According to Fausta Dambrauskaitė, the chairwoman of the Lithuanian Youth Union "Žingsnis", recent studies on the use of psychoactive substances by young people reveal that the problem of e-cigarettes among youngsters is widespread and affecting a large portion of this social group.

"Recent statistics indicate: as the use of regular cigarettes or alcohol decreases among youth, the inclination to experiment with new substances and addictions to other substances are on the rise," she explains.

According to the chairwoman of Lithuanian Youth Union, it is also important to recognize the fact that the use of various psychotropic substances or addictions among young people is not a new phenomenon but is constantly evolving.

"With the new generations, substances used undergo change, and the methods of absorption also evolve. Currently, e-cigarettes, because of their universality, popularity and accessibility, are emerging as one of the most relevant devices for this," Dambrauskaitė shares her insights.

According to her, it is crucial to dedicate as much attention to this problem as possible.

"Our organization has been in operation for almost 27 years, and throughout these years, we have always looked for ways to encourage young people to stay away from any psychoactive substances, because, as the most popular substances are changing, the problem persists. Although the situation is not dire, the issue of various addictions should always be actively addressed because it does not dissipate," said the chairwoman.

According to Dambrauskaitė, this problem is more pressing than dramatic, with its roots tracing back to much earlier times.

"After Lithuania regained its independence, we had a rather significant problem with alcohol consumption. Later, young people began to abuse it, but culturally familiar substances do not elicit as much concern as the new ones. We are used to seeing a young person under the influence of alcohol because we attribute it to youth, but meeting someone under the influence of unfamiliar substances is unsettling. We lack experience on how to behave and how to react", said Dambrauskaitė.

According to Dambrauskaitė, the reasons determining a young person’s choice to harm themselves and their health by smoking can be very diverse, and there is no single correct answer to this question.

"Based on psychological models of human decision-making, three main factors influence our decision-making – cultural environment, social competences, biology/personality. These three break

down into additional aspects comprising a confusing map of components. By affecting even one of those parts, a person, young or old, may be encouraged to follow down a path of consumption," she says.

Dambrauskaitė adds that it is also important to emphasize that consumption is a choice a person makes.

"It can be either conscious, for example, rebellion, curiosity, urge to avoid unwanted emotions, or unconscious, that is, an individual may fail to realise that the choices made are influenced by the aforementioned factors. It should also be stressed that educating young people about the harms of consumption is not enough," she stresses and gives one example.

"I don’t know if I have ever encountered an adult who, after hearing about the types of cancers caused by alcohol or the non-existent safe consumption levels, would become aware and change his behaviour. Thus, it would be quite naive to expect mature reaction from a young individual who experiences his or her life from a completely different perspective," concludes the chairwoman.

Thus, according to Dambrauskaitė, looking at the above aspects, the conclusion is that prevention of consumption and addictions must have several components and should not rely on education alone.

"One of these components is the development of personal competences to understand environmental influences and resist them. Another can involve teachers and parents – it is important to educate them about ways to provide a safe space for young people and talk about consumption and addiction. It is key to realise that just hard facts, fear-based approaches and one discussion per year will not improve the situation or prevent consumption," says Dambrauskaitė.

There are ongoing heated discussions regarding the measures schools should take themselves in response to the recent increase in e-cigarette smoking and the use of other psychotropic substances. However, many question schools’ effectiveness in addressing this problem. According to Dambrauskaitė, it would be inaccurate to claim that all schools fail in addressing this issue, but some shortcomings are more than evident.

"Some schools have been implementing various activities to prevent the use of psychoactive substances and addictions for many years, but there are many more that lack quality prevention or intervention activities, or have none at all," admits Dambrauskaitė, adding that there are multiple reasons for this.

"Part of the problem is mistaken belief that problems need to be solved only when they result in painful consequences. School administrations engage with its students when one of their peers ends up in hospital, but they fail to act before it is too late. The state and society notice the problem only when consumption needs to be halted, but we should begin with prevention to avoid starting," she suggests.

According to Dambrauskaitė, the problem is complex, thus there are numerous reasons why prevention and intervention for psychoactive substances fail to reach every young individual.

"It is easy to blame the state mechanisms, but there is no point in doing so, and I would like to pop the question "why?" to everyone reading this – what is your personal effort to change the situation?" asks Dambrauskaitė.

The youth union "Žingsnis", which she represents, is actively engaged in this cause. According to

Dambrauskaitė, the organisation deals not only with the problem of e-cigarettes but also with general use of psychoactive substances among young people and its prevention.

"At the moment, we are actively conducting self-awareness sessions in schools, organising workshops on similar topics outside schools, and developing additional educational material. Through these activities, we aim to give young people the competences to resist the influence of others, to have courage to say "no", or to create safe environment reflecting their personal values," she said.

She added that "Žingsnis" has an active group of young people aged 16-26 who volunteer their time to organise and run such activities.

"We try to engage young people into relevant and valuable activities, taking into account both the psychological models of human decision-making and the European Union’s principles of effective prevention. We do not use any substances, so, by setting this example, we invite young people to come together and see that it is possible to have a community and to have fun and personal development without psychoactive substances," said Dambrauskaitė.

According to Dambrauskaitė, besides the constant changes occurring in the system or within specific institutions, our society also plays crucial role in addressing this growing problem.

"Not to mention the willingness to make changes, our society should be well informed about effective approaches. When considering effective tools, the first thing I would like to emphasise is that scare tactics are ineffective, and a person will never change if he or she does not see the benefit or the meaning of it. Punishing or scaring a young person can easily alienate them, making discussions about the problems they are facing and possible solving methods practically impossible," she concludes and offers some suggestions for what each of us could do.

"What can each of us do? Initiate a conversation – whether with the young person about his difficulties, or with a friend, perhaps with your child’s school administration about the lack of emotional support or prevention of psychoactive substances. If you work with or influence young people, I encourage you to delve into scientifically based ways how to reduce young people’s use of psychoactive substances, and to continue this conversation with your colleagues," advises Dambrauskaitė.

According to her, sharing knowledge and finding a moment for an important conversation with others is very crucial in this situation.

Raimondas Kubilius, a cardiologist and professor, acknowledges that more and more young people have one or another addiction and admits that statistics he has been observing recently are simply hard to comprehend.

"In America, approximately 11 million people smoke e-cigarettes, with 4 million being young people. In 2017-2018, a survey of more than 1,100 Lithuanian university students revealed that 56.6% of them had experimented with e-cigarettes. According to the Lithuanian Student Lifestyle and Health Survey compiled by the Lithuanian University of Health Sciences, one in five children in grades 5-9 has tried e-cigarettes at least once in the last 30 days, and the prevalence of e-cigarette use is increasing rapidly," shares the doctor, emphasising one more critical aspect.

"In addition, there is a new phenomenon of simultaneous use of traditional cigarettes alongside e-cigarettes. In general, smoking emerged as a new epidemic in 1880-1900, taking almost 50 years to fully comprehend its deadly consequences," reminds Kubilius.

Unfortunately, according to the cardiologist, discussions on the health impacts of e-cigarettes are often speculative, and not every young person is aware of their harmful nature.

"It is said that they are not dangerous or harmful, despite the fact that the European Society of Cardiology has consistently emphasized the disastrous effects of any form of smoking on the body. E-cigarettes, as they are presented as innovative, modern and fashionable, seems very alluring to adolescents and young people, who associates them not only with entertainment, relaxation or stress relief, however, the truth is that they are highly harmful," explains Kubilius.

According to him, there is one more trap e-cigarettes tries to lure us in.

"Unlike traditional cigarettes, an e-cigarette never truly ends, thus, the duration of a single smoking session can be significantly extended. Over the past decade, during the e-cigarette boom, negative effects on many body systems have been observed. Worst of all, we still don’t know what the long-term health effects will be in 5, 10 or 15 years, as e-cigarettes accumulate in cells, disrupt their function, cause genetic damage to cells and that accumulative damage is happening every day," warns the cardiologist.

And scientifically based data tells it all.

"A study by American oncologists a few years ago revealed that when laboratory mice were exposed to e-cigarette aerosol for 54 weeks, one in five of them developed lung cancer, and one in two developed pre-cancerous conditions of the urinary tract. 54 weeks of vaping for a mouse would be equivalent to 3-6 years of smoking e-cigarettes for a human being," concludes Kubilius.

As cardiologist Kubilius emphasises, there is no longer any doubt about the health risks of e-cigarettes, but the most important thing is to made those who, despite the threat to their health or even their lives, still harm themselves with various psychoactive substances to reconsider their choices.

"This year’s research analysis by the American Heart Association highlights the profoundly negative effects of e-cigarettes on the heart and respiratory system. Even more alarming is the growing number of users: in just a few years, the number of e-cigarette smokers has doubled (comparing 2017 and 2019). Despite the absence of long-term results on the effects of e-cigarette smoking, the research evidence is already compelling," emphasizes the professor and provides some specific examples.

"The PATH study has shown that e-cigarettes significantly predict the development of serious lung diseases (chronic obstructive pulmonary disease, bronchial asthma, chronic bronchitis) in the coming years. As recently as 2019, new cases of acute and threatening lung injury (EVALI) caused by e-cigarettes in adolescents have been observed in America with progressive shortness of breath, coughing, and other organ damage such as acute abdominal pain, nausea, vomiting, chest pain, prolonged fever, fatigue, and weight loss. The development of this condition was possibly caused by interactions with additionally vaporised cannabinoid substances. By February 2020 alone, in the US, 2 807 cases of EVALI and deaths have been registered," says Mr Kubilius.

He adds that research has also shown that young people who smoke e-cigarettes are up to 5 times more likely to develop COVID, while those who smoke electronic cigarettes in combination with regular cigarettes have a 7-fold increased risk.

In addition, according to the cardiologist, e-cigarettes induce premature changes in the blood vessel walls, such as stiffening and endothelial dysfunction, leading to an increase in arterial blood pressure and heart rate.

"All these changes induce other vascular pathologies and increase the risk of developing cardiovascular disease. The long-term effects of e-cigarettes are also associated with an increase in sympathetic system tone: daily vaping for at least 30 minutes leads to a pulse increase," explains Kubilius.

As the doctor points out, the majority of e-cigarette users are teenagers or young adults, whose lung and heart systems are not yet fully developed, making the effects of e-cigarettes particularly harmful.

"Several large studies in recent years have shown that nearly one in five e-cigarette smoker is likely to suffer an acute myocardial infarction. In addition, if an e-cigarette is smoked for more than 30 minutes, it has an adverse effect on the stiffening of the vascular wall, which is the same as smoking a regular cigarette," concludes Kubilius.

In addition to the fact that e-cigarette smoking is becoming a growing problem both in Lithuania and worldwide, it is also concerning that individuals are often substituting one harmful habit for another, i.e., replacing traditional cigarettes with e-smoking devices, believing they are less harmful. However, this notion is far from the truth. And cardiologist Kubilius provides evidence to support this.

"Shall not forget that e-cigarettes were introduced to the market by a young man whose father died of lung cancer as a tool to assist those who wanted to quit smoking. Unfortunately, the e-cigarettes eventually gained widespread popularity, even exceeding the number of traditional cigarettes smoked," he recalled.

It is also worth remembering how long it has taken to believe the facts about the damage to human health caused by conventional cigarettes.

"Let’s not forget that it took decades to recognise the harmful health effects of traditional cigarettes, and nearly 60 years for the Guinness Book of World Records to acknowledge smoking as the world’s leading cause of death," he concludes.