E-Cigarette Use Among Adolescents – Clinical Advisor

109 points

Tobacco use is the main reason behind preventable morbidity and mortality in america, and use most frequently begins throughout adolescence and early maturity.1 The usage of battery-operated digital cigarettes (e-cigarettes or ECs) amongst kids and teenagers has turn into a public well being epidemic.2,3 E-cigarettes are the main tobacco product utilized by the US adolescent inhabitants.1,4 Well being care suppliers ought to constantly display screen for and counsel sufferers concerning EC use to assist in well being promotion and illness prevention as the usage of these merchandise can result in critical comorbidities and antagonistic occasions.

Acceptance for EC use is probably going attributed to the notion that they’re safer to devour and in addition could also be used as a smoking cessation software. This widespread notion, together with ease of entry to ECs has led to the introduction of and habit to nicotine merchandise amongst adolescents.5

Hartmann et al carried out a scientific evaluation aimed to find out if ECs can help in smoking cessation.6 Sufferers who obtained nicotine ECs skilled greater give up charges than those that obtained nicotine alternative remedy (threat ratio [RR], 1.69; CI 1.25-2.27) or non-nicotine ECs (RR 1.71; CI 1.00-2.92). Delicate to average antagonistic occasions have been reported corresponding to throat and/or mouth irritation, headache, cough, and nausea. These antagonistic results tended to dissipate with constant use; nonetheless, there was no point out of long-term results related to continued use of ECs.

E-Cigarettes Could Result in Smoking Flamable Cigarettes in Teenagers

Findings from a potential cohort examine by Barrington-Trimis et al present that adolescent EC customers are over 6 instances as more likely to provoke conventional cigarette use in contrast with adolescents who’ve by no means used ECs. As well as, after solely a 16-month follow-up interval, initiation of flamable cigarette use was reported by 40.4% of adolescents who beforehand used e-cigarettes vs 10.5% of those that had by no means used ECs.7 This means the experimentation with ECs could result in transition to flamable cigarette use at an early age.

Composition of E-Cigarettes

E-cigarettes, not like flamable cigarettes, use an electrical component to warmth and vaporize a liquid-based flavorant (e-liquid). This e-liquid consists of water, flavoring, and different substances corresponding to glycerol, ethylene glycol, polyethylene glycol, and propylene glycol. Options with nicotine additionally comprise natural tobacco substances and impurities. Regardless of the labeling of e-liquid contents for customers, inconsistencies in e-liquid manufacturing and labeling have been reported corresponding to false promoting of nicotine-free liquid when nicotine is current or vice versa.8

Well being Dangers of E-Cigarettes

Use of ECs has been proven to have antagonistic systemic results, most notably inside the oral cavity, respiratory, cardiovascular, and immune methods.9 The vapor produced by ECs instantly impacts the reworking of extracellular matrix gingival fibroblasts, which play a big position in repairing periodontal tissues, and obstructs elements that help in cell proliferation, apoptosis, migration, and wound closure.9 Publicity to both nicotine-containing or nicotine-free fluids and vapors in ECs has been demonstrated to extend manufacturing of free radicals known as reactive oxygen species (ROS).9  

The airway epithelium is the subsequent web site of contact for inhaled substances. Inhaled substances from ECs enhance the permeability of the airway epithelium, making a cascade of occasions resulting in airway irritation and destruction of lung tissue.9 This happens with each nicotine-containing and non-nicotine-containing ECs.9 Like flamable cigarettes, continual EC use causes a shift in cardiac autonomic stability towards better sympathetic superiority and elevated oxidative stress ranges, each of that are identified threat elements for the event of heart problems.9 Adolescents doubtlessly take up greater concentrations of EC vapors due to their greater resting respiratory charges and incapability to clear nicotine as successfully as adults.9 Elevated dermal absorption on this inhabitants can be a threat on account of second-hand vapor publicity.9

Inhalation of EC vapor additionally will increase ranges of platelet-activating issue receptors (PAFRs). Pneumococci micro organism make the most of these receptors to bind to host epithelial cells and facilitate pneumococcal illness.9 The usage of ECs additionally will increase the chance for different infections corresponding to methicillin-resistant Staphylococcus aureus, rhinovirus, influenza, and Streptococcus pneumoniae.9

Traditional ECs containing nicotine flavoring have a decrease ROS manufacturing than ECs containing different flavorings.9 The discharge of ROS from ECs containing fruit-flavored e-liquids will be 3 instances better than that of ECs containing tobacco taste.9

Screening for E-Cigarette Use

As ECs have turn into probably the most extensively used tobacco merchandise by adolescents, the American Academy of Pediatrics (AAP) recommends screening, schooling, and cessation counseling for EC use within the main care setting beginning at age 11 years.10 E-cigarettes shouldn’t be really helpful as a tobacco-dependence therapy product, in accordance with the AAP tips.10 As well as, suppliers should turn into accustomed to language used amongst this inhabitants (ie, vaping, JUULing, and e-cig) to maintain an open line of communication and stop missed alternatives for counseling.

The AAP recommends utilizing the 5As Mannequin for Tobacco Screening and Counseling (Determine).10 Clinicians ought to guarantee consistency in asking about tobacco use at every appointment and use standardized documentation. Sufferers must be suggested to give up utilizing tobacco or EC merchandise and clinicians ought to assess the sufferers’ willingness to give up. Help with both pharmacotherapy or counseling sources must be offered and a follow-up appointment must be organized to watch progress in direction of cessation.

Determine. 5As Mannequin for Tobacco Screening and Counseling10

As well as, adolescents must be offered one-on-one time with clinicians to talk freely and confidentially, with out dad and mom within the room. As all the time, this info between the affected person and clinician must be stored confidential until permission is granted by the affected person.11 The AAP’s e-cigarette curriculum consists of ICD-10-CM and CPT billing codes that can be utilized for tobacco use and publicity counseling.


Superior apply suppliers, together with all members of the well being care group, have an inherent obligation to display screen and educate sufferers concerning well being promotion and illness prevention, because it pertains to the usage of vaping merchandise. Schooling on the intense dangers related to ECs must be offered by faculty and campus nurses in addition to main care clinicians. Adolescents and younger adults are at an essential stage of growth, as way of life habits and routines are developed throughout these essential years. Clinicians must be not solely educated however empowered by present proof supporting the necessity for cessation of vaping and different tobacco merchandise.

Britney Lilley BSN, RN, is a labor and supply nurse at Orange Park Medical Heart, Florida. She is at present finding out to turn into a physician of nursing practice-family nurse practitioner on the College of North Florida.


1. Jamal A, Gentzke A, Hu SS, et al. Tobacco use amongst center and highschool college students: United States, 2011-2016. MMWR Morb Mortal Wkly Rep. 2017;66(23):597-603. doi:10.15585/mmwr.mm6623a1

2. Hwang C, O’Neil J. E-cigarette use amongst adolescents. J Nurse Practitioners. 2020;16(6):453-456. doi.org/10.1016/j.nurpra.2020.02.021

3. American Medical Affiliation. AMA and public well being group united on daring motion to forestall e-cigarettes from addicting children. November 22, 2019. Accessed September 22, 2021. https://www.ama-assn.org/press-center/ama-statements/ama-and-public-health-community-united-bold-action-prevent-e-cigarettes

4. Pepper JK, Gilkey MB, Brewer NT. Physicians’ counseling of adolescents concerning E-cigarette use. J Adolesc Well being. 2015;57(6):580-586. doi:10.1016/j.jadohealth.2015.06.017

5. Bhatnagar A, Payne TJ, Robertson RM. Is there a task for digital cigarettes in tobacco cessation? J Am Coronary heart Assoc. 2019;8(12):e012742. doi:10.1161/JAHA.119.012742

6. Hartmann-Boyce J, McRobbie H, Lindson N, et al. Digital cigarettes for smoking cessation. Cochrane Database Syst Rev. 2020;10(10):CD010216. doi:10.1002/14651858.CD010216.pub4

7. Barrington-Trimis JL, Urman R, Berhane Okay, et al. E-cigarettes and future cigarette use. Pediatrics. 2016;138(1):e20160379. doi:10.1542/peds.2016-0379

8. Hahn J, Monakhova YB, Hengen J, et al. Digital cigarettes: overview of chemical composition and publicity estimation. Tob Induc Dis. 2014;12(1):23. doi:10.1186/s12971-014-0023-6

9. Chen IL, Todd I, Fairclough LC. Immunological and pathological results of digital cigarettes. Fundamental Clin Pharmacol Toxicol. 2019;125(3):237-252. doi:10.1111/bcpt.13225

10. Jenssen BP, Walley SC; Part on Tobacco Management. E-cigarettes and related gadgets. Pediatrics. 2019;143(2):e20183652. doi:10.1542/peds.2018-3652

11. American Academy of Pediatrics. E-cigarette curriculum. Accessed September 23, 2021. https://www.aap.org/en/learning/e-cigarette-curriculum/

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