By Maury Grebenau
If you ever want to make someone very nervous, walk into a vape shop and identify yourself to the owner as a high school principal. That’s what I did one afternoon last spring when I realized that I needed to educate myself more on a relatively new issue which is widely affecting our teens. Vapes, or e-cigarettes, are becoming very popular and parents and educators need to be knowledgeable about this phenomenon in order to respond appropriately.
What is vaping?
If you don’t know what vaping is and you have a teen or pre-teen, please educate yourself on it. Vapes, or e-cigarettes, are delivery systems for a number of substances via a process where liquid is heated converting it to vapor which is then inhaled. These devices can look like a slightly longer USB drive or a long pen and fit very easily in a teen’s pocket or purse. Disposable packets of liquid (sometimes called “juice”) are inserted into the vape. The liquid can contain anything from THC (responsible for the high of marijuana) to nicotine (similar to what would be found in a traditional cigarette) to flavored liquids which do not contain addictive substances. It is difficult, if not impossible, to tell what specifically is being inhaled without the use of a lab unless the cartridge containing the liquid in the vape is marked.
We know that the use of e-cigarettes is on the rise in teens. I see the current trend of vaping to be worse than cigarettes of old, for our teens. I am not referring to the health dangers since I do not believe we have enough information yet about vaping to decide if it is worse or better than smoking a cigarette. It is the psychological barrier, or lack thereof, which concerns me. When I was in high school, it was “cool” to smoke, at least when hanging around with other teens, but we all knew that the cigarettes were unhealthy, as well as being a pain. It required a source of fire and made your fingers, clothes and breath smell terrible. We all knew the health dangers and how easy it was to get caught which naturally limited the ranks of social smokers. Those who became serious smokers were few in number and there wasn’t much envy of their behavior and addiction. With vapes, all this has changed. It is essentially odorless, totally self-sufficient (no need for a lighter) and easy to use discreetly. The prevailing feeling among teens seems to be a sense that inhaling water vapor could not possibly be dangerous, especially to teens who already feel invincible. The fear of getting caught is also pretty minimal since vaping is hard to detect, easy to hide and doesn’t require a lighter.
Are there health risks?
Vapes have been introduced, in part, as a “safer” way to quit smoking: An avenue of getting a nicotine dose without some of the health issues associated with the medium of cigarettes. The current research comes to one major conclusion: We really do not have enough long term data to say anything other than a) there are certainly significant health risks to vapes and b) it is premature to conclude that e-cigs and vapes are safer than traditional cigarettes. An article in December of 2014 in the journal Preventative Medicine cited the fact that the studies which have been done are too small and not longitudinal enough to draw solid conclusions. The authors also pointed to the fact that some studies are run by organizations or individuals with significant conflicts of interest.
While it is still unclear if e-cigs are “healthier” by comparison than traditional cigarettes, there is little doubt that they are not healthy. E-cigs have been shown to be dangerous and to contain potentially dangerous chemicals and additives. A current (2017) review of literature in the Journal of the American Heart Association concludes that vapes are not emission-free and they emit chemicals which can be harmful, in some cases at levels which rival traditional cigarettes. The study concludes that more research needs to be done on the long and short term effects of first and second hand vaping. Studies have also found the presence of trace metals and diethylene glycol (a known carcinogen found in antifreeze) in a significant minority of juice (liquid) used in e-cigarettes in the past. Although this study was done in 2009 it reminds us that we need to be well educated about these potential harmful additives and the current state of affairs.
When it comes to nicotine e-cigarettes, even the claim that they are less dangerous than traditional cigarettes is far from proven. A 2016 study found that vapor from e-cigs impairs cellular metabolism in a way parallel to traditional cigarettes and also causes heart disease. A review of the literature in JAMA, a well-respected medical journal, in 2015 recommended treating the water vapor produced by e-cigs as second hand smoke for tobacco until further research is conducted into its effects.
Even when it comes to vape and e-cig juice which is just flavored and does not contain nicotine, some of these concerns are still very much present. In 2000 it was discovered that a food additive called diacetyl, used in microwave popcorn (among other foods), caused severe respiratory issues when people were exposed for extended periods of time to fumes created by heating the diacetyl. The condition was nicknamed “popcorn lung” due to its initial discovery. A 2015 study tested 159 different samples of flavored e-cigarette juice for this chemical and acetyl propionyl, another similarly harmful substance. They found that almost 75% of the samples contained at least one of the chemicals. Another study in 2016 focused on the most popular e-cig brands had almost identical results. There are many other compounds, chemicals and trace metals which appear in vaping juice, even those which are nicotine free. Although in many cases they are only found in very small levels, not enough is known about prolonged exposure to determine the impact on the user.
Another concern which is also important to keep in mind is the possibility of the vape malfunctioning and causing burns. In 2016, the FDA extended their jurisdiction to cover electronic delivery systems including vapes and e-cigarettes. Their site has recommendations for safety measures to avoid burns and fires which can be caused by vapes. https://www.fda.gov/TobaccoProducts/Labeling/ProductsIngredientsComponents/ucm456610.htm
What can we do?
As parents in the Jewish community, especially if our children are in day school, we can sometimes feel that our children are sheltered from risky behavior. While on some level this is true, the reality is that between social media, internet and peers, our children are exposed and have access to vapes and most other risky behaviors teens engage in. Especially if we plan to have them attend secular university, it behooves us to make sure they go off ready to deal with these types of challenges. There are a number of steps we can take to help our teens navigate these waters:
- Educating ourselves – As with all risky behavior in teens, we need to be educated ourselves about the behaviors that are out there and the level of risk they pose.
- Making sure our teens know where we stand – Experience and research tell us that teens who have closer relationships with their parents tend to fare better in avoiding risky behavior. As parents and educators we need to make sure that our teens know where we stand on vaping through open conversations.
- Model responsible behavior – In addition to avoiding risky behavior as adults in the Jewish community, we can also speak with our teens about steps we take to avoid risky behavior or situations we avoid. Much of what occurs in the world is not known or transparent to them and hearing about how we navigate social and work situations can help them in their own lives.
- Know what to look for – Familiarize yourself with what vapes and their chargers look like. The FDA site above has pictures of what a number of different atomizers and vapes look like. If you find what looks like two different vapes have been fused or screwed together, it can be a sign that the vape is being used for marijuana.
- Work with your teen’s school – As schools and communities we should be working together to educate our teens about vaping and other risky behavior. It’s important to attend school sponsored parent education. Knowing more about how your child’s school is educating them on these matters will help guide your own conversations.
Because of their developmental stage, teen experience pleasure at a much higher rate than adults experiencing the same phenomenon. They are also very bad at properly assessing risks due to the pre-frontal cortex being “under construction” during this time. These two factors mean that teens overestimate how enjoyable something is and underestimate the risks which may be present. As parents and schools we need to address risky behavior with our teens and help them navigate these critical years.
Rabbi Maury Grebenau is the principal of Yavneh Academy of Dallas and has published numerous articles on education in educational journals including Phi Delta Kappan, Kappa Delta Pi and Jewish Educational Leadership. He is passionate about working with teens and is particularly interested in educational leadership. One study of high school students found that 12% reported having vaped and over 30% who hadn’t yet vaped said they would use e-cigarettes in the future. Krishnan-Sarin et. al. “E-cigarette Use Among High School and Middle School Adolescents in Connecticut” Nicotine & Tobacco Research, Volume 17, Issue 7, 1 July 2015, Pages 810–818.  Pisinger, C. & Dossing, M. A systematic review of health effects of electronic cigarettes. Preventive Medicine Volume 69, December 2014, Pages 248-260. http://www.sciencedirect.com/science/article/pii/S0091743514003739  Qasim, H. et. al. Impact of Electronic Cigarettes on the Cardiovascular System, Journal of the American Heart Association, 2017 Sep; 6(9). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5634286/?report=classic  A 2016 study found some trace metals which are lower than traditional cigarette but still present in significant amounts and nickel was found in quantities significantly higher than in tobacco products. Palazzolo, D.L. et. al. Trace Metals Derived from Electronic Cigarette (ECIG) Generated Aerosol: Potential Problem of ECIG Devices That Contain Nickel. Frontiers in Physiology, 2016; 7: 663. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5222827/?report=classic  Palazzolo, D.L. Electronic Cigarettes and Vaping: A New Challenge in Clinical Medicine and Public Health. A Literature Review. Frontiers in Public Health, 2013; 1: 56. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3859972/  Shivalingappa, P.C. et. al. Airway Exposure to E-Cigarette Vapors Impairs Autophagy and Induces Aggresome Formation. Antioxidants & Redox Signaling. 2016 Feb 1; 24(4): 186–204. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4744882/?report=classic  Collaco, J.M. et. al. Electronic Cigarette Use and Exposure in the Pediatric Population JAMA pediatrics. 2015 Feb; 169(2): 177–182. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5557497/  There are a number of studies which found that products marketed as “nicotine free” did, in fact, contain a significant amount of nicotine. Five such studies are quoted in this Preventative Medicine article: Pisinger, C. & Dossing, M. A systematic review of health effects of electronic cigarettes. Preventive Medicine Volume 69, December 2014, Pages 248-260. http://www.sciencedirect.com/science/article/pii/S0091743514003739  An article by Kreiss et. al. in the New England Journal of Medicine, Vol. 347, No. 5 · August 1, 2002 documents the study  Farsalinos et. al. “Evaluation of Electronic Cigarette Liquids and Aerosol for the Presence of Selected Inhalation Toxins” Nicotine & Tobacco Research, 2015, 168–174 doi:10.1093/ntr/ntu176  Allen et. al., “Flavoring Chemicals in E-Cigarettes: Diacetyl, 2,3-Pentanedione, and Acetoin in a Sample of 51 Products, Including Fruit-, Candy-, and Cocktail-Flavored E-Cigarettes” Environmental Health Perspectives Vol 124 number 6, June 2016.  Preventative Medicine article in footnote 8  Here is an article from NBC news about the phenomenon of vape batteries exploding: https://www.nbcnews.com/business/consumer/what-s-causing-some-e-cigarette-batteries-explode-n533516  See research by Temple University’s Dr. Laurence Steinberg in his 2014 book “Age of Opportunity”