Teens who vape are at higher risk of nicotine addiction, transitioning to cigarettes, and exposure to toxins, according to the recent analysis. But evidence-based vaping cessation programs geared specifically to adolescents are not widely available, the researchers noted, despite how critical these programs could be to curbing e-cig use. If the vaping epidemic continues its upward trajectory, this could become an even bigger problem going forward. The 2019 National Youth Tobacco Survey found that e-cigarette use among teens increased substantially from 2017 to 2018 (whether this trend continued into 2019 is not yet known). And according to data from the Centers for Disease Control and Prevention (CDC), middle school students increased their e-cigarette use by 48% during that time frame, while high school students saw an increase of 78%.
Biggest Risk: Peer Pressure
Adolescents and adults have may face similar hurdles when it comes to wanting to quit e-cig use and being unable to stop, such as using vaping for stress relief, experiencing physical and mental addiction, and potentially lacking access to evidence-based cessation programs. However, many teens are subjected to peer pressure, which can be a formidable roadblock for quitting, says Osita Onugha, MD, thoracic surgeon and assistant professor of thoracic surgical oncology at John Wayne Cancer Institute at Providence Saint John’s Health Center in Santa Monica, Calif. “There is a level of social addiction, and that needs to be addressed when talking about prevention,” he says. “The chemical addiction is what stimulates the cravings, but the ‘coolness’ of smoking around friends and being perceived as a ‘rebel’ make it difficult to give up the social status that some young adults have with their peers.”
Perception, Marketing, and Concealment
Of course, being negatively influenced by a peer group is not a new phenomenon with vaping. Peer pressure and teen smoking have been linked for decades, and a 2017 meta-analysis about tobacco use found that young people aged 10 to 19 have double the risk of smoking if they have friends who use tobacco products. The analysis included data from 16 countries, highlighting that this is a widespread, global issue. What is distinctive with vaping, though, is the belief that it’s not as harmful as smoking cigarettes, or even that it’s not addictive, says Leah Guttman, PsyD, New York City-based clinical psychologist, and founder of Washington Square Therapy, which specializes in emotional well-being for young adults. Despite evidence to the contrary, some teens think that e-cigarettes don’t contain nicotine, or that the amount is low enough that they won’t have any negative effects, especially if they’re not daily users. But a 2014 study noted that nicotine in any form is a neurotoxin in the developing adolescent brain. Guttman adds that e-cig and vaping manufacturers do little to counteract these beliefs. “The way vaping is marketed, with formulated flavorings like mango and buttered popcorn, appeals to younger users,” she says. “Ease of access and concealment may also contribute to use. And the biological pathways that lead to addiction, and the social reinforcement factors, are the same as any other tobacco product.” Added to all this is the challenge with treatment access, as well as potential medication issues, adds Aaron Weiner, PhD, a Chicago-based clinical psychologist and addiction treatment specialist. “Some of the medications available for treatment of nicotine addiction are not available for adolescents, which can make the hill that much steeper to climb,” he says.
Steps Forward
Like tobacco, the move toward effective cessation will require a multilayered approach that addresses all of the factors that teens face, and also builds much more awareness about the actual risks of electronic cigarettes—not an easy task, since the products are still too new for data about long-term effects. Also like tobacco, this could require decades to change. “Vaping has become a cultural issue for this generation of adolescents, and unraveling it will likely take the same sort of persistence and effort that we’ve seen for cigarettes over the past 30 years,” says Weiner.
