Electronic Cigarette: Impacts among Children and Youth that Should not be Overlooked

Abstract

Electronic cigarettes (e-cigarettes) are products that deliver nicotine through electronic means, which are becoming widely popular around the world, including in Thailand, and are on the rise among children and youth. E-cigarettes are illegal products that cause harm to health.However, it has been popular among Children and youth. Because of distorted information claiming that e-smoking is safer than conventional cigarettes and is less addictive, this information provokes children and youth to try electronic cigarettes. This situation is becoming a concerning public health issue. Electronic cigarettes not only do not reduce the harm of traditional cigarettes as claimed, but also serve as a gateway to nicotine addiction and other substances among children and youth. This article aims to provide comprehensive information on e-cigarettes and the current situation regarding their use. It reviews existing knowledge and understanding of e-cigarettes,including the health impacts of e-cigarette addiction, and existing research on the guidelines for preventing e-cigarette use among children and youth.

Despite perceptions of being less harmful, e-cigarette use constitutes a form of nicotine addiction. E-liquids typically contain synthetic nicotine dissolved in propylene glycol, which transforms into vapor when heated and inhaled. This vapor contains ultrafine particles, approximately 1–2.5 micrometers in diameter, that can easily penetrate deep into the respiratory tract. In addition to nicotine, the vapor carries various chemical substances foreign to the human body. These substances can trigger an immune response, particularly involving white blood cells that attempt to eliminate the inhaled toxins, resulting in inflammation of lung tissue. This inflammatory process mimics the clinical symptoms of infectious pneumonia; however, microbiological cultures of sputum samples often reveal no pathogenic organisms. This condition is medically recognized as EVALI (E-cigarette or Vaping product use-Associated Lung Injury).

Regarding health impacts of E-cigarette use on children and adolescents across multiple body systems, e-cigarette use has been shown to negatively affect various organ systems in children and adolescents, posing both immediate and long-term health risks. In the cardiovascular system, growing evidence suggests that e-cigarettes contribute to increased arterial stiffness,elevated blood pressure, and heightened oxidative stress. These physiological changes elevate the risk of developing coronary artery disease. Furthermore, e-cigarettes impair myocardial blood flow, endothelial function, and nitric oxide production—all of which are essential for maintaining vascular integrity and function. The respiratory system is also highly vulnerable. E-cigarette aerosols contain numerous toxic substances that can damage lung tissue, particularly in young users. One of the most severe health conditions associated with vaping is EVALI, a form of acute lung inflammation that can progress to respiratory failure in severe cases and may be fatal without timely medical intervention. Within the nervous system, nicotine acts on the brain’s reward pathways, increasing the release of dopamine, which reinforces addictive behaviors. This mechanism contributes to the early onset of nicotine dependence in adolescents. Such widespread activation can lead to systemic physiological disruption and has been linked to neuropsychiatric disorders, including depression and schizophrenia.

From a mental health perspective, adolescents are particularly vulnerable to the neurological effects of nicotine, as key brain regions responsible for decision-making, emotional regulation, and impulse control are still developing. Nicotine's interference with these regions can lead to emotional dysregulation, increased irritability, aggression, anxiety, depression, sleep disturbances, and concentration difficulties. Withdrawal symptoms during periods of nicotine deprivation may further exacerbate these issues, reinforcing the cycle of addiction. Furthermore,fetal health may be compromised when pregnant individuals use e-cigarettes or are exposed to secondhand vapor. Nicotine can cross the placental barrier through maternal blood flow and interfere with fetal brain development. Prenatal exposure to nicotine has been associated with long-term neurodevelopmental consequences, potentially impairing the child’s cognitive, behavioral, and emotional development.

To effectively protect children and adolescents from accessing or experimenting with e-cigarettes, the most impactful measure is to maintain the ban on e-cigarette importation as an upstream prevention strategy. This must be supported by strict enforcement of existing laws regulating the illegal distribution of e-cigarettes, along with accelerated efforts to disseminate accurate information to all sectors of society, especially targeting children and youth. Findings from previous studies indicate that various prevention and cessation programs have been developed,primarily targeting high school and university students. Most of these programs have trial periods of less than six weeks. Research has shown that such programs significantly increase knowledge about e-cigarettes, enhance self-efficacy, and strengthen the intention to avoid e-cigarette use among adolescents and youth in Thailand. The review recommends that key stakeholders—nurses,teachers, educational administrators, and parents—work together to protect children and youth from the dangers of electronic cigarettes. They should be well-informed about vaping to effectively raise awareness and safeguard the well-being of this crucial demographic, which will be essential for Thailand's future.

Keywords: Addiction, Children and youth, Electronic cigarettes, Impact of electronic cigarettes

Author contribution

NW: Conceptualization, design, writing, revising, and editing the manuscript

SC: Conceptualization, design, writing, revising, editing the manuscript, and corresponding with the editor-in-chief