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In adolescents, cases of e-cigarette- or vaping-associated lung injury (EVALI) were "a drop in the bucket" compared with COVID-19 cases, a researcher said.

Yet vaping remains a significant health risk for teens, reported Anne Griffiths, MD, of the Children's Hospital of Minnesota, during her presentation entitled "Updates on Youth Vaping" at the American Academy of Pediatrics virtual meeting.

According to the , 11.3% (1.72 million) of high school students and 2.8% (320,000) of middle school students reported using e-cigarettes in the past 30 days.

More than half of youths who vape said they have tried to stop before. That is where pediatricians can intervene, Griffiths said.

Middle school students often start with zero-nicotine, flavor-only products before "they move on to a nicotine-based product and ultimately a THC-based product," Griffiths noted. Of the middle and high school students who vape, . Fruit, candy, and other sweet flavors were the most popular among students.

Of note, disposable e-cigarettes beat out refillable pods and cartridges to become the most popular device of choice this year, with 53.7% of all students who vape reporting use of these products. The increase in disposable usage can largely be attributed to recommendations not to share vape products to reduce the spread of COVID-19, Griffiths said.

Vaping appears to be a risk factor for COVID-19, as it is five times more likely to be diagnosed in adolescents who vape, according to a study published in the .

Previous studies have demonstrated that the . Studies have also shown that e-cigarette vapor may . ACE2 is the receptor that enables entry of SARS-CoV-2 into host cells.

There are methods to differentiate between adolescents presenting with EVALI or COVID-19 (or both), Griffiths said. She noted that the patient's reaction to steroid treatment can be diagnostic: "Unlike SARS-CoV-2 where the [patient's] improvement might be subtle [with a] gradual response to steroids, in EVALI, one day on high-dose steroids and they feel like a million bucks in comparison."

In addition, EVALI may present with leukocytosis and high erythrocyte sedimentation rates and C-reactive protein levels, while COVID patients are more likely to have lymphopenia.

Despite the risks of vaping, "there's an entire culture surrounding [kids] that can glamorize vaping life," Griffiths noted.

Vape championships featured on YouTube, in which competitors perform various smoke tricks, are one method vape companies use to reach out to children. By offering prizes to those who can do the best tricks, they "gamify" vaping, explained Griffiths.

Vape companies also provide ranging from $300 to $5,000 to students. These scholarships often require essays that ask the students to write about the benefits of vaping.

Griffiths highlighted the work of a fellow Minnesota doctor, with 80,000 followers who publicizes the health risks related to vaping. However, Leslie is in the minority on TikTok. According to one study, 63% of TikToks painted vaping in a positive light, while only 13% were negative.

The CDC began tracking EVALI cases in August 2019, and as of February 2020, 2,807 EVALI cases and 68 deaths have been .

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