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Health Risks to Adolescents of Vaping Nicotine

What's the problem with something that causes a release of dopamine and relaxes and makes you feel good? Plenty, at least with respect to adolescents. Although there are no longitudinal studies for vaping yet, as it is so new, there is increasing evidence that vaping nicotine poses significant health risks, in addition to addiction - especially for adolescents whose brains are still developing.

Toxins. Although it is generally agreed that e-cigarettes expose users to fewer chemicals than tobacco, e-cigarettes do not emit only water vapor, as the makers would have you believe. A study published last year in the journal Pediatrics found five cancer-causing toxins in the urine of 16-year olds who inhaled e-cigarette vapor.

Harmful chemicals such as Nicotine (an addictive central nervous system stimulant, discussed below), Glycerol (an ingredient commonly used in antifreeze, paints and explosives), Propylene Glycol (commonly used in antifreeze, paints laundry and dishwashing detergents), and Benzoic Acid (commonly used in antifreeze, paints, sealants, and electronic/electrical products) are contained in JUUL pods, according to JUUL's website.

The National Center for Biotechnology Information lists side effects of Glycerol as headaches, dizziness, bloating, nausea, vomiting, thirst and diarrhea. Side effects of Propylene Glycol include irritation of eyes, nose, throat and skin and acute toxicity if swallowed orally. And although Benzoic acid is an FDA approved food preservative, it is not water soluble (contrary to popular belief) and reaches the respiratory tract when inhaled via a vaping device, beyond the digestive tract.

Formaldehyde, a known carcinogen, Carbonyls, Metals (including chromium, nickel, tin, silver, cadmium, mercury and aluminum) and organic volatile compounds also have been identified in e-cigarette liquid and aerosol. Particulate matter, especially from the heavy metals, is potentially damaging to the lungs. Tests have found that e-cigarette liquid and aerosol can contain higher levels of metals than regular cigarettes.

Importantly, one e-cigarettes that have claimed to be nicotine-free actually do have nicotine.​ Nicotine is Highly Addictive. Nicotine is an incredibly powerful addictive drug, no matter how it is used. It is one of the most addictive known substances on a level comparable to

heroin and cocaine. It stimulates the regions of the cortex associated with reward, pleasure and reducing anxiety. The nicotine content in e-cigarettes is more than adequate to sustain nicotine dependence. Some people get addicted in just a few weeks. Others develop cravings over several months. When nicotine intake stops, withdrawal symptoms include cravings for nicotine, anger/irritability, anxiety, depression, impatience, trouble sleeping, restlessness, hunger or weight gain and difficulty concentrating. ​ Effect of Nicotine on the Developing Brain. Not only is nicotine addictive, it is a psychoactive substance that directly acts on brain areas involved in emotional cognitive processing. Nicotine affects the limbic system which is the portion of the brain that deals with emotion and other brain functions related to instincts and memories. Early

exposure to nicotine during the transition from child to adult may be harmful since it may derange the normal course of brain maturation and have lasting consequences for cognitive ability and concentration, memory and their ability to learn, mental health and even personality. Smoking during adolescence increases the risk of developing psychiatric disorders and cognitive impairment in later life. Adolescent smokers also suffer from attention deficits which aggravate with years of smoking. See these NIH studies. Youth More Susceptible to Nicotine. Youthful experimentation with e-cigarettes can lead to lifelong addiction. The younger the child is when they start using nicotine, the more likely they’ll be addicted. Youth are sensitive to nicotine and can become dependent easier than adults. Although, as mentioned above, e-cigarettes have not been around for enough time for longitudinal studies about the long term health effects, we do know much about the effects of nicotine. Because of nicotine addiction, about three out of four teen cigarette smokers end up smoking into adulthood. Teens who use e-cigarettes are more inclined to become smokers than those who do not. The majority of young people who vape also smoke cigarettes and use hookahs. Heart Attack Risk Doubled. A study released last year of nearly 70,000 people found that daily e-cigarette use can double the risk for heart attack. Early cardiovascular damage is seen in most young cigarette smokers; those most sensitive die at relatively early ages. Among youth who persist in cigarette smoking, one third will die prematurely from smoking. Respiratory Issues. According to a study published in the American Journal of Respiratory and Critical Care, adolescents who use e-cigarettes are twice as likely to suffer respiratory symptoms such as a persistent cough, bronchitis, congestion and phlegm as those who

don't. Teens who smoke cigarettes are not only immediately short of breath, they may end up as adults with lungs that will never grow to full capacity. Such damage is permanent and increases the risk of chronic obstructive pulmonary disease (COPD). COPD is a debilitating, progressive disease which cannot be reversed; when developed at a very young age (in one's ‘30s) it eventually becomes an end stage lung disease. Chemicals in Flavorings and "Popcorn Lung". Even if e-cigarettes don't contain nicotine, health risks associated with flavorings are of concern. There has been limited research on flavoring chemicals in e-cigarettes. However, a recent study involving a random test of 51 vaping devices for 3 dangerous chemicals, including one called diacetyl, found that 47 of the devices had one of these three chemicals.

Diacetyl. This chemical in menthol acts to decrease vaping's harshness on the throat, and has been found to be associated with a severe and irreversible respiratory disease called "obliterative bronchiolitis" or "popcorn lung". It is a rare condition that causes airway scarring of tiny air sacs in the lungs due to inflammation. This results in a thickening and narrowing of the bronchioles, the lung's smallest airways, and in breathing difficulties. There is no cure for this disease except a lung transplant. The disease is known as "popcorn lung" because the chemical was used to give food products such as popcorn a rich, buttery flavor and it was found in popcorn factory workers who inhaled the chemical in the workplace. Symptoms of popcorn lung may be subtle and therefore easy to overlook. People with other respiratory conditions, especially chronic conditions such as asthma, may not be able to tell the new symptoms apart. Symptoms typically occur within 2-8 weeks after exposure and slowly worsen over months. The most common signs and symptoms are wheezing, dry cough, shortness of breath or difficulty breathing deeply especially with physical activity, unexplained exhaustion, rapid breathing and persistent skin, eye, mouth or nose irritation. Second Hand Exposure. The long term effects of second hand exposure also are unknown

at this time. The chemicals in these e-cigarette aerosols remain in the environment, re-emit for varying periods of time and also are capable of reacting with other chemicals to create additional substances known to be carcinogenic. Lack of Regulation and Approval as a “Quit Device”. E-cigarettes have been unregulated until recently. In August 2017, the FDA extended its regulatory powers to include e-cigarettes so regulation has just begun. While it now has the authority to regulate e-cigarettes, the FDA has delayed implementation of key provisions for several years, including a regulation that would require all e-cigarette products, including flavors, to obtain FDA approval before entering the marketplace. Moreover, the FDA has not approved e-cigarettes as a device for quitting tobacco and several studies have indicated that e-cigarettes use actually is linked to lower odds of quitting. The FDA also does not regulate flavorings which leaves alluring flavors on the market to entice kids to try e-cigarettes. Dripping. One in four high school students who have used e-cigarettes also have tried this dangerous vaping method. Dripping involves dropping e-cigarette liquid onto the hot coils of a device to produce a thicker more flavorful smoke and stronger throat hit. It may expose users to higher levels of nicotine and to harmful non-nicotine toxins such as formaldehyde, a known carcinogen. See this USA Today article about dripping.

E-cigarettes as a Gateway to Tobacco Use. A report released last year by the National Academies of Sciences, Engineering and Medicine found "substantial evidence" that vaping might prompt youth and young adults to try cigarettes, making it a route toward smoking for a generation of teenagers whose cigarette use is at a 40-year low. See this New York Times article which discusses the report.

A study published in Pediatrics in 2016 found that teens using e-cigarettes were less likely to see tobacco smoking as dangerous and therefore more likely to take up cigarette smoking. Quoting Department of Health and Human Services data, the study also said an estimated 5.6 million youth could die early from cigarette smoking-related illnesses unless youth smoking rates drop dramatically.

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