Cigarettes: concerns over vaping amongst young people. Paediatricians: screening should begin as early as age 11

According to the latest figures from the Italian National Institute of Health, more than one in three pupils aged between 14 and 17 (37.1 per cent, around 851,000 young people) have used at least one product containing tobacco or nicotine in the last month. From e-cigarettes to pod mods, the rise of e-smoking is creating a generation of teenagers who become addicted to nicotine, often before they even realise they are regular smokers or vapers. The alarm has been raised by the Italian Society for Paediatric Respiratory Diseases (Simri).

According to experts at Simri, developing an addiction is easier than one might think. In adolescents, the first signs can appear even in those who smoke as few as two cigarettes a week. Young people, in fact, are particularly vulnerable because their brains – which are still maturing – are more sensitive to the effects of nicotine. As explained by Maria Elisa Di Cicco, a paediatrician and researcher at the University of Pisa and coordinator of the editorial board of *Pneumologia Pediatrica*, ‘in adolescents, addiction can take on different characteristics compared to adults’. In fact, their use is often ‘intermittent, social, and increasingly linked to electronic devices and flavoured products’. This increases the risk of developing a genuine ‘masked addiction’. Even seemingly modest amounts of nicotine, warns Di Cicco, can quickly make it difficult to quit, causing withdrawal symptoms and problems with concentration or mood: ‘In short, low consumption does not necessarily mean reduced dependence.’

The emergence of a wide range of new products has further complicated an already critical situation. E-cigarettes, pod mods, heated tobacco products and nicotine pouches have proved hugely popular amongst young people, resulting in a proliferation of ways in which teenagers can come into contact with nicotine. “We are facing a veritable epidemic of new products amongst young people,” says Michele Ghezzi, a paediatric pulmonologist at the Buzzi Children’s Hospital in Milan. The biggest problem is that these new-generation devices “are often perceived as a less risky alternative to traditional cigarettes, whilst they expose young people to nicotine and substances capable of damaging the respiratory tract” and, above all, “make it very easy to consume nicotine: the nicotine salts found in pod mods, for example, do not irritate the mucous membranes and make it easier to inhale large quantities of the substance quickly’. Some pod mods, for example, can in fact deliver 15–30 mg of nicotine per pod, an amount equivalent to that contained in approximately 13–30 traditional cigarettes.

The problem, however, is not limited to addiction. SIMRI warns that exposure to vaping is associated with inflammation of the airways, bronchial hyperreactivity, reduced defences against respiratory infections, coughing, shortness of breath and asthma exacerbations, but also to more serious acute conditions such as EVALI, a form of chemical pneumonia specifically linked to the use of e-cigarettes and vaping products.

Faced with the proliferation of new products, doctors have had to adapt their screening practices to meet these new needs. The recommendation made by SIMRI and SIP – the Italian Paediatric Society – to paediatricians is to screen for nicotine use from the age of 11 onwards. It is also necessary to ask adolescents not only whether they use traditional cigarettes, but also whether they vape or use other products. It is not enough, therefore, simply to know whether a teenager smokes: it is necessary to understand what they are using, how often, and whether the first signs of addiction have already appeared. The real challenge, therefore, according to experts, is no longer simply to prevent young people from taking up vaping. The aim is to recognise an addiction at an early stage – one that may already be present even when teenagers do not yet see themselves as smokers – so that they can be helped to break the habit in time.