Vaping in youth: What you need to know

“I know lots of kids my age who are vaping.”

“Vaping is the thing to do these days.”

That’s the common refrain I hear when asking my adolescent and young adult patients about vaping or electronic cigarettes. Unfortunately, they are correct: the use of vapour products and e-cigarettes has been on the rise among that age group in recent years.

But what exactly are “vape” products, how common have they become and how bad are they really?

What exactly are vapour products or e-cigarettes?

Vapour products, also known as e-cigarettes or vapes, are battery-powered devices that heat liquid (known as e-liquid or e-juice) to a high enough temperature that it converts to an aerosol vapour. The aerosol is inhaled through the mouth and lungs where it is then absorbed into the bloodstream.

E-liquid is made up of a carrier solvent (usually propylene glycol and/or glycerol) and flavourings (that consist of chemicals) and may also contain varying amounts of nicotine. The variety of flavour options is something that youth find appealing and is noted as one of the reasons why they start vaping. Some e-liquids are odourless, and vapour devices can mimic the look of common objects, such as USB flash drives, pens and flashlights, making it difficult for parents to know whether their children are vaping.

How common is vaping?

A 2017 Canadian Tobacco, Alcohol and Drugs Survey shows that 23 percent of adolescents (15 to 19 years) and 29 percent of young adults (20 to 24 years) have tried an e-cigarette, compared to only 15 percent among those 25 years and older.

While 43 percent of adolescents who vape are not smokers, recent research shows that vaping increases the likelihood of smoking cigarettes. A study from the University of Waterloo and the Wake Forest School of Medicine found that students in grades 7 to 12 who had tried an e-cigarette were more than twice as likely to be susceptible to cigarette smoking.

Some of the reasons young people start vaping include the novelty, flavours, branding and belief that vaping poses less risk than cigarettes. Almost one in four students in grade 7 to 12 think there is “no risk” of harm using an e-cigarette occasionally.

Are vapour products and e-cigarettes harmful?

It is true that vaping is less harmful than smoking, but that does not mean that it is harmless. There are many unknowns about vaping, including what chemicals make up the vapour and how they affect physical health over the long term.

For example, propylene glycol is considered “generally” safe when used in small amounts in cosmetics or food additives. However, there’s a lack of information about whether it is safe to be inhaled. Environment Canada Domestic Substance List classifies it as “expected to be toxic or harmful” in terms of organ system toxicity.

Research has also found that when e-liquid is heated to produce the aerosol vapours, new chemicals such as formaldehyde can be created by the high temperatures and those are then inhaled. Flavourings are not harmless either. For example, diacetyl is linked to a serious lung disease known as “popcorn lung.” The aerosols created by e-cigarettes can contain other harmful compounds such as benzene (found in car exhaust) and heavy metals including nickel, tin and lead.

One of the most concerning aspects with vapour products is the nicotine – a highly addictive chemical. Adolescents and young adults are especially susceptible to its negative effects, as the brain continues to develop until about age 25. Nicotine can affect brain development, especially memory and concentration, and can even increase impulsive behaviour. It can also lead to addiction and physical dependence.

Not all vaping products contain nicotine, but the level of nicotine can vary widely for those that do. Some mixtures have very low levels of nicotine, while others can contain more than that found in a typical cigarette.

People who use vapour products may be reassured by “nicotine-free” labels on the liquids. However, tests performed by Health Canada found that about half of e-juices that were labelled nicotine-free actually contained traces of nicotine. An Ontario study assessing vaping products at retail outlets determined that of those labelled “with nicotine,” 27 percent of products had concentrations above what was labelled.

Another area of concern is that newer generations of vapour devices can be altered for use with cannabis or its components (THC, hash oil) or other substances.

Lung injury cases

As of October 1, 2019, there have been 1,080 lung injury cases associated with vaping reported to the Centre for Disease Control in the US, and 18 deaths have been confirmed. In those cases, all patients reported a history of using e-cigarette or vaping products and most reported a history of using THC-containing products. These injuries are believed to be related to toxic substances (chemical irritants) entering the lungs. Anyone who has used an e-cigarette or vaping products and experiences symptoms such as shortness of breath, cough, chest pain with or without vomiting, diarrhea, abdominal pain or fever is advised to consult a healthcare professional.

So, what can we do about this?

Parents, teachers, healthcare providers and others who influence adolescents and young adults need to be informed about this topic and openly discuss it with them. The Health Canada website has good information on the subject. Your physicians, nurse practitioners and nurses at Copeman Healthcare can also provide further support and resources.

Copeman Healthcare’s Young Adults Prevention Program offers a personalized assessment and ongoing care designed specifically for young adults aged 18 to 24 to put them on the path to lasting wellness.