E-cigarettes: What Every Parent Needs To Know

I’m about to admit something kind of embarrassing. Until last spring, I didn’t really know that e-cigarette use was a huge deal and I had NO idea what a “JUUL” was or that “juuling” was something I should be concerned about as a parent and a pediatrician.

As a routine, I always ask my teenage patients about their substance abuse habits (in Peds we often refer to these as the “Sex, Drugs and Rock n’ Roll” questions):

Do you smoke cigarettes? Do you use marijuana or other drugs? Do you drink alcohol? etc.

I’m going to be honest here – I live under a bit of a rock and don’t read the news very often because it just depresses me…but I digress. Until I had a patient actually bring up “juuling” during their visit in the Spring of 2018, I had never heard the term or thought to add “vaping” or e-cigarette usage to my line of questioning (you can bet I ask EVERY kid that now). 

Not only am I ashamed to admit that I didn’t realize the EXTENT of the problem when it comes to e-cigarette usage as a pediatrician, but I’m ALSO the parent of a young adult son and teenage daughter…the VERY AGES that we’re seeing a huge increase in the usage of e-cigarettes. And here I was, CLUELESS (not my best parenting moment, for sure).

My goal is to educate as many parents as possible about e-cigarettes and their dangers so that no one remains as clueless as I was – because I can tell you that pretty much EVERY teenager that I ask about e-cigarettes not only KNOWS about juuling/vaping, but has SEEN someone doing it at their school or has actually tried it themselves.

There is SO much information out there about juuling/vaping and I’ve tried to break it down as best I can. For a deeper dive – check out the links at the end of this post.

The BASICS

What is an e-cigarette?

An e-cigarette as a device used to simulate the experience of smoking, having a cartridge with a heater that vaporizes liquid nicotine instead of burning tobacco.

What is vaping?

Vaping is the act of inhaling and exhaling the aerosol, often referred to as vapor, which is produced by an e-cigarette or similar device.

What is a JUUL?

A JUUL is a brand of e-cigarette used for vaping that resembles a USB drive. The device heats up a cartridge (also called a JUULpod) creating a vapor which is inhaled by the user. JUULpods come in a variety of flavors including mango, mint, fruit, cucumber and creme. Each JUULpod contains the same amount of nicotine as one pack of cigarettes.

Are that many kids ACTUALLY using e-cigarettes?

Yep. According to the FDA, more than 2 million middle and high school students used e-cigarettes in 2017. The US Surgeon General cited a 900% increase in e-cigarette usage among high school students between 2011 and 2015. Teens are more likely to smoke e-cigarettes than cigarettes and by the 12th grade, over 16% of teens report e-cigarette usage in the past month.

“E-cigs have become an almost ubiquitous ‒ and dangerous ‒ trend among teens. The disturbing and accelerating trajectory of use we’re seeing in youth, and the resulting path to addiction, must end. It’s simply not tolerable. I’ll be clear. The FDA won’t tolerate a whole generation of young people becoming addicted to nicotine as a tradeoff for enabling adults to have unfettered access to these same products.” -FDA Commissioner Scott Gottleib, MD

So as a parent, why should I worry?

JUULpods and many other e-cigarettes contain nicotine (along with other chemicals). Nicotine has WAY too many effects on the body for me to go into (see references for more details),  but MOST importantly, nicotine stimulates our brain’s reward center to release dopamine – our “happy” chemical. When dopamine is released into our brain, it feels GOOD. We want that feeling again – and so we turn to what made us feel good to begin with (unfortunately in THIS case, it’s nicotine). Check out this GREAT video illustrating how nicotine works on our brains and why it’s so addictive:

Teenagers are PARTICULARLY susceptible to the addictive effects of nicotine. Because their brains are still forming, use of nicotine during the teen and young adult years sets up the child for addiction to nicotine, as well as long term problems with mood and attention.

Next Steps

How do I talk to my kids about vaping?

The most important advice I have for you is to ASK your child questions.

• ASK if they have ever heard of vaping or juuling.
• ASK if they have ever SEEN anyone using JUULs or other e-cigarettes.
• ASK if they have ever been offered or felt tempted to try juuling/vaping.

What do I do if my child admits to juuling/vaping?

Step 1: TAKE A DEEP BREATH AND DON’T YELL AT THEM

Step 2: Thank them for being honest with you.

Step 3: Ask them WHY they choose (or chose) to vape.

     Common answers that I hear:

• I like how it makes me feel.
• It tastes good.
• All my friends were doing it and I didn’t think it was a big deal.
• It’s better than smoking cigarettes or marijuana.

Step 4: Ask them (in a NON judgemental manner) what they know about what they are inhaling (many teens have NO IDEA that they are inhaling nicotine). Ask them if they know how nicotine affects their body and their brain.

Step 5: Educate them.

• The brain continues to grow and make connections into our early 20’s. Exposure to nicotine during this period of growth sets up the user for long term problems with attention, learning, and susceptibility to addiction.
• Teens who use e-cigarettes are more likely to start smoking cigarettes.
• Nicotine is HIGHLY addictive and can cause things like cancer, heart disease, diabetes, and erectile dysfunction (say “erectile dysfunction” to any teenage boy and I PROMISE you will get their attention).
• Liquid nicotine can poison children and adults through ingestion and skin contact (less than 1/2 teaspoon of liquid nicotine can be FATAL to a toddler).

For more information about e-cigarettes, juuling, and how to talk to your kids about it, check out these resources:

Know The Risks: E-cigarettes and Young People

E-Cigarette Use Among Youth and Young Adults: Fact Sheet

Talk With Your Teen About E-cigarettes: A Tip Sheet For Parents

JUUL Fact Sheet

FDA E-Cigarette Prevention Campaign

To juul or not to juul

Resources:

https://www.drugabuse.gov/related-topics/trends-statistics/infographics/teens-e-cigarettes

https://www.drugabuse.gov/publications/drugfacts/electronic-cigarettes-e-cigarettes

https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Richmond-Center/Pages/ENDS-Handout-Clinicians.aspx

https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm620185.htm?utm_campaign=09122018_Statement_FDA%20statement%20on%20addressing%20epidemic%20of%20youth%20e-cigarette%20use&utm_medium=email&utm_source=Eloqua

https://www.cdc.gov/media/releases/2018/p0607-youth-tobacco-use.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363846/