The Vape Debate

I have noticed an uptick in adolescents using vape devices.   This is reflected in the 2017 Monitoring the Future survey (a survey that encompasses tens of thousands of teenagers regarding trends in drug use) that showed about 24% of 10th graders and 28% of 12th graders have used a vaping device in the last year.   The numbers have steadily been increasing in the last few years. One in ten reported vaping nicotine and one in twenty reported using THC.

The vaping industry advertises based on the convenience of vaping and the health of vaping compared to smoking cigarettes. High schoolers have reported using vape pens in class because they are so “clean” and discreet.

While it may be true that vaping poses less risks to one’s health than smoking tobacco, the teenage use (let alone overall use) is concerning.

The concept of electrical cigarettes was developed in the 1960’s, but the wide spread use in the United States goes back about 10 years. That is not nearly enough time to learn if there are any long-term negative effects to one’s health due to vaping.

It was not that long ago, by the way, that doctors were discussing the health benefits of using tobacco. The industry had doctors advertise their “healthy” cigarettes into the 1950’s, when it became clear that tobacco causes severe harm.

What we do know is that nicotine in any form poses health risks. There is evidence that certain metabolites of nicotine are carcinogenic.

Nicotine has its effects in three different systems in the body. It has been shown to cause increased activity in the prefrontal cortex and visual systems. It is also causes a release of neurotransmitters associated with the reward system. The increase in dopamine can improve mood and cognitive function which make it more addictive. It also affects the catecholamine system, associated with adrenaline.

Nicotine causes increased pulse and heart rate, reduced blood flow to the heart and increased blood flow to skeletal muscle; in other words, it stresses the cardiovascular system.

Nicotine affects lung function, even if not ingested via burning a plant.   It stimulates a part of the nervous system that relaxes the body. In the lungs, this means that the airways are more constricted. This can lead to respiratory problems due to not expanding lungs as much as they should be.

Nicotine use has been associated with gastric problems, including an increase in reflux and increased risk for peptic ulcers.

It can suppress the immune system, which can cause some nicotine users to get sick more often and have slower healing.

Regarding vision, it has been shown to cause macular degeneration in mice.

It can lead to erectile dysfunction in males and in females, cause irregular bleeding.

There are more potential health risks due to nicotine use, but those are the highlights.

Vaping itself, with or without nicotine will likely prove to cause health problems. Already, Harvard researchers have found a flavoring chemical, Diacetyl, in many e-liquids tested.   This has been linked to a respiratory disease, bronchiolitis obliterans.   The nickname of this disorder is “popcorn lung”.   That is not the kind of popcorn a person wants, trust me. ( “Chemicals Linked With Severe Respiratory Disease Found In Common E-Cigarette Flavors”)

There is also a concern that vaping will be a gateway that leads teenagers to try smoking tobacco and also to trying other drugs. This is debatable as tobacco smoking rates have not changed much in the last few years, but it takes several years to truly measure trends. Publications that are pro-marijuana tend to be the ones that point out that there is not a gateway risk. They also tend to ignore the fact that there is strong evidence that marijuana itself can be a gateway drug.

When I talk to a teenager about their substance use, including vaping, I want to know why they are doing it. It is best to have a conversation with a teenager, not to lecture a teenager. It is important to understand the value to them of vaping.

Often, over time, it will come out that they are trying to self-medicate due to anxiety, depression, academic struggles or some other major stress.   Of course, the other explanation is that they are a teenager; they are going to try things out and try to be cool and fit in. By listening to the teenager instead of lecturing, you have a better chance of opening those lines of communication.   You may even be able to get to the lecture highlights that I indicated above.

Once it is established why a teenager is using, you can work to find alternative solutions with them. Punishment can work as a consequence, but positive reinforcement consistently results in long-term behavior changes versus punishment.

Therefore, in general, a plan that rewards a teenager for not using will likely be more effective for helping them stop.   Incentives are another way to trigger that greedy reward system that a teenager has.   The incentives may be a way to replace the reward they were getting from vaping.

Yes, the debate on this issue rages on. A lot of teenagers think that we are all just blowing smoke as we discuss the potential risks of vaping. The scary thing is that although they are not burning anything when they vape, they are playing with fire.

     -Indian J Med Pediatric Oncology. 2015 Jan-Mar; 36(1): 24-31


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