But What About the Children? Teen Vaping and E-cigarettes

Recently the Royal College of Physicians issued a report “Nicotine without smoke: Tobacco harm reduction”. In it they state that long-term harm from e-cigarettes and vaping is 95-98% less than smoking. The report concludes that  “in the interests of public health it is important to promote the use of e-cigarettes, NRT(Nicotine Reduction Therapy) and other non-tobacco nicotine products as widely as possible as a substitute for smoking in the UK.” I wrote about this landmark paper here.

Vaping is a disruptive technology that millions of smokers are switching over Chart showing Tobacco and Vaping Useto. It is significantly safer and cheaper than smoking. Because of this, it represents a threat to Big Tobacco and Pharmaceutical Companies as well as to Non-profit and governmental agencies directly and indirectly funded by them. Opposition focuses on an increase in vaping among teenagers, while smoking declines. Vaping flavors are under attack with opponents claiming that these flavors lure teens and becomes a gateway to smoking.

Monitoring the Future is a yearly ongoing study on middle and high school drug and alcohol use.This study provides the predominant data driving drug and health policy and is quoted by the CDC and other governmental agencies. The most recent report states that vaping use now significantly outpaces cigarette use. At the time of questioning, 16% of high schoolers reported vaping in the last 30 days, while 11.4% reported using cigarettes.

Hidden in the study’s data is that the authors consider vaping flavor-only liquid (with zero nicotine) as tobacco use.

Side note: E-liquid (for vaping) is a combination of these ingredients: propylene glycol (a common ingredient in aerosols and safe to inhale), food grade vegetable glycerin, flavorings, and nicotine (which is optional). Cigarette smoke on the other hand contains over 7,000 individual chemicals with 70 known carcinogens.

Pie chart showing that 65% of teen vapers use no nicotineIn the chart we can see that 65% of these kids are vaping something that is 95-98% safer than cigarettes and is not addictive. (Data found on page 43)

Interestingly, the chart shows 6.3% vaping with marijuana or hash to get high. Vaping to get high uses a completely different technology from that used with vapes for E-liquid. (Instead of burning/smoking the marijuana or hash, this vaping technology heats the active ingredients until it converts to a gas but before it burns). This data rightfully belongs under a different category of drug use among teens.

Chart Comparing Teen Tobacco, Alcohol, and Marijuana UseIn fact, the Monitoring the Future study states that 35.1% of high schoolers used marijuana in the last year with daily use of marijuana surpassing daily cigarette smoking. 21.3% of 12th graders smoked marijuana in the last month.

Remember, 65% of the 16.2% of vapers used only flavors and no addictive nicotine.

Clive Bates, a retired civil servant for the Welsh government and outspoken advocate for Tobacco Harm Reduction, looked at the data from 2014 and compared daily vs occasional use in cigarettes and e-cigarettes (vapes). Here is what he states:

Chart Showing that teens use vapes much less frequently than cigarettes
Created by Clive Bates

“Fewer than 1 in 6 teen e-cigarette users count as what one might call regular users (used on more than 20 days in a month), and more than half are using e-cigs less than once a week.  The proportion of daily or regular users is more than twice as high for smokers compared to vapers. So if you use a 30-day prevalence figure you capture very different behaviours.  The most concerning users are those for whom a consolidated smoking habit is emerging (i.e. the ones who may find it harder to quit later).”

So we have kids that are using something significantly safer, at a much smaller frequency. And most use it without the addictive nicotine.

Opponents of vaping  claim that kids who vape will move on to cigarettes. The Royal College of Physicians, however, saw no such correlation in the UK, and neither do we see it here. If it were true, we would see an increase in tobacco smoking along with the rise of vaping. In fact we see the opposite. Teen smoking is decreasing as vaping increases.

Clive Bates, in his article “We Need to talk about the children: The gateway effect examined”states that children will do what adults do. A  primary cause of cigarette smoking among teens is cigarette smoking among adults around them. As more and more adults switch from deadly cigarettes to vaping, kids will follow. This is a good thing as it actually contributes to the decline of smoking in society.

I would much rather an at-risk child experiment with blowing no-nicotine candy flavored vape clouds than smoking. While we know that vaping is significantly safer than smoking cigarettes, I will argue that it is also safer than inhaling the tar and carcinogens from marijuana smoke. Because no-nicotine vaping isn’t mind altering and doesn’t affect judgement, an argument can be made that it is even safer than teen drinking.

Picture Of Flavored VodkaI do believe that there should be some regulation on vaping, and I think that we should actively discourage teens from trying nicotine vapor. At the same time, I believe that we should know that the flavorings in e-liquid are safe to inhale. That said, the current FDA regulations, which are about to go into effect in August, that treats all vaping (including no-nicotine vaping) as tobacco products is a draconian governmental overreach and needs to be altered.

I do not believe that candy flavors should be removed from the market. Just as adults like flavored vodka and kahlua, adults also like sweet flavors to vape. Sweet and fruity flavors helps the smoker dissociate their nicotine fix with the tobacco flavor. It helps them quit smoking.

In the time that you have read this, three people have died from cigarette smoke in the U.S. This year, 480,000 people will die from smoking, including 40,000 from second hand smoke. That’s like 2-3 jumbo jets going down each day. More than 400 infants will die this year from the effects of their parents’ smoking. We don’t hear about these deaths in the news. It’s been going on so long that we’ve become numb.

Vaping, with rituals similar to smoking, provides us with a huge opportunity for us to save lives. I urge you to educate yourselves on Tobacco Harm Reduction as a rational public policy to combat smoking. Encourage your friends and family members who smoke to switch. Tell your legislative representatives that you want a rational and humane policy towards vaping.

Nearly two thirds of all teen cigarette users smoke Marlboro. Most of the rest smoke either Newport or Camels. Less than 2% smoke other brands. Under the new FDA regulations, these deadly and killer products were grandfathered in before February 15th, 2007 and will continue to be sold and poison our kids for decades to come. Because all e-cigarettes and vapes came into existence after 2007, the new FDA policy will regulate 98% of them out of existence in a little over two years.The FDA will ban a product that is 95-98% safer to protect the sales of Marlboro.  I urge you to contact your representatives to support the Cole-Bishop amendment which moves the grandfather date forward to 2016. This will level the playing field and give us a real chance to save lives.

To support the Cole-Bishop amendment go to CASAA or The One Letter

Here is a pdf of this article that can be printed on 4 pages: But What About the Children? Teen Vaping and E-cigarettes


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About Dr. Michael Polsinelli, DC

I really enjoy my work. It is a combination of listening, analyzing, and the skill of performing my craft. I love the expression on my patients faces when I puzzle out a long standing problem of theirs, or when their pain leaves after gently adjusting them. Read more about me


  1. Well said and thank you Dr. Michael for informing the those who would wonder onto your page to read this article. I was a 14 year, 1 pack a day smoker. Thanks to a family member, I was introduced into vaping about a year and a half ago and I kicked cigarettes out of my life 2 months into vaping. I felt pure enjoy and happiness that it finally happened, and I have tried cold turkey, the patch, and the gum and none of that worked at all. I am still vaping til this day, but a lot has changed for me, starting from 18mg nicotine to now 6mg and soon to 3mg. I have felt so much better over the time I have been vaping and I get sick less often.

    Vaping saved my life and I know it can save so much more. A Billion Lives are at risk and it is time for all vapers, smokers, and non-smokers to get together and call your representatives and ask them to support Cole-Bishop. The next person that could die, could be your spouse, your kids, your grandchildren, your parents, your grandparents, your friends, your neighbors, or yourself. We will win the war, keep your head up and don’t back down.

  2. Thank you for a great article about vaping, Dr. Polsinelli, it’s so refreshing to see somebody so informed. Please would you be kind enough to add your support to MOVE – Medical Organisations Supporting Vaping & Electronic Cigarettes.

    I’d like to make a couple of points please.

    1. Nicotine outside of cigarette smoke isn’t addictive. It’s a widely misunderstood belief and of course, it helps sell patches and gum. It’s also imperative for scaremongering by those opposed to vaping. MAOIs are in cigarette smoke and combine with nicotine to create the addiction.

    Dr. Paul Newhouse of Vanderbilt University has, for a long time, been doing clinical trials on never smokers to treat them for cognitive problems, depression, Schizophrenia, Alzheimer’s and Parkinson’s, as well as Ulcerative Colitis. He used high strength nicotine patches for six months at a time and nobody became addicted or started smoking. His trials were cited by the pharmaceutical companies when they applied to the FDA and EU for changes to the labelling of NRT. The labelling change was approved for long term and concomitant use of NRT with other nicotine containing products, including cigarettes, with no concerns for safety or abuse (addiction).

    Because nicotine isn’t addictive, vapers gradually lose their tolerance to it and are forced by the body and superior vaping devices (the ones that will be banned), to reduce the amount of nicotine used. I started out on 24mg/ml and then reduced in 6mg/ml increments easily …. I didn’t even notice the drop …. that isn’t addiction. However, I intend to stay where I am now on 6mg/ml, if I can, because of nicotine’s benefits.

    2. Some of the risks of smoking are exaggerated and risks of second hand smoke were simply made up. I’ve never come across anyone, who knows somebody who died from second hand smoke and I very much doubt anyone else does. Interestingly, smoking prevalence reduced greatly prior to 2007, before stalling for the last decade and then the smoking bans came in when smokers were driven outside; however, asthma rates have increased a good deal. In the 1960/70’s when I was in school and everyone smoked, I don’t recall any children with asthma.

    My comment was rejected as spam, probably because of the links below. In order to provide them, I’ve had to add spaces in certain parts, which will need closing.

    Is Nicotine Addictive? http://www.ecigarette-politics.com/is-nicotine-addictive.html

    Nicotine & Ecig Experts: http://www.ecigarette-politics.com/vaping-quotes.html

    MAOIs In Cigarettes: http:// http://www.jneurosci.org/content/25/38/8593.full

    TV Programme last week you might find interesting. Horizon: Ecigarettes: Miracle or Menace? https://www.youtube.com/watch?v=-hu3F_pz1Qg

    Re: Second-hand Smoke: The Air According To Osha: http://www.nycclash.com/CaseAgainstBans/OSHA.html#OSHA

  3. I really appreciate that you linked this video:

    I had read this article by the doctor in the show a few weeks ago who did not get addicted to nicotine after vaping for a month. I also agree with you that MAOI’s play an important role in the addiction of tobacco products. We know that the cigarette companies put in additives to make them more addictive. It’s also why most people dual use cigarettes with vaping before switching over to vaping completely. However, I’ll argue that some people are naturally less addicted to nicotine. There are people out there that have been easily quit smoking cold turkey while others have trouble cutting down on the nicotine levels with vaping. Here in the US, people are starting to stockpile vaping liquid with nicotine in case the new FDA regulations don’t get overturned. I think that this shows that there is some addiction to nicotine among some members of the population.

    However, I think that the societal harm of this nicotine addiction is similar to caffeine addiction. (Imagine what would happen if we banned coffee and tea?)

    As to the the harms of second hand smoke, I’m going to vehemently disagree with you. Walking by someone who is smoking isn’t going to affect you, but living with someone who smokes will. Less than 10% of the deaths from smoking comes from second hand smoke exposure. This makes it harder for us to see the impact on these individuals (especially when whole families smoke).

    I think that there are many reasons why there was less asthma when you were a kid; kids played outside more, they were more active, there were less c-sections, less use of antibiotics, less sugar consumption, homes were less sealed and had better ventilation. Kids with asthma are twice as likely to be hospitalized if they are exposed to second hand smoke. Which is yet another reason why smoking parents that can’t quick cold turkey, or by using gum or the patch should switch to vaping. (Also, smokers with asthma should also switch).

  4. Thank you for your reply Dr. Polsinelli, much appreciated.

    Regading asthma, we also have much more pollution and I also think the many cleaning sprays may also play a part. I remember reading an article some years ago, where these products were shown to be in mothers’ breast milk. I prefer to use a steam cleaner than absorb these chemicals and avoid others where possible; such as processed food.

    Regarding nicotine addiction and the fact some people struggle with it. I wonder how much is due to the deeply ingrained, constant messages from public health and pharmaceutical companies over many years that it’s highly addictive; akin to heroin and cocaine. Smokers and vapers who believe it, self reinforce this message on a daily basis. The brain is very powerful and I believe if they were told the truth, the outcome would be very different.

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