Bill Klaproth (Host): Many parents are concerned with the rise in teen vaping, so how do you, pardon the pun, cut through the haze to find clarity on this growing issue? With us to talk about the dangers of vaping, is Jennifer Lavallee, a pediatric primary care nurse practitioner at Southern New Hampshire Health. Jennifer, thanks for your time. So, what is vaping, and why has it become so prevalent?

Jennifer Lavallee, MS, APRN, CPNP: Well thanks for having me, Bill. So, vaping is basically the term used for electronic cigarettes or E-cigarettes, which are battery-operated devices. They came to the US market in 2006, but they have really been more heavily marketed since probably 2010. They are available both online and in traditional retail stores, and they basically consist of a cartridge that has a liquid, a vaporization chamber, and a heating element with a battery. So, they are designed to create an aerosol that delivers an e-juice into the lungs. There are various styles and different types out there on the market. They were initially promoted as a smoking cessation tool, but their use among high school students has dramatically increased. It was 1.5% in 2011, and now it’s as high as 20% in 2018, which is over and above three million students.

Host: So, you mentioned marketing. Is that part of the reason why vaping has become so popular with teens?

Jennifer: Yes, it does seem that that’s the case. There actually was a surgeon general’s report in 2016 that concluded that the flavors in E-cigarettes were one of the main reasons why youth were using them. But I mean, you see them, they were, when they first came out, selling them in small kiosks in the middle of shopping centers, and the devices if you look at some of them, are very colorful, and the flavors are – there are as many as 7000 different flavors. So, that certainly led to interest on the part of the teens as well as the fact that the JUUL, which is the most widely used device for teens, is quite easy to conceal. It's about the size of a flash drive and so, that became a way for teens to be using this even in schools or without their parents even realizing what they are using.

Host: So, you mentioned this originally was thought of as a way to help quit smoking, which I imagine is true in some cases. Are there any other benefits to vaping?

Jennifer: So, the main benefit is possibly that it can help smokers cut back or quit cigarettes altogether, however, it is not FDA approved for smoking cessation at this point. There are still ongoing studies. Vaping does offer a way for smokers who are currently smoking to get nicotine without tobacco or tar, which are known carcinogens. But we still don’t know the effects of inhaling the flavorings in the vape.

Host: So, what do we know at this point? What are some of the known risks to vaping?

Jennifer: So, we know that they can cause burns and that some of the devices have actually exploded, so the fact that they are combustible is one risk. There is some evidence that vaping is also associated with cough and asthma symptoms in adolescents. Most of the devices and all of the JUUL devices contain nicotine, and even if they are using a device without – with a juice that has no nicotine; it still contains not just water vapor, but other substances like this polyethylene glycol flavoring, vegetable glycerin and these are things that are safe to eat, but we don’t know if it’s safe to inhale them into the lungs. So, when you heat some of these ingredients, the chemicals can actually become harmful. There are also other ingredients like lead, nickel, and arsenic that have been found in E-cigarettes and in the vapor as well. So, vaping is a fad now, but when the fad goes away, the addiction may remain, and it can take people who know eight to ten tries to quit smoking because nicotine is such a strong addiction. So, quitting vaping is going to be hard, and teens who have vaped are four times more likely to use traditional cigarettes.

Host: And continuing to talk about nicotine. What are some concerns regarding nicotine use with adolescents?

Jennifer: So, teens are more susceptible to the addictive properties of nicotine. The brain in teenagers is continuing to develop right up until about age 25. So, this learning brain will actually learn the addiction more quickly than it does for adult brains. And tobacco companies that own the majority of E-cigarettes now have actually targeted teens in their marketing because they can get hooked so easily. Nicotine at a young age has been associated with mental problems like depression and panic disorder. In addition, the neurotransmitters that control impulse control are permanently altered when exposed to nicotine at a young age, putting kids at higher risk for addiction – other addictions to other substances later in life. And once they are addicted; going without nicotine can actually lead to withdrawal symptoms. So, some of these adolescents are having anxiety, irritability, they are having trouble concentrating, restlessness, impatience, hunger. They can have tremors or racing hearts, feel dizzy, drowsiness, headache, and imagine dealing with all these feelings when you are trying to learn in school which is quite difficult.

Host: Yeah, so are there any regulations in place for vaping devices at this point?

Jennifer: Well in New Hampshire, there’s a state law that you have to be 18 to buy E-cigarettes or vaping devices. Some towns, on their own, have opted to raise the age to 21. But, as I mentioned earlier, they are available online. People have older siblings, so they are not having too hard of a time accessing them, unfortunately. Many public health experts have recommended restricting E-cigarette marketing and advertising to youth and banning flavorings. So, in 2016, the US passed a law requiring liquid nicotine refills to have child-resistant packaging on them. Another way to try to help prevent them from getting into the wrong hands. And also, that same year, the FDA defined E-cigarettes as a tobacco product; hopefully, we will get some more regulations in place because of that. So, cigarette use is banned on airplanes, as well.

Host: I was going to say for a product first thought to be much better than smoking, what you are talking about here, really, there’s a lot of nasty and negative things that are happening with vaping.

Jennifer: Yes, absolutely. Absolutely. In fact, a lot of schools are now banning devices because they are considered drug paraphernalia. The pods that are used in some of these vaping can be altered, and you can even have marijuana added to them. So, a lot of the schools will treat it as if they had possession of drugs if they are caught with any of the vaping devices and be expelled or whatever the consequences may be for each given school.

Host: Yeah, that makes sense. So, for a parent trying to navigate this, what is important for parents to know about vaping?

Jennifer: Well, I think it’s important to start talking to your children at a young age about why you don’t want them to ever try this. We, at the office, give out handouts starting at age 10 to our 10-year-olds at their physicals on what vaping is, what devices look like, and what the potential risks are. So, prevention is absolutely key because we know that once they get hooked on nicotine, which can happen within even a few days, it’s going to be hard for them to stop. So, unfortunately, we don’t have a lot of studies on how to treat nicotine addiction in teens. The studies have only been done in adults. However, if parents have concerns about their teens or know that they are using it; there is a 1-800-QUITNOW access line that is available for treatment services. They aren’t able to provide any over-the-counter nicotine replacement therapies to anybody under the age of 18, but they can give other advice for help. Poison control centers have been getting an increased number of calls because of exposure to liquid nicotine in infants and toddlers. I mentioned the packaging, but if an infant or toddler ingests this, then that can be dangerous as well.

Host: Wow. And with smoking tobacco products, I guess the old adage is the same for vaping. It is better to never start than to try to quit, and a great number there: 1-800-QUITNOW. 1-800-QUITNOW. Jennifer, thank you so much for your time. We appreciate it. For more information, please visit www.snhhealth.org that’s www.snhhealth.org. This is Simply Healthy, a podcast by Southern New Hampshire Health. I’m Bill Klaproth. Thanks for listening.