Newshub headline with Children's Wisconsin logo
Children's Wisconsin vaping E-cigarette or Vaping Use-Associated Lung Injury (EVALI)

Teen vaping: What we now know and where we go from here

In October 2023, Netflix released a four-part docuseries called “Big Vape: The Rise and Fall of JUUL.” While the docuseries explores JUUL’s journey from creation to current state, Children’s Wisconsin is featured as a piece of the puzzle in uncovering how vaping jeopardized kids’ health. Children’s Wisconsin was featured in episode four. I was interviewed for this series as a representative of the team of providers at Children’s Wisconsin who first connected the dots in July 2019 when we had a cluster of patients — all teens — in the hospital with severe lung injury. The common thread was that they all had vaped. I’m proud of our team for so quickly connecting the dots and sounding the alarm to alert the public of the potential dangers. One of our patients, Ksenia, bravely shares her personal story in the documentary as well. The docuseries shows the overwhelming impact marketing products like these can have on children and teens. 

Here we are four years later, and although articles, books and documentaries have increased awareness of the harmful impact of vaping and vaping products — especially those marketed to teens — there are still far too many kids picking up a vape pen or trying another vaping product for the first time and becoming hooked. According to the most recent Wisconsin Youth Risk Behavior Survey (2021), one in three high school students and one in 10 middle school students have tried vaping. Of the middle school students who have tried it, nearly all of them did so before they turned 13. In addition, the 2022 Youth Tobacco Use survey was released recently. The slightly good news is that nationally, the use of tobacco products among high school students is trending downward. However, the bad news is that use among middle school students is trending upward. The most common reported tobacco product being used is still e-cigarettes. This is in a climate that, in the years before vape products were introduced, was seeing a reduction in smoking and tobacco use in teens.

What we know and what we don’t

Vape products haven’t been around long enough for us to know how vaping will impact health throughout a lifetime. However, we do know many of the effects associated with exposure to these chemicals. We’ve seen first-hand here at Children’s Wisconsin the more serious health issues that have led to kids needing intensive care treatment. There is concern that vaping is associated with an increased likelihood of developing lifelong chronic conditions like asthma or emphysema by causing lung inflammation. 

Some of the known health risks for teens who vape (causative or associated):

  • Addiction

  • Sleep issues

  • Mental health issues

  • Lung damage

Some long-term costs and effects associated with vaping:

  • Money. Vaping is expensive.
  • Addictions. Vaping can lead to nicotine and other addictions over time.

  • Academic issues. Vaping can affect memory, concentration, mood and impulse control.

  • Sports and fitness. Vaping can make it hard to breathe, run and participate in sports or activities.

New information about the harm vaping causes continues to be released. Studies suggest that vaping causes injury to the immune system or host defenses in the lung making people more susceptible to lung infections. The safety of the ingredients in the vape device (besides nicotine) has not been established. Heating and aerosolizing ingredients that are meant to be orally ingested can generate more toxic chemicals, including substances like formaldehyde, benzene (found in car exhaust) and heavy metals (nickel, tin, lead). Heating alone can cause burn-like injuries leading to genetic changes in the cells and airway lining. 

Awareness and prevention in schools and at home

We know schools are the place where kids spend most of their time. Educators can play a vital role in raising awareness about the harmful effects of vaping. Children’s Wisconsin experts have developed a number of online vaping resources for educators and parents to help them not only understand and identify vaping, but to educate and inform students about the risks. 

In addition, Children’s Wisconsin offers several engaging e-learning courses for students in grades four through eight on the topics of alcohol, tobacco and other drugs prevention, as well as the skill of analyzing influences, available at no charge to all Wisconsin schools. It’s UR Choice for grades 4/5, 6 and 7/8 helps students make smart choices when faced with the pressures of using and abusing alcohol, tobacco, and other drugs, and helps them learn how to stay drug-free. It’s Your Choice – Analyzing Influences Seventh Grade, is a skills-based course featuring ATOD content (including vaping) that teaches students about the different types of influences, common types of drugs and their health impacts, and other potential consequences of choosing to use or not use drugs. All courses and classroom activities are available at no cost to Wisconsin schools. 

We also have several downloadable fact sheets available for parents and caregivers to help navigate this topic:

Advocacy impacts 

Children’s Wisconsin continues to advocate at both the state and national levels for policies, funding and regulations to address youth vaping, as well as youth use of traditional tobacco products like cigarettes and cigars. This includes efforts to encourage research, provide education to reduce youth use, prohibit enticing flavors and support adequate enforcement. The federal legislation signed in December 2019 made great strides by increasing the purchase age for these products from 18 to 21 years, limiting certain flavored products and prohibiting marketing to youth. Some of my Children’s Wisconsin colleagues, including Louella Amos, MD, have advocated for a state law to raise the purchase age as well. While the federal law was very impactful, the vaping industry is ever evolving, making it challenging for laws and regulations to keep up with the current dynamics. This includes addressing products coming into the United States from other countries. As such, there has been a rise in the availability and use of disposable flavored e-cigarettes, flavored e-liquids in refillable devices and the switch from tobacco-derived nicotine to synthetic nicotine. The U.S. Food and Drug Administration is slowly reviewing marketing applications for allowable e-cigarette products targeted to support adults quitting traditional tobacco. During this process, attractive and harmful products for youth remain on the market unlawfully.

As part of a multi-state settlement agreement to address harms caused by JUUL Labs marketing and sales practices, Wisconsin is expected to receive approximately $14.7 million in funds for prevention and cessation efforts. The Wisconsin Department of Health Services hosted listening sessions earlier this year to obtain community member feedback on use of the funds. Children’s Wisconsin was at the table and shared some of our recommendations including additional support for youth cessation resources and programs, youth education and school-based initiatives — like our e-learning programs — increasing enforcement capacity and multidisciplinary research to better understand the effects of vaping on adolescents.

Where do we go from here?

Our work is not done until we have greatly reduced the number of kids who become hooked after vaping for the first time. Children’s Wisconsin continues to work locally, statewide and nationally to move the needle on the vaping epidemic. It’s part of our responsibility and our mission for Wisconsin’s kids to be the healthiest in the nation.