Smart Investment: Addressing Youth E-cigarette and Vaping Use

In a time where cigarette smoking has generally declined, youth are turning to alternative nicotine delivery methods and are using e-cigarettes and vaping devices more so than ever before. Despite the misconception that these devices produce harmless water vapor, there are serious health risks associated with nicotine levels and long-term usage.

According to the 2018 National Youth Tobacco Survey, 20.8% of high school students used e-cigarettes last year, representing a 78% increase over 2017.The numbers for usage among middle school students totaled 4.9%, increasing by 48% over the prior year. Considering these trends along with local data, the Valley community is taking action to safeguard the region's youth.

Risks: E-cigarettes and cigarettes both deliver nicotine into the body. The stimulating chemical releases dopamine and increases alertness but the smoker also takes in the negative side effects and the manufacturer's additives. The American Lung Association reports that when 600 ingredients in a cigarette are lit, it produces 7,000 chemicals, including but not limited to ammonia, arsenic, carbon monoxide, lead, and tar, which are inhaled into the body. E-cigarettes can also contain heavy metals, such as nickel, tin, and lead.

E-cigarettes have an attractive smell compared to cigarettes because of a broad range of flavors. The health impact of those chemicals is incomplete however since the devices are relatively new and have only gained popularity in the U.S. during the last decade. Diacetyl, for example, is a chemical present in microwave popcorn that is also found in many flavored e-cigarettes, which has been connected to some users developing bronchiolitis obliterans, otherwise known as "popcorn lung." The air sacs found within the lungs become permanently scarred and resemble popped corn. This effect is irreversible and causes respiratory symptoms similar to chronic obstructive pulmonary disease (COPD).

While there is no side stream smoke produced from vaping, exhaled chemicals may produce health risk for pets and loved ones. Richard Le Pera, BS, EP, cardiac exercise physiologist and coordinator of Griffin Hospital's Smoking Cessation Program, said, "Vaping is new and we're still learning about the long-term risks. Our awareness is changing and the information is getting out there. Realistically, helping kids avoid the habit reduces healthcare expenditures for everyone and benefits the community."

Devices: An e-cigarette is just one way to refer to electronic nicotine delivery systems (ENDS). They are also known as JUULs, vapes, and vape pens. There are basic components common to every e-cigarette, such as is a battery or charging mechanism that heats the liquid and an atomizer that transforms the warmed liquid into vapor. While devices can look like cigarettes, many do not.

Pamela A. Mautte MS, MCHES, CPS-R, director of the Alliance for Prevention and Wellness at BHcare in Ansonia, pointed out that the JUUL, a branded device, has a slim design that looks like a thumb drive, a resemblance that is reinforced when it is plugged into a USB port for recharging. "Parents don't even notice it. Other e-cigarettes look like a regular ball point pen or an asthma inhaler. All of these can be hidden in plain sight."

Unlike traditional tobacco products, the FDA does not regulate vaping devices and the amount of nicotine is not limited in e-cigarettes. Access for minors is legally banned but manufacturers offer flavorings to appeal toward a young market, such as cotton candy, birthday cake, and ice cream.

"Young people who never smoked a cigarette are intrigued by vaping because of the flavors. They can order the devices online and have them delivered right to the house so it's not hard to get them."

Mautte reported the results from the 2016 Valley School Survey, which indicated that vaping devices are more widely used among teens than tobacco products. "The nicotine is in there and, soon, teens are addicted."

Furthermore, the smell associated with e-cigarettes allows those who vape to smoke marijuana without a telltale scent. "We encourage parents to attend presentations held in Valley schools, to learn what to look for and how to talk with their children. They should know these devices are not harmless and the health risks are real."

Hidden in Plain Sight is a parents-only event where attendees walk through a mock bedroom, challenged to identify vaping devices, before they talk about what they found, risk factors, and how to speak with their children.

"We don't want parents to be constantly suspicious. That's not the most effective approach. We encourage open and honest communication when they identify suspicious behavior because 90% of addiction disorders begin in adolescence."

She said, "Some signs of vaping include an increased thirst and nose bleeds because vaping dries out the mouth and skin inside the nose. Also, you'll see more respiratory illnesses, coughing, and even pneumonia. Parents might find devices or cartridges in pockets while doing laundry or see wrappers in the trash."

Mautte advises parents to use school presentations as a way to start the conversation with their children, and to overlook their own fears that might stop such an important talk. "Parents can serve as role models for their children," says Mautte. "Not using vaping devices themselves, setting rules with clear consequences, and encouraging safe and fun activities that help to keep teens away from risky situations are all important strategies to prevent vaping among youth."

There are also community approaches to the problem. "Statewide, we're working from a policy and legislative angle, considering the same tools that were successful in reducing tobacco use among our youth, such as increased taxes and licensing fees for retailers and penalties for sales to minors," Mautte added.

Allure: Smoking in any form has a certain allure that has been promoted by tobacco companies for decades. Since 2000, six out of every 10 PG-13 movies contained some form of tobacco use according to data collected by the Centers for Disease Control and Prevention. The organization estimates that changing those ratings to R could reduce the number of teen smokers by 18%.

Le Pera notes that many ads are aimed at teens and the mechanics of the devices lend themselves to an attractive self-image. "You get more smoke from vaping than you do from a cigarette so users often do tricks with that smoke to perpetuate a cool image."

What isn't cool is the result. "Breathing becomes difficult as the lungs stiffen. You can't get the carbon dioxide out of your body so you begin to suffocate as the cilia in your airways fails to remove mucus and infection. Problems like chronic pneumonia set in."
Quitting: The words smoking and quitting are inextricably linked. Since both cigarettes and e-cigarettes contain nicotine, there is no way to escape its intensely addictive quality.

Le Pera's smoking cessation program is part of the hospital's Community Health Improvement Plan. He said, "The most asked question is, 'Are e-cigarettes a good alternative to traditional smoking products?' The answer is that it's not better or worse; they still pose an inherent health risk."

He further explained, "E-cigarettes seem like a way to easily transition off of cigarettes but, because 99% of e-cigarettes contain nicotine, they won't help you quit. Of course, the best health practice is to avoid starting the bad habit altogether, but our goal is to get you completely off smoking. E-cigarettes obscure clinically proven methods of quitting, such as patches, gums, and lozenges, combined with lifestyle changes that are a big part of the program."

Considering the impact to the most vulnerable Valley population, Le Pera added, "Vaping has grown exponentially in the last few years, especially into the child and young adult population. We often receive calls from parents asking how to help them help their children. The good news is that the program can help anyone, any age, and is free
year-round."

Keeping people well throughout their lives and preventing them from forming an addiction to any harmful substance is a critical component of a healthy community.