Tackling Teen Vaping
Vaping and e-cigarettes have pushed teen nicotine use to its highest level in nearly two decades. COVID-19 makes the risks even greater.
By Ambreen Ali
The effects of COVID-19 might have proven less severe for young people compared to the general population, but the threat rose for teens who vape. In 2020, 19.6% of high school students and 4.7% of middle school students reported using e-cigarettes — putting a total of nearly 3.6 million American youth at higher risk.
Individuals who used e-cigarettes have been five times more likely to be diagnosed with COVID-19 than non-users, and 6.8 times more likely to be diagnosed if they both vape and use conventional cigarettes, researchers at Stanford University School of Medicine revealed in a study published in August.
“We could early on speculate that vaping increased the complications after contracting COVID-19,” says Dr. Donald McNally, medical director at AmeriHealth Caritas New Hampshire. “When you inhale, these products damage the protective layers of mucus in our respiratory tract and cause a low-level inflammation. It leaves us more susceptible to illnesses of the respiratory tract.”
The danger doesn’t stop there. Teens who vape also had contracted or spread the virus more easily because of factors like a suppressed immune system, repeated hand-to-mouth movements or sharing vapes among friends, according to Dr. Drew Harris, a pulmonologist and assistant professor of medicine at University of Virginia.
COVID-19 increased the urgency of public health efforts already underway to curb teen vaping. Two months before many states issued stay-at-home orders to slow the spread of the virus, the FDA banned the sale of e-cigarette cartridges in flavors other than tobacco and menthol. In December 2019, the agency also raised the federal minimum age for buying tobacco products — including e-ciga-rettes — from 18 to 21.
City and state governments have taken action as well, moving to restrict or ban the sale of e-cigarettes and vaping products. The number of states that taxed vaping products jumped from nine in January 2019 to 25 by August 2020. And three states — North Carolina, California and New York — sued e-cigarette maker Juul in 2019, claiming the company illegally marketed its products to teenagers.
Public outcry and policy actions have yielded mixed results. According to the 2020 National Youth Tobacco Survey, 1.8 million fewer young people reported using e-cigarettes than in the prior year. But the survey also found a notable uptick in the use of disposable e-cigarettes, which did not fall under the FDA ban and represented “a major loophole,” says Dr. Harris.
“High school students have just switched to disposable products, which are allowed by current law to have youth-appealing flavors like candies or desserts,” he says.
Concerns Beyond COVID-19
The concern about teen vaping extends far beyond their increased vulnerability to COVID-19. The products pose a serious danger to teen health, say Dr. William Riccardelli, an attending child and adolescent psychiatrist and addiction medicine specialist at Boston Children’s Hospital and instructor in psychiatry at Harvard Medical School, and Dr. Tamara Itzel Marti-nez, attending physician in addiction medicine at Boston Children’s Hospital/Harvard Medical School.
“Nicotine is a highly addictive substance, and it has toxic effects on the developing adolescent brain,” Dr. Riccardelli says.
Among teenagers, the drug can mimic anxiety and mood disorders, as well as negatively affect attention, learning, impulse control and sleep. Nicotine can also lead to higher instances of stroke, heart attack and cardiovascular conditions.
Meanwhile, teen users may be developing a lifelong addiction. According to the Centers for Disease Control and Prevention (CDC), e-cigarette use at a young age may spur cigarette use later in life.
The devices themselves can pose additional hazards, including leaking toxic metal aerosols that, when inhaled, can cause organ damage, depress the immune system and raise the risk of some cancers, according to researchers at the Johns Hopkins Bloomberg School of Public Health. And investigation continues into a national outbreak of severe vaping-related lung disease, which resulted in 68 deaths and more than 2,800 hospitalizations from March 31, 2019, to Feb. 15, 2020, the most recent data published by the CDC.
In light of COVID-19 and the potential for other health threats, policymakers should double down on efforts to reduce teen vaping, says Dr. McNally. He recommends many of the same deterrents that helped curtail the use of combus-tible cigarettes: increased taxation, marketing limits, promoting awareness of health risks, restrictions on smoking indoors and at workplaces, and expanded Medicaid benefits for cessation services.
“It’s definitely a problem that can be addressed, but we need a more concerted effort,” he says. “Unfortunately, the pandemic has eclipsed a lot of what has been going on.”
This article appeared in issue 3 (2021) of In Reach by AmeriHealth Caritas.