If you find a vape device in your teen‘s hoodie pocket, one of the first things you want to know is whether vaping is safe.

“The answer is no, it’s not safe,” says Tyler Oesterle, M.D., M.P.H., a Mayo Clinic addiction psychiatrist. “We know the amount of nicotine in a vape cartridge is significantly higher than the amount of nicotine a teenager could be exposed to in a cigarette. A teen puffing on a vape playing video games for an hour could be the same amount of nicotine consumption as a packet of cigarettes.”

The U.S Food and Drug Administration (FDA) projects as many as 1 in 5 high school students has vaped using an electronic or e-cigarette in the last 30 days, despite it being illegal under 2019 federal law to sell tobacco products, including e-cigarettes, to people under 21. In addition, the annual 2022 National Youth Tobacco Survey found that 27.6% of high schoolers use e-cigarettes daily. It’s no wonder the Centers for Disease Control and Protection has talked of a youth e-cigarette epidemic.

What is vaping?

  • Vaping is the catch-all term for smoking an electronic or e-cigarette or any electronic nicotine delivery systems (ENDS) device that heats an e-liquid, e-juice or smoke juice to create an aerosol you inhale into the lungs.
  • Vaping does not actually create a vapor, as the American Cancer Society clarifies: “In fact, e-cigarettes produce an aerosol made up of tiny particles, which is different from a vapor.”
  • The first e-cigarettes were called cig-a-likes because they looked like cigarettes. These were followed by vape pens — rechargeable and disposable, with nicotine or without — mods (modifiable devices), vaporizers and pod-based products, such as the JUUL device, which resembles a USB memory drive.
  • E-cigarettes came to market in the U.S. in 2007 and have been the most popular youth tobacco product since 2014.
  • Products are often brightly colored and feature lights and even sounds (JUUL’s device clicks with each puff). This has led to claims of intentional marketing to young people. Flavored vape products — with flavors such as fruit or candy flavors — are now illegal in the United States, but they may still be available.
  • Two market leaders — JUUL and BLU — are backed by tobacco giants Altria (formerly Philip Morris) and Imperial Tobacco, respectively.

Why is nicotine-based vaping so addictive?

A standard JUUL pod carries 5% nicotine by weight and delivers 40 mg to the user, which JUUL claims is “approximately equivalent” to one pack of cigarettes.

“Vaping is not regulated in the same way as cigarettes,” Dr. Oesterle cautions. “So the mass amount of nicotine that a teen can consume creates an addiction to nicotine much more quickly than with a cigarette.”

He also believes that vaping is an easier habit to slip into compared to cigarette smoking.

“You think of a teen smoking a cigarette for the first time and they’re coughing and spluttering,” he says. “You don’t get those reactions with vape pens. It feels very comfortable. A teenager is able to consume a lot more nicotine than with a cigarette, and nicotine is incredibly addictive. We all know how difficult it is to break dependency on nicotine.”

Dr. Oesterle also points to research showing teens vape differently from adults.

“Young people vape more excessively than adults because it’s more socially acceptable within their peer group. If a teen is in a peer group where everybody smokes, they don’t have the brain maturity to think: Let’s slow down, let’s not use too much, I’m not feeling too good, I’m not breathing well. They’ll just vape or smoke right through those warning signs. This increases the chance of developing an addiction, as compared to adults who will sense some warning signs; they’ll be coughing a lot and have the mental maturity to think, I better back off.”

What are the known risks of vaping?

  • Up to 2020, the Centers for Disease Control (CDC) recorded 2,807 Americans being hospitalized with e-cigarette or vaping use associated with lung injury (EVALI), of whom 68 died (aged between 15 and 75).
  • FDA testing connected most of the 68 deaths to use of illegal black-market cannabis vaping products containing the psychoactive substance THC (tetrahydrocannabinol). This is an alarming find since the CDC reports that one-third of vaping U.S. high schoolers have vaped marijuana, THC or CBD (cannabinoid) in an e-cigarette device.
  • If the contents of e-liquid cartridges are swallowed by a young child or the contents get in a child’s eyes or on their skin, urgent medical attention is required. As of 2023, Poison Control Centers reported 5,138 cases of e-cigarette and liquid nicotine exposure.
  • E-cigarettes can explode, causing significant burns. Between 2009-2016, the U.S. Fire Administration reported 195 cases of explosions and fires related to e-cigarettes.

Vaping and lung disease

Vaping has existed for less than two decades, and long-term respiratory risks are still largely unknown. However, a 2018 report by the National Academies of Science, Engineering and Medicine concluded that e-cigarettes contain or emit potentially toxic substances such as diacetyl, acrolein, vegetable glycerin, propylene glycol, acetaldehyde and formaldehyde. The more substances in the e-liquid, the worse the toxic exposure. The report also noted moderate evidence that vaping may put teens at increased risk for coughing, wheezing and asthma exacerbations. The U.S. Surgeon General also has issued warnings on the inhalation of secondhand e-cigarette emissions since they may contain: “nicotine; ultrafine particles; flavorings such as diacetyl, a chemical linked to serious lung disease; volatile organic compounds such as benzene, which is found in car exhaust; and heavy metals, such as nickel, tin, and lead.”

Dr. Oesterle urges vigilance, especially if your teen is using black-market vaping products, which are cheaper, often available online and circumnavigate retail law. “There’s more danger with black-market e-cigarettes from a consumer standpoint,” he says. “You’re not sure what you’re getting. Studies looking at black-market cartridges show toxic materials like heavy metals, flavorings associated with carcinogens — just a stew of chemicals, some of which have never been tested because they were never intended to be inhaled deeply into the developing lungs of children.”

Though black market vape products containing nicotine offer the gravest health risks, nonnicotine-bearing black-market vape products are no better, since chemical exposure is still prevalent, even if the addictive aspect of nicotine is not.

 

With so many potential risks, why do teens vape?

  • Peer pressure.
  • Vape products have sleek or fun packaging and, though illegal in the U.S., vape products with enticing flavors may be available.
  • To manage academic, family and social stress.
  • It’s less detectable than cigarette smoking.
  • To win social collateral at school by vaping in the restrooms or campus grounds.
  • The false belief that vaping is safer than cigarette smoking.
  • An influential parent or sibling vapes.

Vaping as a gateway to addiction

“Addiction starts in the teenage years,” Dr. Oesterle explains. “If you’re going to develop an addiction to any substance, it’s likely that you were exposed to that substance in your younger years. The higher the exposure, the more likely you are to become addicted.”

Dr. Oesterle frames addiction as a developmental disease, and teen vaping can be an alarm bell for parents to seek help. “There’s certain vulnerable populations,” he says. “And we have data at Mayo Clinic that shows teens with a family history of substance use disorders are more likely to follow that pathway, starting with excessive nicotine consumption that morphs into using other addictive substances.”

Dr. Oesterle‘s top tips for making teens aware of vaping risks

  • Understand why your teen is vaping. Teens will use vaping to relax, if they’re anxious, or for other reasons related to stress and distress. If that’s an issue, seek out professional help so your child learns to manage mental health without vaping or other chemicals.
  • Take your teen to the National Institutes of Health or CDC websites and show them how their developing brains are affected by nicotine. Back that up by saying, “I’m worried that your brain may not develop into what it could be because of your nicotine consumption.”
  • Be clear about the risks to their lungs and lung development and say that you’re worried about it.
  • Try to keep calm and show the value and love you have for your child through clearly explaining the risks to them.

How to help your teen stop vaping

Dr. Oesterle has seen firsthand how vaping withdrawal is harder to manage than stopping cigarette smoking due to the higher levels of nicotine involved. “Vaping is much more difficult to stop, even though it’s the same constitution of withdrawal symptoms,” he cautions. “The symptoms are just more intense. As a result, physicians need to prescribe nicotine replacement therapy medications for longer periods of time.”

Dr. Oesterle recommends that parents follow these steps to support their teen through withdrawal:

  • Arrange for your teen to see a healthcare professional to get advice on nicotine replacement therapies such as nicotine patches, gum, lozenges, nasal sprays or an inhaler.
  • Prepare your teen to expect the worst withdrawal symptoms during the first three days and for cravings to ease by seven days.
  • Designate the family home and vehicles tobacco- and vape-free.
  • If you vape or smoke, model restriction of that substance for your teen and show restraint.
  • Do your best to stay patient and calm.

What to do if your teen ignores vaping risks

If your teen is unresponsive when you bring the dangers of vaping to their attention, Dr. Oesterle suggests setting consequences. “Teen brains are still developing, so concrete strategies can be very helpful,” he explains. “This can include identifying privileges — such as gaming privileges, phone time, tablet time, going to a friend’s house — and removing a privilege unless the child agrees to take a step toward stopping, such as meeting with a doctor. Whatever privilege has value to the teen, removing that privilege becomes a consequence that will occur if the teen doesn’t take your concerns about their vaping seriously. Some parents think this is something to do when kids are very young, but teens are looking for their parents to be involved.”

To get help stopping vaping call 1-800-QUIT-NOW or access the American Lung Association‘s Vaping Conversation Guide for parents here.