Vaping and Teens: What the Evidence Actually Says

Key takeaways

• Legal age to buy tobacco products, including e-cigarettes: 21 nationwide
• Nicotine content: most e-cigarettes contain it, including some labeled nicotine-free
• Most useful single change: Talk with teens early and calmly, and ask what they know rather than lecturing.
• Commonest mistake: Assuming flavored or "nicotine-free" products are harmless.
• See a doctor if any of the signs under "When to speak to a doctor" below apply to you.

What it is

Using e-cigarettes and other vaping devices, which heat a liquid, usually containing nicotine, into an aerosol that is inhaled. It sits within Teen Health. Below are the published figures, in one place.

The numbers, in one place

What helps

You do not have to do all of it, and you do not have to start today.

• Talk with teens early and calmly, and ask what they know rather than lecturing
• Help a teen who vapes make a quit plan with a quit date and strategies for cravings
• Ask your teen's doctor about quit support; counseling and text-message programs are available for teens
• Store e-liquids and devices locked away from children and pets

What to avoid

These come up often, and several of them sound like good ideas.

• Assuming flavored or "nicotine-free" products are harmless
• Vaping THC products, especially from informal or illicit sources
• Vaping around younger children

In depth

An e-cigarette heats a liquid, usually containing nicotine, flavorings and other chemicals, into an aerosol that is inhaled. Many devices used by teens are small, disposable and designed to look like everyday objects such as pens or highlighters, which makes them easy to hide. Many use nicotine salts, a form of nicotine that is less harsh to inhale, allowing very high doses to be delivered without the throat irritation that once acted as a natural brake on use.

Nicotine is particularly concerning for teens because the brain continues developing until about age 25. Nicotine acts on the brain's reward system, and exposure during adolescence is linked to faster development of addiction, and to effects on attention, learning, mood and impulse control. Many teens who vape say they do it to cope with stress or anxiety, but nicotine withdrawal itself causes irritability and anxiety between uses, which can feel like vaping is helping when it is actually maintaining the cycle.

The aerosol is not harmless water vapor. It can contain ultrafine particles, metals such as nickel and lead, volatile organic compounds and flavoring chemicals linked to lung disease. Vaping THC, the main psychoactive ingredient in cannabis, adds its own risks. In 2019, an outbreak of serious lung injury known as EVALI was strongly linked to vitamin E acetate in THC vaping products, especially those obtained from informal sources. Long-term effects of vaping are still being studied.

Signs and symptoms

• Sweet or fruity scents with no obvious source
• Unfamiliar USB-like devices, pods, cartridges or chargers
• Mouth and throat irritation, cough or more nosebleeds
• Increased thirst and drinking more liquids
• Irritability, restlessness or anxiety when unable to vape
• Trouble concentrating, changes in sleep or declining grades

Causes and risk factors

• Curiosity and the appeal of flavors
• Friends or siblings who vape
• Marketing and social media content showing vaping
• Using vaping to manage stress, anxiety or boredom
• Belief that vaping is harmless or only water vapor
• Easy access through friends, online sellers or retailers who do not check age

How it is checked

There is no test needed to know someone vapes; the most useful step is an honest conversation. Doctors are encouraged to ask teens privately about vaping, tobacco and other substance use at checkups, and to keep these conversations confidential within the limits of safety. They may ask how often the teen vapes, how soon after waking they first use it and whether they have tried to cut down, which helps gauge how dependent they are.

If a teen who vapes has a cough, wheezing, chest pain or shortness of breath, the doctor will examine their lungs and may order a chest X-ray or other tests. Doctors also screen for anxiety and depression, which often occur alongside nicotine use and affect the quit plan.

Treatment and support options

Behavioral support

Counseling is the foundation of quitting for teens. It may take the form of brief sessions with a doctor, school-based programs or one-on-one counseling. Support focuses on understanding triggers, planning for cravings, finding other ways to manage stress and building confidence. Even short conversations with a doctor increase the chance a teen tries to quit.

Text and online programs

Free text-message programs designed for young people who vape send daily support and tips and let users text for help during cravings. The National Cancer Institute's Smokefree Teen program offers texting support, apps and online information. Calling 1-800-QUIT-NOW connects to state quitlines, many of which offer services tailored to teens.

Medicines in some cases

Nicotine replacement products such as patches and gum are FDA-approved for adults. For teens who are moderately or severely dependent, some doctors may consider them as part of a quit plan, carefully weighing benefits and risks. Your teen's doctor can explain whether this is an option and how it would be monitored alongside counseling.

Managing withdrawal

Cravings, irritability, trouble concentrating, poor sleep and low mood are common in the first days to weeks after quitting and usually ease with time. Planning activities, getting exercise, staying away from places where others vape and having someone to text during cravings all help. Slips are common and do not mean failure; many people try several times before quitting for good.

Prevention

• Start conversations about vaping before the middle school years
• Share facts about nicotine content and marketing tactics rather than scare stories
• Help teens practice ways to say no to offers from friends
• Set clear family expectations, and avoid vaping or smoking yourself
• Support school and community policies that limit youth access

Day to day

If you discover your teen vapes, try to stay calm and curious. Ask what they like about it, how often they use it and whether they have ever wanted to stop. Teens are more likely to be open if they do not feel judged. Explain your concerns clearly and offer help, such as making a doctor's appointment or signing up for a quit program together. Confiscating devices without offering support can lead to hidden use.

Quitting is a process. Agreeing on a quit date, removing devices and pods, telling supportive friends and planning for situations where vaping happened before can all make it easier. Celebrate milestones such as a day, a week and a month without vaping. If you smoke or vape, quitting alongside your teen can be a powerful source of mutual support.

For specific groups

Teens with anxiety or depression

Teens with mental health conditions are more likely to vape and may find quitting harder. Treating anxiety and depression alongside the quit plan improves the chances of success, so let the doctor know about both.

Teens with asthma

Vaping can irritate the airways and worsen asthma control. A teen with asthma who vapes should talk with their doctor about symptoms and their asthma plan.

Young children in the home

E-liquids can be poisonous if swallowed or spilled on skin, and small children are attracted to bright colors and flavors. Store e-liquids and devices locked away and call Poison Control at 1-800-222-1222 after any exposure.

Questions to ask your doctor

• How dependent on nicotine is my teen, and what quit approach fits best?
• Are there counseling or school-based programs you recommend?
• Is nicotine replacement appropriate for my teen?
• Should we be concerned about my teen's cough or breathing symptoms?
• Could anxiety or depression be contributing to vaping?
• Will what my teen tells you be kept confidential?

More questions, answered

Is vaping safer than smoking cigarettes?

For adults who already smoke, switching completely to e-cigarettes may reduce exposure to some harmful chemicals. For teens and young adults who do not smoke, vaping is not safe; it exposes them to nicotine and other harmful substances and may lead to cigarette smoking.

How much nicotine is in a vape?

It varies widely. Some pods and disposable devices contain as much nicotine as a pack of cigarettes or more, and some products labeled nicotine-free have been found to contain nicotine. Because use is continuous rather than one cigarette at a time, it is easy to take in more than intended.

What is secondhand vape aerosol?

People nearby can breathe in aerosol exhaled by someone vaping, which can contain nicotine, fine particles and other chemicals. Keeping homes and cars vape-free protects others, especially children and people with asthma.

Can a teen get addicted quickly?

Yes. The developing brain is more sensitive to nicotine, and signs of dependence, such as cravings and needing to vape soon after waking, can appear after a relatively short time of regular use.

Are flavored e-cigarettes banned?

Federal rules restrict flavored cartridge-based products, and the FDA must authorize e-cigarette products for sale. Some states and cities have broader flavor bans. However, unauthorized flavored products, especially disposables, are still widely sold.

Does vaping affect sports performance?

Nicotine raises heart rate and blood pressure, and vaping can irritate the airways and cause coughing and wheezing. Teens who vape may notice reduced stamina, and quitting can help them breathe and perform better.

Related topics

• What the Guidance Really Says About Vaping and E-Cigarettes (Substance Use and Recovery)
• The Evidence on Stopping Smoking, Without the Hype (Preventive Care)
• Smoking and the Lungs: Sorting the Evidence From the Noise (Respiratory Health)
• Smoking and the Heart: What Published Guidance Supports (Heart Health)

Where to go next

• Popular Beliefs About Vaping and Teens, and What Is Actually Published
• The First Steps With Vaping and Teens
• Vaping and Teens — the reference entry
• Teen Health: The Complete Guide
• Teen Mental Health and 988: What Published Guidance Supports
• Social Media and Teens: What the Evidence Actually Says

When to speak to a doctor

See your doctor for a cough, wheezing or shortness of breath in a teen who vapes, or for help quitting. Call 911 for chest pain or trouble breathing, and call Poison Control at 1-800-222-1222 right away if a child swallows or spills e-liquid on the skin.

Where this comes from

• CDC — Youth and E-Cigarettes
• FDA — Tobacco 21
• National Institute on Drug Abuse — Vaping Devices (Electronic Cigarettes) DrugFacts

How this page was put together

Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarized or generalized beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.

Medical disclaimer

This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to your doctor, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 911.