Gen Vape: How Clinicians Can Help Their Young Patients Quit

In this video, Chasity Shelton, PharmD, of the University of Tennessee (UT) Health Science Center in Memphis, discusses the various health risks associated with adolescent vaping, and offers healthcare providers advice on how to address these risks with teen patients.

Shelton is the assistant dean for Student Success at UT and an associate professor in the Department of Clinical Pharmacy & Translational Science. She was the lead author of the article “A Comprehensive Review of Vaping Use in Pediatric Patients and Recent Changes in Regulatory Laws” in the Journal of Pediatric Pharmacology and Therapeutics.

The following is a transcript of her remarks:

One of the general health risks for vaping, specifically for adolescents, is nicotine exposure. Nicotine exposure and addiction are very harmful for youth and adolescents.

What most people may not be aware of is that nicotine can actually rewire a teen’s brain to crave more nicotine, which can result in addiction. The brain change is related to their nicotine exposure, which can have long lasting effects on attention, learning, and memory that can promote addiction to the drug.

Also, teens who vape may become addicted to nicotine faster than teens who actually smoke traditional cigarettes. What some people don’t recognize and understand is that a lot of the vape products actually contain more nicotine as part of their content than a traditional cigarette. For example, there are some products on the market where one pod that’s used to vape can actually contain as much nicotine as a whole pack of cigarettes, so that’s 20 traditional cigarettes. So teens who vape may actually become addicted to nicotine faster because of that.

Also, the data is showing that teens who vape are more likely to start smoking, when we think about smoking traditional cigarettes. We already know that cigarette smoke includes a mix of chemicals and other additives that can cause serious disease and death.

Some other things that people aren’t aware of is that vaping may be harmful to the lungs. Vaping can expose users to other toxic chemicals and metal particles, such as lead, chromium, nickel, which can be harmful to the lungs. Also, some chemicals that are found in cigarette smoke are also found in some e-cigarette products or aerosols, and so we know that inhaling these chemicals can cause some irreversible lung damage.

When thinking about how pediatric healthcare providers and pharmacists can talk to children about the health risk associated with vaping, I think one of the first steps is that we learn more about vaping ourselves so we’re prepared to talk about it with teens.

There’s actually lots of resources available for healthcare professionals. The FDA has made some products available for free that are online. There’s actually a website that’s promoted a tool called Quit Vaping, and that’s a very good tool to provide some facts, and also to help you kind of figure out how you can talk and address it with teens.

I think sharing the facts with them, clearing up their misperceptions about vaping, sharing the facts about the health effects of vaping, so being honest with them.

I think also learning how to recognize when a teen might be vaping [is important]. Sometimes it’s hard to tell because vaping is easier to hide than smoking cigarettes because you don’t smell the cigarette smoke, you also don’t see the fingernail color change that occurs often with traditional cigarettes. Also, the manufacturers have become very creative and vapes can look like everyday objects. They look like smart watches, asthma inhalers, flash drives, et cetera, so they don’t look like a traditional cigarette.

I think a lot of times just being knowledgeable and understanding how you can go about identifying these things, and then equipping yourself with the knowledge and resources that are available to us in order to be able to have those discussions with children.

As far as parents’ involvement in the conversation, I think we as healthcare providers have to be careful in this area because it can actually mitigate that relationship of trust we’re trying to build and establish with that teen. I think what we can do instead is empower parents by equipping them with knowledge to be able to recognize the signs of vaping and also the symptoms of addiction, and so kind of working with them and partnering with them. I think having speakers come to schools so teachers are equipped with this knowledge as well, so they know what to look out for.

[Parents] can look for signs of vaping in their own home. A lot of signs of vaping are new behaviors, like secrecy or anger, a change in school performance — remember we talked about how with nicotine there are learning and memory deficits that can occur — if your adolescent has a dry cough or increased wheezing that’s not explained by something else, that could be a sign that your teen may be partaking in vaping, and then recognizing those symptoms of nicotine addiction.

So I think whenever you talk with the teen, if you have them in a safe space where you can talk with them and they do identify that they do vape, maybe trying to assess if they’re actually already addicted or not, and then promote those smoking cessation or vaping cessation tools. Asking them ‘Do they find themselves needing to vape first thing in the morning? Are they feeling anxious or irritable because of cravings? Do they vape without even thinking about it? Are they having trouble concentrating or sleeping, or do they think about it [vaping] throughout the day? I think those are a lot of good questions you can ask and equip yourself with in order to talk about it with these patients.