A Q&A With Liz Wilhelm and Dr. Cora Breuner

Across the United States, e-cigarette use among youth has skyrocketed to epidemic proportions. Currently, one in five high school students reports using e-cigarettes. Also known as e-cigs, vapes, vape pens, mods or tanks, these electronic devices are highly addictive and unsafe for children, teens and young adults.

We spoke with Liz Wilhelm, Seattle Children’s drug-free communities Prevention Works in Seattle (WINS) coalition coordinator, and Dr. Cora Breuner, professor of pediatrics and adolescent medicine at University of Washington and attending physician at Seattle Children’s, about the dangers of e-cigarette use among youth and how healthcare providers can best relay the risks to patients and their families.

What are the primary health risks associated with e-cigarette use, specific to children and teens?

Wilhelm: The developing brains in children, teens and young adults are more susceptible to influences like nicotine addiction than in fully developed, adult brains — making e-cigarette use among youth extremely dangerous because it lays the groundwork for a lifetime of addiction. E-cigarettes also contain dangerous chemicals that, when inhaled, can create reduced lung capacity.

Breuner: Studies have also shown that if children and teens use e-cigarettes, they are more likely to smoke combustible cigarettes and marijuana.

How does JUUL specifically differ from other e-cigarette products, and why do you think the device has been so successful in the market with teens?

Wilhelm: JUUL is a leading manufacturer of pod-based e-cigarettes, which resemble USB flash drives and can be charged via laptop or another electronic device. JUUL devices are unique to other e-cigarettes because of their sleek design, making it easier to disguise them from parents and teachers, but they deliver a similar vaporizing effect to other devices.

Liz Wilhelm

JUUL has also capitalized on producing sweet flavors of eJuices, such as mango or cotton candy, which attract children and teens. Oftentimes, children do not believe nicotine is present in these juices because of their sweet flavors; ingredient labels regarding eJuice’s nicotine content are often misleading, as well.

What are some other common misconceptions about e-cigarettes?

Breuner: Because e-cigarettes don’t emit an odor similar to combustible cigarettes, children and teens believe the vapors they are inhaling are nontoxic — which we know to be false.

Wilhelm: Children and teens also believe that e-cigarettes are harmless because they are simply “vaping” and not “smoking.” However, like smoke, inhaling a hot vapor in itself is dangerous to your lungs.

How do you help untether the risks for teens from the harm-reduction argument often used for adults with chronic smoking?

Wilhelm: While we do have anecdotal evidence that there are adults who have stopped smoking combustible cigarettes by switching to e-cigarettes, they are still addicted to e-cigarettes and inhaling unhealthy vapors. It’s important that children and teens understand that e-cigarettes are not safer than combustible cigarettes; in fact, nicotine levels in e-cigarette juices are often higher.

What is being done at the federal and local levels to educate parents and teens about the risks of e-cigarettes and restrict e-cigarette access to youth?

Wilhelm: For the past 15 years the Prevention WINS Coalition, a nearly 50-member coalition in northeast Seattle, has been working to identify and target strategies to reduce the number of Washington youth who use e-cigarettes and other harmful substances. Our coalition has partnered with the Washington Poison Center to provide educational trainings about the risks of e-cigarettes and teens to local educators, parents and other community coalitions. We also push for stronger state and local legislation to restrict access to teens, such as increasing taxes on e-cigarettes.

Dr. Cora Breuner

Breuner: On a national level, the U.S. Food and Drug Administration (FDA) is finally cracking down on retailers for their child-friendly marketing and illegal sales of e-cigarettes to underage youth. It’s an important step — of many — that is needed to address this epidemic.

Until regulation is firm, it seems healthcare providers have a big role in restricting e-cigarette access to teens. Are there ways they can influence the efforts of the FDA and similar organizations?

Breuner: While we have many responsibilities to our patients in our clinics, we also have the responsibility to protect the health and well-being of our children and their families — both locally and nationally. Many professional organizations, such as the American Academy of Pediatrics, provide resources for members to advocate for their patients at the community, state or federal level.

Wilhelm: Even simply writing a letter that supports positive, bold steps towards prevention efforts can really make a big difference.

How can healthcare providers best communicate the risks of e-cigarettes to their patients? Is there a specific statement that is most convincing or helpful?

Wilhelm: Studies completed by organizations like Truth Initiative have shown that statements regarding e-cigarettes’ effects on personal appearance (wrinkles, yellow teeth, odor) have a stronger impact on teens and young adults than simply relaying general health risks. Discussing how e-cigarette use could impede achievement of athletic, musical or other life goals has also shown to have an impact among this age group.

Are there any barriers to having an open, honest communication with patients about this topic?

Breuner: Oftentimes patients who vape will answer “no” to an assessment that only asks if they smoke cigarettes. So, it’s important for healthcare providers to ask their patients about all of their nicotine use.

Because an honest conversation about e-cigarettes can be difficult to complete when a parent is present, it’s best to ask parents to leave the exam room for a brief period during the appointment in order to establish trust with the patient. Teens also need to be able to articulate health issues and questions without their parents talking for them.

What can parents do to help prevent their children from using e-cigarettes?

Wilhelm: Parents are the first line of defense when it comes to preventing youth e-cigarette use. Teenagers want to know where their boundaries are and how to make decisions, but they won’t necessarily ask their parents for those answers. Parents should send clear messages to their children asking them not to use e-cigarettes and let them know the consequences if they do.

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