UNC Health Care
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5 Things You Need to Know About Your Teens and Vaping

Smoking cigarettes has long been symbolic of teenage rebellion. But today, kids are more likely to be caught in a fog of vapor than a cloud of smoke. In fact, more than 1 in 4 high school students use e-cigarettes, according to the Centers for Disease Control and Prevention (CDC).

E-cigarettes, or vape pens, use a battery to heat a liquid containing nicotine and other substances into an aerosol. Vaping is the inhalation of this product. The liquid, called “vape juice,” can contain many different substances including nicotine, glycerin, propylene glycol and flavoring.

There are different types of e-cigarette products. Top-selling Juul, which looks like a USB flash drive device, is small enough to fit in a closed fist and is refillable. Two other popular brands are disposable e-cigarettes called Puff Bar and Bidi Stick.

So why should teens avoid them? Experts at UNC Health discuss five risks of teen e-cigarette use.

1. Vaping is addictive and can lead to smoking cigarettes.

E-cigarettes contain nicotine, which is highly addictive.

“Some of the products that teenagers are attracted to, especially the pod-based systems, have a high amount of nicotine,” says Ilona Jaspers, PhD, deputy director for the Center for Environmental Medicine, Asthma and Lung Biology at the UNC School of Medicine.

For example, one Juul pod contains as much nicotine as a pack of cigarettes.

Once teens become addicted to the nicotine, it can increase the likelihood they move from an e-cigarette to a traditional cigarette. This can result in long-term, lifelong use of tobacco products.

Data indicates that vaping and nicotine addiction can actually be a gateway drug to other things like smoking cigarettes, and we all know the dangers of that,” Dr. Jaspers says. “And kids who are vaping e-cigarettes are also much more likely to vape THC products.”

THC, or tetrahydrocannabinol, is the ingredient in marijuana responsible for most of marijuana’s psychological effects. In other words, it’s what makes the user feel “high.”

2. Vaping affects brain development in teens.

In addition to being highly addictive, nicotine affects the developing brain.

“The human brain continues to develop until around age 25, so exposure to nicotine during adolescence can impact brain development and affect memory, attention, learning and impulse control,” says UNC pulmonologist Brad Drummond, MD, MHS.

For example: When you create a new memory or learn a new skill, stronger connections, which are called synapses, form between brain cells. Children and teens build synapses faster than adult brains. However, nicotine changes the way these synapses are formed, according to the CDC.

3. Vaping alters heart function.

Not only does nicotine hurt the brain, it also harms the heart.

“With a nicotine addiction also comes the toxicity of nicotine, which has been shown to have adverse cardiovascular effects,” Dr. Jaspers says. “This is obviously of great importance for teenagers.”

New research from the American College of Cardiology found that vaping increases the likelihood of a heart attack, coronary artery disease and depression in adults.

4. Vaping can cause a deadly lung disease.

Vaping can cause an immediate risk to the lungs called e-cigarette, or vaping, product use-associated lung injury (EVALI), a dangerous, newly identified lung disease linked to vaping that has sent more than 2,800 people to the hospital and killed more than 60 people as of Feb. 18, 2020.

The CDC has stated that the additive vitamin E acetate appears to be associated with this vaping-related illness; however, federal investigators haven’t yet identified a single ingredient that definitely causes EVALI. Also, it is not clear how the condition develops or why it can cause the lungs to stop functioning.

Most cases of EVALI have been associated with products containing THC as well as products purchased off the street.

Symptoms are similar to that of the flu, ranging from shortness of breath and sore throat to fever and muscle aches, headaches and fatigue. However, victims do not have respiratory symptoms, and there is no indication of an infection on imaging studies, such as an X-ray.

“This is clearly an immediate or short-term risk associated with electronic cigarette, and the average age (of the victims) was 23, and so this reflects the younger population’s use of electronic cigarettes and shows they are at risk,” Dr. Drummond says.

5. It’s too early to rule out other harmful side effects of vaping.

Electronic cigarettes aren’t just nicotine; they contain a lot of other substances, some of which cause cancer, Dr. Drummond says. But it’s too early to know their long-term effects because they haven’t been around long enough for the medical community to have a full understanding of how they affect the developing lung.

“There are flavorings that have been linked to lung disease, and we simply don’t know what the long-term effects are on the exposure of these agents to developing lungs, which develop until about age 30,” Dr. Drummond says. “Any sort of respiratory exposure during that development has the potential to impair lung development, which could lead to chronic lung diseases down the road.”

Dr. Jaspers says not knowing the long-term consequences of vaping may be its most significant risk factor, especially for teens.

“The biggest danger that I see in vaping e-cigarettes is we have no idea what these products will do long-term in the developing brain or in the developing lung, or the result of chronic exposure on adolescents.”

How to Talk to Your Teen About Vaping

If you find out that your child has vaped, do not freak out. Keep the dialogue open to help him or her navigate a complicated situation. Ask your child to give you more information and then talk to him or her about the dangers of vaping, says UNC Health pediatrician Martha Perry, MD.

Framing your response around your concern for your child’s safety can also help minimize feelings of judgment. Ask teens where they are getting their vapes.

“Many teens think they are only inhaling flavoring without any nicotine. It is important to help them think about the possible dangers of anything they are inhaling in their lungs, even if they think there is no nicotine,” Dr. Perry says. “Ask your teens what they do know about vaping, and try to help fill in any knowledge gaps. Make sure they know that there are often other chemicals added to e-cigarette liquids and that the highly concentrated nicotine makes vaping highly addictive. A lot of kids just aren’t aware of the risks.”


Talk to your child’s doctor if you have concerns about vaping. If you need a doctor, find one near you. To learn about resources that can help your teen quit, visit the UNC Department of Family Medicine’s Tobacco Intervention Programs page.