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Parents need to know more about teen vaping — PCPs can help
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Juul might be one of the greatest marketing successes of the early 21st century, data suggest.
“In the short 3-year period [of] 2015 to 2017, Juul has transformed from a little-known brand with minimum sales into the largest retail e-cigarette brand in the USA, lifting sales of the entire e-cigarette category,” Jidong Huang, PhD, an associate professor of health management and policy at Georgia State University School of Public Health, and colleagues wrote in Tobacco Control.
By 2018, approximately 1 in 5 high school students used e-cigarettes, and 4.9% of middle school students vaped. That spike was a significant factor in wiping out the recent progress the United States had made in reducing overall tobacco product use among teenagers, the CDC said.
The problem has been compounded by numerous cases of lung injury associated with vaping. More than 1,500 injuries in the country have been reported to the agency so far, including more than 30 deaths — one of which occurred in a teenager, aged 17 years.
Yet, a recent survey published in American Journal of Preventive Medicine showed that only 44% of nearly 3,000 parents in the U.S. accurately identified a Juul vaping device in an image. Almost the same number of parents said they were “not at all concerned” about their child’s e-cigarette use.
“Parents are an important sphere of influence over adolescent behavior,” Barbara A. Schillo, PhD, vice president at Truth Initiative, a nonprofit organization that conducted the survey, told Healio Primary Care. “It is important for them to increase [their] awareness of e-cigarettes like Juul, and other emerging products.”
Recognizing e-cigarette use
Although the Truth Initiative survey showed that 56% of the parents had seen or heard of Juul, only 49% of parents with any Juul awareness knew that the device’s pods always contain nicotine.
“Physicians can express the importance of preventing or helping kids to quit Juul use by highlighting that Juul contains a high concentration of nicotine,” Schillo said. “Adolescents are at risk for early nicotine addiction, which can harm their brain development and make their brains more susceptible to other addictive drugs in the future.”
Schillo pointed out that 35% of parents who were shown the picture of a Juul vaping device did not know what it was, and another 11% thought it was a computer flash drive.
Jeannie S. Moorjani, MD, FAAP, a board-certified pediatrician at Arnold Palmer Hospital for Children in Orlando, said teens who vape can show signs of it.
“Vaping makes you feel dehydrated, so if you notice [a] child excessively drinking fluids, then that could be a possible warning sign,” she said in an interview.
She added that teenagers “who were very healthy” and suddenly have difficulty breathing or performing daily tasks, or begin coughing or developing respiratory problems, might also be vaping.
Another potential sign of e-cigarette use is the smell of fruit or candy — aromas that linger for a few minutes after the vaping device is used, according the website My Life My Quit, which is operated by National Jewish Health in Denver. The website also indicates that “unusual irritability, a sudden decline in school attendance or grades, or keeping new friends a secret” might be a sign of vaping use.
Thomas Ylioja, PhD, a tobacco cessation expert at National Jewish Health, pointed out ways to identify e-cigarette use in teenagers that go beyond visual observation.
“Physicians could do blood tests for nicotine and nicotine metabolites (mainly cotinine) if they needed an accurate assessment of tobacco use,” he told Healio Primary Care. “These can be positive if they are exposed to environmental tobacco like secondhand smoke or vape products.”
Efforts to restrict vaping
The Truth Initiative survey is one of many recent reports that references the growing use of e-cigarettes among youth and the concerns about its impact.
Studies have found that teenagers who vape are more likely to use combustible cigarettes as well. Research has also shown that e-cigarettes expose teenagers to carcinogenic compounds, make them more likely to use marijuana and pose other health risks.
Recently, the Trump administration announced a plan intended to remove all e-cigarettes products with flavors from the market in the near future. Specifics of how the administration would enforce its ban and when have not been announced.
Juul decided not to wait for the administration’s ban to take effect. On Oct. 17, the company announced that it would suspend the sale of its nontobacco, nonmenthol-based flavors (creme, cucumber, fruit and mango) in the United States.
However, other flavored vaping products manufactured by Eonsmoke, Ziip, and Vapor4Life remain available. Even if those companies followed Juul’s lead, a report published in Morbidity and Mortality Weekly Report earlier this year warned of counterfeit e-cigarette products that have “common packaging that is easily available online.”
Closing the information gap
The administration’s actions do not leave physicians and parents “off the hook” in learning about e-cigarettes,” Ylioja and Moorjani told Healio Primary Care.
“It is critical that parents continue to access accurate information about e-cigarettes and talking to their child about the potential harms of nicotine and vaping,” Ylioja said.
Moorjani added that “it's definitely still worth the time for primary care physicians to discuss the risks of e-cigarette use.”
“It is critical that parents continue to access accurate information about e-cigarettes and talking to their child about the potential harms of nicotine and vaping,” Ylioja added. – by Janel Miller
References
CDC. Outbreak of lung injury associated with e-cigarette Use, or vaping. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html. Accessed Oct. 18, 2019.
Ghinau I, et al. Morb Mortal Wkly Rep. 2019;doi:10.15585/mmwr.mm6839e2.
Huang J, et al. Tob Control. 2019;doi:10.1136/tobaccocontrol-2018-054382.
Juul. Newsroom. Juul labs suspends sale of non-tobacco, non-menthol-based flavors in the U.S. https://newsroom.juul.com/juul-labs-suspends-sale-of-non-tobacco-non-menthol-based-flavors-in-the-u-s/. Accessed Oct. 18, 2019.
National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. E-cigarette use among youth and young adults: A report of the Surgeon General. [Internet]. Accessed Oct. 18, 2019. https://www.ncbi.nlm.nih.gov/books/NBK538680/
Patel M, et al. Am J Prev Med. 2019;doi:10.1016/j.amepre.2019.06.012.
Disclosures: Schillo, Moorjani and Ylioja report no relevant financial disclosures.