A 15-year-old Texas boy’s death on New Year’s Eve marks the youngest to die from an e-cigarette or vaping product use-associated lung injury (EVALI) among the nearly 60 deaths and 2,600 cases. The outbreak of deaths from short-term e-cigarette and vaping use is shocking, and efforts to protect youth from the tragic consequences are needed now more than ever.


U.S. data shows that vaping use among middle and high school students accelerated an astonishing 1.8 million between 2018 and 2019. The need to understand e-cigarettes and why they are so alluring for adolescents in addition to what can be done to prevent, educate, and decrease this trend has become vital.


There is now data to support that e-cigarettes are not the harmless vapor as they were initially advertised. In addition to nicotine, the aerosol inhaled from vapes and e-cigarettes contain damaging ingredients, including potentially cancer-causing chemicals, ultrafine particles, chemical flavors (e.g., diacetyl, which has been linked to the respiratory disease bronchiolitis obliterans, also known as “popcorn lung”), heavy metals (lead, nickel, and tin), tetrahydrocannabinol (THC), flavorings, and volatile organic compounds. Furthermore, caution should be rendered on products advertising “0 percent nicotine,” as some have contained nicotine when formally tested. 


Vitamin E acetate appears to be one of the likely culprits for EVALI. Typically, vitamin E acetate does not cause harm when ingested as a vitamin supplement or applied to the skin; however, research suggests that when vitamin E acetate is inhaled, it may interfere with normal lung functioning.


Talk With Your Children

Forget putting off concern about the dangers of nicotine or cannabis until you smell smoke on clothing... vaping is odorless and accessible.


Parents should converse with their children about the dangers of vaping before they suspect or have knowledge of their child using. Conversations are most successful when parents keep emotions to a minimum and explain they are coming from a place of love and concern. The Surgeon General provides A Tip Sheet for Parents to assist them in having an effective conversation about e-cigarettes with their children. 


Quitting Vaping and E-cigarettes

Fear of death or illness and the cost of vaping can be powerful motivations to change. Family members and those seeking treatment should initially talk to their doctor. The most effective treatment for tobacco use disorder is nicotine replacement therapy to minimize symptoms of withdrawal in tandem with nicotine cessation counseling.


The National Institute on Drug Abuse provides research, education, and interventions that can be used initially to help those seeking treatment, and the National Institute of Health provides tips on behavioral interventions and planning.


The evidenced-based treatments promoting behavior change which have proven successful in assisting individuals who are battling this addiction include:

  • The Dialectical Behavioral Therapy (DBT) skill of mindfulness teaches the patient to accept and tolerate emotions, while the skills of distress tolerance and emotion regulation allow the patient to find meaning and effectively work through difficult situations.
  • Acceptance and Commitment Therapy (ACT) encourage patients to detach themselves from distressful thoughts and move through instead of fighting against pain towards their values in purposeful, committed actions.
  • Cognitive Behavioral Therapy (CBT) improves functioning through the education that thoughts, feelings, and behaviors are linked.
  • Self-compassion encourages the patient to practice mindfulness, treat themselves with kindness, and understand the concept of common humanity.

Counseling also provides an opportunity to work on why someone continues vaping. Youth may experiment with vaping with their friends or out of natural curiosity; however, if vaping becomes a habit and efforts at cessation fail, then the reasons that underlie continued use must be explored.


Addiction counselors have consistently found that it is not about the drug of choice; rather, there are usually complex issues underlying substance use. Vaping misuse and abuse are no different. Individuals seeking treatment have a significantly higher rate of success when they address the motives which led to continued vaping in the first place.


Regardless of where you reside, help for youth nicotine use is available. Teen.smokefree.gov is a teen-friendly website that offers guidelines and an app to assist those who are combating underage smoking and e-cigarette addiction. Additionally, family and friends can utilize the E-Cigarettes and Youth Toolkit for Partners to find out how to assist in ending this epidemic.


Note: This blog post was originally published on Mind Matters on Menninger, our blog on Psychology Today. It was written by Dalanna Burris, MS, LCDC.