What Is Vaping? An Escalating Health Threat for Teens with ADHD
Hyperactivity, impulsivity, and peer pressure can lead teens with ADHD to try the nation’s newest health risk: vaping. Addiction follows quickly and commonly as the nicotine — a central nervous system stimulant — briefly alleviates ADHD symptoms. Here, we explore how vaping exposes teens to nicotine addiction, carcinogens, chemical toxins and additional health risks.
Teens with ADHD Are at Elevated Risk for Vaping
Attention deficit hyperactivity disorder (ADHD or ADD) is a neurochemical condition that causes impulsivity and lack of focus, a symptom combination that often results in poor decision making, particularly during the adolescent years. Social challenges and low self-esteem compound the problem, making teens with ADHD more susceptible to peer pressure and risky behavior undertaken in hopes of fitting in. Multiple studies confirm that teens with ADHD are at higher risk for unsafe driving, unprotected intercourse, and substance abuse.1
Now, there is a new risk: Vaping.
The incidence of vaping — or inhaling and exhaling the aerosol vapor from an e-cigarette or similar device — is alarming among teens with ADHD. For many, vaping quickly escalates from an innocent curiosity to a dangerous form of addictive self-medication. The nicotine delivered to the body through vaping triggers the release of dopamine and norepinephrine, the ‘feel-good’ chemicals naturally lacking in ADHD brains. Nicotine is a central nervous system stimulant that delivers temporary relief from some symptoms of ADHD; it is also highly addictive. When delivered via a JUUL or STIG vaping device, nicotine also comes along with high levels of metals and other toxins that can cause serious lung conditions such as bronchitis and bronchiolitis obliterans, aka “popcorn lung.”2,3
Vaping is a serious health hazard that many mistake for a healthier alternative to traditional cigarettes.
While nicotine might briefly alleviate ADHD symptoms, it exacerbates them in the long term: the dose of stimulant from nicotine briefly helps with focusing, but over three to six months a serious addiction and craving for nicotine will develop that actually worsens the natural production of dopamine.4 Nicotine addicted teens become even more anxious, more nervous, and have decreased appetite and insomnia. If ADHD symptoms are being treated effectively, teens with ADHD are far less likely to turn to harmful substances or vaping.5
What Is Vaping?
Vaping was originally developed to assist with smoking cessation, but has quickly evolved into a commonplace health risk for young people who might have never considered smoking a typical tobacco cigarette. E-cigarette and vape use increased 900% among high school students from 2011 to 2015.6
Vaping is the act of inhaling and exhaling vapors of heated nicotine fluid that are suspended in propylene glycol and vegetable glycerin. The vapor comes from a metal vaporizer that has a button that activates heat up to 400 degrees Fahrenheit.7 Vapors originate from liquid mods, pods, or e-liquid; marijuana can also be vaporized. E-liquid ‘juices’ and pods that are available in candy and fruit flavors such as watermelon, mint, mango, or crème brûlée are particularly appealing to teenagers.
JUUL is the most common vaping device, owning 50% to 75% of the market. JUUL starter kits — including a JUUL device, charger, and four flavor pods — cost $35 retail and up to $75 on the street. It is illegal for anyone under the age of 21 to purchase e-cigarettes or vaping products in most U.S. counties, and in the cities and unrestricted counties, JUUL is illegal under the age of 18. That means that most high school students who are vaping are doing so illegally.
Each JUUL pod contains 5% nicotine — equal to one pack of cigarettes. This “5% nicotine” label quite often gives consumers the false impression that they are inhaling 95% water vapor; this is not the case.
STIGs are disposable single-use vaping devices that are particularly dangerous as they are readily accessible. They come with pre-filled cartridges and a low-wattage battery that doesn’t need to be charged. STIGs are approximately 6% – 7% nicotine, so they contain more nicotine than a JUUL pod. What is most concerning is the fact that most of these devices look like a flash drive or USB stick and can be charged in the USB port of a laptop computer.
The Dangers of Vaping for Teens with ADHD
The Child Mind Institute estimates that 2.1 million middle and high school students in the United States currently vape.8 Last year, a University of Michigan study9 found nearly 38% of high school seniors and 18% of eighth graders were vaping either nicotine or marijuana. Almost 23% of seniors and 20% of eighth graders are nicotine-craved. Children as young as 11 or 12 years old are vaping today, and we know that nicotine is highly addictive and can harm the developing adolescent brain which continues into the early to mid 20s. Furthermore, the CDC and Surgeon General are clear: the use of ANY tobacco product, including e-cigarette is unsafe for our youth.10
The JUUL website states, “Our ingredients include vegetable glycerin, propylene glycol, oils, extracts, flavor, nicotine, and benzoic acid.”11 There are hundreds of chemicals, toxins, additives, and carcinogens in every mod, pod, e-liquid cap, or juice. Glycerin and propylene glycol were approved by the FDA for food and stomach absorption, but not for inhalation into the lungs. Glycerin and propylene glycol, can potentially break down surfactant in the lungs. They are toxins that cause irreversible, permanent, bilateral lung damage.
When you have lung cancer from combustible, traditional cigarettes, physicians have the ability to surgically remove a portion of the lobe of the affected lung and get treatment. However, through vaping and the pervasive Bronchiolitis obliterans could potentially resulting in the permanent, irreversible lung damage.12
A comprehensive study done in January of 2018 by the Academies of Science, Technology, and Medicine13 concluded that it is dangerous and unsafe to inhale glycerin and propylene glycol. Additionally, in 2009, the FDA tested several types of pre-filled vaping cartridges and found traces of diethylene glycol, a toxin that is found in antifreeze.14
According to the online registry of e-cigarette explosions, ecigone.com, there have been 316 vape device explosions since July 2017.15 Of these, 82 happened during inhalation and use; 92 happened during charging; 75 happened during storage; and 67 involved spare batteries. A staggering 219 vape explosions resulted in personal injury or death. In mid-June, the Washington Post and The New York Times covered the story of a teenager who’s vape exploded: “His entire jaw was cracked and a chunk of the bone had been completely shattered. Several of his teeth were missing and there was a hole in his chin.”16 A pediatric surgeon who operated on the boy thought his injuries looked “like a close-range gunshot wound.”
Education is the key to combating the health risks associated with vaping among teens with ADHD. Doctors and caregivers must share with teens not only the statistics and research regarding vaping, but also graphic images of mouth sores, popcorn lung, and vape device explosions to drive home the severity of this health risk. Some cringe at these scare tactics, but they are incredibly effective in keeping teens away from vaping and from becoming addicted to this new nicotine delivery system.
The following information comes from Kristin Seymour’s, MSN, RN, AHCNS webinar “Vaping and Teens with ADHD: A Parents’ Guide to Prevention, Cessation, and Treatment.” That webinar is available for replay here.
1 Russell A. Barkley. Treatment Matters: ADHD and Life Expectancy. CHADD (Jan. 2019) https://chadd.org/treatment-matters-adhd-and-life-expectancy/
2 E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General. US Department of Health and Human Services (2016) https://e-cigarettes.surgeongeneral.gov/documents/2016_SGR_Full_Report_non-508.pdf
3 Katherine Martinelli. Teen Vaping: What You Need to Know. Child Mind Institute. https://childmind.org/article/teen-vaping-what-you-need-to-know/
4 Monitoring the Future: A Continued Study of American Youth. University of Michigan. http://monitoringthefuture.org/
5 The Dangers of Vaping for Teens with ADHD. The Jewish News. (Feb. 2019) https://thejewishnews.com/2019/02/27/the-dangers-of-vaping-for-teens-adhd/
6 E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General. US Department of Health and Human Services (2016) https://e-cigarettes.surgeongeneral.gov/documents/2016_SGR_Full_Report_non-508.pdf
7 Vaping 360 A Beginners Guide to Vaping. www.vaping360.com
8 Katherine Martinelli. Teen Vaping: What You Need to Know. Child Mind Institute. https://childmind.org/article/teen-vaping-what-you-need-to-know/
9 Monitoring the Future: A Continued Study of American Youth. University of Michigan. http://monitoringthefuture.org/
11 JUUL. https://www.juul.com/
12 Dominic Palazzolo. Electronic Cigarettes and Vaping: A New Challenge in Clinical Medicine and Public Health. (Nov. 2013) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3859972/
13 Public Health Consequences of E-Cigarettes. (Jan. 2018) https://www.nap.edu/resource/24952/012318ecigaretteConclusionsbyEvidence.pdf
14 Dominic Palazzolo. Electronic Cigarettes and Vaping: A New Challenge in Clinical Medicine and Public Health. (Nov. 2013) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3859972/
15 E-Cigarette Explosions: Comprehensive List. eCig One (2019) https://ecigone.com/featured/e-cigarette-explosions-comprehensive-list/
16 Allyson Chiu. A teen’s injuries looked like he was in a ‘high-speed’ crash. Instead, a vape pen exploded in his mouth. Washington Post (Jun. 2019) https://www.washingtonpost.com/nation/2019/06/20/teens-injuries-looked-like-he-was-high-speed-crash-instead-vape-pen-exploded-his-mouth/?utm_term=.4355b31ed5b9