What Parents Need to Know About Kids and Vaping

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Faint scents of mint and mango emanate from middle and high school bathrooms, hallways and classrooms, from students’ parties and from bedrooms. These fruity flavors, subtle and designed to hook kids, belie the harmful effects of their sources: e-cigarettes, or vape devices.

Between 2011 and 2019, vaping increased 1,800% among youth, in large part due to Juul Labs’ sweet-tasting, flash-drive-looking e-cigarettes, often advertised as harmless and cool.

Another reason: “E-cigarette companies are taking the playbook of conventional cigarettes and using young, sexy models and other techniques that they know worked before because there is little to no regulation on marketing for e-cigarettes,” says Dr. Susan Walley, chief of Children’s National Hospital’s division of hospital medicine.

Walley, who chairs the American Academy of Pediatrics’ section on nicotine and tobacco prevention and treatment, says that while ads for cancer-causing cigarettes were banned in the 1970s, “it’s a Wild Wild West” for vaping devices.

According to the American Lung Association (ALA), 8,000 kids are starting to vape every day, leaving them four times likelier to try regular cigarettes. Here’s what parents should know about kids and vaping.


Dangers of vaping

Juuls and other vape devices—which can resemble objects like pens, highlighters and chargers—are often marketed as a healthier alternative to traditional cigarettes, which contain lung-damaging tar, along with thousands of toxic chemicals.

E-cigarettes haven’t been around long enough for long-term research, and it is unknown exactly what chemicals are in them. However, vaping likely exposes users to fewer toxins than regular smoking.

Yet vaping remains unsafe. One vape pod can contain as much nicotine, a highly addictive substance, as a pack of cigarettes.

Worse, vaping is associated with lung injuries and deaths. In February 2020, before COVID-19 dominated headlines, the Centers for Disease Control and Prevention (CDC) confirmed nearly 3,000 cases of e-cigarette or vaping use-associated lung injury (EVALI), with 68 deaths attributed to the condition.

In response, the Food and Drug Administration (FDA) began cracking down on sales of vaping devices, particularly fruit-flavored ones widely blamed for igniting the youth vaping epidemic. Juul discontinued all of its flavors except for menthol and tobacco.

Yet the government’s ban on refillable devices ignited competing brands to produce prefilled disposable ones, some with even higher levels of nicotine than Juuls. Between 2019 and 2020, use of disposables increased 1,000% among high students and 400% among middle-school students, according to the CDC.

“Inhaling these things is very dangerous, but teenagers don’t understand that,” says Dr. Okan Elidemir, chief of pulmonary medicine at Nemours Children’s Specialty Care in Pensacola, Florida. (Elidemir is available by telehealth for patients at the hospital’s Wilmington, Delaware, campus.)

Vaping can increase users’ heart rate and blood pressure and can cause coughing, wheezing and shortness of breath—or bacterial infection and pneumonia.


Stats about vaping

According to the 2021 National Youth Tobacco Survey, 11% of high schoolers and 3% of middle schoolers in the
United States reported they were current users of e-cigarettes, with 80% using flavored products. That’s more than 2 million middle and high school students, compared to 3.6 million in 2020 and 5.4 million in 2019.

These declines could in part reflect young people avoiding stores and spending more time under their parents’ supervision due to COVID-19. At the same time, however, more current users are using daily than before.

Walley sees this statistic as a “proxy for addiction,” a public health crisis related to rising anxiety and depression among youth due to factors like climate change, mass shootings and the COVID-19 pandemic.

“A lot of kids are self-medicating by vaping,” says Dr. Mary Garza of The Maryland Pediatric Group, adding that they also “want to seem like they’re growing up and like they’re cool.”


Signs of vaping in kids

Unlike traditional cigarettes, vape devices lack tobacco’s telltale odor, making them easier to hide. However, signs of use include irritability or restlessness, faint sweet scents and unfamiliar technology or spare parts like atomizers and cartridges.

Other signs include increased thirst, dark circles under the eyes and desire for spicy food, all of which come from vaping-induced dehydration. Since nicotine slows down the healing of wounds, kids who vape are likelier to have long-lasting acne and blemishes.


Tips for conversation

The ALA advises parents to ask open-ended questions and avoid judgment and scare tactics when talking to their kids about vaping.

Even before that, Dr. Panagis Galiatsatos, who directs Johns Hopkins Medicine’s tobacco treatment clinic and helped create a curriculum about vaping that will be implemented in more than 100+ Baltimore schools this fall, says: “The first thing I would tell parents is talk to your kids about how they’re handling their stress.”

Opening the door to these conservations can keep the lines of communication positive between parents and children.


Additional resources

Teens and young adults who want to quit vaping can join the program “This is Quitting” for free by texting DITCHVAPE to 88709.


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