarettes are affecting the health of this young demographic.

A survey from the National Institutes of Health found that vaping among high school students has increased dramatically between the years 2017 and 2018. In 2017, 27.8 percent of adolescents reported vaping during the previous 12 months; this increased to 37.3 percent of adolescents who reported vaping in 2018, and translates to over one million additional teenagers vaping between the years 2017 and 2018.2

JUUL®, an e-cigarette device, is currently a main focus among the media and health advocacy groups due to its popularity among adolescents. According to the company’s website, JUUL pods come in flavors such as cucumber, fruit, crème, mint, and mango. Research has found that adolescents were more likely than adults to use candy- and fruit-flavored e-cigarettes, suggesting that regulation of sweet flavors could curb youth use without affecting adult users.JUUL contains more nicotine than

devices used in smoking cessation studies, which might encourage an addiction to vaping among teenagers who have never smoked cigarettes.4 According to Truth Initiative, an anti- smoking group, one JUUL pod, which lasts for about 200 inhalations, contains as much nicotine as 20 cigarettes. They also explain that JUULs have more nicotine than any other e-cigarette on the market, with competitor products containing 1 to 2.4 percent nicotine and JUUL containing five-percent nicotine that is delivered more than twice as fast as competitors. 5 However, many young JUUL users don’t know this. A study published in Tobacco Control in April 2018 found that 63 percent of young JUUL users weren’t aware that this product always contains nicotine.6,7

Research suggests that exposure to nicotine while the brain is still developing can have lasting effects on adolescents who use these devices. Authors of a review published in the Journal of Physiology explain that nicotine can sensitize the developing adolescent brain to other drugs, priming the individual for future drug use.8 Other research suggests that adolescent nicotine exposure leads to attention deficits and increased risks of developing psychiatric disorders and cognitive impairment in later life.9

As for the other ingredients in e-cigarettes, continued research is slowly uncovering the ways in which these novel, seemingly safe smoking alternatives are not as innocuous as we initially believed. New research published in the Journal of the American College of Cardiology in May 2019 found that the flavorings and solvents used in e-cigarette liquids promote oxidative stress, inflammation, and apoptosis (cell death), which lead to endothelial dysfunction, a risk factor for cardiovascular disease.10


1. American Heart Association site. What you need
to know about vaping. 2019 10 Dec. https:// 7. lifestyle/quit-smoking-tobacco/what-you-need- to-know-about-vaping. Accessed 3 June 2019.

2. Teens using vaping devices in record numbers
[news release]. National Institutes of Health; Dec
17, 2018. news-releases/teens-using-vaping-devices- 8. record-numbers. Accessed June 3, 2019.

3. Soneji SS, Knutzen KE, Villanti AC. Use of flavored e-cigarettes among adolescents, young adults, 9. and older adults: findings from the population assessment for tobacco and health study. Public
Health Rep.
2019 May/Jun;134(3):282–292.

4. Shmerling RH. Harvard Health site. Can vaping
help you quit smoking? 27 Feb 2019. https:// 10. help-you-quit-smoking-2019022716086.
Accessed 3 June 2019.

5. Truth Initiative site. How much nicotine is in JUUL? 26 Feb 2019. research-resources/emerging-tobacco-products/ how-much-nicotine-juul. Accessed 3 June 2019.

6. Willett JG, Bennett M, Hair EC, et al. Recognition, use and perceptions of JUUL among youth
and young adults. Tob Control. 2019 Jan;28(1): 115–116.

7. JUUL e-cigarettes gain popularity among youth, but awareness of nicotine presence remains low [news release]. Truth Initiative; April 18, 2018. juul-e-cigarettes-gain-popularity-among- youth-awareness-nicotine-presence. Accessed June 3, 2019.
8. Yuan M, Cross SJ, Loughlin SE, Leslie FM. Nicotine and the adolescent brain. J Physiol. 2015 Aug 15; 593(Pt 16):3397–3412.
9. Goriounova NA, Mansvelder HD. Short- and long- term consequences of nicotine exposure during adolescence for prefrontal cortex neuronal network function. Cold Spring Harb Perspect Med. 2012 Dec;2(12):a012120.
10. Lee WH, Ong SG, Zhou Y. Modeling cardiovascular risks of e-cigarettes with human-induced pluripotent stem cell-Derived endothelial cells.

J Am Coll Cardiol. 2019 Jun 4;73(21):2722–2737.

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