In Light of New FDA Warnings; E-Cigarettes, Vaping and Juuling 101: What Parents Need to Know

No doubt, most students are familiar with vaping or e-cigarettes, an alternative to conventional tobacco cigarettes. Although once touted as a product to help adult tobacco smokers quit, e-cigarettes containing nicotine are now believed to entice, and ultimately hook, younger smokers with attractive flavors – candy, bubble gum, mint, fruit. In fact, since e-cigarettes were introduced in the U.S. in the mid-2000s, they have become the most common tobacco product used among middle and high school students.

Unfortunately, these novel products are much more difficult for parents and teachers to recognize – and equally difficult to know if children or students are using them. We asked board-certified oncologist Dr. Arati Patel, Medical Director of the Thoracic Oncology Program at CH, and board-certified pediatrician Dr. Bhargesh Mehta, to discuss some of the most frequently asked questions about e-cigarettes and the new phenomenon: JUUL.

 What are e-cigarettes?

E-cigarettes are the digital equivalent to the conventional tobacco cigarettes in delivering nicotine. E-cigarettes contain a heating element that produces an aerosol from a liquid that users can inhale through a mouthpiece. According to the Centers for Disease Control and Prevention, 99 percent of e-cigarettes sold in the U.S. in 2015 contained nicotine. E-cigarettes include a range of devices including a new type of e-cigarette on the market called a JUUL.

 What is a JUUL?

JUUL is a top-selling, brand name e-cigarette that came on the market for adult smokers in 2015 but is now popular among middle, high school and college students. A JUUL looks just like a USB flash drive or thumb drive and can be easily concealed. It is charged through a laptop or computer USB port. What concerns medical professionals who treat young people is that one JUUL pod contains as much nicotine as one pack of cigarettes and currently the package is not labeled with this information. “Teens and young adults who use these devices can become extremely addicted to the nicotine and are ultimately much more likely to use other tobacco-related products such as traditional cigarettes,” said Patel.

Are there dangerous chemicals in e-cigarettes? Do they result in cancer?

E-cigarette devices contain more than just harmless water vapor and flavorings. According to a new report from the National Academies of Sciences, Engineering and Medicine, there is conclusive evidence that in addition to nicotine, most e-cigarettes contain and emit numerous potentially toxic substances. The liquids used in e-cigarettes are primarily made of substances generally safe for ingestion. The question that researchers are studying is what happens when these substances are heated up, vaporized and inhaled. A study published in the medical journal Pediatrics in March 2018 found at least five cancer causing toxins in the urine of 16-year-olds who inhaled e-cigarette vapor, according to Mehta. “Currently, there is no evidence of short-term carcinogenic impact. However, it will require years of research to understand the long-term impact of these chemicals, especially given the extreme popularity and the young age of the users,” said Patel.

Why is nicotine especially harmful to teens?

Nicotine is a stimulant, so it speeds up the heart and constricts blood vessels which increases blood pressure—it also gives younger users a buzz or ‘high.’ Scientific evidence suggests that nicotine exposure during adolescence, a critical window for brain development, may have adverse consequences on decision-making and impulse control, according to Patel. Nicotine also activates areas of the brain affected by alcohol and marijuana.

Minors may be telling their parents that vaping or using e-cigarettes is okay—it’s just water vapor. “The presumption with teens and parents is that e-cigarettes are safe but it is my belief that these electronic devices are the gateway to real cigarettes,” said Mehta.

A study published in the American Journal of Medicine found that young adults who use e-cigarettes are more than four times as likely to begin smoking tobacco cigarettes within 18 months as their peers who do not use e-cigarettes, said Mehta.

 This trend is already impacting our community. According to a 2016 survey provided by the Calvert County Health Department, prior to the popularity of JUULs and other e-cigarettes, 34.2 percent of high school students and 18.4 percent of middle school students responded that they had smoked an e-cigarette product at least one day during the 30 days before the survey. Department officials expect those numbers to go up in the next survey.

“Nearly 90 percent of cigarette smoking starts before the age of 18, and these nicotine-containing devices being used by young people have the potential to result in lifelong addiction to tobacco-related products,” said Patel.

At a time when traditional tobacco cigarette smokers are on the decline, and only 9.9 percent of Calvert County high school students and 1 percent of middle school students surveyed identified as smokers, e-cigarette and JUUL use by young people today may lead to an increase in tobacco cigarette smokers and, potentially, an increase in health-related consequences of smoking such as cancer, lung disease and heart disease in the future.

Meet the Specialists:

Arati Patel, MD is part of the cancer team at CalvertHealth Hematology & Oncology. Board certified in medical oncology, she also serves as the director of CHMC’s thoracic health program.

Bhargesh Mehta, MD  is a board-certified pediatrician who has practiced in Calvert County for more than 20 years.