Vaping: The new face of nicotine


E-cigarettes. Vapes. E-hookahs. Cigalikes. It’s hard to keep up with the terminology but one thing is certain: teens are using these products at an alarming rate.

According to a 2016 Report of the Surgeon General, the number of high school students who have used e-cigarettes increased 900 percent between 2011 and 2015 — making e-cigarettes the most common type of tobacco product used by teens and young adults.

“These products pose an interesting public health question because they’ve been accepted by some in the public health community as a useful smoking cessation tool,” says Sharon Levy, MD, MPH, director of the Adolescent Substance Abuse Program (ASAP) at Boston Children’s Hospital.

Levy says that framing e-cigarettes in this way has led to mixed messages — and potential health risks.

“Saying something is ‘better than smoking’ is not setting a very high bar,” says Levy. “And yet many teens hear this and believe vaping doesn’t pose a health risk.”

Levy says that although these products are officially touted as a smoking cessation tool, many teens are getting a different message — a message supported by a booming $3.5 billion e-cigarette business. “When you enter a vape shop, it’s all about partying and the latest cool flavors. No one is talking about how to quit.”

Vaping-flavorsCreating a new generation of smokers?

Levy is concerned that e-cigarettes are being marketed in much the same way that cigarettes were when they were first introduced. Even more worrisome is that kid-friendly flavors and sleek, colorful packaging make these products appealing to kids who would otherwise be at low risk for smoking.

“The true consequences of using these products over the long term are unknown, but we’d do far better to assume they’re harmful than to assume they’re safe,” Levy says. “Because many of these products contain nicotine, we’re putting a whole new generation at risk for nicotine addiction. All the good work we’ve done with tobacco cessation is being threatened.”

Tools for pediatric practice

The growing popularity of vaping puts pediatricians on the front lines when it comes to delivering accurate health information about these products.

Levy offers the following tips for talking about e-cigarettes in pediatric practice.

  • Ask your patients about their perception of e-cigarettes.

    Even kids who have no interest in conventional cigarettes may be curious about vaping, and are likely misinformed about the safety of these products.

  • Discuss the health risks.

    Kids may not know that e-cigarettes contain a host of chemicals — including known carcinogens like formaldehyde, that the lungs simply aren’t made to process. “When you call it ‘raspberry,’ it sounds like candy,” says Levy. “But it’s important to remind kids that this product isn’t going into their gastrointestinal system, it’s going into their lungs.”

  • Talk about the risks of nicotine addiction.

    Many e-cigarettes contain nicotine, which is highly addictive. Levy says that the regulation of e-cigarettes is questionable and the rate of mislabeling is high, so even products that claim not to contain nicotine actually do.

Learn more about Boston Children’s Adolescent Substance Abuse Program (ASAP) and the upcoming Adolescent Medicine 2017 CME.