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The Vaping Explosion: A Pediatrician's Perspective

Bill Klaproth (Host): Many parents have questions and are concerned with the growing trend of vaping. So, we talked with Dr. Michelle Bowden, a pediatrician specializing in adolescent medicine to get her thoughts and to see if she has noticed a rise in teen vaping.

Michelle Bowden, MD (Guest): Yeah, we’re seeing it more and more. I think as the media has brought light to this; we’re starting to see parents especially who come in and have found vaping devices and luckily, I think we are actually – parents are recognizing them more, to the credit I suppose of some of these corporations. These devices have become very incognito. They look like USB drives and they are easy to conceal in pockets and in backpacks and so, teenagers are really – they think that they can’t be discovered when they are using them because they look so much like their devices that we are using in our regular everyday lives. When really, these are very dangerous devices that a lot of adolescents have easy access to.

Host: And I would imagine you don’t smell like smoke when you come home, so it’s harder for your parents to discover.

Dr. Bowden: Exactly. We have teachers that are coming in and saying they are finding these devices; kids are using these devices even in the back of classrooms. Because they’ve been engineered to produce so little byproduct that smell different. They smell like the flavors they are consuming which at this point is over 8000 flavors including things like mango and fruit punch and cinnamon roll and so these – even the children may not know the dangers of them because of the flavors that they buy them in and then you see them using them in their bedrooms and in their bathrooms and at school. Because they are just so easily accessible and produce so little byproduct.

Host: With all of these 800 flavors to vape, do we know what the health risks are of inhaling those heated vaporized flavors?

Dr. Bowden: Yeah, so the health risk even of just the flavors and I think this is a good point to bring this up is that a lot of our kids actually think they are just smoking a flavor. They’ve been marketed that way and they are sold that way. When in actuality, within most of these products, they still contain nicotine even if they are marketed primarily for their flavor. There’s a study from 2016 that shows that about 60% of adolescents didn’t know that what they were smoking contained nicotine in it. So, the products themselves are dangerous certainly when they contain nicotine. The problem is that our kids don’t know that they are containing nicotine. And even when they don’t contain nicotine; the products, the flavors themselves are made out of things like the products that we make antifreeze out of that are being inhaled by our students and our adolescents.

We’ve seen even in short-term smoking studies of these vaping products that there are increased cases, reported cases of shortness of breath, and cough and fevers and there has even been some increased cases of a specific type of pneumonia that’s related specifically to the byproducts that are related to these flavors. So, certainly even if there weren’t nicotine which most of them do have nicotine in them; just the flavors themselves are products that aren’t going to have any health benefit to our students.

Host: You just mentioned shortness of breath, cough, fever. So, what are the real health risks associated with vaping?

Dr. Bowden: Yeah. Well, as I have kind of alluded to, the primary health risk that we are all concerned about is the risk of addiction to nicotine. Some of the products on the market right now, like I said, they don’t advertise that they contain a lot of nicotine very often, especially when they are marketing towards the younger audience. But they do in reality contain significant amounts of nicotine. One particular product contains as much nicotine as an entire pack of cigarettes in one vaping pod.

So, just with the consumption of one pod that an adolescent would purchase; they would get over 200 puffs worth of nicotine. And then in the adolescent brain, what we know is that our brains aren’t fully developed into an adult capabilities until we are in our mid-20s, probably 25 or 26 and when add an addictive substance like nicotine into a developing brain; you have even more profound affects then you would see in an adult brain. So, if we take some scientific type of approaches to studying nicotine addiction in adolescents; what we know is that the higher levels of nicotine are more likely to produce addiction in adolescents. And potentially could even lead to permanent brain alterations in the chemistry and in the structure of the way that that brain will potentially develop over time when they do have a fully functional adult capability type brain.

And so, the risks of addiction are very real and more pronounced than in older people. The risk of those brain chemistry alterations is very real in adolescents who are using vaping products. And ultimately, what we don’t know yet is perhaps even scarier is that because these products have been so on the market such a short time is that we think there are probably other risks like does this predispose adolescents to other types of addiction and those are things that we are still studying and still trying to find good answers to.

Host: Dr. Bowden you mentioned 60% of the kids using these vaping devices didn’t realize the nicotine content within. Has this become so popular because kids don’t realize the dangers of vaping?

Dr. Bowden: Yeah, absolutely. I think we as adults who are responsible for kind of educating and caring for these kids, I think have not done a great job at keeping up with honestly, some of the advertising and just the growth that we’ve seen specifically in E-cigarette use over the last few years. and I think a lot of that does have to do with education that our adolescents don’t realize that they are smoking a nicotine containing product and certainly don’t realize the amount of nicotine that’s available in some of these products. I don’t think they realize that flavors are made from potentially very harmful products that could cause damage to their lungs and cause symptoms later as they use them more and over time.

And ultimately, we’ve even seen things like the E-cigarettes have exploded in pockets and in people’s faces and caused those kinds of damage that potentially long-term damage based on those burns that they could cause if that were to happen to one of our adolescents. So, overall, pretty much anyway we break this down; E-cigarettes are dangerous for adolescents and really should never be used.

Host: So, Dr. Bowden, the AAP recently released a policy paper calling for a ban on sales of E-cigarettes to people under the age of 21. What do you think about that? Is that a good idea?

Dr. Bowden: Yeah, I think that’s an excellent idea. What we know is that adolescent brains continue to develop well into their 20s and the amount of nicotine content that we a seeing in these products certainly the nicotine affect is going to have long-lasting effects the earlier that the adolescents are able to start smoking and using these products.

And so I think really allowing adolescents to make more informed decisions as they grow, and their brains continue to develop; I think it is an excellent idea and really there’s just lots of regulatory issues that are involved in these products including the types of flavors that are being sold and really who that market is geared toward. So, I absolutely support the AAP policy and I’m hopeful that we will see movement in terms of policy towards regulating and restricting these types of devices in the future.

Host: Last question Dr. Bowden. What advice do you have for parents worried about their children and the temptation of vaping?

Dr. Bowden: Man, that’s a great question and a question that I’m always pleasantly surprised to hear from our parents when they are kind of ahead of the game by asking that question and really want to get out in front of what their kids are learning from their peers or learning from commercials or other advertisements about vaping. Really parents talking to their kids is the best preventive measure that we have as pediatricians and as activists who really want to see our adolescents have such bright healthy futures.

And so, my advice would really be to bring up the conversation and I think that feels scary for a lot of parents to bring up a conversation about something that maybe they don’t know very much about or that we didn’t grow up having to learn about or deal with even as many of us didn’t even have the option of E-cigarettes in our adolescence. But really there’s some great information out there that the American Academy of Pediatrics publishes some great information about E-cigarettes. The Center for Disease Control actually has a talking to your child toolkit that you can use that has some great advice about when and how to bring up that conversation with teens and that doesn’t have to be an awkward let’s have a very serious conversation about this where you say at 4:30 on Tuesday we are going to sit down and talk about E-cigarettes.

But just when you are going to a basketball game or riding down the street and you see somebody using an E-cigarette, it is just as simply as tell me what you think about E-cigarettes is a great conversation starter. Especially I would encourage parents to start that conversation younger. That what we know is that middle schoolers are being exposed to this and 5% of middle schoolers say that they have used E-cigarettes in the past. So, I think parents really getting a hold of that conversation before an adolescent has to make that choice of whether or not they are going to use; I think is a really great opportunity for them to provide some education for their child and then if they need backup or they want to continue the conversation to reach our to their pediatrician to continue those conversations and to really make sure that our adolescents are fully equipped to make the best decisions that they can and that they know that they can talk to their parents and their pediatricians when they are faced with those kind of decisions.

Host: Well, that’s great advice. Look for those opportunities for discussion and conversation about E-cigarettes when your children, when they occur. Well, Dr. Bowden, thank you so much today and talking with us about the dangers of vaping. This is the Peds Pod by Le Bonheur Children’s Hospital. I’m Bill Klaproth. Thanks for listening.