Teens and vaping: What parents should know

A CHOC pharmacist explains the risks of vaping for teens

In recent years, the prevalence of preteens and teens vaping has increased tremendously, which may cause some parents to worry. We understand. You may have tons of questions like: What is vaping? How can I prevent my child from vaping? How can I help them quit?   

Codi Peterson, Doctor of Pharmacy at the Julia and George Argyros Emergency Department at CHOC Hospital in Orange, is here to answer all your questions about vaping, and how to help your child avoid it.  

How vaping works  

E-cigarettes (or “vapes,” “vape pens” or “e-cigs”) will always have three basic components – a heating element (the atomizer), the battery, and the vaping liquid. These devices heat a liquid until it becomes a vapor, which is then inhaled, says Codi. The liquid (called e-liquid or “vape juice”) most commonly contains nicotine, but these devices can also be used with THC (the compound in marijuana that creates a high) distillate or oil.  

E-cigarettes can either be refillable or come pre-filled with cartridges containing the e-liquid. The pre-filled e-cigarettes (called “Puff Bars”) are designed for one-time use. After taking a certain number of “puffs,” the user throws the device away. 

Vaping has become increasingly popular among preteens and teens  

A study by the Centers for Disease Control and Prevention (CDC) found that in 2022, 2.55 million U.S. middle and high school students reported current (in the past 30 days) e-cigarette use, which includes 14.1% of high school students and 3.3% of middle school students. Nearly 85% of those youth used flavored e-cigarettes and more than half used disposable e-cigarettes. 

Why is vaping so popular for teens? 

It’s relatively new technology, says Dr. Peterson. It’s only about 15 to 20 years old, so its newness may explain some of its popularity. But there are a few other reasons why vaping is popular for some teens, he adds, like: 

• Nicotine is addicting. 
• Vapes often deliver nicotine in the form of tasty flavors that mimic treats like candy, fruit and desserts that are appealing to teens.  
• Vaping is discreet. Teens may be able to vape anytime, anywhere — at school, out in public or even in the bathroom — oftentimes leaving little evidence of use other than a slight smell or vapor in the air.  
• Vaping is relatively accepted. In recent years, teens have leaned into vaping instead of smoking cigarettes. Most teens would never consider smoking cigarettes because everyone knows how bad they are for you. But even when vaping nicotine, teens don’t put it in cigarettes in the same category.  

What are the health risks of vaping for preteens and teens? 

It seems like many preteens and teens think that vaping is safe. However, the reality is that there are some known harms from vaping, as it can cause the following health risks, says Codi:   

• Chronic bronchitis. 
• Coughing and lung irritation 
• Lung inflammation.   
• Difficulty breathing 
• Nicotine (or THC) addiction that can alter a teen’s brain chemistry. 
• Increased risk of anxiety and depression.  
• Harmful effects on the immune system of the lungs. 
• Serious lung damage or even death.  

Get more expert health advice delivered to your inbox monthly by subscribing to the KidsHealth newsletter here.

What is EVALI? 

EVALI stands for e-cigarette or vaping-associated lung injury. In 2019, there was a steep increase in hospitalizations for lung injuries associated with vaping in the United States. Unfortunately, thousands of people — including teens — became seriously ill from lung damage.  

Investigators have since discovered that unregulated THC-containing e-cigarettes were the most common culprit of this outbreak. More specifically, FDA research pinpointed that vitamin E acetate, a chemical added to some vape liquids to make them thicker and easier to vape, was most likely causing these injuries.  

When inhaled, vitamin E acetate negatively interacted with fats in people’s lungs and caused havoc, even at low doses, says Dr. Peterson.  

Symptoms of EVALI included rapid and difficulty breathing, coughing, chest pain, fever, low oxygen and coughing up blood in some cases. For most EVALI patients, the recovery process was long and arduous, with half of patients still reporting long term effects, and some patients may never fully recover. 

Now, although vitamin E acetate isn’t being used as an additive in vapes anymore, Codi warns parents about the unregulated ingredients and parts of vapes that still put teens at risk for developing lung injuries.   

“Although EVALI isn’t happening regularly anymore, there could be an outbreak of a different substance included in new vapes,” he says. “The safest way to prevent injuries in teens is to encourage them not to vape at all.”  

How might a parent be able to tell that their child is vaping? 

“Because vaping is so accessible and easily hidden, it can be difficult to tell if your child is vaping without looking through their room or in their belongings,” says Codi. “And I don’t recommend that.” 

Here are signs that parents can watch for, he says:  

• New health issues such as chronic coughing or wheezing. 
• E-cigarette supplies, like cartridges or small bottles of liquid.  
• New smells (some flavorings are banned, but others are in nicotine and marijuana vapes — so parents might notice fruity or sweet scents). 
• Nicotine withdrawal symptoms like irritation, restlessness, trouble concentrating, trouble sleeping, weight gain and feelings of anxiety, sadness or depression.  

But the best way to be able to tell if your child is vaping is to have an open and honest conversation with them about it, without judgment, says Dr. Peterson.   

How can parents prevent their preteens and teens from vaping?  

Don’t over-stigmatize vaping, Codi recommends. Be open and honest with your kids about vaping and explain the health risks it may cause. Explain to them that their friends or other students may vape, but they don’t need to just to fit in. If you catch your child vaping, be sure to ask them what it is that they like about vaping, and what positive effects they perceive to get from it.   

I can also be helpful to keep an eye out for changing behavior in your teens. They may be:  

• Socializing with new people whom you have not met before. 
• Avoiding something in their lives like school, sports or friends. 
• Isolating themselves. 

If you notice any significant changes in behavior, check-in with your child about how they are doing.  

How do I help my teen quit vaping?

The reality is that teens are going to encounter vaping. Either their friends vape, people at school vape or they vape themselves,” says Codi. “Kids are going to be curious.”  

The key is to explain the risks of vaping for your child, says Codi. You can help them find the motivation to quit. You might want to talk about: 

• Wanting to be the best, healthiest version of themselves. 
• Not wanting to be addicted. 
• Avoiding health effects like lung injuries.  
• Not wanting to increase anxiety or depression. 
• Saving money. 
• Going against advertising that targets young people. 
• Straying away from what might be considered “cool” by other teens their age.  
• Avoiding unsafe, unregulated vaping parts and liquids.  

Support your teen as they try to quit vaping. Get rid of vaping supplies, set a good example by taking care of your own health and make your house smoke-free and vape-free. If you smoke or vape, make the commitment to quit with them. 

Your teen or preteen’s common vaping questions: Answered  

There are common misconceptions about vaping, and your teens may have questions about them. Dr. Peterson helps parents address their teen’s questions and misconceptions about vaping.  

Are vapes safe? 

No. There is a serious lack of federal and state regulation for vaping, says Codi. So, you may never be sure if vape parts are safely made, or what ingredients are included in the vape juice.  

Is vaping better for you than marijuana or cigarettes? 

There is not enough research about vaping’s long-term health effects yet to know for sure.  

The CDC reports that cigarette smoking causes more than 480,000 deaths per year in the United States. People don’t typically die from smoking marijuana, says Codi, but it does negatively affect the brain chemistry and lifestyles of teens.  

Vaping may not be as harmful as smoking cigarettes or marijuana, but it still does carry risks — and scientists will be studying how much harm it really does cause for years to come. 

The benefits of vaping are simply not worth the risk, says Codi.  

CHOC teen advisers offer tips on avoiding peer pressure to vape. 

Does vaping help you quit smoking cigarettes? 

“The answer to this question is yes and no,” says Codi. 

Some people do use vaping as a strategy to quit smoking cigarettes. It’s easy for smokers to go from cigarettes to vapes because there is still nicotine in vapes, says Codi, and they are fulfilling their nicotine addiction. However, it’s still a challenge to quit vaping because vaping is also considered addictive.   

“The best option is to not smoke cigarettes or vape because they are both addictive,” he says.  

Is there a healthy vape? 

“No. Vape manufacturers are putting all kinds of different vitamins and ingredients in vapes to try to call them healthy,” says Codi.  

The truth is that lungs were never meant to deliver anything besides air to our bodies. With vapes, the lungs must adapt to the chemicals that people are putting into them, which can cause short term, or even permanent, lung damage.  

Is taking one puff of a vape OK and healthy for you? 

“You will not become addicted from one puff from a vape,” says Codi. It’s natural to be curious, but again, it’s important to consider the health and safety concerns of vaping and it’s addictive potential.  

“My advice is to not start vaping in the first place because it could be difficult to quit,” he says.  

Can your lungs heal from vaping? 

Yes and no. Unfortunately, once someone begins to develop EVALI, their lungs won’t heal right away and may never fully recover. That’s why so many people are still recovering from EVALI. It’s all about prevention — to keep your lungs healthy, you should avoid inhaling chemicals that are found in vapes.  

---