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After years of declining nicotine use amongst teens,Series Archives rates have once again surged amongst young people thanks to e-cigarettes. One in four high school students now vapes.

To many teens, the devices look cool and sleek, not unlike how a cigarette seemed glamorous long ago. They can be easily concealed because they often look like flash drives, flashlights, or pens. They also don't emit the tell-tale odor of a traditional cigarette. The discreet, even secretive, nature of vaping can give teens a convenient thrill — along with a jolt of nicotine that reduces stress and anxiety.

Those hits, however, can quickly turn to addiction, and teens are prone to getting hooked on nicotine faster than adults, says Susan Walley, chair of the American Academy of Pediatrics Section on Tobacco Control. That's because teens' brains aren't yet fully developed and, as a result, are more powerfully influenced by a substance like nicotine.

That exposure is dangerous and can lead to long-lasting brain cell damage and permanent behavior changes like attention-deficit hyperactivity disorder. And just like old-fashioned cigarettes, an e-cigarette product with nicotine, like vape pens, pod systems, hookah sticks, and personal vaporizers, contains tobacco and harsh chemicals that may inflame the lungs and cause damage to blood vessels.

Last year, an outbreak of e-cigarette or vaping use-associated lung injury (EVALI) left patients, some of them young, with a severe respiratory illness that was fatal in some cases. That outbreak was linked to vitamin E acetate, an additive that had been used in some marijuana and nicotine vaping products. Users often got the tetrahydrocannabinol (THC)-containing products from friends, family, or in-person or online dealers. (Not all vaping cartridges have the harmful ingredient.)

Though the Trump administration originally threatened to ban all flavored vaping products, partly in an effort to keep young users from trying them once the outbreak occurred, it backed down from that decision and many remain on the market.

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The known and potential health hazards are great reasons for teens to consider quitting their e-cigarette habit, but the new coronavirus pandemic adds urgency to that equation. While it's not yet clear whether vaping increases a person's risk to contract the coronavirus, or puts them at higher risk for life-threatening complications, the virus tends to be more catastrophic for those with compromised heart and lung health.

Teens might think they're safe from this risk because COVID-19, the official term for the disease caused by the virus, disproportionately affects older people, but age might not exempt them from worrisome health issues. In a recent blog post, Nora Volkow, director of the National Institute on Drug Abuse, said COVID-19 could be an "especially serious threat" to those who smoke or vape marijuana or tobacco.

"Right now, if you need a reason to quit, look no farther than COVID-19," Walley said.

That's going to feel like an impossible challenge for many teens who are using e-cigarettes to cope with pandemic anxiety. Torn from their normal school routine and unable to spend time with friends in person, some teens may decide now is not the time to eliminate something that makes them happy.

The good news is they can start with small steps.

1. Work with a doctor or trusted adult.

Walley recommends working with their physician, a tobacco treatment specialist, or trained counselor. Those professionals can help them complete the brief "hooked on nicotine" checklist. The 10 questions are designed to help gauge how addicted a teen might be to nicotine. If a teen answers yes to any of the questions, it means they're showing signs of addiction, and it's time to make a plan to quit.

2. Get treatment.

Though treatments for quitting e-cigarettes haven't been studied widely amongst adolescents and teens, Walley said that counseling is recommended and that physicians have the option to prescribe nicotine replacement therapy for minors. A prescription is required because the Food and Drug Administration has yet to approve nicotine replacement therapies like gum, lozenges, and patches for those under 18 years old.

Those products contain much less nicotine than tobacco products and, when released in the body, don't produce the same quick high, which helps users manage cravings. While nicotine replacement therapy isn't always effective, research shows that it dramatically increases the likelihood of quitting.

3. Come up with a plan.

Walley recommends resources like SmokeFree Teen and 1-800-QUIT-NOW, both government smoking cessation initiatives, to help teens connect with free, confidential counseling and resources. The This is Quitting program, developed by the Truth Initiative, uses text messages to support teens trying to kick e-cigarettes.

The key, Walley said, is to talk to professionals with specific training, including tobacco treatment specialists, physicians, or counselors. They can discuss how to manage withdrawal symptoms, which include headaches, insomnia, and anxiety, and how to develop a strategy for dealing with triggers that make them reach for an e-cigarette, like social stress or academic pressure.

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4. Focus on your mental health.

Addressing underlying mental health conditions like depression or trauma is also critical since e-cigarette use can be a coping skill. Identifying supportive friends and family as well as self-care strategies, including exercise, healthy eating, and mindfulness or meditation, can help a teen stick with their plan to quit.

In general, people struggling with mental health challenges are more likely to smoke, and Walley said that may have to do with a "false sense" that it will keep uncomfortable feelings like anxiety at bay.

With the right tools, said Walley, teens can quit e-cigarettes, and there's no better reason than a pandemic to consider stopping right now.