Teen health crisis: Vaping

Jay S. Berger, MD, Chief Medical Officer, Pediatrics, ProHEALTH Care


ProHEALTH Care offers a full range of health care services at locations across New York. We are a group of highly trained doctors and other health care providers with access to the latest medical information and technology.

With a network of urgent care, primary care, and specialty care centers, our goal is to provide patients with the care they need, when and where the need it.

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The steady decline of youth smoking over the past two decades has been celebrated news for those of us caring for adolescents and young adults. In the 1990s, 25 percent of teens smoked.

The rate is now down to 4.2 percent.1 From our clinics and through public health channels, the message about the health risks of cigarettes seems to have reached its target.

Unfortunately, rather than pause to celebrate this significant progress made, we must turn our attention to a new and explosively popular nicotine delivery trend: vaping.

Over the past two years, teenagers have taken up the practice of vaping, often referred to as “juuling,” named for the dominant brand favored by the youth market.

Originally, e-cigarettes and vaping devices were marketed to help adults quit smoking. These products claimed to deliver nicotine with the benefit of removing the dangerous by-products of combustion.



Much ado was made about the potential “safe smoking” held.  We have since learned that vaping is not “safe smoking.”

Starting in 2015, the vape market has changed in several significant ways:

  1. Smaller, easily disguisable units appeared on the market
  2. Brightly colored packaging with sweet flavors such as, fruity pebbles, jolly rancher, and strawberry milk were advertised
  3. Social media channels are now full of commercials featuring dozens of young people dancing and vaping.  All of this has made vaping decidedly appealing to teenagers. Marketing to children today has become the norm.
    Middle and high school children have taken to it like wildfire. In the two years since the inception of Juul and similar vaping devices, 27.8 percent of teens2 have taken up the habit. The need to educate and intervene with this trend is evident and a clear priority.

What is vaping?

Vaping gets its name from the vapor produced when a battery-powered electrical coil heats the installed packet of liquid or juice, vaporizing it to be inhaled.

Devices vary from cigarette look-alikes, to pen shapes, to the most popular with teens, the Juul rectangular plastic device similar to a USB flash drive.


These devices can be used to deliver nicotine and flavoring. After inhaling, the user exhales a small amount of vapor which may or may not have an odor. To recharge, the device plugs into a USB port on a computer.

How are kids getting a hold of vaping devices?

Although tobacco products are illegal for persons under age 18, teenagers face no major barriers to buying vape devices. Products are sold via the internet with nothing but a check box as verification of legal age, and storefront shops are nearly everywhere.

Teens are able to acquire their vapes through social connections or lax law enforcement.

Once in their hands, vape devices are tricky for parents and teachers to identify and monitor.

For example, as teachers turn their backs during class, students can routinely take out their Juuls and vape. By the time a teacher has eyes back on the student, the vape cloud has dissipated.

Absence of a lingering cigarette smell keeps teachers and parents from suspecting the use of these devices. To add to the challenge, the Juul device preferred by teens looks like a flash drive, a standard piece of tech at home in most backpacks.

What do kids know about vaping?

While counseling my patients and in conversations with my teenage children, I have noted a disturbingly prevalent myth about the harmlessness surrounding vaping. This accounts for the erroneous opinions regarding smoking cigarettes versus vaping.

Teens are quick to call smoking “gross” and “unhealthy,” claiming they would never do something “so stupid.”  In contrast, they believe vape cartridges contain “just water” or “just flavor” and are as innocuous a pastime as chewing gum, with no negative health effects.

What is the medical evidence for harm?

Direct evidence is difficult to come by for a drug delivery system that will likely unveil its harmful effects over decades. However, there are some easily drawn conclusions.

All vape pods, specifically the brand used by teens, contain nicotine, and in amounts dramatically higher than cigarettes – which according to the Juul Company is at least twice — and by some accounts four times higher — than cigarettes.3

Nicotine is undeniably addictive, leading to concerns about the development of additional tobacco habits. Additionally, the damage nicotine causes to cardiovascular health is well documented.

The water that fills the e-cigarette pods contains a stew of questionable compounds. Diacetyl, which is often used to provide the sweet flavoring vaping liquid, originated as a flavoring agent in microwave popcorn.

Popcorn factory workers coating the kernels without proper respiratory protection fell ill with Bronchiolitis Obliterans,  where alveolar walls break down in the lungs (similar to COPD).

This condition is now known as “popcorn lung.” Glycerol, another common vaping ingredient, breaks down to formaldehyde, an embalming preservative and a well-known cancer-causing agent, when heated. All of this is being inhaled deep into the lungs … over and over again.

How do we protect our patients?

Awareness of the vaping/Juuling issue is the first step. Despite the absence of long-term studies, we know enough to advise our patients that vaping is addictive and unhealthy.

Most teens are under the illusion that this habit is fun and consequence-free, but as clinicians and bastions of preventive health, it is our duty to inform kids and their parents of the evidence against the myth.

With as much vehemence as we fought the culture of cigarette smoking, we must now direct our efforts to this newest nicotine-delivering harbinger of harm.

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  1. Vaping popular among teens; opioid misuse at historic lows. National Institutes of Health. https://www.nih.gov/news-events/news-releases/vaping-popular-among-teens-opioid-misuse-historic-lows. Published December 14, 2017. Accessed September 25, 2018.
  2. Ibid.
  3. Belluz J. Juul, the vape device teens are getting hooked on, explained. Vox. https://www.vox.com/science-and-health/2018/5/1/17286638/juul-vaping-e-cigarette. Published August 22, 2018. Accessed September 25, 2018.

This publication is informational and for educational purposes for practitioners only. The views and opinions expressed herein are those of the authors and do not necessarily represent the views of Optum Care. The views and opinions expressed may change without notice.

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