A decade ago, electronic cigarettes surpassed traditional cigarettes as the preferred nicotine product of high school students in the United States. The product hit peak popularity in 2019, with 27.5% of teens using it, or approximately 5 million.

Thanks to swift public health action, their popularity and use among teens continues to decline. According to the Centers for Disease Control and Prevention, youth vaping has reached its lowest level in a decade with approximately 1.5 million users. Still, there is work to be done. And for parents and caregivers, it’s important to stay aware, understanding what e-cigarettes are, how kids are getting them and what to do if you think your child is vaping.

What is vaping?

Vaping refers to using an e-cigarette or other electric device to smoke that contains toxic chemicals and/or nicotine. A battery heats the solution, which is typically flavored, and users inhale the resulting vapor. Some teens also use e-cigarettes to inhale THC, the compound in marijuana that creates a high.

What are the health effects of vaping?

There are many health risks associated with vaping. Many people, kids and adults alike, mistakenly believe vaping is a “safer” alternative to smoking cigarettes. Experts say vaping is just as dangerous — and there isn’t enough data to truly understand the long-term effects.

When you vape, the particles inhaled can cause inflammation and scarring of your lungs. Vaping can also narrow the tubes that bring air in and out of your lungs, making it harder to breathe.

It’s important to remember that no tobacco products, including e-cigarettes, are safe. E-cigarettes don’t contain tobacco in the traditional sense, but they do contain nicotine, a highly addictive chemical compound often derived from tobacco.

“Even using vapes one time has been shown to land some kids in the hospital with breathing problems,” says pulmonologist Heather De Keyser, MD. “It has negative effects on the heart as well.”

Anyone who is pregnant should not vape. Nicotine is known to permanently damage a baby’s developing brain, lungs and other organs.

What is E-VALI and should I be worried about it?

E-cigarette or vaping-associated lung injury, or EVALI, is an inflammatory condition that damages the lungs. It was first identified in 2019 after a spike in lung illnesses and deaths linked to vaping. These cases occurred across a number of states, including Colorado.

The outbreak peaked in September of that year, and investigators have since shown that THC-containing e-cigarettes sold on the street played a major role. The culprit seems to be an additive called vitamin E acetate, and although the evidence wasn’t strong enough to rule out other contributors, cases have declined steadily since then, likely due to the removal of vitamin E acetate from many vaping products. But vaping products are poorly regulated, so there’s always the risk of EVALI and other potentially harmful vaping-related illnesses.

“There’s no good way to predict which kids will develop EVALI and when,” Dr. De Keyser says. “There are so many chemicals in vape products. Even without vitamin E acetate, we can’t be sure other chemicals in vapes won’t cause EVALI or other types of lung damage.”

Symptoms of EVALI tend to resemble lung infection: trouble breathing, cough and fatigue, as well as chest pain, fever, low oxygen and coughing up blood, in some cases. Parents, healthcare professionals and educators should check for a history of vaping in all kids, particularly if they have any of these symptoms. If symptoms persist, they need to see their doctor or a pediatric lung specialist. The treatment for EVALI is different from the treatment for lung infection, and early treatment may be important to stopping progression.

Is vaping addictive?

The vast majority of e-cigarettes and vaping products contain nicotine, and teens don’t always know it. Currently, Vuse, JUUL and NJOY are the most popular e-cigarette brands on the market. None of these brands offer a nicotine-free option. One cartridge alone contains roughly the same amount of nicotine as an entire pack of cigarettes.

The teenage brain is especially vulnerable to nicotine because it is still in the process of growing and developing, and exposure can have lasting effects into adulthood. Teens who use nicotine show lower cognitive function, shorter attention spans, and increased impulsivity, depression and anxiety in adulthood.

“The high level of addictive chemicals can affect the brain’s chemistry and brain development. Nicotine addiction may even make kids more likely to become addicted to other substances as well,” Dr. De Keyser says.

Why is vaping appealing to kids and teens?

Vaping companies’ target teens with flavors like bubblegum and cotton candy clearly intended to entice teens, and many have positioned themselves as a safer alternative to other tobacco products. And although the U.S. Food and Drug Administration banned the sale of many flavored e-cigarettes in 2020, there are still many flavored vapes on the market due to loopholes in the policy. The ban does not cover newer products, such as disposable e-cigarettes or e-cigarettes that use tanks rather than cartridges or pods.

E-cigarette advertising is unregulated and may influence teens online since many vaping companies still advertise heavily on social media. Lastly, vaping is much easier to disguise than regular cigarettes. Many companies make products actively intended to hide their purpose, including watches and even hoodies that have a designated spot where users can insert their vape for discreet use.

How can parents prevent their kids from vaping?

The best tool parents have to keep their kids from vaping is open communication.

Start the conversation with your kids as young as 9-10 years old.

“It’s so addictive that once they try it the cat is already out of the bag,” Dr. De Keyser says. “It’s best to try to have these conversations before they ever start.”

Talk with your kids about the dangers of vaping and emphasize that we don’t yet know just how bad it might be. Make sure that they know e-cigarettes contain nicotine, which can have lasting effects on their brain and behavior. Remind them that their brains develop until early adulthood. The surgeon general offers tips for starting a conversation with your teen about e-cigarettes.

Take advantage of teachable moments. You may find an opportunity to talk with your child about vaping when you see a character on TV vaping or someone vaping on the street while driving to school. Use these moments when the conversation arises naturally. Also consider other people who can influence your child’s decisions:

• Set up an appointment with your pediatrician if you think your child is more likely to listen to a medical professional about the dangers of vaping. Talk with your child’s teachers and school administrators about how they are preventing vaping at school.
• Remind your child that smoking conventional cigarettes is not an alternative to vaping (and vice versa).
• Talk with other parents about their children and how they are preventing them from using e-cigarettes.
• Ask your kids about what they’re seeing online and on social media about vaping.
• And finally, think about actions you can take. Be a good role model by not vaping or smoking. It’s never too late to quit smoking, and your child is more likely to listen to you if you are modeling the behavior you want your children to show. Become an advocate and tell your politicians that you support legislation that limits teens’ access to vaping products.

Action and advocacy on teen vaping

Although research is still ongoing on the long-term effects of vaping, one thing is clear: It is not safe — not for teens, not for anyone. In addition to ongoing research, Children's Colorado's government affairs team continues to pursue legislative action.

In recent years, Children's Colorado influenced policy changes by helping to update the Colorado Clean Indoor Air Act to prohibit vaping in public spaces and supporting policies related to tobacco retail licensure at the state and local levels. Additionally, we advocated for a statewide ballot measure, Proposition EE, that voters adopted in 2020 to raise the state’s tobacco tax and close the outdated tax loophole on vaping. Price increases are one of the most effective ways to reduce smoking, especially among youth. Research shows that every 10% increase in cigarette prices reduces youth smoking by about 7%.

Children’s Colorado has also supported state and federal policies that raised the age of tobacco and nicotine product sales from 18 to 21 years old f. In partnership with other advocates, Children’s Colorado continues to work on policies that end the sale of flavored tobacco products to help prevent youth from starting and continuing tobacco and nicotine use.

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