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New Findings on Teens and Vaping

Here's what parents need to know.

Key points

  • Vaping was intended to be a safer alternative to conventional tobacco smoking. It is a harm-reduction tool to help adult smokers quit.
  • Adolescents and previous non-smokers have started vaping at alarming rates. Both nicotine and marijuana vaping have become prevalent among youth.
  • There are risks associated with adolescent vaping, including nicotine addiction, increased risk of conventional smoking, and lung injury.

Your teenager comes home with an odd-looking pen or something resembling a USB flash drive. You quickly realize you need a crash course on vaping. Here’s what you need to know.

What is vaping, exactly?

Vaping consists of using a battery-operated device (known as e-cigarettes, e-cigs, or electronic nicotine delivery systems [ENDS]) to heat e-liquid (also called “vape juice”) into an aerosol that is then inhaled by the user. Vaping was originally intended to be a means of harm reduction from conventional tobacco smoking. The goal was to create a safer way to inhale nicotine, devoid of the combustion in tobacco smoking that produces harmful carcinogens. Indeed, JUUL, one of the leading ENDS brands, describes its mission as “to transition the world’s billion adult smokers away from combustible cigarettes, eliminate their use, and combat underage usage of our products” (JUUL Labs, Inc., 2021, para 1). And some research evidence supports the use of e-cigarettes as an effective way to quit smoking tobacco products (Grabovac et al., 2021).

Despite this original goal, however, vaping has taken on a life of its own. Specifically, adolescents and previous non-smokers have started vaping at alarming rates. According to the Monitoring the Future (MTF) survey, 16.6 percent of 8th graders, 30.7 percent of 10th graders, and 34.5 percent of 12th graders vaped nicotine in the previous 12-months (Miech et al., 2021). After years of dramatic increases in adolescent vaping trends, the numbers leveled off in 2020 (yet some evidence suggests this leveling was due largely to the COVID-19 pandemic; Kreslake et al., 2021).

So, what are adolescents vaping?

Many teens are vaping nicotine in various concentrations. For example, JUUL offers two nicotine strengths (5 percent and 3 percent), and other brands (e.g., PHIXvapor) report that each cartridge or pod used in the e-cigarette contains the equivalent of two packs of tobacco cigarettes (PHIXvapor, 2021). Along with nicotine, researchers have found 50 different chemical compounds in e-cigarettes (Armendariz-Castillo et al., 2019), and due to the prevalence of non-commercial, off-brand, and homemade “vape juice,” the quality and content of ENDS vary considerably. Some adolescents vape flavored e-liquid labeled as “nicotine-free,” yet recent data reveal that a number of these products still contain trace amounts of nicotine.

Many adolescents also are vaping marijuana concentrates, including THC (the psychoactive ingredient in cannabis) and CBD (cannabidiol, a non-psychoactive ingredient in cannabis). The MTF survey revealed that 8.1 percent of 8th graders, 19.1 percent of 10th graders, and 22.1 percent of 12th graders vaped marijuana in the previous year (Miech et al., 2021). Moreover, among high schoolers who vaped in the previous 30 days, more than half (52.7 percent) reported vaping marijuana (Farsalinos et al., 2021). Oftentimes vaping marijuana is preferable to smoking due to the absence of burning, which reduces the recognizable odor of cannabis use. Importantly, the concentration of THC in vaped cannabis oil often is much higher than that of a smoked joint.

And what’s the harm?

When used as intended, vaping appears to be a safer alternative to conventional tobacco smoking (Farsalinos & Polosa, 2014). However, when used by adolescents or previous non-smokers, there are several risks:

1. Nicotine is an addictive substance, and its use can lead to nicotine addiction. When used during adolescence (a time when the brain is still developing), nicotine use can lead to difficulties in learning, attention, and control (NIDA, 2020). Additionally, teenage nicotine use has been found to lead to mood shifts, decreased attention, and increased sensitivity to the rewards of other drugs of abuse (Leslie, 2020).

2. The use of e-cigarettes among non-smokers increases the risk of using conventional cigarettes in the future (Epstein et al., 2021). Studies reveal that ENDS may be an introduction to nicotine that leads some adolescents to subsequently begin smoking tobacco products.

3. Vaping marijuana can lead to the inhalation of harmful chemicals. In 2019, there was an outbreak of e-cigarette or vaping product use-associated lung injury (EVALI), which has been linked to vaping THC solutions containing vitamin E acetate, which is harmful to inhale (Hall et al., 2021). Additionally, researchers have found that vaping marijuana correlates with detrimental respiratory conditions (e.g., wheezing, whistling, dry cough; Xie & Li, 2020), and consuming high concentrations of THC can be harmful to individuals with preexisting mental health conditions.

4. Much is still unknown. E-cigarette emission has been found to contain metals and other particulate matter (Fernandez et al., 2015), and the exact effects of these chemicals and compounds are still being researched. Indeed, a researcher has stated, “We have a generation of teenagers who are effectively human guinea pigs for the health effects of e-cigarettes” (Leslie, 2020, p. 1).

What’s the bottom line?

Vaping may be a useful tool for adult tobacco smokers who are seeking a less harmful alternative, yet adolescents and non-smokers should not begin vaping. Recently, the Food and Drug Administration prohibited the manufacturing of flavored e-liquid cartridges (e.g., fruit, dessert, mint) that appeal to youth, allowing only menthol and tobacco flavors. Additionally, in 2019, it became illegal to sell e-cigarettes to anyone under the age of 21. These legislative actions are aimed at combatting the prevalence of vaping among adolescents.

If you have a teenager who has started vaping, it is important to have ongoing conversations about it. Oftentimes, youth are influenced by the social modeling of their peers (and the media) and are not fully informed about the intended purpose and potential risks of vaping. Given that motives for vaping vary considerably (e.g., to fit in, to calm anxiety, to feel pleasure, to escape, to combat low self-esteem), it is important to ask your teen about their reasons for vaping (or what vaping does for them) and find more adaptive ways of meeting those needs.

There is some data suggesting that vaping could be a means of regulating mental health symptoms such as depression or anxiety (Spears et al., 2019) and may occur simultaneously with the use of other drugs of abuse (Benyo et al., 2021). Therefore, it is important to explore your child’s mental health symptomology and substance use patterns. A family counselor or individual counselor may be a helpful resource in this process.

References

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Benyo, S. E., Bruinsma, T. J., Drda, E., Brady-Olympia, J., Hicks, S. D., Boehmer, S., & Olympia, R. P. (2021). Risk factors and medical symptoms associated with electronic vapor product use among adolescents and young adults. Clinical Pediatrics, 60, 279-289. https://doi.org/10.1177/00099228211009681

Epstein, M., Bailey, J. A., Kosterman, R., Rhew, I. C., Furlong, M., Oesterle, S., & McCabe, S. E. (2021). E-cigarette use is associated with subsequent cigarette use among young adult non-smokers, over and above a range of antecedent risk factors: A propensity score analysis. Addiction, 116, 1224-1232. https://doi.org/10.1111/add.15317

Farsalinos, K., Barbouni, A., & Niaura, R. (2021). Changes from 2017 to 2018 in e-cigarette use and in ever marijuana use with e-cigarettes among U.S. adolescents: Analysis of the National Youth Tobacco Survey. Addiction, 116, 139-149. https://doi.org/10.1111/add.15162

Farsalinos, K. E., & Polosa, R. (2014). Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: A systematic review. Therapeutic Advances in Drug Safety, 5, 67-86. https://doi.org/10.1177/2042098614524430

Fernandez, E., Ballbe, M., Sureda, X., Fu, M., Salto, E., & Martinez-Sanchez, J. M. (2015). Particulate matter from electronic cigarettes and conventional cigarettes: A systematic review and observational study. Current Environmental Health Reports, 2, 423-429. https://doi.org/10.1007/s40572-015-0072-x

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Hall, W., Garther, C., & Bonevski, B. (2021). Lessons from the public health responses to the U. S. outbreak of vaping-related lung injury. Addiction, 116, 985-993. https://doi.org/10.1111/add.15108

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Kreslake, J. M., Simard, B. J., O’Connor, K. M., Patel, M., Vallone, D. M., & Hair, E. C. (2021). E-cigarette use among youths and young adults during the COVID-19 pandemic: United States 2020. American Journal of Public Health, 111, 1132-1140. https://doi.org/10.2105/AJPH.2021.306210

Leslie, F. M. (2020). Unique, long-term effects of nicotine on adolescent brain. Pharmacology, Biochemistry, and Behavior, 197, 173010. https://doi.org/10.1016/j.pbb.2020.173010.

Miech, R. A., Johnston, L. D., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E., & Patrick, M. E. (2021). Monitoring the Future national survey results on drug use, 1975-2020: Volume 1, secondary school students. Ann Arbor: Institute for Social Research, the University of Michigan.

National Institute on Drug Abuse (2020). Tobacco and nicotine drug chart. https://www.drugabuse.gov/drug-topics/commonly-used-drugs-charts#tobacco

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Spears, C. A., Jones, D. M., Weaver, S. R., Yang, B., Pechacek, T. F., & Eriksen, M. P. (2019). Electronic nicotine delivery system (ENDS) use in relation to mental health conditions, past-month serious psycholoigcla distress and cigarette smoking status, 2017. Addiction, 114, 315-325. https://doi.org/10.1111/add.14464

Xie, Z., & Li, D. (2020). Cross-sectional association between lifetime use of electronic cigarettes with or without marijuana and self-reported past 12-month respiratory symptoms as well as lifetime respiratory diseases in U. S. adults. Nicotine & Tobacco Research, 22, s70-s75. https://doi.org/10.1093/ntr/ntaa194

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