Living In The Vaping Epidemic- Revised

“It’s cool”

“Everyone is doing it”

“It smells real good”

“My friends say it tastes good and that it’s not bad for you”

“All the cool kids do it”

“It’s a prerequisite to be popular”

“I love sweet flavors like gummy bear”

“Mango is the best”

“It’s just vapor”

“I would like to try it because it smells really good, but I haven’t yet because we have been researching all its harmful effects”

Adolescents and teens today are living through situations we can’t even imagine. In addition to the typical pressures of growing up we all had to go through, middle school and high school students are having to deal with social media pressures, body image pressures, and the ever increasing school performance and sports performance pressures. Our kids today have schedules that are busier than our work schedules and our expectations are higher than what we would expect of ourselves on a great day. And to top it all off we have the very convenient e-cigarette or Juul delivering the easily accessible drug, nicotine, in fun, sweet, and exciting flavors found in e-juice. Nicotine affects the brain by binding to acetylcholine receptors and releasing dopamine. Dopamine is the feel good neurotransmitter that incites pleasure and decreases anxiety. Because nicotine releases dopamine, it is addictive and primes the brain for drug reinforced behaviors.

Juul is the most popular e-cigarette among teens. It is a small sleek device that looks like a flash drive, easy to hide from parents and teachers. One Juul pod is equivalent to one pack of cigarettes. Some adults may ask, “What’s the difference, regular cigarettes have been around forever, why not worry about regular cigarettes?”

Teens today believe regular cigarettes are disgusting and nasty. They smell terrible and it’s just not cool to smoke. On the contrary, e-cigarettes are cool, sleek, high tech, and fun. Teens today can Juul during school, at church, during camp, and in their rooms at home. They can Juul anytime of day without getting caught. Juuls don't give out the regular cigarette signature aroma. They emit fun odors also found in lotions and candy. The aroma does not last long in the environment where it is used and it quickly dissipates leaving no evidence behind. Some devices don’t even emit large amounts of the aerosol. Teens today have a way of inhaling so very little aerosol is exhaled. Because of the ease of use and convenience of Juuling, teens can go up to using 2 Juul pods per day which is equivalent to two packs of regular cigarettes per day. Some studies have actually reported one Juul pod to be equivalent to 2 packs of regular cigarettes. This means teens and young adults that are using 2 Juul pods per day may actually be getting the amount of nicotine equivalent to 4 packs of regular cigarettes per day. Years ago when regular cigarettes were more popular among teens, teens were not able to smoke two packs a day because it was just not convenient. Todays teens are getting high amounts of nicotine, harmful chemicals, flavorings, and metal particles into their lungs. They are inhaling these with their Juuls any time of day and night and adults don’t even know it.

Teens are being bombarded by fun ads, YouTubers and Instagram stories showing young adults and teens performing awesome tricks with the aerosol that is emitted from these Juuls and e-cigarettes. Some teens and young adults will vape up to 4 devices at a time all with different flavors and nicotine levels. Tricks such as multiple rings, cascading waterfalls, ghost inhaling, the dragon, vapor bubbles. the tornado, liquid mist, blowing O’s, and bane & french inhaling are just to name a few of the cool tricks. Teens at parties are sharing their Juuls with different flavors not knowing that studies have shown that mixing and using multiple flavors at once increase toxicity and harmful effects.

Did you know the FDA does not regulate these products or the e-juice? Did you know there is no required list of ingredients? Did you know nobody really knows what’s in these e-juices? Did you know some advertised nicotine free e-juices contain nicotine? Did you know some e-juices with nicotine list their nicotine level, however actual levels of nicotine are much higher than listed?

How can something that is not regulated by the FDA, something that no one really knows the ingredients and chemicals that are found in it, something that has not been assessed for its safety, be out in the market and being advertised as safer than regular cigarettes. Is it safer? Maybe, only time will tell. Juul and the e-cigarette companies have been running this market without FDA approval. Thankfully, this will now come to an end in May 2020, the new shortened deadline for these companies to submit applications to the FDA for market approval. But is this too little too late for all the teens that are now addicted?

We can’t allow the youth of today getting hooked on e-cigarettes. Nicotine is as addictive as other illegal drugs, such as cocaine. Nicotine has negative effects on your cardiovascular system, cerebrovascular system, gastrointestinal system, hormonal system, central nervous system, and respiratory system. Just to name a few, nicotine can cause GI cancers, peptic ulcer disease, insulin resistance, atherosclerosis leading to myocardial infarctions, widening of the aorta leading to aneurysms, and cardiac arrhythmias.

It is a fact that flavors hook kids. As written by the US Food & Drug Administration, “In 2009, FDA banned cigarettes with characterizing flavors other than menthol (e.g., cherry, chocolate), which are known to appeal to youth and young adults.This ban was an important first step for responsible tobacco regulation to protect the American public, particularly children, from the dangers of cigarettes—the product most responsible for tobacco-related death and disease in the United States.” Why then are there 15,500 flavors of e-juice?

We need to get e-cigarettes out of high schools. We need better monitoring in schools. Some schools are investing in e-cigarette monitors and installing them in bathrooms. One very important responsibility is for every state to increase the legal age to purchase tobacco and e-cigarette products to 21 without exceptions. And I reiterate, WITHOUT EXCEPTIONS. Some tobacco 21 bills have exceptions that minimize the regulations of e-cigarettes and actually make it easier for kids to get their hands on them. Increasing the legal age to 21 will help get these products out of high schools where seniors that can legally buy them and distribute them to the younger kids.

Regular cigarette use was at an all time low. We were finally seeing a drop in teenage regular cigarette use. All the Truth Initiative ads showing adults with cancer and COPD was working. It was not cool anymore. Now these numbers are increasing because of Juul and other e-cigarettes. Did you know that 30.7 percent of teens that use e-cigarettes switch to regular cigarettes in six months? Why is this? Why do they switch if they think it nasty and disgusting? Because they are addicted to nicotine and regular cigarettes are cheaper (if they have to buy several e-cig devices). Teens can become dual users of both regular cigarettes and e-cigarettes.

I will not stand by the sidelines and I refuse to bury my head in the sand. I encourage every concerned parent to act now. As a physician and concerned parent, I have decided to become active and not allow another generation get swept by tobacco and nicotine addiction. I have joined PAVe, Parents Against Vaping & E-cigarettes, and will be the PAVe Georgia representative and advocate along with them for tobacco 21 bills without exceptions and banning flavors that are hooking kids. I am writing a resolution for the Medical Association of Atlanta and the Medical Association Of Georgia to increase the legal age to purchase tobacco and e-cigarettes to 21 without exceptions in the state of Georgia. I would like for physicians to consider thinking of checking quantitative urine nicotine levels in teens that present with new onset seizures, acute respiratory failure, and shortness of breath due to pneumothorax among other presentations. It is a new phenomenon for all of us and we must be aware that nicotine and e-cigarettes may be the culprits.

I urge you to get involved and talk to your kids about becoming advocates themselves. My twin boys, Juan and Marco Borrego, have started a non-profit organization, Vaping-Attention To Prevention, that is involved in education, increasing awareness, research, advocacy and policy. Not only parents, but also kids are needed to put a stop to the vaping epidemic currently sweeping through high schools in the nation.

Those interested in learning more you can reach the student led organization through their website or message them on Facebook @vapingAttentionToPrevention, Instagram, and twitter. You can reach the parent led organization, PAVe, at