I was at lunch with some co-workers a few years back, and after we ordered our food, we were all chatting when one of the guys in our group pulled out an e-cigarette. Having never seen one — and never one to shy away from asking questions — I dove right in with my interrogation, curious to find out what in the world this thing was that he was smoking — openly, mind you — in the middle of this non-smoking restaurant. “How does it work? Does it cause cancer? Why doesn’t it smell? What does it taste like? How much does it cost?”

Fast forward to today, and e-cigs seem almost as ubiquitous as iPhones, and moreso in the high school and even middle school crowd than the adult population. In fact, according to the U.S. Surgeon General‘s website, more high school students use e-cigarettes than regular cigarettes, and the use of e-cigarettes is higher among high school students than adults. People whip them out everywhere from restaurants to sporting events and everywhere in between — all under the guise that they’re safe. Or safer, at least, than cigarettes. Sure, they don’t smell, making the signature stench and fear of secondhand smoke less of a concern, but safe? Yeah, not so much.

Before we get ahead of ourselves, though, let’s all get up to speed on what exactly an e-cigarette is. According to the Surgeon General, e-cigarettes are defined as “devices that heat a liquid into an aerosol that the user inhales. The liquid usually has nicotine, an addictive product, as well as flavoring and other additives. E-cigarettes are considered tobacco products because most of them contain nicotine, which comes from tobacco.”

What is an e-cig?

The anatomy of an e-cig | Image: vapes.com

“E-cigarettes have some unique health risks when compared to cigarettes, including ‘popcorn lung’ and infections such as MRSA,” says Dr. Toby R. Smith, a Pulmonary and Critical Care Medicine physician at TriStar Summit Medical Center.

Popcorn lung, a lethal disease caused by diacetyl, the chemical flavorant used in e-cigarettes, is named such due to its prevalence in people who worked at microwave popcorn processing facilities. After long-term inhalation of diacetyl, which was used (and still is in some brands) to create the buttery flavor in the popcorn, many of the workers became ill with bronchiolitis obliterans (aka “popcorn lung”) and died.

David Christiani, Elkan Blout Professor of Environmental Genetics at Harvard’s T.H. Chan School of Public Health, who co-authored a 2015 study on e-cigarettes published in Environmental Health Perspectives, says in this article, “Since most of the health concerns about e-cigarettes have focused on nicotine, there is still much we do not know about e-cigarettes. In addition to containing varying levels of the addictive substance nicotine, they also contain other cancer-causing chemicals, such as formaldehyde, and as our study shows, flavoring chemicals that can cause lung damage.”

What’s more, where it used to be tough for the under-18 set to get their hands on cigarettes, let alone not get caught having smoked them thanks to the lingering smell, e-cigarettes are a game-changer — and some argue a huge step backward — in the effort to eliminate nicotine use in this population altogether.

“Kids are not just using e-cigarettes instead of cigarettes. That is what we were frankly hoping to find,” says Jessica Barrington-Trimis in this New York Times article. She’s a postdoctoral scholar research associate in the Department of Preventive Medicine at the Keck School of Medicine at the University of Southern California and the lead author in a 2016 study published in Pediatrics. She goes on to say that not only were the teens in the study smoking cigarettes as expected, but they were using e-cigs as well — a double hit, if you will. In fact, at least 2 million teens have tried or are using e-cigarettes, according to a stat included in this video produced by Newsy Science.

“We had a trend of decreasing nicotine use,” says Dr. Jonathan Winickoff, Professor of Pediatrics at MassGeneral Hospital for Children and Harvard Medical School, in the NYT article. “What the e-cigarette has done is halted that decrease in its tracks.” It’s not too difficult to surmise why that may be; with flavors like cotton candy, iced berry, mango tango and the hundreds of other fun and fruity options available, one would be crazy not to partake, right?

“I think that e-cigarettes are marketed directly to my age group,” says Connor Pendarvis, a high school sophomore in Gainesville, GA. “Not only because of the flavors, but because people feel like it’s totally safe and that it won’t cause any harm to the lungs.”

The EVOD e-cigarette comes in a rainbow array for $17.99 each.

The EVOD e-cigarette comes in a rainbow array for $17.99 each.

the JOMO mod will set you back $49.99 each.

Prefer something smaller but still just as colorful? The JOMO mod may be the solution. These will set you back $49.99 each.

“What people don’t realize is that a person who smoked cigarettes at some point in their lives, if they quit, their lungs can heal and return to normal functioning,” says Scarlet Pendarvis, RN, BSN, Connor’s mother and a clinical nurse instructor in Gainesville. “It may not have the long-term ramifications, depending on how long you smoked. But this stuff — the diacetyl — tears up your lungs. It’s not reversible. You’re not going to get better. You can’t come back from it.”

Additionally, e-cigarettes are thought to have a more elevated feel. “There are kids at my school who would never touch a cigarette because of the social stigma,” adds Connor. “E-cigarettes are seen as more socially acceptable. It’s not seen as dirty or redneck like cigarettes are.”

“The kids who would never smoke cigarettes are vaping like crazy,” Scarlet concurs.

Couple that with the fact that there’s little to no smell, and the days of getting busted by Mom and Dad — or teachers — are long gone. A Memphis mom, who spoke under the condition of anonymity, says that her son, a middle schooler, shares stories all the time about his peers who are vaping in the school bathroom. “He says they go into the bathroom and inhale an entire JUUL pod over the course of a few minutes,” the mom says, “which is the equivalent to inhaling an entire pack of cigarettes worth of nicotine into your body, at once, for the purpose of getting a quick nicotine high.”

Make no mistake, the importance of educating ourselves as well as our children is as important as ever.

When you have some extra together time over the holidays, start (or continue) the conversation, educate your children, inform your friends who have kids, and be proactive in getting the word out that these newfangled smoking devices are every bit as lethal — perhaps more so — as the old-school smokes that have been denounced for years.

“Overall, the health effects of e-cigarettes are poorly studied, and their chemical levels are unregulated,” says Dr. Smith. “Emphasize to teens that the devices are not a safe alternative to smoking, their use can create a smoking habit, and nicotine use can damage their young brains. Most importantly, set a good example and do not use e-cigarettes yourself.”

Let’s get the ball rolling. Here’s the SB FAQ on e-cigs, JUULs and vaping. And remember, it’s not a one-time discussion — it’s ongoing. The brain doesn’t stop growing, experts say, until around age 25. So yes, it bears repeating even to your college-age kids.

E-cigs, JUULs and Vaping: A Crash Course

You explained what an e-cigarette is, but what is a JUUL?

JUUL is an e-cigarette brand. It is smaller than a typical e-cig and resembles a USB flash drive, making it very hard to detect. It’s size and weight are similar to an actual cigarette. According to vaping360.com, it’s perfect for beginner vapers as well as those who prefer to keep their vaping on the down-low because it’s small and inconspicuous. Have a teenager? Juuls are the rage.

Do they have any other names I should be aware of?

Yes. Some additional names for e-cigarettes include vape pens, e-cigs, e-hookahs, JUULs, vaporizers, vape mods and mods.

JUULs are considered "ideal" for new vapers or those looking for a more discreet vaping experience. On the left, you can see that the JUUL resembles a cigarette, in appearance, size and weight. At top right, the USB plugs directly into a computer for recharging. At bottom right, the pods, which run about $15.99 for a four-pack, are each equivalent to a pack of cigarettes.

JUULs are considered “ideal” for new vapers or those looking for a more discreet vaping experience. On the left, you can see that the JUUL (black rectangular device) is the approximate size of a cigarette. At top right, the USB plugs directly into a computer for recharging. At bottom right, the pods, which run about $15.99 for a four-pack, are each equivalent to a pack of cigarettes in regards to nicotine concentration. Image: juulvapor.com

Where are kids getting these things?

You’ve likely seen “Vape” shops in your city — they’re popping up faster than title loan stores and mattress shops. There are also plenty of online shopping opportunities — electrictobacconist.com, vapes.com, vaporfi.com and blu.com are just a few.

What does all of this stuff cost?

Ballpark, you can find a JUUL online for around $34.99, and the pods it requires cost $15.99 for a four-pack. To put it into perspective, one pod is said to be the equivalent of a pack of cigarettes; how long one pod lasts will differ from user to user. We found e-cigarette devices for less than $10 and some that were nearly $100.

Is this even legal?

The laws surrounding the use and purchase of e-cigarettes are largely the same, meaning illegal for under 18-years of age, but there are some variances by state. Here is a website that discusses the vaping laws for all 50 states.

I don’t work in a popcorn factory, so why should I worry about popcorn lung?

Diacetyl was the chemical that was used to create the butter flavor in microwave popcorn. It’s the same chemical that is used to flavor the cartridges and pods used in e-cigarettes. Oh, and it’s deadly and irreversible, so there’s that.

I heard that e-cigs are a gateway to traditional smoking, but I thought they were designed to help people quit smoking. What gives?

new study by University of Pittsburgh Schools of the Health Sciences published in the American Journal of Medicine found that “Young adults who use electronic cigarettes are more than four times as likely to begin smoking tobacco cigarettes within 18 months as their peers who do not vape.”

Where can I learn more?

There is no shortage of information online about e-cigarettes, their dangers and how to broach the discussion with your loved ones about those dangers and how (and why!) to quit using them. Here are a few we recommend:

Breathe deep, friends. Knowledge is power. Go forth and start the discussion — you’ve got this! And, share this article. We’re all a little in the dark and together we can help spread the word.

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