Just the FACTS:
What parents and caregivers need to know about vaping and juuling
Updated in September 2018 by the Scituate FACTS Coalition
What is vaping? What is juuling?
Vapes (sometimes called e-cigarettes) are devices used to ingest vaporized liquid nicotine, liquid THC from marijuana, flavorings, or a combination. All vape devices consist of a battery,
an atomizer with a heating coil, and an absorbent material that absorbs a liquid called “e-juice” that may contain nicotine, THC, flavoring, and always containing a variety of chemicals. No vapes contain “harmless water vapor.”
The battery allows the atomizer to heat the liquid which creates an aerosol vapor that is breathed into the lungs and breathed out into the air repeatedly – sometimes forming large aerosol clouds. Parents could spend some time conducting YouTube searches to view how-to videos, vape cloud contests, and user reviews of vape products, to get a sense of the pervasive vape culture.
Vape products were created by the tobacco industry to replace lost customers of cigarette smoking, which has been steadily declining over the last 40 years. There are literally thousands of e-juice flavor options such as Creme, Cucumber and Mango, a marketing tactic to lure new customers that is especially appealing to young people. Many consumers are unaware of the harms from vaping. Some people believe that it’s safer than smoking, even though there is no science yet to support that theory. Even though vaping is promoted as a ‘cutting down’ strategy for adult smoker, there is scant evidence that vaping helps anyone discontinue their nicotine use.
There are different device styles and brands, but the hottest vape product on the market is the JUUL vape, pictured here from www.juul.com. JUUL now controls a remarkable 72% of the e-cigarette market, according to Nielsen data. JUULs, as they are called, are appealing to the youth and college market for several reasons: sleek look; slim size; equipped with a USB charger; easy to use pods in desirable flavors; low cost (around $40); and high function. Basically, JUULs are discreet and they work well: the technology creates a strong “throat hit” and delivers bursts of nicotine to the user. One pod – which might be shared with a group of friends in one hangout, or consumed over the course of a few days by an individual user – contains 5% nicotine, the same amount of nicotine in an entire pack of cigarettes.
How common is vaping?
There has been a dramatic increase in the use of vapes by youth in the last few years (tripling among US HS students between 2013 and 2014). Vaping is now the most common way to use nicotine in the United States. The tobacco industry is marketing to young people with fruity flavorings, cool technical devices, and a vape culture, that is deliberately not branded like a tobacco product. Massachusetts Attorney General Maura Healey has launched an investigation to examine JUUL’s efforts to audit its own website and other online retailers that sell its products to see how effective they are at preventing minors from accessing JUUL and JUUL-compatible products. The investigation will explore what JUUL does, if anything, to stop online retailers that fail to verify a purchaser’s age and prevent minors from purchasing its products or those that are compatible or similar. The attorney general is also reviewing industry practices that are causing harm to minors. Other public health organizations are working to strengthen policies that protect youth.
Meanwhile, a marked increase in use among Scituate students has occurred over the past year. “Have you ever tried vaping?” among Scituate High School Students has ranged from 45% in 2015, to 48% in 2016, 46% in 2017, and 50% in 2018. “Have you vaped in the past month?” answers ranged from 28% in 2015, to 33% in 2016, 30% in 2017, and 41% in 2018. We will continue to closely monitor trends and adapt our school policy, health curriculum, and supports accordingly.
In Massachusetts, 41% of all high school students report having tried vaping at some point in their life, compared to 50% of Scituate High students (2018 YRBS). According to the same 2017 statewide Youth Health Survey, 20% of MA high school students report using a vape in the past 30 days, which is considered “current use.” By comparison, 41% Scituate High students report vaping in the past 30 days, according to our 2018 anonymous survey, significantly higher than the peer group across Massachusetts. So, vaping is a pronounced area of concern locally. Scituate teens are vaping more.
How harmful is vaping?
- Nicotine is highly addictive – No matter how it is ingested – smoked, chewed or vaped – nicotine itself is addictive. Nicotine has even stronger rewarding effects in adolescents than adults. All JUUL products (and 95% of all vape products) contain large amounts of nicotine. The earlier teens start using any product with nicotine, the stronger their addiction will be and the harder it will be for them to quit, according the American Academy of Pediatrics, AAP. Adolescents can develop symptoms of nicotine dependence such as increased tolerance and inability to stop using, as well as withdrawal symptoms like headaches, irritability, and difficulty sleeping, after only a few weeks of vaping. Early use of vapes is also linked to cigarette smoking, meaning it is fairly common to use both eventually.
- Isn’t it safer than smoking? Probably, yes, but only for those who already smoke cigarettes! Many cancer harms result from combustible nicotine (smoked cigarettes),
so non-combustible (vaped) nicotine is probably not as harmful. It’s just too new to tell what the long-term health consequences of vaping will be.
- All vape flavorings contain chemicals and toxins. We do know from research that the chemicals found in vapes are not harmless to the user or the people around them.
The aerosols produced by the chemicals in e-juice, enter into the user’s lungs and leave chemical residue behind. These may include propylene glycol, glycerin, flavorings, nicotine and other harmful chemicals and toxins, some known to cause cancer
- Ear, eye, and throat Irritation is common among people who vape. Coughing and throat-clearing are common signs of youth use.
- Popcorn lung, or bronchiolitis obliterans, is an incurable medical condition that results from long term exposure to a flavoring chemical called diacetyl that is found in both traditional cigarettes and many e-juice products Breathing in diacetyl may scar the smallest air passageways, causing coughing and shortness of breath. (https://ehp.niehs.nih.gov/15-10185/#tab1)
- Correlated to polysubstance use and adult addiction – The early use of any substance – most commonly nicotine, alcohol or marijuana – increases the likelihood of other substance use and the chance of having a substance use disorder as an adult. There is no “gateway drug” that causes a young person to use another drug. But there is strong evidence that using anything early increases chances of addiction later in life. (http://www.jhsph.edu/news/news-releases/2000/smoking-drugs.html)
- Some vape devices explode and may cause burns. Batteries can malfunction and cause vape devices to catch on fire or explode during use. This is common with cheaper models that have “mechanical mods” – as well as among inexperienced users.
- Third-hand smoke refers to the chemicals in the vaporized aerosol that remain on surfaces and in dust, which remain and react with other chemicals in the environment
to form toxic chemicals that are known to cause health problems.
What can do if my child is vaping?
- Intervene immediately –It is ideal to interrupt early experimentation before a habit
or dependence sets in, especially since we know dependence on nicotine develops so quickly. Sometimes young people are simply bored, curious, or are participating so they can fit in or feel cool. Regardless of the reasons provided, early use is a major risk factor for a host of problem behaviors later and should not be taken lightly. Remember, most young people are not vaping. If your child is vaping, it’s reason for concern.
- All teenagers make mistakes, it’s completely normal and can be an opportunity to learn. Even when serious mistakes happen, try to keep your emotions in check. Take time to cool off then express your disappointment, anger, or frustration calmly. Believe it or not, kids do not want to disappoint their parents, so this is often an effective approach, especially early on.
- Next, establish clear rules & consequences for having vape paraphernalia or for using nicotine. The long-term threat of addiction is usually not compelling for a young person. Think of immediate consequences that will affect your child right away. As you come up with your own family rules, consider the health impacts listed above, as well as:
- Vapes and paraphernalia are not allowed on Scituate Public School property
- School suspension and loss of privileges (may include dances, graduation, etc.), unless alternative consequences are met. These alternatives may include sessions with the School Adjustment Counselor, or completion of a nicotine cessation support group. See Handbook for details.
- Zero tolerance consequences for student athletes who are caught vaping per the MIAA and Patriot League policies, including 25% game suspension and loss of captaincy for one year
● Determine how you will monitor the new rules. Strategies may include cell phone/social media access, bedroom/backpack checks, no sleepovers, or other ideas to ensure non-use. Avoid making empty threats or you’ll lose credibility.
● Overall monitoring
(The following advice is adapted from www.drugfree.org):
1. Know where your teen is at all times – physically and virtually 2. Get to know your kids’ friends – and their parents. 3. Find out how your teen plans to spend his or her day. “So… what’re you up to tomorrow?”
4. Limit the time your child spends without adult supervision. After-school hours are the most high-risk time for teens to be on their own. 5. Use technology to check in with your teens to find out where they are, who they’re with and what they’re up to. These ideas can be challenging to implement, because your teenager is naturally seeking independence. Try to strike a balance.
- Remember that when things are going well — which will be most of the time – it helps to praise your teenager. Reinforce and reward positive decisions and behavior.
- Consider connecting your child with an individual counselor, so he or she may safely explore their reasons for using in the first place, as well as their own motivation to slow down or stop. Scituate residents have access to a free match service through Interface Referral to find a community-based mental health professional that meets your needs. Be sure to request a professional who specializes in adolescents and substance use. Start by calling the William James Interface Referral Service at: 888 244-6843 x 1411. Specialized programs such as Boston Children’s Adolescent Substance Use and Addiction Program (ASAP), Mass General’s Addiction Recovery Management Service (ARMS) specialize in assessing and treating adolescents and young adults with problem substance use.
- Ask your pediatrician or counselor for nicotine cessation strategies, including:
- Prescription nicotine replacement therapies (NRT) such as patches, gums, and lozenges are often recommended for adolescents who are unable to stop on their own. The American Academy of Pediatrics now supports the use of nicotine replacement products to help adolescents who are daily cigarette or e-cigarette users to quit. These nicotine replacement products can be prescribed by your primary care doctor (pediatrician or family doctor), or through one of the specialty treatment programs listed above (ASAP, ARMS, Catalyst).
- Supplement with online support tools found at: https://teen.smokefree.gov, such as the QuitSTART app
and SmokeFree for Teens texting app
- Look for in-person nicotine cessation support groups that are tailored for adolescents. Scituate FACTS and SPS will be implementing a 7-week, support group called Project Connect during the 2018-19 school year for students.
Please contact Jen Lopes at SHS (firstname.lastname@example.org) or Lyndsey Newton at Gates (email@example.com) for more information.
If it’s illegal, how are they getting it?
- The most common means for a young person to require any substance – legal or otherwise – is through a social source, meaning a friend or relative. Often, a good friend will offer the item to try for free. Kids need some “go-to” lines to use in these situations to avoid that first use. It’s even plausible that the friend who is offering will be discouraged from continued use. No one wants to use alone – and teenagers care a lot about what their friends think about them.
- Legal purchase age for vape products used to vary from town to town. Governor Baker recently signed a new law which will raise the legal age to buy tobacco products statewide from 18 to 21, beginning in December. The new law broadens existing prohibitions on public smoking to include e-cigarettes and prohibits the use of tobacco products on the grounds of any public or private school. Additionally, any entity that offers health care services or employs licensed health care providers is prohibited from selling tobacco products in Massachusetts. Already, in the Town of Scituate, buyer must be 21 years of age and show a valid ID, per the Scituate Board of Health regulations adopted in 2014.
- Vape shops are now common in Massachusetts, with a vape store open at 2 Booth Hill Road in North Scituate. The Scituate Board of Health and Scituate Police Department have worked proactively to ensure all sales comply with our local regulations, and require age verification for any person under the age of 27. Vape shops, medical marijuana dispensaries, and soon, adult use marijuana stores, will be more common across Massachusetts. Parents should expect more access to vape products in the years ahead, with teens asking a legal-age friend or relative to buy vapes/supplies for them at retail stores. Regular compliance checks at vape shops, gas stations and convenience stores will help prevent underage sales.
- Online sales– particularly re-sellers on eBay- sell vape devices and e-juice without age verification. Underage youth may use Visa Gift Cards purchased at stores like CVS, and PayPal accounts that they have set up on their own or with someone else’s identification, to procure vapes illegally online. Look out for small packages delivered to your home, since e-juice pods will need to be replaced frequently.
What if he/she won’t stop?
Get professional help. If the behavior continues despite monitoring and consequences,there are likely underlying reasons. Pursue a specialty counseling route as soon as possible. Many people misuse substances as a way of coping with anxiety, stress, or depression. These individuals are also at greater risk for addiction, so it’s important to treat the “why” before a serious problems set in.
If your child is also using alcohol, marijuana or another substance, there are several youth programs in the Boston area that offer a Comprehensive Assessment to determine problem severity. Consider any of the following specialty programs that offer comprehensive assessment, treatment, and case management services for families:
ARMS at MGH – Addiction Recovery Management Service (for ages 14-26); 617 643-4699
ASAP at Children’s – Adolescent Substance Addiction Program, 617 355-2727
Beth Israel Deaconess Clinic, Dr. Kevin Hill, 617 667-1504
Catalyst Clinic at Boston Medical Center (up to age 25) 617 414-6655
McLean Hospital, Belmont, 617 855-3505
Support is also critical for the parents to manage their stress and effectively support their child. Certain parenting skills are proven to work in motivating a child toward reducing their use or initiating treatment. An online training in the Community Reinforcement and Family Training (CRAFT) approach is available through Allies in Recovery. Set up your own free training account at www.alliesinrecovery.net, using your zip code.
Never worry alone. Involve trusted parents, teachers, coaches, your pediatrician, school counselor and other adults who can help you support your child’s health and well-being.
Workshops for caregivers on vaping will be offered as part of the Power of Prevention Conferenceoffering on Sunday, November 18, 2018, from 1:00-4:00pm at Gates.