When I addressed a room full of adolescent girls at a Suburban Hospital community health event in the fall, I included electronic cigarettes among my discussion topics. Despite being a child and adolescent psychiatrist, I had yet to encounter similar discussions in my office. Since then, three of my teenaged patients have told me about their "vaping" habit.

The broad emerging conversation about e-cigarettes reflects their staggering, sudden growth among adolescents. The number of adolescents who have tried e-cigarettes surged between 2011 to 2014, with more than 2 million doing so by 2014 (including more than a quarter-million who had never smoked a cigarette before).

While industry officials and some researchers tout the potential benefits of vaping, versus using traditional tobacco products such as cigarettes, vaping is harmful to adolescents' health. E-cigarettes contain nicotine and other potentially toxic chemicals, and may increase their risk of smoking tobacco products.

Despite what advertisements and some researchers say about e-cigarettes' unknown long-term effects, my stance on vaping is clear: Kids should not do it. Here's my explanation, along with advice on how to prevent and handle vaping among minors.

E-Cigarette Exposure

E-cigarettes feature a battery-powered pipe with space for replaceable liquid cartridges. Users typically press a button to boil the liquid and produce an inhalable vapor.

E-cigarettes emerged roughly a decade ago. Many of the same companies that manufacture traditional tobacco products created these nicotine-infused vapors to offer a less toxic alternative to smokers, especially those who wanted to quit smoking tobacco, but still enjoyed smoking.

These companies are also targeting another demographic, much like Joe Camel and the Marlboro Man were used to make cigarettes attractive to minors when we were growing up. There are campaigns today to make vaping attractive to your kids. Ads often air where minors can see them, including on social media, elsewhere online and on television. Vendors also sell them in booths at malls.

As a result, seven in ten middle and high schoolers (more than 18 million kids) in the U.S. were exposed to e-cigarette ads in 2014. The president of the Campaign for Tobacco-Free Kids called this media blitz "as strong as anything we've ever seen," with the ads incorporating the same themes (rebellion, independence) as conventional tobacco products. (The e-cigarette industry increased advertising spending on all demographics from $6.4 million in 2011 to $115.3 million in 2014.)

In addition to the advertising blitz, the liquid cartridges come in flavors like, cotton candy, bubble gum and "Katy Perry cherry," and feature colors including hot pink, yellow and lime green. If those sound like the colors you used to pick for your cross-trainers or scrunchies, that's because they were. E-cigarettes are also attractive to minors, because they can vape without having to deal with foul-smelling cigarettes smoke.

The marketing is working. Middle and high school students exposed to the ads in any medium are more likely to try e-cigarettes, according to a national study published recently in the journal, Pediatrics. Researchers did not establish a direct causal relationship between exposure and use, but they did not mine for one either. "It's no coincidence," as the Centers for Disease Control (CDC) director put it in The Washington Post, "that as the advertising has skyrocketed, the use of e-cigarettes has skyrocketed." Indeed the rate of high school students out of 1,000 who reported using an e-cigarette within the past 30 days increased from 15 in 2011 to 160 in 2015, while the rate of middle schoolers surged from six to 53.

E-Cigarettes' Long-Term Impact

E-cigarettes have not been around long enough for the longitudinal studies needed to evaluate their long-term impact. Industry officials argue that they are a healthier alternative to cigarettes that can help adult smokers quit. But government officials have seen enough evidence to act when it comes to e-cigarettes and kids. The Food and Drug Administration announced in May that it will ban distributing e-cigarettes to minors beginning in early August. This ruling follows earlier bans in Virginia, Maryland and the District of Columbia, and warnings from the CDC and the American Medical Association.

These groups recognize the potential dangers of e-cigarettes. Nicotine has been shown to be addictive and interfere with an adolescent's long-term brain development. Many e-cigarettes contain formaldehyde, found in fungicide and industrial-strength cleaners, and chemicals that may lead to severe respiratory illness if inhaled as vapor. Even kids who don't inhale the vapor will be exposed to these chemicals by breathing contaminated air.

In addition, new research shows using e-cigarettes is connected with smoking traditional cigarettes among adolescents. For example, one study confirmed that Hawaiian teens who tried e-cigarettes were more likely to try smoking within a year.

Regulations and research won't stop kids from vaping. Informed and vigilant parents are needed too. To prevent your children from falling into this unhealthy habit, treat vaping like any harmful drug: Set a positive example by avoiding vaping in front of them and talk to them about it. Take advantage of an e-cigarette advertisement, for example, by discussing vaping when it airs.

If your child is already vaping, talk to them about it and raise the issue with their primary pediatrician, who may refer them to an addiction specialist. (If you use e-cigarettes, keep the cartridges out of the reach of small children, as many have been poisoned by the e-liquids.)

These conversations will not be comfortable, but, like any conversations about unhealthy habits, they beat ignoring the problem. Vaping is a health problem. Don't think just because your son's bedroom smells like bubble gum and not tobacco or dirty sweat socks anymore, that vaping is no big deal. It is. More importantly, it could lead to a much bigger deal, such as cigarette smoking or worse.

Your children need you to intervene. If we were drawn to a cartoon camel wearing sunglasses, how do you think they may respond to a flavor called Katy Perry Cherry?


Shana Gage, MD, is a board-certified child and adolescent psychiatrist practicing in Largo with the Mid-Atlantic Permanente Medical Group (MAPMG). She specializes in treating addiction. Ryan Basen is a writer with MAPMG.