Is vaping dangerous, especially for children and young adults?

Yes, Vaping is Dangerous—Especially for Children and Young Adults

Vaping poses serious health risks to users and nonusers alike, with electronic nicotine delivery systems (ENDS) containing highly addictive nicotine, toxicants, carcinogens, and metal particles that harm cardiovascular, respiratory, and neurological health. 1

Why Vaping is Harmful

Nicotine Toxicity and Addiction

• Nicotine is both highly addictive and toxic, causing increased blood pressure, heart rate, arterial narrowing, and hardening of arterial walls that can lead to heart attacks 1
• The developing brains of children and adolescents are particularly vulnerable to nicotine dependence, with addiction occurring far earlier than previously believed 1
• Nicotine exposure during adolescence causes addiction and harms the developing brain, while prenatal exposure crosses the placenta resulting in sudden infant death syndrome and other adverse consequences 1

Cardiovascular and Metabolic Harm

• Electronic cigarettes adversely affect cholesterol metabolism and cardiovascular health—they are not harmless alternatives to traditional cigarettes 2, 3
• Vaping increases cardiovascular disease risk through multiple mechanisms, including effects on blood pressure, lipid profiles, and promotion of atherosclerosis 3
• There is conclusive evidence that most e-cigarette products contain and emit numerous potentially toxic substances beyond nicotine 1

Respiratory Effects

• ENDS solutions and aerosols contain toxicants, carcinogens, and metal particles that pose respiratory health risks 1
• Evidence is emerging that vaping introduces high levels of dangerous chemicals into the body and can cause severe lung injury and death 4
• Vaping has been linked to respiratory symptoms, though long-term health implications in adolescents require further study 5

Special Dangers for Youth

Epidemic Proportions

• In 2014, more youth reported using ENDS than any other tobacco product, with increases of 650% among middle school and 890% among high school students between 2011-2014 1, 6
• The U.S. Surgeon General designated nicotine product use among adolescents as a national epidemic 7
• ENDS threaten to renormalize and glamorize nicotine use, reversing more than 50 years of progress in tobacco control 1

Marketing Targeting Children

• Vaping companies utilize marketing methods with flavors, design, and messaging that distinctly target young people 1, 8
• Weak legislation allows companies free rein to expose children to vaping without adequate warnings about potential health effects 8

Poisoning Risk

• Concentrated and often flavored nicotine in ENDS solutions poses acute poisoning risk for young children 1
• Reports of acute nicotine toxicity from U.S. poison control centers have been increasing, with at least one child death reported from unintentional exposure to nicotine-containing ENDS solution 1, 6

Secondhand and Thirdhand Exposure

Involuntary Exposure Harms

• Nonusers are involuntarily exposed to ENDS emissions through secondhand and thirdhand aerosol containing nicotine, carcinogens, and metal particles 1, 6
• Thirdhand aerosol remains on surfaces and in dust after ENDS use, can be reemitted into the gas phase, or react with oxidants to yield secondary pollutants 1
• There is no safe level of tobacco smoke or aerosol exposure for children 6

Clinical Recommendations

Screening and Counseling

• Screen for tobacco, nicotine, and electronic cigarette use at diagnosis and regularly thereafter, starting at puberty for all adolescents and young adults 1, 2
• Questions must be modified to include "vape" or "vaping" and electronic cigarettes, hookah sticks, e-hookahs, and vape pens, as many families do not consider ENDS as "tobacco" 1
• Include tobacco use prevention as part of anticipatory guidance, with messages starting as early as age 5 when children are developmentally ready 1

Clear Directive

• Electronic cigarette use or vaping should be discouraged in all patients, particularly youth with chronic conditions like diabetes who face increased cardiovascular disease risk 1, 3
• Advise individuals to avoid vaping and using e-cigarettes either as a smoking cessation method or as a recreational drug 3
• If patients are using e-cigarettes to quit smoking, advise them to avoid using both combustible and electronic cigarettes simultaneously and develop a plan to eventually quit e-cigarettes as well 3

Common Pitfalls to Avoid

Misperceptions About Safety

• Many people incorrectly perceive e-cigarettes as harmless or significantly less harmful than traditional cigarettes—this is false 2, 3
• While e-cigarettes likely pose less risk compared to combustible tobacco cigarettes (a very high-risk comparator), they should not be characterized as harmless 3
• There is no safe tobacco product—e-cigarette products contribute to nicotine dependence 3

Underestimating Exposure Routes

• Do not assume that only direct use poses risks—secondhand and thirdhand aerosol exposure harms nonusers, particularly children 1, 6
• Thirdhand smoke exposure is often underestimated, as harm continues after vaping ceases through residue on surfaces 6

Missing Non-Cigarette Products

• Do not focus solely on traditional cigarettes—hookahs, little cigars, chewing tobacco, and ENDS all pose distinct health risks 1, 6