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Kids are using vapes and they're using them in the craziest of ways. According to a recent study published in the journal Pediatrics, around one in four high-school vapers are 'dripping' e-liquids directly on to the heating coils in their devices, so that they can blow bigger vapor clouds. Naturally, this has caused some concern. Not only is dripping associated with the emission of higher levels of toxins, but it also means that the users—in this case, 16-year-old children—are exposed to a coil that can heat between 266 and 662°F.
However, things might not be quite as worrying as they initially appear. Before we all go hysterical and reach for some nicotine stress-relief ourselves, let's take a closer look at the aforementioned study. The researchers gave out surveys to 7,045 US high-school students. Out of those 7,045 students, 1,080 (15.3 percent) had used a vape at least once in their lives. And out of those 1,080 ever-vapers, 26.1 percent had dripped on at least one occasion. If we run some quick math on these figures, it turns out that 4 percent of the entire adolescent sample has ever dripped. Let's put that 4 percent figure into context: Three national surveys carried out in 2015 suggest that between 20 to 35 percent of US adolescents have drank alcohol in the past 30 days, while a 2014 study indicates that 10.2 percent of US teens have used illicit drugs in the past month. In light of these alcohol and drug use rates among kids, that 4 percent dripping figure doesn't seem quite so high, or indeed so frightening.
In fact, the same can be said for adolescent e-cigarette use in general. In the original Pediatrics study, 15.3 percent of teens were ever-vapers. This means that any of those 15.3 percent could have puffed on a pal's vape once and never used it again. It's not uncommon to find this sort of figure elsewhere in teen vaping research. For example, nine large scale studies carried out from 2011 to 2014 suggest that between 6.5 to 31 percent of US adolescents were ever-vapers. Even more recent US research from 2015 indicates a marginal increase to 38 percent of high-school students. It's important to emphasize that these figures are ever-use rates. This sort of measurement includes all the kids who had a drag on their older sibling's e-cigarette, coughed a bunch and swore to never touch a vape again. So let's also examine past-30-day rates, which give a better idea of children who are vaping more regularly. Unsurprisingly, past-30-day use is even lower among adolescents, with nine large surveys reporting that 2 to 14 percent of US teens displayed more regular use between 2011 and 2014. Once again, we're back in the realm of teenage risky behaviors, where vaping rates seem to fit snugly between illicit drugs and underage alcohol consumption.
Of course, it's also worth acknowledging that while adolescent vaping occurs at similar rates to other risky behaviors, it appears to be increasing year-on-year too. Between 2011 and 2012, US teen ever-use increased from 3.1 percent to 6.5 percent. This almost doubling of ever-use is reflected elsewhere across the globe, with ever-use among UK schoolchildren increasing from 4.6 percent (2013) to 8.2 percent (2014) and New Zealand high-school students nearly tripling their ever-use from 7 percent to 20 percent across a three-year period.
So why is this happening? We were all teenagers once and can likely relate to an explanation that draws upon adolescent boundary-pushing and the perceived coolness of doing something risky. However, another explanation may lie in the year-on-year decrease in US child smoking rates. Clearly, these decreasing rates have been observed since the late 90s and therefore can't be wholly attributed to an uptake of vaping. Nonetheless, as e-cigarettes were initially designed as smoking-cessation devices, it's important to consider that adolescents may be using them for exactly this purpose.
Indeed, among adult vapers, the evidence seems to suggest that e-cigarettes can be an effective way of stopping smoking. A 2016 report from the British Royal College of Physicians suggests that vaping is effective enough to be considered "a gateway from smoking," with minimal long-term risks. The relative risk of vaping is emphasized by an earlier 2015 report from Public Health England, which led with an estimate that "e-cigarettes are around 95 percent less harmful than smoking." Both of these reports highlight that although vapor inhalation could involve some toxin consumption, the majority of e-liquid ingredients are already approved as safe by national regulators, or could be easily subjected to regulation. Meanwhile, tobacco smoking is universally regarded as dangerous and has been directly linked to cardiovascular and respiratory diseases, as well as a number of cancers.
While it's all well and good to discuss vaping in relation to smoking cessation, we can't ignore the fact that some children may be using vapes for other reasons. This is certainly reflected in the earlier Pediatrics study, where 64 percent of teens reported dripping for a thicker cloud of vapor, 39 percent for a more pleasurable taste and 28 percent for a stronger throat hit. Although there may be some overlap, none of these reasons directly relate to stopping smoking. Equally importantly, none of these reasons directly relate to consuming nicotine, either. What they do appear to relate to is the hedonistic enjoyment of different flavors and the emergent phenomenon of vaping tricks, whereby users create various shapes with their vapor clouds (presumably, in some cases at least, using non-nicotine e-liquids). Both of these motivations are supported by a multi-method study into British teenage views towards vaping. This, at least, may allay some of the fears of tobacco researchers who suggest that nicotine use during adolescence may be detrimental to cognitive development and executive function.
Taken altogether then, the current adolescent vaping research raises a broader and slightly more controversial question: If vaping means that kids are blowing vapor rings instead of hiding behind the bike shed for a cigarette, is it such a bad thing after all?
Richard Greenhill is a research assistant who studies child vaping at the University of East London.