“I wouldn’t smoke, it’s just nasty. Vaping isn’t as big of a deal though.”

This seems to sum up the trend among adolescents today. Fewer teens are lighting up traditional cigarettes while e-cigarettes are exploding onto the scene. This is refocusing our attention on the impact of nicotine on the teenage brain.

Let’s start with a history lesson.

We’ve known since the tobacco lawsuits in the mid-1990s that tobacco companies historically targeted children and teens in their promotion efforts. Though they didn’t know the brain science then they did know the statistics. Their market research showed that if young people turned eighteen without smoking, the odds were five to one that they never would. Most habitual smokers began to smoke when they were teenagers.

Now we have a much better understanding of why Big Tobacco would lose lifelong customers if they didn’t get them hooked during high school. It turns out that nicotine has a triple whammy effect on teens:

1. It increases the neurotransmitter dopamine, which I call “happy” since it makes us feel good.
2. It increases the number of nicotine receptors in the brain;
3. It affects the mix of neurotransmitters.

Let’s explore each of these a bit more. Similar to alcohol, nicotine affects the adolescent brain differently than it affects an adult’s. Because the brain is under-construction, it is more sensitive to the potent chemicals contained in cigarettes. Nicotine, for example, impacts almost two-dozen neurotransmitters, which are the “molecules of emotion” inside our brains. Notably it is very effective at elevating the neurotransmitter dopamine which provides pleasure. When young people smoke, their growing brains also change in response by quickly increasing the number of nicotine receptors in key regions of the brain. Every time a young person lights up, the brain extends its desire for more nicotine by creating more of these “docking stations.” When the “docking stations” are plugged with nicotine the dopamine level remains high. However, when the increased number of nicotine receptors are not “plugged” the dopamine level drops leaving the smoker feeling lousy. The way to feel good again is to add more nicotine. Craving more nicotine quickly follows. The adult brain, on the other hand, has a fairly fixed set of nicotine receptors, which buffers it from rapidly extending the brain’s desire for more nicotine.

Nicotine and a brain under construction

Given that the prefrontal cortex is still under construction during adolescence, there is some emerging evidence that nicotine may interfere with cognitive development, executive functioning, and inhibitory control. These effects are strongest when smoking begins earlier in the teen years.

The good news is that tobacco is the only drug for which usage by teens has decreased dramatically. Between 2000 to 2011, the percentage of high school students who smoke dropped from 27.9% to 15.8%. The drop is due, in large part, to successful advertising campaigns funded by the tobacco settlements. Unfortunately, e-cigarettes are quickly taking the place of traditional cigarettes among middle and high school students. E-cigs are battery-operated devices that contain a nicotine filled cartridge along with other chemicals that are turned into vapors and inhaled by the user. Use of e-cigs tripled among middle school and high school in 2014.

There is intense debate about the health impacts of “vaping” and currently e-cigs aren’t regulated by the FDA (yet). While e-cig vapors are purportedly less harmful than the smoke of burned tobacco leaves and the industry argues that use of the devices is driving down the rate of regular cigarette use, many worry that they are simply hooking a new generation on nicotine. It doesn’t help that e-cigs are marketed using many of the tactics of Big Tobacco in the 1950s including thousands of unique flavors (including “Swedish Fish” and “Graham Cracker”), free samples, and aggressive marketing to youth.

The debate will continue on as the FDA considers regulatory measures on e-cigarettes. In the meantime, start talking to your kids now about nicotine and the brain:

Tips:

• Talk about the brain. In addition to the health risks associated with smoking, share information with your kids about the impact of nicotine on the teenage brain and addiction.
• Make it clear that you do not want your children to smoke cigarettes or e-cigarettes. Be honest, clear, and consistent with your message.
• Media literacy matters. Smoking continues to be glamorized in movies and on TV. E-cigs are presented as “cool,” harmless, and tasty. Talk about these manipulative marketing strategies and have conversations early and often about the “myths vs. realities” of nicotine consumption in real life.
• Start early. Many kids start experimenting with nicotine as early as eleven years old. Don’t wait until high school to talk about the risks.
• Create a smoke free home. Don’t allow anyone to smoke indoors, including any current smokers.
• Role play strategies for refusing a cigarette or e-cig.
• Listen first. If you catch your child smoking, first try to understand why he or she decided to try it. Was it to fit in with friends? Gain a sense of calm? Get your attention?