An assortment of e-cigarettes, chargers and e-juice. 
Some e-cigarette chargers are designed to look like USB flash drives. 
Many e-cigarettes use cartridges filled with a liquid concentrate. 
The packaging for e-juice is often branded to appeal to kids with fun-sounding flavors. 
Juul is 16 times more likely to be the e-cigarette of choice for teen users. 
The Suorin Drop is the shape of a teardrop and can be hidden in the palm of the hand, and the Suorin Air is about the size of a credit card and can fit in a wallet.
“Dabbing,” “juuling” and “vaping.” Have you heard of these? Your teen probably has.
Have you noticed a change in your teen’s behavior? How about a sleek-looking pen, a gadget that resembles a computer flash drive or a USB charger that doesn’t connect to any of your electronic devices? Have you come across a small vial of concentrated liquid or a small plastic cartridge that you don’t recognize?
If so, then you may have stumbled upon one the newest and fastest-growing teenage trends.
If you are a parent, here is a primer on teenage vaping.
Smoking Hot Statistics
According to the Centers for Disease Control and Prevention, e-cigarette usage increased 75 percent among high school students between 2017 and 2018. The CDC now estimates that one in four high school students are using or have tried tobacco products.
Recently published data suggest that four out of five kids who are using tobacco products started with a flavored e-cigarette product, with use starting as young as age 12.
It shouldn’t take long to connect the dots here. We have a significant rise in teen/preteen use of tobacco products in just one year and all indicators point to e-cigarettes as the gateway.
What Is an E-cigarette?
An e-cigarette is a handheld electronic device that allows a person to inhale aerosolized substances such as nicotine or cannabis in a discreet way.
These devices may be referred to as “e-cigs,” “vapes,” “vape pens,” “Juuls,” “Suorins,” “dabs,” “e-hookahs” or by other names. Some look like regular cigarettes or cigars, while others may be stealthily designed to look like a pen, USB flash/thumb drive, battery charger or an asthma inhaler.
How Does an E-cigarette Work?
Most e-cigarettes have a battery, a heating element, a place to insert a cartridge or a reservoir to hold a liquid concentrate. They produce an aerosol or “vape” by heating a liquid that usually contains nicotine or cannabis, flavorings and other harmful chemicals that the user inhales into his lungs.
Unlike conventional cigarettes, there isn't usually an odor or residue. Many of these devices are recharged with a USB charger.
What Is In an E-cigarette?
In addition to delivering a high dose of nicotine or cannabis into the lungs, a “vape” also will deliver ultrafine particles (harmful to lungs), diacetyl (a compound linked to serious lung disease), propylene glycol (which can release carcinogenic formaldehyde vapor when heated), heavy metals (nickel, tin and lead) and other known cancer-causing chemicals.
What Are Some of the Health Risks That Doctors Are Concerned About?
In a nutshell, the medical community is very worried about teenage vaping and the potential for nicotine addiction, mood changes, brain rewiring, lung damage, increased risk of cancer and other harmful effects of vaping.
Nicotine is known to be an extremely addictive and toxic substance. This is especially the case with a developing teenage brain. Neuroscience has taught us that a developing teenage brain can sustain long-term changes, including a permanent “rewiring” of brain synapses that can alter attention span, memory function and the ability to learn.
Nicotine also will enhance a teenager’s impulsivity and cause irritability, anxiety, mood swings and learning difficulties.
The current generation of e-cigs can deliver up to six times the amount of nicotine as the first generation of e-cigs, making it especially addictive to young teens and adults. This helps us better understand why there has been a 75 percent increase in e-cigarette use in just the past year.
Throw in an increased risk of cancer to the primary “vaper” (and their secondhand vape buddies) and you start to understand why e-cigs are starting to get the attention of parents, doctors and other health advocates across the country.
Flavors Hook Kids
You may have seen some commercials talking about “flavors hooking kids.” Why are e-cigs flavored, and how do they “hook” kids?
E-cig manufacturers cleverly use “flavors” such as cotton candy, fruit, cereal flavors, coffee and chocolate to mask the harsh taste of tobacco, making it easier for kids to tolerate and enjoy.
Surveys have shown that most kids think they are just vaping a flavored/scented water vapor and have no idea that they are actually inhaling a highly concentrated, addictive nicotine product along with other harmful chemicals.
Types of Devices
To better understand e-cigs, one must become more familiar with the types of devices being used.
» Closed systems. With a closed system device, the user purchases pods or cartridges (prefilled with nicotine or cannabis) to attach to their e-cig. Of the closed system devices, Juul is the most popular. Some consider the Juul to be the “iPhone of e-cigs.”
According to one publication, Juul has taken over 70 percent of the e-cig market share and is 16 times more likely to be the e-cigarette of choice for teen users. A Juul device is easy to hide because it looks like a flash drive and can be charged in a USB port. All Juul flavors contain nicotine. One Juul pod can contain the nicotine of 20 cigarettes and can deliver nicotine up to 2.7 times faster than other e-cigarettes.
» Open systems. With an open system device, the user can refill the device with any “e-liquid” or “e-juice.” As a result, thousands of flavors are available with this type of system. The packaging for e-juice is often branded to appeal to kids with fun-sounding flavors, and it is marketed to appeal to younger kids. These devices can be filled with flavored nicotine, cannabis or other substances.
Suorin makes several stealth and very popular open system e-cigarette devices. The Suorin Drop is the shape of a teardrop and can be carefully hidden in the palm of the hand while one takes a hit, while the Suorin Air is rectangular-shaped, about the size of a credit card and can slide into a wallet.
(With traditional cigarettes, the harsh taste and side effects of tobacco might discourage a teen from smoking 20 cigarettes. With flavor added, imagine just how much nicotine an unsuspecting teen could vape in a short time frame with one of these e-cig nicotine delivery systems.)
What Is a Dab?
Dabbing used to be football quarterback Cam Newton’s signature touchdown celebration. Now, “dabbing” is a way for teenagers to get high by vaping an easily concealable, odorless and smokeless cannabis concentrate that is made up of 50 percent to 80 percent THC (by comparison, regular marijuana is about 12 percent THC).
Because dabbing involves a much higher concentration of THC (tetrahydrocannabinol — the psychoactive chemical found in marijuana), its physical and psychologic effects may be more severe. Since a dab vaporizes at a much higher temperature, it also can lead to the individual inhaling dangerous byproducts, including benzene (known to cause leukemia), rust and other toxic metals into their lungs.
Why Are Teens Vaping?
Vaping has become a hot new trend, and reasons why teens vape are numerous. Some vape because it is what their friends are doing and they take a hit when it is offered to them. Others own personal devices and may even give names to their pens. For some, vaping may offer the thrill of puffing out a big cloud of smoke, and others may be truly addicted to nicotine and need professional to help break their addiction.
What Can Parents Look For?
With traditional cigarettes, parents used to be able to smell the scent of tobacco on their teen’s clothes or on their breath. With modern e-cigs, there is no smoke and virtually no smell. So how might a parent know if his or her son or daughter was vaping?
You might notice a change in your teen's behavior, including mood swings, irritability, impulsivity and wanting to hang out behind closed doors. (I understand that this also describes many teens who are not vaping.)
You might get a hint of a fruity or unusual smell coming from your teen’s room, or you might notice a fancy-looking pen, thumb drive, credit card or stylus in their backpack, wallet or on their desk. If a pen has openings on the top and bottom, you might take a closer look.
Listen carefully. If you start hearing your teen or her friends use terms such as “vaping,” “Juuling” or “dabbing,” then you might want to start engaging in more conversation. If you hear your teen or their friends constantly talking about an individual whom you don’t recognize, ask about it and don’t be shocked if you find out that the name actually refers to a vape pen and not an actual person.
Check your credit card for unusual charges. Online purchases of vaping products are widely available, and while technically illegal for a teen to purchase, it's pretty easy for a savvy teen to figure it out. It may be as simple as a click on a website banner that says you are 21. To conceal their purchase, some teens may have their online items shipped to a friend’s house instead of their own.
You many notice an increase in your teen sipping more liquids or having more frequent nosebleeds. These may be subtle changes, but the propylene glycol found in e-juice can lead to dry mouth and brittle nasal passages, causing increased thirst and more frequent bloody noses.
For those vaping cannabis, red eyes and the munchies are still a reliable tipoff.
What Can a Parent Do?
From my encounters in the office, vaping is becoming much more common in our community. Many of the patients and parents I talk to have heard about e-cigs but are unaware of just how common and easy they are to acquire. Most are unaware of the presence of nicotine and just how addictive and dangerous nicotine can be on a developing teenage brain.
My best advice is for parents to educate themselves about e-cigarettes and then talk to their teens. Ask them if they ever see e-cigs, Juuls or dabs at school or at a friend’s house. Ask them about which of their friends may be vaping. Keep this dialogue running.
Talk to other parents. Some kids vape alone, while others vape in larger social groups. You may find out that some parents are OK with their kids vaping, and this might help you decide whether you really want your teen to hang out or sleep over at that friend’s house.
In my opinion, it is OK — and necessary — to take a look every now and then in your teen’s backpack, desk drawer, wallet or car glovebox. If you see a device that raises a red flag, ask about it. Maybe it’s just the latest in computer storage devices, or maybe it is an addiction that you can help prevent by acting early.
For teens who are vaping regularly, they may already have a significant addiction to nicotine and you may need to contact their doctor to talk about nicotine addiction.
If you are a parent who vapes, try to keep your devices secure and be sure to let your kids know that their developing brains and lungs are especially vulnerable to permanent damage.
Let’s work together to learn more about teen e-cigarette use and nicotine addiction in our community. Since vaping seems to be starting in the middle school years, parent and student education needs to start in the elementary school years. Let’s collaborate to take the “high” out of junior high and high school and prevent Santa Barbara from becoming a teenage vapeland.
To find out more about vaping and e-cigarettes, I would recommend visiting Tobacco Free California's Flavors Hook Kids website.
— Dr. Dan Brennan is a board-certified pediatrician at Sansum Clinic. He can be contacted at 805.563.6211, or click here for more information about Santa Barbara Pediatrics. The opinions expressed are his own.
