1. Beal, Judy A. DNSc, RN, FNAP, FAAN

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The 2019 National Youth Tobacco Survey (NYTS) documents the alarming rapidly growing popularity of electronic cigarettes among teens (Centers for Disease Control and Prevention [CDC], 2019). According to the CDC, more than 3.5 million teens reported using e-cigarettes in 2018. This reflects an increase of more than 1.5 million teens from 2017. From 2017 to 2018, use of e-cigarettes increased from 11.7% to 20.8% among high school students and from 3.3% to 4.9% among middle school students (CDC). Data show use of e-cigarettes is on the rise and teens are using them more frequently. In response to the NYTS report, the American Heart Association (AHA, 2019) released a statement calling on the Federal Drug Administration (FDA) to take immediate action to strengthen its campaign to reverse this epidemic including: removing e-cigarettes from the market; prohibiting all marketing promotions aimed at children; and suspending online sales until effective age verification procedures are established.


E-cigarettes were first introduced to the United States in late 2006. Since then, they have gained significant popularity among teens and are now the most commonly used form of tobacco among American youth. E-cigarettes are also known as e-vaporizers, or electronic nicotine delivery systems with more than 460 different brands on the market. Other common nicknames include: e-hookahs, hookah pens, vapes, vape pens, and mods (National Institute on Drug Abuse, 2018). These battery-operated devices typically deliver a heated aerosol that may or may not contain nicotine. Teens are lured to these products for their promise of safety over traditional cigarettes and a variety of flavored aerosols. Their marketing approach makes e-cigarette use or vaping very appealing and purchase easy for teens.


The health effects of e-cigarette use have been well documented. Effects of nicotine are well known on blood pressure, respiratory rate, and heart rate. As with most addictive substances, effects on the development of the brain's reward system. Continued e-cigarette use has been found to lead to nicotine use and also to cocaine and methamphetamine use. Other long-lasting effects of e-cigarette use in adolescence include disorders of attention and learning, mood disorders, and decreased impulse control (U.S. Department of Health and Human Services, 2016).


Although some researchers have determined that e-cigarettes might be less harmful than traditional tobacco products and that e-cigarettes can assist in lowering nicotine cravings and assist with smoking cessation, there are no rigorous data in the scientific literature to make these conclusions. New risks to e-cigarette use have lately surfaced including lung exposure to toxic chemicals such as nickel and chromium (Hess et al., 2017).


Pediatric nurses can play a vital role in curbing the rising epidemic of adolescent vaping. Becoming informed about the incidence as well as the risks to adolescent e-cigarette use is critical. Sharing data from the NYTS report (CDC, 2019) and the AHA (2019) position statement with parents and youth is a first step. Nurses are well positioned as the nation's most trusted professionals to advocate with legislators to advance the AHA recommendations to the FDA. It is alarming that e-cigarette use has increased by 78% among high school students and 48% in middle school students (CDC). The impact of long-lasting negative health outcomes for our nation's youth is clearly a call for action.




American Heart Association. (2019). New CDC data highlight e-cigarette epidemic's threat to nation's youth (News Release). Dallas, TX: Author. [Context Link]


Centers for Disease Control and Prevention. (2019). Tobacco use by youth is rising: E-cigarettes are the main reason. CDC Vital Signs. Retrieved from Accessed February 24, 2019. [Context Link]


Hess C. A., Olmedo P., Navas-Acien A., Goessler W., Cohen J. E., Rule A. M. (2017). E-cigarettes as a source of toxic and potentially carcinogenic metals. Environmental Research, 152, 221-225. doi:10.1016/j.envres.2016.09.026 [Context Link]


National Institute on Drug Abuse. (2018). Electronic cigarettes (e-cigarettes). Retrieved from Accessed February 24, 2019. [Context Link]


U.S. Department of Health and Human Services. (2016). E-Cigarette use among youth and young adults. A report of the surgeon general. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Retrieved from Accessed February 24, 2019. [Context Link]