In recent years, a rise in cases involving seemingly healthy young people suddenly having trouble breathing has baffled doctors. With no signs of infection or any other underlying issue, doctors suspected the only other hobby the patients had in common — vaping.

Throughout the United States, 805 cases of vaping-related respiratory illnesses have been reported in 46 states. These cases are linked to people who modified their vaping devices or use illegally modified e-liquid. Similarly, vaping products that contain THC, the component found in marijuana that produces mind-altering effects, is a common denominator as well.

Due to these potential effects, vaping is a major health concern that may need intervention from a healthcare professional. It’s of growing importance for family nurse practitioners to build more communicative relationships with youth patients as well as parents, in order to better identify and intervene where vaping is an issue.

Early recognition and intervention by medical professionals are essential to slow the spread of chronic ailments, like respiratory illnesses that can be caused by vaping. Such nursing professionals also serve patients throughout their life cycle, which is beneficial to providing family-focused care and being able to communicate openly with both patients and parents to address these social determinants of health. For children younger than 18, pediatric nurses can help identify and prevent illnesses while providing routine care.

Before seeking the help of a health professional, it’s important to understand problems associated with vaping, recognizing the signs of vaping, and taking action to address the issue.

What Is Vaping?

Vaping is the act of inhaling aerosol, which is often referred to as “vapor,” and is produced by e-cigarettes. Contrary to popular belief, e-cigarettes do not produce tobacco smoke or water vapor — rather, the aerosol contains tiny, fine particles that consist of various toxic chemicals.

Besides e-cigarettes, vaping devices include vape pens and advanced personal vapors, also known as MODS. E-cigarettes and vape pens are typically small in design and resemble regular cigarettes or fountain pens, respectively. Generally, a vaping device is made up of a mouthpiece, a battery, a cartridge, and a heating component.

The cartridge, containing the e-liquid or e-juice, is heated up which turns the liquid contents into an aerosol. When someone inhales this aerosol, it makes its way into the lungs where it can cause severe damage, including irritation to both the upper and lower respiratory tract, as well as bronchospasms. Vaping can also cause more serious effects, including:

• Inefficient immune systems;
• Altered brain functions;
• Tremor and muscle spasms.

How Vaping Started

Vaping originally hit the market as an alternative to smoking. Now it is a billion-dollar industry.

1930: This was the first reference to an e-cigarette in a patent.

1960s: Herbert A. Gilbert created the first vaping device that resembles modern e-cigarettes.

1979-80s: Phil Ray first commercialized the e-cigarette. However, the device was faulty and failed to sell.

1990s: Numerous patents were filed, however, the FDA denied requests to commercialize them due to the fact that they were considered an unapproved drug delivery device.

2003: The first successfully commercialized vaping device was created in Beijing, China.

2006: E-cigarettes were introduced to Europe.

2006-07: E-cigarettes are introduced to the United States.

2007: N’Joy, one of the first major e-cigarette brands was founded.

2008: The World Health Organization (WHO) claims that e-cigarettes are not a legitimate smoking cessation.

2009: President Obama signs the Family Smoking Prevention and Tobacco Control Act, giving the FDA power to regulate the tobacco industry.

2010: The FDA can only regulate e-cigarettes as a tobacco product unless therapeutic claims are made.

2011: Studies are published stating that smokers are finding success in smoking cessation with e-cigarettes.

2012: The vaping industry starts holding conventions throughout the U.S.

2013: The Testimonials Project is born to collect stories from smokers who have found success in smoking cessation with e-cigarettes.

2015: JUUL starts advertising in Vice Magazine, the “#1 youth media company.” E-cigarettes are starting to sell online, making it convenient for people to obtain them.

2016: E-cigarette companies aggressively market to youth and young adults. Truth Initiative found that more than 20 million youth saw at least one e-cigarette advertisement.

2018: The number of vapers grows to 41 million. Users in the United States, the United Kingdom, and France spend $10 billion on vaping products.

2019: The vaping industry costs 12.4 billion and is expected to grow by 20.8% from 2020 to 2027.

Vaping companies continually target young audiences in terms of marketing, including:

• Offering scholarships;
• Creating a buzz on social media;
• Sponsoring music festivals and events;
•  And introducing appealing flavors, like cotton candy and gummy bear.

Although the Family Smoking Prevention and Tobacco Control Act banned cigarette flavors other than menthol, it does not regulate other tobacco products. E-cigarette companies capitalized on this regulation gap in order to market to a younger audience.

Types of Vape Devices

Vape devices come in all shapes and sizes, and it’s important to know how to spot them.

Electronic Cigarettes:

• Small, convenient, easy to use, and perfect for stealth-vaping;
• Sold by JUUL, blu eCigs, Mig Vapor, Green Smoke, Joyetech, and more;
• $15-$50;
• Also known as “e-cigs,” “e-hookah,” “cigalikes,” and “JUULs.”

Vape Pens:

• Better performance than e-cigs, limited capacity, long battery life, refillable;
• Sold by Morpheus, Mig Vapor, Kandypens, Vapor4life, and more;
• $50-$120 for first-time buyers; $30-$60 for refills;
• Also known as “pen,” “vape,” “juice,” or “smoke juice.”

Mechanical Modified Nicotine Delivery Systems (MODS):

• Large, high vapor production, powerful, used by experiences vapors;
• Sold by Vaporesso, Innokin, Joyetech, Vandy Vape, SMOK, Horizon, and more;
• $35-$100;
• Also known as “fogger,” “ENDS (electronic nicotine delivery system),” “PV (personal vaporizer).”

Pod Systems:

• Small, pre-filled or refillable, compact, lightweight;
• Sold by SMOK, Smoking Vapor, MOJO, Vaporesso, Suorin, Aspire, and more;
• $10-$65;
• Also known as “vape pods,” “pod mods,” and “mini vapes.”

Understanding the Dangers of Vaping

Since the outbreak of cases related to e-cigarette or vaping product use-associated lung injury (EVALI), patients have experienced many symptoms, including:

• Coughing;
• Shortness of breath;
• Chest pain;
• Difficulty breathing;
• Nausea;
• Vomiting;
• Diarrhea;
• Fatigue;
• Abdominal pain;
• Fever;
• And weight loss.

More seriously, e-cigarettes are associated with respiratory disease among adults. Chronic bronchitis, emphysema, and asthma are among the most common. Since vaping devices can contain nicotine and other chemicals, vaping can also lead to changes in our appearances. These changes include:

• Bad breath;
• Stained teeth;
• Accelerated skin aging;
• And stained nails.

Vaping can also be dangerous to nonusers, since vaping devices release high amounts of toxicants in addition to particulate matter.

Is Vaping Addictive?

Nicotine can be found in most vaping devices, which makes vaping a potentially addictive hobby. The more a body gets used to nicotine, the harder it becomes to go without it. As nicotine levels drop, the body feels withdrawal symptoms which makes a person want to ingest nicotine to curb those feelings. This is the definition of nicotine addiction.

Other withdrawal symptoms include:

• Irritability or restlessness;
• Headaches;
• Increased sweating;
• Feeling sad or down;
• Feeling anxious;
• Feeling tired or groggy;
• Trouble concentrating;
• Trouble sleeping;
• And hunger.

Nicotine withdrawal is different for everyone, which can make quitting hard or unreachable. Healthcare professionals from accredited nursing schools across the nation are trained to understand smoking cessation best practices, in large part due to the health risks associated with vaping. In fact, tobacco cessation training programs are fairly common for healthcare professionals.

Many programs prepare healthcare professionals to talk to patients about quitting and to track their progress. Nurses and doctors are in key positions to influence and control tobacco cessation programs because of their roles as educators and researches. They can also help manage withdrawal symptoms in order to help their patients to quit smoking or vaping.

Is Vaping Illegal for Minors?

Federal regulations restrict the sale of vaping devices and products to people who are under the age of 21. However, many state laws regarding minors and vaping vary. For instance, some states do not define e-cigarettes as tobacco products, such as Florida, Ohio, and Washington. Additionally, Maryland allows 18-year old military members to purchase vaping devices and materials.

If a minor is in possession of a vaping device, there are legal ramifications for both the user and the seller, although they do vary by state. Some examples include:

• In Chicago, underage users can be fined anywhere from $100-$500, or must partake in a diversions and education program;
• In California, underage users are not fined for the possession of vapes, however, they could be fined for using it in a place that prohibits it, like movie theatres.
• In Washington State, business owners can be cited up to $3,000 for selling vaping devices to a minor.

How to Address Vaping

Vaping can cause lingering respiratory issues, which is why it’s important to recognize the signs of vaping and take the appropriate steps to address the situation.

Signs of Vape Device Use

It may be hard for parents to see signs of vaping in their children. With the epidemic of youth vaping, it’s more than likely that a child has been exposed. However, there are some common signs to watch for:

• Finding unusual items: Some vaping parts are detachable, like the batteries or the refillable pods. Others can look like pens, UBS drives, or even watches. If you find any items that you cannot identify, you should ask your child what they are.
• Heavy mood swings: Mood swings are a sign of nicotine withdrawal and most vapes have certain amounts of nicotine in them. Note if your child drastically changes moods, develops the inability to concentrate, or becomes anxious easily.
• Trouble breathing: This is one of the main signs of respiratory illness. Even child athletes in peak physical condition can experience this symptom.
• Unusual sweet smells: Many vapes that are marketed toward children contain sweet flavors like cotton candy or watermelon. If you suddenly find yourself smelling a sweet or fruity aroma around the house, it could be a sign of vaping.
• Weight Loss: Nicotine is an appetite suppressant. Children who are vaping may eat less. They could also experience bouts of nausea or vomiting if they are just beginning to vape.
• Mouth sores and coughing: Vaping can cause lung injury and inflame mouth cells, leading to lesions, gum disease, or more seriously, respiratory issues. The vapor made from these devices produces tiny, fine particles that can easily damage organs.
• Seizures: The FDA reported 127 seizures in relation to vaping cases. Although it is not the main symptom, vaping could be an underlying cause of seizures.

How to Stop Someone From Vaping

Addressing a vaping situation requires a straightforward and open discussion. It’s important to react in a calm manner and listen to what your child has to say. Other actions you can take include:

• Start talking to them about vaping at a young age. Prevention is one of the best ways to stop your children from vaping. By warning children about the dangers of vaping before they start, there is a better chance they won’t start at all.
• Create an open environment. Your child could be more willing to talk with you if you create an honest relationship. Instead of catching them in the act of vaping, it is more productive to have an open dialogue about it.
• Stay calm. Children can easily shut down if they are met with opposition and anger. Though this might lead them to stop vaping, it can also lead to resentment. Instead, talk to your children about whether you can help them quit and the options they have.
• Get outside help. If your child has a nicotine addiction, it is best to get them the help they need from one of the resources in the last section of this guide.

Learn Smoking Cessation Best Practices

Healthcare professionals and guardians can help curb vape use by participating in smoking cessation training programs. These programs include counseling, behavior therapy, and smoking cessation tools like:

• Nicotine patches;
• Gum;
• Lozenges;
• Inhalers;
• And nasal sprays.

Additionally, nurses play a major role in helping their patients quit smoking. By obtaining their nursing certification, these healthcare professionals will be trained in the latest tobacco cessation methods. All of these tools, including nurses, can help an individual address their nicotine addiction.  

Online Resources to Stop Vaping

In addition to seeking assistance from community-focused healthcare professionals, such as public health nurses, there are many resources and tools available online.

Parent/Teen Resources

• CDC Youth Engagement User Guide: This guide employs strategies that appeal to youth and gives program managers information on how to engage young people as a part of a comprehensive tobacco control program.
• Consequences of Smoking Consumer Guide: This guide shows the effects of smoking and nicotine addiction, as well as the benefits of quitting and resources to help.
• The Ex Program: This is an online cessation program that is designed for employers and health plans. It provides an active social network with thousands of smokers and ex-smokers, and includes digital, personalized coaching.
• Ex Community: This site is made up of a community of people who want to quit smoking. People can post blogs about their journey, take a daily pledge, get support from an online community, and find motivation through other’s stories.
• Project Prevent: This is a statewide youth tobacco prevention coalition in Arkansas. They host monthly online meetings between different chapters and provide opportunities for youth participation, such as an annual conference.
• Quit Vaping: This site provides tools on how to quit vaping, including how to get through the first day without vaping, and strategies to combat vaping addiction and nicotine withdrawal.
• Youth Engagement Alliance: The Youth Engagement Alliance is a site that provides toolkits, resources, webinars, opportunities for engagement, and a list of national organizations.

Resources for Healthcare Professionals

• QuitNowTXT Message Library: This text messaging service allows healthcare professionals to send text messages to serve as smoking cessation interventions for people ready to quit smoking.
• Treat Tobacco: this site is designed to provide support for the treatment of tobacco addiction.
• Cancer Control P.L.A.N.E.T: This portal provides web-based resources that can assist in assessing the cancer burden in a given state and identifying potential partner organizations.
• Quick Reference Guide: This Quick Reference Guide for Clinicians presents summary points from the Clinical Practice Guideline and provides appropriate treatments for every patient.
• Helping Smokers Quit: A Guide for Clinicians: This guide outlines a strategy to help patients quit smoking.

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