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Wednesday, August 15, 2018

Gummy bear-flavored e-liquid. (Credit: vapeg.ru)

Bubblegum-flavored e-liquid. (Credit: theimgpic.pw)

Vaping warning poster sold on Amazon. (Credit: Amazon.com)

E-cigarette and cartridges, often mistaken for USB devices. (Credit: sethbarhamreview)

The medical and business worlds are abuzz with the new phenomenon known as vaping, the common vernacular for inhaling the vapor of electronic cigarettes. After hitting the U.S. market in the 2000s, e-cigarettes have grown into a multi-billion-dollar market, with a growth estimate of over 20 percent in the next five or six years.

It has also become one of the latest in teen trends. Despite an FDA ban on selling e-cigarettes to minors, the 2016 National Youth Tobacco Survey showed 1.7 million high school students and 500,000 middle school students using e-cigarettes worldwide. How are underage kids accessing them? Local psychologist Dr. Bin Goldman explained that it is easier than one might think. “All it takes is that one place to sell them to undearage kids, and then all the kids find out where. They can get them on the internet, sometimes you have enterprising kids who sell them to their friends, or one kid who looks older and is able to buy them.” The most popular e-cigarette brand for teens is Juul, with common vernacular creating a verb out of the company’s name; to use Juul is “Juuling.” The device itself has a sleek metal design, and the accompanying nicotine “pods” (cartridges that look like USB drives) are brightly colored, with youthful flavors such as tutti frutti, bubble gum and cotton candy.

Dr. Goldman works mainly with middle school and high school students in the Bergen County area, most of whom are from local yeshiva day schools and high schools. When asked if adolescent e-cigarette use is common in the Jewish community, he replied that it absolutely is—and it spans all across the spectrum of Orthodoxy. “It’s been a common issue for a while. Schools have begun to recognize how serious it is and really think through taking organized steps to address it as a real crisis.” He added, “Kids are Juuling in the school bathroom. Kids are Juuling in class. Teachers are now a little more aware of it, so they might be able to recognize a Juul when they see one and know it’s not a USB device. But it’s so easy to take a hit when no one is looking, or to have it in your pocket.”

Unlike regular cigarettes, Goldman said, e-cigarettes don’t leave any telltale signs or scents. “It used to be if you were smoking, you’d have to take all of these precautions. You’d have to wash your hands and make sure you don’t smell, and that your clothing and your breath don’t smell,” he explained. Vaping is much more difficult for parents and schools to detect.

E-cigarettes are marketed as a safer alternative to smoking as they don’t contain all of the tobacco, tar or smoke known to cause cancer and lung disease in traditional cigarettes. Many e-cigarette companies, such as Juul, claim on their website that their mission is “to eliminate cigarettes” and that its products are “intended for adult smokers who want to switch from combustible cigarettes.” Their website won’t sell products to anyone under 21, requiring customers to verify their age when they sign in.

However, many argue that the product design is particularly attractive to young teens, and accuse companies as purposefully marketing them that way.

The terminology itself—Juul (pronounced like the precious stone), e-liquid and vaporizer—connotes a cool, clean, innocuous habit. Many assume that besides nicotine and flavoring, the e-liquid is made up of only harmless ingredients such as water. However, researchers have found that some e-liquid and aerosol samples contain toxic metals such as nickel, lead and chromium. Studies also suggest that e-cigarettes are likely carcinogenic (cancer-causing), although since they are so new it has yet to be seen how they affect the body long term. Especially disconcerting is the fact that, according to WebMD, no federal agency currently oversees the e-cigarette industry; literally “no standards exist.”

An equally pressing issue is the severe damage that nicotine itself can do to young, developing brains. Dr. Goldman shared his concern on this matter. “Nicotine is a very addictive substance and it works on the brain. Research says that exposure to nicotine in adolescents has cognitive impact on things like attention and problem solving. It affects the brain while it is being used, and it also impacts the brain in ways that last through adulthood.”

Goldman explained that the main part of the brain affected by nicotine is the prefrontal cortex, which is responsible for functions like thinking, academic work and rational decision making. “Developmentally, [if you vape] you’re affecting prefrontal cortex activity for the rest of your life. It puts you more at risk for mental health issues, behavioral problems, academic problems, those types of things,” he said.

Goldman also explained that teens are biologically much more vulnerable to addiction than adults because their brains respond more strongly to chemical rewards. Therefore, an adolescent can build up a dependence to nicotine much faster than an adult. “For an adolescent, just smoking once or twice a day can put them in a situation where their brain is addicted in a way that an adult would not be. Even after a day or two of first inhaling an e-cigarette, a kid or teenager could be addicted. And they had no idea.”

Goldman recently witnessed this phenomenon in a gas station store. “A kid was buying his first refills of the pods of a Juul. These were kids who were clearly just starting out. They were young, maybe ninth graders, and they were excited. One of them said, ‘I guess this means I’m addicted! So I guess I’ll be seeing you!’” Goldman added, “What these kids don’t realize is that they’re going to be more likely to become addicted for the long term, and to be dealing with cigarette addiction for the rest of their lives. They’re also going to be more likely to become addicted to other substances because the brain becomes primed for addiction once it develops those kinds of dependences.” Indeed, the NIH reports that teens who vape are 22.6 percent more likely to start using regular cigarettes. Additionally, many teens put other substances, such as marijuana, into their e-cigarette cartridges.

Dr. Goldman reported that often kids simply don’t have all the facts. “Something that I get from a lot of kids is ‘I didn’t realize it was such a big deal. Everybody’s doing it, and I didn’t realize it’s really wrong. People say that it’s so much better than smoking,’” he relays. “I think schools are now adopting policies and starting to talk to kids about it, but up until last year there weren’t a lot of schools that were talking directly to kids about Juuling.”

Goldman commended the schools that are stepping up. “A lot of schools—because of their own initiative, and also pushed by collective action—are really taking this seriously and doing a lot of positive things. I think that’s something that is going to create change in this area.” He broke down how the schools are helping, and the tricky situations they have to navigate. “A lot of it has to do with education—educating parents about the risks, and the fact that it’s going on, what they can do to speak to their kids and address the issues as they come up. Some of it has to do with policies—how do you treat a situation where someone is vaping? Do you kick the kid out of school? Schools, yeshivas especially, think very carefully before they kick a kid out. But they also want to be sure that they’re sending [the right] messages to the students, and make sure that they’re not allowing kids to influence other students in a problematic way.” Goldman emphasized the importance of clear policies that show students that the school knows what is going on and is taking it seriously.

Dr. Goldman encouraged parents to be proactive—to educate themselves about this issue and to open a line of communication with their kids. “Don’t think that just throwing facts at your kid, and telling them that it’s bad for them, is going to help. You really do have to have a conversation, to be able to engage them,” Goldman said. “Ask your kids what they know about vaping. Get their perspective on it. Find out what the allure is. Don’t shoot them down, but really hear them out.” After that, Goldman said, tell them about why they are unsafe and won’t be allowed. He advises parents, “You can be open about the fact that it isn’t possible for you to control everything they do; but you care about their well-being, and this is something you will take seriously because their health is important to you.”

“Safer does not mean safe” is the conclusion of many medical professionals evaluating e-cigarettes. It is not sufficient to concede that at least today’s youth are less likely to be smoking regular cigarettes; the hazards of vaping are enough to constitute a major public health concern for teens. As a community, we have a responsibility to educate ourselves and work together to take on this issue.

By Rachel Retter


Rachel Retter is a third-year intern and contributor to The Jewish Link. She is a rising sophomore at Stern College for Women.