Electronic Cigarettes and Teen Health

New Drug, New Risks

Emerging Health Risks

The 2015 Monitoring the Future survey results tell us that among United States students, approximately 10% of 8th graders and 15% of 9th through 12th graders use e-cigarettes monthly⁶.

If such rapid growth in use in the U.S. is any indicator of teen use throughout the rest of the world, we all must be concerned, as e-cigarettes pose cancer, addiction, and intoxication risks.

Unknown Quantities of Addictive Nicotine

Students are generally unclear about the contents of their e-cigarettes. Among 12th-grade students who used e-cigarettes in 2015, 65% reported their e-cigs contained only flavoring, while 22% believed they contained nicotine, 6% thought they were vaping marijuana or hash oil, and a final 6% had no idea what they were vaping⁶.

Unfortunately, this confusion among students is understandable. E-cigs marketed as "nicotine free" often do contain nicotine. Even if not marketed as nicotine free, many brands do not specify how much nicotine or other chemicals their e-cigarettes contain. E-cigarette companies have not been obligated by any governing body to regulate or monitor the amount of each substance that goes into their products.

To highlight the inconsistency of nicotine concentration in e-cigarettes, researchers in the United Kingdom tested 16 different e-cigarettes⁷. They found wide variations in nicotine levels per puff. Their findings suggested that nicotine concentration not only varies by brand, but also between inhalations of the same product!

More startling, nicotine levels per puff ranged from 0.5mg to 15.4mg in the study. The typical nicotine concentration in a puff of a tobacco cigarette is 1.54mg to 2.60mg. This means that e-cigarettes may deliver nearly six times the amount of nicotine a tobacco cigarette would.

Nicotine is widely known to be an extremely addictive chemical. Biological studies show that teens are much more susceptible to the development of nicotine addiction than are adults. Adolescents may develop nicotine dependency within just a day of use⁸.

Alcohol in E-cigarettes

The FCD Student Attitudes and Behavior Survey has found that in some communities, students are exposed to e-cigarettes sooner than they are to alcohol⁹. Even more disturbing, new research suggests that students may be exposed to alcohol for the first time through their early use of e-cigarettes.

Many e-vaporizer liquid solutions contain alcohol to extract their flavors from base ingredients. Yale School of Medicine found that some commercially available electronic cigarette liquids contain enough alcohol concentrations to significantly impair users' motor skills¹⁰. When study participants were asked to perform a motor task, those under the influence of higher alcohol concentration e-cigarettes performed more poorly than those not under this influence.

Exposure to alcohol through e-cigarettes puts students at a long-term risk for addiction and a short-term risk for intoxication and impairment. Students who do not know that e-cigarettes can contain alcohol may unwittingly put themselves at risk not only for an addiction to nicotine, but also for an addiction to alcohol through vaping. Students using e-cigs may also drive under the influence of alcohol unknowingly or otherwise put themselves at risk for accidents and physical harm as a result of motor impairment.

Out of the dozens of e-liquids tested in the Yale study, one-third did not contain measurable alcohol, while 40% of e-liquids registered at 0.75% or less alcohol content, and another 23% contained 1-3% alcohol levels. Some e-liquid brands have been measured to contain over 23% alcohol content. As prior research has demonstrated, the concentration of such chemicals in e-cigarettes has not historically been regulated by manufacturers nor made known to consumers.

Cancer

If we have heard any messaging about e-cigarettes, it likely includes the notion that e-cigarettes don't cause cancer. However, studies attempting to classify the contents of e-cigarettes have revealed a number of troubling substances known to be carcinogenic within the products.

For instance, a New England Journal of Medicine study reported that some e-cigarettes release formaldehyde when heated by high voltage batteries⁷. A Cleveland Clinic study found that the liquid in many e-cigs contain propylene glycol⁷. While considered safe to eat in food in small quantities, propylene glycol as a carcinogen has not yet been longitudinally studied in a context where it is deeply and repeatedly inhaled by children and teens.

E-pens, too, marketed as "nicotine-free" e-solutions have been found by a San Diego Veterans Affairs lab investigation to damage cells in ways that could lead to cancer⁷. The researchers exposed cells in petri dishes to an extract of e-cigarette vapor and found that the cells showed breaks in DNA strands and a greater tendency towards cell death.

Other Health Risks

Respiratory damage, burns, and poisonings are among the additional risks of e-cigarette use.

A flavoring chemical in some e-cigarettes called diacetyl is associated with a disease called bronchiolitis obliterans or "popcorn lung," so named because the illness was found among plant workers exposed to airborne diacetyl from the artificial butter flavoring of microwave popcorn production¹¹. Popcorn lung is a condition similar to chronic obstructive pulmonary disease (COPD), marked by cough, shortness of breath, and irreversible scarring of the lungs. A study of 51 e-cigarette varieties found higher than normal diacetyl levels in 39 of its tested flavors.¹¹

An outcome of inconsistent manufacturing quality among e-cigs is the risk of burn injuries related to their use. In January 2016, The Canadian Press reported on a 16-year old student who sustained significant facial and dental injury as a result of an e-cigarette explosion during use¹². The teen has had multiple surgeries for first- and second-degree burns and two root canals resultant from the incident.

In addition to burns and other external injury, e-cigarette toxicity is a concern too. The number of calls to U.S. Poison Control Centers involving e-cigarette liquids containing nicotine rose from one per month in September 2010 to 215 per month in February 2014, according to the CDC¹³.

The Impact on Students

In some school communities, a young person's first exposure to a drug, including alcohol, will be an electronic cigarette. This means that lower and middle school communities must work to educate their students about the risks of electronic cigarettes before first use or exposure occurs, and that middle and upper school communities must have initiatives in place to prevent use as students grow.