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.

APA citation format.

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

C K

.C O

M /

O LI

V IE

R L

E M

O A

L; S

H U

T T

E R

S T

O C

K .C

O M

/ V

A G

E N

G E

IM

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.

 
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