Raffaella Nenna is Associate Professor at the Sapienza University of Rome (Italy). She does research in paediatric respiratory diseases and is Chair of the Paediatric rare lung and airway disease group of the European Respiratory Society.
What are the biggest health risks of electronic cigarettes (e-cigarettes) for teenagers and how do they compare to traditional cigarettes?
We can say that all the problems with traditional cigarettes, or at least the problems related to carcinogenesis or carbon deposits, for example, are reduced when using e-cigarettes. However, there is evidence of different health problems caused by the products that are inside e-cigarettes.
What we also know is that using vaping products, certain types in particular, can cause a severe injury to the lungs known as EVALI (e-cigarette or vaping product use-associated lung injury). While we have substantial information about this acute lung injury, there are also suggestions that vaping could lead to other types of lung disease. For example, using these products can cause people with asthma to have acute asthma attacks.
It’s important to note that many of the substances used in e-cigarettes can be safe to consume in other forms but can be harmful when inhaled. We can draw parallels to certain occupational diseases that affect adults who inhale similar substances, indicating the possible risks associated with e-cigarette use.
Your research highlights the effects of nicotine on brain development. Why are teenagers more at risk from these effects than adults?
Raffaella Nenna: During adolescence, our brains are not yet fully mature and undergo significant developmental changes, which is why teenagers are more susceptible to the negative effects of nicotine and to the possibility of developing addictions when using products containing nicotine. Furthermore, these products’ marketing and style are particularly attractive to young people, making them want to try vaping products.
Another fundamental problem that needs to be understood by the whole population is that these are not safe products. There is a misperception of the real harm caused by these products among a younger audience. They think that it is something sweet, something new and accessible that is not as bad as a normal cigarette. Therefore, they want to try the various vaping flavours, thinking that it is the same as tasting a new chewing gum or something similar.
It is also relevant to mention that not all e-cigarettes contain nicotine, but the ones that contain nicotine can have a really high volume. This also depends on the type of product and the number of inhalations that you take.
There are many different challenges circulating online that encourage young people to use e-cigarettes. Some of these challenges involve vaping as much as possible to reach an unconscious state, vaping at school or even vaping inside backpacks. There is a sort of world surrounding vaping among young people, which is quite concerning.
Why do so many teenagers still believe that e-cigarettes are safer than traditional smoking despite growing evidence of their risks?
Raffaella Nenna: There isn’t much information available on this topic. If you want to buy a traditional pack of cigarettes, you know what to expect on the packaging. However, if you look at e-cigarettes, you might find them in places like bars and corner shops, often displayed near sweets. They look quite different from traditional cigarettes and there are no warning labels about lung cancer or heart attacks on their packaging.
One reason many people might perceive e-cigarettes as being less harmful is that they were introduced as products intended to reduce the risks associated with traditional smoking. As a result, many people believe they are less harmful and think they are worth trying. However, a significant concern is that some teenagers start with e-cigarettes but may eventually transition to other vaping and smoking products, such as traditional cigarettes.
Flavoured e-cigarettes are very popular among young people. What health concerns are linked to these flavours and how do they contribute to the appeal of vaping?
Raffaella Nenna: It’s a real problem because people may think that it is like smelling or eating cake, but it’s definitely not the same, because you are inhaling molecular particles. Therefore, as more and more different flavours appear on the market, an increasing number of people, especially younger people, are drawn to trying them.
There is some evidence regarding second-hand vapour. The issue is different to smoke from traditional cigarettes because the vapour produced by vaping tends to form a cloud that dissipates quickly. As a result, after the cloud dissipates, there are fewer molecules left in the air compared to after traditional smoking, when the smoke becomes part of the surrounding air. However, if you vape close to other people, there is still a risk of exposing them to second-hand vapour.
How can schools and teachers play a bigger role in educating students about the dangers of e-cigarettes and preventing their use?
Raffaella Nenna: I’m a paediatric pulmonologist and during my patients’ visits, I realise not everyone fully understands the danger of e-cigarettes. We should therefore start from the beginning so that teenagers know what kind of products they are getting into.
Understanding vulnerability can be challenging for adolescents. They need to understand that e-cigarettes can be harmful; this would allow them to make informed choices about whether to use potentially harmful products. We should address this issue starting in schools, but it’s also important to involve the wider community. Many young people who start smoking often have siblings or parents who smoke e-cigarettes, so they don’t see it as a problem.
The first time adolescents try vaping is usually around the age of 10, which means they are primary school students. A significant number of them have seen someone vaping at school or at home. Therefore, it’s important for us to approach schools and ask teachers not to vape in front of children, and to encourage parents to refrain from vaping at home and on school premises.
We need to begin by recognising that although e-cigarettes are not the same as traditional cigarettes, they are still harmful products. Then, the law should be strictly enforced, as too many individuals under the age of 18 can easily access these products. On some websites, all someone has to do is confirm that they are over 18 by clicking on a button and they can then easily buy e-cigarettes.
The EU has proposed extending smoke-free policies to include e-cigarettes and outdoor areas where children are And in countries such as Belgium, tobacco products, including e-cigarettes, can no longer be visible at points of sale. Do you believe these measures will be effective in reducing e-cigarette use among young people? What additional steps would you recommend?
Raffaella Nenna: I believe taking action on this matter as soon as possible is very important. By doing so, we can clearly establish that both traditional and e-cigarettes are harmful products. This should be our first step, followed by efforts to increase awareness and gather as much data as we can.
Currently, it has become increasingly rare to see anyone smoking on screen. We need to achieve a similar shift in perception regarding e-cigarettes, as it is crucial to change the way they are viewed in terms of safety.