Vaping, or smoking an electronic cigarette (e-cigarette), has become a popular alternative to cigarette smoking among adults and youth nationwide. There’s no doubt that cigarette smoking has dramatically decreased in both adults and youth, however the use of e-cigarettes has dramatically increased, especially among our youth. According to the Centers for Disease Control and Prevention, 2.8% of U.S. adults were current e-cigarette users in 2017. Nearly 1 of every 20 middle school students (4.9%) reported in 2018 that they used e-cigarettes in the past 30 days — an increase from 0.6% in 2011. Nearly 1 of every 5 high school students (20.8%) reported in 2018 that they used electronic cigarettes in the past 30 days—an increase from 1.5% in 2011.

E-cigarettes are known by many different names, including e-cigs, e-hookahs, mods, vape pens, vapes, tank systems and electronic nicotine delivery systems. Some e-cigarettes are made to look like regular cigarettes, cigars or pipes, while others resemble pens, USB flash drives and other everyday items. No matter the device, all e-cigarettes produce an aerosol by heating a liquid that usually contains nicotine — the addictive drug in regular cigarettes and other tobacco products. The CDC reports the liquid also contains harmful substances, such as volatile organic compounds, ultrafine compounds, cancer-causing chemicals, heavy metals (i.e. nickel, tin and lead) and flavorings (i.e. diacetyl, a chemical linked to a serious lung disease). It is difficult to know what these products contain, as quality testing has revealed that some e-cigarettes marked as containing 0% nicotine have been found to contain nicotine. Users inhale this aerosol into their lungs, which can also be inhaled by bystanders when the user exhales into the air. E-cigarettes have also been used to deliver marijuana and other drugs.

Many users mistake e-cigarettes as being “safe.” The aerosol generally does contain fewer toxic chemicals than the mix of 7,000 chemicals in the smoke from regular cigarettes, however the aerosol is not harmless. Scientists are still learning about the long-term health effects of e-cigarettes. Most e-cigarettes contain nicotine, which has known health effects including being highly addictive, harming adolescent brain development into the early to mid-20s, and being a health danger for pregnant women and their developing babies. Acute nicotine exposure can be toxic. Both children and adults have been poisoned by swallowing, breathing or absorbing e-cigarette liquid. The aerosol inhaled includes cancer-causing chemicals and tiny particles that reach deep into the lungs, which can lead to lung cancer and an array of chronic lung conditions. E-cigarettes can also cause unintended injuries from defective batteries causing fires and explosions.

E-cigarettes shaped like USB flash drives are among the most popular in youth. The JUUL is the top-selling e-cigarette brand in the U.S. as of December 2017. The use of the JUUL specifically is sometimes called “JUULing” as opposed to “vaping.” The JUUL contains pods, which are nicotine liquid refills. They are available in several flavors such as Cool Cucumber, Fruit Medley, Mango and Mint. All JUUL e-cigarettes contain nicotine. A single pod contains as much nicotine as a pack of 20 regular cigarettes. Other examples of e-cigarettes shaped like USB flash drives include the MarkTen Elite (contains nicotine) and the PAX Era, which is a marijuana delivery device that looks like the JUUL. News outlets and social media sites report widespread use of JUUL and other e-cigarettes by students in schools, including classrooms and bathrooms.

It is imperative that parents, educators, pediatric health care providers and all adults are informed about the many different shapes, types and risks of all forms of e-cigarette use for our youth. We can prevent and reduce the use of e-cigarettes by talking to our youth about the risks, asking about the use of any type of e-cigarettes, setting a positive example by being tobacco-free and expressing firm expectations that they remain tobacco-free. Educators can develop, implement and enforce tobacco-free school policies. Pediatric health care providers can screen youth and help educate parents about the risk of all forms of tobacco use.

Many adult users start using e-cigarettes in an effort to quit smoking regular cigarettes, however the Food and Drug Administration does not approve of e-cigarettes as a smoking cessation aid. There are a few studies on the issue, and the results are mixed. There are two randomized controlled trials that found e-cigarettes containing nicotine can help smokers stop smoking in the long term compared with non-nicotine e-cigarettes. The CDC reports most users do not stop smoking cigarettes and continue to use both regular and electronic cigarettes. Because smoking even a few cigarettes per day can be dangerous, quitting smoking completely is very important to protect one’s health.

If you or someone you know is interested in quitting tobacco products, contact the QuitlineNC at 1-800-Quit-Now or www.quitlinenc.com. They provide free and confidential cessation services to any North Carolina resident, including adults and youth of any income or insurance status. They have helped millions of people quit tobacco products using proven techniques. Take advantage of this invaluable resources to make the best decision to protect your future health — quit now!

Meagan Overman, MS, is a clinical exercise physiologist at Vidant Wellness Center and can be reached at 252-975-4236.