My Casualty Report for Salvo Issue 48 is on the increase of vaping among teens. I wrote this report just as the FDA was investigating whether Juul, the largest provider of vaping liquids, knowingly targeted teens. Teen vaping had increased so much in the last two years—78% increase among high school students–that the FDA released the CDC’s 2018 report on cigarette and vaping ahead of schedule and called it a public health concern.

I received several responses from people when I mentioned I was writing this article. Teachers agreed this was a big problem in schools, and one that was difficult to regulate because teens can vape discretely. Others, who didn’t smoke or vape, didn’t see what the problem was because they didn’t realize the flavored liquids had nicotine in them. As a note, many teens didn’t realize they were smoking a nicotine-containing product when they smoked kid-friendly flavors like cotton candy and Cheerios. The last group responded to this by sending me materials about how vaping is a safer alternative to smoking. They were pro-vaping and believe that it will help those addicted to cigarettes.

There’s a dilemma here. Among adult smokers, vaping is a better alternative to combustible cigarettes. This doesn’t mean vaping is free from harmful side effects or even good for your health, but given the two options, vaping is better. And for this group, Scott Gottlieb, former head of the FDA, was hesitant to call for taking e-cigarette products off of the market

On the other hand, nicotine is particularly addictive in teens, and it was Gottlieb who called this an “addiction problem” and a public health issue. I didn’t go into the neuroscience in my article, but the studies show that the developing teenage brain latches onto nicotine much more readily than the adult brain making it incredibly difficult to stop using e-cigarettes or combustible cigarettes. In fact, 90% of current cigarette smokers first started smoking when they were teenagers.

As a compromise, the FDA has banned the sale of flavored liquids (other than menthol) at convenience stores and is cracking down on age-verification for purchasing e-cigarettes. Overall, I think the larger issue is the lack of studies showing the side effects of vaping, including in teens. Anecdotal evidence from adults who switched to e-cigarettes from combustible cigarettes shows that many of them ended up smoking more, not less, because vaping is convenient. There is, thus far, no studies showing that e-cigarettes help someone stop smoking. There are also few regulations, so people are getting varying amounts of nicotine in the liquids they buy.