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During the past few years, the use of E-cigarette among youths and young adults has significantly increased, which has led to increased concerns regarding the health of the youths and young adults who are using vaping products. The increased use of vaping products by the youths and young adults has increased tobacco use since the vaping products contain nicotine, which is an addictive drug in tobacco. Generation Z is the youths and young adults who were born between the years 1997 and 2012, and they are considered to be the ones who have been greatly affected by the issues of vaping and the use of E-cigarettes. Most of these individuals are introduced to vaping products through the advertisement they see in electronic devices around them since they are active users of social media and smartphones that advertise the use of vaping products. As of 2019, national youth tobacco survey statistics show that E-cigarette products have doubled among the youths, especially among high school students, while it has tripped among the middle school students. Youth vaping has brought about addiction among generation Z, which is a threat that reduces the years of progress in reducing tobacco use among the youths. According to doctors, the use of nicotine by the youth in any form such as E-cigarettes is harmful to their health since it causes addiction as well as harms brain development, which affects their attention, learning, and memory or leads to increased risk of addiction to other drugs such as marijuana or tobacco (Dai & Siahpush, 2020). Since most of the E-cigarette products deliver huge doses of nicotine, they present youths at great risk of being addicted, and parents and teachers share the issues of youths who are suffering from nicotine addiction due to the use of E-cigarettes. To deal with the rising issue of youth vaping, most schools educate the youths on the negative effects of vaping while parents are encouraged to discourage their children from using E-cigarette products. This article provides a literature review of the rising issue of youth vaping and possible ways of resolving the dilemma of vaping.

Generation Z and their characteristics

Generation Z is also known by other names such as iGen, Homelanders, post-millennials, or centennials, and it refers to an individual born between 1996-2010 after the millennials. Singh & Dangmei (2016) suggest that this generation has been brought up in an environment where they can access the internet, social media, and digital technology. Due to the exposure to a different environment, this generation is significantly different from the silent generation, baby boomers, generation X, and the millennials. For instance, the environment within which they grow up has more technological advancement than the rest of the previous generation. Pew Research Center (2020) adds that other factors such as political, economic, and social differences also play a significant part in defining the character and life experience of generation Z compared to the later, Millennials generation. For example, earlier political factors such as the 9/11 terrorist attack are well comprehended by the Millennials generation, while generations Z may not remember the incident.

Moreover, in terms of race and ethical diversity, generation Z is more diverse compared to millennials. Pew Research Center (2020) suggests that generation Z is global, social, visual, connected, educated, and technologically based. They also form the highest percentage of the current young adult, youths, teens, and tweens populations. Globally, they comprise about 2 billion people who form a significant segment of early adopters, social media drivers, pop-culture leaders, and brand influencers. This means that this generation has a significant potential to create and represent the future (Singh & Dangmei, 2016). Pew Research Center (2020) adds that most generation Z individuals spend most of their young and youthful period in an environment with crisis events such as terrorism, global economic recession, pandemic outbreak, climate change, and rapid technological advancement. Typically, this is the current teenagers and young adults in universities, new employees, and tomorrow's new consumer (Seemiller & Grace, 2016). It is also essential to note that despite the influence of the environment they grew up in, this generation is also influenced by the previous generations' factors. For instance, the Pew Research Center (2020) suggests that the baby boomers grew up during the television expansion period, influencing their connectivity and lifestyles globally. Generation X that followed grew up during the computer revolution era, and the millennial generation is raised during the internet explosion era. These factors are influence the current generation Z because there are still present and more advanced than ever.

Youth Vaping Statistics

The popularity of vaping is currently on the rise, with the present statistics showing the different numbers of vaping in different areas, such as its popularity, vaping statistics worldwide, statistics in the U.S., and age and youth vaping statistics. According to King, Jones, Baldwin & Briss, 2020, nine percent of American young adults have confessed to occasional or regular use of vape while almost 27.5% of United States high school students are active vaping products of 2019. This survey shows that more than five million American high and middle school students were involved in using vaping products in their past 30 days. Moreover, the statistics also show that almost 1 million youths who are vape users use the products on a daily basis, while almost 1.6 million use vaping products more than 20 times in a single month. From the year 2011 to 2019 the use of E-cigarette among the youths have risen by an 1800% in which two-third of this young users are youths between the age of 15 to 21 years who do not understand that the vaping products contain nicotine.

Stalgaitis, Djakarta & Jordan, 2020 suggest that the significant increase in the use of E-cigarettes products among youths and young adults has brought about an overall rise in tobacco product use with a 38% rise among high school students and 29% among middle school students from 2017 to 2019. The highly addictive nicotine in most of the E-cigarette products has greatly contributed to the increased rise in the use of these products by middle and high school students. Of all the current E-cigarette users, more than 82% of the user prefer flavored E-cigarette, which there are 84% of high school users and 73.9% of middle school users. Miech, Patrick, O'Malley, & Johnston, 2017 adds that 61% of the youths and teenagers who are vapers did it to experiment where 42% were experimenting the different flavors such as candy and mint of E-cigarette, 38% wanted to have a good time while 37% wanted to feel good and relieve tension. This research also estimates that one in five high school students, as well as one in twenty middle school students, are current users of E-cigarette.

Public Health Campaign and policy

Generally, health campaigns are programs designed to increase public awareness about health threats and promote a proactive measure that enhances public health and individual wellbeing. Shaleh, R. I. (2020) suggest that the public health campaigns involve a wide set of communication and interaction strategies applied by healthcare promotion specialists to spread persuasive messages to a particular target audience and help them establish health live. On the other hand, health policy refers to decisions, plans, measures, and actions initiated to achieve particular health goals in society. Van de Goor et al. (2017) suggest that a public health policy allows a nation to establish tools that support the public from health threats by preventing diseases and promoting a healthy population. Based on these two programs, public health campaigns and health policy can significantly help prevent youth vaping and enhance public health threats awareness associated with e-cigarette among the current generation Z teen, youths, and young adults. The FDA (2020) states that from 2014 to 2016, the FDA's media campaign based on real cost theme (every cigarette cost you something) prevented more than 587,000 youth from starting smoking/vaping globally.

Nonetheless, the mortality rate is still high among different nations. For example, America still has more than 480,000 deaths, and smoking health issues cost the country nearly $300 billion annually. It is also apparent that most individual starts smoking in their young or youthful age. FDA (2020) suggests that about 90% of adult smokers start smoking by the age of 18, and more than 950 male youth use e-cigarette for the first time smoking experience. The objective of the real cost campaign is to reduce and prevent smoking among USA adolescents. It focuses on convincing youth not to smoke, and therefore it should be an ongoing approach that reduces the percentage of teens and youths currently using an e-cigarette. FDA (2020) suggest that recently in 2017, about 2.1 million students reported to use e-cigarette and projection indicate potential higher rate in the future. This implies that immediate action should be in place to address and prevent this issue. With that in mind, FDA (2020) suggest that there are different advertising and prevention measures (television ads, online video ads, youth-based real cost campaign programs, social media and learning institutions poster) that are delivered to warn young adults/youth about the risk for addiction and health disorders associated with an e-cigarette. These measures will promote the American Lung Association policy-support objective and vision for developing/advocating for a world (future for generation Z) free from lung diseases (American Lung Association, 2020).

Role of advertising E-cigarettes

Advertisements aim to deliver the right designed message to a targeted audience group with common characteristics by making unified communication regarding the issue that is important to all members of the group. Yule & Tinson, 2016 suggests that the E-cigarette products industry focuses on the psychographic aspect to present various products and brands when targeting youths and teenagers. The strategy of targeting tobacco interventions and using peer crowd messages has been confirmed to be effective. This is because to make the advertisement even more successful, and the companies align themselves with fashionables, celebrities, and youthful places where youths carry out their activities to make the products appealing to the youths. Through the internet and social media, where most of generation Z exists, the companies can display attractive promotion prices and compete through group discount vouchers to attract more young people and be able to communicate directly with the audience.

McCausland et al. 2020 add that the advertisement of tobacco products can motivate the youths to use tobacco products, which has led to an increase in E-cigarettes' advertisement. More than 69%of high and middle school students get exposed to advertisements of E-cigarettes through the internet, in retail stores, in movies, or through magazines and newspapers which advertise different types of E-cigarette products. Many different types of vapes brands, such as Juul or RJ Reynolds, leverage different advertising strategies to create and introduce vaping products in their market. Some of the current brands have even introduced the addition of fruit flavors in their products to attract more customers and dominate the markets.

Significant Vaping case

Since the E-cigarette was introduced in the United States, several cases have been published that discuss lung diseases related to nicotine vaping or extracts of marijuana. According to Sisson, 2020, from 2019, there has been an increased number of induced lung injury cases due to vaping, which led to increased mortality and morbidity that captured the national attention of the use of vaping E-cigarette products. Although E-cigarette was created as a safer alternative for individuals to quit traditional cigarette smoking, the current research shows there is pulmonary toxicity present in E-cigarette vapor, which is made up of flavored fluids, heavy metals, and aerosolized nicotine, among other additives that are volatile compounds. According to the article, one of the most recent cases involving vaping is the mysterious lung illness, where there were more than 450 possible cases in more than 33 states, including five deaths. According to health officials and physicians, the largest and earliest number of cases that had been published, they offered detailed descriptions of lung disorders for individuals who were vaping in a number of the article in the journal of medicine.

Though the state officials suggested that the cause of the diseases was not known, the illness severity and the increase in a number of cases of the clinical syndrome shows that the case present new challenging pulmonary diseases which are related to vaping as reported by the health department officials who carried out an investigation on 53 patients. The food and drug administration suggested that the patient's test's findings showed the presence of vitamin E acetate, an oil extracted from vitamin E in marijuana products sample collected from the patients who had become ill due to vaping. According to research by the physicians and doctors, when the chemical in vape liquid are heated, they undergo a thermal degradation where they produce new compounds which have possible harmful consequences on the patient which lead to various pulmonary illnesses such as lipoid pneumonia, which results in lungs injury (Messina, Levin, Conrad & Bidiwala, 2020).

Advantages and disadvantages of vaping

There is a lot of research which have been carried out regarding the advantages and disadvantages of youth vaping. Dobbs, Clawson, Gowin & Cheney, 2020 found out that one of the advantages of vaping is that it is 95% safer compared to smoking since it does not involve combustion, there is no tar in vaping products and switching from smoking enables one to have health benefits of being smoke-free. This enables smokers to have better skin health, lung capacity, oral hygiene, and sense of smell and taste. It is also suggested that one was becoming a vapor assist in regulating the nicotine intake since through vaping, one is able to control the nicotine dose in their vape. This because there are various strengths available, starting from nicotine-free to vape containing high strengths of nicotine, which enables the users to choose the amount of nicotine present in their vape. Another major advantage of vaping is that it has instant satisfaction since it has a quick effect that easily silences one's craving. All types of vapes have a battery that can sustain the device throughout the day without the need for maintenance or upkeep.

Despite the advantages, vaping also has some disadvantages. Some of the disadvantages have been provided by Seiler-Ramadas, Sandner, Haider, et al., who suggested that vaping has a youthful perception. Depending on an individual's region, there are regulations that control the legal age of buying vape to be 18 or 21 years old due to the establishment of the Tobacco 21 laws. Moreover, most of the vapors are individuals who are between the age of 18 and 29 years, which has created the perception that vaping is for the youth through some of the adults above the age of 29 are also active vapors. It is also suggested that cumulative cost is also a disadvantage of vaping. This is because, like most of the consumable products, vape needs to be purchased repeatedly since the liquid has to be replenished. There are different prices for E-liquids depending on their quantity and quality or brand since some of them replenish faster than others. The continuous consumption of vape leads to the addition of cost while buying the liquid and different flavors.

Resolving the issue of youth vaping

Some of the issues that have been brought about by youth vaping are the increased severe lung and heart disease, the development of nicotine addiction, which affects brain development, and the youths are exposed to harmful substances such as heavy metals. Hammond, Reid, Burkhalter & Rynard, 2020suggests that some of the strategies that have been in place to deal with the issue of youth vaping include requiring teachers to try and discourage the student from using or getting engaged in the use of vape in schools. Despite this, there are also other strategies that have been implemented to resolve the issue of youth vaping, such as the ban of flavored E-cigarettes, increasing the minimum age of buying E-cigarette from the age of 18 years to 21 years, and restricting the online sales to E-cigarette products. Some of the vaping companies have resisted the ban of flavored vape though they are under investigation to prove that they advertised vape products that were harmful than cigarettes. In some of the schools, they have addressed youth vaping by providing mental health services and guiding their students away from being socially influenced to start vaping. The schools are also getting the students to be involved or create anti-vaping campaigns that offer peer to peer education and counseling. There is a collaboration among state, local and federal action to create a Youth tobacco prevention plan to initiate ways to restrict the youths from accessing vaping products, educate the youths, and deal with the teenage focused marketing strategy (Gartner, 2018).

The possible outcome for resolving vaping issues

According to Essa et al. 2020, the ban on the sale of flavored vaping products will have a significant effect on vaping companies since they have employees starting from small shops to well-established hardware designers. Eliminating the legal sales of flavored vaping products will lead to the establishment of a huge black market for E-cigarettes, which will be very harmful to the youths since they find themselves vaping from devices with cheaper substances. Moreover, the author adds that changing the age limit from 18 years to 21 years may not work to prevent most youths from accessing the E-cigarettes since most of the youths suggest that the first time they accessed a vape, they were at the age of thirteen. A high number of youths with E-cigarette products have confessed to buying the products from individuals they were living with rather than from shops, which shows that raising the age limit will not affect the issue.

Application of state and local action to eliminate the rising issue of youth vaping will lead to an increased burden on state government, local schools, and boards of education to deal with the issue of youth vaping. But despite this, most of these localities have already applied strategies to deal with vaping, such as banning vaping on school grounds; there are several states that have enacted the ban of flavored vaping products while others have raised the age limits to 21. There has been an installment of traditional strategies to monitor washrooms and hallways to confiscate vaping tools and offer on-site counseling on active vapers. Providing mental health services in schools to guide students away from being encouraged to use vaping products can be one of the most effective strategies since students get to understand these products' health dangers. The community has been able to collaborate to prevent and eliminate the issue of youth vaping. Most of the youths are encouraged to use vaping products in the community, which will be eliminated.

Discussion

Generation Z is individuals who have grown up in an environment where they can access the internet, social media, and digital technology, which makes them vulnerable to be exposed to youth vaping products. This is because most of the advertisements of youth vaping products are carried out on digital media such as social media, the internet, and televisions, and they are mostly focused on enticing the youth to use the products. By conducting the literature review, I was able to access the statistics of youth vaping, which showed that 27.5% of United States youths are active vape products. The statistics showed that more than five million American high and middle school students were involved in using vaping products where more than 1 million of the youth are an active user of vape while almost 1.6 million of the youths use vape more than 20 times in one month. The main reason for carrying out public health campaigns and health policy is to assist in reducing or prevent youth vaping, thus improving public health threat awareness. It focuses on convincing youth not to smoke, and therefore it should be an ongoing approach that reduces the percentage of teens and youths currently using an e-cigarette. When it comes to advertisement, advertising's main role is to encourage and motivate the youths to use the different types of vaping products such as the Juul and the RJ Reynolds, among others.

Conclusion

In conclusion, we can say that the best way to deal with the rising issue of youth vaping is to get every individual to be involved in eliminating the use of vape through educating ourselves about the effects of E-cigarettes. It is essential that community centers and schools or areas where youths get together to have tobacco-free policies to prevent this issue. Those who are users of vape or tobacco products should have a commitment to quitting since the youth are motivated to use the product if those around them are users.

References