The panic around teenagers who vape was ratcheted up a level last month, when the US Surgeon General, Dr. Jerome Adams, declared:
According to one media report, Adams warned:
“Nicotine is “very and uniquely harmful” to the developing brain. It can impair learning and memory for people under 25, “prime the brain” for addiction to other substances and increase the risk they will turn to combustible tobacco just as smoking is at a record low.”
The Surgeon General wasn’t an outlier. He was repeating the talking points of FDA Commissioner Scott Gottlieb, who previously declared an epidemic of youth vaping and even threatened to pull e-cigarettes off the market entirely if teen vaping doesn’t abate.
With such authoritative voices issuing dire warnings—aided and abetted by the media—what parent of a vaping teen wouldn’t feel deep concern?
But let’s pause to consider whether panic is rational.
“There is a difference between trying a substance and using it often enough and heavily enough that it causes health, social and life problems,” explains Dr. Sheila Vakharia*, policy manager for the Office of Academic Engagement at the Drug Policy Alliance. “Although we should keep an eye on use rates, it is more important to think about how frequently and often people are using any substance.”
After scrutinizing the 2018 Monitoring the Future national survey of teen drug use, Dr. Vakharia summarizes the data as follows. Note how, although numbers of teens who have ever vaped seem high (and all of the numbers have risen since the 2017 survey), the figures drop when you look at the teens who vape more often.
Lifetime prevalence:
* One in five 8th graders has tried vaping
* 36.9 % of 10th graders have tried vaping
* 42.5% of 12th graders have tried vaping
Past-year prevalence:
* 17.6% of 8th graders vaped last year
* 32.3% of 10th graders vaped last year
* 37.3% of 12th graders vaped last year
Past-month use:
* 10.4% of 8th graders vaped last month
* 21.7% of 10th graders vaped last month
* 26.7% of 12th graders vaped last month
The survey produced large-seeming percentages by asking teens if they’d vaped in the past month, the past year, or ever, but omitted to ask about the most frequent use, which you’d think would be the cause of most concern. “There is not publicly available data on daily use,” notes Vakharia, “but it stands to reason that they are a small fraction of people who use … What this data tells us is that teens have been experimenting with nicotine. We can’t tell if they are using to degrees that cause problems in their lives or impact them negatively.”
Unfortunately, neither the resources on nicotine and vaping for teens and parents created by the Surgeon General’s office—“Know the Risks: E-cigarettes & Young People”—nor The Tobacco Prevention Toolkit from researchers at Stanford University reflect this reality.
The information in these toolkits is compromised by:
* Not distinguishing between recreational/occasional use and problematic use. “Know the risks” proclaims falsely that, “No matter how it’s delivered, nicotine is addictive and harmful for youth and young adults.” If that were true, why are some doctors recommending nicotine patches to teens who are dependent on vaped nicotine?
* Not stating that vaping is vastly safer than smoking, a vital distinction.
* Using scare tactics. “Know the Risks” asserts, “Youth and young adults are also uniquely at risk for long-term, long-lasting effects of exposing their developing brains to nicotine. These risks include nicotine addiction, mood disorders, and permanent lowering of impulse control.” The FDA’s Youth E-Cigarette Prevention Campaign videos are a case in point. One, titled “An epidemic is spreading,” shows creepy worms beneath the skin, burrowing deep into the bodies and brains of teenagers who vape. In fact, the whole brain damage case rests on a few ambiguous rodent studies. No research in humans has yet backed the claim that nicotine harms the developing brain. If that’s true, where are all the millions of brain-damaged former or current teen smokers?
* Failing to provide comprehensive, reality-based information to help adolescents reduce potential harms associated with nicotine use. This leaves parents simply telling their teenagers to “just say no” to vaping—when many teens are already saying “yes.”
In the context of these failings, it’s important to discuss nicotine calmly and accurately, and to present advice to parents accordingly.
Nicotine is widely misunderstood and demonized because of its association with combustible tobacco—and there are over 480,000 tobacco-related deaths in the US each year.
When you remove the combustion and isolate the nicotine, it’s a very different story. Nicotine doesn’t cause cancer and it doesn’t kill users.
Nicotine’s effects on the brain are largely transitory. It is not intoxicating like alcohol. The drug has both stimulant and sedative properties, which is why people use it both to boost alertness and to relax. Research shows that nicotine increases focus, attention and memory and decreases appetite and symptoms of anxiety and depression.
Nicotine is also a self-titrating drug; people stop using it when they feel the desired effects. If a person uses too much nicotine, they experience jitteriness and an increased heart-rate—much like consuming too much caffeine. Nicotine use can lead to dependence. But most people who use it will not experience this, as demonstrated by the figures shown earlier.
The Surgeon General additionally flags health risks in the chemicals and particles that are inhaled along with nicotine by people who vape, many of which sound frightening (though they are to an extent disputed).
Such risks should be viewed in the context of the overall finding, in a major review by Public Health England, that vaping is still 95 percent safer than smoking. It’s worth remembering that all drugs, including caffeine, acetaminophen and others that we and our teens use frequently without a second thought, carry some risks—as do activities like driving, or inhaling the chemicals in furniture. But we tend to view such risks, which are exponentially less likely to cause death than smoking, as reasonable.
In this context, here is a list of dos and don’ts** for parents with far more practical value than the resources we mentioned earlier.
DO:
1. Talk honestly about the effects of nicotine. Acknowledge that nicotine has positive effects as well as negative. If you lie, scaremonger or exaggerate, you will lose credibility. Teens believe that vaping is much safer than smoking, and they’re right!
2. Ask your teen what they like about vaping and listen empathically and without judgement. If they tell you it alleviates depression or anxiety, that’s a signal to address those negative feelings they’re experiencing. But if they only vape occasionally, for social or enjoyment reasons, that should be of much less concern.
3. Allow your teenager to vape at home, in agreed spaces. This eliminates the hiding and rebellion aspects of vaping.
4. Discuss tapering down to a non-harmful level or quitting if your teen is vaping in a problematic way—i.e., if it’s negatively affecting their academic and work performance, costing them too much, or causing them discomfort or other concerns.
5. Visit a vape shop with your teen. Staff have a wealth of knowledge about vaping products and can offer expert advice, whether your teenager continues to vape, or wants to taper down or quit.
6. Find a therapist who practices harm reduction psychotherapy and is trained in motivational interviewing and stages of change, if your teen needs therapy.
7. Remember that boredom is the BFF of drug use. Help your teenager find passions that engage them—art, sports, theater, music, film, writing, dance, volunteering, activism—and purposes and roles in life that can help safeguard them from developing a problematic relationship with any drug.
DON’T:
1. Yell. Your teen will stop listening if you do.
2. Shame your teenager for vaping.
3. Drug test your teen. It’s humiliating and counterproductive.
4. Send your teen to a “tough love” boot camp. Many of these programs use confrontation and verbal and physical abuse to enforce abstinence.
5. Imagine that your teen isn’t capable of rational thinking about their nicotine use. Young people tend to be smart and resilient. If sufficiently motivated, they can stop or reduce vaping, with or without help.
6. Be afraid to set boundaries on vaping, in discussion with your teen.
7. Punish your teen by taking away activities they enjoy.
As a result of the government-induced drug panic over JUUL, sensational headlines in the media are reminiscent of the 1990s crack panic: “Vaping now an epidemic among US High Schoolers,” “Schools and parents fight a Juul e-cigarette epidemic,” “JUULing is the new vaping fad taking over school bathrooms” and “‘I can’t stop’: Schools struggle with vaping explosion.”
More and more stories are designed to attract attention by frightening parents. One article, titled “Vaping sent this teenager into rehab: His parents blame Juul’s heavy nicotine dose,” profiled 15-year-old Luka Kinard, who sold his clothes in order to buy JUUL pods. His parents checked him into a drug treatment program for 40 days. The New York Times ran a piece, “The Price of Cool: A Teenager, a Juul and Nicotine Addiction” that chronicled Matt Murphy, a 17-year-old who was so dependent on Juul that he called it his “11th finger”.
These articles use emotionally loaded words—like “tidal wave,” “surge” and “hooked”—that stoke fear and confusion. All the problems in the profiled teens’ lives—their moodiness, anxiety, depression, anger, wanting to be alone, poor grades, headaches, difficulty breathing, even a seizure—are attributed to vaping. Many of those interviewed—teachers, girlfriends, parents, college roommates—make unsubstantiated anecdotal claims about vaping that are presented as fact.
But many other groups of teen vapers are never profiled by the mainstream media: the teens who were dependent on nicotine and successfully quit on their own with no confrontations with parents; those for whom vaping helps alleviate their symptoms of depression, anxiety or ADHD; those who vape once in a while; those who only vape in certain situations, like at parties or before an exam; and those who vaped a couple times and stopped because they decided it wasn’t cool to JUUL.
Where are their stories?
There is no single pattern of nicotine use among adolescents, but that doesn’t prevent the media promoting the false narrative that if teens vape, they’ll end up like Matt or Luka.
With all drugs, there is a continuum of use, from experimental to regular to chaotic and out-of-control and lots of ways in between. But the vast majority of teen use of any substance falls into the categories of experimental, occasional, or social.
Happily, not everyone is buying the “vaping epidemic” message. In response to an article in the New York Times, “How to Help Teenagers Quit Vaping” readers posted these two refreshingly sensible comments:
**Sheila Vakharia is a board member of The Influence Foundation, which operates Filter, and a Filter contributor.
* The Dos and Don’ts were inspired by and in part adapted from drug education materials developed by the Drug Policy Alliance: “Safety First, A Reality-Based Approach to Teens and Drugs” by Marsha Rosenbaum, PhD and “Beyond Zero Tolerance, A Reality-Based Approach to Drug Education and School Discipline” by Rodney Skager, PhD. Information from a newsletter “Working with young people who use drugs” by Jeannie Little, LCSW of The Center for Harm Reduction Therapy was also incorporated.
Image via Vaping360.com