E-cigarettes and Vaping

E-cigarettes and Vaping

Contrary to popular belief, vaping is not safe for anyone, but especially for youth and adolescents.

By Amy Cranage

The Food and Drug Administration says that in 2019 more than five million American youth used e-cigarettes or vaping devices. This recent growth in vaping by youth translates to a dramatic increase in overall tobacco use. After decades of successful anti-smoking campaigns, the widespread (false) belief that vaping was safe quickly erased years of progress. The result is an urgent public health crisis.


According to the Partnership for Drug-Free Kids, “vaping is the act of inhaling and exhaling aerosol or vapor produced by a vape device.” A vape device is a machine that converts a liquid or juice containing nicotine (and other substances) into an aerosol to be inhaled. Not vapor, after all, and not safe either.

Developed in 2003 by a smoker in China who wanted to quit, modern vaping devices became widely available in the U.S. by the 2010s. In 2015, e-cigarette company JUUL Labs, Inc., patented a method to deliver nicotine in a way that is more pleasant than other brands. Due to the brand’s immense popularity, the term juuling became interchangeable with vaping.

The misconception that vaping was safe perhaps emerged from stories of former longtime smokers who quit the habit by replacing tobacco with e-cigarettes. Indeed, for cigarette smokers, vaping may be the lesser evil — it is “safer” only for them and only if they are carefully using e-cigarettes to wean themselves off nicotine.

Vaping devices are marketed to appeal to youth. Kids who would never have dreamed of smoking a cigarette are enticed by sweet flavors, flashy advertising, Internet contests (“cloud competitions”) and the misconception that vaping is safe. Some vaping devices look like colorful tech gadgets. They are small and easy to conceal. At least one could be mistaken for a wristwatch. Vaping at school — in bathrooms or even during class — is not uncommon.

“Everyone wants to try something that your friends are doing…and I didn’t want to miss out,” says R.B., a local high school student who tried vaping a few times as a freshman. “More and more people are participating in this because they want to look cool in front of their friends at a party. Then they are hooked, and they can’t stop doing it.”


What’s the hook? Nicotine. “The only substances more addictive than nicotine are cocaine and heroin,” says parent and pediatrician Susanne Tanski, M.D., of Grantham, N.H. When nicotine reaches the brain, it triggers chemical events “that are central to feelings of both reward and disappointment — pleasure and pain.” Because that part of their brain is still growing “adolescents are developmentally primed for drug use and developmentally susceptible to addiction.”

It takes less nicotine to hook a younger brain. Vaping delivers a higher concentration of nicotine than cigarettes, but without the unpleasant taste and odor. One Juul e-juice “pod” contains as much nicotine as an entire pack of cigarettes. There are kids who are vaping a pod a day within weeks or months of their first hit, whereas the typical length of time between first smoking a cigarette to a pack-a-day habit is two years.

“Some kids go from their first hit of a vape to weekly use in one step,” says Tanski. “They come for the flavors and stay for the nicotine.” The adverse effects of nicotine on a young brain include difficulty concentrating and learning, impulse control issues and the likelihood of becoming addicted to other substances.


In addition to the brain, vaping damages the lungs. When vaping, substances in the “e-juice” or “pod” are aerosolized and then inhaled into the lungs. The resulting aerosol can contain harmful ingredients, according to the Centers for Disease Control and Prevention, including volatile organic compounds, ultrafine particles, cancer-causing chemicals, heavy metals, and diacetyl, a chemical linked to lung disease. Especially homemade juices by do-it-yourselfers pose the risk of containing harmful substances.

There have been numerous reports of people of all ages being hospitalized with lung injuries or even dying because of vaping. In 2019, one American teen required a double lung transplant due to the irreversible and life-threatening damage that vaping had done to his lungs. According to the Partnership for Drug-Free Kids, because “vaping is a relatively new phenomenon,” there are no long-term studies on the impact of e-cigarettes on the health of youth and young adults.


If you are worried that your child is vaping, be aware that, unlike cigarettes, vaping does not leave the scent of tobacco on one’s clothing or breath. You won’t find matches or a pack of cigarettes in their sock drawer. Instead, vape devices look like tech gadgets and have replaceable parts that detach.

That colorful new pen or USB drive that fell out of your teen’s backpack might not be what you think it is. Or maybe you noticed the scent of cotton candy or mango when you walked past your child’s room. While some vape device manufacturers are eliminating the flavors most appealing to youth, the damage for many is already done.

Other signs to look out for:

  • Frequent sore throats or coughing
  • Increased thirst, drinking more water, and going to the bathroom more often
  • Decreased caffeine consumption (replaced by nicotine)
  • Reduced level of physical endurance
  • Adding salt to food
  • Nosebleeds
  • Acne
  • Mysterious online purchases or packages in the mail


“Kids still do listen to their parents,” says Keith Loud, M.D., pediatrician and director of Children’s Hospital at Dartmouth-Hitchcock (CHaD) in Lebanon, N.H. “Trust your instincts, don’t be afraid to ask.”

Chances are, whether they have tried vaping or not, simply by going to school and being around other kids, they have heard other kids talking about vaping. Ask her what she has heard about vaping and talk about it. Make it clear that “vaping is not a good choice,” says Loud. “Kids want and need to know what their limits are.”

If you discover that your child vapes and may be addicted, make an appointment with your child’s doctor or contact your local tobacco cessation resource. Before you ground him for the rest of his life, focus on treating the addiction more than punishing the child. Addiction and the dangerous health risks of vaping are probably punishment enough.

Parent Tip
If you smoke or vape, it might be a good time to quit. If not, be sure to smoke or vape only where your children cannot see or smell it. Ask friends and relatives to follow suit.


When kids realize they are addicted, they may not know what to do or where to turn. Kids who feel ashamed or are afraid to reach out to their parents for help can talk to their school nurses, resource officers, or guidance counselors. Addiction is a “chemical response, not a moral issue,” says Kate McNally, Tobacco Treatment Specialist at Norris Cotton Cancer Center, where tobacco cessation services are offered free of charge.

McNally lists seven techniques for dealing with nicotine addiction. Depending on the person, a customized program may include nicotine patches, gum, lozenges, nasal spray, inhaler, medication (such as Wellbutrin) and/or counseling.


The good news is that health care providers, teachers and school administrators as well as local, state and national legislators are aware of the vaping problem. Last November, Dartmouth-Hitchcock launched its NoSafeVape campaign to increase public awareness of the dangers of vaping by youth and a wealth of information is available at dartmouth-hitchcock.org/patient-education/vaping.html

Among the reasons vaping is less rampant among youth in other countries are stricter age requirements, higher taxes and advertising restrictions. In addition to maintaining open communication with our children, we as parents would be wise to make our opinions regarding legislation known to our elected officials.


Northern New England Poison Center
U.S. Surgeon General
Centers for Disease Control and Prevention
Truth Initiative

Text “DITCHJUUL” to 88709

New Hampshire
Teens enroll at MyLifeMyQuit.org or call/text 1-855-891-9989
Adults enroll at QuitNowNH.org or call 1-800-QUIT-NOW

Teens/adults call 1-800-QUIT-NOW

Upper Valley
Kate McNally, Tobacco Treatment Specialist
Norris Cotton Cancer Center
(603) 650-2998 or 650-8537

Amy Cranage lives in Grantham, N.H., with her husband, daughter, and two border collies. Contact her at aehcranage@gmail.com

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