We have good news to report on the vaping front! Across the United States, rates of teenage nicotine vaping have taken a genuine nosedive. Currently, about 20% of high school seniors report any nicotine vaping over the past year. This is far less than what we observed pre-pandemic, when about 35% of high school seniors reported vaping. The results from 10th and 8th graders bring similar good news that vaping nicotine is on the decline.
These
results align well with a recent personal experience speaking to a group of
high school students. Most of these kids already recognized that vaping was
essentially no healthier than smoking traditional cigarettes. In fact, use of
alcohol, cannabis, and other drugs have also trended downward in high school
students, making this generation about as mischievous as the teenagers on Happy Days. As the legendary British
band, “The Who,” sang many years ago, “The kids are alright!”
Of
course, we are not ready to quit our day jobs here at Johns Hopkins (though we
might get fired by President Trump). We do not know how these national
statistics translate to our unique community. Many teenagers and adults
continue to struggle with vaping and other substance use. And as parents, the
job of providing correct substance use education is never completely over
because curiosity, sensation seeking, and peer pressure are all part of normal
adolescence.
As
a clinical psychologist, my biggest worry about vaping is that it will lead to
a problem of substance dependence. In fact, with the large reduction in vaping
among high school students, it is quite possible that those who continue to
vape have the most difficult time stopping.
It
is easy to get hooked on nicotine because each vape contains roughly the
equivalent of a pack of 20 combustible cigarettes. Even the seasoned cigarette
smoking adults I work with rarely smoke an entire pack each day. Because vaping
is essentially odorless, there are few barriers to smoking it all day,
including during school hours.
We
know that many (though, of course, not all) teenagers progress quickly from
experimenting with vapes to daily use. For instance, about a quarter of kids
who have tried e-cigarettes eventually smoke them daily. We also worry about
kids switching from vapes to traditional cigarettes. It seems as if about 15%
of kids who start vaping end up at least trying traditional cigarettes as a
teenager.
When
we talk about addiction, we also consider the impact of nicotine on brain
development and maturity. Vaping clearly interferes with routine synaptic
transmission. These changes in brain circuitry seem to trigger more compulsive
use, which coincides with experiencing less reward from other things, such as family,
learning, sports, or music. And while vapers often report that nicotine
improves attention and relaxation – the known short-term benefits of nicotine –
we know that down the road these same kids exhibit more problems with focus and
anxiety.
The
literature is also starting to document the medical harms of vaping. We see
that kids who vape have higher rates of asthma and bronchitis. Routine
illnesses bring more breathing problems that may require hospitalization. What
is important to understand, according to our pulmonologists, is that this
pattern of harm aligns closely to the types and patterns of problems
experienced by teenagers in previous generations who smoked traditional
cigarettes.
Vapes
were initially touted as a healthier option to traditional cigarettes because
they do not possess tar and other chemicals directly associated with
respiratory health. But there is no shortage of cancer-causing agents! Recent
science shows that nicotine vapes contain several toxic chemicals that lead to
lung disease and other serious medical harms.
There
is also the worry that vaping will lead to more intensive drug use. As we have
noted previously, it is almost impossible, statistically, to speak of “gateway”
drugs. It is certainly true, for example, that most people who use heroin
started first with cannabis, yet they also drank milk as a teenager, and no
scientist would want to connect milk consumption with opioid use.
Yet
we do see that about half of the kids who vape nicotine also report vaping
cannabis. While there are many plausible biological reasons for this
association, it is also reasonable to suggest that a teenager’s pattern of
substance use is highly influenced by those whom he or she hangs out with. Our rabbis
have much to say about the influence of our neighbors.
Finally,
for parents who have children already involved in vaping, we should mention
that nicotine addiction is a very treatable disorder, and earlier treatment
tends to have a better prognosis. For those who have a physical addiction,
meaning that they experience withdrawal symptoms (agitation, depression,
insomnia) and find relief only when returning to vaping, there are several
treatment options used successfully by traditional smokers: nicotine
replacement gums or patches, medications like varenicline (Chantix) or
bupropion (Wellbutrin), and even, more recently, cost-free vaping apps that
provide encouragement and guidance (like the CDC’s quitSTART app).
Because
vaping is tied closely to anxiety and depression symptoms, psychotherapy might
be helpful to disentangle cravings and drug-seeking from other mental health
concerns or worries and get to the bottom of why substance use is playing such
an oversized role in a teenager’s life.
It
is certainly good news that rates of vaping have recently come down across the
country, though, of course, the extent to which these findings generalize to
our community is unknown. Drug use popularity tends to cycle in ways that we
rarely understand. What is clear is that our kids deserve to grow up with a
drug-free brain and without worrying about getting COPD or lung cancer in the
future. In our complicated world, they already have enough to worry about.
Michael Kidorf is a clinical psychologist and Associate Professor at Johns
Hopkins University School of Medicine.
