Thursday, 11 August, 2022
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Adolescent vaping – monitoring needed to detect potential future health issues

With a surge in electronic cigarette (EC) popularity among youth over the past decade, and insufficient data on the effect of its use in adolescents, vigilance and monitoring of potential harms are key, according to a US study.

In the US, exclusive current use of ECs rose to record levels among youth between 2011 and 2018, according to the Centres for Disease Control and Prevention (CDC), with a further large increase in the period 2018-2019.

In terms of demographics, no gender difference has been reported, but white non-
Hispanic youth have the highest vaping rates. In the UK, New Zealand and Australia, similarly high prevalence of EC use among youth has not been reported.

Vaping by young non-smokers is a legitimate concern. Although not studied in depth, there is a risk that 
some will become nicotine-dependent or may take up tobacco smoking. Although as yet there is 
little information regarding the long-term health effects of legally purchased combustion-free nicotine 
products in young people, some experts have raised concerns that EC use may have adverse effects in developing brains and lungs of adolescents.

The most commonly reported adverse effects are throat/mouth irritation, headache, cough, and nausea, which dissipate with continued use.

Study details

A Close Look at Vaping in Adolescents and Young Adults in the USA

Riccardo Polosa, Thomas Casale, Donald Tashkin.

Published in The Journal of Allergy and Clinical Immunology: In Practice (2022)

Vaping by adolescents and young adults is a legitimate concern as there is a risk that some may start smoking and that electronic cigarette (EC) use may have adverse effects in their developing lungs.
EC use has surged greatly among high school students and young adults over the past decade but 
fortunately has declined significantly since its peak in 2019. During the same time period, smoking rates 
have constantly fallen to new low record levels. These trends argue against EC use as a gateway to 
smoking. Most EC usage is infrequent and unlikely to increase a person's risk of negative health
Furthermore, the majority of EC usage has happened among those who have previously smoked.
There is a dearth of data on the long-term health implications of EC usage in adolescents and 
young adults. We do not know whether short-term or intermittent use of EC in youth can lead to negative 
health outcomes in adulthood, and long-term high-quality studies in well-defined groups are needed. 

Although vaping has been linked to respiratory symptoms, they tend to be transient and of uncertain significance. This commentary provides up-to-date information so health care providers can give objective and responsible medical advice on EC usage. 

The prevalence of youth vaping in the US has been monitored by many national surveys, including the 
Monitoring the Future (MTF) funded by the National Institute on Drug Abuse (NIDA). 

The MTF survey found that youths who have never smoked were much less likely to use EC than those 
who have smoked (18,24). Only 1.7 and 0.7% of never smokers reported using EC for > 5 days and 20–30 
days of the past month, respectively. In contrast, 14.7% of current regular smokers and 15.0% of youth who 
smoked regularly in the past were using ECs frequently, suggesting that for some youth there is a 
predisposition to the use of nicotine containing products in general.

The current trends of decreasing combustible cigarette smoking and EC use are encouraging. Nonetheless, 
we must remain vigilant to ensure that excessive levels of vaping among youths are promptly detected and 
reversed as soon as possible. In the meanwhile, authorities must enforce current regulations addressing illicit sales to minors to limit access to tobacco and nicotine products.
When compared to tobacco cigarettes, ECs have been shown to emit far fewer toxicants and carcinogens.
Despite existing knowledge about the potential adverse effects of the chemicals in EC emission aerosols – 
based on analytic chemistry, and the toxicology and epidemiology of those exposures – we do not know 
whether short-term or intermittent use of EC in youth can lead to adverse health consequences in 
adulthood, and clearly long-term high-quality studies in well-characterised populations (that consider 
important factors such as user characteristics, frequency of use, device utilised, and e-liquid type 
 consumed) are needed.
While the US FDA’s strict regulatory requirements will ensure that ECs on the market for US smokers are “appropriate for the protection of public health”, robust post-market surveillance will be required to identify any unanticipated health issues that may arise from any harmful chemicals emitted by ECs.


The Journal of Allergy and Clinical Immunology: In Practice article – A Close Look at Vaping in Adolescents and Young Adults in the USA (Open access)


See more from MedicalBrief archives:


Vaping may play a role in adolescents starting to smoke


Huge uptick in adolescent cannabis vaping – Columbia study


Anti-vaping research drowns out harm reduction advocates in Australia



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