According to Curran et al. (2018) the highest risk of subsequent drug and alcohol use was in individuals who used both e-cigarettes and conventional cigarettes. The risk was moderate in conventional cigarette use alone, and lowest in sole e-cigarette use. These remained significant even after accounting for demographic differences and in children otherwise considered low risk for drug and alcohol use. Some research suggests that the initial trial of e-cigarettes is experimentation as part of the natural adolescent developmental stage.
However, this can also be a timeframe where addiction initiates. One study looking at individuals with addiction showed that most people suffering from addiction started before the age of 18 (Curren et al., 2018). Other research on adolescents and nicotine exposure shows that this population may be more sensitive to nicotine than adults, putting them at a higher chance of becoming dependent upon it (Johnson & Selekman, 2019).
A study by Simon et al. (2018), focused on socioeconomic status and its impact on e-cigarette use. Their study proposed that the rate of advertisements and exposure to e-cigarette products is higher in lower socioeconomic areas, therefore, influencing more adolescents to begin using them. The result of the study showed that there was a higher likelihood of e-cigarette use among adolescents of lower socioeconomic status and that there was a trend of future conventional cigarette use among this population.
Smoking and tobacco use can cause a myriad of health problems, with the severity of morbidity increasing with the length of time of exposure. Examples of some health problems are coronary disease, lung disease such as cancer and COPD, and compromise of the immune system. Even secondhand smoke can cause a large list of complications for both adults and children.
Adults exposed to secondhand smoke have a higher rate of stroke along with lung and cardiac disease. In children, secondhand smoke increases the risk of SIDs, ear infections, upper respiratory infections, and asthma (Centers for Disease Control and Prevention, 2020).
Experiementation and use of nicotine containing products can quickly turn into a dependence or addiction for adolescents. When this occurs, it puts their immediate and future health at risk. An easy, reliable, and valid screening tool to determine which adolescents may be suffering from, or at risk for, a substance use disorder is the CRAFFT tool.
This tool includes questions around six areas: Car, Relax, Alone, Forget, Friends, Trouble. Research that has compared the positive screening point of 2 points on the CRAFFT questionnaire to the criteria discussed in the DSM-V, showed it to be accurate in determining adolescents at risk for substance use disorder (Shenoi, R.P. et al., 2019). Although CRAFFT has been used mainly in clinical settings, it is a quick and easy tool available for school nurses to implement. When used correctly, it can screen for students in need of further evaluation and intervention to prevent future complications.
- Centers for Disease Control and Prevention. (2020, April 28). Smoking and tobacco use: Health effects. Retrieved from
- Curran, K.A., Pitt, P.D., & Middleman, A.B. (2018). Trends and substance use associations with e-cigarette use in US adolescents. Clinical Pediatrics, 57(10), 1191-1198. DOI: 10.1177/0009922818769405
- Johnson, K. & Selekman, J. (2019). Students engaging in high-risk behaviors. In J. Selekman, R. A. Shannon, & Yonkaitis, C.F. (Eds.), School nursing: A comprehensive text (3rd ed., pp. 603-626). F. A. Davis.
- Simon, P., Camenga, D.R., Morean, M.E., Kong, G., Bold, K.W., Cavallo, D.A., & Krishnan-Sarin, S. (2018). Socioeconomic status and adolescent e-cigarette use: The mediating role of e-cigarette advertisement exposure. Preventive Medicine, 112, 193-198.
- Shenoi, R.P., Linakis, J.G., Bromberg, J.R., Casper, T.C., Richards, R., Mello, M.J., Chun, T.H., & Spirito, A. (2019). Predictive validity of the CRAFFT for substance use disorder. Pediatrics, 144(2), 1-12. DOI: 10.1542/peds.2018-3415