Case Study

Screening for Adolescent Vaping

E-cigarettes, or vapes, are the most commonly used tobacco products among youth. In 2023, more than 2 million U.S. middle and high school students reported using e-cigarettes in the past 30 days.

Centers for Disease Control and Prevention [CDC}, 2024

“I know people who vape,” says 13-year-old Tanya. “I did it twice. It won’t cause lung cancer like real cigarettes do.”

Adolescents who vape often believe they are inhaling harmless flavored water vapor and can be unaware that e-cigarettes can contain nicotine. The toxic and powerfully addictive drug can damage the developing brain through age 25 years (CDC, 2024). Recent studies show that e-cigarettes are associated with a higher likelihood of smoking cigarettes and using other substances (CDC, 2024).

“Well, yeah, I do like to vape,” says 16-year-old Orin. “My parents both cough and wheeze a lot from cigarettes, but not me. E-cigs aren’t like smoking. They won’t mess up my lungs. It’s just water vapor.”

E-cigarettes produce an aerosol of chemicals and ultrafine particles that can be inhaled deep into the lungs. The CDC lists the following potentially harmful ingredients of e-cigarette vapor:

  • Nicotine
  • Flavoring chemicals such as the solvents propylene glycol and glycerol, and diacetyl, a chemical linked to a serious lung disease
  • Volatile organic compounds that are linked to cancer
  • Heavy metals such as nickel, tin and lead

“Oh, I just quit smoking!” says 18-year-old Joel. “My girlfriend hates it. She says it smells bad, so I started vaping instead. Right away, it felt better on my throat, and my girlfriend is okay with it.”

Screening and Counseling

Primary care providers are in a key position to open a dialogue about vaping with adolescent and young adult patients. Nationally, “e-cigarette use has been documented as highest among boys, non-Hispanic white youth, and Hispanic youth” (American Academy of Pediatrics [AAP], 2019).

Annual preventive medical checkups provide an ideal opportunity for early detection and discussion of e-cigarette use. Ask open-ended questions such as:

  • What do you and your friends think about e-cigarettes?
  • What have you learned about e-cigarettes online?
  • How do you and your friends learn about the health effects of vaping?
  • What does your school teach students about vaping?

Tanya, who has vaped and thinks it’s safe, needs to know:

  • Medical studies show that e-cigarettes may contain lots of chemicals that are linked to cancer, heart attack and asthma.
  • Public health officials are warning teenagers away from e-cigarettes because of the risk of severely damaging your lungs.
  • E-cigarette labels may not show all the chemicals they contain, like nicotine, which is addictive and can harm your brain. Nicotine can reduce your ability to think, remember things, and do well in school so you can get the kind of job you want.

Orin, who vapes rather than smokes so he doesn’t cough like his parents, needs to know:

  • E-cig vapor isn’t water at all but an aerosol of chemicals that can cause cancer and injure your lungs.
  • Vapes may contain nicotine, which is what causes people to get addicted in the first place.
  • Vaping can cause problems while you’re still young. Little is known about what the effects may be when e-cig users get older.

Joel, who switched from smoking to vaping, needs to know:

  • Congratulations for quitting smoking. Cigarettes are addictive and cause lung cancer and other breathing diseases.
  • You switched to vaping, but medical studies show that it can cause those same problems because the vapor has nicotine and toxic chemicals.
  • No strong evidence shows that e-cigarettes help people quit smoking regular cigarettes. What other ways have you tried to quit smoking and break the nicotine addiction?

Why It Matters

As a trusted primary care provider, you can help address dangerous myths about e-cigarettes by educating young patients and their families about vaping with accurate and reliable information. Counsel youth during their annual preventive medical checkups, and always ask about e-cigarettes when discussing substance use and other risky behaviors.

References

American Academy of Pediatrics. (2019). Policy Statement: E-Cigarettes and Similar Devices.

Centers for Disease Control and Prevention. (2024). About E-cigarettes (Vapes).