Among adolescents, cases of e-cigarette or vaping-associated lung injury (EVALI) were “a drop in the ocean” compared to cases of COVID-19, one researcher said.
Still, vaping remains a significant health risk to teens, Anne Griffiths, MD, of the Children’s Hospital of Minnesota, reported during her presentation entitled “Updates on Youth Vaping” at the American Academy of Pediatrics virtual meeting.
According to the 2021 National Youth Tobacco Survey, 11.3% (1.72 million) of high school students and 2.8% (320,000) of high school students reported having used e-cigarettes in the past 30 days.
More than half of young people who vape said they have tried to quit before. That’s where pediatricians can step in, Griffiths said.
High school students often start with zero-nicotine, only flavor-based products before “moving to a nicotine-based product and eventually a THC-based product,” Griffiths noted. Of the middle and high school students who vape, 85% use flavored products. Fruit, candy and other sweet flavors were most popular among students.
Note that disposable e-cigarettes beat refillable pods and cartridges to become the most popular device of choice this year, with 53.7% of all students who vape reporting using these products. The increase in single-use use can be largely attributed to recommendations not to share vape products to reduce the spread of COVID-19, Griffiths said.
Vaping appears to be a risk factor for COVID-19, as it is five times more likely to be diagnosed in adolescents who vape, according to a study published in the Journal of Adolescent Health.
Previous studies have shown that the flavors in e-cigarettes can suppress innate immune function. Studies have also shown that e-cigarette vapor can increase ACE2 expression in the lungs. ACE2 is the receptor that allows SARS-CoV-2 to enter the host cells.
There are methods for distinguishing between adolescents who present with EVALI or COVID-19 (or both), Griffiths said. She noted that the patient’s response to steroid treatment may be diagnostic: “Unlike SARS-CoV-2 where the… [patient’s] improvement may be subtle [with a] gradual response to steroids, in EVALI, one day to high-dose steroids and they feel like a million dollars in comparison.”
In addition, EVALI may present with leukocytosis and high erythrocyte sedimentation rates and C-reactive protein levels, while COVID patients are more likely to have lymphopenia.
Despite the risks of vaping, “there’s a whole culture around it” [kids] that can glorify vaping life,” Griffiths noted.
Vape championships on YouTube, in which competitors perform various smoking tricks, are one method vape companies use to reach children. By offering prizes to those who can do the best tricks, they “gamify” vaping, Griffiths explains.
Vape companies also offer academic scholarships ranging from $300 to $5,000 to students. These scholarships often require essays asking the students to write about the benefits of vaping.
Griffiths highlighted the work of fellow Minnesota physician Rose Marie Leslie, MD, an 80,000-follower “TikTok doc” who publicizes the health risks of vaping. However, Leslie is in the minority on TikTok. According to one survey, 63% of TikToks painted vaping in a positive light, while only 13% were negative.
The CDC began tracking EVALI cases in August 2019, and as of February 2020, 2,807 EVALI cases and 68 deaths have been reported.
Lei Lei Wu is a news intern for Medpage Today. She is based in New Jersey. To follow
Griffiths reported no industry relations.