Students and Vaping

E-cigarettes, or e-cigs, have been the most widely used tobacco product among teens since 2014. The federal government estimated that more than 3.6 million middle and high school students used e-cigs in 2018.

The number of teens vaping grew 900 percent from 2011 to 2015. Surgeon General Jerome Adams has called it an “epidemic of youth e-cigarette use.”

Health researchers have found that teens are exposed to a lot of information about the risks of traditional tobacco products. But researchers worry that public health experts may not be giving teens enough information about e-cigarettes, their risks and what’s in the e-liquids.

Teens may not know that the most popular brand of e-cigarette, JUUL, is in fact an e-cigarette.

JUUL is the top-selling e-cigarette brand in the United States. More than three in every four e-cigs sold in the United States is made by JUUL Labs Inc.

Each device resembles a USB flash drive and uses a pod of e-liquid or “juice” that contains nicotine, flavorings and other chemicals.

Public health experts have discovered that many teens consider the brand to be an entirely different device from an e-cigarette. Some teens also used the term “JUULing” instead of “vaping,” again considering the two as completely different activities.

But JUULs are e-cigarettes, and JUULing is the same as vaping.

Health officials survey teens every year about nicotine use. The National Youth Tobacco Survey in 2019 was the first to list JUUL devices specifically as e-cigarettes. A researcher with the U.S. Centers for Disease Control and Prevention told The Los Angeles Times that he believed the simple change in language could reveal even more teen e-cigarette use.

Vaping poses particular risks for teens and young adults. At the same time, e-cig advertising reaches a substantial number of teens, and the e-liquids that put the vapor in vaping come in teen-friendly flavors.

The surgeon general’s 2019 advisory on youth vaping declared that “any e-cigarette use among young people is unsafe.” That’s partly because teens and young adults are susceptible to greater risks from vaping than older adults are.

E-cigarette vapor usually contains fewer dangerous chemicals than tobacco smoke, but it is not harmless. Vaping still puts a lot of harmful substances into your lungs. And many of them can cause serious and permanent medical problems.

Most teens don’t realize there’s nicotine in virtually all e-cigarettes. Almost all e-juices contain the highly addictive chemical. A 2019 study in the journal Pediatrics found vaping teens inhale as much nicotine as smokers, but don’t realize it.

The researchers found that 40 percent of teens who thought they were vaping nicotine-free products were actually inhaling nicotine. The researchers also found that teens who used e-cigarettes more frequently showed more nicotine in their systems.

A 2018 study in the journal Tobacco Control found that 63 percent of young people who used JUUL e-cigarettes didn’t know that all JUUL products contain nicotine.

“All JUUL e-cigarettes have a high level of nicotine,” the CDC reports. “According to the manufacturer, a single JUUL pod contains as much nicotine as a pack of 20 regular cigarettes.”

In 2019, researchers at Stanford University wrote in Tobacco Control that JUUL’s introduction touched off a “nicotine arms race” among e-cigarette makers to cram the most nicotine they can into their products.

Before JUUL came out, most vaping liquids were only 1 percent to 3 percent nicotine. That may not sound like much, but those 3 percent e-juices were marketed to heavy tobacco users who smoked two packs a day.

When JUUL hit the market in 2015, it came with a 5 percent dose of the chemical. By 2019, other e-cig and e-liquid makers competing with JUUL had ramped up their nicotine content to as high as 7 percent, according to CNN.

The Stanford researchers said nicotine levels that high make e-cig pods “potentially addictive” to teens.

JUUL products use nicotine salts. These allow the user to inhale more nicotine more easily and with less irritation than they could with free-base nicotine that’s traditionally used in tobacco products, including e-cigarettes. The surgeon general warns that this can make it easier for a user to become nicotine dependent.

Nicotine addiction can strip teens of their willpower to quit vaping. NBC News reported about a 15-year-old who required rehab to break his JUUL habit. Luka Kinard of North Carolina was spending $150 a week on vape pods before he sought help. He suffered a seizure and spent 40 days in rehab before kicking his vape habit.

Several parents have also started filing e-cigarette lawsuits against manufacturers after their teens developed nicotine addiction. Lawyers are accepting cases on behalf of people who used Juul e-cigarettes while they were under 18 and became addicted or had health problems such as lung problems or seizures. In addition, people injured by Juul vaporizers that exploded or caught fire may also file lawsuits.

In September 2022, Juul agreed to pay nearly $440 million to 33 states to settle allegations from an investigation that found its marketing tactics targeted teens. In December 2022, Juul agreed to settle about 5,000 lawsuits for an undisclosed amount. The settlement included about 10,000 plaintiffs. A few days after the announcement, Bloomberg’s sources said the settlement amount was $1.2 billion.

In March 2023, the city of Chicago reached a $23.8 million settlement with Juul over allegations that the e-cigarette maker used deceptive marketing and sold its products to minors.

Nicotine is especially dangerous to young people because it can harm still-developing brains. The brain isn’t fully developed until a person is about 25 years old. When you inhale nicotine, it goes straight to the brain in as little as 10 seconds. It activates parts of the brain that make you feel happy and satisfied.

But if your brain is still developing, nicotine can damage the parts of it that regulate your ability to learn new things, pay attention and control your impulses.

Nicotine does this by rewiring your brain. Normally, every time you learn some new skill or create a new memory, you build stronger connections between brain cells. These are called synapses. Nicotine changes the way your brain creates synapses.

This rewiring can have serious long-term consequences. Using nicotine while your brain is still developing can increase your risk of developing a psychiatric condition when you are older. It may also damage your ability to remember things, concentrate or make your own decisions later in life.

Some evidence suggests that e-cigarettes may be less harmful than smoking tobacco. Regular cigarettes release 7,000 chemicals as they burn, including 70 that cause cancer, according the American Cancer Society.

They may be safer for adults who already smoke, but e-cigarettes are not safe for teens, young adults, pregnant women and people who don’t already use tobacco products, according to the CDC.

Risks from both vaping and smoking can be closely related for teens and young adults.

There’s not a lot of research on the long-term consequences of vaping because e-cigarettes have only been around since 2007. But there’s evidence that even short-term vaping can cause issues with lung function. And teens who use e-cigarettes are more likely to take up smoking, which can lead to long-term health problems.

A 2015 study in the Journal of the American Medical Association found that teens who used e-cigarettes were more than three times more likely than non-users to start smoking tobacco within six months.

In 2018, researchers at Yale University discovered the transition to tobacco may happen even more quickly. They found a direct link between students who say they used an e-cigarette in the previous month and those who went on to smoke tobacco cigarettes.

Partly because nicotine can rewire developing brains to make them more susceptible to addiction, putting off vaping may prevent you from becoming addicted to nicotine and cigarettes. The CDC suggests that most people who don’t start smoking before their mid-20s never will.

Nearly seven in 10 middle and high school students regularly see ads for e-cigarettes, according to the CDC. The agency believes that heavy exposure to ads in stores, on the internet, in magazines, on TV and in movies may be driving the increase in teen vaping.

JUUL Labs publicly supports raising the legal age for purchasing its products to 21 years old. But it has made use of marketing strategies that appear targeted at teens.

A research team at Stanford University examined thousands of JUUL’s ads in emails, Instagram posts and conventional advertisements. They concluded the company’s marketing campaigns in JUUL’s first six months were “patently youth-oriented.”

The company aggressively used social media to market its e-cigs and pods until the FDA pressured JUUL to shut down its Facebook and Instagram accounts in November 2018.

The researchers also found the company handed out free JUUL e-cigs to youthful influencers at sampling parties and movie or music events during its 2015 product launch. The company followed up with aggressive advertising featuring 20-something models to appeal to younger customers.

The company toned down its ads targeting youth about six months after JUUL launched, but it still didn’t feature older adults in its marketing. JUUL’s advertising rebooted again in 2018 as government regulators and public health officials raised alarms about its marketing. It shifted from youth-related themes to more ads about helping older adults stop smoking.

About one in every five high school students and one in 20 middle school students vaped in 2018, according to the U.S. Surgeon General’s advisory.

You can spot signs that your teen is vaping if you know what to look for. Chemicals in e-liquids can affect a teen’s behavior, cause dehydration and reduce some senses, such as taste and smell. These may be clues of e-cig use.

Parents need to understand why their teen may be drawn to vaping. Teens may take up vaping for a variety of reasons. Curiosity, kid-friendly flavors and boredom top the list, according to the Partnership for Drug Free Kids.

Talking to your teen may be the most important thing you can do to prevent or stop a vaping habit. Addiction experts and medical professionals stress the importance of honest and open discussions. It’s vital to plan ahead for that conversation.

The U.S. Surgeon General and the CDC offer a tip sheet with more ideas about how to plan and have a conversation about vaping. It also provides questions to expect from your teen and ideas for how to best answer them.