Vaping Fast Facts

More than 16% of American 12th graders have used e-cigarettes in the past month. More than 4% of 8th graders have done so. Overall, more than 1 in 4 American high school students report having used an e-cigarette in the past month.

A national survey found a 78% increase in vaping among high school students between 2017 and 2018. Among middle school students, e-cigarette usage increased by 48% in the same one-year period: an estimated 3.05 million high schoolers and 570,000 middle schoolers vape.

Almost one-third of teenagers who vape start smoking within six months. That’s more than three times the rate among teens who don’t vape.

The vapor produced by almost all e-cigarettes contains nicotine, a highly addictive and harmful substance. Nicotine is especially detrimental for young people, whose brain development is hindered by the chemical.

E-cigarette vapor often contains other harmful chemicals and substances that can cause both short-term and long-term health problems.

United Brain Association

E-cigarette vapor often contains other harmful chemicals and substances that can cause both short-term and long-term health problems.

What is Vaping?

Vaping is the process of inhaling the vapor produced by an electronic cigarette (commonly called an e-cigarette). The vapor is produced by heating a liquid inside the e-cigarette until it turns into a mist that is inhaled directly into the user’s lungs.

The vapor almost always contains nicotine, a toxic substance that is also highly addictive. The vapor usually also contains other chemicals and ultra-fine particles that can cause damage. The dangers of vaping stem from the fact that users ingest these highly toxic substances directly into their lungs, one of the most sensitive and vulnerable parts of their bodies.

Symptoms of Vaping Addiction

About 99% of the liquids used in e-cigarettes contain nicotine, even when their manufacturers claim they are nicotine-free. Nicotine is found in tobacco, and it is considered to be as addictive as drugs such as heroin. When users vape, they are at high risk of developing a dependency on nicotine that is very difficult to overcome.

Symptoms of nicotine dependency include:

  • A strong, almost irresistible urge to vape
  • Continuing to vape even if you think that it’s harmful to you
  • Irritability when you can’t vape
  • Intrusive thoughts about vaping
  • Vaping behavior that causes problems with family, friends, school, or work
  • The inability to stop vaping even when you try

When you’re addicted to nicotine, you will experience withdrawal symptoms if you don’t vape for an extended time and the nicotine level in your bloodstream drops.

Symptoms of nicotine withdrawal include:

  • Headache
  • Anxiety
  • Irritability
  • Sweating
  • Restlessness
  • Fatigue
  • Insomnia
  • Depressed mood
  • Hunger or food cravings
  • Intense craving for vaping

What Causes Vaping Addiction?

Nicotine is so addictive because it interferes with brain chemistry in a way that drives users to need ever-increasing doses to feel well. Vaping is likely to cause addiction because it very quickly and directly introduces nicotine into the lungs. It can be absorbed into the bloodstream and delivered directly to the brain within seconds of inhalation.

Once in the brain, nicotine triggers the release of chemicals called neurotransmitters. One of these chemicals, called dopamine, stimulates parts of the brain that produce feelings of well-being, happiness, or even euphoria. The result is a quick, intense “high” that makes the user associate vaping with good feelings.

The problem is that the good feeling is very short-lived, much more so than the high associated with other addictive drugs. The fleeting euphoria drives the user to continue vaping to maintain the good feeling.

Even worse, continued vaping decreases the brain’s sensitivity to dopamine, leading to a need for more frequent vaping to trigger the pleasant effects. Regular use also alters the brain circuitry that controls learning, stress, and impulse control. These changes can contribute to withdrawal symptoms.

Is Vaping Addiction Hereditary?

The reasons that people begin to vape and become addicted to the practice are complex. Environment, culture, peer pressure, and a long list of environmental factors play a role. However, there is evidence that susceptibility to nicotine addiction and addiction to other substances have an inherited component, too.

Studies have found that the heritability of nicotine addiction risk may be as high as 80%. Scientists have not, though, been able to determine which genes might increase the risk, and it’s not clear how the inherited risk works in terms of brain chemistry.

Analysis of study data has shown hundreds of different gene variations that may be a factor in addiction risk. These genes may affect how nerve cells communicate with each other in the brain or affect the brain’s response to dopamine and other neurotransmitter chemicals.

Aside from the genetic component, there is strong evidence that people who grow up in households where vaping or tobacco use is present are much more likely to become addicted to nicotine themselves.

How is Vaping Addiction Detected?

Early detection of vaping behavior is essential in heading off the long-term consequences of the addiction. Spotting the signs of vaping can be difficult, especially for parents of children trying to hide their behavior.

Parents and loved ones should be on the lookout for these tell-tale signs of vaping:

  • Unusual devices in a child’s room or among their belongings. Vaping devices are not always easy to identify. Many e-cigarettes are designed to look like innocuous objects such as pens and flash drives. Another clue is the presence of paraphernalia, such as vaping liquid refills and rechargeable batteries.
  • Unusual odors. Unlike smoking, which produces strong, tenacious odors, vaping produces very little in the way of lasting smells. However, many vaping liquids are infused with flavors that have intense, often sweet scents while the user is vaping.
  • Unusual thirst. The chemicals in a vaping liquid often cause dehydration, leading the user to be more thirsty than usual.
  • Changes in food preferences. Vaping can cause decreased taste sensitivity so that users may begin to salt or season their food more enthusiastically.
  • Nosebleeds. Vaping dries out tissues inside the nose, and the dryness can lead to frequent nosebleeds.
  • Mouth sores. Vaping also has been linked to sores in the mouth that are unusually slow to heal.
  • Coughing. Vaping can lead to a chronic cough similar to that experienced by smokers.

How is Vaping Addiction Diagnosed?

To determine whether a patient has a nicotine addiction, a doctor will ask questions about their vaping behavior. The frequency of vaping and the length of time that the patient can go without vaping (especially after waking in the morning) indicate the addiction’s intensity. Differences in intensity will suggest different types of treatment that may be effective.

How is Vaping Addiction Treated?

Because vaping is a relatively recent phenomenon, the effectiveness of vaping-related nicotine addiction treatments has not been thoroughly studied. Healthcare providers have been forced to resort to treatments developed for smoking-related addiction, but some of these treatments might not be effective for vaping addictions, especially among young users.

  • Nicotine replacement therapies. A common treatment for smoking-related nicotine addiction involves products that deliver nicotine in a less harmful way than smoking. Nicotine patches, gum, lozenges, or other products relieve withdrawal symptoms and gradually reduce the patient’s dependence on nicotine.
  • However, vaping often delivers a higher dose of nicotine than smoking, and nicotine replacements might not be sufficient to relieve withdrawal symptoms. This drawback can make them less effective as a treatment.
  • Medications. Some antidepressants may reduce nicotine dependence by increasing dopamine levels in the brain. The drug varenicline (brand name Chantix) works by reducing nicotine’s pleasing effect and controlling withdrawal symptoms. However, Chantix is not recommended for use by people under the age of 16.
  • Support groups. Peer support groups and addiction counseling can be helpful, especially when used in combination with other treatments.

How Does Vaping Addiction Progress?

Because many of the most severe health effects of smoking are linked to toxins other than nicotine, vaping is often thought to be safer than smoking. However, vaping comes with health risks of its own, and it is hazardous for young people.

  • Nicotine interferes with the development of nerve cells in the brain. It can harm the areas of the brain that control learning, impulse control, attention, and mood. The effects may be particularly pronounced in young people, whose brains continue to develop until well into young adulthood.
  • Vaping can increase the likelihood that a user will start smoking or become addicted to other drugs.
  • Vaping mist can contain very fine particles that may cause lung disease. Toxins such as heavy metals, volatile organic compounds, and other carcinogens are also often present, increasing the risk of long-term health issues.
  • Flavoring chemicals, especially diacetyl, have been linked to bronchiolitis obliterans, a severe and potentially fatal lung disease.
  • Vitamin E acetate, a chemical often found in THC-based vaping products, has also been linked to severe lung disease cases.

How Is Vaping Addiction Prevented?

Once a user is addicted to nicotine, the addiction is challenging to break. Therefore, the best way to deal with the problem is never to begin vaping in the first place.

Some steps you can take to help prevent your children from experimenting with vaping include:

  • Make sure they’re educated about the dangers of vaping. Your child likely thinks vaping is a safe alternative to smoking. Ensure they know the health dangers posed by vaping and understand the seriousness of nicotine addiction.
  • Make them smart about vaping and marketing. Be sure your child knows how vaping manufacturers develop strategies to make their products appealing to young people.
  • Be alert to warning signs. Keep lines of communication open with your child. Make it clear that they can talk to you about the pressures they face from their peers surrounding vaping.
  • Don’t vape or smoke yourself. Your child is much more likely to begin vaping if vaping or smoking is part of their home life.

Vaping Addiction Caregiver Tips

If your child or loved one is addicted to vaping, there are ways that you can help them to quit.

  • Help with education. A vaper has to want to quit, and misinformation about vaping can stand in the way of the desire to stop. Many young people don’t understand the dangers of vaping, and many don’t even know that the vaping liquid they use contains nicotine. They’re more likely to want to quit when they know the truth.
  • Point them toward resources. Online support resources such as Truth Initiative and BecomeAnEx are designed to help young people quit vaping.
  • Expect bumps in the road to quitting. For nicotine addicts, vaping becomes a way to deal with the stresses of everyday life. As withdrawal symptoms peak, your loved one will need to find new ways to cope with stress. You can help by taking their frustrations in stride and not adding to the pressure.
  • Be upbeat and supportive. The process of beating nicotine addiction is frustrating. Rather than focusing on your loved one’s setbacks along the way, emphasize your pride and enthusiasm for their desire to quit.

Many people with a vaping addiction also suffer from other brain and mental health-related issues, a condition called co-morbidity. Here are a few of the conditions commonly associated with vaping:

Vaping Addiction Brain Science

Because vaping delivers nicotine into the body in a different way than smoking or nicotine replacement therapies, scientists haven’t been entirely sure that vaping affects the brain the same way that smoking does. However, recent studies have shown that nicotine from vaping causes the same activation of the brain’s pleasure-and-reward centers. Resuming vaping after a period of abstinence also decreases withdrawal symptoms, suggesting that the user’s brain responds the same way that a smoker’s does in a similar situation.

Research is ongoing into whether nicotine addiction from vaping resembles addiction from smoking in every way, but initial studies suggest that the mechanism of addiction is very similar.

Vaping Addiction Research

Title: Feasibility of PET/CT to Detect the Oral/Pulmonary Distribution of Nicotine Following E-cigarette Use

Stage: Recruiting

Principal investigator: Michael V. Knopp, MD, PhD 

The Ohio State University Wexner Medical Center

Columbus, OH

The investigators aim to (1) establish a methodology for the evaluation of the biodistribution of radio-labeled nicotine following e-cigarette use, (2) determine the oral/pulmonary distribution of nicotine following e-cigarette use, and (3) determine the lowest required dose using the new digital PET/CT technology to provide detailed or accurate oral/pulmonary distribution data following e-cigarette use. Potential participants will be identified using advertisements such as brochures and online social media postings. After participants are identified, their eligibility will be determined using survey tools. All eligible participants will first have a screening visit at the WCIBMI for study participation. During this initial visit, subjects will be informed about the study in detail, and the relevant consent form will be reviewed and signed. If the participant agrees to participate, they will go through a full dress rehearsal. Up to 10 volunteers will only participate in the dress rehearsal. All other volunteers (30) will have a dress rehearsal without radiation exposure on day 1, and then on a second day, they will participate in the full imaging study using 11C-nicotine. During the imaging study, S-nicotine will be labeled with 11C and placed in the cartridge of an e-cigarette. There will be two dose groups: (A) 3 mCi dosage or (B) 9 mCi doses. The investigators intend to use dose level A; however, if it does not lead to the expected results, an alternate dose level as an option is needed, which is the 9 mCi (B) dose level. Subjects will take a maximum of 10 puffs (1 puff per 30 seconds) from the e-cigarette while positioned in the PET/CT system. Dynamic PET/CT imaging will be performed for a maximum of 60 minutes following inhalation. The subject will be placed in the PET camera to generate axial images of the following regions: head/neck (e.g., brain, oral cavity, and throat) and thorax (e.g., trachea, lungs). From the PET/CT images, quantitative radioactivity deposition will be determined, and the biodistribution and uptake/clearance will be evaluated. PET data will be acquired in list-mode and subsequently used for simulation to determine the potentially lowest dose feasible using the next generation digital PET/CT technology. 

Title: Investigating the Cardiovascular Toxicity of Exposure to Electronic Hookah Vaping

Stage: Recruiting

Principal investigator: Mary Rezk-Hanna, PhD 

University of California, Los Angeles

Los Angeles, CA

Hookah (water-pipe) smoking has quickly grown to become a major global tobacco epidemic among youth, with electronic hookahs more recently increasing in popularity, especially among young female adults, who endorse marketing claims that these products are a safer alternative to traditional hookah, but scientific evidence is lacking. The study aims to elucidate the comparative effects of traditional hookah smoking vs. electronic hookah inhalation on human vascular and endothelial function and examine the role of inflammation and oxidative stress as likely mechanisms in hookah-related cardiovascular disease pathogenesis.

Title: Responses to E-Cigarette Advertising

Stage: Recruiting

Principal investigator: Elise M. Stevens, PhD 

Harvard University

Boston, MA

While conventional cigarette use continues to decline among youth and young adults, e-cigarette (EC) use is on the rise. The use of ECs during young adulthood, particularly 18 years of age, is especially alarming because it is a critical period in adolescent development and a time when tobacco use is established. Additionally, the tobacco industry targets individuals of this age with the hope that they will one day progress to using combustible cigarettes. Advertising may be one reason leading young people to use ECs, and the Food and Drug Administration (FDA) now has the authority to regulate EC advertisement features. The goal of the study is to determine which EC ad features most strongly influence young adults’ attitudes, susceptibility, and intentions to use ECs. Fifteen ads from the most popular EC brands that employ a brand, product descriptions, and modeling features were selected. Young adults who are susceptible to EC use will come into the lab and view these ads. During exposure, they will be assessed for real-time visual attention using eye-tracking, orienting responses using heart rate, and arousal using skin conductance as well as pre-and post-ad self-report measures of attitudes, susceptibility, and behavioral intentions. These factors will help determine the most high-impact features, which will be associated with the most significant visual attention, orienting responses, and arousal levels, and changes in attitudes. Findings from this study will provide public health officials essential and urgently needed information about what advertising features contribute to the sharp rise in the use of ECs among young adults. 

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