Nicotine use by adolescents is a global health concern, with recent reports suggesting a marked rise in youth consumption of the stimulant – not via the traditional cigarette but via its trendier cousin, the electronic cigarette or vape.
Results from the annual Monitoring the Future (MTF) survey, which tracks drug use and attitudes among 8th, 10th, and 12th graders in hundreds of schools across the US, found that respondents across all grades have vaped nicotine.
Nicotine vaping was most commonly noted among their oldest respondents (29.7 percent), followed by flavourants (25.7 percent) and marijuana (13.1 percent).
Survey reveals large increase in nicotine vaping among high school students; more than 20% of 12th-graders reported that they vaped nicotine in 2018. The increase in adolescent nicotine use from 2017 to 2018 was explained by an increase in vaping. https://t.co/U1Qoy9PFNt
— NEJM (@NEJM) December 19, 2018
Meanwhile, the use of Juul, the producer of a popular e-cigarette that resembles a USB drive, is increasing among American youths, but awareness of its nicotine presence is low.
According to one study, 63 percent of Juul users were not aware that the product contains nicotine.
As nicotine is a highly addictive drug, reports such as these are worrying.
The pull factor
Reasons for the increased usage of e-cigarettes with nicotine may vary between countries.
In the US, the MTF survey notes that more 8th and 10th graders have found vaping devices and e-liquids containing nicotine easier to obtain in 2018 than in 2017.
Meanwhile, exposure to e-cigarette marketing may also play a role.
The 2016 National Youth Tobacco Survey (NYTS) in the US notes that “78.2 percent of middle and high school students – 20.5 million youth – had been exposed to e-cigarette advertisements from at least one source, an increase from 68.9 percent in 2014.
“Another study found that 82 percent of 12 – 17-year-olds and 88 percent of 18 – 21-year-olds reported seeing e-cigarette advertising in 2015. The investment in e-cigarette marketing has been coupled with an increase in use among youth and young adults.”
It adds that “A 2016 study in Pediatrics, analysing 2014 NYTS data, found that exposure to e-cigarette advertising is associated with current e-cigarette use among youth and that greater exposure to e-cigarette advertising is associated with higher odds of use.”
While it does not state if the ads relate to non-nicotine or nicotine e-cigarettes or both, it is worth noting that while some e-cigarettes are labeled as nicotine-free, they may, in fact, contain nicotine.
MTF says, “students do not always know what is in the device they are using; labelling is inconsistent, and they often use devices bought by other people. The most popular vaping devices on the market do not offer options that are nicotine-free.”
Meanwhile, in Hong Kong, researchers have found that some of the things associated with current e-cigarette use among secondary school students include poor knowledge about the harm of smoking, cigarette smoking and use of other tobacco products.
Nicotine use among adolescents has many risks
Adolescents report symptoms of dependence even at low levels of nicotine consumption.
Nicotine exposure during adolescence impairs development of the prefrontal cortex which is responsible for cognitive decision-making.
— Jake Mendel (@ijakemendel) December 21, 2018
So what’s the big deal with nicotine use?
Research shows that the brains of adolescents, specifically, the prefrontal cortex, which plays a critical role in executive functions and attention performance, have not yet fully developed.
Healthline reports that nicotine “largely affects the area of the brain responsible for attention, memory, learning, and brain plasticity.”
Meanwhile, Yale Tobacco Center for Regulatory Science co-leader Suchitra Krishnan-Sarin told Yale Medicine that “We have a lot of evidence showing that the adolescent brain is extremely sensitive to the effects of nicotine.”
“Studies have shown us that nicotine can interfere with memory and attention processing,” she said, adding that the brain doesn’t stop growing until around age 25.
Meanwhile, experts warn that “nicotine use among adolescents can enhance the rewarding effects of other drugs, particularly cocaine”.
Child Mind Institute child and adolescent psychiatrist in New York City Sarper Taskiran says “chronic nicotine use can make teens more impulsive, less focused and attentive, and at risk of cognitive problems”, while numerous studies suggest adolescents who use e-cigarettes are at risk of graduating to tobacco smoking.
Stamping out nicotine-e-cigarette use
While the attraction of vaping or Juuling among youths partially lies in the exotic flavours offered and the clever marketing tactics used to push the sales of these products, some countries have taken a more conservative approach to tackle the problem of e-cigarette use by banning them.
For example, Australia has banned the use of nicotine e-cigarettes; however, it is still legal to use e-cigarettes that do not have nicotine. Hong Kong is set to follow suit, with the government planning to ban e-cigarettes and other new tobacco products.
Singapore has made it illegal to buy, use and possess e-cigarettes, e-pipes and e-cigars as of February 2018. Meanwhile, in Poland, prior to 2016, the country had “no age-related sales restrictions that limited the ability for teenagers to purchase e-cigarettes or nicotine-containing e-liquids from different sources”.
Meanwhile, other countries have opted to regulate instead of imposing an outright ban on e-cigarettes.
The UK’s “robust regulation” to protect children through limiting marketing and restricting the sales of e-cigarettes appears to be working, according to Action on Smoking and Health (ASH) data, which notes that e-cigarette use among youths is “very low” in Great Britain.
Educating youths about the dangers of nicotine is another way to tackle the problem.
Krishnan-Sarin encourages parents to talk to their children openly about vaping and to “provide accurate information” to them, in addition to encouraging their children to read and understand the science on the issue.
While critics argue that nicotine e-cigarettes have its benefit, including acting as a smoking cessation tool, its use remains a hotly debated topic that continues to polarise people.