How the Next Generation Inhales: Changes in Teen Smoking

In a recent post by Nursing@Simmons, “Extinguishing the American Smoking Habit,” we examined the negative effects that smoking has on the health of American adults, as well as the role that Family Nurse Practitioners (FNPs) have in prevention and cessation. In this post, we will focus on teen smoking in America, what declining rates of tobacco use actually mean, the impact of electronic cigarettes, and what FNPs can do to support their young patients.

The Realities of Teen Smoking

Although the Centers for Disease Control and Prevention (CDC) reports rates for cigarette smoking among middle and high school students have declined in recent years, the use of other forms of tobacco products has increased — including e-cigarettes, hookahs, and smokeless tobacco. In fact, a recent CDC report indicates that e-cigarette use, or “vaping,” tripled within this population in just one year (2013–2014). E-cigarettes are subject to less regulation than conventional tobacco products and are considered less harmful due to their often-lower nicotine content, but most sources agree they are still detrimental to children and teens. According to CDC Director Tom Frieden, M.D., M.P.H., “We want parents to know that nicotine is dangerous for kids at any age, whether it’s an e-cigarette, hookah, cigarette, or cigar.”

No federal agency currently regulates e-cigarettes, although the Food and Drug Administration (FDA) has taken steps to begin regulation. As a result, the ingredients of e-cigarettes can vary widely, but usually include water, nicotine, flavorings, and other chemicals. E-cigarettes are often promoted as cessation devices and produce vapor rather than smoke, which make users more comfortable with the risks associated with using them. However, with no regulation and limited public understanding of the possible risks, e-cigarettes present a myriad of dangers to young users. According to Mitch Zeller, J.D., director of the FDA’s Center for Tobacco Products, “In today’s rapidly evolving tobacco marketplace, the surge in youth use of novel products like e-cigarettes forces us to confront the reality that the progress we have made in reducing youth cigarette smoking rates is being threatened. These staggering increases in such a short time underscore why FDA intends to regulate these additional products to protect public health.”

The Impact of E-Cigarettes on Teen Health

While e-cigarette producers and marketing campaigns pitch them as smoking cessation aids, it seems that when it comes to teens, nothing could be further from the truth. According to a recent National Institutes of Health study, e-cigarettes may actually lead to higher rates of traditional tobacco use by teens. Since smoking during adolescence is often the starting point for a lifelong struggle with this destructive habit, prevention and cessation support for teens is key.

In fact, the American Academy of Pediatrics (AAP) has just issued a wide range of recommendations on tobacco and e-cigarettes, largely urging that they be treated like other tobacco products by regulating bodies. Karen M. Wilson, M.D., M.P.H., FAAP, chair of the AAP Section on Tobacco Control, was quoted in the report, saying “the developing brains of children and teens are particularly vulnerable to nicotine, which is why the growing popularity of e-cigarettes among adolescents is so alarming and dangerous to their long-term health.”

Strategies for FNPs

In addition to its recent recommendations, the AAP published its “Clinical Practice Policy to Protect Children from Tobacco, Nicotine, and Tobacco Smoke” in the November 2015 issue of Pediatrics. The association recommends specific steps that health care professionals should take when helping their adolescent patients prevent or stop smoking, whether it is traditional tobacco products, e-cigarettes, or other types of inhalants. FNPs should consider such recommendations in the care of the patients and families they serve, including the following that are specific to teens:

  • Ask about tobacco use and tobacco smoke exposure as part of health supervision visits.
  • Include tobacco use prevention as part of anticipatory guidance.
  • Offer tobacco dependence treatment and/or referrals to adolescents who want to stop smoking.
  • Refer tobacco-dependent individuals to quit lines (1-800-QUIT-NOW, or SmokefreeTXT).

Smoke Free Teen (SFT) also provides a variety of tech tools for teens — including text support and smoking cessation apps. In addition, the American Nurses Association offers in-depth guidance regarding how nurses working in a variety of settings can help teens with prevention and cessation. Cessation plans can assist teens and adults in their efforts to stop using tobacco and nicotine products, including e-cigarettes.  

Although the declining rates of cigarette smoking in teens indicate a positive trend, new challenges have risen both for teens and the FNPs who want to help prevent health hazards caused by smoking. FNPs play a crucial role in preventing e-cigarettes from becoming even more popular with America’s kids and in helping them avoid becoming nicotine-dependent adults.