Nursing paper. 2 pages
Discusses possible outcomes of both positions. Present plans each for resolving the issue (for patient, family and the nurse).
Supports ideas with 3 scholarly literature nursing peer reviewed not older than 5 years.
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Use this link to take you directly to the ANA website to access the Code of Ethics. When prompted, choose “No I do not wish to register at this time. Take me to the Code now.” https://www.nursingworld.org/practicepolicy/nursing-excellence/ethics/code-of-ethics-for-nurses/
CON T EMPORARYP ED I AT R I C S . C O M | A U G U S T 2 01724
PEER-REVIEWED FEATURE Teen Vaping
Dr Douglass is DNP program
director and assistant
clinical professor, DNP
Program and Nurse
Practitioner Programs,
Drexel University College
of Nursing and Health
Professions, Division of
Nursing, Graduate Nursing
Programs, Philadelphia,
Pennsylvania.
Dr Solecki is assistant
clinical professor of nursing,
DNP Program and Nurse
Practitioner Programs, Drexel
University College of Nursing
and Health Professions,
Division of Nursing,
Graduate Nursing Programs,
Philadelphia. The authors
have nothing to disclose in
regard to affiliations with
or financial interests in any
organizations that may have
an interest in any part of this
article.
The vaping culture of using non–cigarette
tobacco and electronic nicotine delivery
systems (ENDS) is the latest risky trend
among adolescents and young adults. Vap-
ing is the use of high-tech, advanced elec-
tronic devices such as electronic cigarettes
(e-cigarettes), refillable atomizers, and
other tobacco products as an alternative
or in addition to regular cigarettes.1 A con-
cerning 10-fold to 11-fold rapid rise noted
in middle and high school students poses
dangers of nicotine exposure to the pediat-
ric population.2
This article will explore the risk-taking
behavior of adolescents engaging in vaping;
the effects of vaping and the indiscriminate
use of nicotine products on the young; and
strategies that healthcare providers can use
to collaborate with patients and families to
reduce their risk of harm from this emerging
public health epidemic.
Background The first e-cigarette was conceptualized
and patented in 1965 by Herbert Gilbert as
a safe and harmless modality to smoking
cigarettes.3,4 In 2003, an electronic atomiz-
er version was patented by Ruyan Technol-
ogy in China, marketed to the United States
in 2007, and touted as a healthier alternative
to smoking conventional cigarettes.3 Since
the emergence of Ruyan’s first-generation
e-cigarette, novel models have emerged in
design, engineering, and nicotine delivery
methods resulting in second-, third-, and
fourth-generation ENDS delivery devices.4
Modern generation devices have included
mid-sized e-cigarettes known as personal va-
porizers (PVs), which are similar to a pen or
laser pointer.4 The advanced personal vapor-
izers (APVs) contain a mechanical firing de-
vice called a “mod” (short for “modification”)
that may be used in conjunction with differ-
ent atomizers (tank systems), and they vary in
size, shape, and delivery methods. The most
innovative and advanced devices, however,
are regulated “vape mods,” which contain
an internal circuitry. Lingo used among the
diversity of delivery devices includes vapes,
vape pens, e-cigs, e-hookahs, mods, and tank
systems.3,4
Regardless of the novel delivery devices,
use of nicotine-containing products in any
Teen vaping Time to clear the air
BRENDA L DOUGLASS, DNP, APRN,
FNP-C, CDE, CTTS; SUSAN SOLECKI,
DRPH, FNP-BC, PPCNP-BC
Vaping has escalated at alarming rates among adolescents
and young adults. It’s time to educate teens about the hidden
health risks of these innocuous nicotine delivery systems.
CONTINUED ON PAGE 28
CON T EMPORARYP ED I AT R I C S . C O M | A U G U S T 2 01728
peer-reviewed
S H
U T
T E
R S
T O
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.C O
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V IE
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E M
O A
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E R
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/ V
A G
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form presents dangers and is unsafe.4
Escalation of misuse Vaping is a significant public health
concern and has escalated at alarm-
ing rates among adolescents and
young adults. During 2011-2012, data
from the National Youth Tobacco
Survey revealed a modest increase in
e-cigarette use (used 1 or more times
within the past 30 days) among stu-
dents in grades 6 to 12, from 1.1% to
2.1%.4 From 2011 to 2014, the use of
e-cigarettes grew rapidly to 13.4%
of high school students and 3.9%
of middle school students. By 2014,
e-cigarettes had become the most fre-
quently used tobacco product among
young persons, exceeding conven-
tional cigarette use. In 2015, over
3 million middle school and high
school students reported e-cigarette
use, equating to 1 in every 6 school
students, and over 25% reported try-
ing e-cigarettes.
In young adults aged 18 to 24 years,
e-cigarette use (used 1 or more times
within the past 30 days) more than
doubled from 2013 to 2014 to 13.6%,
and as of 2014, more than one-third
had tried e-cigarettes.4 E-cigarette
use data among teenagers and young
adults represent the various product
types of ENDS.3,4
What the vaping culture entails Vaping refers to the vaporization of
substances (nicotine, flavorings, can-
nabis, or other substances in popu-
larity) wherein oil, liquid, or plant
material is heated to a temperature
resulting in the release of aerosol-
ized water vapor and active ingredi-
ents (nicotine, cannabis) delivered
via inhaled aerosol.3-5 Tremendous
controversy has arisen surrounding
potential harm reduction or risks as-
sociated with e-cigarettes/vaping in
young persons.3
Nicotine, a highly addictive sub-
stance in any form, is commonly
vaped.3,4 Health effects of nicotine in-
clude hemodynamic effects second-
ary to catecholamines (eg, increase
in heart rate and blood pressure; va-
soconstriction of arteries and vessels;
endothelial dysfunction; atheroscle-
rosis acceleration).3 During adoles-
cence while the brain is developing,
nicotine can result in addiction and
harmful consequences such as be-
havioral and cognitive impairments,
memory issues, inattention, and ex-
ecutive function impairments.4,6
Harmful effects have been found
from e-cigarette aerosol and addi-
tives.4 Brief exposure to propylene
glycol aerosol has been reported to
PEDIATRIC-FOCUSED LINKS ON E-CIGARETTES AND VAPING
AMERICAN ACADEMY OF PEDIATRICS:
E-Cigarettes and Electronic Nicotine Delivery Systems bit.ly/AAP-ENDS
CALIFORNIA STATE UNIVERSITY FULLERTON:
Electronic Cigarettes: Information for Parents bit.ly/CSUF-ecig-parent-info
CAMPAIGN FOR TOBACCO-FREE KIDS:
Electronic Cigarettes: An Overview of Key Issues bit.ly/tobaccofreekids- ecig-overview
CENTERS FOR DISEASE CONTROL AND
PREVENTION:
E-Cigarettes and Young People: A Public Health Concern bit.ly/CDC-ecigs
MYHEALTH.ORG:
The Truth: Is Your Teen Vaping? bit.ly/myhealthoc-teen-vaping
NATIONAL INSTITUTE ON DRUG ABUSE:
Teens and E-Cigarettes bit.ly/NIDA-teens-and-ecigs
TV Spotlight on Electronic Cigarettes: YouTube bit.ly/NIDA-youtube-ecigs
NEMOURS FOUNDATION, DUPONT PEDIATRICS:
KidsHealth: About E-Cigarettes bit.ly/KidsHealth-ecigs
TeensHealth: E-Cigarettes bit.ly/TeensHealth-ecigs
US DEPARTMENT OF HEALTH AND HUMAN
SERVICES:
E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General bit.ly/HHS-ecigs- SurgeonGeneral-report
Know the Risks: E-Cigarettes and Young People bit.ly/HHS-ecigs-know-the- risks
Know the Risks: E-Cigarettes and Young People. Talk with your Teens About E-Cigarettes: A Tip Sheet for Parents bit.ly/HHS-ecigs-parent-tip-sheet
US FOOD AND DRUG ADMINISTRATION:
Vaporizers, E-Cigarettes, and Other Electronic Nicotine Delivery Systems bit.ly/FDA-tobacco-products
FROM 2013 TO 2014
E-cigarette use among middle and high school students tripled, rising from approximately
660,000 to 2 million students19
CONTINUED FROM PAGE 24
29A U G U S T 2 017 | CON T EMPORARYP ED I AT R I C S . C O M
peer-reviewed
be a respiratory and eye irritant in
patients without asthma.6 Contem-
porary generations of high-powered
e-cigarettes comprising tank sys-
tems have the capacity to heat nico-
tine liquids to high temperatures that
produce cancer-causing carcinogens
such as formaldehyde and acetalde-
hyde in the vapor.4,6 Metals detected
in some e-cigarette aerosol, includ-
ing lead, silver, tin, nickel, iron, cop-
per, and cadmium, may be products
of the heating element (coil).4
Secondhand e-cigarette aerosol
exposure to nicotine, particles, and
potentially toxic chemicals have been
found in emissions studies.3 The ef-
fects of potentially harmful doses of
heated and aerosolized ingredients of
e-cigarette liquids including solvents,
flavorings, and toxicants are not fully
understood.4
Dual use of vaping nicotine and
smoking cigarettes presents added
health concerns.3,4 An association has
been identified in young persons be-
tween e-cigarette use and the propen-
sity to use other tobacco products, in
particular the use of combustible prod-
ucts (ie, cigarettes).4 To illustrate, 58.8%
of high school students in 2015 report-
ed using e-cigarettes and additionally
combustible tobacco products.
The evolving landscape of rec-
reational and medicinal marijuana
(cannabis) use has given rise to an in-
crease in vaping cannabis.5,7 In 2017,
a study conducted among 3847 high
school students in Connecticut was
consistent with high rates of using
e-cigarettes to vape cannabis (life-
time cannabis user, 18%; lifetime dual
users, 26.5%).7 Besides the potential
for nicotine addiction, addiction risk
exists for cannabis and other illicit
drug use.4 Little is known about the
long-term health effects of vaping and
even less has been established about
the potential harm of vaping other
substances such as cannabis.5
Targeted advertising Robust marketing and colorful adver-
tising campaigns directed toward the
youth population through social me-
dia outlets, television, and on the In-
ternet proliferated between 2011 and
2013.3,6 One study found television ad-
vertisements soared 256%, reaching
over 24 million young persons.3 Ap-
pealing, child-friendly flavorings are
a marketing endeavor to attract ado-
lescents, disguise harsh tobacco, and
facilitate nicotine addiction.4,6
In 2014, 466 brands and 7764 dis-
tinctive flavors of e-cigarette products
were available.3,4 Emerging evidence
suggests that flavorings when vapor-
ized at high temperatures result in
chemical reactions of toxic levels of
carbonyl compounds such as form-
aldehyde, although the health effects
are not completely appreciated.4,8
Flavorings/taste were among the
3 most commonly reported reasons for
e-cigarette use among teenagers and
young adults along with perceived low
harm as compared with conventional
tobacco products and curiosity.3
Emerging evidence of use patterns
has revealed that e-cigarettes are
being utilized by young persons for
various alterative behaviors such as
smoke tricks, vape competitions, and
vaping other substances including
cannabis and cocaine.8
“Dripping” is one of the newest
trends wherein e-liquid at high tem-
peratures is manually applied direct-
ly on the atomizer coil and the vapor
produced is inhaled.8 In the first study
to evaluate prevalence rates for drip-
ping conducted by Yale University on
high school students (n=7045) from
8 different Connecticut schools,
anonymous surveys evaluated to-
bacco use behaviors and perceptions.
Results of the anonymous surveys re-
vealed that 26.1% of e-cigarette ever
users (n=1080) reported using the
device for dripping, equating to 1 in
4 adolescents. Reasons for dripping
included: thicker vapor clouds (63%);
better-tasting flavors (38.7%); and a
stronger hit produced in the throat
(27.7%) by dripping. Safety studies are
not available on the practice of drip-
ping, although some research sug-
gests e-liquid exposure may have a
considerable increase in toxic vapors
(eg, acetaldehyde, formaldehyde, ac-
etone) and may increase exposure to
high levels of nicotine.
VAPING AND OTHER SMOKING PRODUCTS AND CHILDREN
I. Introduction
A. Attention Grabber
A. Children, adolescents or often adults believe vaping is safer than smoking regular cigarettes. That is wrong, vaping also has nicotine which is highly addictive just like regular cigarettes. The only difference is that it is electronic.
A. Liquid e-cigarettes can cause nicotine poisoning to younger children or pets when drunk, sniffed, or touched.
B. Statistics (Nataliya)
B. According to Doughlass & Solecki (2017), National Youth Tobacco Survey revealed an increase in e-cigarette use among students of 6 to 12 years of age from 1.1% in 2011 to 2.1% in 2012. In high school students between the years 2011 to 2014 the increase went up rapidly to 13.4% and in middle school students the use increased to 3.9%.
B. Children and adolescents are often not aware not vaping is the same thing as smoking since it also contains nicotine. Children often think they’re not harming their body and only tasting the flavors and having fun. Doughlass & Solecki (2017) mention that 60% of surveyed teenagers in one study said their main reason for vaping is “just flavoring” as they were unaware that e-cigarettes contain nicotine while another 10% said they are using them to quit smoking regular cigarettes. In this case they’re uninformed that e-cigarettes also contain nicotine so vaping will not help to quit smoking regular cigarettes but will only make the addiction worse.
II. Description of the Dilemma (Nataliya)
A. Vaping is not a safer approach to smoking like many think especially to children or adolescents. Reasons for that include:
A. According to Knopf (2017), electronic cigarettes are addictive and can harm brain development in children or adolescents. Secondhand vapor is also harmful to the growing lungs. In agreement with Knopf, Doughlass & Solecki (2017) add on that nicotine can result not only in addiction but create behavioral and cognitive impairments, memory issues, inattention and excessive function impairments.
a.
1. Ethics (Linda)
B. Why its “good” (Nataliya)
1. Reasons
a. Many of the electronic cigarettes like juuls are fashionable and convenient to use for youth compared to regular cigarettes. According to Prudkovsky (2019) they’re mostly odorless and can be charged over a short period of time from an electronic device such as a computer. Such feature makes smoking less noticeable by the parent or teacher.
a. As stated by Doughlass & Solecki (2017) flavorings/taste were one of the three commonly reported reasons for e-cigarette use among teens and young adults. Other two reasons are that e-cigarettes are considered to be less harmful than other tobacco products and lastly, it’s simply the curiosity to why it attracts the youth.
a.
1. Ethics (Linda)
C. Resources to Resolve the Dilemma (Spring)
1. Vaping and E-cigarettes have become very popular and appealing among young adults due to their advertisement, price discount, and enticing new products. Also, these teens are dealing with peer pressure and they might give in to try it so they can fit in. That is why it is crucial for the guardian or parents to educate their children about the dangers of these products and why it should not be used. It is also important to have that talk with your child early as possible. This can help the child understand it better and they can help their friends understand it better too. This can also prevent them from becoming a victim to smoking those products. One of the education campaigns is called Truth Initiative which help teen understand how bad these products and companies are.
1. Some states passed the no smoking in public law like Washington. The Spokane county prohibited vaping in places that include indoor spaces, places of employment like the theater, restaurants, and more, and outdoors that are within 25 feet of doors. Washington also has their own requirement to be eligible to buy those smoking products which are, having a license to sell and buy, specific age, etc…Even though this does not banned vaping or smoking completely, it still reduces the chance of other people inhaling it when they are nearby. More states should implement this rule and Illinois should be one of them.
1. Since most teens are buying these products, the prices should increase so that it will reduce the number of buyers.According to heart.org, increasing the price and prevent them from smoking since they are concerned about the prices.
1. Because these are more focused on the younger audience, the marketing should ban their products toward young people.
D. Possible Outcomes and Plan for Resolving the Issue (Vincent)
1. One of the outcomes Doughlass & Solecki (2017) mention is a suggestion that parents can get educated themselves and then educate their children on the harms and risks associated to e-cigarette use or other nicotine products as well as illicit substances. Parents/guardians should abide a tobacco-free model to their children and have open discussions with them about the harms of smoking.
1. Doughlass & Solecki (2017) also mention the role of healthcare providers in this situation. Healthcare provides may often forget to screen for vaping in pediatric population since children often do not consider vaping to be smoking. A recommendation is to add vaping to the electronic medical record’s tobacco screening questions along with regular smoking questions. Besides parents, healthcare providers also play a big role in educating the pediatric population in regard to vaping.
1. Another solution that can help solve the dilemma is on the federal level. There should be a law that will forbid e-cigarette companies to target the pediatric population, will forbid the sales to the pediatric population and make it less appealing for such population to buy the products and use them.
III. Conclusion
References
Douglass, B. & Solecki, S. (2017). Teen vaping: Time to clear the air. Contemporary Pediatrics,
34(8), 24-38.
Knopf, A. (2017). Warning to parents: Tell your children vaping is not safe. Brown University
Child & Adolescent Behavior Letter, 33, 1-2. https://doi.org/10.1002/cbl.30261
Prudkovsky, D. (2019). Saying No to Vaping: What you should know about the dangers of
e-cigarettes. Dental Assistant, 88(2), 10-11.