What parents should know about vaping
An interview with researcher Bonnie Halpern-Felsher
Hundreds of people in the United States have contracted a condition, newly termed vaping-associated pulmonary injury, and more than 25 have died from it. While it’s not clear what causes VAPI, public officials, health experts and parents fear that young people are especially susceptible, as nicotine vaping has become popular among teens. Bonnie Halpern-Felsher, PhD, professor of pediatrics at the Stanford School of Medicine, spoke with Stanford Medicine News about her research on young people’s perceptions of these products.
Why should parents be concerned about nicotine vaping devices?
In recent months, there have been hundreds of cases reported nationwide of a severe vaping-related lung disease that resembles pneumonia. The U.S. Centers for Disease Control is investigating, and my team has been following the news closely.
Every adolescent knows about e-cigarettes and is either at risk of using or is already using them. It’s concerning because adolescents’ developing brains are more likely to become addicted, and they are more likely to have learning issues and problems concentrating if they develop a nicotine addiction.
The nicotine content of e-cigarettes ranges from none to over 41 milligrams per pod, which is the amount in Juul, the product most youth are using. Forty-one milligrams is equivalent to one and a half to two packs of cigarettes — a tremendous amount of nicotine. For other e-cigarettes, the average is 25 to 36 milligrams, around a pack of cigarettes’ worth.
It’s not just the amount of nicotine that is hazardous. Juul uses salt-based nicotine, which produces a less painful “throat hit” than what is inhaled from a combustible cigarette. Youth find it easier to use salt-based nicotine in higher amounts, and thus become addicted to it more quickly and easily.
Your research on e-cigarettes and pod-based devices like Juul uncovered misunderstandings in teens’ perceptions of the devices. What did you find?
Adolescents do not recognize how much nicotine is in any e-cigarette, particularly pods. And they’re not aware of other ingredients, such as propylene glycol, benzoic acid and flavorants. Often, teens are using these products because of the flavors but don’t realize that the flavoring chemicals — such as vanillin, diacetyl and cinnamon aldehyde — can cause problems in the lungs. Recent Stanford research shows that flavor compounds in e-cigarettes harm cells lining our blood vessels.
Young people also tend to misperceive e-cigarettes as safe after being exposed to advertising claims that label these products as less harmful than combustible cigarettes. For adults who smoke combustible cigarettes, they may be less harmful, but we don’t have clear studies on that.
An important distinction is that today’s adolescents are not using or planning to use combustible cigarettes at all. Saying these products are “less harmful” is not true for youth. These products are far more harmful than not using nicotine at all.
How do teens perceive e-cigarette marketing?
The young people in our studies told us, “They’re clearly advertising these products for me.” The flavors appeal to young people, as do the beautiful, colorful advertisements, with bling, music, dancing. Our research shows that the fact that these devices are sleek, easy to hide and don’t have a traditional cigarette smell are also reasons teens use them.
The FDA and Congress are investigating how Juul’s marketing targets young people. Decades of traditional tobacco ads were aimed at adolescents, and there is great concern about those tactics being revived.
You’ve developed an online tool kit about vaping. What are its key messages?
Our Tobacco Prevention Toolkit, available at https://med.stanford.edu/tobaccopreventiontoolkit, is a free resource for parents, educators and health care providers. We really try to illuminate the role that marketing plays in getting kids to use nicotine products. We want young people to understand that they’re being manipulated by manufacturers.
We also talk about the chemicals in e-cigarettes and vapes and the associated health risks, as well as the addiction risk for the developing brain.
And we discuss how to refuse these products. Teens brainstorm things they can say to avoid vaping: “I’ve tried it and I don’t like it”; “I’m allergic to it”; “I have asthma, so it’s not good for me”; or my favorite, “When I get home, I have to hug my parents. If I smell like blueberry or mango, they’ll know something is up.” Teens want to save face with their friends, and they do better in these situations if they can give a reason for saying no.
What can parents do if they think their teen is vaping?
Talk to your sons and daughters using open-ended questions. You can say, “I read an article about vaping products. I’m curious: What do you know about these?”
Then you can share your concerns: “If you’re using these products, I want to understand so I can get you some help. I’m not going to be mad.” You can also talk with your kids about how to refuse, helping them plan responses so that they feel ready to say no.