Most youth would quit vaping if flavors, including menthol, were not available, research shows

Flavoring is driving teenagers to use vaping products, and a new study shows teens would stop if they did not have multiple flavor choices available to them.

Nearly 71% of survey participants between the ages of 14 and 21 would quit vaping under a tobacco-only product standard, researchers from the Center for Tobacco Research at the Ohio State University Comprehensive Cancer Center found in the new study. Under a tobacco and menthol standard, nearly 39% of the participants said they would quit.

The current U.S. Food and Drug Administration flavor ban only applies to cartridge electronic cigarette devices. If you look behind the counter at your local gas station, you’ll see dozens of devices with different flavors available to purchase. Since the FDA began enforcing the flavor ban in 2020, sales for disposable e-cigarettes have increased from 24.7% to 51.8%.

“Our data add to an expanding body of evidence showing that youth have a preference for sweet flavorings that make vaping easier for novice users of e-cigarette products, priming them for a potential lifetime of dependency to nicotine,” said Alayna Tackett, senior author of the study and a researcher with the Center for Tobacco Research.

Researchers from the Center for Tobacco Research at the Ohio State University Comprehensive Cancer Center surveyed 1,414 individuals between the ages of 14 and 21 regarding their e-cigarette use and behaviors. The study was published in the Journal of Studies on Addiction and Drugs.

“We’re seeing younger and younger kids do it,” said Mike King, a respiratory therapist with Dayton Children’s. Health providers like King are seeing children in middle school and even elementary school trying e-cigarettes.

“A lot of what we’re seeing is a lot of peer pressure,” said Katy Oppy, who is also a respiratory therapist with Dayton Children’s.

Health risks from vaping

The high nicotine content is part of what is concerning to health experts.

“The nicotine content in these products are a record high,” said Bruce Barcelo, senior program coordinator at Montgomery County Alcohol, Drug Addiction and Mental Health Services (ADAMHS). Adolescents and youth may not realize the e-cigarettes they are using contain more nicotine than combustible cigarettes, like Marlboro.

Nicotine makes smoking difficult to quit, but it can also impact brain development in adolescents. In addition to the nicotine, doctors say vaping causes users to ingest other dangerous chemicals that can cause harm to the lungs.

“You are adding a heating element with the vapes, so you’re creating even more dangerous chemicals that they’re ingesting, as well as the high concentrations of nicotine that can cause toxicity to their bodies,” Oppy said. “That can make them very sick, like headaches (and) vomiting. The chemicals that they’re inhaling are causing lung issues.”

With the liquids in the vapes, there is an oil that is sent through a heating element, which turns it into basically an aerosol, King said.

Some of the oils in the flavor enhancers in vape products can also cause a condition called popcorn lung. Popcorn lung is when small airways in the lungs become inflamed, damaged, and then scarred because of inhaling toxic substances or from infections, according to the Cleveland Clinic.

“It’s very, very similar to what emphysema is to an adult patient who’s smoked for 50 years,” King said.

Different flavors reaching younger audiences

Health providers also say the different flavors of the e-cigarettes are appealing to kids.

“In the early 2000s, the younger folks weren’t latching on to the tobacco products. They didn’t like the smell of it, they didn’t like the taste of it, and then when the first e-cigarette was invented, it was supposed to be marketed for a quit smoking aid. Then cigarette companies and tobacco companies got ahold of that, and they’ve tweaked it into what it is now,” King said.

Adolescents and young adults using flavors with cooling additives, such as “fruit ice,” reported higher odds of discontinuing use under a tobacco-only product standard compared with users who preferred menthol flavor only, said Tackett.

“In this sample of adolescents and young adults, it appears that non-tobacco flavors may be important for their interest in and continued use of e-cigarettes,” Tackett said.

The “fruit ice” flavor refers to e-cigarette flavors with a fruit base characterizing flavor with a cooling additive such as menthol or a synthetic cooling agent.

“Menthol cools the harshness of any tobacco product,” Barcelo said. “If it’s less harsh, doesn’t burn their throat, has great taste—that’s more than likely going to keep them coming back.”

Regulation of e-cigarettes

Regulating e-cigarettes is a challenge, said Barcelo, who pointed to the proliferation of products already available.

“One of the big new problems that we’re seeing in vaping is the huge uptick of sales from e-cigarettes from China,” said Barcelo. E-cigarettes hit the U.S. market around 2005, Barcelo said, but in 2020 was the first time the FDA started the pre-approval process with e-cigarettes.

“It’s like trying to shut the door when it’s already out,” Barcelo said. “FDA doesn’t have a lot of great tools to either ban those or keep them from entering the country.” Companies can also rebrand their products, Barcelo said, if one of the products gets a warning from the FDA.

“There’s just, at this point, no effective way to deal with the flux that are coming from China, let alone what the vaping industry in the states are doing,” Barcelo said.

The best option for regulation of these products is local control, Barcelo said.

“It’s just almost impossible to stem the tide, unless there’s like a local (ordinance), like Columbus’ Pass the Flavor ban,” Barcelo said. “Having a local ordinance that’s effective, that has checks, that has meaningful penalties for selling to underage youth, only those communities are going to be successful.”

Helping kids

Parents should take day to day opportunities to educate their children on vaping, Barcelo said. Parents also shouldn’t put their kids on the spot.

“It needs to be conversational and not punitive,” Barcelo said. “We need to provide education.”

Parents should reserve judgement, he said, and talk to their pediatricians if their child has become addicted to vaping.

In talking to schools, Barcelo said they should avoid using suspension as a first resort to a student caught vaping, instead offering education and possible cessation classes on the first couple of offenses. Dayton Children’s also offers a cessation program, which includes classes on the dangers of vaping, as well as teaches new coping skills and stress management.

“Let’s help with their addiction,” Barcelo said.

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