It takes a village: community interventions to address teen e-cigarette use

“While the surge of teen vaping levels off, it still remained high as of early 2020,” said Maria Rahmandar, MD, FAAP, medical director of the Substance Use & Prevention program at Lurie Children’s Hospital in Chicago, Illinois, during her presentation at the virtual 2021 American Academy of Pediatrics National Conference & Exhibition. “We also still don’t know what has happened in the past year, and should find that out in a couple of months. What we do know is that teen mental health has suffered during the pandemic, and so we can only imagine what’s going on with youth e-cigarette use.” Rahmandar also noted that as children are now back to school, e-cigarette use will again become a huge problem in high schools, with students using on school grounds, in bathrooms, and even classrooms.

Rahmandar next discussed the types of e-cigarettes available, which include cig-a-likes, vape pens, mods, advanced personal vaporizers, e-cigars and pipes, and pod systems. As some of these e-cigarette users inhale into their lungs, bystanders can also inhale the aerosol when the person who is using the e-cigarette exhales. E-cigarettes contain varying amounts of nicotine as well as propylene glycol, vegetable glycerin, flavoring, and other compounds. Additionally, they can contain carcinogens, heavy metals, and ultrafine particles.

“The risks of e-cigarettes, as we know, can initiate use of combustible tobacco products, result in nicotine addiction, poisoning and burns,” said Rahmandar. “There are also both emerging and unknown long-term health risks.”

In helping teenagers to stop e-cigarette use, Rahmandar urged practitioners to ask these patients about tobacco use at every visit and make asking routine, consistent, and systematic, with questions such as “Do you use any tobacco products, like cigarettes, hookah, or chrewing tobacco? Have you used them in the past year?” Additionally, Tahmandar suggests, consider screening for other mental health concerns using the PHQ-A screening for depression or the GAD-7 screening for anxiety. Using other tools, such as the Hooked on Nicotine Checklist may show the teen that they are, in fact, addicted to nicotine. If you find your teenager is ready to quit, help them set a time, within 2 weeks, and avoid stressful periods like final exams. “Also,” says Tahmandar, “there are cessation support services like Smokefree Teen, and This is Quitting, as well as 1-800-QUIT-NOW, to help teens stop their e-cigarette habit.”

For patients not quite ready to quit, you can discuss the relevance and risks of not quitting; roadblocks that may arise; and repetition: that it may take several attempts to succeed in quitting. Having e-cigarette resources handy in your office such as brochures, posters, and videos can also be helpful.