Kids love e-cigs and hookahs — but they won’t love what they’re doing to their hearts

The days of young people thinking that smoking cigarettes is cool may be coming to an end. But there’s a catch.

Tobacco use among youth has dropped nearly 25 percent in less than a decade, from 4.5 million middle and high school students in 2011, to 3.6 million in 2017, according to findings from the 2017 National Youth Tobacco Survey (NYTS).

E-cigarettes, though, have skyrocketed to become the most commonly used tobacco product among both middle and high school students since 2014, according to the Morbidity and Mortality report published by the Centers for Disease Control and Prevention. Among the 3.6 million tobacco users in 2017, 2.1 million used e-cigarettes.

And the number of U.S. high school students who reported being e-cigarette users increased a whopping 78 percent from 2017 to 2018, to 3.5 million, reversing previous declines of tobacco use, the youth survey found. E-cig usage among middle school students increased by 48 percent to 570,000.

The study authors listed three causes for the big jump: the appealing design of e-cigarette products, the high nicotine content, and the enticing flavor options, namely fruit and candy flavors.

Also popular is a smoking device that has spanned centuries, with origins tracing back to ancient Persia and India. Enter the hookah — an unmistakable staple among South Florida’s night life scene, with hookah bars and cafés being a major draw among college students.

“It’s becoming problematic to say the least,” said Dr. Metee Comkornruecha, director of the division of adolescent medicine at Nicklaus Children’s Hospital. “Unfortunately, these two forms of smoking are wrongly perceived by the public to be less harmful and thus parents may not be as concerned if they see their kids partaking. They may see it as a “lesser of two evils” situation,” he said, compared to cigarette use.

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Dr. Metee Comkornruecha, director of the division of adolescent medicine at Nicklaus Children’s Hospital

Comkornruecha warns that the nicotine emitted from these products is highly addictive and can harm the developing adolescent’s brain. He says education and stronger regulations regarding marketing and packaging of e-cigarettes and hookahs are key to combating the rise among young users.

“Both devices have flavored products that would seem to be marketed toward youth or at least young adults. Hookah smoking is often seen as a communal activity and a social event given the rise of hookah bars within our communities,” he said. “Ultimately, as parents and citizens, we need to realize the potential harm that these products can cause to our developing youth.”

E-cigarettes, which made their debut in the U.S. in 2006, are also known as vapes or vape pens. They’re battery-powered smoking devices that have cartridges that the user fills with an e-liquid (also called “vape juice”) that usually contains nicotine, flavorings and chemicals.

The liquid is heated into an aerosol, which the user inhales and then exhales as vapor. Vape pens come in all different sizes, shapes and colors and can be charged in a USB port. The term “vaping” is commonly used to describe using e-cigarettes.

Until recently, little information on the health risks of electronic tobacco products was available, but now, more studies and results from randomized trials are making headlines.

A study published last year in the American Heart Association Journals shows that tobacco flavoring compounds found in e-cigarette “juice” increases inflammation in endothelial cells, which line the interior surface of blood vessels and lymphatic vessels, and can cause cardiovascular toxicity.

Preliminary research also suggests that people who smoke e-cigarettes are more likely to suffer from heart disease and stroke than non-smokers.

“We see a lot of patients that have used and are using e-cigarettes,” said Dr. Carlos R. Zayas-Torres, a cardiologist with the Orlando Health Heart Institute, who specializes in cardiovascular disease. “Sometimes patients say they are drawn to e-cigarettes because they believe it’s a clean and safe alternative or believe it’s an alternative for smoking cessation therapy, or they believe it reduces the exposure of secondhand smoke.

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Dr. Carlos R. Zayas-Torres, a cardiologist with the Orlando Health Heart Institute

“At this time, in the young population, it’s difficult to see the long-term effects of e-cigarettes,” he said, “but definitively we’re seeing more cardiovascular events. Ten years ago, it was rare to see myocardial infarctions in people less than 50 years old. Nowadays we see patients in that age group arriving at the hospital with acute cardiovascular events on a weekly basis,” he said.

“Those events are triggered by risk factors such as smoking (including e-cigarettes), obesity, physical inactivity, hypertension and diabetes.”

Whether vaping is a better alternative than smoking is still a hotly contested topic.

The CDC says that e-cigarettes “have the potential to benefit adult smokers who are not pregnant if used as a complete substitute for regular cigarettes and other smoked tobacco products.”

For people who are addicted to nicotine, the user could still get their “fix” from vaping, and nicotine levels can be reduced by choosing a low dose e-liquid, which has found favor among former cigarette smokers.

A study published last month in the New England Journal of Medicine showed that e-cigarettes were more effective for smoking cessation than nicotine-replacement therapy, when accompanied by behavioral support.

According to the FDA, almost 90 percent of adult daily smokers started smoking by the age of 18, and nearly 2,000 youth under 18 smoke their first cigarette every day in the U.S.

“Use of tobacco products, no matter what type,” according to the FDA, “is almost always started and established during adolescence when the developing brain is most vulnerable to nicotine addiction.”

Last year, the FDA took steps to ban the sales of flavored e-cigarettes at traditional retail stores throughout the U.S., in hopes that more young people would choose not to vape. Flavored varieties can now only be sold at age-restricted shops or through online merchants, which must verify the customer’s age.