Toxic substances

Smoking and Vaping

Addiction to nicotine is the most common addiction in the United States. It is estimated that 90% of those who smoked began by the age of 18. Regardless if it is electronic or in the form of cigarettes, the use of tobacco products is detrimental to the health of adolescents. Vaping is much more popular than smoking nowadays in teenagers, mainly because of its several flavors and relatively low costs. Educating teens about the risks associated with smoking and vaping helps avoid starting this habit in the first place.

Facts on Smoking

  • Smoking contains nicotine, a highly addictive substance, and carcinogenic substances such as arsenic.

  • Each year, there are 480,000 deaths in the United States due to cigarette smoking.

  • The use of tobacco is one of the leading causes of preventable disease, disability, and death in the United States.

  • Each day, around 1,600 minors smoke for the first time.

  • Approximately 16 million people live with diseases caused by smoking.

  • 1 out of 13 children will die prematurely because of smoking-related diseases if smoking continues at its current rate.

Smoking Complications

  • Cancer

  • Cardiovascular disease

  • Stroke

  • Lung diseases

  • Diabetes

  • Reduced fertility in men and women

  • Pregnancy and birth-related complications

  • Osteopenia/osteoporosis

  • Rheumatoid arthritis

  • Cataracts

  • Macular degeneration

  • Immune system disorders

  • Increased risk of tuberculosis

Facts on Vaping

  • Around 99% of e-cigarettes sold in the U.S. contain nicotine

  • In 2020, 3.6 million middle and high school students were using e-cigarettes in the U.S.

  • E-cigarettes are appealing to youth because they come in various flavors, are less expensive, and there is a misconception that they are harmless

Vaping Complications

  • Most e-cigarettes contain high levels of nicotine, which causes:

    • Brain damage (can affect attention, learning, mood, and impulse control)

    • Increased risk for future addiction to other drugs

  • E-cigarette product use-associated lung injury (EVALI)- a life threatening lung injury

  • Fire and explosion causing serious injuries

  • Life-threatening poisons by swallowing, breathing, or through direct contact with the skin or eyes

Asking the Experts

Interview with:

Nydia Martinez, MD, FCCP

Associate Director of Advanced Lung Disease Program

Department of Pulmonary and Critical Care Medicine

Cleveland Clinic Florida

Q: It is well established that smoking has deleterious effects. Why do you think some teens are still starting this habit and what can be the effects in this age group?

A: There are multiple reasons that explain smoking in teens:

  • Teenagers may be particularly susceptible to marketing campaings that specifically target their population: Tobbaco companies, Vaping and cannabinoid industries have use media, and film industry to portray smoking habits as cool, fun, attractive.

  • They usually try smoking simply because they like to try new things, but they aren’t mature enough to think of the long-term consequences.

  • Nicotine and cannabinoids may relieve stress and teenagers underestimate the highly addicting potential of those substances.

  • Once teenagers become smokers, they encourage their friends to try cigarettes.

  • They may see smoking as a way of going against the rules and showing independence

Q: Vaping has become popular among teens and many see it as a healthily alternative to smoking. What is your opinion regarding the effect of vaping in teens?

A: Vaping in teenagers is a major public health concern. It started as an alternative to help smokers quit but this was never proven. But the e-cigarette industry realized the lack of regulations directed to them, and the profits generated by their addictive potential, they have used unstoppable marketing strategies, starting with artificial flavors specifically made to attract young population. People in general believe that it is a "healthier alternative" but it isn't. We just don't have robust scientific data because they are newer, but we already are well aware of the toxicity. I personally have had very young patients in the ICU with respiratory failure secondary to vaping lung injury. Some ingredients found in e-cigarettes produce direct toxicity: i.e. propylene glycol, vegetable glycerin and acrolein.


A very serious problem that our nation's health is facing is underage drinking. The most commonly used substance among young Americans is alcohol, which poses serious consequences to not only the people that drink, but the rest of the population. Underage drinking is when people below the nationally established legal drinking age of 21 drink alcoholic beverages. Peer pressure, the desire for independence, and stress are some of the many factors that contribute to underage drinking.

Facts on Alcohol

  • Excessive alcohol use causes approximately 95,000 deaths each year in the United States.

  • In 2019, 29% of high school students were drinking alcohol, 5% drove after drinking, and 17% rode with drivers that have been drinking.

  • Drinking early in life is related to excessive drinking in later years.

  • 210,000 years of potential life are lost by underage drinking each year.

Signs of Underage Drinking

  • Changes in mood

  • Academic problems in school

  • Problems with coordination

  • Declining interest in activities or hygiene

  • Concentration problems

  • Low energy

  • Changes in sleeping pattern

Underage Drinking Complications

  • Problems at school

  • Social problems

  • Legal problems

  • Effects on health

    • Memory loss

    • Brain development disruption

    • Alcohol poisoning

    • Affected growth and development

  • Physical and sexual violence

  • Unwanted/unprotected sexual activity

  • Risk of suicide and homicide

  • Increased risk of usage of other drugs

Other Drugs

High-risk drug use is drug use by adolescents that can lead to injury, crime, school dropout, and death. Curiosity, peer pressure, emotional struggles, and stress are some of the reasons why teens start using drugs. Recognizing what drug use entails can prevent these problems from arising.

Facts on Teen Drug Abuse

  • 6% of 12th graders smoke marijuana every day.

  • About half of high-schoolers have ever tried marijuana.

  • 20% of twelve graders used prescription medicine without a prescription.

  • 15% of high schoolers reported having ever used illegal drugs.

Illicit Drugs

    • Cocaine

    • Heroin

    • LSD

    • Marijuana

    • MDMA

    • Methamphetamine

    • Mushroom

    • K2 or spice

Prescription Drugs

    • Sedating medications

      • Sleep medications

      • Anxiety medications

      • Some seizure medications

    • Opioids (controlled pain medications like morphine and oxycodone)

    • Over- the-counter medicines

      • Dextromethorphan

      • Loperamide

      • Pseudoephedrine

    • Stimulants

      • Amphetamines

      • Methylphenidate


The legalization of recreational marijuana in some states has led to an increase in use, especially in teenagers. Easier access to marijuana products and the misconception that it is safe to use have also contributed to this. Nevertheless, there is evidence that marijuana leads to several complications, including hallucinations, delusions, schizophrenia, depression, suicidal behavior, increased risk of bronchitis, and other lung damage. Marijuana can also affect brain development in individuals younger than 25.

Signs of Teen Drug Abuse

  • Secretive behavior

  • Unusual tiredness

  • Poor hygiene

  • Frequent hunger

  • Laughing for no reason

  • Bloodshot eyes

  • Loss of interest

  • Academic problems

  • Avoidance of eye contact

Teen Drug Abuse Complications

  • Legal problems

  • Brain development disorder

  • Mood disorder

  • Future financial problems

  • Increased risk of STDs (including HIV and hepatitis B and C)

  • Birth defects in pregnant teens

  • Unintended pregnancy

  • Violence

  • Death from overdose

Asking the Experts

Interview with:

Darby Sider, M.D., F.A.C.P, F.A.A.P

Vice-Chair of Internal Medicine

Program Director

Internal Medicine Residency

Graduate Medical Education

Q: Is abuse of controlled prescription medications a problem in teenagers?

A: Yes, teens are finding prescriptions in their parents medicine cabinets and are taking them and then developing substance use disorder. Prescription drug abuse is the fasting growing drug problem in the US. According to National Survey on Drug Use and Health (NSDUH) data on youth and young adults, more than 5,700 youth in 2014 reported using prescription pain relievers without a doctor’s guidance for the first time. The majority of adults who meet the criteria for having a substance use disorder started using substances during their teen and young adult years. Youth with substance use disorders also experience higher rates of physical and mental illnesses, diminished overall health and well-being, and potential progression to addiction.

15% of high school students reported having ever used select illicit or injection drugs (i.e. cocaine, inhalants, heroin, methamphetamines, hallucinogens, or ecstasy

  • 14% of students reported misusing prescription opioids.

  • Injection drug use places youth at direct risk for HIV, and drug use broadly places youth at risk of overdose.2

  • Youth opioid use is directly linked to sexual risk behaviors.

  • Students who report ever using prescription drugs without a doctor’s prescription are more likely than other students to have been the victim of physical or sexual dating violence.

  • Drug use is associated with sexual risk behavior, experience of violence, and mental health and suicide risks.

Q: What is your opinion regarding the use of marijuana in teenagers?

A: Fortunately, the rate of use of marijuana is declining in teens. Teens don’t believe that marijuana is harmful when in fact research shows the effect on the adolescent brain is much more harmful than on an adult brain.