Use of E-cigarettes Rises Among Teens

A father of four looks past the smoke and mirrors at the phenomenon known as vaping.

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By now you’ve probably heard that the percentage of active smokers among us has steadily and significantly dwindled. Today nearly 16% of high-school-age kids are regular puffers, as opposed to 36% of teens in 1997. This is, in a word, fantastic. Fewer teen smokers means fewer addicted adults down the road, and ultimately, fewer smoking-related deaths. However, in a potentially worrisome development, over the past three years there’s been an almost 800% increase (yes, that’s an 8) in the use of electronic cigarettes—small, battery-powered machines that deliver vapor that is far gentler than tarry, chemical-riddled smoke but still carries a hefty nicotine payload.

E-cigarettes can be flavored to taste like candy and emit a vaguely scented, superfine substance often referred to as vapor, which is actually aerosol. It dissipates almost instantaneously without telltale traces on breath or clothes. E-cigs can be used one drag at a time, allowing novices to precisely control their nicotine intake without “wasting ” half or more of a cigarette before they’ve built up a tolerance. It’s not hard to imagine an enterprising kid whipping out an e-cig in the school stairwell and grabbing a couple quick puffs on the way to geometry.

E-cigarettes are so new that there’s no long-term research on their health effects. Technically, they emit lower levels of toxins than conventional cigarettes, meaning e-cig smokers inhale fewer noxious chemicals to get the same dose of nicotine. But that’s only because tobacco smoke is so incredibly toxic. “When you burn tobacco, you release thousands of chemicals,” says Peter Shields, MD, deputy director of the Ohio State University Comprehensive Cancer Center. “You just don’t get that in an e-cig.” This is welcome news to long-term smokers looking for a safer alternative, but it’s hard to ignore the feeling that these devices might make it significantly easier for kids to pick up a lifelong addiction. Are e-cigs harbingers of a brave new smoke-free future, or are they just the latest Trojan horse from big tobacco?

If we’re going to try to answer that question, we’d better do it soon, because kids are not waiting for scientific data to be handed down by white-coated experts. Between 2011 and 2014, e-cigarette use among high school students jumped from 1.5% to 13.4%, a shockingly precipitous rise.

The uptick makes sense: E-cigarettes are new to the market and their usage level has yet to stabilize. Plus, e-cigs still enjoy a certain novelty that can’t be denied. But they also provide a frighteningly gentle path to nicotine experimentation. Before e-cigs, a new smoker had to go through a highly unpleasant initiation ritual. (Perhaps you’re familiar with it from your own days as a teen.) This experience typically included some combination of the following: attempting to look cool while holding something that is technically on fire, trying and failing in a valiant attempt to not inhale and start coughing like crazy in front of your friends, intentionally inhaling and turning green from the instant rush of nicotine to your brain, needing to lie down for an hour, and getting yelled at by your parents when you come home smelling like smoke.

Today, however, e-cigs come in a variety of nicotine levels and are unlikely to induce lung-throttling coughs. They have almost no lingering odor and are available in a cheerfully tempting array of flavors, including Candy Appletini, Banana Nut Bread and Unicorn Blood (described by its manufacturer as “fruity, sweet, rainbow goodness”). In fact, the names are so blatantly innocuous-seeming, it’s hard to escape the feeling that vaping is tailored precisely to the immature palate and the inexperienced user. Which just seems sinister. “We’re very concerned with these devices becoming an initiation product for kids to start tobacco use,” says Paul G. Billings, senior VP for advocacy and education at the American Lung Association. “E-cigarette companies certainly have exploited this gap in regulation through aggressive marketing and promotion.”

It bears noting that tobacco isn’t going down without a fight. For generations, cigarette smoking has been a powerful symbol of rebellion and adulthood. And during those yearning years on the way to maturity, kids long for such signifiers. The car. The girlfriend or boyfriend. Experimentation with drugs and alcohol. Today’s kids probably know the dangers of cigarettes better than any other generation—and yet are still drawn to them, though not at the same levels as previous gens. “The romantic element of having a cigarette in your mouth is still definitely there,” says James*, a New York City high school junior who has friends that smoke, but who credits his ex-smoker parents with drilling the dangers into his head. Indeed, what better way to show you don’t care whether you live or die than by doing something that kills about half the people who do it regularly? Your parents may have given you a car. They may think your significant other is charming. But they most certainly do not approve of your smoking habit. After all these years, there is still no faster way to affect a “cool” outsider stance than to light up a butt.

Thankfully, the romantic self-image cigarettes confer does not appear to extend to e-cigarettes. In the course of reporting this piece, I spoke with several teens about nicotine use in their peer groups. My findings are, of course, purely anecdotal. They were also strikingly consistent. Every teen I spoke with (all of whom were in either 10th or 11th grade) said that conventional cigarette smoking in their school, while on the decline overall, was very much alive within the edgy, outsider-y crowd to which it has always appealed. All of them estimated that around 10% of their classmates were regular smokers and that another 5% did it occasionally. Most interestingly, all of them also reported that e-cigarettes were seen as “babyish,” “immature” or “a toy.” Although that conclusion conflicts with 2014 CDC findings stating that e-cigs are more commonly used by high schoolers than conventional cigs, 13% versus 9%, Colorado high school junior Ashley* was pointed. “You look kind of dumb smoking a little plastic tube,” she stated. “No one’s going to say you look cool doing that.”

E-cigarettes simply do not provide the same forbidden thrill as conventional smoking, it seems. Based on the students I spoke with, kids are still ducking out a side or back door to huddle by the the school Dumpster for a puff between classes. But anyone who pulls out a vape pen is likely to be laughed at. Which is not to say that e-cigs don’t have their place on the child rebellion spectrum. It’s just that, dismayingly, that place would appear to be middle school. My teen interviewees said it’s not uncommon to see seventh- and eighth-graders playing around with e-cigarettes. According to Ashley, “They’re like toys, not the real thing.”

Except of course, they are the real thing, at least as far as nicotine delivery goes. Alarmingly, e-cigarettes are now available for sale in most places that carry tobacco, though technically they can’t legally be sold to minors except in a handful of states. E-cigs are way more potent than the conventional kind—each one typically holds as many puffs and as much nicotine as an entire pack of cigarettes, if not more. Vapor goes down a lot smoother than smoke, meaning kids are far less likely to have to endure massive coughing fits when they start vaping. And pretending to puff continues to come naturally to kids. Shields says smoking is still very much ingrained in the way kids experience the world. “A typical fifth-grader will tell you all the bad things about regular cigarettes,” he says. “But if you hand them a candy version, they’ll start pretending to use it.” What if it puffed out big plumes of smoke that tasted like gummy bears?

Making this territory even more difficult to navigate is the lack of definitive info available. Anti-smoking activists have tried their best to play up the negative health effects of e-cigarettes while the pro-vaping camp has done the opposite. The truth is that solid research on these devices is only in the early stages. At the moment, consensus seems to be that propylene glycol and vegetable glycerin, the two main ingredients in e-cig vapor, are safe for most people when used in foods and skin products. However, what happens to the lungs when these compounds are heated and inhaled is not yet known. What has been studied extensively, of course, is nicotine.

Anti-smoking crusaders tend to reflexively distrust anything to do with nicotine, along with anything big tobacco companies say. This distrust is well-earned. The hijinks of cigarette manufacturers during the 50 years since the Surgeon General’s 1964 report on smoking has been nothing short of astonishing, and millions of preventable deaths could be laid at their door. But this is not a matter of trust, it’s a matter of science. In large doses, nicotine is indeed toxic. And very addictive—which is a huge concern, especially when kids are factored into the equation. Ninety percent of adult smokers started their habit by the age of 18. “Smoking is really an adolescent disease that kids bring forward into adulthood,” says Shields. “Addiction happens over time, and the high school to college years are when that really gets cemented.”

Some kids are going to smoke in high school. This is not news. But e-cigarettes are changing the landscape in terms of the path to nicotine addiction. Even if you think your kids are too young to try e-cigarettes, it’s important that you bring it up with them early—by seventh grade at the latest. Be honest and be factual. Tell them that it took humans a long time to figure out that smoking kills. Explain that e-cigarettes are new and thus haven’t been around long enough for us to know their true effects. Explain why e-cigarettes were invented: as a way for addicts to control their habit. Kids experimenting with them was never the plan. Remind them that anyone who is using e-cigs to avoid smoking today probably started smoking in his or her teens and is now willing to try anything in order to be able to quit the unhealthy, expensive habit for good. Bring up the fact that for decades, big tobacco systematically targeted children as new smoking recruits and just how truly evil that is, given that about half of those children died before they had to. Make sure they know that the same stuff that’s in old-school cigarettes is in e-cigarettes and that addiction is a very real possibility.

Open up the dialogue without judgment about their behavior or that of their friends. If you uncover that they’ve experimented with e-cigs or even real cigarettes, avoid getting upset or issuing knee-jerk punishments. You will become the enemy, and once that happens you will lose your information privileges. It’s worth remembering that e-cigarettes don’t come with the obvious telltale signs of smoking. If your children wanted to hide e-cig use from you, it would be distressingly easy to do so.

Remember also that the social side to the smoking/vaping equation is incredibly important. They may have questions about how to handle hanging-out situations where other kids are smoking or vaping. There’s a good chance you won’t need to struggle to convince them that conventional cigarettes are bad for you, but it’s important to maintain your credibility with them by not overblowing the dangers of e-cigs. Nicotine has been thoroughly researched and is most assuredly addictive.

Let them know that you’re in their corner and they can always come to you for advice without fear of reprisal. Talk honestly about your own experiences as a teen encountering smoking for the first time. Emphasize the fact that they are the only ones responsible for their decisions now, and that you just want to make sure they have the knowledge they need to make the right ones. Remind them that in a few short years they will be out on their own in college, operating almost entirely unsupervised. Reinforce the fact that adulthood is way too much fun to compromise it with addiction and unnecessary disease. Life is full of enough health challenges without taking on voluntary ones. Most importantly, avoid getting into an adversarial stance around smoking and vaping if at all possible. Because teens might not be experts in decision making, but they are the undisputed champions of tuning out unsympathetic voices.

If you can keep them off nicotine until they’re 18, your kids’ chances of becoming adult smokers diminish overwhelmingly. If they make it past the age of 25, the data say it’s likely they will not start smoking. Remember what we learned from Shields at Ohio State: “Smoking is a disease of adolescence.” We parents provide the best shot at a cure.

*Names have been changed

How to Win the E-Cig Argument with Your Kid

Electronic cigarettes may seem relatively harmless—like toys, even. Reality: They’re highly effective drug delivery mechanisms that can set your tween or teen up for a lifetime of nicotine addiction and disease. Luckily, your kids are smart. Give them the facts and they’ll do the right thing. Here are your key lines of attack and what to say.

Appeal to Science: These devices haven’t been thoroughly studied, which means we don’t fully understand their effect on humans. Don’t put anything into your body if you don’t know what it does.

Appeal to Health: Even without smoke, nicotine is a powerful stimulant that raises blood pressure, elevates heart rate and causes arteries to narrow. Does that sound like something that‘s good for you?

Appeal to Vanity: “Smoker’s face” is a well-documented phenomenon that occurs over many years, causing wrinkles and crow’s-feet around the eyes. Research has shown that smoking may increase production of an enzyme that breaks down collagen, causing skin to sag. You know where you’ll find some of the stuff that’s in cigarettes? E-cigarettes. Think about it. (The Internet can give you lots of good visual ammunition for this particular chat.)

Appeal to Freedom: As long as you’re addicted to something—anything—you’re not free. Being an addict limits your life in a completely avoidable way. Want to know why people kill themselves with cigarettes? Because they can’t handle withdrawal. Don’t paint yourself into that corner.

Appeal to Sticking It to the Man: Big tobacco is one of the most maligned industries in the world, with a history of win-at-any-cost tactics. But now people are wising up and stopping smoking. So tobacco companies spent a whole lot of money buying up e-cigarette companies to stay alive. Guess what happens if no one buys their product? They don’t make money.