April 28, 2025

Teens and Vaping

By Debra E. Koss, MD

In 2024, e-cigarettes were the most-commonly-used tobacco product among middle and high school students in the United States. According to the National Youth Tobacco Survey, 5.9% of all students used e-cigarettes. This included 410,000 (3.5%) middle school students and 1.21 million (7.8%) high school students. Multiple factors influence early e-cigarette use including flavored products that appeal to kids (fruit or candy flavors), harm misperceptions, and impulsive risk taking associated with adolescence. Given the knowledge that any tobacco use is harmful, and that most tobacco use begins during adolescence, parents and pediatric health care providers must collaborate to address this serious public health concern.

How do E-cigarettes work?

E-cigarettes are generally made up of four parts, including a cartridge or reservoir which holds a liquid containing nicotine, flavorings and other chemicals; a heating element; a power source, such as a battery; and a mouthpiece used to inhale. Generally, puffing triggers the battery-powered heating device. This turns the liquid into a vapor which is then inhaled by the user. Using e-cigarettes is called vaping.

E-cigarettes usually contain nicotine but may also contain other drugs such as marijuana, and other potentially harmful chemicals. E-cigarettes come in many shapes and sizes. Some look like regular cigarettes or pipes. Others look like ordinary items used by students, such as pens or flash-drives.

What are the health risks associated with vaping?

Respiratory Illness: Harmful chemicals in e-cigarettes can cause inflammation and damage to the lungs, resulting in bronchitis, pneumonia and exacerbation of asthma. In addition, e-cigarette or vaping product use-associated lung injury (EVALI) is a serious lung condition that has resulted in severe respiratory distress and death.

Cardiovascular Disease: Nicotine stimulates the release of epinephrine which increases pulse, blood pressure and respiratory rate, resulting in increased risk of cardiovascular disease. In addition, vaping may contribute to increased risk of atherosclerosis, heart attacks, and strokes.

Oral Disease: Vaping may cause irritation to the gums, teeth, and mouth.

Cancer: Certain chemicals contained in e-cigarette products, such as formaldehyde, are known carcinogens.

How does vaping affect the teenage brain and body?

Brain development continues until the mid 20s, so adolescents are especially vulnerable to the effects of nicotine and other substances on the central nervous system. Nicotine is highly addictive. It stimulates the release of dopamine, a neurotransmitter associated with pleasure and reward. Early exposure reinforces nicotine use, leading to cravings and drug-seeking behaviors. Repeated nicotine use may also negatively affect the development of brain circuits responsible for attention, learning, mood and impulse control.

Prevention and Treatment

Parents and health care providers must work together to help children to learn about the harmful effects of e-cigarettes, nicotine, and other substances involved in vaping. Education and awareness campaigns can help to address the myths and misconceptions associated with e-cigarettes and engage youth in setting healthy lifestyle goals. Prevention initiatives must begin with children and continue through adolescence while resources to promote cessation must be readily available to adolescents. Here are several strategies for parents and pediatric health care providers.

Parents

Access credible information about youth vaping at CDC.gov/Vaping.
Maintain open communication with children. Remain calm and attentive. Avoid criticism or punishment. Identify opportunities to correct misconceptions.
Model healthy behavior. Avoid the use of nicotine and e-cigarettes. Create smoke free zones in your home.
Enlist the support of your child’s health care provider. Schedule an appointment to discuss the health risks associated with vaping.

Pediatric Health Care Providers

The American Academy of Pediatrics notes that pediatric primary care providers have a responsibility to ACT to identify youth who use tobacco and other nicotine products such as e-cigarettes, and connect them with the resources needed to quit. This approach can be completed in just several minutes and includes the following three steps:

ASK: Screen patients age 11+ for tobacco use, including e-cigarettes, at every clinical encounter.
COUNSEL: Discuss the harmful effects of nicotine and the benefits of quitting.
TREAT: Refer youth to resources to promote quitting, including behavioral health treatment. Assess for the need for smoking cessation medication.

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