Many parents and caregivers feel at a loss when it comes to talking to their kids about smoking cigarettes or dealing with the newer phenomenon of vaping, but it’s a necessary conversation.
According to the Centers for Disease Control and Prevention (CDC), tobacco is the single largest preventable cause of death and disease in the U.S.
Cigarette smoking kills more than 480,000 Americans annually. Besides causing cancer, smoking harms nearly every organ in the body and greatly increases the risk of developing heart disease, stroke and emphysema. Smoking while pregnant increases the risk of prematurity, low birth weight and sudden infant death syndrome (SIDS).
Secondhand smoke causes increased risk of heart disease, stroke and cancer. Children exposed to secondhand smoke have more ear infections, frequent and severe asthma attacks and respiratory infections such as bronchitis and pneumonia.
The rate of teen smoking has been declining steadily, thanks to strong anti-smoking campaigns and government regulations that restrict sales and marketing to youth.
The bad news is that over the last few years, the electronic cigarette and other electronic vaping devices have taken the young adult world by storm. The regulations that require warning labels, control ingredients and restrict product promotion and marketing to kids do not apply to electronic cigarettes or other vaping products.
Here are some essential facts that you need to know to be able to talk to your kids about this trend and help them to choose not to smoke or vape.
Vaping is the act of inhaling vapor from a battery-operated device that heats an e-liquid and creates a vapor that the user inhales. The liquids in e-cigs contain propylene glycol (PG) and/or vegetable glycerin (VG) and flavorings. Nearly all contain varying concentrations of nicotine. There are a wide variety of vaping devices. E-cigs are made to look like traditional cigarettes and are widely available at gas stations, convenience stores and the newly formed “vape shops” along with a variety of e-liquid refills. “Vape pens,” “vape mods” and “e-hookahs” do not resemble cigarettes. These devices can be refilled with commercially available e-liquid or e-juice or with do-it yourself mixtures. E-juice comes in a wide variety of flavors attractive to young people, such as bubble gum, cherry limeade and cotton candy. Do-it-yourself instructions and ingredients are readily available in stores and online to create your own e-juice. These custom mixtures are often made to include marijuana and other drugs.
Internet sales have been unrestricted, and billions of dollars have been spent marketing these products. New regulations adopted by the Food and Drug Administration took effect in August 2016 and now restrict all sales to those under 18 years of age, but do not address access to kid-friendly flavorings or exposure to teens of aggressive marketing, all of which have been prohibited for other tobacco products.
Who’s Doing It
While the majority of kids are still choosing not to smoke or vape, use by middle and high school students is increasing at an alarming rate. There is a nine-to-tenfold increase in the number of middle and high school students who reported vaping between 2011 and 2015, according to the CDC. For the first time in 2014, more kids reported using e-cigarettes than smoked cigarettes. This trend is threatening to reverse the steady progress that has been made in reducing youth use of tobacco products. Studies are also finding that kids who vape are more likely to try cigarettes and other tobacco products as well.
Is Vaping Safe?
There is a widespread perception among teens and many parents that vaping is safer than smoking and a cool, attractive and fun social experience — without the ash, butts and smell.
There is significant debate about whether vaping is a safer alternative to traditional cigarette smoking for adult smokers, but almost all agree that vaping is not harmless. While there is less tar and carbon monoxide inhaled than with traditional cigarettes, there is still an unhealthy dose of nicotine and other chemicals. Vapor has been found to contain irritating micro-particles, formaldehyde and other carcinogens, though in fewer concentrations than traditional cigarettes. There is evidence of airway irritation, increased cough and increased airway restriction and reduced resistance to respiratory infection in those who vape. There is simply not enough research on these relatively new products to know all the long-term health risks.
But the most important and often overlooked factor in the debate about safety is nicotine. Young people should never start using nicotine in any form, period.
Nicotine is a highly addictive, toxic substance found to affect the brain the same way cocaine, heroin and other addictive drugs do. Teens are much more vulnerable to addictive substances than adults because of the rapid growth and development of portions of the brain during adolescence. It takes less exposure for a teen to become addicted to any substance, including nicotine. The younger the age of first use, the greater the risk of addiction. Teens who use e-cigarettes regularly can easily become addicted to nicotine and suffer withdrawal symptoms such as intense cravings for nicotine, headache, anxiety, difficulty concentrating, irritability and more.
Nicotine can be absorbed through the skin and mucous membranes as well as by inhalation, so handling of the refill liquids themselves carry risks. Nicotine affects the brain, heart and nervous system and raises heart rate and blood pressure. In higher doses it can cause nausea, vomiting, chest pain and abnormal heart rhythms. Because of thousands of poison-control reports of kids (mostly under the age of five) being exposed to toxic doses of nicotine, a federal law was recently passed to require childproof packaging of all e-liquid products.
The vast majority of readily available vaping products contain varying quantities of nicotine, and some have much greater concentrations than traditional cigarettes. Studies have shown that teens do not know the ingredients of the vaping products they are using. They and their parents often believe that they are just inhaling flavored water vapor. Also because of lack of industry regulation, there is no guarantee that the labeling on a product is accurate. Traces of nicotine have been found in some e-juice products labeled nicotine-free.
Communicate With Your Kids
We know that parents influence children’s habits and behaviors, no matter how much kids roll their eyes and push back. So do not be afraid of broaching the smoking/vaping topic. An open-ended discussion about the subject is the best approach. “I’ve heard a lot about vaping…. What have you heard/seen at school,” etc. Don’t confront your kids directly or ask yes or no questions, which are conversation stoppers.
Teens today seem to be more health conscious. Discuss that nicotine is a serious drug and that it can lead to an expensive lifelong addiction. If you are an ex-smoker, tell your kids why and how hard it was for you to quit. Talk about the unknowns of the safety of vapor, even if it does not contain nicotine. The long-term effects of the chemicals inhaled in vapor are just not known — why risk it?
Set clear expectations, and tell your kids that smoking and vaping are both off-limits. If you don’t want them to smoke or vape, set an example of not smoking or vaping. Make your home and car a smoke-free, vape-free zone.
How to Tell If Your Child Smokes or Vapes
One of the factors that makes vaping attractive to kids is the lack of the telltale odor and waste that traditional cigarettes produce, so use is easier to hide. But there are signs of vaping, including:
1. Any candy, fruit or minty odor, when none of these items are around.
2. Unfamiliar gadgets, especially those that resemble high-tech pens (look for holes in each end of an unfamiliar device).
3. Increased thirstiness (the glycerin or propylene glycol ingredients in vapor causes dry mouth).
4. Caffeine sensitivity (your child loved coffee or energy drinks and suddenly no longer does).
5. Batteries and chargers (some devices can be charged with a USB cable, but many require rechargeable batteries).
6. Thin, metallic wires, organic cotton and empty plastic vials.
7. Discarded atomizers (the metal part that heats and turns e-juice into vapor, which have to be replaced periodically).
8. Signs of nicotine withdrawal.
Nicotine is a powerful drug, and quitting isn’t easy. Luckily there are resources to assist. Start with your pediatric healthcare provider. There are also web-based programs and apps that appeal to teens (teen.smokefree.gov; http://betobaccofree.hhs.gov/quit-now/index.html).
As an informed parent, you have much more credibility with your kids than you may think. Check out YouTube, Instagram, Snapchat and other social media sites popular with teens. A quick search can show you the ads, celebrity endorsements and sites that promote vaping. You and your teen share the same goal: for them to grow up smart, safe and healthy. So keep your eyes and ears open, and keep talking.
Laura Searcy, MN, APRN, PPCNP-BC, is the president of NAPNAP and has more than 25 years of experience in clinical practice, nursing leadership, health policy and advocacy with a focus on pediatric primary care, child and adolescent injury prevention, substance abuse prevention and government affairs. She is a founding member of the Cobb Community Alliance to Prevent Substance Abuse (CCAPSA) and a frequent presenter on issue related to prevention of youth use of alcohol, tobacco and other drugs.