By Gelyka Ruth R. Dumaraos
Photos by Ramir G. Cambiado
Vito* is first introduced to vaping in 2016. He just turned 14. A classmate brought an e-cigarette to school and they both sneaked into the restroom to try it. As a first-timer, Vito remembers how interested and amazed he was. It had a chocolatey pungent aroma, he recalls. He puffed a couple, coughed hard a few times, and then puffed some more. Since then, Vito and his classmate would alternately share it among his peers in between classes.
Yuan*, meanwhile, is a 27-year-old advertising professional who has been vaping since 16. Growing up with a smoker uncle, cigarettes have always been a household necessity. Often, he would be asked to buy a couple of sticks in the nearby variety store. He had tried smoking tobacco at the onset of his teenage life but shifted to e-cigarettes later on. It was safer and handy, he says.
The two have different stories on how they started. But theirs are just a reflection of millions of stories worldwide—just a couple of needles in a haystack of millions of youngsters who are into this alarming tobacco alternative.
Public health threat
The disturbing data is already there. The U.S Food and Drug Administration (FDA) and the Center for Disease Control’s (CDC) 2019 National Youth Tobacco Survey reveal that more than five million American youths have used e-cigarettes in the past 30 days. Nearly one million use it daily.
In the Philippines, there are over 230, 000 electronic nicotine delivery systems (ENDS) users as of 2018. Based on the National Nutrition Survey, 1 in 5 vape users is below 20 years old.
The first documented case in our country was in November 2019, a 16-year-old girl from the central Philippines reportedly hospitalized for severe shortness of breath and met the criteria for E-cigarette Vaping Lung Injury (EVALI). It was found out that the patient has been using e-cigarettes for the past six months.
There has not been another vaping-related case that was documented and reported, there is a global call to spread awareness on the harms of e-cigarettes, especially among the young, which has been the target of the industry since its inception.
This is what Yuan has always known. “I tried smoking tobacco before but it was not just for me,” Yuan says. “I decided to use vape instead. I know that this is safer than tobacco so I just stick to this.”
Dr. Ulysses Dorotheo, Executive Director of Southeast Asia Tobacco Control Alliance (SEATCA), meanwhile says that e-cigarettes entered the US market only 15 years ago. It is also too early to say that vaping is significantly less harmful than smoking but what is certain is that health harms have already been identified, he says.
E-cigarettes and the brain
One of the most alarming risks of vaping is its possible effect on a teenager’s brain. Most e-cigarettes have nicotine, which is highly addictive and can harm their developing brains.
For young users, upside effects such as lessened pain and other negative emotional symptoms like anxiety are cited.
Vito, for one, recalls that at times, he feels relaxed and calm but there are certain moments when he feels tired and down. “It depends on how I feel while vaping,” he says. “Sometimes, I feel positive. But when I encounter some problems in school and in my family, I usually feel so down.”
In the U.S, a study conducted by the Johns Hopkins Center for the Prevention of Heart Disease, in Baltimore with lead author Dr. Olufunmilayo Obisesan reveals that there is a strong association between vaping and depression. The study was published in JAMA Network.
The experts revealed that there is twice the likelihood of current e-cigarette users to have been diagnosed with depression compared to people who had never used one. And former users are more likely to have had bouts of depression. However, researchers stress that this study can’t prove vape directly causes depression.
Another expert meanwhile underscores that nicotine “messes with the human brain.” Dr. Shawna Newman, a child, and adolescent psychiatrist at Lenox Hill Hospital in New York City say that depression increases the risk of suicidal thoughts and attempted suicide. “Short-term, your mood might get a little boost from nicotine, but long-term exposure appears to have some profound negative effects on mood.”
But what probably is considered as the greatest harm of nicotine in vaping is nicotine addiction that may start during their teenage years.
“The brain matures until it reaches the age of 25,” Dr. Rizalina Raquel H. Gonzalez, Chair of Tobacco Control Advocacy Group of the Philippine Pediatric Society says. “The last part of the brain to mature is the prefrontal cortex (PFC) or the CEO, the one responsible for impulse control and judgment.”
Thus, if a young user frequently uses an e-cigarette, this part of the brain is affected. She says, “Repeated inhalation of nicotine harms the maturation of this PFC through the recruitment of the dopamine reward pathway.”
The brain then gets used to more pleasurable feelings leading to addiction altering the supposed wiring and connections of the brain for control, affecting the user’s brain in the long run.
Moreover, Dr. Gonzalez stresses that young people’s brains build synapses faster than adult brains. “Because addiction is a form of learning, adolescents can get addicted more easily than adults.”
Dr. Ortiz seconds this, saying that the use of tobacco most often occurs in young adolescents as they have behaviors characterized by risk-taking, novelty-seeking, urge to experiment, and where they are at the age of developing their decision making, planning, and impulse control.
“First use of tobacco most often occurs in young adolescents,” she says. “The earlier one begins, the less likely that one can stop using tobacco products, and the more likely he/she will continue to use tobacco with greater quantities.”
As they try experiments with vaping and its user-friendly features and handy devices, youngsters perceive the upside effects on them that make them keep the habit. Thus, there is a likelihood that a teenager can develop nicotine dependence even after they have gone past their experimentation stage.
Dr. Ortiz added that about 2/3 of those who smoke at age 12-years-old become regular adult smokers while 1/2 of those who smoke in Grade 11 or 17-year-olds regular adult smokers. Even infrequent experimentation with smoking cigarettes can increase the risk of becoming a regular adult smoker.
Yuan admits to vaping at a certain time of the day, usually in the afternoon when he’s done with work. “It has been part of my every day,” he says. “And I don’t think I will ever stop this in the future. I’d rather use this than return to cigarettes.”
For Vito, who is now on is 4th year of vaping, he can only use his vape once a week as he does not have enough allowance since their online schooling started.
PH against vaping
With the seemingly increasing data of teenagers who are into vaping, the country’s current programs on the regulation of e-cigarettes and fighting its harmful effects on users still have a long way to go.
After the first recorded vaping-related injury last year, the Department of Health (DOH) had plans to roll out measures on vaping-injury documentation but was challenged in court by the vaping industry, halting the implementation. The health bureau is still active in campaigning against vaping and smoking, relaying all health risks it is associated with and underscoring its effects in the lungs, brain, and other parts of the body.
Regulations, too, are only limited to product standards from the Food and Drug Administration and Department of Trade and Industry.
Dr. Dorotheo added, “The recent sin tax law amendment mandates the FDA to regulate e-cigarettes and heated tobacco products, and the FDA was in the process of developing new regulations under this mandate when the COVID-19 pandemic set in.”
For their part, the Department of Education has set a similar position in its role as an educator for the youth. Several local government units also have passed ordinances that prohibit both smoking and vaping in public places.
However, it can be noted that some legislators in the lower house are pushing to enact laws that would lower the minimum age to access e-cigarettes from age 21 back to18.
In their statement against vaping, SEATCA takes a firm stand against e-cigarettes and states that these are not harmless and can kill people. “Whether they are less harmful and how much less harmful compared to cigarettes is still undetermined. E-cigarette devices and their use are attractive even to youths,” their statement reads. “While strengthening proven tobacco control measures to help smokers quit, strong precautions must be taken to prevent a new epidemic.”
Saving the young
As a physician, parent, and public health advocate, Dr. Dorotheo stresses the importance of guiding and informing teens about nicotine addiction.
“My advice to teens would be for them to do their research into the addictiveness of nicotine, the health harms that have already been identified, and the tactics used by the tobacco and vaping industry to target youth as replacement smokers, and then to ask themselves if they are willing to be the nicotine addicts that these companies have targeted them to be.”
He also adds that parents/guardians should educate themselves about vaping and its harms, especially to children, and be supportive and understanding of their children and help them quit vaping as soon as possible.
Likewise, Dr. Gonzalez encourages the youth to quit vaping and smoking to save the body and the brain from the potential health risks in the future.
Vaping is considered by medical experts as a false representation of a safer alternative to smoking. One cannot give a solution that only presents health harms.
As millions of teenagers and adolescents turn to e-cigarettes, just like what Vito and Yuan have done, it also gives false promises and risks the health of the young and developing body and brain in the long run.
This story was produced under the “Nagbabagang Kuwento Media Fellowship Program Cycle 4” by Probe Media Foundation Inc. (PMFI) and Campaign for Tobacco-Free Kids (CFTFK). The views and opinions expressed in this piece are not necessarily those of PMFI and CFTFK.