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Prakash Chandran (Host):  Hello and welcome to Children’s Health Checkup where we answer parents’ most common questions about raising healthy and happy kids. I’m your host, Prakash Chandran. Our topic today is the health effects of vaping. Here to help us as our teens navigate the dangerous addiction is Dr. Devika Rao, a Pediatric Pulmonologist at Children’s Health. So, Dr. Rao, the dangers of vaping is a top news story almost every single day. So, let’s start with how vaping enters the lungs and what happens that makes it so dangerous.

Devika Rao, MD (Guest):  So, the thing about vaping is that you have to first understand the components of the vape itself. And vape is the kind of colloquial term. In the medical community we refer to them as electronic cigarettes. So, basically, what you have is you have a compartment where you insert either what you call E-juice, or the electronic cigarette already contains that and then you have that fluid that’s heated up by a coil that’s powered by a battery. And so, that metal coil, when it heats up the fluid, it creates an aerosol and that’s a really important thing to remember is that the liquid that is heated makes an aerosol and what distinguishes an aerosol from regular vapor is that aerosols contain small particles, small solid particles whereas vapor is really just water in the form or a gas.

And so, from that particular e-cigarette or vape, the person using the device then inhales the aerosol which can go deep into the lungs and what we know from studying electronic cigarettes is that the tiny particles that is produced from the fluid being heated, they are small enough to really go down deep into the lungs to the point where gas exchange occurs into the lungs. And those components in the aerosol what we’ve found can be dangerous to a person or a user’s health.

Host:  Yeah, you know I’ve never heard someone break it down that in-depth before, so I really appreciate that. In addition to the particles going into the lungs, I’ve also heard that vaping is responsible for teens being more addicted to nicotine. Is that true and can you explain why?

Dr. Rao:  Yes. So, the nicotine that’s contained in vape or electronic cigarettes is very highly addictive and that’s for a couple of reasons. So, some manufacturers have found that adding particular types of benzoate salts actually changes the pH of the liquid or the aerosol which leads to a more pleasurable experience. In other words, the user won’t have as much throat irritation as they would with a regular combustible cigarette and that kind of pleasurable feeling enables the user to kind of have that good feeling and so it kind of makes them want to use the e-cigarette more often.

In addition, the developing brain of an adolescent or a teenager makes them susceptible more so to developing a nicotine addiction compared to adults. In other words, what happens is when you get that hit of nicotine to the brain, you release dopamine and dopamine is that substance that’s kind of the feel good substance. It’s the substance of addiction and when you first experience that sort of pleasurable feeling from the release of dopamine; you want to experience that more and more.

And that’s where addiction comes in. And so you want to use the product more and more because you are feeling that pleasurable sensation. And so there’s that kind of cycle of use, release of dopamine, wanting to experience that pleasurable sensation again and so it leads to this cycle of use and can lead to addiction. And what we know from medical studies is that the teenage brain is particularly susceptible to this and in fact, most users of regular traditional cigarettes became addicted to cigarettes mostly because they started using cigarettes and nicotine under the age of 18 and so we don’t have long-term data in terms of use of electronic cigarettes; but there are a lot of people in the medical community that worry that we are addicting a whole new generation of adolescents and teenagers to nicotine through the use of electronic cigarettes.

And so, this is quite worrisome to us. A lot of teenagers and adolescents they use, they start to use electronic cigarettes for many reasons. Some of the top reasons that they will start to use these devices is because their friends are using it, they may have experienced some peer pressure. Another thing that’s been studied in the medical literature is exposure to commercials and advertising including in retail as well as on television and as well as exposure by family members. And so, these are some of the different ways that influence adolescents and teenagers to start using electronic cigarettes to the point where it’s become kind of a national headline where even schools are getting involved. They know that teenagers are addicted. They know that teenagers just have to leave the classroom frequently. They see that they are getting up frequently because they need to use their vape devices because they are addicted to nicotine.

Even bathrooms in high schools are actually referred to as kind of vaping rooms or places where teens can sort of escape to use their electronic cigarette devices. And they can use these devices very, very discreetly. There are many, many different ways that teens can really kind of fly by even a watchful parent’s eye. There’s hoodies with, it’s kind of like if you are trying to drink water, kind of like the backpacks that they’ve made for people going hiking and you can just kind of take a sip of water through a little tube that’s hooked up to your backpack. Well they have backpacks like that for electronic cigarettes. They have hoodies that conceal the electronic cigarette device.

Host:  It’s really become an issue. I can totally see what you mean because not only the dopamine hit that you are talking about but all of the marketing that’s around this and I even see some YouTube videos literally talking about how you can hide your vape pen or how you can conceal things from your teachers and your parents at school. It’s really become an issue here. And beyond all that, I’ve heard that using a vape pen can lead to other substance abuse beyond just nicotine. So, can you speak to that a little bit?

Dr. Rao:  Yes, absolutely. There has been some research done that shows that adolescents and teenagers who use electronic cigarettes are four times more likely to go on to smoke traditional cigarettes. And even use other sort of illicit drugs. So, there is some thought that even electronic cigarettes can serve as sort of a gateway drug. And I think more research needs to be done on this, but the initial results are quite alarming. And so, the combination of the addiction as you pointed out, with the ability to conceal what you are doing from your teachers and your parents; they even make electronic cigarettes that are similar to bracelets and lipsticks, USB devices. They are very, very discreet. It really helps teens to conceal what they are doing.

Host:  Yeah. So, I’m a parent and I’m really curious as to how we as parents can talk to our children about vaping and the associated risks especially because of the peer pressure, the dopamine hit that you are talking about and all of the marketing that’s around. How can we effectively talk to our children?

Dr. Rao:  So, I think that the conversation has to begin with your children quite early. I think one thing that the recent epidemic of the kids who were hospitalized with vaping illnesses, one benefit from that is it really increased public awareness and increased public awareness is the first step. The next step is to open up the conversation with your kids even starting in the fifth grade. I think that’s when I was a child, that I experienced the DARE program Just Say No to Drugs, and I think it really left a considerable mark on my little ten year old brain.

Host:  Yeah, I remember that.

Dr. Rao:  Right, right. I think that program was effective because you start early and children learn about what’s out there and so I think that’s a really prime time 8-10 years old, we just kind of start the conversation that these products exist and that they are not good for you. They could be potentially harmful.

Host:  And speaking of that harm, I think one thing to also get across is that it can really lead to poor lung health, poor cardiovascular health. I’ve read so many of the risks associated with it; so maybe speak to some of those health risks just so we can tell our children that this is something that they should be taking seriously.

Dr. Rao:  Right. So, I think the first thing to educate children about is that these products are harmful and that many of them, in fact probably most of them do contain nicotine. That is one fairly common misconception amongst teens and adolescents is that it’s just harmless vapor. But it’s actually not. It’s an aerosol that’s produced that contains fine particles, that contains things like toxic heavy metals, like chromium and nickel and lead. These kinds of substances as well as flavorings. So, the flavorings can be pretty attractive to teens and adolescents. But what we are finding in research done by even toxicologists is that those flavorings are safe for ingestion, but they are not safe for inhalation. And that they have injurious effects on the cell lining of the lung.

And it can lead to cell death of the lung. It leads to increased production of mucus. There have been some studies that show that teens who use electronic cigarettes are more prone to developing chronic bronchitis. Those with asthma have more frequent asthma exacerbations. You may see that a teenager has a more frequent developing a chronic cough of sorts. And yes, there’s even more research being done about the cardiovascular effects in terms of high blood pressure and cardiac function, too.

So, these are some of the real effects that we are seeing of all the substances that are found in the aerosol. So, it’s not just harmless vapor. But there’s actual chemical substances that affect the lungs, that affect the heart and again, we don’t know the long-term repercussions. We know the long term effects of smoking regular cigarettes. We’ve been doing that research for decades. And we know what it leads to. Unfortunately we don’t have that data yet on electronic cigarettes which are about a decade old. And so we’ll be finding out what those effects are.

Host:  So, just in wrapping up here, I’m curious as to how we get our teenager to quit. Like what tactical strategies would you recommend that they do? Because there are a lot of pressures that we discussed here today. But what strategies can we give to our children to help them to stop?

Dr. Rao:  I think that’s a really tough question. I think that parents should approach this like an addiction. And an addiction is actually a disease. It has a lot of stigma, a lot of shame associated with it. The inclination is really to blame the teenager or the adolescent for making a bad choice. But honestly, their brains are primed to make bad choices. And so, we as mentors, as parents, as caregivers; really have to guide them and I think one of the first steps is to seek medical attention from a professional. And go about dealing with the addiction in that way. And so really, speaking with the physician about your concerns about a nicotine addiction and approaching it in terms of an addiction is really where the conversation should start.

Host:  Okay awesome. And just final question here, is there a main message that you’d like to leave us with about vaping in general?

Dr. Rao:  I guess the main message I want to convey is that there’s a lot of people working hard to try and make the public believe that electronic cigarettes are okay. That they are harmless. That it is just kind of water vapor, that it’s flavorings but we know more than that. We know from really good medical evidence that the aerosol produced by these devices is harmful. Now is it less harmful than cigarettes? Honestly, I don’t think that that’s really even relevant. What we know is that electronic cigarettes are completely different compared to regular combustible cigarettes. It’s a completely different device. It’s a completely different set of chemicals. Yes, they may be less numerous in number compared to the toxins found in combustible cigarettes. But less doesn’t mean better especially when it comes to a vulnerable developing teenaged adolescent brain with the potential for long-term nicotine addiction.

Host:  Well thank you so much Dr. Rao. This has been extremely informative and insightful today. That’s Dr. Devika Rao, a Pediatric Pulmonologist at Children’s Health. Thanks for listening to this episode of Children’s Health Checkup. To learn more about programs and services and to see other health tips for your family visit www.childrens.com. If you found this podcast helpful, please rate and review or share the episode and please follow Children’s Health on your social channels. Thanks and we’ll talk next time.

This podcast is intended for educational and informational purposes only. Please consult with your healthcare professional for specific recommendations about your health.