Hektoen International

A Journal of Medical Humanities

Self-regulation in peril

Yasmina Rebani-Lee
New York, New York, United States

Photo by Nathan Salt on Pexels 

One day on my walk home, I began to tally up the number of vapor shops, or vape shops, I came across. To my dismay, I found that four of these shops had sprouted within a five-block radius, practically the equivalent of one on each block. I began to wonder about the correlation between the increase in vape shops and the ability to self-regulate, especially for adolescents and young adults.

We all possess the innate ability to regulate our emotions, attention, and behavior, starting as early as infancy. Notably, infants learn to coordinate their sleep-wake cycles and regulate their emotional state, often in the form of self-soothing. This capacity evolves gradually throughout the child’s development, encompassing more complex behaviors that prepare the child to live in society. For instance, preschoolers typically acquire the ability to delay gratification by resisting the temptation of an immediate pleasurable experience in favor of a later and more gratifying one.1   

The benefits of cultivating and refining the capacity to self-regulate include better resilience, improved stress-coping abilities, and, above all, a propensity to attain one’s goals.2 Regrettably, this natural process is often hindered among young adults who engage in unhealthy behaviors, like smoking or drinking. These behaviors, aimed at aiding emotional regulation, must however be discreet due to societal condemnation. Vaping, on the other hand, offers both a discreet and convenient way to consume psychoactive substances like nicotine and THC. Given that it produces minimal odor and visible vapor, it eliminates at least the inconvenience to others that would typically be caused by tobacco smoke.

As a result, vaping appeals to adolescents and young adults. A recent study in Austin, Texas, surveyed 3,754 college students and found that about 50% endorsed vaping.3 Furthermore, the 2022 FDA report on tobacco use among young people revealed that more than two million current e-cigarette users were aged 11 to 18. Those results prompted the FDA to officially designate vaping as having reached “epidemic proportions.”4

Although vaping is generally considered less harmful than combustible smoking, it is not without health risks, and its long-term effects are still being studied. The US Centers for Disease Control (CDC) does not endorse vaping as a healthy alternative to smoking or as an aid to smoking cessation because of the association of vaping with lung injury.5,6 E-cigarette- or vaping-use-associated lung injury (EVALI) was identified as the cause of mysterious deaths that occurred among adolescents in 2020. Similarly, a form of lung inflammation (bronchiolitis obliterans) was caused by the presence of the chemical diacetyl present in many e-cigarettes.7

The negative effects of vaping on physical health should certainly raise concern about its potential effects on mental health. This is particularly relevant given that these vaporized substances (nicotine or THC) are rapidly absorbed into the bloodstream through the lungs and brain, resulting in a quicker onset of effects compared to traditional smoking and ultimately enhancing their addictive potential.8,9

Furthermore, the amount of nicotine or THC contained in an e-cigarette varies across devices, as some possess a larger reservoir than others, resulting in a greater output. Indeed, a higher nicotine concentration in e-liquids results in higher nicotine yield. According to a 2007–2013 review, the nicotine levels in e-liquids ranged between 0 to 87.2 mg/ml.10 To put it into perspective, a 20 mg/ml vape with 40 mg of nicotine is actually the equivalent of smoking one or two packs (20–40) of cigarettes.11

Setting aside the issue of quantity, these substances in any amount affect the brain by interfering with neurotransmission within specific brain regions, producing changes that negatively alter brain functioning. These harmful effects are particularly detrimental to the developing brain of the adolescent, including deficits in short-term memory and attention, and increased risk for psychiatric disorders such as anxiety and depression.12 In short, those changes could jeopardize healthy cognitive functions and success in daily functioning.13

Despite those facts, the potential psychological impact of vaping is still relatively underexplored. Increased reliance on psychoactive substances leads to decreased capacity to self-regulate. Without healthy self-regulation, the individual is not able to successfully suppress intrusive thoughts and reduce negative emotions, such as anger. They are also not equipped with the capacity to cope with stress and cultivate resilience, thereby elevating their risk of developing a psychological disorder later on, such as anxiety and depression.14,15

A recent CDC report surveying adolescents’ psychological well-being revealed increased hopelessness, depression, and suicidal ideation among both boys and girls.16 Furthermore, the June 2023 task force recommendation for screening adults from 19 to 64 for anxiety disorders and depression further underscores the concerning state of adolescents’ well-being.17 Admittedly, deficient self-regulation could be both the cause and consequence of adolescents’ attraction to vaping. Thus it would be misleading to claim that vaping is solely responsible for adolescents’ declining mental well-being.

That said, we cannot deny the fact that the popularity of vaping represents a significant hindrance to the practice of self-regulation. Many cities have already taken substantial steps to bolster residents’ mental well-being through programs and community initiatives. And schools could develop a comprehensive mental health curriculum in tandem with the academic one. Such a curriculum should encompass topics like stress management and emotional regulation, blending theoretical knowledge with practical exercises for both children and parents.


  1. Raffaelli M, Crockett LJ, Shen YL. Developmental stability and change in self-regulation from childhood to adolescence. J Genet Psychol. 2005;166(1):54-75. doi:10.3200/GNTP.166.1.54-76.
  2. Opdenakker MC. Developments in early adolescents’ self-regulation: The importance of teachers’ supportive vs. undermining behavior. Front Psychol. 2022;13:1021904. Published 2022 Nov 23. doi:10.3389/fpsyg.2022.1021904.
  3. Kelsh S, Ottney A, Young M, Kelly M, Larson R, Sohn M. Young Adults’ Electronic Cigarette Use and Perceptions of Risk. Tob Use Insights. 2023;16:1179173X231161313. Published 2023 Mar 7. doi:10.1177/1179173X231161313.
  4. Results from the Annual National Youth Tobacco Survey | U.S. Food and Drug Administration, FDA. 2022. Accessed October 9, 2023 https://www.fda.gov/tobacco-products/youth-and-tobacco/results-annual-national-youth-tobacco-survey
  5. Boudi FB, Patel S, Boudi A, Chan C. Vitamin E Acetate as a Plausible Cause of Acute Vaping-related Illness. Cureus. 2019;11(12):e6350. Published 2019 Dec 11. doi:10.7759/cureus.6350.
  6. New Cases in Outbreak of E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) On the Decline | Centers for Disease Control and Prevention. December 20, 2019. Accessed October 9, 2023. https://www.cdc.gov/media/releases/2019/p1220-cases-evali.html
  7. Shmerling, RH. Can Vaping Damage Your Lungs? What We Do and Don’t Know | Harvard Health Blog, June 15, 2023. Accessed October 9, 2023. https://www.health.harvard.edu/blog/can-vaping-damage-your-lungs-what-we-do-and-dont-know-2019090417734] Accessed 21 September 2023
  8. Allain, F, Minogianis, EA, Roberts, DC, Samaha, AN. How fast and how often: The pharmacokinetics of drug use are decisive in addiction. Neuroscience & Biobehavioral Reviews. 2015; 56:166-179
  9. Lee DC, Crosier BS, Borodovsky JT, Sargent JD, Budney AJ. Online survey characterizing vaporizer use among cannabis users. Drug Alcohol Depend. 2016;159:227-233. doi:10.1016/j.drugalcdep.2015.12.020
  10. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on the Review of the Health Effects of Electronic Nicotine Delivery Systems; Eaton, D. L., Kwan, L. Y., & Stratton, K., editors. Public Health Consequences of E-Cigarettes. National Academies Press (US), 2018, January 23. Chapter 4, Nicotine. [https://www.ncbi.nlm.nih.gov/books/NBK507191/]
  11. How Much Nicotine Is in a Cigarette Compared to a Vape | The Guardian. June 23, 2023. Accessed October 9, 2023 https://www.theguardian.com/society/2023/jun/23/how-much-nicotine-is-in-a-cigarette-compared-to-a-vape
  12. Goriounova NA, Mansvelder HD. Short- and long-term consequences of nicotine exposure during adolescence for prefrontal cortex neuronal network function. Cold Spring Harb Perspect Med. 2012;2(12):a012120. Published 2012 Dec 1. doi:10.1101/cshperspect.a012120
  13. Jacobus J, Tapert SF. Effects of cannabis on the adolescent brain. Curr Pharm Des. 2014;20(13):2186-2193. doi:10.2174/13816128113199990426
  14. Blair, C. Stress and the development of self-regulation in context. Child Development Perspective. 2010;4(3): 181-188. doi:10.1111/j.1750-8606.2010.00145.x
  15. Hofmann W, Schmeichel BJ, Baddeley AD. Executive functions and self-regulation. Trends Cogn Sci. 2012;16(3):174-180. doi:10.1016/j.tics.2012.01.006
  16. Youth Mental Health Listening Tour Report. OMH New York State | Office of Mental Health, New York State. 2023. Accessed October 9, 2023 https://omh.ny.gov/omhweb/statistics/youth-mh-listening-tour-report.pdf
  17. Anxiety disorders in adults: Screening. Recommendation: Anxiety Disorders in Adults: Screening | United States Preventive Services Taskforce. June 20, 2023. Accessed August 10, 2023. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/anxiety-adultsscreening#:~:text=The%20USPSTF%20recommends%20screening%20for%20anxiety%20in%20adults%2064%20years,some%20factors%20that%20increase%20risk

Further reading

  • Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young Adults | Centers for Disease Control and Prevention. August 30, 2023. Accessed Ocotober 9, 2023. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html#:~:text=The%20brain%20keeps%20developing%20until,%2C%20mood%2C%20and%20impulse%20control.&text=Each%20time%20a%20new%20memory,are%20built%20between%20brain%20cells.
  • Farley JP, Kim-Spoon J. The development of adolescent self-regulation: reviewing the role of parent, peer, friend, and romantic relationships. J Adolesc. 2014;37(4):433-440. doi:10.1016/j.adolescence.2014.03.009
  • Institute of Medicine (US) Committee on Opportunities in Drug Abuse Research. Pathways of Addiction: Opportunities in Drug Abuse Research. Washington (DC): National Academies Press (US); 1996. 4, Epidemiology. Available from: https://www.ncbi.nlm.nih.gov/books/NBK232973/
  • Pas P, Hulshoff Pol HE, Raemaekers M, Vink M. Self-regulation in the pre-adolescent brain. Dev Cogn Neurosci. 2021;51:101012. doi:10.1016/j.dcn.2021.101012

YASMINA REBANI-LEE, an emerging writer passionate about mental health, particularly anxiety, is gaining recognition for her insightful work, publishing a personal essay in OC87 Recovery Diaries (December 2023) and other notable mental health platforms (ADAA, NAMI) with the goal of destigmatizing mental health issues. Yasmina runs mindriselife.org, a website sharing resources and insights on anxiety, offering vital support.  

Fall 2023



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