Is Your Teen a Vaper?

Reviewed by Hansa D. Bhargava, MD on June 23, 2016

With youth cigarette use at an all-time low thanks to price hikes, smoking bans, and graphic public-service campaigns, today's parents may assume they don't have to worry much about their kids lighting up.

But are they "vaping"?

Every parent should broach this subject with their teenager, say public health experts, as the popularity of electronic cigarettes and other vaping devices grows exponentially among minors. In 2015, government surveys show, 16% of high schoolers and 5% of middle-schoolers used e-cigarettes (up from 1.5% and 0.6% in 2011), making them by far the most popular tobacco product among youth. To curb the trend, the FDA this summer banned their sale to those under 18. But some fear they'll still be easily accessible online or via older friends, and much damage has already been done.

"They have normalized smoking again for a group of young people who had begun to see regular cigarettes as no longer cool," says Karen Wilson, MD, MPH, head of Pediatric Hospital Medicine at Children's Hospital Colorado in Aurora.

Teens and smoking:

  • +900%: E-cigarette use by high schoolers jumped from 1.5% to 16% in the last five years: a 900% increase.
  • 3 million: Number of middle schoolers and high schoolers who use electronic cigarettes.
  • 28%: Percentage of teens who smoked regular cigarettes in 1996. Only 8% smoke them today.

Not just "harmless vapor."

Unlike conventional cigarettes, e-cigarettes use a battery to heat up an often nicotine-infused liquid and turn it into an inhalable vapor.

Because they contain fewer carcinogens and don't emit the carbon monoxide that comes with combustion, they are probably less hazardous than cigarettes, says Stanford University tobacco researcher Judith Prochaska, PhD. But e-cigarette vapor is not harmless. It's made from propylene glycol, a lung irritant that can affect behavior and the central nervous system. It also typically includes chemical flavoring, and with more than 7,000 largely unregulated varieties --from cotton candy to Katy Perry cherry -- it's impossible to know if all are safe, she says. Animal studies show certain varieties can be toxic to cells. One recent study by Harvard University researchers found that 75% of flavored e-cigarette liquids contained diacetyl, a chemical linked to a respiratory disease known as popcorn lung.

While cases are rare, several dozen e-cigarette users have reported that their batteries overheated and exploded, either causing fire or burning their mouths or tongues. Meanwhile, roughly 4,000 calls have been made to poison control centers from parents whose children under 6 drank liquid nicotine intended for e-cigarette refills. Four went into a coma, two had a seizure, and one died.

A gateway to cigarette addiction?

Most e-cigarettes contain nicotine, and young brains are particularly vulnerable to nicotine's addictive properties (90% of adult cigarette smokers started before age 18). One recent study found that ninth graders who use electronic cigarettes are about 2.5 times as likely to smoke traditional cigarettes, and many used e-cigarettes first.

"You are exposing young, developing brains to an addictive substance that alters its reward system and may set them up to be a long-term nicotine user," Prochaska says. "It's just not worth the risk."

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Show Sources


Karen Wilson, MD, medical director of Hospital Medicine, Children's Hospital, Denver.

Judith Prochaska, PhD, associate professor of medicine, Stanford Prevention Research Center, Stanford, CA.

Singh. "Tobacco use among middle and high school students – United States, 2011-2015". Published online.


Glantz. Circulation, May 13, 2014.

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U.S. Fire Administration.

Smith. Pediatrics, June 2016.

U.S. Department of Health and Human Services Office of Adolescent Health.

Leventhal. JAMA, Aug. 2015.

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