Perhaps you’ve heard the incessant radio commercials promoting “juuling” as a safer alternative to traditional cigarette smoking but don’t believe the hype, according to Sankaran Krishnan, M.D., M.P.H., a pediatric pulmonologist at Maria Fareri Children’s Hospital affiliated with Boston Children’s Health Physicians and an Associate Professor of Pediatrics at New York Medical College, both in Valhalla. Krishnan also has done extensive research on juuling as the Research Director of the Children’s Environmental Health Center of the Hudson Valley.
Juuling, or vaping as it is also commonly called among teenagers, has reached “an epidemic proportion” according to the Food and Drug Administration (FDA). More than 2 million middle and high schoolers were regular users of e-cigarettes last year. While the problem is prevalent across the nation, Westchester County is not immune to this phenomenon and in fact, just this past summer the age to buy any tobacco or smoking products including e-cigarettes in the county was raised from 18 to 21 in part to curb use of these products in minors. However, all of these products are widely available on the Internet without any restrictions.
Parent knowledge about juuling varies and often adults with older children know more about it than parents with younger children. According to Krishnan, it is worthwhile to know about it no matter what age your children are, especially as the statistics show that it is a growing trend and that the age of first use is skewing younger.
There are many terms used interchangeably to describe juuling, vaping and/or e-cigarettes, which clinicians refer to as electronic nicotine delivery systems or ENDS, explains Krishnan. ENDS are noncombustible tobacco products meaning that an “e-liquid” is used and heated to create a mist that the user then inhales.
E-liquids may contain nicotine, as well as varying compositions of flavorings, antifreeze and other ingredients. Some e-cigarettes resemble pens, highlighters or USB flash drives thus making them easy to conceal. There are as many as 7,700 flavorings of e-cigarettes in kid-friendly flavors such as watermelon, cotton candy and chocolate. “They are using these flavors to lure kids,” notes Krishnan.
Besides the kid-friendly flavor, ENDS have additional appeal to kids as many like to do tricks with them and “ghost their vapor.” With ENDS, users can suck the vapor in and hide it for a while and then release it, which is known as ghosting. YouTube features countless videos of vape tricks such as the French inhale or pink spot ghosting and teens often get bragging rights if they are able to do these.
There are many chemicals in ENDS and the nicotine content can vary from 0 to 36 ml compared to conventional cigarettes, which have 10 to 30 ml of nicotine. “An ENDs device can contain way more nicotine than a regular cigarette which makes it highly addictive. Nicotine can be a gateway to other addictions to all types of inhaled products like hallucinogens,” warns Krishnan.
But it’s not just the nicotine in ENDS that has doctors and parents alarmed. There has to be a solvent with heat to vaporize the e-liquid so other toxic chemicals and carcinogens are found within these products including antifreeze, diacetyl, acetoin and 2,3 pentanedione which linger in the body.
Diacetyl is a particularly troublesome chemical used in many of the kid-friendly flavors used in ENDS. This chemical was also previously used in making popcorn and gives popcorn its distinctive flavor and odor. Inhaling this chemical can cause scarring in the lungs especially in the smallest air passages, which is a condition called popcorn lung.
ENDS can cause respiratory illnesses and asthma. Krishnan sometimes sees ENDS users that suddenly have persistent coughs or trouble breathing during exercise. In ENDS users that are severely addicted other health issues can be sleep disturbances, loss of appetite, irritability and even tremors.
An additional problem that parents need to be aware of is the pod packaging that e-liquids come in. Very young children have ingested these pods because they look cute and taste good. The National Poison Control Center gets between 200 and 300 calls a month about kids under 5 years of age consuming these pods. As if ENDS weren’t dangerous enough, there are also cases of them exploding causing serious burns.
Although ENDS do not have the typical tobacco smell, the flavoring smell can linger. If your kid is constantly using mints or coughing at night and was typically healthy before, that can be a warning sign.
Krishnan believes that parents need to emphasize that ENDS are not safe. He often hears children say it isn’t as bad as regular smoking. “Everyone needs to understand it is not an alternative to smoking. It is addictive and can lead to longer-term addictions. It has harmful effects that can hurt you in the short-term and in the long run,” notes Krishnan.
Stacey Pfeffer is an editor and writer based in Chappaqua.