Vaping and E-cigarettes

How common is e-cigarette use among teens?

A Surgeon General report released in December 2016 concluded that e-cigarette use is unsafe in children and adolescents.  Unfortunately, vaping e-cigarettes has become the most commonly used form of nicotine by adolescents.  As of 2018, 20.8% of high school students and 4.9% of middle school students reported use of e-cigarettes within the prior 30 days.  This was an increase of 78% in 2017 from 11.7% in high school students.  Fortunately, the rate of rise slowed in 2020, when only 22% of 10th and 12th graders reported e-cigarette use in the last 30 days. Proposed reasons for this plateauing include changes in laws, increased education on dangers of vaping, as well as decreased accessibility and opportunity for use due to shelter-in-place measures related to the COVID-19 pandemic (Miech et al. JAMA Pediatrics December 2020). Additionally, Gaiha et al. (Journal of Adolescent Health 2020) found that e-cigarette users were 5 times more likely to be diagnosed with COVID-19.

What are e-cigarettes?

E-cigarettes are devices that turn liquids into vapor, hence the term vaping.  Another name is Electronic Nicotine Delivery Systems (ENDS). The appeal to adolescents is not surprising.  There are flavors to make it ”taste” better. There is a false perception of safety.  A user can vape other liquids too, such as alcohol and marijuana.  Up until 2016, adolescents could purchase e-cigarettes.  Since then the law states that no one under 18 years old can purchase them.  The FDA has also required most flavors to be removed from shelves to discourage adolescents and children from being enticed. Despite this 80% of surveyed teen users in 2020 reported they could easily get a flavor other than tobacco or menthol, with most common being fruit (59%) and mint (27%) (Miech et al. JAMA Pediatrics December 2020).

There is a wide variety of types of e-cigarettes.  Common names for them are vapes, mods, tanks, pod systems (JUUL).  Early products resembled cigarettes but the most current ones are tank-style systems with large refillable cartridges.  Many of the new designs resemble a pen, small flashlight or a computer flash drive.  The term “mods” is used because of the ability to modify the devices.

What do parents need to know about vaping?

  1. E-cigarettes don’t look or smell like cigarettes. Therefore, it may be harder to tell if your child is using them. In fact, the flavor is the most appealing factor at first. A survey in 2015 showed that more than 80% of adolescents who vape do so because “they come in flavors I like.” Unfortunately, the nicotine from e-cigarettes is addictive like that from cigarettes.
  2. Due to Big Tobacco-esque marketing efforts, vaping has become the new “cool” thing to do. Adolescents see vaping in movies, on TV shows, in commercials, in digital ads on favorite websites and social media, and in print ads in favorite magazines.
  3. Vaping has been marketed as a safer alternative to cigarettes due to the lack of tar and perceived decreased effect on the lungs. It has also been marketed to help individuals stop smoking cigarettes. However, e-cigarettes have thousands of chemicals like regular cigarettes. The vaporization process creates other chemicals like carbon monoxide that are harmful to the lungs. Additionally, the nicotine in liquid tobacco for vaping is addictive all the same. Adolescents and young adults who use e-cigarettes are 3.6 times more likely to use traditional cigarettes.
  4. There is a newly diagnosed complication of using e-cigarettes known at EVALI (E-cigarette or Vaping Product Use Associated Lung Injury). EVALI is caused by vaping either with e-liquids and more prevalently THC and presents with either or both respiratory and gastrointestinal symptoms.  The symptoms can be mild such as asthma like symptoms or severe requiring hospitalization.
  5. E-cigarettes are the new “gateway drug.” For decades data have shown adolescents are far more likely to try illicit drugs like marijuana, cocaine, heroin and meth if they already smoke cigarettes. Emerging data show e-cigarettes have a similar relationship. Additionally, e-cigarette use in adolescence is strongly associated with later daily cigarette smoking (Pierce et al. Pediatrics January 2021).
  6. Talk to your adolescent if (s)he is becoming more reclusive, more secretive, or less hungry than usual (nicotine side effect). Ask him/her what they have heard about vaping or if they know of people/friends at school who vape. Do not broach the subject in an accusatory manner. Seek to have an open dialogue about it.

What do teenagers need to know about vaping?

  1. Liquid nicotine is just as addictive as the nicotine in cigarettes. Nicotine is consistently ranked as one of the most addictive, if not the most addictive, substances on earth. Trying it once can get you hooked.
  2. Vaping is bad for your lungs. You may not get tar deposits like you would with cigarettes, but liquid nicotine used in e-cigarettes can harm lungs too. Carbon monoxide is inhaled while vaping, as well as many of the thousands of chemicals (>4,000 in fact) in tobacco products besides nicotine.  Many of these substances are considered toxic and cancer-causing.  These substances also cause decreased endurance, speed and power in competitive athletes.
  3. Nicotine changes your brain too. The wiring and chemical connections in your brain are still developing into your 20’s. Nicotine prevents the wiring and chemical connections from forming normally. This increases your risk for:
  • Addiction (to nicotine as well as other substances such as alcohol, drugs and medications)
  • Anxiety and/or Depression
  • School struggles (decreased ability to get and stay focused in class and while studying)
  • Poor decision making (decreased impulse control) is a great resource to help teens quit e-cigarettes


  1. Singh  T, Arrazola  RA, Corey  CG,  et al.  Tobacco use among middle and high school students—United States, 2011-2015. MMWR Morb Mortal Wkly Rep. 2016;65(14):361-367.
  2. Ambrose  BK, Day  HR, Rostron  B,  et al.  Flavored tobacco product use among US youth aged 12-17 years, 2013-2014. JAMA. 2015;314(17):1871-1873.
  3. E-Cigarettes and Similar Devices | American Academy of Pediatrics (
  4. Clinical Features of E-cigarette, or Vaping, Product Use–Associated Lung Injury in Teenagers | American Academy of Pediatrics (
  5. Pierce JP, Chen R, Leas EC, et al. Use of E-cigarettes and Other Tobacco Products and Progression to Daily Cigarette Smoking. Pediatrics. 2021; 147(2):e2020025122
  6. Miech R, Leventhal A, Johnston L, O’Malley PM, Patrick ME, Barrington-Trimis J. Trends in Use and Perceptions of Nicotine Vaping Among US Youth From 2017 to 2020. JAMA Pediatr. Published online December 15, 2020. doi:10.1001/jamapediatrics.2020.5667
  7. Gaiha SM, Cheng J, Hapern-Felsher B. Association Between Youth Smoking, Electronic Cigarette Use, and COVID-19. Journal of Adolescent Health. 67 (2020) 519e523