Pediatric Associates of the NW Blogs

Vaping: What You Should Know and How to Talk to Your Kids About It

Peter Reed, MD, MPH, FAAP
October 01, 2019 05:00PM

Why vaping has been in the news

About a month ago the Centers for Disease Control and Prevention (CDC) started to report cases of serious lung injury in adolescents and young adults that seemed to have one thing in common: vaping. There are more than 800 confirmed cases and 12 deaths nationwide, including two deaths in Oregon. The Oregon Health Authority has issued a public health warning: “People should stop vaping immediately.”

As parents - especially parents of adolescents - this news is frightening. For years, tobacco use among young people had been declining. Smoke-free policies like Oregon’s Indoor Clean Air Act mean we rarely see people smoke indoors. Tobacco taxes have made cigarettes more expensive and less affordable for youth. And Oregon was one of the first states to raise the legal age to buy tobacco to 21. In 1996, more than one in every four Oregon high schoolers smoked cigarettes. In 2017, that was down to just 8% ( The battle against tobacco is one of the great public health wins, a model for other initiatives.

Big Tobacco has taken notice of this trend and has found a new nicotine trap for the digitally-wired Generation Z: e-cigarettes. In the last five years, e-cigarettes have evolved rapidly from so-called “cigalikes,” which essentially look like plastic cigarettes, to USB-shaped devices. And people have started modifying their e-cigarettes to carry different substances, like THC, the active ingredient in marijuana, and to operate at a higher voltage to create thick clouds of aerosol.

It is these tanks, “mods,” and USB-shaped devices that have driven a rapid rise in e-cigarette use among kids. One brand in particular, called Juul, captured more than 60% of the e-cigarette market in a single year due to its sleek appeal as a tech device, flavors like mango and cucumber, and a massive ad campaign targeting young people. Part of Juul’s appeal to adolescents is that it is concealable - a parent may think the device is a new USB drive, when in fact it is an extremely efficient way to deliver a powerful punch of nicotine.

E-cigarettes and other vapes, as they’re sometimes called, are full of nicotine and highly addictive. Most kids may not think their Juul has any health risks, let alone that it contains a chemical more addictive than heroin. But nicotine is poison for the developing brain, which is more susceptible to its addictive qualities. Nicotine can increase anxiety, especially during periods of nicotine withdrawal, and rewire the brain to make it more susceptible to other addictions as well. Adolescents are already faced with mood swings, impulsivity, and learning difficulties; nicotine makes these challenges worse as it changes the brain’s ability for attention, learning, and memory. Even more alarming is that the changes from nicotine can be permanent, and that kids who use e-cigarettes are far more likely to start using regular cigarettes as well.

For the first time in years, the rate of tobacco product use among kids has started to inch back up, due to the increasing popularity of e-cigarettes. In Oregon, e-cigarette use went up nearly 80% from 2017 to 2019. They are the most popular tobacco product among kids, and they are largely unregulated. The fact is that no one knows the long-term health effects of e-cigarette use, but more and more, we are learning that they are not good.


What you should know as a parent

As a parent, there are some specific things you can look for.

If you do not think your kids use e-cigarettes, but you are not sure, look for:

  • Sweet or fruity smells. There are more than 15,000 flavors of e-cigarette - and counting - and these sweet flavors are the reason many kids pick them up to begin with.
  • Unfamiliar school supplies or tech products that you do not recognize. The most popular brands of e-cigarettes can look like flash drives or brightly colored eye droppers.
  • Chargers, coils, or batteries that are not familiar.
  • Physical symptoms like more frequent headaches and nausea. These can be signs of nicotine withdrawal.
  • Changes in your kid’s behavior, like irritability, mood swings, anxiety, or changes in performance at school. These can be routine parts of adolescence, but they can also be signs of nicotine addiction.

If you know your kids use e-cigarettes, look for the signs of lung injury:

  • Cough, shortness of breath, or chest pain
  • Nausea, vomiting, or diarrhea
  • Fatigue, fever, or abdominal pain
  • These symptoms may appear suddenly over a few days, or they can increase gradually over a few weeks.

If you have any concerns about these symptoms, please call us or make an appointment right away.


How to talk with your child about vaping

Talking with kids about addiction is one of the hardest things we do as health care providers. For the vast majority of kids who use e-cigarettes, they likely do not recognize that these products are harmful. E-cigarette companies make use of the marketing and regulatory loopholes that have limited cigarette advertising for years. They can be advertised on TV, on billboards, on social media, on the radio, and using cartoon characters and candy-like packaging. The biggest e-cigarette companies - including Juul - are owned in part by the tobacco industry, which has deployed all the same marketing tactics that it used in years past for cigarettes and chew.

All this marketing means that most people mistakenly think that e-cigarettes are harmless, or that their purpose is to help people quit smoking, even as more and more evidence - including the most recent outbreak of lung injuries - shows that e-cigarettes have very clear health harms.

So here are some tips for how to talk to your kids about vaping and e-cigarettes.

Ask Questions - and LISTEN to the Answers

You can start with the simple questions: Do you have friends who vape? Are you curious about it? Where do you see people vaping at school? Have you tried it? What made you say yes? What made you say no?

There are a lot of kids who use e-cigarettes in schools, and it is important to understand the culture - the peer pressure, the expectations to fit in, their beliefs about the health harms - instead of starting in on a lecture.

Try being silent as you listen to their answers. They may seem wrong-headed to you, but your child is sharing their experience, and their experience is what matters when they need help.

Have Many Conversations - Not Just the “Big One”

One talk will not be enough to protect your child throughout their adolescence and young adulthood - wouldn’t that be amazing! When you keep talking to your child about the temptation to vape and the new challenges they will face as they get older, your goal is to be a resource over the years.

Talk About the Science

There are a lot of reasons not to use nicotine beyond addiction. It is hard for kids to process long-term consequences; for example, they likely will not care about exposure to heavy metals that could cause cancer down the road. But they may care about the impact on their memory and learning, or that it will make their anxiety worse as they work through their teen years.

Blame Flavors and the Tobacco Industry

Youth likely will not connect Big Tobacco with the young, hip, tech-savvy vape industry. That is no accident. Even though these industries are siblings - with the same tobacco industry parents and nicotine-containing genes - their parent companies maintain separate looks and marketing strategies so that youth think their brand is different from the nasty-smelling cigarettes that killed their grandparents, or that their parents use.

Adolescents hate feeling like pawns, but the truth is that the tobacco industry is marketing to them through fun flavors and kid-friendly packaging. Take, for example, the flavor “Unicorn Vomit,” which is marketed with this message: “Imagine you’re 9 and your mom let you get whatever you wanted at the store and you chose the most sugar-filled, sour powder you could find.”

Get Help

You can always call in a professional - we are here to help you succeed. Sometimes, kids will listen to us when it is hard for them to hear from their parents. You can also encourage your kids to check out, a text-based app from the Truth Campaign designed for kids hooked on e-cigarettes.


What We Can Do - As Individuals, As a Community

  • Support increasing the price of tobacco products, including e-cigarettes: When tobacco is more expensive, kids are less likely to use it. Oregon does not tax e-cigarettes, which means these flavored products are less expensive and more accessible to kids on limited budgets. In November 2020, Oregon will have a ballot initiative to raise the cigarette tax and put a tax on e-cigarettes for the first time. Nearly all the additional revenue will go to health programs like Medicaid and programs that prevent kids from starting to use e-cigarettes to begin with.
  • Support a tobacco retail license in your county: Did you know that Oregon is one of only nine states in the country that does not have a statewide tobacco retail license? We require a license for your pet dog and to sell a Christmas tree, but not to sell the state’s leading cause of death. What this means is that there are limited consequences for people who sell e-cigarettes and other tobacco products to kids. In Oregon, one in five tobacco retailers sold e-cigarettes illegally to people under 21 in 2019, and one in four tobacco retailers illegally sold little flavored cigars, which are also popular among youth. Other than a small fine, there is no lasting consequence for repeat offenders of the law. Multnomah County was one of the first counties in Oregon to adopt a tobacco retail license, and a movement is afoot in Clackamas County to do the same. You can call your county commissioner to let them know you are concerned about e-cigarette use among kids - and that you expect them to take this simple step to do something about it.
  • Advocate for banning all flavored tobacco products, including e-cigarettes: Unicorn vomit is bad. Also bad is little cigars in flavors like “Boozy Mango” and “Red Berry.” A recent report from the Oregon Health Authority found that nine out of ten tobacco retailers in Oregon sell flavored e-cigarettes or little cigars. New York and Michigan are two states that have temporarily banned flavored e-cigarettes, and Oregon could do better. Flavored products are intended for one audience only - our kids. You can let your county commissioner or representatives in state government know that you would like all these products removed from the market.

There are so many ways we can advocate for our kids. This is one where we can make an immediate difference. The current outbreak has brought home the fact that the tobacco crisis is not solved - it has transformed. We have the power - as individuals, as parents, and as concerned citizens - to make a difference.


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