Advocacy: Youth Vaping Prevention in the Time of COVID

Crystal Shen, MD, MPH, FAAP
Co-chair, WCAAP Legislative Committee

Reflecting back to this time last year in 2019, active investigation of cases of EVALI (e-cigarette or vaping product use-associated lung injury) was ongoing across the United States. Now, as the COVID-19 pandemic continues, youth vaping remains a relevant health issue. A recent study from Stanford shows that COVID-19 is associated with youth use of e-cigarettes as well as dual use of e-cigarettes and cigarettes. In the study, COVID-19 diagnosis was five times more likely among users of e-cigarettes only and seven times more likely among dual users than among those who use neither e-cigarettes or cigarettes.

infographic about the risk of vaping & COVID-19


This research is particularly concerning in light of the ongoing increase in youth vaping across the US as well as within Washington state. An August 2020 CDC MMWR article reports that in 2019, a total of 50.1% of US high school students had ever used electronic vapor products, while 32.6% were frequent users of vapor products, with significant increases in current vapor product use from 24.1% in 2015 to 32.7% in 2019. This concerning trend is reflected in Washington state data mentioned in this DOH new release which shows increasing youth vaping rates with nearly 30% of high school seniors in WA reporting use of vapor products.

Cases of EVALI have continued during the COVID pandemic. Eight COVID-negative patients in California were hospitalized with EVALI in April 2020, some requiring mechanical ventilation, as noted in this CDC report. There’s also concern that COVID infection could be worse in those who vape, as exposure to aerosols can harm lung cells and diminish their ability to respond to infection, which is detailed in a NIH – National Institute on Drug Abuse post.

What can pediatricians do?
It’s even more important now to screen youth for vaping and provide counseling and support for cessation. Some approaches include using motivational interviewing or using the 5A’s model (Ask, Advise, Assess, Assist, Arrange Follow Up). Helpful tools to assess youth nicotine dependence include the Hooked on Nicotine checklist, E-cigarette Dependence scale, and Modified Version of the Fagerstrom Tolerance Questionnaire (mFTQ). Consider starting nicotine replacement therapy for youth with more significant dependence (information and dosing recommendations from the AAP). Setting a quit date with teens may be helpful.

Washington state resources for vaping cessations also include:

The AAP continues to develop resources for pediatricians, with many available on the AAP Richmond Center site. The AAP also started an E-cigarette Chapter Champion program involving pediatricians across the US, collaborating to help stem the rise in youth vaping. As the Washington state E-cigarette Chapter Champion, I will continue to share information and resources for vaping prevention and cessation with WCAAP members.

Our WCAAP legislative committee work for vaping prevention advocacy also continues. Although encouraged by the passage of Tobacco 21 in our state in 2019 (went into effect January 2020), more policies to protect youth are needed. A federal flavor ban exists but is weakened by allowing menthol flavored products as well as allowing flavored disposable vapes and refillable e-cigarette pods, which does little to help prevent youth use. A stronger flavor ban did not pass in Washington state last legislative session, but advocacy for this continues.

Increased vape taxes to at least meet parity with cigarette taxes are also important for helping slow the rise of youth vaping. WCAAP has joined Vaping Prevention Stakeholder meetings with Representative Gerry Pollet and Senator Patty Kuderer which bring together representatives from various health and community organizations as well as others involved in vaping prevention work to discuss and propose legislative policies to address youth vaping. More work is in process, and progress in addressing the youth vaping epidemic is needed now more than ever in the time of COVID.

For any questions or for more information on vaping resources or advocacy, feel free to email me at

DOH infographic on COVID & Vaping:

Links for resources:

Stanford study:

CDC MMWR: icon

CDC report: icon

DOH news release:

NIH NIDA post:

DOH Vaping cessation resources:

AAP resources: