While traditional cigarette use has been declining, electronic cigarettes, also known as e‑cigarettes, are being used by teens under 18 in dramatically increasing numbers. In the fall of 2018, U.S. Food and Drug Administration (FDA) Commissioner Scott Gotlieb said that e‑cigarette use by youth had reached "epidemic proportion."
  E‑cigarettes are not regulated, are not approved by the FDA as a nicotine replacement therapy and can potentially harm users with undisclosed chemical ingredients. The Maine Center for Disease Control and Prevention (CDC) notes that because the product is unregulated, there is no way to know how much nicotine is in them. "This is dangerous because 30‑60 mg of nicotine is a deadly dose for adults, and even 10 mg can be deadly for children."
     While smoking traditional cigarettes by high school youth has declined from 40% in 1997 to 10% in 2017, the use of e‑cigarettes, or "vaping," at the high school level had increased to 20% by 2018, according to the CDC. However, at a discussion held by Healthy Acadia tobacco cessation specialists Julie Daigle and Georgie Kendall and hosted by Calais Regional Hospital on the evening of March 5, Daigle suggested that the rise in use is so rapid that the figure is more likely to have since increased to about 30% in Maine high schools.
     While the early versions of e‑cigarettes were made to look like traditional cigarettes, that quickly changed. However, the delivery of nicotine remains the same. The technology uses a pod that contains liquid, or "juice," that is a mixture of delivery chemicals and nicotine, along with a battery and an inhaler. The battery can be charged with traditional batteries or by a computer or cell phone jack. The battery converts the liquid into an aerosol vapor that is inhaled. The e‑cigarette that is gobbling up market share with teens, Juul, has pods and delivery sticks that look like variations on thumb drives, which has made them easy to hide in schools, at home or in other places where adults might intervene. Of the six most popular e‑cigarette companies, the market share for Juul rose from less than 5% in 2015 to 40% in 2017.

Teens unaware of dangers
     E‑cigarettes are touted as a way for adult smokers to cut down on tobacco cigarettes or quit altogether. However, Daigle points out that that is not really how they are advertised. The FDA was so concerned about the targeting of not just teens but younger youth with flavors such as cotton candy, fruit loops and gummy bear that in September 2018 it said it would take action against manufacturers and retailers to restrict such flavors if steps weren't taken to ensure that those under 18 weren't buying the products.
     Daigle states that many teen users don't realize that their "vaping" is delivering into their system more than a pleasant cocktail of flavors. One pod contains about the same amount of nicotine as a standard pack of cigarettes, but it's much more difficult for a user to know how much they've ingested when they're vaping. While 54% of Maine youth in a 2018 study thought they were vaping "just flavor," in reality 99.6% of all e‑cigarette products sold contain nicotine. "There's a disconnect in perception," she added.
     Nicotine is addictive, and in youth and young adults the brain is still developing, with nicotine addiction withdrawal symptoms occurring every two hours. This means that every two hours a smoker or vaper must manage those symptoms. Youth and young adults are especially susceptible to the addictive effects of nicotine and other drugs, states the U.S. Department of Health and Human Services, with a strong indication that those teens who use e‑cigarettes are going on to smoke tobacco cigarettes. Some studies suggest that the young brain is made more receptive to the effects of other drugs, such as cocaine, when it is exposed to nicotine.

Vapor may contain unknown chemicals
     In addition to nicotine, e‑cigarettes contain propylene, glycol, glycerol, flavorings, water and additional substances that have shown up in tests to sometimes include such toxic chemicals as formaldehyde, which is known to cause cancer.
     One chemical found in many of the flavors, diacetyl, has been linked to permanent and progressive scarring of the lungs. "Popcorn lung" was discovered to be related to the chemical, which for years was used to create the buttery taste found in such ready‑made snack items as popcorn. Most manufacturers stopped using the chemical when the connection was discovered.      However, according to Medical News Today, a 2015 study of flavored e‑cigarettes found that 39 out of 51 tested brands contained diacetyl. The same study concluded that most of these brands also contained the toxic chemicals acetoin and 2,3-pentanedione, chemicals that are also used for snack flavorings, particularly in candy, and have similar health effects on the lungs.
     In 2018 about half a million people died in the United States from tobacco‑related diseases. In the same year about 47,000 people died from opioid‑related deaths. The numbers show "the scale of the tobacco epidemic," Daigle adds.
      Healthy Acadia has a number of resources available for tobacco cessation, including talking to teens about e‑cigarettes, building tobacco‑free communities and writing policy language for businesses. To learn more, visit <www.healthyacadia.org>.