Understanding Current Adolescent Vaping Trends.

by Deepak Santhiraj, Licensed Clinical Social Worker.

When Americans engaged one another on the country scenes of the Civil War during the 1860s, morphine became a battlefield standard. Millions of doses were given to soldiers in need of treatment from surgeries, accidents, as well as diseases and injuries. Many morphine drips and sterile syringes were sold by mail order and made accessible at local drug stores as thousands of veterans were taught to self-administer their use long after the war had concluded. Morphine’s medical use increased, but so did the number of Americans dependent upon its use simultaneously.

The healthcare community attempted to control this new epidemic through public demonstrations of its effects upon the body after misuse and abuse in response to this vortex of dependency. Morphine addiction was more commonplace as its use became ubiquitous amid the furor of substance use for medical attention. In reflection of the former American struggle of morphine’s accessibility in post-war America, we have entered into another similar health dilemma, but now a youth crisis with increasing concern.

E-cigarettes as a technology went from being largely unknown in the last decade to exploding onto the frontier as a $2.5 billion dollar industry that created ongoing debate in whether they aid in assisting smokers to quit. Since the 1950s, the tobacco industry has spent time, effort, and research into developing newer devices to help mitigate the varied health costs and vaping became a new lifestyle phenomenon with a social media presence and an emergent youth subculture.

According to the recent findings from the 2018 Monitoring the Future (MTF) study, America’s teens are demonstrating a dramatic increase of using vaping devices within any single year, with 37.3% of surveyed 12th graders reporting “vaping any device” in contrast to 27.8% in 2017. The MTF study releases findings the same year the data is collected. It has been conducted by researchers at the University of Michigan at Ann Arbor since 1975. Overall, 44,482 students from 392 public and private schools participated in this past year’s MTF survey. Since 1975, the survey has measured drug, alcohol, and cigarette use and related attitudes in 12th graders nationwide. Eighth and 10th graders were added to the survey in 1991. Survey participants generally report their drug use behaviors across three-time periods: lifetime, past year, and past month.

At the Institute of Social Research within the University of Michigan at Ann Arbor, researchers are noting the significance of vaping within the American adolescent landscape. Vaping involves the use of a battery-powered device to heat a liquid or plant material that releases chemicals in an inhalable aerosol. Examples of vaping devices include e-cigarettes such as the popular brand JUUL and “mods.” The aerosol may contain any of the following: nicotine, the active ingredients of marijuana, flavored propylene glycol, and/or flavored vegetable glycerin. Liquids that are vaporized come in hundreds of flavors, many of which are likely to be attractive to teens (e.g., bubble gum and milk chocolate cream).

Vaping of all substances increased dramatically in 2018. Nicotine vaping in the last 12 months increased by 3.4, 8.9, and 10.9 percentage points in 8th, 10th, and 12th grades. In 10th and 12th grades these increases are the largest ever recorded for any substance in the 44 years that MTF has 3 tracked adolescent drug use. Nicotine vaping prevalence rates in 2018 were 11%, 25%, and 30%, respectively. Marijuana vaping also increased substantially in 2018 as this new way of using marijuana becomes more mainstream. In 2018 prevalence of use in the last 12 months increased 1.3%, 4.2%, and 3.6% in 8th, 10th, and 12th grades to levels of 4.4%, 12.4%, and 13.1%, respectively.

Vaping just flavoring also substantially increased in 2018 to past-year prevalence levels of 15%, 25%, and 26% in 8th, 10th, and 12th grades. Teens associate little risk of harm with vaping. MTF asks separately about regular use of “e-cigarettes” and also regular vaping of nicotine.

Within the US, the statement that nicotine harms the developing brain is widely used in official documents. This means any e-cigarette use by American youth, even experimentation, is viewed as a cause for concern. This transatlantic discussion between the U.S. and the UK has wider implications because reports of study findings are played out in the global media, causing confusion in countries that have not yet decided how to regulate e-cigarettes. The reported rise in youth vaping in the U.S. has resulted in a crackdown on the American e-cigarette market, with the US Food and Drug Administration (FDA) requiring Juul and other similar vaping products to be removed from many retail outlets. The FDA has invested in graphic public information campaigns to discourage youth vaping.

“Teens are clearly attracted to the marketable technology and flavorings seen in vaping devices; however, it is urgent that teens understand the possible effects of vaping on overall health; the development of the teen brain; and the potential for addiction. Research tells us that teens who vape may be at risk for transitioning to regular cigarettes, so while we have celebrated our success in lowering their rates of tobacco use in recent years, we must continue aggressive educational efforts on all products containing nicotine.”

Nora D. Volkow, M.D., Director of NIDA (National Institute on Drug Abuse)

Those within the medical community agree that freedom is the adolescent drug of choice – freedom from and freedom for. Teens want freedom from childhood restraints and for adult behaviors. Substance use is one way to achieve a state of freedom where “nothing is forbidden and everything is permitted.” Drugs are not just physically intoxicating, but they are psychologically intoxicating. They create an in-the-moment sense of limitless possibility for young people when throwing off and expanding limits. Freedom is what a teen wants to experience.

When in discussion with your teen about vaping, here are some reminders as parents:

• Use a tip sheet to start the conversation during a natural moment. Bring up real-life scenarios will increase the likelihood of mutual engagement, active listening, and reflective dialogue.

• Consider the Eight “Deadly” Risks of which parents are most afraid for their adolescent: victimization from violence, accidental injury, school failure, illegal activities, sexual misadventures, daring risk taking, suicidal despondency, drug and alcohol involvement. Eliminate the last of the eight risks, and you dramatically reduce the incidence of the other seven. If you believe that your teen is continuing to use a vaping device, foster healthy dialogue and reflective listening but also explain your expectations and desires as a parent through psychoeducation about the risks of vaping.

• Stella Wilson, Clinical Supervisor of AMITA Alexian Brothers Behavioral Health Youth Addiction Services states, “SAFER is not safe. Vaping is deceptive. Devices, such as the Juul, deliver high levels of nicotine, thus causing them to be extremely addictive. When the vaping trend first started, I had many parents ask if it’s okay. While it is never “OK” to “let” your child engage in anything illegal (which it is for minors), it is unclear the dangers with vaping. There is a growing body of evidence that suggests that nicotine, like other drugs, harms and negatively impacts the developing adolescent brain. If your child says they are vaping, because they are trying to quit smoking cigarettes, it is not helping them quit, but rather sustaining the addiction in a different form. It is not necessarily the lesser of two evils. Early assessment, intervention and education are key in helping students make healthier decisions. If vaping has started, discontinue use BEFORE addiction becomes evident.”

• Determine which level of use (experimental, recreational, or excessive) your teen demonstrates and respond appropriately. Of course, any measure of use can result in negative health effects. Even with “good experiences” of vaping use can result in bad outcomes. Adolescence is by definition a risky process during which young people are eager to try more worldly experiences. Substance use only increases these normal risks, and you can read more about the risks associated with the vaping trend here.

• Developmental psychologist and professor of pediatrics from Stanford University, Bonnie Halpern-Felsher, states that teens acquire vaping products from their peers more so than stores. She says, “The majority of youth get their products from each other, and second from smoke or vape shops. Youth are not getting them from convenience stores.” Selling tobacco products to teens under 18 is still illegal. The vaping industry maintains its gleam for many teens that desire an ‘unharmful’ recreational product without stringent FDA regulations and moderate restrictions. Current research provides evidence that young people that perceive tobacco products as readily available are more likely to use them. Take inventory of your teen’s social circle and monitor the vaping’s youth cultural reputation.

In general, where experimental, recreational, and accidental excess use occurs, parents must insist on adequate two-way communication with their teen to determine circumstances of use, choices made, effects experienced, risks taken, and what parents need to have happen now. Where intentional excess occurs, parents should get their teen to a certified drug/alcohol counselor to assess risk of more serious substance involvement. Where abuse or addiction is evident, drug counseling or treatment is in order.

“Nicotine vaping in the last 12 months increased by 3.4, 8.9, and 10.9 percentage points in 8th, 10th, and 12th grades.