The Great American Smokeout this Thursday, Nov. 15, was a great excuse for parents to talk to their kids about e-cigarette use, or vaping. Traditionally the focus has been on kicking the traditional, combustible cigarette habit. But now, with the increasing use and popularity of vaping, with devices like Juul that may not be recognizable as a smoking device and with flavors like cinnamon and cherry that seem consumer-friendly, it is important for people of all ages to talk about the real risks of vaping.

I remember seeing my first Juul device not long ago when a teenage patient showed it to me. It was during a routine check-up and the conversation had started with tobacco use. The 16-year-old said to me, “I’m a non-smoker — I vape a little, but I’m a non-smoker.” So out of his backpack, he happily pulled out this device that looked like a USB drive, and he talked about how all his friends vaped and that he had his favorite flavors.

I said, “OK, let’s talk about this. What do you know about vaping?” He was certain that all that was in it was the flavor, and maybe a little nicotine. So we brought up a website that listed 65 or so chemicals that were either in the product or formed during the vaporizing process. Some of them are known carcinogens. I cannot say that I convinced him of the health risks, but I at least tried to educate him.

The e-cigarette is helping to re-normalize nicotine use. And that is a problem because, unfortunately, it may undo decades of public health progress. There have been some studies showing success in adults who are weaning themselves off of combustible cigarettes by using e-cigarettes. So maybe the teen or adolescent population is hearing parents or grandparents saying, “Oh, my doctor told me to switch to e-cigarettes, and I’m not smoking anymore.” The predominant message that seems to be out there now is that vaping is safe. And it’s the opposite of safe. Vaporized nicotine and flavors may have fewer chemicals, but they are chemicals nonetheless.

And then there’s the issue of nicotine. I come from a strong background in addiction medicine. Nicotine is addictive, and it is not a good thing for an adolescent, developing brain. It can negatively impact brain development, making it more difficult to concentrate, learn and control impulses. And, there is mounting evidence that nicotine primes the brain for addiction to other substances; it can lead to other drug use down the road.

With my teen or pre-teen patients — even as young as 11 or 12 years old — I always open up with the question, “What do you know about vaping?” Often, the parents do not know much or anything about e-cigarettes, so it is important they educate themselves first. It’s understandable. This is something new that we parents simply had no exposure to when we were growing up.

As for the kids, after about age 14, I talk to them without parents in the room, and they are pretty forthcoming. They will tell you that they have friends that vape, or have tried it. Typically, young people are already well-versed in the harms of combustible cigarettes, so that’s an easier conversation for a physician to have. But with vaping, I have to start more at the beginning with questions like, “Did you know that there are these harmful chemicals in them? Did you know that e-cigarettes are not regulated the same way regular tobacco products are? How do you feel about something being marketed to you as a kid without regard for your health?” Kids are pretty thoughtful and generally have negative opinions of that.

I have three kids of my own, including a 10-year-old. She and her friends are on YouTube a good amount, watching videos made by “influencers” who may be selling or normalizing all kinds of products. My own daughter is fascinated by that world — all young people are, it seems. And they know way more than we think they know. So my advice to even parents of pre-teens is to start the discussion about the risks of vaping. There is not a wrong time to bring it up.

Gregory Maddox, MD, is a primary care physician with Overlake Medical Clinics.