Policy Statement on Vaping and Electronic Cigarettes
Background
Youth vaping is an emerging epidemic, with 1 in 10 (2.5 million) U.S. middle and high school students currently vaping. Vaping is the act of inhaling vapors produced from a liquid solution aerosolized by an electronic device such as an electronic cigarette (e-cig) or vape pen. The liquid solution used in vaping devices typically contains a psychoactive drug such as nicotine or Δ9-tetrahydrocannabinol (Δ9-THC), the primary addictive components of tobacco and cannabis, respectively. Vaping of other cannabinoids including cannabidiol (CBD) and legal Δ9-THC analogues (e.g., Δ8-THC) is also increasing in popularity. Vaping results in higher blood serum concentrations of THC and nicotine compared to smoking combustible forms of cannabis or tobacco products. As a result of this higher exposure, regular vaping of THC and nicotine among youth can lead to vaping-related cannabis and tobacco use disorders characterized by the development of tolerance, habituation, loss-of-control over vaping behaviors, and experience of withdrawal symptoms upon cessation.
Nicotine exposure during adolescence is associated with behavioral and neurochemical changes along with continued engagement in tobacco and other drug use. Further, tobacco-naïve youth are initiating nicotine exposure through vaping. Youth who vape are also more likely to smoke cigarettes. Cannabis use, and particularly high-potency THC use, is associated with development of cannabis use disorder and the misuse of other substances. Problems associated with heavy cannabis use during adolescence include worsening mental health with increased risk of suicide, cognitive dysfunction, altered neurodevelopment, decreased school completion, and other health and socioeconomic consequences.
Not all harms related to vaping are the result of nicotine or THC exposure. Recent studies have found an array of environmental toxins within the vapors of commonly used e-cig brands including heavy metals, reactive oxygen species, aldehydes, and carbonyls. These toxins often result from chemical reactions between the heating elements, fluid components, and chemical flavoring agents. Specific carcinogens identified in the vapors include formaldehyde, acetaldehyde, and nitrosamines. Vaping may result in increased risk of toxicity and pulmonary injury, including e-cigarette or vaping associated lung injury (EVALI), as well as mechanical burns.
Youth are being increasingly targeted through direct advertisements, peer marketing, social media, and pop culture. Products are also designed for easy concealment as everyday items (e.g., highlighter, USB flash drive). Flavor additives have been shown to be the most important factor in youth initiation of vaping. While the safety of electronic vaping devices has not been scientifically established, e-cigs have been portrayed as less hazardous than conventional tobacco or combustible cannabis products. Manufacturers have also advertised e-cigs as tobacco cessation treatments. In fact, online interest in vaping has surpassed conventional tobacco cessation treatment among individuals who want to quit smoking. These factors contribute to decreased perceived harm of vaping. Though many states have enacted age restrictions, vaping devices and liquid cartridges remain easily accessible to underage youth through online purchasing and within local communities and peer groups.
To protect youth from behavioral and physical harms associated with vaping, the American Academy of Child and Adolescent Psychiatry:
- Recommends that clinicians screen all youth for vaping behaviors and for vaping as a method for consumption of nicotine and cannabinoids, following Screening, Brief Intervention, and Referral to Treatment (SBIRT) guidelines, and promote the use of evidence-based treatments for vaping cessation across all youth health care settings.
- Encourages researchers to prioritize the development of primary and secondary prevention strategies for youth at risk of vaping and to develop and promote evidence-based treatments for youth who develop vaping-related cannabis and tobacco use disorders.
- Supports state and federal policies that restrict youth access to vaping devices, flavor additives, and direct advertising that target youth and are associated with increased uptake of vaping among youth.
- Supports state and federal regulation of e-cigarettes, electronic vaping devices, liquid cartridges, and any product containing nicotine or cannabinoids.
- Supports policies that identify and address barriers to substance use disorder treatment for youth, including stigma associated with seeking treatment.