No butts about it, vaping is just as dangerous

Teens are getting their nicotine fix on the sly using portable electronic devices

Even if you don’t smell cigarette smoke on your teen, that doesn’t mean he or she isn’t addicted to nicotine – and isn’t using it in the dugout or in class.

New forms of vaporized nicotine dressed up in fruit and candy flavors and wrapped in fun decals or “skins” available at gas stations and convenience stores, are packing a wallop. So, while statistics show fewer teens are smoking cigarettes, recreational nicotine use is rising.

Does your son smell less like Axe and more like chocolate or cotton candy? Does your daughter leave a fruity fragrance in her wake? School administrators, resource officers and bus drivers are reporting that vaping and “juuling” flavored nicotine is leaving a telltale scent in school bathrooms, hallways and on buses.

Nicotine and the brain

Why is youth nicotine use so dangerous? Susanne E. Tanski, MD, MPH, FAAP, a pediatrician at Children’s Hospital at Dartmouth-Hitchcock, has a special interest in tobacco control.

“Nicotine, found in tobacco products, is highly addictive. Nicotine is a potent psychoactive drug, that is, a chemical that affects the central nervous system. It is considered a gateway drug, because it affects the developing brain by changing the same dopamine and pleasure pathways that are activated with other addictive substances — including alcohol and opioids,” Dr. Tanski said.

A stimulant, nicotine increases heart rate and blood pressure by triggering a release of dopamine and epinephrine, making users feel alert and more relaxed, boosting mood, and suppressing appetite. With repeated use, users develop a tolerance, which leads to needing more nicotine. Addicted users need to have nicotine regularly or they suffer from withdrawal symptoms such as irritability, anxiety, anger, nausea, increased appetite, tremors, depression, insomnia, and difficulty concentrating.

The cycle of nicotine addiction is reinforcement of behavior that restores nicotine and makes the user feel good and avoids withdrawal. The cigarette, e-cig, vape pen, “mod” or JUUL is the delivery device; the nicotine provides the “buzz.”

Youth are particularly vulnerable

Photo courtesy of Breathe NH

Vaping devices are small and portable, and some are even designed to look like other personal items.

Now imagine a teen or tween whose brain is still developing.

“The adolescent brain appears uniquely susceptible to nicotine addiction, with symptoms of dependence appearing within days to weeks of intermittent tobacco use, and well before daily smoking,” Dr. Tanski said.

“This is biology and not a lack of self-control. If a teen makes it through the vulnerable period when their brain is changing so rapidly without being exposed to nicotine or other drugs, there is convincing evidence to suggest they will not become addicted.”

According to the National Youth Risk Behavior Survey, 44.9 percent of high school students nationwide have tried an e-cigarette, and 24.9 percent have used in the past 30 days.

Rates of using in the past 30 days were similar among Granite State high schools: 25 percent overall, ranging from 17.6 percent of freshmen to 32.4 percent of seniors. Multiple studies have found that youth who try vaping once have a markedly increased risk of smoking cigarettes.

Speedy delivery in higher concentrations

One of the newest of the electronic devices is the JUUL. It resembles a thumb drive or memory stick with the battery chargeable in any computer USB port. According to commercial websites that sell the product, the sleek device produces “a thick, consistent vapor,” and “packs the same amount of nicotine as a pack of cigarettes into a tiny liquid-nicotine cartridge” for “better nicotine blood absorption, for a quicker fix.”

Teens inhale the battery-heated e-juice vapors to get the nicotine buzz. Teachers and school bus drivers report kids using JUULs behind their backs, hidden in the palm of their hands, with vapor — lesser amounts than vapor produced by vape pen or pipe — blown into long sleeves or backpacks.

A starter kit of a battery, charger and four pods of e-juice or pod juice costs about $50. One JUUL pod contains the nicotine equivalent of 200 puffs on a cigarette, or an entire pack. The pod is the thumbnail-sized e-juice container that attaches to the JUUL.

Although it’s illegal to sell any form of tobacco or electronic nicotine delivery system (ENDS) device to anyone under 18, any child with a gift card can purchase these items online, simply by claiming they are 18 or older. (JUUL Labs recently upped the age to buy online to 21.) Others get JUUL money by charging friends a few bucks for a hit off their device.

Ultra-portable and designed to be sneaky

Another new and even smaller device is the Suorin Drop, a teardrop-shaped unit that is advertised as “ultra portable and discreet for stealth use,” and Suorin Air. Less expensive than JUUL, it’s refillable with “Blow Sauce,” another name for e-juice/liquid nicotine or nicotine salts.

Vapes are also being designed to look like cosmetics, including lipsticks and mascara. The PUFFiT vaporizer looks exactly like a medical inhaler and uses “dried herbs.”

Many vaping products also allow do-it-yourselfers to refill them at home. However, liquid nicotine is highly toxic, absorbed through the skin, and causes burns in concentrated form. Less than a half- teaspoon of e-juice with nicotine can be fatal to a toddler or pet.

“There are videos on social media showing people how to take apart and fill various devices,” Allyssa Thompson, Director of Programs for Breathe New Hampshire (a nonprofit public health agency dedicated to lung health), said.

Thompson believes today’s viral climate is fueling the use of ENDS of all types. Kids are attracted by the flavors, like the techie look of the various gadgets, and connect with others by “sharing information — good and bad.” There is also aggressive online marketing.

Many users believe that e-cigs and JUUL devices can be used where combustible cigarettes cannot, such as on smoke-free campuses and in dormitories. But, “all electronic nicotine delivery systems including JUUL and Suorin Drop fall under New Hampshire’s Youth Access to and Use of Tobacco Products, Section 126-K, which bans such products from public educational facilities,” said Kim Coronis, policy and program manager for Breathe NH.

The law states that the purpose of the law is to protect children “from the possibility of addiction, disability, and death resulting from the use of tobacco products.” 

To help combat youth nicotine addiction, and in response to requests for information about vaping, in March Breathe New Hampshire launched Vaping Unveiled, an informational program for adults and teens.

At the first Vaping Unveiled, guest panelist Devin Oot, executive director of Partnership for a Drug Free NH, said bus companies have reported that kids are vaping on buses, blowing vapor into empty water bottles, then releasing clouds of vapor at the driver — a dangerous activity teens call “vapor bombing.”     

At a presentation at a high school with a zero-tolerance policy, administrators and school resource officers noted that some devices are so small, and are used so quickly, it’s hard to catch someone in the act. A resource officer said that because the policy for using drugs — including tobacco — mandates suspension, there were high school seniors who could not graduate with their class.  

We don’t know the long-term effects of inhaling a mixture of heated chemicals (including a known poison), in unknown concentrations directly into the lungs.

Coronis notes that, according to the National Institute on Drug Abuse, 66 percent of teens surveyed believe that vape pens, e-cigs and other devices contain only “flavoring.” They don’t associate nicotine with ENDS.

It’s up to parents and educators to warn young people about the known risks of nicotine addiction, and the potential danger of unknown effects on delicate lung tissue of sucking in unknown chemicals.

Go to for more information, or to host a Vaping Unveiled program in your community.  

Mary Ellen Hettinger, APR, is the Director of Public Relations and Communications for Breathe New Hampshire.

Categories: Teens