Vaping, JUULing and e-cigarettes: What teens and parents need to know

A guide for parents and teens on e-cigarettes“Which flavor is this? Cherry cheese cake? French vanilla? Crème brûlée?” If you are a teen in high school these days, chances are that you’ve already asked yourself this question and have inhaled at least a few breaths of some of the powerful scents coming from a JUUL or other type of e-cigarette.

The popularity of electronic cigarettes has increased exponentially in the past five years: nearly one in three seniors in high school say that they have used an e-cigarette in the past year. The FDA has recently released a statement warning about the risks of vaping and supporting strict regulations to avoid exposure to e-cigarettes for children and teens. But are e-cigarettes all that bad?

A breakdown of the health risks

There is now enough evidence to say that e-cigarettes carry many important health risks, especially for young people. One of the main culprits: nicotine. When adolescents, whose brains are still developing, are exposed to nicotine on a regular basis, there can be negative impacts on memory, learning and emotional control. We also know that teens that use e-cigarettes are three to seven times more likely to use traditional cigarettes, alcohol, marijuana and illicit drugs. In addition, electronic cigarette liquid, or e-liquid (with or without nicotine) contains a handful of heavy metals and chemicals, which, when inhaled at high temperatures, increase the risk of cancer and lung injury.

While those are some of the more long-term risks, e-cigarettes also have several immediate health risks. For example, emergency rooms are seeing high numbers of severe facial and leg burns linked to e-cigarette explosions while vaping, or simply from defective e-cigarettes being stored in clothes pockets. E-liquids are also an important health hazard for young children and can cause serious poisonings and intoxications.

E-cigarettes were initially designed to help adults quit smoking. The problem is that vaping products are often sold in youth-friendly flavors and packages than can look a lot like candy or toys. Some e-cigarettes, like the “JUUL” look like small USB flash drives; e-liquids often come in colorful, sweet and catchy flavors like “gummy bear”, “tutti frutti” or “cool mint”, to name a few. While popular e-cigarette companies like “JUUL” claim that their products are not meant to be used by minors, teens that are exposed to e-cigarette advertising are not only more likely to vape, they are also almost twice as likely to use conventional cigarettes.

Current policies to protect children and teens

At present, laws about labeling and packaging of e-cigarettes vary widely across states and e-cigarettes products are generally easy to order online, even for minors. While some products clearly indicate nicotine content and health risks if used by children or adolescents, it is not true of all products. As a result, the majority of teen e-cigarette users report that they use e-liquids containing only flavoring. However, a study by the Truth Initiative, shows that 99% of e-liquids contain at least some nicotine.

E-cigarettes, especially when they contain nicotine, are highly addictive, more so than other substances like alcohol and marijuana. ~ Dr. Chadi

Schools across the country are responding to the “vaping epidemic” with serious disciplinary measures. The discrete shapes of some of the newer models of e-cigarettes are making this challenging for school staff: students often use them in class or school bathrooms. The Boston Public School Board has recently released a new policy prohibiting all cigarette products from school properties and in all school-related activities. The policy also requires students who are caught vaping for a second time to seek treatment for e-cigarette use, either with a school counselor or a health care provider.

How to help adolescents quit

E-cigarettes, especially when they contain nicotine, are highly addictive, more so than other substances like alcohol and marijuana. Teens can develop symptoms of nicotine dependence (increased tolerance, inability to stop using) and withdrawal (headaches, irritability, difficulty sleeping) after only a few weeks or months of vaping. The American Academy of Pediatrics now supports the use of nicotine replacement products (patches, gums, lozenges) to help adolescents who are daily cigarette or e-cigarette users quit. These nicotine replacement products, can be prescribed by primary care doctors (pediatricians or family doctors) or in specialized substance use programs such as Boston Children’s Adolescent Substance Use and Addiction Program (ASAP). Other effective ways to help teens quit using nicotine include individual substance use counseling and use of online cessation apps, such as QuitSTART.

Given their popularity with youth, it is important for parents to discuss the risks of e-cigarettes at home. The first and most important point to discuss is that the majority of adolescents choose not to use them, and this is the safest and healthiest option. While there may be benefits for adults to use e-cigarettes instead of traditional cigarettes, the risks and harms highly outweigh the benefits for children and adolescents. As mentioned in a recent New York Times article, the JUUL might seem “too cool” at first sight but saying “no” to e-cigarettes is ultimately a much safer alternative for children and adolescents.

More information on the JUUL and e-cigarettes can be found at and American Academy of Pediatrics Richmond Center web page.

Learn more about Boston Children’s Adolescent Substance Abuse and Addiction Program (ASAP).

About the blogger: Dr. Nicholas Chadi is a pediatrician, specializing in Adolescent Medicine. He is the first Pediatric Addictions Fellow in North America and is currently conducting clinical and research work with the Adolescent Substance Use and Addiction Program (ASAP) at Boston Children’s Hospital. Follow him on Twitter @nicholaschadi or at