Vaping devices, also known as e-cigarettes, are the new epidemic among young people in the United States, according to Nancy Sayegh-Rooney, RN, a lung nurse navigator on Staten Island, NY, and a Certified Tobacco Treatment Specialist who educates students in middle school and high school about the dangers of vaping.
“The chemical flavoring in these vape pens is not candy; it’s like a wolf in sheep’s clothing,” she said at the AONN+ 2020 Midyear Conference. “We’ve created a new generation of addicts. This is a scary time for us in tobacco.”
Nearly all tobacco product use begins in adolescence, and nearly all tobacco products, including e-cigarettes, contain nicotine. Youth nicotine use can harm the developing brain, impacting learning, memory, and attention. Nicotine is the most commonly abused drug, and it is the fastest delivery of a drug to the brain. Vaping simulates the feeling of smoking with a dopamine release, and that feeling can lead to addiction.
“Nicotine doesn’t cause the cancer; it doesn’t cause the lung disease; it causes the addiction,” she said. “The patients that I see come in for lung screenings started smoking in their teen years, and they wish they never started. That speaks volumes to what we have to do in educating our kids.”
According to Ms Sayegh-Rooney, the adolescent mind is still developing and has a natural tendency toward risk-taking. “They’re invincible,” she said. “They don’t think anything’s going to ever happen to them, so they will try things.”
Although previous generations have smoked heavily, young people today often pride themselves on being an antismoking generation. “We thought it was over, so we stopped talking about it,” she said. “Meanwhile, the tobacco companies were losing money, and they came in the back door.”
The Teenage Smoking Epidemic
The CDC reports e-cigarette use increased by 68% to 78% among high school students between 2017 and 2018. The JUUL became the most popular e-cigarette in the United States at the end of 2017 and had a market share of 72% as of September 2018.
Ms Sayegh-Rooney said that the majority of young people in middle school and high school have no idea what’s actually in their e-cigarettes. In addition to nicotine, vaping pods contain glycerol (a colorless, sweet liquid formed as a byproduct in soap manufacturing used as an emollient and laxative, and also for making explosives and antifreeze), propylene glycerol (a byproduct of fossil fuel that is often used to create polyurethane plastic and is also a cancer-causing agent), benzoic acid (a product used in insect repellent), and vitamin E acetate (a thickening agent that burns the lungs, used in vaping products containing THC).
Many Names, Same Damage
Be it a JUUL, Myle, Suorin, or a wax pen, the ingredients that go into e-cigarette vapor are not regulated by the FDA. These are all noncombustible and fall under a classification called electronic nicotine delivery systems.
“I ask these kids if they know how much nicotine is in their JUUL pods, and they think it’s the same as a pack of cigarettes,” she said. In reality, a pack of cigarettes contains about 20 mg of nicotine, while a JUUL pod contains between 55 and 60 mg, the equivalent of 3 packs of cigarettes.
“I want them to know that the tobacco companies are lying to them,” she added. “This isn’t sugar water, and it’s not equal to a cigarette. With each ‘rip’ they’re going to want more, and that’s how the addiction starts. Some of these kids are smoking a pod a day.”
It’s critical that healthcare providers now make the distinction between smoking combustible cigarettes and vaping. “Asking our patients if they smoke is not good enough anymore,” she said. “We now have to ask, ‘do you vape?’ Because these kids will tell you they do not consider vaping smoking.”
Two Connected Epidemics
The damage caused by smoking and vapor inhalation is now well known and documented. This year, the New England Journal of Medicine covered the 2 distinct but related epidemics connected with vaping: a continued surge in use by young people, and a recent outbreak of lung injuries.
EVALI (e-cigarette, or vaping, product use–associated lung injury) is the name given by the CDC to the dangerous, newly identified lung disease linked to vaping following the outbreak first documented in Wisconsin in August 2019.
As of January 2020, 2602 cases of EVALI have been reported to the CDC from all 50 states, and 57 of these cases have resulted in death. “These cases that died were between the ages of 18 and 40,” she said. “That’s 57 young deaths.”
According to Ms Sayegh-Rooney, because this is a new diagnosis, currently there is no way to predict how patients will fare after being released from the hospital following treatment (typically some combination of corticosteroids, antibiotics, and/or antivirals).
Due to the lack of long-term data and the fact that patients have died of EVALI, the prognosis for those affected remains uncertain. “Some of these young adults tell me they’re not worried about lung cancer,” she said. “But with e-cigs and vaping, we know it’s causing this type of irreversible lung damage sooner rather than later.”
We all share the responsibility of keeping harmful and addictive tobacco products out of the hands of kids and young adults, said Ms Sayegh-Rooney.
The FDA’s plan to stop youths from using tobacco products, especially e-cigarettes, focuses on 3 key areas: preventing youth access to tobacco products (ie, price increases, indoor-use restrictions), curbing the marketing of tobacco products aimed at youth (ie, flavor restrictions), and educating teens about the dangers of using tobacco products and retailers about their key role in protecting young people in this regard.
“We need a call to action. We need it to be grounded in science, and we need to make these tobacco companies accountable,” she said. “Don’t stop the conversation.”