Electronic cigarette use is becoming more prevalent in society as more smokers choose this alternative to eliminate the harms of tobacco use. Teenagers are experimenting with electronic cigarettes as part of their normal growth and development. Risks of harm from electronic cigarettes are orders of magnitude less than for tobacco cigarettes. Teens who smoke cigarettes should be encouraged to stop. Teens that experiment with electronic cigarettes are at lower risk of harm, though the behavior should be discouraged with truthful information about nicotine’s role in establishing habits that may be difficult to break.
The major developmental task for teenagers is identity and self-perception (Erikson, 1968). They seek to build their independence and autonomy as individuals (Rice, 2001). Developing a moral respect for law and order and society maintaining orientation is a major part of their learning (Kohlberg, 1984). Risk-taking behavior is part of normal growth and development at this stage as is the questioning values of family and society is part of building their experience and beliefs (Rowen, Ashwill, & Droske, 2002).
For decades smoking has been a problem in risk-taking teenagers (US Surgeon General, 2014). In the past tobacco companies actively sought to intervene in the market to attract youth (House Committee on Energy and Commerce Subcommittee on Health and the Environment, 1994). Since the Tobacco Master Settlement Agreement [MSA] in 1997 and the Family Smoking Prevention and Tobacco Control Act in 2009 tobacco companies no longer have legal access to this market. Despite these innovations teen smoking has been difficult to keep in decline (Centers for Disease Control, 2014).
Smoking has 7000 chemicals and particles 70 of which are known to cause cancer (Centers for Disease Control, 2010). While immediate harm from smoking is minor (nausea, vomiting, coughing) tolerance often develops very quickly. In teenagers smoking is often part of their attempts to develop their own identity and challenge both parental and societal authority (Erikson, 1968). Thus, despite the immediate and unpleasant side-effects, they will often persevere in their efforts in order to “be cool” with their peers.
The problem with this behavior stems from the middle and long-term consequences. The health effects from smoking tobacco cigarettes stems from years of repeated exposure to the smoke (Wald & Hackshaw, 1996). Research is showing that nicotine, thought to be the addictive component in cigarettes, may play a very different role. Nicotine enhances repetitive pathways in the developing brain (Kandel & Kandel, 2014). When smoking is the means of obtaining nicotine then the habituation of smoking becomes ingrained behavior leading to the difficulty smokers have in quitting their habit. The toxicological profile of cigarettes is shown to have levels of carcinogens and particulates far above the levels necessary to cause cancer (Robbins, et al., 2006; Wald & Hackshaw, 1996).
In 2009 an alternative to smoking was imported to the United States. That alternative is electronic cigarettes (Consumer Advocates for Smoke-free Alternatives Association). This alternative has a far lower risk profile than conventional smoked tobacco (Burstyn, 2014). While smoking exposes the user to 70 known cancer causing chemicals at levels sufficient to actually cause cancer, electronic cigarettes may expose users to less than 10% of these chemicals and at levels far below the known cancer-causing thresholds (Hajek, Etter, Benowitz, Eisenberg, & McRobbie, 2014; Farsalinos & Polosa, 2014; Misra, Leverette, T., Bennett, & Brown, 2014). The most prevalently reported cancer-causing chemicals are shown here with the exposure limits. Clearly the risk to users is far different between electronic cigarettes and cigarettes. In fact the levels detected in electronic cigarettes are factors of 10 times LOWER than the exposure limits and thousands of times lower than the toxic levels found in conventional tobacco cigarettes [Figure 1].
Furthermore, the risk from continued inflammation of lung tissue from smoking is far greater than the risks demonstrated with electronic cigarettes (Misra, Leverette, T., Bennett, & Brown, 2014; Sussan, et al., 2015; Robbins, et al., 2006). Indeed, while much press has been given to one of the most recent studies on electronic cigarette’s effects on pulmonary function, it is important to note that, relative to smoking and environmental exposures (car exhaust, dust, household chemicals) the risks to pulmonary health are in line with non-smokers (Misra, Leverette, T., Bennett, & Brown, 2014; Sussan, et al., 2015; Robbins, et al., 2006).
Having established that risk-taking behavior is a normal part of teenage growth and development and that smoking behavior is a major risk-taking behavior among teens the question becomes how to mitigate the risks. Reports from the CDC already demonstrate a clear displacement between smoking and use of electronic cigarettes [Figure 2] (Centers for Disease Control, 2014). This is good news for parents as the trend in tobacco smoking is accelerating towards zero! What grabs headlines however, is the rise in the use of electronic cigarettes. There has been speculation in the press about a gateway effect, where teens who use electronic cigarettes would graduate to tobacco cigarettes. Clearly the data do not show this to be true. For a gateway effect to be present there needs to be an increase in the prevalence of the more harmful target corresponding to an increase in the gateway agent. The data simply do not support this conclusion with electronic cigarettes (Centers for Disease Control, 2014). Instead we find that the trend in electronic cigarette use among adolescents is short term experimentation without long-term commitment or habituation (Hajek, Etter, Benowitz, Eisenberg, & McRobbie, 2014; West & Brown, 2014). This is likely due to the fact that the nicotine content in electronic cigarettes is variable, with a zero nicotine option available; the delivery of nicotine to the user is lower and slower than tobacco cigarettes, meaning that the enabling of habitual pathways is weaker than for tobacco cigarettes (Farsalinos & Polosa, 2014; Kotz, Brown, & West, 2013). What this means for parents is that there is less risk that their teen will become irreversibly addicted to the smoking behavior, thus avoiding the lifetime risks associated with tobacco smoke.
While no one wants teens to smoke, all the laws, limitations on advertising, restrictions on sales have failed to eliminate the behavior altogether. While these efforts have certainly helped push smoking rates lower among teens and should be continued, alternatives to smoking that pose less risk to the teenager are now available. These alternatives are easier to detect for parents and, with limitations on sales and possession on school grounds already in place throughout the country, parents are empowered with the tools needed to work with their teenagers to make appropriate decisions about their behavior. Be vigilant, and help guide your teen to make decisions that encourage their identity and independence in ways that are healthy. Present the evidence clearly, never lie to them about risks, as their development of critical thinking skills and societal trust depends upon accurate and unemotional presentation of facts.
About the Author:
Bruce Nye is an award winning RN specializing in acute care of trauma / surgical patients at a Level I Trama Center in the Midwest. He is also an active advocate for alternatives to the harm smoking causes the 43 million Americans who smoke tobacco.
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