The vaping culture of using non–cigarette tobacco and electronic nicotine delivery systems (ENDS) is the latest risky trend among adolescents and young adults. Vaping is the use of high-tech, advanced electronic devices such as electronic cigarettes (e-cigarettes), refillable atomizers, and other tobacco products as an alternative or in addition to regular cigarettes.1 A concerning 10-fold to 11-fold rapid rise noted in middle and high school students poses dangers of nicotine exposure to the pediatric population.2
This article will explore the risk-taking behavior of adolescents engaging in vaping; the effects of vaping and the indiscriminate use of nicotine products on the young; and strategies that healthcare providers can use to collaborate with patients and families to reduce their risk of harm from this emerging public health epidemic.
The first e-cigarette was conceptualized and patented in 1965 by Herbert Gilbert as a safe and harmless modality to smoking cigarettes.3,4 In 2003, an electronic atomizer version was patented by Ruyan Technology in China, marketed to the United States in 2007, and touted as a healthier alternative to smoking conventional cigarettes.3 Since the emergence of Ruyan’s first-generation e-cigarette, novel models have emerged in design, engineering, and nicotine delivery methods resulting in second-, third-, and fourth-generation ENDS delivery devices.4
Modern generation devices have included mid-sized e-cigarettes known as personal vaporizers (PVs), which are similar to a pen or laser pointer.4 The advanced personal vaporizers (APVs) contain a mechanical firing device called a “mod” (short for “modification”) that may be used in conjunction with different atomizers (tank systems), and they vary in size, shape, and delivery methods. The most innovative and advanced devices, however, are regulated “vape mods,” which contain an internal circuitry. Lingo used among the diversity of delivery devices includes vapes, vape pens, e-cigs, e-hookahs, mods, and tank systems.3,4
Regardless of the novel delivery devices, use of nicotine-containing products in any form presents dangers and is unsafe.4
Escalation of misuse
Vaping is a significant public health concern and has escalated at alarming rates among adolescents and young adults. During 2011-2012, data from the National Youth Tobacco Survey revealed a modest increase in e-cigarette use (used 1 or more times within the past 30 days) among students in grades 6 to 12, from 1.1% to 2.1%.4 From 2011 to 2014, the use of e-cigarettes grew rapidly to 13.4% of high school students and 3.9% of middle school students. By 2014, e-cigarettes had become the most frequently used tobacco product among young persons, exceeding conventional cigarette use. In 2015, over 3 million middle school and high school students reported e-cigarette use, equating to 1 in every 6 school students, and over 25% reported trying e-cigarettes.
In young adults aged 18 to 24 years, e-cigarette use (used 1 or more times within the past 30 days) more than doubled from 2013 to 2014 to 13.6%, and as of 2014, more than one-third had tried e-cigarettes.4 E-cigarette use data among teenagers and young adults represent the various product types of ENDS.3,4
What the vaping culture entails
Vaping refers to the vaporization of substances (nicotine, flavorings, cannabis, or other substances in popularity) wherein oil, liquid, or plant material is heated to a temperature resulting in the release of aerosolized water vapor and active ingredients (nicotine, cannabis) delivered via inhaled aerosol.3-5 Tremendous controversy has arisen surrounding potential harm reduction or risks associated with e-cigarettes/vaping in young persons.3
Nicotine, a highly addictive substance in any form, is commonly vaped.3,4 Health effects of nicotine include hemodynamic effects secondary to catecholamines (eg, increase in heart rate and blood pressure; vasoconstriction of arteries and vessels; endothelial dysfunction; atherosclerosis acceleration).3 During adolescence while the brain is developing, nicotine can result in addiction and harmful consequences such as behavioral and cognitive impairments, memory issues, inattention, and executive function impairments.4,6
Harmful effects have been found from e-cigarette aerosol and additives.4 Brief exposure to propylene glycol aerosol has been reported to be a respiratory and eye irritant in patients without asthma.6 Contemporary generations of high-powered e-cigarettes comprising tank systems have the capacity to heat nicotine liquids to high temperatures that produce cancer-causing carcinogens such as formaldehyde and acetaldehyde in the vapor.4,6 Metals detected in some e-cigarette aerosol, including lead, silver, tin, nickel, iron, copper, and cadmium, may be products of the heating element (coil).4