Case Study

E-Cigarettes: An Epidemic Among Youth

Walker is in your office for his annual Texas Health Steps preventive medical checkup. As part of your routine practice, you speak privately with Walker’s mother and then with Walker. You sit at eye-level with Walker, briefly explain your approach to confidentiality, and ask if he has any concerns to share. Walker shrugs and shakes his head no. “There are some topics I discuss with all my teenaged patients,” you say. “Is it okay to talk about them?” After Walker agrees, you screen him for substance use, asking specifically about cigarettes, alcohol, and marijuana and other drugs. “No, I don’t do any of that,” he says. “I try to stay healthy, and I lift weights.” You are aware that e-cigarette use is increasing dramatically among adolescents so you ask Walker if has tried e-cigarettes. “You mean vaping? Oh yeah, I do that,” Walker says. “But that’s not smoking. It’s only vaping. It’s safer than smoking cigarettes.”

According to a 2019 American Academy of Pediatrics (AAP) policy statement about e-cigarettes, how should you respond to Walker’s remarks?

portrait of boy
Patient
Walker
Sex
Male
Age
16

The AAP recommends that primary care providers take four steps in their clinical practice to help end the e-cigarette epidemic among youth.

Screen patients for e-cigarette use, just as you did with Walker. E-cigarette use (known as vaping) among youth is at epidemic levels in the United States. About 3 million high school students used e-cigarettes in 2018, a 78 percent increase in just one year (Centers for Disease Control and Prevention [CDC], 2018). E-cigarette use in middle school increased almost 50 percent. E-cigarettes “are the most commonly used tobacco product among youth,” yet they are unsafe for children and adolescents (AAP, 2019). In addition, youth who vape “are much more likely to go on to use traditional cigarettes—a product that kills half its long-term users” (Ibid).

Screen patients for exposure to e-cigarettes and advertising. More than three-quarters of high school and middle school students saw or heard e-cigarette ads in 2016 (AAP, 2019). Exposure to such ads “increases intention to use e-cigarettes,” according to the AAP, and youth are at higher risk of transitioning to conventional tobacco products through experimental use of e-cigarettes.

Provide counseling during clinical exams to help prevent e-cigarette use by patients. Primary care providers have a responsibility to educate youth about the health risks and long-term consequences of using e-cigarettes. E-cigarette liquid contains nicotine, which is highly addictive, and other toxic chemicals. Numerous toxicants and carcinogens have been found in e-cigarette solutions (AAP, 2019). E-cigarettes are especially dangerous for youth because the human brain is still developing until about age 25 and nicotine can damage brain development. In addition, secondhand vapor from e-cigarettes can harm those who are involuntarily exposed, including unborn babies and children, and can pollute indoor air. Third-hand vapor clings to surfaces and dust and can become a pollutant as well.

The AAP recommends that pediatricians counsel families, caregivers, and patients that homes, cars, and places where children and adolescents live, learn, play, work, and visit should have comprehensive tobacco-free bans on e-cigarettes and other tobacco products.

Why It Matters

As a primary care provider, you serve as a credible source of important health information for your patients. You can help bust dangerous myths about e-cigarettes by providing patients and families with accurate information about e-cigarettes and the damage they can do to individual and public health. “The increasing use of e-cigarettes among youth threatens 5 decades of public health gains in successfully deglamorizing, restricting, and decreasing the use of tobacco products” (AAP, 2019).

For more information, read the AAP Policy Statement E-Cigarettes and Similar Devices.

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