Teen vaping: what can parents do?
Even though e-cigarettes and vaping products are illegal for young people, it doesn’t appear to have stopped or even slowed teen use. The U.S. surgeon general has called vaping among young people an epidemic and the numbers support that.
In 2019, 27.5 percent of students admitted to vaping in the past 30 days and over one million of them vape every day, according to the National Youth Tobacco Survey done collaboratively by the federal Centers for Disease Control and Prevention (CDC) and the federal Food and Drug Administration (FDA.) Compare that to the statistics that 20.8 percent of high school students vaped in 2018 and 11.7 percent did so in 2017, which shows a steady increase in the habit.
“It is truly amazing how this took off and how the medical community, parents and teachers are now all playing catch-up,” said pediatrician Kathryn Rudman, MD, at Seaside Pediatrics in Yarmouth. “It’s really frightening just how quickly the cat got out of the bag.”
In December, Dr. Rudman joined a newly formed vaping task force in the town of Barnstable, which she describes as a “really vibrant group of people who are really hoping to somehow be able to influence this epidemic.”
They have their work cut out for them. Many teens are already addicted. The vaping liquid manufacturer Juul, appealed directly to young people with fruit and candy-flavored vaping liquid and a sleek design that looks like a flash drive.
“I feel like it is far worse than ‘big tobacco’ because Big Tobacco didn’t (at least at first) market so blatantly towards children,” Dr. Rudman said. “If Juul hadn’t made their product so strong, people might not have gotten addicted as quickly. They have tasty flavors and super, super strong nicotine, so you get one hit and it’s like you just smoked five cigarettes. They have totally targeted kids and I think they are going to be criminally prosecuted over and over again.”
In fact, the lawsuits have already begun. Attorney generals in New York, Minnesota, California and Pennsylvania have all filed suit. On February 12, Massachusetts Attorney General Maura Healy announced that her office has sued Juul Labs for “creating a youth vaping epidemic by intentionally marketing and selling its e-cigarettes to young people.” The lawsuit follows an in-depth investigation done by Healy’s office that documents Juul’s marketing plan specifically to adolescents. Additionally, the lawsuit alleges that Juul intentionally shipped e-cigarettes to underage kids who ordered them online.
Another part of the problem is that, unlike cigarettes, vaping does not produce as obvious of an odor, so it can go undetected. Plus, there are now products to help kids hide vaping equipment.
Dr. Rudman cited an episode of NBC’s Today show that illustrated just how easy it is for teens to conceal vaping. Reporters hid 14 vaping devices in a classroom and challenged teachers and parents to find them. The highest number that any adult found was just five out of the 14. The devices were disguised to look like USB devices, smart watches, a highlighter pen, and even an ink pen that actually writes. Other hidden spots included the strings of specially-made hoodies and a pocket in the straps of a backpack.
“A lot of parents don’t even know their kids are vaping because it’s so easily hidden,” Dr. Rudman said.
“Hidden in Plain Sight”
Locally, Dr. Rudman pointed to the Falmouth Police mobile “Hidden in Plain Sight” trailer as a fabulous resource for parents to learn just how easy it is for kids to hide evidence of alcohol, drugs and vaping in ways that no adult will recognize.
“’Hidden in Plain Sight’ has been around for some time,” said Falmouth Chief of Police Edward Dunne. “It used to be a display at the mall or schools, but I realized that we just weren’t reaching enough people so I decided to put it in a trailer.”
The trailer didn’t cost taxpayers any money. It was purchased with money seized during drug arrests, which Chief Dunne said is routinely used for community education. The trailer was built for free by the Sheriff’s department and local businesses donated the furnishings in exchange for becoming a sponsor partner in the project with their names on a sign on the trailer.
It’s the only such teaching tool in the entire state, and the audience is not kids. It’s parents. In fact, the trailer has a notice on one side that says only parents are allowed inside. The benefit goes beyond just the town of Falmouth. Any police department or group that works with teenagers can make a request to borrow the trailer by calling 774-255-4527, ext. 4500.
The trailer is a simulation of a teenager’s bedroom with all kinds of hidden warning signs inside. Parents are allowed to explore the faux bedroom, look through drawers and see all of the signs of trouble their children actually do leave in plain sight.
But Chief Dunne doesn’t want parents to go home, search their child’s room and start yelling.
“The idea of the program is to educate parents and at least start the conversation,” he said.
Dr. Rudman said that is a great first start.
“It’s been proven over and over again that kids whose parents talk to them about substance abuse and caution them are less likely to use, she said. “Parents need to show their disapproval of any kind of substance abuse. I think a lot of people don’t talk to their kids about this stuff.”
Honest Talk Needed
Parents need to educate themselves about vaping and have honest discussions with their kids about the dangers, she said.
“Parents should not be afraid to say ‘we don’t approve of you vaping because this is what it can do to your body,’” she said. “Parents should look for this stuff around the house and in their child’s room. This is tough love. It is a very serious thing.”
In the latest news about the vaping crisis, the CDC reports that over 2,700 people have become ill with the vaping-related lung illness they have named EVALI (or e-cigarette or vaping product use-associated lung injury). There were 60 deaths by late January and the numbers keep rising. The CDC now says they have evidence that vitamin E acetate (a cheaper, synthetic form of Vitamin E oil) in many THC vaping products is one component that may be to blame.
Dr. Rudman said that makes sense.
“Remember when we used to say don’t give mineral oil to babies for constipation because they could aspirate it into their lungs?” she said. “An oil is the worst thing you can aspirate. It is not meant to be in the lungs.
But even if your child doesn’t end up with products that contain vitamin E acetate, vaping liquids are still dangerous. They likely contain hundreds of unknown chemicals. Many are not regulated so the public has no idea what other chemicals they contain and the long-term effects are unknown.
Plus, new evidence has come to attention that vaping, particularly vaping THC, can damage the lungs, Dr. Rudman said. The metal coils that electronic cigarettes use to heat up the vaping liquid to turn it into an aerosol can cause toxic metals to leach into the liquid.
Quitting is extremely difficult, even if a teen does want to quit, because the Juul product, especially, is stronger and therefore much more addictive than nicotine from a cigarette. The dose in one Juul pod is equal to a pack of cigarettes, according to Dr. Rudman. That large dose of nicotine means people become addicted much quicker, which then means that typical nicotine replacement therapies like patches, gums and lozenges don’t work as well as they do for quitting smoking, Dr. Rudman said.
What Can Parents Do?
If you discover that your child is vaping, Dr. Rudman recommends that you get to the bottom of why they are doing it. Ask them why they started.
“Many kids just start because they’re curious, but a lot of kids start because they’re under pressure and someone tells them this will take the edge off the academic pressures, the home pressures, the sports pressures, and then they’re hooked,” Dr. Rudman said. “With the anxiety and pressures kids are under today, they are looking for an escape. So, you need to get to the heart of everything, and work on what the issues are, whether it be anxiety or poor self-esteem.”
She offers the following advice to parents whose children vape:
- Try getting the teen to cut back little by little.
- Get them to agree to leave the vape pen at home.
- Encourage the teen to involve both parents and friends in support of their willingness to quit, i.e. someone to “keep them honest.”
- Work with a therapist, preferably one who specializes in cognitive behavior therapy, or addiction treatment to work on the emotional issues that may behind the reason they are self-medicating.
- Seek out help at addiction medicine clinics specializing in adolescent care such as Boston Children’s Hospital.
- Use online support services specifically designed for teenagers like My Life, My Quit and The Truth Initiative. Both rely on texting for programs and support, which is attractive to teens.
While the four-month ban on vaping products in the state of Massachusetts was well-intended, there was a lot of worry that it could have had unintended consequences, like driving people to the underground dealers, which is where many completely uncontrolled products causing problems seem to be originating.
The other worry is that kids have turned to THC, Dr. Rudman said. The year 2017 to 2018 saw the largest year to increase in use of any single substance (nicotine), she said, but the following year saw one million additional THC vapers, which was the second largest increase.
“Now most kids are vaping THC,” she said. “While people were still talking about Juul, kids had totally move on to THC.”
Teenagers by nature think they are invincible, Dr. Rudman said. It’s not uncommon for patients to hear about the illnesses and deaths in the news, but still be in denial about whether it could happen to them.
“It seems like I have two main camps of kids,” she said. “I have the kids that were vaping pretty regularly but now are scared by the news, and were able to quit. And then I have the kids that are so addicted and they don’t want to quit because they don’t think they are at any risk.”
Nationally, kids are falling into the same two camps that Dr. Rudman has described seeing in her practice. Some kids who have fallen ill to EVALI are turning to social media to warn others not to vape. Others are finding ways around the flavored vaping ban.
When the Trump administration decided to prohibit flavored e-cigarettes, they created a loophole that some teens are exploiting. The new policy allows flavors in devices that cannot be refilled, like disposable e-cigarettes sold in convenience stores. For kids who got hooked on Juul, switching to the disposable Puff Bars with flavors like banana ice and sour gummy was an easy transition.
“Prevention is so important, and parents need to be completely educated and stay on top of this stuff,” Dr. Rudman said. “Whether it is looking at the “Hidden in Plain Sight” trailer or educating themselves on what the latest substance the kids are going after.”