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November 5, 2019 / 3:32 PM
/ CBS/AP

New research published Tuesday indicates the surge in underage use of electronic cigarettes shows no signs of slowing down. Another study also released Tuesday shows U.S. teens who use e-cigarettes prefer those made by Juul Labs , and mint is the favorite flavor for many of them, suggesting a shift after the company stopped selling fruit and dessert flavors in stores.
An estimated 28% of high school students and 11% of middle school students said they'd used e-cigarettes within the past month, according to a report based on a national survey conducted earlier this year. That amounts to 5.3 million young users, compared with about 3.6 million last year, despite federal law that prohibits sales to those under 18.
The government report, surveying almost 20,000 young people, also found that Juul is the preferred brand for 60% of high school e-cigarette users. Most of them used flavored e-cigarettes, and among those who did, nearly 60% favored mint or menthol.
A separate study , led by University of Southern California researchers, suggests menthol doesn't have the same appeal as mint. The study found that mint was the most popular flavor among Juul users in 10th and 12th grades and the second-most popular among middle-schoolers.
In contrast, less than 6% of teenagers across all grades preferred menthol. The study was based on a different national survey that included 1,800 Juul users. The results are worrisome but not surprising, said Thomas Ylioja, a smoking cessation expert at National Jewish Health hospital in Denver.
"We have a whole generation of young people who are addicted to these products," said Ylioja, who was not involved in the studies. "Rather than giving up when they can't get their particular flavor, they're switching to a flavor that is more available."
E-cigarettes typically heat a solution that contains nicotine, which makes cigarettes and e-cigarettes addictive. They have been sold in the U.S. for more than a decade and are often pitched as a lower-risk nicotine source for adult smokers.
Both studies were published online in the Journal of the American Medical Association. Erika Sward, spokeswoman for the American Lung Association, said the findings "call for drastic action to be taken. We are in the midst of an e-cigarette crisis, the aftermath of which we could be dealing with for decades."
A few states have taken steps to prohibit flavored e-cigarettes, and in September, the Trump administration proposed a nationwide ban, including mint and menthol. However, Axios reports the federal ban will likely include exemptions for tobacco and menthol flavors, according to sources familiar with the plan.
"There will probably be some process for those products to come back on the market later if they, you know, meet certain scientific criteria for the FDA although we're waiting to see the details of that and whether such a pathway actually exists," Axios health care editor Sam Baker said on CBSN. An announcement is expected soon from the Food and Drug Administration.
Health groups and anti-vaping advocates were worried that regulators may be backing away from their original proposal. "Exemptions for mint and menthol are problematic if we're really thinking about preventing kids from using these products," said USC study co-author Jessica Barrington-Trimis.
Flavors are banned for traditional cigarettes in the U.S., except for menthol. The San Francisco-based Juul, the best-selling vaping brand in the country, stopped selling some flavors last year in stores and only sold them online.
Last month, the company voluntarily halted all sales of its fruit and dessert-flavored e-cigarette pods, leaving only mint, menthol and tobacco-flavored products on the market. Facing multiple state and federal investigations, Juul has pledged to not lobby against the federal flavor ban.
The Vapor Technology Association, which represents the industry, however, is pushing back against a ban with a marketing campaign. Juul representatives did not immediately respond to a request for comment on the new research.

First published on November 5, 2019 / 3:32 PM

© 2019 CBS Interactive Inc. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed. The Associated Press contributed to this report.

Copyright ©2022 CBS Interactive Inc. All rights reserved.

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Teen Vaping Addiction: How to Get Your Teen to Stop Vaping

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Using e-cigarettes (vaping) is now a teen epidemic. Between 2017 and 2018, e-cigarette use among middle schoolers increased by 48 percent and among high schoolers by 78 percent, according to the U.S. Centers for Disease Control. More than a quarter of all high school students are frequent e-cigarette users. 28 percent vaping more than 20 times per month.
About a year ago, the trend hit home for Keri Williams, 42, a banking business systems consultant in Charlotte, North Carolina. That’s when the mom of five discovered that her children Amias, 16, and Kayla, 15, had been vaping on and off for about a year using a popular device called JUUL.
When Williams found out both of her teens were vaping, she made them keep their bedroom doors open unless they were changing clothes. She also took away their cellphones and media for one month. “I wanted to ‘go big’ so they understood just how serious this was,” Williams says.
She was right to be concerned. “Almost all e-cigarettes contain nicotine, even those that claim they don’t, because there’s no FDA oversight of the manufacturing,” says Jennifer Hobbs Folkenroth, national senior director, tobacco control at American Lung Association.
Nicotine is highly addictive ; it’s what gets users hooked, Folkenroth says. Nicotine exposure during adolescence can harm a teen’s developing brain. The inhaled aerosol also contains other potentially harmful chemicals, such as acrolein and diacetyl, both of which have been linked to serious lung damage. Most recently, there have been increased reports of vaping-related lung illnesses and even some deaths due to the chemicals use in vaping products.
Many schools are implementing policies aimed at reducing vaping in school. This includes employing bathroom monitors and imposing consequences like suspension or even expulsion. But these measures may not be enough, especially if your teenager is becoming a more frequent—and addicted—user. If you suspect your teen is vaping, there are some things that parents should do.
Vaping is easier to hide because it doesn’t leave a telltale odor of traditional cigarettes or visible secondhand emissions, says Steven Schroeder, M.D., director of the Smoking Cessation Leadership Center at the University of California San Francisco.
To figure out what’s up with your teen, create an environment where it’s easier for your teen to talk about it, Dr. Schroeder says. Rather than asking your teen directly (You’re JUULing, aren’t you?), ask nonjudgmental questions, maybe while you’re driving somewhere, such as:
If you get the sense from your conversations that your teen is vaping, even just occasionally, such as at parties, talk about the risks. Be prepared to hear that JUULing isn’t a big deal.
“Many teens know cigarettes are bad for you but think vaping is inconsequential ,” Dr. Schroeder says. Many teens don’t realize, for example, that all JUUL pods contain nicotine—as much as a pack of cigarettes. Recent reports of illnesses- and deaths – caused by vaping should bolster your argument here as well.
Appeal to your teen’s natural sense of rebellion. “Talk to teens about how the vaping industry is manipulating them,” Folkenroth says—for example, by making JUUL pods in flavors that appeal to young consumers, such as mango, crème, and fruit. (Under pressure from the Food and Drug Administration, JUUL recently agreed to eliminate some flavors from retail stores. However, they are still available online.)
You might say, for example: “The company is trying to make JUULing cool so you’ll get hooked and buy more JUUL pods. But shouldn’t you be the master of your own body and health ? You’re the one who makes the decision about what goes in.”
About a month after she banned vaping, text messages on her teens’ phones clued Williams in to the fact that they were vaping again . Determined to stop them, she ordered nicotine urine tests on Amazon and tested each teen daily until they were clean. Since then, she’s been randomly testing them a few times a month.
Parents can feel lost and even a little desperate when it comes to stopping vaping. But the American Lung Association cautions against this kind of screening. Instead they favor education, consistent parent-teen communication, positive support, and parents connecting teens with intervention or cessation programs.
This is Quitting is a smoking cessation program developed by Truth Initiative in collaboration with Mayo Clinic that offers a texting program to help quit e-cigarettes . Teens can enroll by texting “QUIT” to 706-222-QUIT. The program delivers tailored messages via text that give age-appropriate quitting advice.
The American Lung Association also offers several programs to help educate teens on e-cigarette use, including Not On Tobacco (a voluntary youth cessation program) and Intervention for Nicotine Dependence: Education, Prevention, Tobacco and Health. To learn more, call 1-800-LUNG-USA or visit lung.org.
You may even send your teen to the pediatrician. “We know for combustible cigarettes, if your physician tells you not to smoke, it doubles your chance of quitting,” Dr. Schroeder says. “Just the authority of a pediatrician talking to a teen about not vaping in the absence of his parents might be helpful.”
For more great information on this topic, enroll in the Your Teen Workshop on Vaping , featuring a panel of experts discussing the facts and answering real parents’ questions.
Sandra Gordon is a freelance writer and frequent contributor to Your Teen . You can read more at sandrajgordon.com

For a full list of topics: A-Z Index

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Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young Adults
What’s the Bottom Line on the Risks of E-cigarettes for Kids, Teens, and Young Adults?
Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products
Find Data on E-cigarette Use Among Youth

E-cigarettes produce an aerosol by heating a liquid that usually contains nicotine, flavorings, and other chemicals that help to make the aerosol.
The liquid used in e-cigarettes often contains nicotine and flavorings. This liquid is sometimes called “e-juice,” “e-liquid,” “vape juice,” or “vape liquid.”
Users inhale e-cigarette aerosol into their lungs. Bystanders can also breathe in this aerosol when the user exhales it into the air.
E-cigarette devices can be used to deliver marijuana and other drugs.

Why Is Nicotine Unsafe for Kids, Teens, and Young Adults?

Most e-cigarettes (vapes) contain nicotine—the addictive drug in regular cigarettes, cigars, and other tobacco products.
A CDC study found that 99% of the e-cigarettes sold in assessed venues in the United States contained nicotine. 1
Some vape product labels do not disclose that they contain nicotine, and some vape liquids marketed as containing 0% nicotine have been found to contain nicotine.
Nicotine can harm the developing adolescent brain. 2 The brain keeps developing until about age 25.
Using nicotine in adolescence can harm the parts of the brain that control attention, learning, mood, and impulse control. 2
Each time a new memory is created or a new skill is learned, stronger connections – or synapses – are built between brain cells. Young people’s brains build synapses faster than adult brains. Nicotine changes the way these synapses are formed.
Using nicotine in adolescence may also increase risk for future addiction to other drugs. 2

How Does Nicotine Addiction Affect Youth Mental Health?

When a person is dependent on (or addicted to) nicotine and stops using it, their body and brain have to get used to not having nicotine. This can result in temporary symptoms of nicotine withdrawal.
Nicotine withdrawal symptoms include irritability, restlessness, feeling anxious or depressed, trouble sleeping, problems concentrating, and craving nicotine. 3 People may keep using tobacco products to help relieve these symptoms. 4
Youth may turn to vaping to try to deal with stress or anxiety, creating a cycle of nicotine dependence. But nicotine addiction can be a source of stress.
What may start as social experimentation can become an addiction.

The most common reason U.S. middle and high school students give for trying an e-cigarette is “a friend used them.” 5
The most common reason youth give for continuing to use e-cigarettes is “I am feeling anxious, stressed, or depressed.” 5

Youth e-cigarette and cigarette use have been associated with mental health symptoms such as depression. 9, 10

Do symptoms of nicotine withdrawal improve after quitting?

Yes. As long as a person stays quit, withdrawal symptoms will fade over time as the brain gets used to not having nicotine.

Does quitting vaping improve mental health?

Scientists are still learning about the effects of quitting vaping on mental health. Quitting smoking cigarettes is associated with lower levels of anxiety, depression, and stress, as well as improved positive mood and quality of life. 9

What Are the Other Risks of E-cigarettes for Kids, Teens, and Young Adults?

Scientists are still learning about the long-term health effects of e-cigarettes.
Some of the ingredients in e-cigarette aerosol could also be harmful to the lungs in the long-term. For example, some e-cigarette flavorings may be safe to eat but not to inhale because the gut can process more substances than the lungs. 1
Defective e-cigarette batteries have caused some fires and explosions, a few of which have resulted in serious injuries.
Children and adults have been poisoned by swallowing, breathing, or absorbing e-cigarette liquid through their skin or eyes. Nationally, approximately 50% of calls to poison control centers for e-cigarettes are for kids 5 years of age or younger.

Flavors and Marketing Make E-cigarettes Appealing to Youth

E-cigarettes come in various flavors, including fruit, candy, mint, and menthol.
A study from 2013-2014 showed that most youth who use e-cigarettes first start with a flavored variety, and flavors are the primary reason youth report using e-cigarettes. 6
In 2021, most youth who reported using e-cigarettes used flavored varieties (84.7%). Among middle and high school students who currently used any type of flavored e-cigarette in 2021, the most commonly used flavors were fruit (71.6%), candy, desserts, or other sweets (34.1%), mint (30.2%), and menthol (28.8%). 5 , 9
On January 2, 2020, the U.S. Food and Drug Administration (FDA) finalized an enforcement policy that prohibits the sale of prefilled cartridge e-cigarettes in any flavor other than tobacco or menthol, unless authorized by FDA. FDA has since taken additional steps to prohibit certain companies from selling youth-appealing, flavored disposable e-cigarettes and flavored e-liquids without authorization. 7
Several states and communities have restricted the sale of flavored tobacco products, including menthol-flavored products. 8
E-cigarettes are also advertised using the same themes and tactics that have been shown to increase youth initiation of other tobacco products, including cigarettes. In 2021, about 7 in 10 middle school and high school students (70.3%)—more than 17.7 million youth—said they had seen e-cigarette advertising. 9
Widespread advertising for e-cigarettes, including via media for which advertising for conventional tobacco products is prohibited (e.g., TV), and the lower costs of some e-cigarettes relative to regular cigarettes has contributed to use among youth. 1
Many youth also report using e-cigarettes because they are curious about these products. 1

Can Using E-cigarettes Lead to Future Cigarette Smoking Among Kids, Teens, and Young Adults?

Many young people who use e-cigarettes also smoke cigarettes. 1 There is some evidence that young people who use e-cigarettes may be more likely to smoke cigarettes in the future.
Specifically, a 2018 National Academy of Medicine report found that there was some evidence that e-cigarette use increases the frequency and amount of cigarette smoking in the future. 4
E-cigarettes also can be used to deliver other drugs, including marijuana; in 2016, approximately one-third of U.S. middle and high school students who have ever used an e-cigarette reported using marijuana in the device.
But e-cigarette use among young people is still unsafe, even if they do not progress to future cigarette smoking.

Aren’t E-cigarettes Safer Than Cigarettes?

E-cigarettes expose users to fewer harmful chemicals than burned cigarettes. 1
But burned cigarettes are very dangerous, killing half of all people who smoke long-term.
The use of any tobacco product, including e-cigarettes, is unsafe for young people.

Are E-cigarettes Regulated at the Federal Level?

Yes. In August 2016, the regulatory authority of the FDA was extended to cover e-cigarettes through the agency’s “deeming rule.”
Through authority granted by the Family Smoking Prevention and Tobacco Control Act (FSPTCA), FDA has authority to develop regulations that address the manufacturing, marketing, and sale of e-cigarettes.
There are some strategies that the FDA does not have authority to implement, such as including e-cigarettes in smoke-free policies or increasing the minimum legal sales age for these products, unless directed to do so by Congress. However, the FSPTCA does not prevent states and communiti
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