Why is Vaping Bad for Teens & Kids–Addiction Facts & How to Help

Episode Transcript

Dr. Nicole Beurkens

Hi, everyone, welcome to the show. I’m Dr. Nicole, and today we’re going to talk about the issue of kids and vaping. This is something that many of you have asked me to address on the show as unfortunately, it’s becoming a more widespread problem among younger and younger kids. While it initially was touted as a safer version of smoking, this has been marketed to kids as risk free and fun, the reality is very different. We now know that vaping carries a significant number of health risks, and leads kids on a path toward addictive behavior and substance use that can be difficult to break away from. My colleagues and I are seeing kids at our clinic who are experimenting with or addicted to vaping at much higher frequencies than even two years ago, and I’ve had several teary teens in my office finally disclose their vaping habits, desperate for a solution to free themselves from an addiction they never thought could happen. Whether you are already aware of this issue or not, it’s an important one to have on your radar, regardless of your child’s age. To help us understand the issues and the risks involved, as well as how to talk with your kids about this issue. I’ve invited Dorian Fuhrman and Meredith Berkman on the show today. Let me tell you a bit about them.

Dorian, and Meredith are two of the co-founders of Parents Against Vaping e-cigarettes , PAVe for short, a national grassroots education and advocacy organization. They founded PAVe as a response to the youth vaping epidemic, and when they discovered that a Juul representative had spoken to their son’s ninth grade class and told them it was totally safe and about to get FDA approval. We’re going to hear more about that story in just a minute. They testified about this incident in Congress. Today, PAVe has volunteers around the country, educating parents about the dangers of flavored e-cigarette products, and advocating to end the sale of all flavored tobacco products. Dorian, Meredith, such a pleasure to have you here to talk about this really important topic. Welcome to both of you.

Dorian Fuhrman

Thank you so much.

Meredith Berkman

Thank you so much.

Dr. Nicole Beurkens

So I’d love to start. Meredith, let’s start with you. I want to hear more about this story about how this first came on your radar. So as I mentioned in the intro, you had sons together in the ninth grade, tell us more about how this unfolded, because it sounds like this is what initially put this issue in front of both of you.

Meredith Berkman

As you were describing it, I was thinking, “Oh my gosh, that’s a crazy story. Oh, wait, that really happened and it happened to us.” In fact, in April of 2018, my son, I have one son and three daughters. My son was then 16 at a new school in ninth grade with Dorian’s son, Philip, and the son of our third co-founder, Dina Alessi. And my son Caleb came home and said “Mom, dad, I need to talk to you about” what he called a “mixed message anti addiction talk” at school that day. And he proceeded to tell us that when the teachers and administrators left the room for this assembly, which was what is commonly done so the kids will speak freely to these outside anti addiction speakers, this supposedly trusted adult began telling a room of ninth graders, of teenagers, about Juul. Now most of the kids in the room knew what Juul was. And so many of them were already using it. We adults, I certainly had no idea what that was, but they did. And he proceeded to tell them that Juul was for adults, not for kids, but that it was “totally safe”. Again, he went on and he said it was for adults. It was not for kids, but it was “99.9% safer than combustible cigarettes”, and as you said, would be receiving FDA approval “any day”, and I was horrified and I immediately called Dorian to see what she’d heard. And within 24 hours, we discovered in fact, this was a Juul representative that had come into the school through an outside anti addiction group, without the school’s knowledge, and I’ll let Dorian take the story from there.

Dorian Fuhrman

You know, that’s basically the gist of it. What we ended up doing after that was we started talking to everyone we knew. We called our pediatrician, we called our therapist, psychiatrist, school counselor, everyone we knew to find out what was happening, and the more we found out the more overwhelmed and discouraged we were. I mean, this was becoming a trend, and parents were not aware of it, no one really knew what was going on. And it was a brand new device, it had so much nicotine, and kids were using it behind their parents’ backs, they were using it behind their teachers’ backs, and we wanted to let people know what was happening. So we started off by putting together a website, and we thought, okay, we’re going to tell parents what’s going on. We put the website up and running. And as soon as we went live, we started getting emails from parents around the country asking for help. They didn’t know what was going on with their kids. They didn’t know what this product was. We started helping, talking to people, but then we realized that if we wanted to make a change, we really had to advocate. We had to tell elected officials what was happening, we had to stand up in legislative hearings and talk about this. So we dragged our boys to White Plains, which is a city about 30 minutes from here, for a tobacco 21 hearing, and we signed up to speak, they got up, they told their story, they ended up on the news, which was thrilling for them. And the law passed, and we realized that there really was a voice. And we really had a responsibility to do something. So that’s kind of how we started, and we haven’t looked back.

Meredith Berkman

One thing I’ll just say is that we did not share the story of Juul in the school for another year, when she says we shared our stories. The boys got up and we got up and talked about how prevalent this product was. I mean, we were so appalled by both the duplicity of this company, that we very quickly discovered by scouring the internet and almost randomly connecting with researchers that we would reach out to it, we realized in some cases, Juul was taking their material and using it and presenting it as their own from Stanford. So instinctively, there was an email exchange the day after that happened between us in which we said we’re not going to share the school story until we’re standing up before a committee in Congress because we wanted to have maximum impact. And so we started educating, and as Dorian said, we started advocating, and that’s what we do all over the country. Advocating to end the sale of all flavored tobacco products. We had such a high, fast and large learning curve. It wasn’t just Juul. Over time, they opened a Pandora’s box that unfortunately cannot be closed. There were so many copycats like Puff Bar, and so many of these disposable flavored products that have followed. And we also understood that the tobacco industry had been using flavors, including menthol, specifically, in menthol cigarettes to prey upon vulnerable and priority populations in the case of menthol cigarettes, specifically African American smokers for decades and over generations. So we realized that we were taking on something really large, so our sort of tagline has always been “Big tobacco messed with the wrong moms.”

Dr. Nicole Beurkens

Love it. And so many things come to mind as I listen to that story and how this all came about. But I want to say, kudos to you for raising kids who were able to hear that information, take it in and go, “Something about this doesn’t seem right”, and then your kids have the relationship to come and talk with you about it. I think that in itself is so often a challenge. Parents are either not necessarily open to hearing things, or kids are not feeling like they go to their parents. So really, so many pieces came together to bring this to the forefront, for you to be able to do this kind of advocacy. I want to just talk about some basics for a minute, because I think we may have some parents and even professionals listening who are like “Yeah, okay, I’ve heard about this vaping thing. I don’t really know what it is.” Let’s just talk for a minute about some basics when we talk about vaping. You’ve mentioned nicotine, you’ve mentioned flavors, we’ve mentioned the company Juul, which I think is the biggest one out there that people maybe are aware of, but if one of you can just give parents who are not really sure they know what this is, just give a synopsis and what are we talking about when we talk about vaping?

Dorian Fuhrman

Okay, well, I can start and then Meredith jump in anytime, but I think Juul launched in 2017, give or take a few months, and it was a project by two Stanford grad students, and they created this device, they call it ENDS, Electronic Nicotine Delivery System, and basically it delivers nicotine through an aerosolized formula, and is heated to extremely high temperatures, and what they did was they created a new formulation of nicotine, it’s called a nicotine salt. It is faster, it’s more easily absorbed by the body and more easily absorbed by the blood. They put it together with amazing fruity flavors which were very attractive to kids, and they put it in a stealth, flash drive looking device. So that’s what Juul was. They advertised on social media, they threw amazing launch parties, and kids were basically hearing this information and parents were unaware. So that’s how Juul started, and Juul ended up creating the youth vaping epidemic, because these products were so highly addictive, because they contain such high levels of nicotine, and had a very, very efficient delivery system. So the first generation of e-cigarettes , which came about many years before Juul held no interest for children. They kind of looked like cigarettes, they didn’t have a very attractive taste or flavor, they didn’t look very cool. So there was nothing for kids to be interested in. And then Juul came along, and as Meredith said, opened Pandora’s box and created this youth vaping epidemic with these products. Now, when everyone else saw what a hit this was, they all wanted to jump on the bandwagon, and the flavors became more and more fantastic: Blueberry ice, mango lychee, and all these crazy things, and there was no regulation by FDA. So what happened was disposables came along, and they are single serving single use products, and kids would use them and throw them away. Again, same high nicotine levels. But parents, again, we’re caught very unaware.

Dr. Nicole Beurkens

I think part of it is we don’t have a reference point in our own youth. We think about smoking cigarettes, smoking a joint, smoking as being something that is not this. And so this is not on parents’ radar to think about that, something that looks like this in their child’s bag or whatever would be something related to substance use, certainly at the beginning of this, I think more parents are aware of that now. But I think that was tough, because we really didn’t have a reference point for that, as being a way that kids were using substances.

Meredith Berkman

That was not an accident. I mean, these were jealous by design, as both of you have referenced. Juul was created by Stanford design students who had actually gone to the tobacco archives at Stanford, to study what tobacco advertising looked like. And as one of our now partners, Dr. Robert Jackler of Stanford testified, when they came to him, they came to him under, let’s say, cloudy circumstances, and what they took, you can see in the early marketing, they took sort of the best and the worst. They turned the advertising on its head and made it sleek, and they made they use young looking influencers, all of these things, and the flavors to mask the harshness, and then the worst, meaning using so much nicotine that is delivered, as Dorian said, so efficiently, we’re only focused on youth, we’re talking about minors 21 and under. And so the core of our advocacy and really of our education is about the flavors, because the previous research, and the research has continued to show over and over that the flavors have initiated kids into the use of these products, and largely flavors have always initiated kids into tobacco use. And to your point about us as parents, I mean when we were young, we already had the message: Only the “bad” kids, maybe where I went to school in the back parking lot, were smoking clove cigarettes. In 2009, all flavored cigarettes except for menthol, which is a whole other story, we talked about that briefly, were taken off the market. But this was so rapid and so under the radar, that it was many months after our sort of cataclysmic wake up call, almost nine months later until the FDA commissioner at the time, the Health and Human Services Secretary at the time, the US Surgeon General at the time, referred to this as the “youth vaping epidemic”. You have to remember, this really is the worst piece of it in a way, this is a generation that otherwise would never have been initiated into such widespread tobacco use. The youth smoking rates in this country, because of decades of heavy lifting of educators, of prevention specialists, of psychologists, addiction psychologists, all of this, this went up like a puff of smoke. The smoking rates just before Juul’s introduction were 6%. So that’s really the worst piece of it all. And again, it’s not by accident. These are the same players. Juul, in late 2018, was partnered with Altria, for which Philip Morris is the parent company. I think, was what was it, Dorian, a 13.something billion dollar investment, 30 something percent of Juul? So we at the beginning would call Juul big tobacco 2.0. But then it became clear: This is just big tobacco. And so many of the copycats and the products that have followed, it’s the same players. Big Tobacco did not go away, they were just lying in the muck, like the Loch Ness Monster, waiting to reemerge. They needed a new generation of customers because the poison that they sell kills off their customers. And I know we all agree that we will not let them create an entire generation of nicotine addicts, which is why it’s so important to have these conversations, and we’re really grateful for the opportunity.

Dr. Nicole Beurkens

My experience clinically echoes what you’re saying about the timeline with that, because for so many years, this wasn’t an issue. This generation of kids, even prior to our current school age kids, we weren’t seeing them coming in with smoking, as even a secondary issue. And then, in the last several years, it has skyrocketed. I know nicotine, obviously, is the big issue here. But also these companies make these vape cartridges that don’t have nicotine or other substances, but have the flavors, sort of this juice that kids will say, “Well, it’s not a problem that I’m doing this, I get the cartridges that don’t have the nicotine!” And that also, I want to touch on that, because I think that’s also very problematic as we get into my next question about health issues. I just want to have you touch on the fact that we’re not just talking about nicotine as the only substance in these things.

Dorian Fuhrman

Well, exactly. I mean, I think you have to say that we don’t really know what’s in these things. There are a lot of chemicals. It’s proprietary, so no one is saying what is in these devices. And then when you heat them at such high temperatures, and they combine with other chemicals, they’ll form a third chemical that no one even knows about. And the problem with the non-nicotine vapes, which they call them Wellness vapes to relax, or to focus, or lavender or whatever, it basically is just normalizing the behavior. You’re initiating these kids into this vaping behavior, and it really doesn’t take much for them to move on. Then they’ll move on to nicotine, then they’ll move on to marijuana. And we know from decades of studying nicotine that it’s a gateway. And not only does it create a whole host of problems psychologically, mentally, but it is a gateway. So on all levels, all of these products, whether they contain nicotine or whether they don’t, whether they contain marijuana, they’re all extremely detrimental to the developing adolescent brain, and that’s what we’re focused on.

Meredith Berkman

Right, and I have to say, I really appreciate Nicole that you’re bringing up these so-called Wellness vapes, which are all over TikTok, and are targeted at the younger adolescents, as Dorian said. In fact, we had our first meeting with the new FDA commissioner and the new Robert Califf, and the new head of the Centre for Tobacco Products at FDA, Dr. Brian King, just last Thursday. And that was one of the issues that we told them we wanted to share. These products, unfortunately, supposedly non-nicotine vapes, fall into a regulatory gray zone because they are not considered tobacco products, because they are not considered food or vitamins, and so no one is regulating them. And they’re sold over the counter with no age gating at Urban Outfitters and online, and as we discussed with Dr. Califf and with Dr. King, we actually think that some of these products can and should be under the authority of FDA, and the products, by the way, that we’re talking about, which can be so harmful to the lungs, developing lungs in particular, are called Ripple, Monq, Cloudy. There’s one called Love. That one boasts about being Juul compatible. And so therefore, as we told the FDA that they can take action, and we would hope that they will, but as you said, those products contain some of the same elements that you find in the nicotine ones, the PG, VG; that’s propylene glycol and vegetable glycerin. And while those substances may be considered safe for consumption, there’s no research that shows that it is safe at high heat. In fact, the opposite. So as you said, when you talk about the nicotine vapes, we know that nicotine and the developing brain do not mix, but for the developing lungs, none of that is good.

Dr. Nicole Beurkens

No, and I think two important points here, because I want to get into the risks of this, because I really want parents to hear the risks of this because I’m seeing it in my practice, and the research is bearing it out. I think one side is the psychological side, the addiction science side, Dorian, as you so eloquently talked about, that these are gateways. When we, especially in younger kids, and we’re talking about preteens here, we have kids as young as 9, 10 years old in our clinic who are exposed to this, experimenting with this. Psychologically, it’s a gateway because we build that repetitive habit, right? We build that habit of using a substance in a certain way, using it at certain times, and then it’s very easy for that then to cycle into using other kinds of substances. But we also have the physiological side of it. As I was listening to talk about propylene glycol and vegetable glycerin, okay, right, and none of those things belong in our lungs. Right? We’re talking about a product where we’re breathing these vapors directly into our lungs, and I mean, you certainly know the research on this better than I do, but we’re looking at anecdotal records now and case studies and research showing teens and young adults with major medical problems, to the point of even needing lung transplants as a result of using these things. That, to me, outpaces even what we see in traditional cigarette smoking, in terms of the early onset of the damage. So I’d love to have you talk about, just to really hone parents in on this, that there are real safety and medical concerns here, correct?

Meredith Berkman

Absolutely. In fact, people who’ve been in this fight since big tobacco 1.0, say in these meta-analyses, and we’re not scientists, we don’t have degrees and we’re not doctors, but we read all the science and we work with all of the researchers, and we know that there is enough information about the harms caused by e-cigarettes. There’s actually more than there was when the Surgeon General, back in the, I guess, in the 60s or 70s, gave his famous report about cigarettes and how harmful they were to your health. So the Surgeon General’s warning about cigarettes, there’s already more information about the negative harms of e-cigarettes than there were when he stepped forward at that time. So for example, when you’re talking about young kids, we talked about the addiction, but the latest federal studies, the gold standard, the NYTS, the National Youth Tobacco Survey, we know that the most recent studies, which were done during COVID, so we will see very, very soon when the new numbers come out how that is going, we certainly know from, as is your anecdote, we hear from partners all across the country that with the return of in person learning, and what we know and the Surgeon General has talked about, and certainly best, the adolescent mental health crisis, that epidemic that we’re living in, that combination was a perfect storm for an explosion of vape use. And so there’s a much higher use rate. So the numbers show that there was likely more addiction, so we’ve talked about that. There are studies that show for example, in terms of the lungs, that those who use e-cigarettes have a much higher incidence of more severe asthma. Now, I can give you horrifying anecdotes. I can give you some scary anecdotes that we hear all over the place of kids’ whose asthma becomes so bad, or even some who didn’t have breathing problems, that they can’t run a mile. A basketball player or a hockey player, that they’re huffing and puffing up the stairs. I can talk to you about a woman, a parent who reached out to us following the death of her son. He was a twin, they were both addicted. And her son began having really cataclysmic asthma attacks and the fourth one killed him. He would go to the hospital each time, but he couldn’t stop, he was so addicted. Now that’s a really extreme example. But the science bears that out right? There are multiple studies that show asthma. There’s evidence about the degraded nickel from the repetitive use of these devices. I wouldn’t know if I had an allergy to nickel, but there are people who see this is impacting their lungs. There are all kinds of — and Dorian, I’ll let you go on about more of the science, enormous amounts of weight loss. I mean, there have been studies that look at the higher rates of eating disorders that are related to nicotine use. Go ahead, Dorian.

Dorian Fuhrman

Well, I think there’s nicotine use, and then there’s the nicotine that these kids are getting at such high levels. I mean, with the cigarette, there’s portion control. You put it out after one cigarette. These devices have no portion control, so they’re sucking on them all day long. And the levels of nicotine that are in their blood are so high, because it just doesn’t even have time to deplete out of their blood, they just keep replenishing it. So of course, you have the worst cases, which are these awful lung illnesses. We have many parents whose kids have only nicotine in their blood; they’ve done tox screens, we have kids with seizures, because again, the nicotine levels are so high, but again, those are the extreme examples. But as Meredith referenced, the kids who are just using these all day long, they have severe gastrointestinal issues, which means that they’re nauseous, they have diarrhea, their stomachs hurt, they’re losing extreme amounts of weight, but then you also just have severe anxiety; these products are stimulants. So a lot of kids will use them because they think it makes them feel better. Some of these kids are self-medicating, they have anxiety, they have depression, they have maybe undiagnosed ADD or ADHD, so they are self-medicating. But again, the extremely high levels of nicotine are a stimulant, it does create anxiety, depression, so whatever these kids think they’re trying to cure by using these, it actually exacerbates it and makes it worse.

Meredith Berkman

The really scary thing of course is what we don’t know, is that our kids could be used as lab rats. So we do know scientifically that nicotine can, and this is not specifically about, an e-cigarette, but I don’t know the scientific term, but if you have, God forbid, a cancer or tumor, nicotine will speed it up as it metastasizes. There’s one animal study that shows a link between e-cigarette nicotine use in mice, and now I believe there is also I think at West Virginia, there’s one study that that suggests there are certain kinds of cancers that the research has been coming out to say that you have a greater likelihood of, I think one of them is lymphoma, and there are a few others. But what we didn’t know about cigarettes early on, we don’t know where this will go. And when we’re talking about children, again, our advocacy is focused on the flavors because the flavors are hooking the kids on these products that are incredibly harmful and dangerous. Adults can make choices because they have better judgment. Their prefrontal cortex is further developed, the brain is not fully developed until you’re 25 or 26. So we really focus on the kids. And a society that doesn’t protect its kids from harm is not a healthy society. And so that’s the issue, that we know it’s bad. But there’s so much we still don’t know. But the tobacco industry has a long history of hiding from the public. The tobacco documents that were released and are at UCSF, the tobacco library, they knew what they were doing. And the thing that came out in the congressional testimony that we and others gave, is that very early on, the Juul leadership understood that they were hooking kids, and they used social media marketing to go after them. And that’s why, for example just last week, we saw that 33 states and Puerto Rico settled with Juul, because of its targeting to kids, for $440 million, which sounds like an enormous amount of money, but there’s no number that you could ever put on the human cost of this epidemic that has affected millions of kids and their families across the country. And at the end, the worst part is there will be public health consequences and costs for decades to come. And we don’t even know what they are.

Dr. Nicole Beurkens

There’s so many layers of this, and I’m really glad you’re talking about the bigger picture of how insidious this is, from a marketing perspective, the intentionality of it, because we see this happen in lots of different arenas. I think this is important. One of the things I wanted to spotlight that came to my mind from my clinical practice, in terms of the physiological stuff that that you were mentioning, Dorian, you mentioned certain things like getting nauseated, having GI issues, I can’t tell you the number of kids now, generally teens, young adults, who we see in the clinic who have unexplained symptoms, right? It starts with that they are seen some specialist and they’re having GI issues, they’re having nausea, they’re having weight loss, or their anxiety is spiking, or whatever it is, and when you develop a relationship enough with them where they start to open up, and then I’ll ask about, “Tell me what’s really going on, I know you’re exposed this, I know, there’s kids in the bathroom at your school doing this. Have you ever thought about it? Tell me about this for you”, it often will come out that they actually are vaping, that they have them, that they’re quite addicted. And when you have that piece of information, suddenly it helps explain a lot of the physiological issues. We also have kids who are on medications for mental health or other kinds of medical issues, who this can really become a problem for. High doses of nicotine consistently throughout the day can have negative interaction effects with their prescription meds, and a lot, most of the time, I would say, at least in my clinical experience, and just raising four kids now for 22 years, most of the time, kids are not fully transparent with the adults in their life about this stuff. And so there’s really a need for us as parents and adults to be aware of it, so that we can broach these topics, because kids can be experiencing side effects and issues and we’re not aware of actually where that’s coming from. So I just really want parents to hear that.

Meredith Berkman

I want to ask you, Dr. Nicole, when you ask these kids — you’re obviously great at what you do, and you have a good relationship, and you ask them: How many of those kids seem relieved or are so grateful that you have uncovered it? Like they’re desperate to unburden themselves, because I’ve seen that in my own family. I believe this is true, but please correct me if I’m wrong: I don’t think adolescents really know what addiction is necessarily, until they’re so addicted, because they feel that they’re leading the process. And it’s whatever moment they get to or when someone cares enough to ask them in the right way, and then they realize they’re so desperate and they don’t know what to do. So I applaud you as a professional and as a fellow mama of four, because we talk so much to parents, and this all sounds so grim and scary, and it is, but at the same time, we’re the first national parent voice to fight the tobacco industry. We think it’s so important. The good news is that there are so many resources out there, and that parents can educate themselves now. They can know what these devices look like. And as long as parents are willing to partner with their kids and speak to their kids in a non-confrontational way, one of the things that we tell people is exactly what you said: It’s broaching conversations about “I’ve been doing some reading/I’ve been hearing a lot about these products and vaping. I know they used to call it the Juul room in the bathroom. What happens when you go to a party? And what does it feel like?” If you ask the average kid, with transparency, “So do you vape?” “No, but I found this.” We were doing a conversation as part of our conference with the North Carolina Attorney General Josh Stein, who was the first one to settle for $40 million with Juul, and he said, “I only discovered this because I found that in my house, and I asked my children, and they said it belong to their friends. And I was thinking, like, we know that story. We all do.” So you can’t just say to a child, your own child, “Are you doing this?” Who’s gonna say yes? I’m sure there are kids out there, God bless them and their families, but the majority of kids will not, it has to be a series of conversations of openness. And there’s what we didn’t know, and I’m sure you do in your professional field is there’s so much stigma around addiction, and so much shame. And that’s something that we have to fight against, so that we as parents are willing to ask for help from specialists for our kids, but so that the kids can come to us. And in this case, in particular, these kids were targeted. It’s not to say that there are no rules, that whatever, you are free range. That’s not what this is about. It’s saying “We understand these kids were preyed upon, and we want to help them. You don’t punish for addiction. You have to partner with these kids to help fight addiction, That’s what we think.

Dr. Nicole Beurkens

It’s so true. And they are desperate to have this secret out there. They know it’s not good. Especially, I think what you alluded to there, is this very sudden, “This got out of control for me” feeling. None of these kids, none of these young adults intended for it. It went from something that they just thought was helping them to fit in or something that was fun or harmless, to suddenly realizing one day that they cannot function without it, and that they are addicted. And that’s really scary for a kid. And it’s really scary for them to be alone, I think you’re absolutely right, for the vast majority of them, unless a trusted adult broaches the conversation and creates a safe space for them to open up about that. They’re not going to. They don’t want their parents to be angry. They don’t want to get in trouble at school, right? So they keep it to themselves. And then the addiction just gets stronger and stronger. And they’re kids, they don’t know how to get out of that. So I’d love to hear, Meredith, you shared some good starting points or ideas there for what parents can do. Dorian, from your perspective, what are the things that you share with parents around how early we should be talking to our kids about this, and how do we start those conversations? Because I think this is something that a lot of parents really struggle with.

Dorian Fuhrman

Oh, absolutely. We say it’s not a one-time conversation, this is something that you just keep bringing up casually. You start as young as eight years old. I mean, these kids are seeing the real cost and the Truth Initiative anti-vaping ads on Nickelodeon. So they’re seeing it, so you have to start that conversation early so they know what it is, and so they know that they can come to you. If you’re walking down the street and you see a vape shop, say “Hey, what do you think that is?” It can be opportunistic; it can be when you’re driving in a car and you’re not looking at each other. Sometimes that’s a little easier for kids to open up if they’re not being stared at. So I think every one really needs to understand how their own kids function and how comfortable they are sharing this information. But it’s really not a one-time conversation. You have to start early, you have to be opportunistic, don’t talk about it in front of their friends because this is something that is really better one on one. But it’s so important to have that dialogue. You cannot wait until something happens to let your kids know that they can come to you. You should start early so that they know.

Meredith Berkman

It’s a real balance. You don’t want to glamorize something by talking about it too early. Some of the saddest things I’ve ever heard on this topic or when we have conversations, like at our conference, with parents and kids together, kids who’ve struggled, and one young man who’s slid back into it, because the problem is, and you’ll know this as a professional, once your nicotine receptors are activated, it never goes away. And that’s why there’s so much return, it’s so hard. Anyone who’s ever quit smoking will tell you how hard it is. There is three times as much nicotine in these devices, as there is in cigarettes. So can you imagine for a young person, how hard that is? One of these young people, the question was asked by a pediatrician volunteer mom on our team: What would you tell a younger child who hasn’t started using these products? And I will never forget, he said, “I would just say please don’t start, you will regret it.” And this is a young man who’s like 18 or 19. And I’ve heard those things before. My own child told me about a boy at school that everyone knew, he was constantly in the bathroom and getting in trouble. And by the way, one of the things we can talk about another time is, we work with schools, with our partner organizations to say we believe in alternatives to suspension. It doesn’t mean that there are no rules and it doesn’t mean there are no consequences. But that punitive model, when you’re talking about addiction, it doesn’t make sense, it’s not helpful. So that’s a whole separate thing. But again, my daughter said that he went up to a younger boy, and said, “I just want to tell you, you don’t want to end up the way I am, don’t start.” These are children. It’s heartbreaking.

Dr. Nicole Beurkens

Well, and I think so much about this is us, as parents, or teachers, or adults in kids’ lives, dealing with our own emotions around this and our own responses when we find out that our child or a student at school or whatever is doing this, that we want to partner with them. And I think Dorian, what you were saying about this is not a one and done conversation, that this is something that evolves over time, I think one of the really important things that we directly need to say to our kids is, “Hey, if you ever find yourself struggling with this, if you ever find yourself” — whether it be talking about any substance, “I’m here to help you, you’re not going to be in trouble. I’m going to partner with you, we’re going to figure that out together.” And kids need to hear that, because by and large in my practice, the number one obstacle that gets in the way that kids bring up, whether it’s 10 year olds or 25 year olds, what they bring up around why they have not gone to anyone in their life about it is they’re afraid of their parents being angry, disappointed or upset, or they’re afraid of getting in trouble at school. And so I love what you said, Meredith, about working with the schools around supporting the real issues there, not punitive, supporting issues of why people are using in the first place, and then really helping them address that. But as parents, I think it’s super important that our kids know that they can come to us, and they’re going to get support. Now support is different than saying, “Oh, it’s okay.” We don’t have to agree with the decisions they’ve made, but to be a support so that they know they can come to us and we’re going to help them with it, not punish, not ostracize, not condemn them. I just think that’s such an important thing because I’ve had so many kids over the years share that that’s what gets in the way of them coming forward about it.

Meredith Berkman

Right, and about the suspension piece, I think, again, I can tell you, there are a couple of parents who really were struggling with their kids. I’m thinking of one mom in particular in Maryland, who said that I think it was the assistant principal, that she partnered with him, and her son knew that if he went to the bathroom and it was just too much, and people were vaping — he once called her from like inside the stall so that she would go get the assistant principal, help him come to my office, let’s just take a breath. Let’s try some breathing. And I thought that was so remarkable that the schools, that these educators care about protecting and helping kids. It’s just very hard. I think being open with schools about the topic, I think it’s important for parents to push schools that they feel aren’t doing enough education within the schools for the kids. There are still schools out there that are pretending that there’s no problem. And then there are hundreds of school districts that are suing Juul. School districts aren’t normally litigious, there’s a reason, and it’s not just Juul anymore. I mean Juul created this youth vaping epidemic and Juul has to be held accountable, but there are so many copycats, and one of the major advocacy problems, as Dorian mentioned much earlier, is that the FDA failed to fully regulate these products from 2016 on. In fact, just last week, we passed the one year anniversary of FDA’s postponement. There was a federal court ordered deadline for FDA to rule on whether or not all of these products that came in the market from 2016 on can remain on the market, rather than taking all of them off the market till they decided if they were the standard is appropriate for the protection of public health. They’ve let them remain and proliferate. So there has not been full regulation. That is, to us, another one of the most shocking aspects of this. The FDA is meant to protect the public health of all of us, and especially of our children, and they have not taken action, federal court ordered action, they’ve not done that for over a year, for years. So until the federal government removes these flavored products from the market, we really don’t have a chance. And so it’s so important for us. We work with parents who will stand up, volunteers at the city, state and local levels to advocate in their communities for ending the sales of these products. But our education, in some ways, is the most important form of advocacy. If we don’t educate parents about what these devices look like, how to talk to their kids, how to partner with professional schools, then we can’t get anywhere.

Dorian Fuhrman

And support parents. I mean, I would just like to add: We talked about the kids needing support, and that’s absolutely true. But the parents need support as well. We’ve had parents who said, “Oh, my God, I was so ashamed, I didn’t know who to talk to because our family life was just so difficult.” You have explosive outbursts of anger, and anxiety. And parents don’t know how to deal with it either. So you have to give parents a safe place with other parents who have been through it to talk too, and we also do that.

Dr. Nicole Beurkens

It’s such an important point, absolutely. Parents, not knowing where to turn for that either and how best to support their kids. There are about a million other questions that I have around this. There’s so many more things we can talk about here, but I know we need to wrap up, and I want to make sure that people know where they can find out more about your organization PAVe. I know you’ve got resources, you’ve got ways that parents can educate themselves, get involved in advocacy. What’s the best place for parents to go?

Dorian Fuhrman

Well, I was going to say obviously, you can go to our website, which is parentsagainstvaping.org, but also, we have a very vibrant Facebook group, we have a private Facebook support group where parents can answer a few questions. And it’s only for parents who are dealing with this addiction, so they can join the support group, or on Twitter, or Instagram. We’re kind of everywhere, but I would say Facebook and our website. You can find out information by state, you can learn how to help your child quit, learn how to talk to your child. There’s so much information.

Meredith Berkman

And we also have resources from some of our partners, including FDA and the Surgeon General and all of the public health groups. If you go to our website, parentsagainstvaping.org, if you have a specific question for us, you can always write to us at info@parentsagainstvaping.org. If you want to get involved in the state where you are, in the state of Michigan, or in any state, or if you have questions about parents in your state or in your area who are volunteers with us, you can always again, info@parentsagainstvaping.org. And we also do presentations for schools, for community groups. You can request that as well. We do those in Spanish and in English, and we’ve started doing ASL. So we would hope that people will go on our website, contact us if you have a question at info@parentsagainstvaping.org. We appreciate your work, your time, and the opportunity to have this conversation. And frankly, we’d love to have you come on our podcast, and maybe do a webinar. We do a lot of Ask the Expert because your approach is so important about the way you described getting kids to open up about what the real issues are, and partner with parents. So we’re thrilled. This was a great opportunity for us to talk but also to get to know you, and I hope we can continue the conversation again.

Dr. Nicole Beurkens

Absolutely happy to do it. You both have a wealth of information on this. You’ve put together such amazing resources. I want to encourage all of you listening to go check that out. Again, whether you have a young child and this really isn’t something you’re dealing with yet, prepare yourself. Know the signs. Being proactive is way better than being reactive, so make yourself aware. And for those of you who feel like, “Oh gosh, I should have already talked to my kids about this, or this is already an issue for us”, there are so many resources and supports available for you as well. It’s not too late. Take advantage of what PAVe is providing. I love that you have a Facebook group where parents dealing with these issues can come together and support each other. This has just been a great conversation. Thanks to both of you, first of all, for creating, and you’re doing this amazing organization. I know it’s a nonprofit, certainly a ton of work. Thank you for that and also for spending time with us today. Really appreciate you both. Thank you.

PAVe

Thank you so much. Thank you.

Dr. Nicole Beurkens

And thanks, as always, to all of you for being here and for listening. We’ll catch you back here next time.