E-cigarette vaping devices, those nicotine-rich cigarette alternatives, may not be as safe as once believed. This is especially so for the market’s fastest growing population: teenagers.

The U.S. surgeon general reports nicotine itself is risky to use for both pregnant populations as well as adolescents who have developing brains. Because of the increasing use of these nicotine-filled electronic devices, research is growing to show the long-term effects in adults.

Although nicotine replacement therapies like gum and lozenges have fewer negative effects compared to traditional cigarette smoking, there’s still a concern in people with cardiovascular disease.

What nicotine does to the brain

According to the Centers for Disease Control and Prevention (CDC), nearly half of all high school students in the United States reported trying a tobacco product once. It’s during these formative years that some portions of the brain are still developing.

Research shows smoking during adolescence increases the risk of developing psychiatric disorders and cognitive impairment later in life.

Nicotine largely affects the area of the brain responsible for attention, memory, learning, and brain plasticity.

Brain development continues throughout adolescence and into young adulthood. However, different portions of the brain mature at varying speeds.

For example, the areas for social and sexual behaviors are fully developed at an early age with puberty. In contrast, development of the frontal cortical areas responsible for cognitive control over behavior extends into young adulthood.

“In adolescents, early exposure to nicotine can reduce brain activity and negatively affect concentration and memory,” says Patricia Folan, RN, DNP, director of the Center for Tobacco Control at Northwell Health in Great Neck, New York. “Nicotine exposure during adolescence can cause addiction and can harm the developing adolescent brain.”

Being influenced by social media, peers, advertising, and to use drugs is due in part by this portion of the brain that’s fully developed in puberty — thus making the adolescent drive strong.

The cognitive, self-control, and decision-making strategy portion of the brain is still in development. And this is the area which is largely affected by nicotine.

Each year, cigarette smoking kills 6 million people around the world, estimates the CDC — a number expected to rise to 8 million per year by 2030.

Further, secondhand smoke is responsible for nearly 900,000 deaths per year, notes the World Health Organization.

This makes cigarette smoking the world’s most preventable killer.

More teens interested in e-cigarettes

According to data from the 2017 National Youth Tobacco Use Survey, almost 3 million high school students and 670,000 middle school students use tobacco products.

Of these, the largest portion — 2.1 million — use e-cigarettes. Much of the reason why children use these devices is because of “use by friend or family member” (39 percent) and “availability of flavors such as mint, candy, fruit, or chocolate” (31 percent).

Since April, there’ve been at least three lawsuits against Juul Labs, the manufacturer of a popular e-cigarette device.

The litigation alleges the company has deceptively marketed the device as being safe when they contain more potent doses of nicotine than traditional cigarettes. Part of the suit requests changes to the company’s marketing practices.

The U.S. Food and Drug Administration (FDA) is currently requesting documentation from e-cigarette companies regarding design, focus groups, and even marketing practices. The FDA states that based on the information they learn from these companies, they could take enforcement against them.

According to the National Cancer Institute, there are more than 250 chemicals in cigarettes known to be harmful, with at least 69 that cause cancer. Some of the cancer-causing chemicals include arsenic, formaldehyde, nickel, carbon monoxide, and even cyanide.

Many look to e-cigarette devices as a safe alternative to cigarette smoking, but experts warn these devices can also contain dangerous chemicals.

“There are over 7,000 e-liquid flavors, most of which have not been tested for toxicity in vaporized form,” Folan says. “Some of the basic ingredients in e-liquids can be ingested orally but can be toxic when inhaled and impair lung function. The long-term impact of e-cigarette use may not be known for some time.”

A recent study published in the journal Thorax found lung cells exposed to e-cigarette liquid were more likely to have their immune system cells damaged.

Although the FDA does approve several nicotine replacement therapies, such as gums, lozenges, and patches, e-cigarettes have yet to demonstrate their ability to help people quit smoking, notes the National Academies of Sciences, Engineering, and Medicine.

Other dangers of nicotine use

The surgeon general warns against the use of nicotine during pregnancy, as it can affect fetal brain development. Additionally, nicotine can also increase the risk of stillbirths and preterm pregnancies.

The American College of Obstetricians and Gynecologists also agrees nicotine can lead to hypertension, diabetes, obesity, neurobehavioral defects, infertility, and even respiratory failure.

Nicotine is addictive, which is especially dangerous for teens whose brains are still developing. According to the CDC, almost 90 percent of smokers took their first puff before the age of 18.

Nicotine can have mind-altering properties and cause cravings that are sometimes uncontrollable. Many experts still recommend that no one under the age of 21 should try any form of it, especially with the compelling evidence showing nicotine can alter the function of the developing brain.

The surgeon general warns “that nicotine exposure during adolescence adversely affects cognitive function and development. Therefore, the potential long-term cognitive effects of exposure to nicotine in this age group are of great concern.”

From advancing research and looking into the marketing practices of e-cigarette manufacturers, many officials have their eyes on this industry.

Folan believes supporting “the FDA in their efforts to label the contents of the e-cigarette devices properly, oversee the safe handling and manufacturing of the products, mandate childproof packaging, eliminate the flavors, place and enforce age restrictions on the sale of these products, and restrict advertising, as well as anti-vaping commercials targeting youth” can all help reduce the risks associated with this growing trend.