Electronic cigarettes are banned in some countries, highly available in others, but with internet sales, they are available just about anywhere, and just about anyone can buy them, including adolescents. The popularity of these products has outpaced scientists' ability to determine if they are safe. But since electronic cigarettes deliver nicotine, doctors already know a lot about nicotine and its effect on teenagers.
Dr. Jonathan Winickoff, at Massachusetts General Hospital for Children and Harvard Medical School, compared teens' experimenting with any nicotine product, including electronic cigarettes, to "playing Russian roulette with the brain."
Winickoff works with the American Academy of Pediatrics to protect children from tobacco and secondhand smoke.
"Essentially, this drug creates a biologic need that can be permanent,” he told VOA. He said the effects include decreased working memory, tension problems as adults, and increased rates of depression and anxiety.
Yet teens and young adults are attracted to electronic cigarettes. In the U.S., where they are not yet regulated, the Centers for Disease Control and Prevention says use more than doubled among teens, including young teens, between 2011 and 2012. That's got public health officials and pediatricians like Dr. Winickoff alarmed.
Enticing ads and Online sales
"Television advertising for e-cigarettes has increased two-fold for youth and three-fold for young adults in the U.S. in the past two years," she said. Duke added that the ads appeal to teens. One ad for Blu Electronic Cigarettes describes them as "sleek, hot and blue" without the smell of tobacco, which it described as a turnoff for those looking to attract a date.
This ad didn't say the product is safe, but Duke is also concerned about the lack of health information on electronic cigarettes. She says teenagers are taking their cues from ads.
"Currently it’s the only source of information that most consumers have about e-cigarettes, and they’re portraying them as safe and healthy alternatives. They’re fun and they're glamorized in these advertisements as modern and a fun adult activity. So I don’t think it’s surprising that youth also find these products appealing," said Duke.
Electronic cigarettes, also known as e-cigs, are battery powered devices that can look like a cigarette or like a tube. They usually have a removable tank that can be filled with a flavored, nicotine-containing liquid. A report in Tobacco Control, an international professional journal published by BMJ, lists the main ingredients as nicotine, propylene glycol, vegetable glycerine/glycerol, flavoring and water, although it points out the levels of nicotine can vary widely or may not be present at all.
Teens buy the products online, as do many adults. The Tobacco Control study said there is no hard data about internet sales, but up to 50 percent of purchases may take place on-line. But since the internet is where teens interact with each other, they report about their experiences with e-cigarettes on social media and post videos about it. One youth likened the nicotine to caffeine.
A young woman reported that she ordered her e-cigarette through the internet and that her experience was "fantastic."
First step toward addiction?
Duke said there was "no definitive proof that the use of e-cigarettes will lead to the use of tobacco products," a statement shared in the Tobacco Control report. But Winickoff said his studies and experiences have led him to a different conclusion. "It also sets up the adolescent brain for more durable and stronger addiction pathways," he said, "not just for nicotine, but for other substances such as cocaine, marijuana and other drugs."
Winickoff said the teen brain becomes dependent on nicotine much more rapidly than the adult brain. "The most susceptible youth will lose autonomy over tobacco use after just a few times. So before they even know they’re addicted, they’ll first start wanting, then craving nicotine whenever they go too long between uses," he said, "And more exposure to nicotine at an early age will up-regulate nicotine receptors more rapidly in those developing centers of the brain than in adults. More receptors mean more craving."
The fact that these products come in fruity flavors as well as flavors with names such as "birthday cake," and "cherry crush," makes them more appealing to teens.
The Tobacco Control report said that sales to minors should be banned. Some owners of electronic cigarette stores agree.
Brett Rice co-owns a Vaporfi franchise in Washington. He said, "We sell no products to anyone under 18 years old. That is our company policy, period." Rice said most of his customers come in looking for an alternative to smoking cigarettes and the most popular flavors are tobacco and menthol, flavors he said are preferred by cigarette smokers.
The report published by Tobacco Control also says that local clean indoor air policies that ban cigarette smoking should be applied to e-cigarettes as well. The report explains that regulating e-cigs will help protect consumers from substandard products and reduce the chance children will be put at risk.
But Duke, and other health specialists, are concerned that those policies may be too late -- that e-cigarettes have introduced a new generation of teenagers to nicotine addiction.