Adolescent Vaping.

Agranee Kunwar, a medical student at KMCTH, is passionate about improving the way healthcare reaches people across Nepal. She enjoys exploring new ideas in clinical science and believes patient care should be as empathetic as it is efficient. With each step in her training, she is working toward making healthcare more accessible and forward-looking, while staying grounded in the realities of patient needs. 

THE CLOUD OVER YOUTH

What began as a harm-reduction tool for smokers has become a source of harm for teens.

When e-cigarettes first appeared, they were marketed as a safer alternative for adult smokers. But over the past decade, what was intended as a harm-reduction tool has become a source of harm itself—especially among teenagers. One in seven high school students in the U.S. reported using e-cigarettes in 2022. Behind this statistic are real stories of lung injuries, hospitalizations, and even deaths. Th e rise of vaping-related illnesses has forced clinicians and policymakers worldwide to confront an unsettling question: How did a product designed to help smokers quit turn into a public health crisis for youth?

From Smoking Cessation Aid to Teen Trend

E-cigarettes, also known as electronic nicotine delivery systems (ENDS), are often promoted as an alternative to smoking and a possible quitting aid. Some studies suggest they may be more effective than nicotine gums or patches, while others find no clear benefit. What’s certain is that their long-term safety remains unknown.

For adolescents, vaping has taken on a different meaning altogether. Sleek devices—vape pens, e-hookahs, pods, and mods—paired with flavored e-liquids like mango ice or cotton candy have made vaping appealing and accessible. These devices work by heating a liquid into an aerosol that users inhale. But what’s inside that aerosol is far from harmless: nicotine, ultrafine particles, volatile organic compounds like diacetyl (linked to serious lung disease), and even heavy metals.

EVALI: A New Disease on the Radar

The most alarming health risk linked to vaping is EVALI—e-cigarette or vaping-associated lung injury. First recognized in 2019, EVALI has already caused thousands of hospitalizations and dozens of deaths, many among young people.

By early 2020, the CDC had recorded over 2,800 hospitalizations and 68 deaths due to EVALI. Strikingly, 15% of those cases were in individuals under 18.

Common Symptoms

EVALI symptoms often mimic other respiratory infections and can include:

• Shortness of breath, cough, and chest pain
• Fever and chills
• Nausea, vomiting, or abdominal pain
• Rapid heart and breathing rates

Diagnosis and Complications

The diagnosis is tricky—imaging may show abnormalities, but not always. Some patients present like they have pneumonia or the flu. It remains a diagnosis of exclusion, requiring:

• Detailed history
• Imaging (often chest X-ray or CT showing pulmonary opacities)
• Laboratory investigations

Mental health comorbidities are also common. Imaging findings are often variable, with some studies showing consistently abnormal chest radiographs, while others report both normal and abnormal results.

Rare complications have been documented, including:

• Pneumomediastinum
• Subcutaneous emphysema
• Pneumothorax

Management

In the acute stage, patients may require differing levels of respiratory support, ranging from supplemental oxygen via nasal cannula to intubation and mechanical ventilation.

Treatment: Supportive Care with a Cautionary Note

There is no magic pill for EVALI. Treatment is largely supportive and tailored to the severity of illness.

• Many patients require supplemental oxygen.
• Severe cases may need mechanical ventilation or extracorporeal membrane oxygenation (ECMO).
• Corticosteroids often help by reducing lung inflammation.
• Because EVALI’s symptoms overlap with infections, doctors frequently start empiric antibiotics or antivirals until other causes are ruled out.

The Bigger Picture: Youth at Risk

While e-cigarettes may play a role in harm reduction for adult smokers, the narrative changes when it comes to adolescents.

• Nicotine exposure during adolescence affects brain development, increases addiction risk, and has been linked to impaired attention and learning.
• Add aggressive marketing, social media trends, and enticing flavors, and you have a recipe for a public health challenge.

Back in 2013, a panel of experts from diverse fields—including medicine, pharmacology, toxicology, psychology, and public health—assessed the relative harms of 12 nicotine-containing products across 14 criteria addressing risks to both users and others.

Their findings suggested:

• Combustible cigarettes were the most harmful.
• Electronic nicotine delivery systems (ENDS), such as e-cigarettes, were substantially less harmful.

This conclusion was popularized in the media as the claim that e-cigarettes are “95% less harmful” than traditional cigarettes.

However, the authors themselves acknowledged a major limitation: the absence of robust evidence to support many of their estimates.

Since then, vaping devices and e-liquids have evolved considerably, and accumulating data have highlighted significant potential harms. The 2013 estimate should no longer be considered valid. Today’s vaping products are very different from those of a decade ago, and research increasingly suggests that the harms may be greater than previously thought.

What Needs to Happen Next?

The vaping epidemic among youth is a wake-up call. Protecting adolescents requires multi-pronged action:

• Regulation: Stronger oversight of e-cigarette manufacturing, content, and advertising—especially flavored products.
• Education: Campaigns targeting teens and parents to dispel myths about vaping’s “safety.”
• Research: Long-term studies to assess health risks and the true role of vaping in smoking cessation.
• Clinical Vigilance: Healthcare providers must routinely ask about vaping use and recognize early signs of EVALI.

A Public Health at Crossroads

E-cigarettes occupy a tricky space:

• They might help some adults quit smoking,
• Yet they pose undeniable risks to young people.

Policymakers, clinicians, and communities must navigate this delicate balance with a clear priority—protecting youth from a lifetime of nicotine addiction and preventable harm.

As one pulmonologist put it:

“We cannot afford to let another generation get hooked on nicotine under the guise of harm reduction.”

Conclusion

Vaping is no longer just a clinical concern—it has become a pressing public health challenge.

Adolescents, lured by enticing flavors and savvy marketing, face unique risks:

• Nicotine addiction
• Impaired lung development
• Lasting psychosocial effects

This vulnerable group deserves focused protection.