Cigarette smoking is the leading cause of preventable death in the United States. E-cigarettes or “vapes” are often marketed as a healthier alternative, but smoke from vaping also contains harmful chemicals that cause serious health problems including lung disease, heart disease, and cancer. People with asthma, infants, and children are especially at risk.
E-cigarettes and vape pens work by heating a cartridge to create a mist that is breathed into the lungs. This method of smoking has unfortunately become popular with middle and high school-aged children. Some vaping products are manufactured in flavors that appeal to young people. Kids might not realize that most e-cigarettes contain nicotine, which is highly addictive and can harm the developing adolescent brain.
Lisa E. de Ybarrondo, MD, a board-certified pediatrician and an associate professor in the Department of Pediatrics at the McGovern Medical School at UTHealth Houston, often counsels families on the dangers of tobacco use as part of her practice. She brings deep experience educating about and managing asthma and has served as an Asthma Faculty Champion for NEEF since 2007, supporting the organization’s work to provide pediatric asthma training resources for healthcare professionals.
“Sometimes people think vaping is a ‘better’ way of smoking, but that is not true,” said Dr. de Ybarrondo. “Beyond the negative health impacts of the dangerous chemicals that e-cigarettes contain, nicotine primes young brains for other substance use, like smokeless tobacco and cigarettes.”
Youth Vaping Trends
While e-cigarettes remain the most popular tobacco product among US youth, the good news is that usage has declined since 2019. A 2024 survey by the US Food and Drug Administration (FDA) found that 1.63 million young people reported using e-cigarettes, including 410,000 middle school students and 1.21 million high school students, with vaping being more popular with females than males. Among those who used e-cigarettes, about 38% had used one at least 20 out of the last 30 days. Nearly 67% reported trying to quit over the past year.
“Surprisingly, kids with asthma have higher rates of vaping,” said Dr. de Ybarrondo. “It is challenging because kids often do not think of vaping as a problem. They see their friends doing it or on social media.”
Even with the recent decline in reported usage, it is important to remember that there are no safe tobacco products for children, teens, or young adults. Smoking can increase the risk of getting a respiratory illness and is considered a leading cause of adult-onset asthma.
The Dangers of Secondhand and Thirdhand Smoke
Vaping is also concerning for youth who themselves do not smoke but who spend time with friends or relatives who do.
“All healthcare providers need to ask their patients if they are exposed to secondhand smoke,” said Dr. de Ybarrondo.
Secondhand smoke is any tobacco smoke inhaled by those who are near someone smoking. It is a major factor in indoor air pollution. Exposure to secondhand smoke may actually be worse than smoking because it contains higher and unfiltered amounts of toxic chemicals. Exposure to secondhand smoke, even for short periods, can lead to asthma symptoms.
Thirdhand smoke is also an environmental asthma trigger. It can be detected by the lingering smell of smoke in a room or on clothes, or yellowish stains on a wall or countertop. Thirdhand smoke is especially harmful for young children who often spend more time indoors and have increased contact with contaminated surfaces without washing their hands. It can make them more vulnerable to ear infections, bronchitis, and pneumonia due to increased inflammation in their airways.
Addressing the problem of lingering smoke is difficult. HEPA air purifiers can remove particulate matter from smoking, but toxins will potentially remain in the environment. The good news? There are simple steps you can take to eliminate the danger of secondhand and thirdhand smoke for your family, as advised by the Centers for Disease Control and Prevention (CDC).
“Our recommendations have not changed in 30 years: get smoke out of your home and your car,” said Dr. de Ybarrondo.
How Doctors and Parents Can Help Kids Quit Vaping
Both parents and healthcare providers have an important role to play in talking to kids and teens about the dangers of vaping—and providing help so they can quit if they do try these products.
“The most important thing you as a parent can do is set a good example. If kids see their parents smoking, it gives them the green light,” said Dr. de Ybarrondo. “If you notice a problem, consult with your primary care provider for treatment.”
Unfortunately, vaping can be easy to hide. Wondering if your middle or high schooler has tried e-cigarettes? Look for changes in your child’s behavior, like poor school performance or not sleeping well. Vape pens can be mistaken for markers or USB drives. Keep an eye (and nose) out for discarded vape cartridges, which often have a distinctive scent.
Healthcare providers should also be proactive in talking to their young patients about vaping and nicotine use.
“For our ‘Well-Child’ checkups, we always ask about substance use,” said Dr. de Ybarrondo. “It is also important to have a heart-to-heart with parents about the impacts of their own smoking.”
Doctors can connect families with resources if their child develops a nicotine addiction. However, medical cessation options like nicotine gums are not approved for use in children. If you are interested in seeking a prescription, additional outreach to a psychiatrist may be required.
Resources to Help Youth Quit Smoking
Parents, the first step to helping your kids make healthy decisions when it comes to vaping is to start a conversation. Follow these tips from the American Lung Association to get started:
- Know the facts about the health problems that vaping causes, especially for those with asthma—but avoid scare tactics.
- Open up a natural discussion and avoid passing judgment or showing frustration. Try to put yourself in your child’s shoes.
- Thank your child for their honesty. Afterward, follow up to keep the lines of communication open.
If you find out that your child is struggling with nicotine use, help them make a plan to quit. Dr. de Ybarrondo cited the recommendation of the American Academy of Pediatrics (AAP) to quit completely within two weeks. You can support your child by helping them identify potential triggers such as peer pressure from friends and support them in self-care activities like exercise and meditation to help them stay on track.
Explore these free resources to help your loved one quit vaping or smoking:
- 1-800-QUIT-NOW: The CDC provides free counseling and practical information about how to quit and can help you create a personalized quit plan.
- Youth Tobacco Cessation App: The AAP created an app intended to assist physicians in supporting youth tobacco cessation by delivering the “Ask-Counsel-Treat” model during a checkup.
- SmokefreeTXT for Teens and Adults: Sign up to receive daily text messages to support your efforts to quit smoking, offered by the National Cancer Institute’s SmokeFree.gov.
Healthcare professionals are invited to access NEEF’s Environmental Management of Pediatric Asthma Online Course, a one-hour learning session that provides foundational information and skills for asthma care and management. If you are interested in becoming a NEEF Asthma Faculty Champion, or if you would like to arrange for an environmental management of pediatric asthma training in your facility, please email us at health@neefusa.org.
