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VAPING

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Vaping has become incredibly common among kids, teens, and young adults. Most vapes contain nicotine, a toxic and highly addictive substance that interferes with brain development among many other physiological consequences. Vapes come in many shapes and sizes, and their use is significantly easier to conceal given the lack of smoke and smell. In recent years companies like JUUL have launched campaigns that target young people and introduced flavors that make vaping seem more enticing. As a result, 1 in 10 or more than 2 million middle and high school students reported vaping/e-cigarette use in 2022.

INTRODUCTION

To combat the epidemic of youth vaping there are many organizations and campaigns that have helped teens and parents alike understand the risks of vaping and provide resources on quitting and how to have productive conversations about the topic as a whole. 


This definition helps determine whether an incident is bullying or another type of aggressive behavior or both.
 

American Lung Association: Get the Facts about Vaping

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Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young Adults (CDC // Spanish Version)

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  • What’s the Bottom Line on the Risks of E-cigarettes for Kids, Teens, and Young Adults?
     

    • The use of e-cigarettes is unsafe for kids, teens, and young adults.

    • Most e-cigarettes contain nicotine. Nicotine is highly addictive and can harm adolescent brain development, which continues into the early to mid-20s.

    • E-cigarettes can contain other harmful substances besides nicotine.

    • Young people who use e-cigarettes may be more likely to smoke cigarettes in the future.
       

  • What Are E-cigarettes?
     

    • E-cigarettes are electronic devices that heat a liquid and produce an aerosol, or mix of small particles in the air.

    • E-cigarettes come in many shapes and sizes. Most have a battery, a heating element, and a place to hold a liquid.

    • Some e-cigarettes look like regular cigarettes, cigars, or pipes. Some look like USB flash drives, pens, and other everyday items. Larger devices such as tank systems, or “mods,” do not look like other tobacco products.

    • E-cigarettes are known by many different names. They are sometimes called “e-cigs,” “e-hookahs,” “mods,” “vape pens,” “vapes,” “tank systems,” and “electronic nicotine delivery systems (ENDS).”

    • Using an e-cigarette is sometimes called “vaping.”

 

  • How Do E-cigarettes Work?
     

    • E-cigarettes produce an aerosol by heating a liquid that usually contains nicotine, flavorings, and other chemicals that help to make the aerosol.

    • The liquid used in e-cigarettes often contains nicotine and flavorings. This liquid is sometimes called “e-juice,” “e-liquid,” “vape juice,” or “vape liquid.”

    • Users inhale e-cigarette aerosol into their lungs. Bystanders can also breathe in this aerosol when the user exhales it into the air.

    • E-cigarette devices can be used to deliver marijuana and other drugs.
       

  • What Is JUUL?
     

    • JUUL is a brand of e-cigarette that is shaped like a USB flash drive. Like other e-cigarettes, JUUL is a battery-powered device that heats a nicotine-containing liquid to produce an aerosol that is inhaled.

    • All JUUL e-cigarettes have a high level of nicotine. According to the manufacturer, a single JUUL pod contains as much nicotine as a pack of 20 regular cigarettes.

    • JUUL is one of a few e-cigarettes that use nicotine salts, which allow particularly high levels of nicotine to be inhaled more easily and with less irritation than the free-base nicotine that has traditionally been used in tobacco products, including e-cigarettes.

    • News outlets and social media sites report widespread use of JUUL by students in schools, including classrooms and bathrooms.

    • Approximately two-thirds of JUUL users aged 15 – 24 do not know that JUUL always contains nicotine.

    • Although JUUL is currently the top-selling e-cigarette brand in the United States, other companies sell e-cigarettes that look like USB flash drives. Examples include the MarkTen Elite, a nicotine delivery device, and the PAX Era, a marijuana delivery device that looks like JUUL.

    • Additional information about USB-shaped e-cigarettes and actions that parents, educators, and health care providers can take to protect kids is available from the CDC.
       

  • Why Is Nicotine Unsafe for Kids, Teens, and Young Adults?
     

    • Most e-cigarettes (vapes) contain nicotine—the addictive drug in regular cigarettes, cigars, and other tobacco products.

    • A CDC study found that 99% of the e-cigarettes sold in assessed venues in the United States contained nicotine.

    • Some vape product labels do not disclose that they contain nicotine, and some vape liquids marketed as containing 0% nicotine have been found to contain nicotine.

    • Nicotine can harm the developing adolescent brain. The brain keeps developing until about age 25.

    • Using nicotine in adolescence can harm the parts of the brain that control attention, learning, mood, and impulse control.

    • Each time a new memory is created or a new skill is learned, stronger connections – or synapses – are built between brain cells. Young people’s brains build synapses faster than adult brains. Nicotine changes the way these synapses are formed.

    • Using nicotine in adolescence may also increase risk for future addiction to other drugs.
       

  • How Does Nicotine Addiction Affect Youth Mental Health?
     

    • When a person is dependent on (or addicted to) nicotine and stops using it, their body and brain have to get used to not having nicotine. This can result in temporary symptoms of nicotine withdrawal.

    • Nicotine withdrawal symptoms include irritability, restlessness, feeling anxious or depressed, trouble sleeping, problems concentrating, and craving nicotine.

    • People may keep using tobacco products to help relieve these symptoms.

    • Youth may turn to vaping to try to deal with stress or anxiety, creating a cycle of nicotine dependence. But nicotine addiction can be a source of stress.

    • What may start as social experimentation can become an addiction.

    • The most common reason U.S. middle and high school students give for trying an e-cigarette is “a friend used them.” 

    • The most common reason youth give for continuing to use e-cigarettes is “I am feeling anxious, stressed, or depressed.” 

    • Youth e-cigarette and cigarette use have been associated with mental health symptoms such as depression.
       

  • Do symptoms of nicotine withdrawal improve after quitting?
     

    • Yes. As long as a person stays quit, withdrawal symptoms will fade over time as the brain gets used to not having nicotine.
       

  • Does quitting vaping improve mental health?
     

    • Scientists are still learning about the effects of quitting vaping on mental health. Quitting smoking cigarettes is associated with lower levels of anxiety, depression, and stress, as well as improved positive mood and quality of life.
       

  • What Are the Other Risks of E-cigarettes for Kids, Teens, and Young Adults?
     

    • Scientists are still learning about the long-term health effects of e-cigarettes.

    • Some of the ingredients in e-cigarette aerosol could also be harmful to the lungs in the long-term. For example, some e-cigarette flavorings may be safe to eat but not to inhale because the gut can process more substances than the lungs.1

    • Defective e-cigarette batteries have caused some fires and explosions, a few of which have resulted in serious injuries.

    • Children and adults have been poisoned by swallowing, breathing, or absorbing e-cigarette liquid through their skin or eyes. Nationally, approximately 50% of calls to poison control centers for e-cigarettes are for kids 5 years of age or younger.
       

  • Flavors and Marketing Make E-cigarettes Appealing to Youth
     

    • E-cigarettes come in various flavors, including fruit, candy, mint, and menthol.

    • A study from 2013-2014 showed that most youth who use e-cigarettes first start with a flavored variety, and flavors are the primary reason youth report using e-cigarettes.

    • In 2022, most youth who reported using e-cigarettes used flavored varieties (84.9%). Among middle and high school students who currently used any type of flavored e-cigarette in 2022, the most commonly used flavors were fruit (69.1%), candy, desserts, or other sweets (38.3%), mint (29.4%), and menthol (26.6%).

    • On January 2, 2020, the U.S. Food and Drug Administration (FDA) finalized an enforcement policy that prohibits the sale of prefilled cartridge e-cigarettes in any flavor other than tobacco or menthol, unless authorized by FDA. FDA has since taken additional steps to prohibit certain companies from selling youth-appealing, flavored disposable e-cigarettes and flavored e-liquids without authorization.

    • Several states and communities have restricted the sale of flavored tobacco products, including menthol-flavored products.

    • E-cigarettes are also advertised using the same themes and tactics that have been shown to increase youth initiation of other tobacco products, including cigarettes. In 2021, approximately 76% of students reported exposure to tobacco product marketing through traditional sources and approximately 74% of students who used social media had seen e-cigarette–related posts or content.

    • Widespread advertising for e-cigarettes, including via media for which advertising for conventional tobacco products is prohibited (e.g., TV), and the lower costs of some e-cigarettes relative to regular cigarettes has contributed to use among youth.

    • Many youth also report using e-cigarettes because they are curious about these products.
       

  • Can Using E-cigarettes Lead to Future Cigarette Smoking Among Kids, Teens, and Young Adults?
     

    • Many young people who use e-cigarettes also smoke cigarettes. There is some evidence that young people who use e-cigarettes may be more likely to smoke cigarettes in the future.

    • Specifically, a 2018 National Academy of Medicine report found that there was some evidence that e-cigarette use increases the frequency and amount of cigarette smoking in the future.

    • E-cigarettes also can be used to deliver other drugs, including marijuana; in 2016, approximately one-third of U.S. middle and high school students who have ever used an e-cigarette reported using marijuana in the device.

    • But e-cigarette use among young people is still unsafe, even if they do not progress to future cigarette smoking.
       

  • Aren’t E-cigarettes Safer Than Cigarettes?
     

    • E-cigarettes expose users to fewer harmful chemicals than burned cigarettes.1

    • But burned cigarettes are very dangerous, killing half of all people who smoke long-term.

    • The use of any tobacco product, including e-cigarettes, is unsafe for young people
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  • Are E-cigarettes Regulated at the Federal Level?
     

    • Yes. In August 2016, the regulatory authority of the FDA was extended to cover e-cigarettes through the agency’s “deeming rule.”

    • Through authority granted by the Family Smoking Prevention and Tobacco Control Act (FSPTCA), FDA has authority to develop regulations that address the manufacturing, marketing, and sale of e-cigarettes.

    • There are some strategies that the FDA does not have authority to implement, such as including e-cigarettes in smoke-free policies or increasing the minimum legal sales age for these products, unless directed to do so by Congress. However, the FSPTCA does not prevent states and communities from including e-cigarettes in smoke-free policies or from regulating the sale and distribution of e-cigarettes. These types of strategies can include further raising the minimum legal sales age, licensing retailers, implementing price policies, and restricting or prohibiting the sale of tobacco products.
       

  • Are There Any National Public Education Prevention Campaigns Focused on Youth and E-cigarettes?
     

    • Yes. In 2018, the FDA expanded its successful youth tobacco prevention campaign, “The Real Cost,” to reach the more than 10 million youth aged 12–17 who have used e-cigarettes or are open to trying them. The campaign educates youth about the potential risks of using e-cigarettes.

    • The “Real Cost” reaches teens where they spend most of their time: in school and online. The campaign is also placing e-cigarette prevention materials in high schools across the nation, both in school bathrooms and on educational digital platforms accessed by students during the school day.

    • The Truth Initiative® launched the “Safer ≠ Safe” campaign in 2018, focusing on correcting youth misperceptions and providing accurate information about e-cigarettes and youth. The campaign is being promoted on digital and social media, including the Safer ≠ Safe website, which features videos, articles and interactive activities for youth.
       

  • What Do We Know About Heated Tobacco Products?
     

    • Heated tobacco products (HTPs) like IQOS and Eclipse, sometimes marketed as “heat-not-burn” technology, represent a diverse class of products that heat the tobacco leaf to produce an inhaled aerosol. They are different from e-cigarettes, which heat a liquid that can contain nicotine derived from tobacco.

    • HTPs are available in at least 40 countries and several have been authorized for sale in the United States by the FDA. In 2018, few U.S. adults (2.4% of all surveyed, including 6.7% of people who currently smoke surveyed) had ever used HTPs. In 2022, 1% of U.S. middle and high school students, combined, reported having used heated tobacco products in the past 30 days.

    • Scientists are still learning about the short-term and long-term health effects of HTPs, but the available science shows they contain harmful and potentially harmful ingredients. Youth use of any tobacco products, including heated products, is unsafe.

    • It is important that we continue to modernize proven tobacco prevention and control strategies to include newer products entering the market such as HTPs.
       

  • What Can I Do to Prevent My Child from Using E-cigarettes or to Help Them Stop?
     

    • Set a good example by being tobacco-free and ensure that your kid is not exposed to the secondhand emissions from any tobacco products, including e-cigarettes.

    • If you use tobacco, it’s never too late to quit. For free help, visit smokefree.gov or call 1-800-QUIT-NOW.

    • Talk to your child or teen about why e-cigarettes are harmful for them. It’s never too late.

    • Get the Talk With Your Teen About E-cigarettes  tip sheet for parents. Start the conversation early with children about why e-cigarettes are harmful for them.

    • Let your child know that you want them to stay away from all tobacco products, including e-cigarettes, because they are not safe for them. Seek help and get involved.

    • Set up an appointment with your child’s health care provider so that they can hear from a medical professional about the health risks of tobacco products, including e-cigarettes.

    • Speak with your child’s teacher and school administrator about enforcement of tobacco-free school grounds policies and tobacco prevention curriculum.

    • Encourage your child to learn the facts and get tips for quitting tobacco products at Teen.smokefree.gov.

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QUICK FACTS/STATS

  • Five Facts about Vaping You Need to Know (John’s Hopkins)
     

    • 1: Vaping is less harmful than smoking, but it’s still not safe.

      • E-cigarettes heat nicotine (extracted from tobacco), flavorings and other chemicals to create an aerosol that you inhale. Regular tobacco cigarettes contain 7,000 chemicals, many of which are toxic. While we don’t know exactly what chemicals are in e-cigarettes, Blaha says “There’s almost no doubt that vaping exposes you to fewer toxic chemicals than smoking traditional cigarettes.”

      • However, there has been an outbreak of lung injuries and deaths associated with vaping. In February 2020, the Centers for Disease Control and Prevention (CDC) confirmed 2,807 cases of e-cigarette or vaping use-associated lung injury (EVALI) and 68 deaths attributed to that condition.

        • “These cases appear to predominantly affect people who modify their vaping devices or use black market modified e-liquids. This is especially true for vaping products containing THC,” explains Blaha.

      • The CDC has identified vitamin E acetate as a chemical of concern among people with EVALI. Vitamin E acetate is a thickening agent often used in THC vaping products, and it was found in all lung fluid samples of EVALI patients examined by the CDC.
         

    • The CDC recommends that people:

      • Do not use THC-containing e-cigarettes or vaping products.

      • Avoid using informal sources, such as friends, family or online dealers to obtain a vaping device.

      • Do not modify or add any substances to a vaping device that are not intended by the manufacturer.

      • Research from The Johns Hopkins University on vape ingredients published in October 2021 reveals thousands of chemical ingredients in vape products, most of which are not yet identified. Among those the team could identify were several potentially harmful substances, including caffeine, three chemicals never previously found in e-cigarettes, a pesticide and two flavorings linked with possible toxic effects and respiratory irritation.
         

    • 2: Research suggests vaping is bad for your heart and lungs.

      • Nicotine is the primary agent in regular cigarettes and e-cigarettes, and it is highly addictive. It causes you to crave a smoke and suffer withdrawal symptoms if you ignore the craving. Nicotine is a toxic substance. It raises your blood pressure and spikes your adrenaline, which increases your heart rate and the likelihood of having a heart attack.

      • Is vaping bad for you? There are many unknowns about vaping, including what chemicals make up the vapor and how they affect physical health over the long term. “People need to understand that e-cigarettes are potentially dangerous to your health,” says Blaha. “Emerging data suggests links to chronic lung disease and asthma, as well as associations between dual use of e-cigarettes and smoking with cardiovascular disease. You’re exposing yourself to all kinds of chemicals that we don’t yet understand and that are probably not safe.”
         

    • 3: Electronic cigarettes are just as addictive as traditional ones.

      • Both e-cigarettes and regular cigarettes contain nicotine, which research suggests may be as addictive as heroin and cocaine. What’s worse, says Blaha, many e-cigarette users get even more nicotine than they would from a combustible tobacco product: Users can buy extra-strength cartridges, which have a higher concentration of nicotine, or increase the e-cigarette’s voltage to get a greater hit of the substance.
         

    • 4: Electronic cigarettes aren’t the best smoking cessation tool.

      • Although they’ve been promoted as an aid to help you quit smoking, e-cigarettes have not received Food and Drug Administration approval as smoking cessation devices. A recent study found that most people who intended to use e-cigarettes to kick the nicotine habit ended up continuing to use traditional and e-cigarettes.

      • In light of the EVALI outbreak, the CDC advises people who use e-cigarettes for smoking cessation to weigh the risks and benefits and first consider use of other FDA-approved smoking cessation options.
         

    • 5: A new generation is getting hooked on nicotine.

      • Among youth, e-cigarettes, especially the disposable kind, are more popular than any traditional tobacco product. According to the 2021 National Youth Tobacco Survey, more than 2 million U.S. middle and high school students reported using e-cigarettes in 2021, with more than 8 in 10 of those youth using flavored e-cigarettes.

      • According to Blaha, there are three reasons e-cigarettes may be particularly enticing to young people. First, many teens believe vaping is less harmful than smoking. Second, e-cigarettes have a lower per-use cost than traditional cigarettes. Finally, youths and adults find the lack of smoke appealing. With no smell, e-cigarettes reduce some of the stigma of smoking.

        • “What I find most concerning about the rise of vaping is that people who would’ve never smoked otherwise, especially youth, are taking up the habit,” says Blaha. “It’s one thing if you convert from cigarette smoking to vaping. It’s quite another thing to start up nicotine use with vaping. And, getting hooked on nicotine often leads to using traditional tobacco products down the road.”

      • Research from the CDC shows that vaping among youth has declined somewhat since 2020. Kids being stuck at home under their parents’ supervision during the COVID-19 pandemic could contribute to that trend.

      • But, Blaha says, interpreting the data is tricky, since young people change their preferences often, and, when surveyed, may not consider using disposable products such as “puff bars” as vaping. The same CDC report says disposable e-cigarette use has increased 1,000% among high school students and 400% among middle school students since 2019.

        Vaping and the COVID-19 Pandemic
         

      • When the coronavirus pandemic first began, Blaha says, data show that e-cigarette sales went down, possibly because people were spending more time at home and avoiding stores and public areas.

      • “The number of people who vaped daily used to be 1 in 5, but now it’s up quite a bit, which is concerning because it implies more nicotine addiction. I’m keeping a close eye on that.”

      • Vaping, smoking and other lung irritants can compound the respiratory problems associated with COVID-19.

        Want to quit smoking?
         

      • There’s a strong link between smoking and cardiovascular disease, and between smoking and cancer. But the sooner you quit, the quicker your body can rebound and repair itself. Talk to your doctor about which smoking cessation program or tools would be best for you.

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QUICK TIPS/ADVICE

  • Talk with your teen about E-Cigarettes: A tip sheet for parents
     

  • Vaping Conversation Guide (American Lung Association)
     

    • Before you talk: Know the facts, put yourself in your child’s shoes, take an open and calm approach, find the right place and time, take time to practice

    • While you’re talking: acknowledge your child’s independence, ask for their perspective, be ready to hear that your child may have vaped, blame big tobacco (not your kid), avoid scare tactics, connect with what they care about

    • After you talk: say thank you, help your child manage stress, help your child manage peer pressure, follow up, stay up to date, share relevant information
       

  • How Do I Know if My Child Is Vaping? (link to full page)
     

    • Start by asking your child in a nonjudgmental, concerned way if they have tried vaping. You want to encourage conversation, not shut it down. Even if you don’t think your kids vape, talk about it with them anyway so they know it’s unhealthy.
       

  • Signs of vaping include:
     

    • new health issues such as coughing or wheezing

    • e-cigarette supplies, like cartridges or other suspicious looking items

    • new smells (some flavorings are banned, but others are in nicotine and marijuana vapes — so parents might notice fruity or sweet scents)
       

  • What Should I Do if My Child Vapes?
     

    • Your child will need your help and support to quit. Help them find the motivation to stop vaping. You might want to talk about:

      • wanting to be the best, healthiest version of themselves

      • not wanting to be addicted

      • avoiding health effects including impotence and decreased sports performance

      • not wanting to increase anxiety or depression

      • saving money

      • going against advertising that targets young people

    • Some people use vaping to curb their appetite, but there’s no proof that vaping helps with weight loss. If you think this is why your child vapes, talk to them about healthier ways to stay at a healthy weight or lose weight.
       

  • How Can Kids and Teens Quit Vaping?
     

    • For those who want to quit, it can help to:

      • Decide why they want to quit and write it down or put it in their phone. They can look at the reason(s) when they feel the urge to vape.

      • Pick a day to stop vaping. They can put it on the calendar and tell supportive friends and family that they're quitting on that day.

      • For some people, chewing sugar-free gum or lollipops can help distract them from cravings.

      • Get rid of all vaping supplies.

      • Download tools (such as apps and texting programs) to their phone that can help with cravings and give encouragement while they're trying to stop vaping. Truth Initiative’s This Is Quitting texting program, for example, can help young people quit vaping. Smokefree.gov also offers free apps and other tools that can help someone trying to quit smoking or vaping.

      • Understand withdrawal. Nicotine addiction leads to very strong cravings for nicotine, especially in the first few days after stopping. It also can lead to headaches; feeling tired, cranky, angry, or depressed; trouble concentrating or sleeping; hunger; and restlessness. These problems get better over the following days and weeks.
         

  • What Else Should I Know?
     

    • Lend your support as your teen tries to quit. Set a good example by taking care of your own health. Make your house smoke-free and vape-free. If you smoke or vape, make the commitment to quit. Keep all vaping supplies and refill materials in child-resistant packaging out of the reach of children. Nicotine exposure can poison and even kill a child.
       

RESOURCES

Organizations
 

SUPPORT GROUPS AND OTHER ORGANIZATIONS

MEDIA AND APPS

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