Vaping among adolescents, an avoidable health hazard

Vaping, or the inhaling of aerosols produced by electronic cigarettes (e-cigarettes) or other similar devices, is growing in favor among many people. For those unaware of the term, e-cigarettes are battery-operated devices that use an electric pulse to heat a liquid contained in a cartridge or reservoir. The liquid very often contains nicotine, the addictive drug found in tobacco products along with other chemicals such as propylene glycol, glycerin, and flavorings. On heating, the chemicals in e-liquid transform into a potentially harmful aerosol that is inhaled and exhaled by the user.

Aerosols are tiny solid particles or liquid droplets that lie suspended in air naturally, such as fine dust or mist, or when expelled by a person or product through smoke, fumes, or transmission of disease causing viruses and bacteria through cough and sneeze of infected persons. These extremely small particles can enter deep into the lungs when inhaled causing adverse health effects. Aerosols are often referred to as a vapor, and hence the term ‘vaping’.

Introduced in the United States in 2007, vaping soon found appeal among many people, especially when tobacco companies began advertising e-cigarettes as a method to help nicotine addicts to reduce or quit smoking. However, there was no truth to these spurious claims, as numerous studies that compared the use of e-cigarettes, placebos, and nicotine patches have categorically shown that there is no significant difference in abstinence rate among users.

But because e-cigarettes were being marketed as a treatment option, they were initially not subject to the same regulations as combustible cigarettes. It was only in 2016 that the Federal Drug Administration (FDA) in the United States was given the authority to regulate e-cigarette packing and sales. Although vaping might appear innocuous at first glance, and a safer alternative to traditional smoking, the vapor from e-cigarettes carry several harmful chemicals that pose a significant health risk.

With many countries banning the advertising of tobacco products in newspapers and other print media, tobacco companies have increasingly resorted to using the largely unregulated popular social media platforms to advertise e-cigarettes and related products to teens. A study showed that between 2014 and 2016, over 78 percent of middle- and high-school students in the US were exposed to at least one advertisement that encouraged the use of e-cigarettes.

In addition, e-cigarette cartridges containing the liquid are usually flavored with to allure adolescents with scents found to be popular among them, including mint, cinnamon, and frosted sugar cookies. The use of flavors is especially concerning as previous studies have shown that popular flavors are one of the most important factors behind adolescents trying e-cigarettes in the first place.

While several surveys and studies have confirmed a steady decline in the use of combustible cigarettes among adolescents in many countries, there has also been a concomitant increase in the use of e-cigarettes among this age-group. The continued marketing of e-cigarettes by tobacco companies, which specifically target teens, is particularly harmful given the significant health risks these products pose to the lungs, heart and growing brains of adolescents.

Even more worrying is the lack of awareness among many teens on the harmful products contained in e-cigarettes. A study showed that while some students knew about the damaging effects of nicotine in combustible cigarettes, more than 63 percent of the surveyed teens did not know that e-cigarettes contain nicotine. Studies show that several e-cigarettes contain as much as 59 mg of nicotine per milliliter, which is equivalent to nicotine found in nearly 20 combustible cigarettes.

Adolescent brains are still developing, and nicotine exposure has been linked with cognitive deficits and impairment in memory and executive function. One study demonstrated that exposure to e-cigarette vapor during times of rapid brain growth, such as during adolescence, can cause hyperactivity and impulsive behavior changes, increased risks of physical fighting, and attempted suicide, when comparing teens who used e-cigarette and non-users

Other studies have shown that adolescents who use e-cigarettes are 3.6 times more likely to report using combustible cigarettes, and become more susceptible to nicotine addiction later in life. Studies show that close to 90 percent of adult daily smokers started the habit before the age of 18. Thus, tobacco company advertisements that increase the use of e-cigarettes among teens are effectively creating a new generation addicted to nicotine, and more profit to the companies.

The inhalation of liquid vapors during vaping is similar to the use of nebulizers by asthma patients and others who use the device to rapidly and efficiently deliver medications to the lungs. But in contrast to bathing lung tissue with a therapeutic mist, as a nebulizer does, vaping coats lungs with potentially harmful chemicals that rapidly go deep down into the lungs causing inflammatory responses.

Some of the common substances found in e-liquid or produced when it is heated which pose a risk to the lungs are diacetyl, a food additive, used to deepen e-cigarette flavors, but known to damage small passageways in the lungs. Formaldehyde, another toxic chemical found in e-liquids that can cause lung disease and contribute to heart disease. Acrolein, a chemical found in vaping liquid and often used as a weed killer in gardens, causes damage to lungs when inhaled.

In addition, vitamin E, which is used as a thickening and delivery agent in vaping fluids, has been found in lungs of people with severe vaping-related damage. Although vitamin E is safe and beneficial to the body when taken orally or when used externally to soften dry, irritated skin, it is a potential irritant to the lungs when inhaled.

Usually doctors ask first-time patients several questions to ascertain their social history and potential health hazards, as this could help in the diagnosis and treatment prescribed to them. Besides diet, exercise and other lifestyle patterns, doctors often ask patients whether they drink alcohol, do drugs, or smoke cigarettes. Considering the growing trend among adolescents to vape and given the potential health hazards of this practice, it would be pertinent for healthcare providers to also begin asking young patients, “Do you vape?”

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