Most teenagers who smoke e-cigarettes instead of traditional cigarettes are unaware that vaping exposes them to nicotine, a new study revealed.

Statistics from the U.S. Centers for Disease Control and Prevention have estimated that roughly 4.9 million American teens used e-cigarettes in 2018.

In a new report, while many teens admit they regularly use e-cigarettes, most of them swore they only vaped "nicotine-free" products. However, urine tests for a chemical that's a known marker for nicotine proved otherwise.

Teens Do Not Know E-cigarettes Expose Them To Nicotine

A team of researchers led by Dr. Rachel Boykan from Stony Brook University in New York found that about one in five high school students say they have used e-cigarettes at least once over the past month.

In just 2017 and 2018, the rate of teens that vape increased to 78 percent, researchers said.

To determine whether teens understand the "dangers" of vaping, Boykan and her colleagues asked 517 participants aged 12 to 21 to answer questionnaires regarding the use of e-cigarettes, traditional cigarettes, and marijuana.

The results of the survey were then compared against the results of urine tests that looked for traces of a chemical called cotinine.

Cotinine is a chemical that's known as a marker for presence of nicotine in a person's body. Boykan and her colleagues reported that urine tests for cotinine came up positive 40 percent of the time among the survey participants.

Majority of the survey participants were honest about their answers. Only about 2 percent of participants who said they did not smoke e-cigarettes, traditional cigarettes, or marijuana were actually found to have traces of nicotine, pot, or tobacco in their urine samples.

Researchers found a big discrepancy among young vapers. In fact, about four of every 10 teenagers who said they vaped non-nicotine e-cigarettes were found to have cotinine in their urine.

This lack of awareness occurred with the use of Juul vaping pods, researchers said. Such vaping pods apparently have the highest concentrations of nicotine to date, the study said.

What's more, Juul vaping pods have also become the most widely used products among teenagers, researchers said.

Stricter Regulations For E-cigarettes To Raise Awareness

Experts believe that because of the lack of awareness regarding nicotine in e-cigarettes, teens could potentially have more lifelong nicotine addictions since they believe vaping is more "harmless" compared to traditional smoking.

Patricia Folan, director of the Center for Tobacco Control at Northwell Health in New York, said other studies have shown that teens use e-cigarettes because they believe they are harmful than combustible cigarettes, without full knowledge of the actual contents of e-cigarettes.

"The risk for addiction is clear," Dr. Len Horovitz, a lung health specialist who was not involved in the study, said.

Horovitz explained that e-cigarettes deliver more nicotine because every "draw" yields nicotine. In comparison, traditional cigarettes burn down between puffs and deliver less nicotine.

Meanwhile, Folan said more must be done to alert teens to the dangers of e-cigarette smoking. Folan urged that there must be more regulation regarding e-cigarettes, including health warnings and labeling of ingredients.

Educating teens about the ingredients of vaping products may help them make more educated decisions, Folan added.

Details of the new study are available in the journal Pediatrics.

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