Hawaii Health Alert: Would You Know If Your Child Is Vaping?

The signs of e-cigarette use are subtle, but the health risks are clear.

Hawaii Health Alert: Would You Know If Your Child Is Vaping?

If you’re the parent of a teen—or even a “tween” who’s navigating middle school—you need to know about e-cigarettes. Odds are your child not only knows about them, but also has access to them and may be tempted to try one, even though sales of tobacco products, including e-cigarettes, are illegal for anyone under 21-years-old in Hawaii.

Don’t be fooled. Despite being marketed and advertised as a healthier alternative to smoking, e-cigarettes pose significant health risks, which may be particularly harmful for young people with developing minds and bodies. In the United States, e-cigarette use, or vaping, among kids and teens has increased dramatically and continues to rise.

In Hawaii, e-cigarette usage among teens and tweens is at near epidemic levels according to the Hawaii Department of Health. Forty-two percent of high school students and 27 percent of middle school students have tried e-cigarettes. Hawaii teens also regularly vape at nearly twice the rate of Mainland teens. According to the Truth Initiative, a group working to reduce smoking, in 2017, 25.5 percent of Hawaii’s high school students reported using e-cigarettes in the last 30 days, compared to 13.2 percent nationally. According to the Centers for Disease Control and Prevention, by 2018, 20.8 percent of high school students nationally were using e-cigarettes. Data for Hawaii’s teen vaping rates in 2018 are not yet available.

In early 2019, Hawaii legislators introduced a bill to ban the sale of flavored e-cigarettes to help curb teen vaping. Unfortunately, the bill failed as legislators felt that teens would order the devices online.

The U.S. Surgeon General issued an advisory on the e-cigarette boom among American youth in December 2018. Some parents, however, still aren’t aware of just how pervasive e-cigarettes have become, while others may assume their child isn’t at risk, says Russell Delaney, MD, a pediatrician affiliated with LewisGale Medical Center in Salem, Virginia.

“Almost every middle schooler and high schooler that I’ve talked to tells me that they know people who are using e-cigarettes, and that they have had an opportunity to use them. And I still have a few parents who don't even know what they are,” Dr. Delaney says. “Without a doubt there are some parents who are naive about how prevalent vaping is in the schools and that their children may be doing it.”

If you’re wondering exactly how e-cigarettes work, why they are harmful and how you would even know if your child is using them, keep reading.

What is a JUUL anyway?
Brace yourself. There are more than 430 different e-cigarette brands being sold to consumers. You might hear a variety of different terms—like e-cigs, vapes, vape pens, mods, and hookah pens—but they’re all e-cigarettes. JUUL, a particular brand of e-cigarettes, has emerged as one of the most popular products, holding the greatest share of the U.S. e-cigarette market as of December 2017.

Here’s where things get even more tricky. E-cigarettes come in different shapes and sizes. They may look like regular cigarettes, cigars, or pipes, but some look like pens or USB memory sticks and can even be charged on a laptop.

These products all operate in a similar way. Typically, a cartridge or reservoir of e-liquid or “e-juice” is heated by a battery-powered device, allowing users to breathe in the resulting vapor. It’s important to understand that this vapor isn’t harmless.

Vaping isn’t a “safe” alternative
Like regular cigarettes, most e-cigarettes contain nicotine. JUUL also uses nicotine salts, which enable the user to inhale high levels of nicotine more quickly and more easily.

Nicotine is highly addictive, and exposure during childhood or adolescence poses additional health risks. Teens who use e-cigarettes are more likely to start smoking in the future, the CDC reports. The U.S. Surgeon General also warns that nicotine exposure can harm young brains, which continue to develop until about age 25. Nicotine can not only prime the brain for addiction early on, but also lead to mood disorders and problems with learning, impulse control, memory, decision-making, and attention.

The liquid in e-cigarettes contains other potentially harmful chemicals, such as formaldehyde, acrolein, volatile organic compounds, and metals, like nickel and lead, according to the American Lung Association. These chemicals could increase the risk for heart disease, lung damage, cancer, and other serious health issues.

Making matters worse, e-cigarettes may also contain fruit and candy flavors, like strawberry, grape, chocolate—and even “Maui Mango” and “Cookie Monsta”—that appeal to young people. Many of these e-liquids have labels that resemble kid-friendly foods, like peanut butter and jelly and popular sugary cereals. This marketing tactic can make them appear less dangerous. Not so.

A small but striking study published in June 2019 in the Journal of the American College of Cardiology found that use of flavored e-cigarettes, in particular, damages endothelial cells (the main type of cells found in the lining of the blood vessels). Scientists suspect that such damage could lead to heart disease.

After exposing these cells to six different flavors of e-liquid in a lab, the researchers found the cells didn’t function normally. Certain flavors were more detrimental than others. The study’s authors noted that menthol tobacco-flavored e-liquid had a harmful effect, even if it was nicotine-free.

Many of the flavorings used in e-liquids are approved by the Food and Drug Administration for consumption by mouth, but there isn’t enough evidence to suggest they are safe to inhale. The fact is, e-cigarettes are relatively new products and there are still many unknowns about their long-term health effects, Delaney notes.

“Kids are viewing this as a safer option because they've heard that people use e-cigarettes to try and quit smoking,” he says. “What I'm trying to impress on my patients is that e-cigarettes haven’t been around that long. What are we going to know 50 years from now about the people who started vaping and were addicted to nicotine when they were 14, 15, or 16 years old?”

Yes, it could be your child
Statistically, more boys use e-cigarettes than girls. Young people with a strong desire to “fit in” may also be more likely to try vaping, while teens with depression or anxiety may also use e-cigarettes as a way to self-medicate, notes Delaney. But he urges all parents to assume their child has access to these products and will have an opportunity to try them, if they haven’t already.

“My real take-home message would be: Don't try to figure out which child is at higher risk, because all children—boys, girls, straight-A students, students who are struggling, students who are known to get in trouble, or students who never get in trouble—are at risk,” Delaney cautions. “Know e-cigarettes are there, know children are seeing other kids use them and know that they will have an opportunity to try them.”

Are there any telltale signs?
When people smoke, it’s usually fairly obvious. The distinct tobacco odor may cling to their hands, hair, and clothes. It’s more difficult to know if your child is vaping. If there are clues, they are going to be subtle, Delaney explains.

“That's the scary part,” he says. “You're not going to smell it. Nicotine is a stimulant, and you might notice some subtle behavior changes if your child has recently used it, especially if he or she is new to the drug. They could seem a little more on edge or a little jittery.”

In short, any change in behavior should alert a parent that something's up, Delaney cautions.

Suddenly wanting to spend more time alone and not engage with the family is another sign that your child may be vaping, he suggests. He adds that simply being aware of the trends and the devices can help parents know when they’ve stumbled upon an e-cigarette in their child’s room, pocket, or backpack.

“I hate to encourage parents to go snooping, but I recently had parents tell me that they found a vape device in their child's video game case,” Delaney recalls. “Just be aware that these things are so small and can be easily hidden. It might just be sitting on their dresser and parents might not even realize what it is.”

Start the conversation now
It’s never too early to start talking to your child about e-cigarettes or substances in general, according to Delaney. “Even in early elementary school, you should talk to your child about not taking something that someone else gives you,” he explains. “When you see people smoking or vaping in public, you can talk to your child and say, ‘Oh, that's called a JUUL, it’s sort of like smoking and it's bad for you.’ Keep it simple.”

As children approach middle school and gain more independence, these conversations can become more detailed, Delaney adds. “That's when more vaping opportunities are going to become available. Talk to kids about how they might handle that situation.”

It’s also important to lead by example. Parents who vape as a way to quit smoking should consider the effects that this may have on their children’s behavior, Delaney points out. They may want to consider an alternative strategy to kick their habit.

Other tips to help parents ensure that their children make healthy choices as they navigate their teen years:

  • Stay in touch with your children. “Play a game, go out for a walk. Do stuff with them to keep them engaged in family activities—even if it's going out and shooting some hoops in the driveway,” he says.  
  • Establish a clear smoke-free policy. Be direct and tell your children you do not want them to vape or use any form of tobacco—at home or when they’re out on their own. Don't allow anyone to smoke indoors, and make sure the places your children go are also smoke-free. Remember that it is illegal to smoke or use e-cigarettes at state parks and beaches in Hawaii.
  • Know your kids’ friends. It’s important to know if your child is socializing with friends who smoke or vape. Talk to your child about how they can effectively say “no” and refuse an offer to use an e-cigarette.
  • Be clear about the harms. Young people should know about the near- and long-term health effects of nicotine, vaping, smoking, and exposure to second-hand smoke.
  • Talk about the cost. Living in Hawaii is expensive enough already. Remind your child about how much money vaping costs and how much they could save by avoiding this habit entirely.
  • Give kids a reality check. Try to make your child aware of the false glamorization of tobacco and e-cigarettes in ads, movies, social media, and magazines.
  • Don’t skip well visits. Over the years, children get to know their pediatrician during routine office visits. This rapport will help them feel more comfortable speaking with their doctor about concerns they may have down the road. Be sure to give your teen or tween a few minutes during each doctor’s appointment speaking with their pediatrician alone to voice any concerns they may have.

Medically reviewed in July 2019.

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