PIA Seminar 2018 – “Vaping: Essential Information and Strategies for Protecting Youth”

(Presented in partnership with the Hallways Program of Freedom Institute)

By Melanie Wells

The explosive rise of vaping and JUULing is a deceptively normalized phenomenon, with research now revealing that these activities are far less benign than users initially assumed. And yet, according to Hallways, parents should not despair, but should remember this hopeful message:

“YOU are still the most important influence in your child’s life. TALK to your kids, early and regularly.”

In perfect alignment with PIA’s long-time support for effective communication, Freedom Institute’s Rachel Russell (Chief Clinical Officer, Freedom Institute) and Katherine Prudente (Hallways Program Manager) enlightened the audience at the Collegiate School on Wednesday, April 11 with a reassuring message: you have a key role to play in protecting your child’s well-being, and there are strategies you can employ to effectively do so. That was the good news.

The more sobering news, delivered first, was a dense tutorial on the ominous explosion of the use of JUULing/vaping by teens, and the clinical facts surrounding it. The audience was urged to take note: “We are at a critical turning point,” said Russell, likening it to a similar flash point that emerged around cigarette smoking decades ago, when a long-ignored health threat demanded action and intervention.

Before launching into the details, Russell asked the audience, “Are you curious? Nervous?” Both feelings were acknowledged. Russell assured the crowd that they’d learn “essential info” to better understand vaping/JUULing and to counter myths; and they’d also learn practical tips to use at home.

First, Russell offered some background on teen development, pointing out that parents need to know what will NOT work with this age group. “Scare tactics,” she emphasized, “DO NOT work.” (Think “just say no” and “here is your brain on drugs” – tactics from the crack cocaine years.) Further, she added, facts alone (even medical lectures) don’t work either. Kids, typically, do not ingest these facts and then avoid substances; rather, the research shows, they listen, become more curious, and then go experiment. What does work, said Russell, are holistic preventive efforts that promote social-emotional wellness, whereby kids develop important life skills. An effective prevention approach is:

1)  Data-driven (evidence-based facts stand up best to scrutiny);

2)  Community-based (looking at all elements – family, school, cohort, teams, other activities);

3)  Ongoing and strategic (informed by science);

4)  Person centered (keyed to the ages and culture of the kids involved).

Social-emotional wellness, firmly established, is key, but, Russell noted, it is “hard to gauge.” Social-emotional wellness comprises the “softer skills” (good decision making, impulse control, emotional regulation, ability to weigh consequences, i.e., the “frontal lobe” stuff). Effective prevention programs use skills-based learning to encourage and promote healthy development. However, working counter to the steady, successful development of social-emotional wellness, are a few risk factors. A big one is the adolescent brain itself, which, Russell explained, not only doesn’t fully develop until age 25-26, but more critically, develops “back to front,” allowing the primitive systems (think, “old brain”) to mature first, and the all-important executive function system (frontal lobe) to develop last.

This late development of executive function explains those puzzling times when parents, seeing a bad decision their child has made, may ask incredulously, “WHAT were you thinking??” The answer is, they weren’t. The ability to think ahead, weigh consequences and synthesize data to make good decisions is still a work in progress in the teen years. Similarly, when a parent asks a teen or tween to describe her feelings, the blank stare the parent gets in response is not always surliness, it is often simply evidence of a brain not yet able to find the abstract words to describe the feelings.

Still, social-emotional wellness skills are crucial to avoiding addiction (which is, by the way, an adolescent onset illness – with 90% of cases beginning in the teen years) and therefore must be taught if we are to help protect teens. Adolescents who rate high on stress (and many in our community do) are three times more likely to experiment with marijuana and two times more likely to do so with alcohol.

Further, and with relevance to our community, research has revealed a surprisingly big risk factor: affluent culture. This doesn’t mean an individual family of means is necessarily at huge risk, but it does mean the CULTURE of affluence surrounding our teens increases addiction risks. Per the research of Suniya Luthar, negatives associated with affluent culture include:

1) higher rate of substance abuse than the national norm

2) higher rate of depression/anxiety

3) immense pressure for achievement

5) focus on external markers of success

6) priority on extrinsic, as opposed to intrinsic, value

7) easy access and exposure to substances (with money for purchase power).

Kids internalize messages about success, noting the high value affluent culture places on external markers, vs. acknowledgment of the child’s own inherent worth. A sense of one’s inherent worth increases confidence; a lack of it has the opposite effect.

With this background in mind, what are the nuts and bolts of vaping and JUULing?

Facts: e-cigarettes (ENDS, or “electronic nicotine delivery systems”) come in many forms, from pipes to plug-ins, and deliver differently according to their mechanisms. (Kids know the terrain well. They’ve even learned to take ENDS apart and tweak the mechanics in order to deliver drugs other than nicotine, or to increase nicotine’s effect.)

Nicotine is delivered via vaporized liquids, which come in over 7,000 flavors, often cannily named and packaged to suggest a fantasy candy-land, with the young user in mind. (No self-respecting adult is likely to be seduced by “Cake Berry Blaster,” “Tutti Frutti,” “Cotton Candy” or “Avalanche Apple Slam.”) These “vape sauce” flavors represent an obviously cynical marketing approach on the part of companies who clearly target young people, while adhering to the fiction that the product is meant only for the legal user (age 18 and over). Virtually all marketers know that the best time to grab new customers is in the teen (or even tween) years, said Russell.  And this is a $3.7 billion market, she added, projected to rise to $5.1 billion by end of 2018, with three major tobacco companies involved. Teens are blissfully ignorant of risk, and believe “vape sauce” is harmless, said Russell, and though some products are labelled “nicotine-free,” the industry is not well regulated. The flavoring agents, notably, are unregulated, and though their ingredients may have been approved for ingesting, they haven’t been approved for inhalation into the lungs. Some trace compounds in the flavored “vape sauce” are carcinogenic, if inhaled.

Regulation holds no appeal for companies seeing profits from three million middle- and high-school students who use their products annually, and some recent research on vaping is funded by the very companies who profit from it. However, counter to early claims, there is data to show that vaping has NOT proven an easy path to quitting traditional cigarettes; rather, vaping may prompt teens to START smoking traditional cigarettes, within 6 months of e-cigarette use. Further, the kids who vape and JUUL are not seduced solely by nicotine producers. Vaping has a huge presence on social media, with YouTube videos demonstrating “vape tricks” under titles like “simple vape tricks everyone should know.” Hiding a JUUL in the string of a hoodie (readily accessible to pop in the mouth for a quick hit) or creating weird vapor “trails” are shown as easy, fun ways to rebel. Ducking under a desk for a quick hit in class, when the teacher turns to the board, works too.

JUUL, with its small size and resemblance to a pen or USB stick is the most popular delivery system with many kids. It is easy to hide (adults don’t recognize it) and is convenient – it comes with pre-filled pods, carrying a liquid nicotine of choice. It’s easily found at any bodega or online. Kids “hack” the system by taking it apart to access the heating coil and pour liquid on it directly to intensify the hit (“dripping”), or to swap out nicotine for THC, in the pod. It’s ubiquitous – and its popularity is going nowhere but up.

So, is this really safe? Russell noted side effects: impulsivity, attention deficits, gum disease, lung cell damage, bronchitis, wheezing, elevated blood pressure and “popcorn lung” (scarring). It’s time to “amass forces,” said Russell, which will take “all of us, working together” to intervene – parents, schools, community. Early prevention works best, she said; Hallways currently goes into the schools to do its preventive work. Ask your kids what’s happening in their schools around this subject, she advised.

Russell stressed again that the heart of successful intervention is overall social-emotional wellness, combined with strong family relationships, with a focus on coping, decision making, stress management, building interpersonal skills and empathy. What should parents know about what THEY can do to help?

1) STRONG ADULT RELATIONSHIPS are key. Do your part in strengthening yours with your child.

2) SKILL REINFORCEMENT is crucial. It must come from home, school, community. Russell likened it to teaching a toddler to walk – parents patiently assist them over and over until they can manage alone. Social-emotional skills, too, need to be WALKED THROUGH and PRACTICED, over and over.

3) REPETITION is key. You don’t tell your child once in his life to pick up his clothes and make his bed; you remind him, again and again. Social-emotional skills, too, take reminding over time to become habit. Tell your children over and over that you want them make good choices.

4) BE PROACTIVE: talk to your child EARLY, OFTEN and CONSISTENTLY. Russell noted that kids “value their relationships with their parents and want to know they can talk to you, even if they seemingly resist.”

5) USE TEACHABLE MOMENTS. Become adept at the “one-minute conversation,” described by Russell as quick, frequent, in-the-moment observations you can make to your teen. And for longer conversations, carve out the time needed to extend those teachable moments into a full discussion.

6) EMPATHIZE. It’s hard to be a teen! Remember? Recognize their lives are tough, often with social hurt.

7) DON’T CRITICIZE TEEN FRIENDS. Instead of saying “I don’t like so and so – she’s trouble,” say that you’re worried about her well-being. Express concern for the friend. If you convey concern, your child will know that if he screws up, you’ll worry about him rather than reject him.

8) SET BOUNDARIES. Be clear with your expectations. Say plainly, “I don’t want you vaping, I don’t want you smoking pot – I want you to be healthy and safe.”

9) MODEL what you want to see. If you come home and say, “What an awful day – I need a drink!” what are you telling your child? That if things are tough, go find a chemical? Wrong message!

10) ANTICIPATE SITUATIONS, TALK THROUGH THEM, AND ROLE PLAY. If you want your child to avoid risky situations, play through them and help her brainstorm ways to handle them safely, or extricate herself.

11) ENFORCE CONSEQUENCES for risky behaviors. Russell acknowledge this is a hard one, always. Yet, she said, kids who have no consequences are pitied by other kids. Kids with them, feel cared for.

Russell also noted warning signs for parents to heed. For nicotine use: evidence of pods or packaging in bedrooms or backpacks; little thumb-drive-looking things; unusual changes in online purchases; hiding/secrecy (sneaking out to vape/JUUL); anxiety, or restlessness. For THC: red eyes; dilated or constricted pupils; changes in sleep/eating/activity patterns; changes in dress or grooming; declining grades or decline in extracurricular participation.

Katherine Prudente, Hallways Program Manager, noted that a substance abuse problem develops over time, and she outlined the stages:

1) This is fun, and it feels good. (Your child still has some control).

2) I want to do it again. (Still more a “want” than a “need.”)

3) I had a terrible day and I need to get high. (Now it’s a need).

4) I feel bad if I don’t use. (Now it’s a requirement to avoid withdrawal; fully developed dependence).

It is important, said Prudente, to intervene before there is a fully developed pattern of dependence. The Hallways intervention system (Hallways Indicated Prevention Program, or HIPP) follows a protocol of assessment (teasing out symptoms vs. normal teen behavior, identifying other factors that may be at play, such as depression or anxiety and determining what intervention is needed); short-term counseling (including learning healthy skills and practicing); and referrals (if indicated).

Prudente also provided a short list of intervention strategies that parents may use:
1) If you see something, say something.

2) Parents/caregivers must all be on the same page and the same team.

3) Trust the strength of your relationship.

4) Always lead with concern.

5) Use dialog, not reprimands.

6) Discuss family history – if there is addiction, share that information with your child.

7) Seek support.

Finally, she advised, find your OWN words for talking points. Express yourself as yourself, in ways that will help your child hear you. Be clear. Most important, say where you stand, without ambiguity.

The speakers then took a few audience questions:

Q: What is the nicotine high? A: The “hit” may make users a little dizzy, but they don’t know they’re hooked until they cannot get more of it. It is subtle.

Q: Does vapor trigger smoke alarms? A: No

Q: Are e-cigs as toxic as traditional ones? A: No, but they aren’t safe. It’s like the difference between 60 mph with no seatbelt or 90 mph with no seatbelt. Neither is safe, but it’s a matter of degree.

Q: Where do kids get THC? A: Online, in the form of oil or “dabs.”

All parents want the same things – to see their children grow up healthy, and to keep them safe. But no parent, alone, can face a crisis of the expanding magnitude of the JUUL/vape crisis. Take heart, take heed of Hallways’ valuable tips, and take comfort in numbers – we are a community. Stay involved, informed and connected, and together our community will find the strength to support our children – through love, attention and ALWAYS, through consistent communication.

FREEDOM INSTITUTE, a non-profit organization, was founded in 1976 as one of the country’s first intervention programs.  For more information about Freedom Institute, its services and the Hallways Program in New York City middle and upper schools, go to www.freedominstitute.org or www.hallways.org.