The past few years have seen a rise in the use of electronic cigarettes among adolescents. The adolescent brain is especially vulnerable to the nicotine compounds in electronic cigarettes due to its unique chemistry and is not only more easily addicted to nicotine, but also significantly more harmed than post-adolescent brains. Considering this, it is troubling that many leading electronic cigarette brands fail to dissuade teenagers from their product and might even actively target them. While electronic cigarettes must be acknowledged as a valuable alternative to traditional cigarettes for adult users, it is also imperative that measures must be taken to protect adolescents from the risk of addiction and harm.
The Rise of Electronic Cigarettes
In the past year, several high schools across the United States have made the unusual decision to ban flash drives. The problem, of course, was not with the flash drives themselves, but with the device that disguises itself as one - e-cigs - or electronic cigarettes. Electronic nicotine delivery systems come in many forms, but the most popular one is called a Juul- a small, sleek device that resembles a flash drive, but stores nicotine instead of computer files. Unlike traditional cigarettes, which pair nicotine with carcinogenic substances, e-cigarettes vaporize liquid nicotine through a heating element and produce a vapor that is inhaled. According to the manufacturers, e-cigs were intended to provide a less harmful alternative than traditional cigarettes for adult smokers;but in a malicious turn of events, the e-cigs have found a new market and created a new generation of nicotine addicts. In the past couple of years, the U.S. has seen an increase in e-cig use among adolescents;between 2011 and 2018, the percentage of e-cigarette users among high schoolers jumped from 1.5% to 20.8% . With this trend likely to continue, it is important to recognize that e-cig use in adolescents can have detrimental and life-long effects on brain development. Moreover, we must examine the ethical consequences of neglecting to take measures that would mitigate teen e-cig use.
The Adolescent Brain on Nicotine
Adolescence is a period of transition from childhood to adulthood marked by increased vulnerability to drug abuse due to behavioral changes like increased risk-taking, novelty-seeking, and peer associations. Neurobiologically, adolescence is a period of profound structural reorganization of brain regions necessary for mature cognitive and executive function. During adolescence, the brain matures by reorganizing preexisting grey matter, white matter, and associated neurochemical systems. The teenage brain consolidates learning by pruning away less-utilized synapses (grey matter) while stabilizing and strengthening the remaining connections (white matter) . Thus, grey matter decreases during adolescence in the prefrontal cortex, which is critical for executive function and motivated behaviors. This decrease in executive control and decision-making areas is compounded by corresponding increases in white matter, which results in increased efficiency of impulse transduction, and thus an increase in impulsive behavior. The imbalanced maturation of executive and impulse control systems puts teenagers at particular risk of indulging in risk-taking behavior, experimenting with e-cigarettes, for example. Even in the case of traditional tobacco smokers, 90% of users started before the age of 18 . E-cigarettes are simply a new face of substance abuse, one that teenagers have molded in their own image.
When cigarettes first rose to popularity in the 1930s, there was little awareness about its health risks. This, of course, was followed by the tragic rise in lung cancer rates that lagged behind by approximately a 30-year period. Similarly, because of its novelty, there is very little research that exists on the potential neurological effects of teenage e-cigarette use, which is troubling in itself. The research that does exist indicates that adolescent brains are especially vulnerable to damage from nicotine addiction. The rapidly changing adolescent brain has a higher sensitivity to drugs such as nicotine compared to mature brains, and drug exposure during this time can lead to long-term changes in neural circuitry and behavior .
Nicotine works by binding to nicotinic acetylcholine receptors (nAChRs) in the brain. This results in the release of dopamine, a chemical that creates a pleasurable experience and causes the “high” that is associated with nicotine. However, nAchRs are also critical regulators of brain maturation in the teenage brain, and when nicotine disrupts the nAchR system during adolescence, it produces drastic and lasting alterations in neurochemistry and neuronal signaling . Research also shows that nicotine may elicit lifelong detriments in the serotonin system, which can contribute to depression or anxiety disorders down the road . Furthermore, chronic nicotine exposure during adolescence also has long-term consequences on cognitive behavior. Nicotine addiction in adolescents has been shown to result in diminished cognitive function, reduced attention span, and enhanced impulsivity later in adulthood . There is even evidence that teenage nicotine exposure, increasingly occurring as a result of e-cigarette use, may induce epigenetic changes that sensitize the brain to other drugs and prime it for future substance abuse .
With increasing evidence that disruption of nAChRs during adolescence triggers lasting changes in neuronal signaling, it is clear that teenage use of nicotine-laden e-cigarettes has significant consequences on their cognition and emotional regulation. Thus, we must consider the ethical implications of leaving vulnerable teenagers at risk for nicotine addiction. Although marketed as a safer alternative to smoking, e-cigarettes are often not subject to FDA regulation and can be purchased by minors in many states . Compounded with a wide selection of flavors and popularization through social groups or social media, e-cigarettes have become both accessible and appealing to many young people. It is thus necessary to take quick and decisive action and implement measures to curb teenage use of e-cigarettes. However, this progress has been slowed by the problem of maintaining accessibility to adult users, who may require the product in order to avoid the greater evil of tobacco. Last year, the leading e-cigarette company Juul added a small label to its packaging that reads “The alternative for adult smokers,” but rejected putting a bigger, more aggressive statement out of fear that it would make the product seem “edgy” for adult customers. However, there are measures that can be taken without reducing accessibility for adults- for example, increasing federal regulation on the marketing of e-cigarettes or raising the minimum age for the sale of nicotine products. Teenagers are so much more uniquely vulnerable to nicotine than adults and may suffer its harmful effects for a lifetime. We need to combat the epidemic of teenage nicotine addiction before it culminates in a brand new generation whose addiction will haunt them for years to come.
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