By Dr. Louise Stanger, who specializes in Parent Coaching at Paradigm Treatment Centers.

Last year, I never thought when I first wrote about the rise of vaping that it would in nanoseconds turn into a national epidemic. According to a report in the Daily Mail, “an estimated 3.6 million U.S. teens are now using e-cigarettes, representing one in five high school students and one in 20 middle schoolers” and rates have doubled over the past year.

Nor did I think that these concerns about the substances teens inhale through vapor would extend to marijuana. Nearly one in 11 U.S. students, which represents two million people, have tried vaporizing marijuana, as published in a school-based survey, reports CBS News.

Witnessing the sheer numbers of students inhaling nicotine, marijuana and other chemically-laced vapor, parents, teachers and health officials took notice and began to warn about the dangers. In fact, the growing amount of damning evidence about the risks of e-cigarettes and growing teen use prompted the U.S. Surgeon General to declare the problem an epidemic, reports a December 2018 article in the Daily Mail.

It’s easy to see how teen use accelerated so fast. Unlike tobacco, the liquid doesn’t burn, the vapor exhaled is thin and feathery, nearly invisible to the naked eye. Flavors range from fruity to minty, and these battery-operated devices are so sleek and small in design, they can pass for a flash drive or pencil in a school classroom.

Teens were also caught in the crossfire due to mixed messaging about the “benefits” of vaping – sold as a way for smokers to quit cigarettes. “E-cigarettes sit in the middle of a tug-of-war between being a device that is harmful to children, but potentially helpful to adult cigarette smokers,” writes Laura Kelly for the Washington Times. “In surveys of teenagers, smoking cigarettes is viewed as unacceptable, but e-cigarettes are the ‘healthier alternative’.”

Despite the mixed messaging, “school and health officials say several things are clear…Nicotine is highly addictive, the pods in vaping devices have a higher concentration of nicotine than do individual cigarettes, and a growing body of research indicates that vaping is leading more adolescents to try cigarettes,” writes Kate Zernike for The New York Times.

And with research suggesting teens who experiment with e-cigarettes are more susceptible to try real cigarettes, threatening to undo decades of progress in curbing cigarette use in the United States, health officials are worried about nicotine addiction. “We now have for the first time in this country, in a long time, the prospect of a lot of kids being currently addicted to nicotine,” said FDA Commissioner Dr. Scott Gottlieb to the Washington Times.

In fact, according to Joanne Ebner, manager of cancer prevention services at the Anne Arundel Medical Center in Annapolis, the hospital has seen an uptick in the number of parents looking for nicotine addiction treatment for their teenage son or daughter hooked on e-cigarettes.

“We’ve actually seen one of the teens already and we worked with their pediatrician to provide nicotine replacement therapy because he was so addicted,” said Ebner. The issue is that outside of pediatrician-provided nicotine replacement therapy, the treatments adults use to kick the habit—skin patches, chewing gum and lozenges—are not approved to be used on the youth, further complicating the matter. Still, services to help kids quit have popped up around the country in response to the growing epidemic.

As programs to treat teen nicotine addiction ramp up, officials and lawmakers are going after e-cigarette companies to restrict their grip on a captive teen audience. According to a report in Reuters, the FDA (Food & Drug Administration) came out with sweeping restrictions in November of 2018 on flavored tobacco products, the likes of which include e-cigarettes, and restricting the sale of these products at some retail outlets. Officials with the FDA also met with top-level executives of e-cigarette makers to address the issue of some of these companies hinting at backing away from commitments related to youth access of these tobacco products.

“There’s no reason manufacturers must wait for FDA to forcefully address the epidemic. Yet some already appear to back away from commitments made to the FDA and the public,” FDA Commissioner Scott Gottlieb said. Gottlieb went so far as to say “manufacturers and management are accountable for the youth epidemic” in a Tweet related to the FDA announcements.

And if you don’t believe manufacturers have a hand in getting teens hooked, just ask Jennifer Kovarik, an educator who runs tobacco prevention programs for Boulder County in Colorado. “If they didn’t want youth to use it, it would be sold in 18-and-over-only establishments. It’s available at Circle K’s across the country.”

It’s not just nicotine and harmful chemicals parents are worried their child is vaping – marijuana raises particular concerns. For starters, “vaping THC does not produce the telltale smell that emerges when smoking marijuana through a joint, blunt or pipe,” making it difficult for parents to detect if their child is using it, and “users tend to consume higher concentrations of THC” through vaping, says Brandie Pugh, a research associate at the Center on Addiction and a Ph.D. candidate in Sociology at the University of Delaware.

Additionally, marijuana is particularly harmful to a teen’s developing brain. “Damage to brain function from the drug can be worse during adolescence,” says Bonnie Halpern-Felsher, a developmental psychologist at the Stanford University School of Medicine in California. “Marijuana use has been linked to depression and memory problems. Once marijuana is introduced, you’re altering the brain forever.”

As a clinician and interventionist, I know further research is critical for this topic. However, in a few short months this issue went from a fleeting adolescent fad to the FDA and Surgeon General labeling it an epidemic.

With any public policy debate, I challenge communities, parents, schools, businesses, churches and friends to educate themselves about the risks involved with young adults consuming unknown, new or dangerous substances. And now that the issue is causing nicotine addiction in young adults, I urge behavioral health professionals, healthcare providers, school and community programs to ramp up efforts to get teens to quit this harmful addiction.

Moreover, companies and advertisers must be held accountable for pushing harmful products on vulnerable and impressionable populations. This issue mirrors the marijuana legalization debate in many ways, and I stand for greater transparency and stricter regulations for companies engaging in these businesses.

For parents of a teen son or daughter, one of the first things you can do is to have an open an honest conversation with them. You also are still in charge at home and it is your responsibility to set healthy boundaries. You must decide what you are willing to pay for or not – as for the most part you are the ones paying for these vaping devices and cartridges.

Though the jury is still out on research-based evidence, it’s important to come equipped with facts and meaningful reasons for why you’re concerned for your child’s health. According to this infographic from the Surgeon General providing useful information for parents to talk to their children about e-cigarettes, in addition to providing facts, parents must:

• Be calm, listen, and avoid criticism
• Respond to questions with thoughtful answers
• Ask questions and show interest
• Set a positive tobacco-free example
• Set Healthy Boundaries
• Decide what you are willing to pay for or not
• Develop parent-based alliances within your community
• Keep the dialogue open by maintaining an active presence in your son or daughter’s life
• Remember you are the Parent, a teen does not have the same cognitive capacity as you do.
• Their brains are still growing and you get to have a say in what behaviors you choose to tolerate.

Dr. Louise Stanger specializes in Parent Coaching at Paradigm Treatment Centers. If you are worried about your teen and want help, call Dr. Stanger at 619-507-1699.