Adolescent Use of E-cigarettes

Some of us gay dads are raising teenagers. Some of those teenagers like to experiment with e-cigarettes. No big deal, right? Or is it? At the request of Gays With Kids, pediatrician Fadzi Kasambira did some digging into this topic and here’s what he found. 

These are a few of the descriptions that my children came up with when I asked them what effect tobacco smoke has on a person’s body: “Your breath smells. Your teeth turn yellow. Your hair smells like smoke. You have a yucky cough.” My kids’ conclusions, garnered from observing people outside our home who use tobacco, are arguably not far from the truth.

The negative medical effects of tobacco use, however, comprise a much longer list. Cigarette smoke affects nearly every organ in the body (1). A few of these conditions include: atherosclerosis (the buildup of fatty material inside the walls of blood vessels), leading to coronary heart disease and stroke; lung disease such as bronchitis and chronic cough; diabetes; and cancers of many types, including that of the tongue, throat, stomach, liver, pancreas, and lung. And the list goes on.

It is fairly common knowledge that the harmful effects of tobacco are due to the many chemicals contained in cigarette smoke, principal among these being nicotine. This addictive chemical keeps smokers hooked, increasing their risk of developing negative health effects.

In an effort to have smokers avoid breathing in these chemicals while allowing them to continue enjoying the experience of smoking, innovative manufacturers developed so-called electronic cigarettes (or e-cigarettes) around 2006. These devices heat a nicotine-containing fluid, creating a vapor that reportedly contains only nicotine and few or none of the harmful chemicals found in tobacco smoke.

The public’s concern about the impact of tobacco use on the health of children and adolescents has expanded to include e-cigarette use. The hip advertising, sleek designs, and candy and dessert flavors of these devices are deemed by some to be a ploy to convert kids into e-cigarette users. The advertising push for e-cigarettes since they were launched has dramatically increased the exposure of children and adolescents to these devices (5), and there has been a parallel explosion in e-cigarette use among the youth. E-cigarette use among middle and high school students tripled between 2013 and 2014, and according to The National Youth Tobacco Survey, about half a million middle school students and two million high school students use these products (4).

Are e-cigarettes as harmful as regular cigarettes containing tobacco? The results of studies attempting to answer this question have yielded conflicting results. A Cochrane review and a large study by Public Health England (an autonomous executive agency of the Department of Health in the United Kingdom) (2,3) both concluded that e-cigarettes are less harmful to one’s health than regular cigarettes, and when used in conjunction with smoking cessation aids, can help people quit tobacco use altogether. A comprehensive independent study conducted by the Center for Environmental Health in California, however, found that the majority of marketed e-cigarette products contain high levels of acetaldehyde and/or formaldehyde, chemicals that have reportedly been associated with cancer (4).

The urge to smoke e-cigarettes among adolescents who are non-smokers of tobacco is strong. One study found that when these youth smoked e-cigarettes, they were more willing to try regular cigarettes (6). In another study, an association was found between e-cigarette and regular cigarette use among 11th and 12th grade students; just under half of the current e-cigarette users had never even used tobacco products (7). This suggests that adolescents were taking up e-cigarettes regardless of whether or not they had smoked regular cigarettes first.

In summary, the jury is still out on whether or not e-cigarettes are safe for use when compared with regular cigarettes. While e-cigarettes may be an important aid in helping smokers to quit tobacco use, these electronic devices may make some non-smoking adolescents more willing to try tobacco products. Given the evidence showing several harmful chemicals in e-cigarette vapor and the public health goal of having fewer children smoking any type of nicotine-containing product, further measures are needed to ensure that children and adolescents are discouraged from using e-cigarette products.


  • U.S. Department of Health and Human Services. How Tobacco Smoke Causes Disease: What It Means to You. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010 [accessed September 15, 2015].
  • McRobbie H, Bullen C, Hartmann-Boyce J, Hajek P. Electronic cigarettes for smoking cessation and reduction. Cochrane Database of Systemic Reviews 2014, Issue 12 [Epub 2014 Dec 17]
  • McNeill A, Brose LS, Calder R, Hitchman SC, Hajek P, McRobbie H. E-cigarettes: An evidence update. A report commissioned by Public Health England. ( Published August 2015 [accessed September 15, 2015].
  • Cox C. A smoking gun: Cancer-causing chemicals in e-cigarettes. Center for Environmental Health Report, Sept 2015 ( [accessed September 15, 2015]
  • Duke JC, Lee YO, Kim AE et al. Exposure to electronic cigarette television advertisements among youth and young adults. Pediatrics 2014;134:e29-e36
  • Willis TA, Sargent JD, Knight R, Pagano I, Gibbons FX. E-cigarette use and willingness to smoke: a sample of adolescent non-smokers. Tob Control 2015 Aug 10 [Epub ahead of print]
  • Barrington-Trimis JL, Berhane K, Unger JB et al. Psychosocial factors associated with adolescent electronic cigarette and cigarette use. Pediatrics 2015;136(2):308
  • Posted by Dr. T. Kasambira

    Dr. Kasambira is a pediatric infectious diseases physician and science writer who has worked for years in clinical study management and drug regulation. He is married, has three children, and lives in the Washington, D.C. area.

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