Vaping has exploded in popularity in the past five years or so. Electronic cigarette use is rising faster than any other substance use recorded. And the biggest worry is that one of the main users - teenagers - are not the demographic for which these devices were originally intended.

It’s a sad irony that a product that was originally conceived as a smoking cessation aid is, in fact, creating a whole new generation of nicotine addicts. According to the Truth Initiative, between 2011 and 2019, youth e-cigarette use rose 1,800% and it is now the most common source of tobacco for young people. While e-cigarettes may be less harmful than traditional cigarettes, they are in no way harmless. In North America a sudden outbreak of lung injuries associated with e-cigarettes during the summer of 2019 highlighted some of the short-term dangers of these devices. But perhaps even more concerning is that they are so new that experts don’t yet know what the long-term effects might be.

What is Vaping?

Vapes, vape pens, mods, tanks or e-cigarettes are collectively known as Electronic Nicotine Delivery Systems (ENDS). These battery-operated devices heat a liquid into an aerosol that is then inhaled. This liquid usually – but not always – contains nicotine, and thus, in theory, helps smokers wean themselves off cigarettes. One of the reasons behind the rapid uptake among teens, however, is that many have fruit or candy flavours added which appeal to young people. Another, is the product design which has become increasingly sleek and techy-looking. Devices can look like pens or zip drives and fit neatly into the palm of a hand. And then there’s the marketing, much of which is on social media and targets this age group. E-cigarettes have also succeeded in removing many of the negative connotations of conventional cigarettes – users don’t inhale the tar, there is no smoke or unpleasant smell, and they are cheaper than tobacco – all of which add to their appeal.

Vape Use in Cayman

Although 40+ countries worldwide have prohibited vaping in all forms, in Cayman these devices are readily available in gas stations and corner shops, and are often prominently displayed, says Simon Miller, the National Drug Council’s prevention specialist. Although by law tobacco products cannot be sold to under-18s in Cayman, it’s a grey area as some vapes do not contain nicotine and are therefore not technically tobacco. However, the good news is that vaping products are in the process of being regulated here. Nonetheless, the NDC’s 2020 Student Drug Use Survey, which polled almost 3,500 students in Cayman schools, found that e-cigarettes were the second most common substance used by young people after alcohol, with 29% reporting having vaped at least once. These figures have increased since the 2018 survey. The survey also found that children aged 13 and younger reported having tried vaping – double the rate that had tried tobacco.

Risks of Vaping

Because vapes have been around for less than 15 years, the long-term effects have yet to be seen. Their recent emergence also means that there is little regulation surrounding them, and some of the chemicals used in them are unknown, so their safety has not been established. Most vapes deliver nicotine, a highly addictive substance that is known to raise the heart rate and increase the risk of heart attack. Nicotine is particularly dangerous for young people, as it can have damaging effects on brain development: it may lower impulse control in developing brains and can harm the parts of the brain that control attention and learning. Evidence indicates that those who consume nicotine through vaping are more likely also to use traditional tobacco products and try other drugs.

Juul, by far the largest vape brand, makes refills that contain the same amount of nicotine as a pack of 20 cigarettes – such concentrations are prohibited in the European Union – which in addition to addiction, can lead to nicotine poisoning. Nicotine toxicity can cause headaches, nausea, vomiting, changes in heart rate, seizures and, in severe cases, death.

Even when vapes don’t contain nicotine, the e-liquids that are heated contain other chemicals, some of which are known to be harmful. One, diacetyl – a chemical used for flavouring – is linked to a condition called 'popcorn lung', which causes scarring and obstruction in the lungs; another, Vitamin E acetate, was found to be associated with EVALI, the vaping-associated lung injury that hospitalised thousands in 2019.

Some vapes can also be modified to smoke marijuana, Miller says, and the devices work in such a way that the smell is barely perceptible, so teens could be smoking at home, unbeknownst to their parents.

Additionally, the heated coils may expose users to heavy metals such as nickel, tin and lead, and in rare cases, faulty lithium batteries have exploded causing injuries and burns.

Is Your Teen Vaping?

It’s not always easy to tell when young people are vaping as the devices are discreet and, unlike conventional cigarettes, there isn’t the same smell that clings to hair and clothes. However, signs to look out for, include:

• Changes in behaviour, irritability, or mood swings

• Nosebleeds (vaping dries out the mucus membranes in the nose)

• Increased thirst

• Unusual, sweet or fruity odours from the flavourings

• Unfamiliar paraphernalia (many look like zip drives or pens but have holes at either end)

• Coughing

• Mouth sores

• Decline in academic or athletic performance.

Talking to Teens About Vaping

“Whether your child is vaping or not, have a conversation about it with them,” Miller advises.

Adolescent brains are almost hard-wired to take risks, so you may not be able to stop your teen from trying vaping, but you can talk to them to ensure that if they do, they do so knowing the facts.

Talking about vaping need not be confrontational: try to make it a two-way conversation rather than a lecture. Find out what they know about the risks and fill them in on the details they don’t know, emphasising how much is still unknown.

Look for openings – such as when you see someone on the street or on TV vaping – to ask them if they have tried it and start a dialogue. It may be more effective to have the conversation over time, in small chunks, so that it remains an open and ongoing discussion.

The US Surgeon General has a website dedicated to vaping among teens that includes tip sheets and fact sheets that suggest approaches to opening a discussion and that help equip parents with the right information.

Getting Professional Help

For teens who have trouble quitting vaping, Miller says the support would be the same as for those trying to quit smoking. Your GP may be a first port of call, but there are also smoking cessation classes offered by both HSA and Cayman Islands Cancer Society. Counselling centres, such as Infinite Mindcare, also run programmes specifically for teenagers.

As Miller points out, even if your child is not vaping, they will know someone who is. As a parent, you can’t control what your teenagers do, but you can make sure they know the facts. And perhaps the most important point to impart is that at this early stage it is the unknowns with vaping that are at least as worrying as the knowns.