The electronic cigarette, like its forebear, the cigarette, carries an appeal so palpable, a sixth of U.S. adolescents have tried them. Never in my career as a scientist have I seen such a rapid and widespread increase in use by youths of something containing an addictive substance.
These devices, proposed as less harmful alternatives to other tobacco products like cigarettes and cigars, are available in more than 7,000 flavors, including everything from watermelon and strawberry to Gummy Bears and Fruit Loops, and even pina colada.
Anecdotal evidence from many adult smokers suggests e-cigarettes may be helpful to those trying to stop smoking, though we lack the scientific evidence on whether these products are the magic bullet for quitting. But almost everyone agrees, youths should not use these devices.
Most state — and more recently federal — laws ban e-cigarette sales to minors. Despite this, the use of these products by youths grew 11-fold between 2011 and 2015. For many middle- and high-school adolescents, e-cigarettes are the first tobacco product they try, suggesting it is not just youths trying to quit smoking who are using these devices.
In fact, youths find these products novel and love the ability to personalize e-cigarettes. They can change the temperature and how they puff from the device. They can manipulate existing devices or build them from scratch, and can change the constituents of e-liquids to include nicotine, flavors and anything else that can be vaporized — including marijuana. Youths can directly drip e-liquids onto heated coils to get a "better hit." They can use e-cigarette devices to create smoke tricks like rings, ghosts, dragons and tornadoes. And after all of this, they could even become professional vapers. These devices give young people the autonomy they crave, and flexibility and control.
As the public health debate about e-cigarettes persists, it is important to balance the risk vs. benefit of these devices for smokers or vapers of all ages. I would argue e-cigarettes offer no benefits to non-smoking youths, or those who are using the devices for vaping marijuana and other substances, creating smoke tricks, participating in vape fests or breathing in hot vapors produced from direct dripping.
E-liquids contain propylene glycol and glycerin, which are used in fog machines. When vaporized at high temperatures, these chemicals make cancer-producing compounds like acrolein and formaldehyde. Many e-liquid flavors contain chemicals that are toxic when vaporized. Flavors like "atomic cinnacide," which contain very high levels of cinnamaldehyde, and buttery flavors containing the chemical diacetyl, both known to cause popcorn lung, were removed from the market.
While most flavor chemicals are generally recognized as safe for environmental exposure or edible use, we do not know the consequences of constantly inhaling vapors containing these chemicals. In certain configurations, these devices can result in exposure to higher levels of nicotine than received from a standard cigarette. This raises concerns about nicotine exposure and addiction, especially among adolescents, whose developing brains are more sensitive to the effects of nicotine than adult brains.
Most users, young and old, do not know these products were not regulated until only recently. They assume that just because e-cigarettes are for sale, someone must have made sure they were safe. The Food and Drug Administration rule, which puts regulations into place to reduce youths access and advertising of these products, went into effect on Oct. 1 and allows manufacturers up to three years to comply. However, the rule is silent on the issue of flavors, the predominant appealing feature for young users. Moreover, the federal government is already being bombarded with lawsuits that could further delay the implementation of this rule.
So, while we wait for regulations to go into effect the upsurge in use among youths continues. Adolescents, parents and teachers need to know that these products do not just produce benign water vapor and that we know little about the effects of short-term and long-term inhalation exposure on adolescent health. We need to educate our youths to balance the pull of these very appealing devices against their known and unknown risks.
Suchitra Krishnan-Sarin, Ph.D., is a professor of psychiatry at Yale University School of Medicine and a Public Voices Fellow at The Op-Ed Project.