Boston Children's Health Physicians | 6 Facts About E-Cigarettes

September 28, 2019

A growing number of children and teens are using electronic cigarettes. But health officials warn that this habit comes with many serious—and even life-threatening—risks. That makes it essential for parents to get the facts to help keep their kids safe

E-cigarette. Electronic cigarette. Electronic nicotine. JUUL. Vape pen. This latest trend goes by many names and comes in many shapes—but no matter what you call it or how it looks, the danger remains, according to Amy Brown, MD, a pediatric pulmonologist with Boston Children’s Health Physicians.

Vaping Deaths and Illnesses

She points out that there have been hundreds of recent reports of people falling ill with an emerging disease named VAPI (vaping associated pulmonary illnesses). The term vaping is a bit misleading, as the action of what is occurring is not just production of a harmless water vapor but rather an aerosol, or suspension of particles, that can then be inhaled by the e-cigarette user.  There have also been multiple deaths tied to vaping, Dr. Brown explains. These cases have prompted the Centers for Disease Control and Prevention (CDC) to recently issue a warning that vaping can cause severe lung disease. New York and other states are also taking action to restrict e-cigarette flavoring that appeals to kids. Other states have taken measures to ban the sale of vape products.

Exploring key facts about e-cigarettes

Dr. Brown stresses that parents need to understand the risks so that they can help their children make smart choices when it comes to vaping. Here are six important facts about e-cigarettes:

Fact #1: E-cigarettes are easy for kids to hide.

E-cigarettes are battery-powered devices that contain coils used to heat up “pods” containing nicotine and chemicals. The devices turn the liquid from the pod into a fine aerosol mist or vapor that people can inhale. In contrast to conventional cigarettes, electronic devices leave minimal telltale odor on clothing or the user’s breath. E-cigarettes also come in the shapes of common items, such as pens, computer flash drives, key fobs, and even asthma inhalers. This makes it easy for kids to use these devices without people noticing.

Fact #2: JUULs and e-cigarette come in many flavors that appeal to kids.

The flavor choices for e-cigarette juice (a common term for the flavor pods) are endless with names such as cola, cinnamon, buttered popcorn, unicorn milk, and bubble gum and fruit flavors, all of which appeal to young people. The flavor pods are also marketed with graphical images to match the flavor that appeal to our youth. The latest research from the National Youth Tobacco Survey (NYTS) shows using e-cigarettes can actually make teens more likely to smoke tobacco cigarettes, this should be particularly worrisome for parents. Once kids start to smoke e-cigarettes or regular cigarettes, it can be very difficult to quit.

Fact #3: The chemicals in e-cigarette pods are not meant to be inhaled.

The flavoring in e-cigarette pods comes from chemicals. While these chemicals have been approved by the US Food and Drug Administration (FDA) as food-grade, they are meant to be ingested (eaten), not inhaled. With so many flavors (more than 7,000) on the market, there is much uncertainty about what happens when these chemicals are heated in the e-cigarette device but some flavoring chemicals, such as diacetyl, have a track record of causing significant and severe pulmonary disease. Further, certain flavors require multiple chemicals to be combined. Some of these combinations could also pose health risks that have not yet been identified, Dr. Brown says.

Fact #4: Kids are getting easy access to e-cigarettes.

In the majority of states, it’s illegal for anyone under the age of 18 to purchase e-cigarettes or related accessories. In New York (as well as in a few other states), the legal age was recently raised to 21. Yet tweens and teens seem to have no problem buying e-cigarettes. The latest National Youth Tobacco Survey (NYTS) found current usage increased steeply in both middle school and high school students from 2017 to 2018 (the most recent data available) and the numbers are continuing to climb. Many teens are ordering e-cigarettes online, where they are able to get around age restrictions, and some of them are also purchasing from individuals who sell to underage kids.

Fact #5: THC can be used in vaping devices with concerning health effects.

Dr. Brown points out that many of the illnesses and fatalities linked to vaping seem to involve using THC (short for tetrahydrocannabinol, which is the chemical in marijuana that causes a psychoactive, or “high” effect). Some people add THC with the flavor pods, while others use the vaping device to heat straight THC. But little is known about exactly what it is about vaping with THC that has led to the catastrophic effects and whether it is the THC or other toxins in those pods that mediate the pulmonary illnesses associated with VAPI.

Fact #6: Nicotine addiction is a pediatric disease.

Electronic nicotine delivery systems (ENDS) can deliver a large amount of nicotine. One JUUL pod, a popular ENDS brand, equals the same amount of nicotine as an entire pack of cigarettes. Nicotine is very addicting, especially for young brains that are still developing.  Nearly 90 percent of all smokers today began smoking in adolescence.

“Preventing the use of nicotine in our youth and young adults, whether in electronic devices or with conventional cigarettes, is key to curtailing the myriad of very serious tobacco associated diseases,” Dr. Brown says.

What parents can do

The best way for parents to fight back against e-cigarettes is to show — don’t tell — their children about the risks, says Yardaena Osband, M.D., a pediatrician with General Pediatrics of Woodlawn in New York, which is part of Boston Children’s Health Physicians.

“Have your child do the research with you so they can see for themselves what is being said about e-cigarette products and the dangers, rather than telling them second-hand,” Dr. Osband says. They need to read the headlines that reveal people are dying from using these products so they really understand. Parents can also work with their local schools and anti-drug coalitions to bring in experts in the field to speak to the students about health effects and plans for prevention of use. It’s also always important to make sure you are getting your information from reliable sources.

“Finally, stay up on the latest updates on vaping and share any concerns about JUULs or e-cigarettes with your pediatrician,” she adds.

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