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Friday, 13 April 2018

'Vaping': What is it and is it 'safer' than smoking for our teens?

Recently I have received a number of messages from parents wanting to know more about 'vaping'. Each of them had recently found a device in their child's room and had little, or no idea, what it actually was, how it was used and whether it was harmful or not. Here is an edited version of one of the requests for information:

"Last weekend I found a strange-looking device in our son's room. When I asked him what it was he said it was a 'vape'. It looked like a long cigarette and when we asked him why he had it he told us that it was a 'bit of fun' and he and his mates occasionally used it when they got together. He insisted he only used it to do tricks and that these vapes were harmless. We confiscated it anyway and told him we wouldn't allow it in the house. Since then we found out that one of his friends is smoking cigarettes. Our son played it down and said his mate is actually using the device to try to give up smoking. Just last night I found another vape in my son's desk drawer as I was looking for something. I wasn't spying on him - he was in the room at the time. I confiscated it and again I got the same arguments - "Don't be ridiculous mum, these things are harmless" and "I only do tricks on them like blowing round circles!" So now I have two vapes confiscated. What should I do? Are they really harmless? I have got no clue what substance he has inside the vape."

So, what is a 'vape'? Essentially it's a street term for devices usually referred to as 'e-cigarettes'. So what exactly are these and how are they different from traditional cigarettes? More importantly, what are the harms associated with their use, particularly when it comes to young people?

Firstly, let me make it clear that I do not want to try to get into the middle of the debate that has been raging in the smoking cessation area for the past few years. There are some in the tobacco prevention area who believe that e-cigarettes could (and should) play a major role in assisting smokers quit in this country, while there are others who are staunchly opposed to their use and have campaigned (and for the most part been successful) to ensure there is a blanket ban of these devices. My only concern here is for young people and their parents and trying to sort out 'fact from fiction'.

An e-cigarette is a nicotine delivery device that simulates tobacco smoking by producing a vapour. Operated by a battery, it vaporizes a liquid solution (called 'e-liquid' or 'e-juice') which may contain nicotine (amongst other things, including a range of flavours from fruit through to chocolate and bubble-gum) and is promoted by manufacturers as being 'safer' than traditional smoking because it is a tobacco-free product that eliminates the burning process. When the liquid is turned into a vapour, this is inhaled or 'vaped'. Confusing the issue is that many of these e-liquids are nicotine free, with these devices simply releasing a flavoured vapour!

We have little up-to-date data on how many Australian teens are vaping. What we do have suggests that this is an issue that we need to monitor carefully. According to the latest Australian Secondary School Students Alcohol and Other Drugs (ASSAD) study conducted in 2014, 13% of 12-17-year-old students reported that they had ever used an e-cigarette. Use increased with age, from 5% of 12-year-olds to 22% of 17-year-olds, with young men being more likely to say that they had ever tried (one quarter (25.8%) of 17-year-old males), with 7.7% reporting use in the previous four weeks. It is unclear as to whether use has increased since that data was collected but from the anecdotal reports I am getting from schools and parents, it certainly seems as though this issue has not gone away ...

So are these devices legal? It is currently illegal in Australia for commercial retail outlets to sell nicotine e-cigarettes. Regulation of the sale of non-nicotine e-cigarettes continues to vary across Australian state and territory jurisdictions. While nicotine e-cigarettes or the nicotine vial refills may be purchased online for personal use, throughout Australia it is illegal to do this without a medical prescription for nicotine. As far as schools are concerned, most of those I have spoken to about this issue have elected to view these devices as tobacco products, whether or not they contain nicotine, and deal with them accordingly.

I have one major concern about these devices, regardless of whether they contain nicotine or not. We continue to have some of the lowest smoking rates in the world, particularly amongst school-based young people, due in no small part to making smoking be seen as anti-social. Even though e-cigarettes don't involve 'smoking' per se, they still simulate the practice and there is a very real danger that the 'anti-social' message could be eroded over time. This issue is compounded by the number of times you see these devices now being used on American TV programs, particularly comedy shows, where they are usually (but not always) using them to smoke cannabis. Now that cannabis has been legalised for recreational use in California, we are seeing more and more US comedy shows using the vaping (and smoking) of cannabis to get a laugh.

In the mother's message above she talks about her son telling her that he "only used it to do tricks". Type in 'vaping tricks' into YouTube and you will literally see hundreds of videos that have been uploaded by people from around the world. Some of you may remember some of the party tricks that smokers would do back in the days when smoking a cigarette was pretty cool - these vaping videos put all of those to shame! This compilation video of vaping tricks clearly shows why some young people are attracted to these devices. Ok, it's not smoking, but vaping's increased presence on TV shows and in other media certainly increase the visibility (and possibly perceived acceptability) of a behaviour that for a long time was seen in a very negative light, particularly by young people. Most worryingly, smoking (or something that looks a lot like smoking) becomes 'cool' again.

So does the evidence suggest that vaping by teens is a 'gateway' to smoking? As the mother discusses in her message, it would certainly appear that there are some young people who could be vaping in an attempt to quit smoking. The research evidence in this area is mixed and both sides of the e-cigarette debate often throw the same data around to support their particular stand, which makes it even more difficult to sort through! There have been studies that suggests vaping is actually 'replacing' rather than 'encouraging' tobacco smoking amongst young people, while others have found that those who do experiment with vaping are, in fact, actually more likely to become smokers. This is usually explained by the fact that teens who experiment with vaping are more likely to be sensation-seekers, who would be more inclined to try smoking later anyway. Regardless, adolescent vaping cannot be ignored and some parents are going to find themselves faced with having to deal with finding out their teen is using one of these devices.

The one thing that all those in tobacco prevention field agree on is that whatever policy is adopted in the e-cigarette area, it should include some kind of restrictions around vaping by young people. As an excellent article written for the New York Times by Lisa Damour titled 'How to Talk With Teenagers About Vaping' states - "Vaping is generally understood to be less risky than smoking. But not vaping is healthier than vaping". She then goes onto talk through some simple strategies that parents can use in this area. Even though most use by teens appears to be experimental and regular use is rare, what is abundantly clear is that trying to prevent young people vaping is a good idea!

What's my advice for parents in this area and what did I say to the mother who sent me through the message? Firstly, I recommend parents follow how most schools are dealing with these devices - treat them just like you would any tobacco product, regardless of whether they contain nicotine or not. In most cases, parents would have outlined their expectations and values around tobacco smoking and if they then subsequently found their child with a pack of cigarettes, most would confiscate the product and roll out a consequence. You have to make the decision for yourself but as far as young people are concerned, it is most probably best to regard experimenting with smoking or vaping in the same light.

What happened in this mother's case is that she found the product, confiscated it and then made it clear to her son that such a device was not allowed in the house and then he openly defied her. Strike one! He also successfully bamboozled her with information about a product she knew nothing about and left her floundering. She was completely left on the back foot! Strike two! As I always say to parents who contact me when they have found some strange product, device or substance in their child's room, don't react before trying to find out exactly what you're dealing with! By all means remove it if you feel you need to but then do your best to try to find out all you can about what it is as quickly as possible (and don't just rely on what your teen tells you!). The best place to go in the first place is the Alcohol and Drug Information Service in your state and territory (you can find the number for where you live on the DARTA website). This is an anonymous and confidential telephone helpline manned by trained counsellors who should be able to provide you with some advice and information on whatever you may have found.

Vaping is not going to go away anytime soon and parents need to be prepared. Although smoking rates amongst young people are still at an all time low, parents continue to have discussions with their children about this issue. A friend of mine recently told me about a conversation she had with her 5-year-old daughter after she saw a 'no-smoking' sign and wanted to know what it was. When she told her, her child responded with "What's smoking?" It's a wonderful story and shows exactly how far we've come in this area. My advice is to add e-cigarettes to any discussion you may have around smoking - don't force the issue, let it come naturally - but raise it and let your child know exactly where you stand on young people and vaping.
References:
Damour, L. (2018). How to talk with teenagers about vaping. New York Times, February 14. https://www.nytimes.com/2018/02/14/well/family/how-to-talk-with-teenagers-about-vaping.html
accessed 13 April, 2018.

Saturday, 7 April 2018

If you give your teen two drinks to take to a party, is that all they're likely to drink? A group of 16-year-olds tell it from their perspective ...

Last week I got into a fairly heated discussion with some Year 11 students at a school I was visiting about a blog entry I had written about parents providing alcohol to teens to take to a party. Apparently when one of them had asked their parents to give them a couple of bottles to take to a friend's gathering (as they had a number of times before), they were told they were not going to be given any alcohol. They were then shown what I had written and told something along the lines of "Paul Dillon said ..." Now, as I've said many times before, I don't believe anyone can tell a parent what to do with their child in this area - you've got to make the decision for yourself. But when you've made that decision, whatever it is, own it! Firstly, to change your rules (i.e., provide alcohol for parties and then stop doing so for no real reason - this young man had not done anything wrong) is unfair and will undoubtedly lead to conflict. But most importantly, from my perspective, to put it all on me is totally inappropriate. By all means, use what you may have recently learnt to update how you parent and let them know where (or who) you got that information from, but too often I hear from parents who are so worried about being 'disliked' that they are unwilling to own the tough decisions ... 'Blaming' someone else for your decision is not appropriate and ends up undermining your authority!

Understandably, these students were not impressed! Considering what had gone down, they were incredibly respectful and polite. They could have gone on the attack but instead they just wanted to express their frustration and make it very clear to me that what I had written had affected their lives. The article they were referring to was one in which I discussed new Australian research that found that proving alcohol to young people is not protective and the best option for parents is 'delay, delay, delay'. The section that riled these students up was the claim the researchers made that "parental supply is associated with increased risk of other supply, not the reverse", i.e., if you give them alcohol, they're more likely to go and find more! They were adamant that in their case, this was simply not true - what they were given is what they drank, no more, no less!

Now I can only go by my experience over the years and what I have been told by teens about their drinking behaviour and when these research findings were released I wanted to shout the results from the rooftops! Finally we had some hard evidence that this idea of giving a 15-year-old a couple of drinks will result in them only drinking that much and could actually be 'protective' in the long-term was not true. Of course, there are always going to be some young people who do the 'right thing' and only drink what is provided but, we're dealing with teenagers and developing brains - even though they may have the best of intentions, bad decisions are likely to be made when surrounded by their peers in a party environment ... So when this group of five 16-year-olds (three young men and two young women) wanted to challenge me (and the research findings) I grabbed the opportunity to find out what they thought about this issue and what was actually happening amongst their peers.

As far as they were concerned, there were a few key points they believed that parents needed to be made aware of in terms of parental provision of alcohol. After I had taken those on board and agreed with them on most of what they said, I raised other issues and asked them to think about themselves and their peers and tell me their thoughts. To their credit they were incredibly honest and were willing to accept almost all of what I said ... I told them that I would be writing another article on the topic based on our discussion and wanted to come up with a series of key statements that they believed could assist parents to make a decision about whether or not to provide alcohol to their teen. Here are those statements, placed in order of importance according to those five young people:
  • All young people are different and trying to come up with rules for teenagers as a group is unfair and is not going to work.  They felt strongly that they were often lumped into a group with kids who they felt 'did the wrong thing' and, as a consequence, their social lives were affected. A number of them felt that rules within one family could be different in some cases, with one boy believing that he and his older brother should have dramatically different rules. His brother drank to get drunk, whereas he only drank a little to socialize - the rules his parents imposed should reflect that 
  • If parents want teenagers to develop into responsible adults, they need to trust them to do the right thing, particularly around alcohol.  They talked a lot about trust and how important it was that their parents trust them to make good choices. When I asked them whether they had ever lied to their parents about anything to do with alcohol and parties, it took a while but eventually all five of them said that they had ... Did they think they would lie again? All of them said they most probably would, mainly to protect their parents from knowing something that could upset them ...
  • When parents do provide alcohol to teens to take to a party, some of them only drink what has been given to them, others do not. They were willing to accept that many of their friends certainly did drink far more than their parents had provided but this did not happen all of the time. It apparently depended on a range of things, including what type of party they were going to, if the teen was going to have to go home after the party or not and what other alcohol was available
  • Some young people intend only to drink what has been given to them but when put into a social situation with peers can end up drinking far more. This was most probably the one statement I had difficulty getting them to agree with because all of them, particularly the young man who had initiated the conversation, insisted that they had never drunk more than had been provided. After a lot of discussion, all of them finally agreed that they had actually drunk more at least once, with a couple of them admitting to becoming quite ill as a result. The important thing they wanted to highlight was that this was not their intention (i.e., they had not meant to break their parents' trust) but it had to do with where they were and the social pressure of being around peers who were having a good time drinking more ... One girl also admitted that if she drank the two drinks she was given too quickly, she was much more likely to drink more due to her feeling a little more disinhibited
  • In some cases, when parents provide low-alcohol drinks to their children, these are traded to younger teens and stronger alternatives are obtained, usually bottles of spirits.  The young men wanted to make it clear that when parents insisted on providing low-alcohol beers to 16-year-olds, they were rarely, if ever actually drunk. The girls said that it was a similar story for young women with low-alcohol pre-mixed spirits. Amongst those groups of teens who drank spirits, alcohol provided by parents was usually on-sold or traded to younger partygoers
The one thing I could not get agreement on was around the 'messages' that teenagers were likely to pick-up from their parents should they decide to provide them with alcohol. As far as these young people were concerned, the message they would be getting was that their parents trusted them enough to give them a couple of drinks. The problem was that they all admitted that they had broken that trust at some time or another and were likely to do it again. As much as trust is incredibly important in a parent-teen relationship, so is safety. Research evidence suggests that when we follow-up teens who are given alcohol by their parents the only real message that they takeaway from the experience is 'my parents gave me alcohol'. They don't report that it made for a more trusting relationship with their parent or that it taught them to drink more responsibly.

Most importantly, when these five young people were asked what other information their parents had ever given them when the alcohol was handed over to them on a Saturday night, there was almost no response. Most agreed that one or both of their parents had probably said something like "Be careful" or "Now you know that we trust you" as they got out of the car or left the house, alcohol in hand, but not one of them could remember an actual example of that type of conversation. All of these teens had, at one time or another, been provided alcohol by their parent and not one of them could think of one safety message that had ever been discussed ...

At some point you are going to have to trust your teen to do the 'right thing' around alcohol, but are you actually able to trust them to always make good choices and not make mistakes - of course not! Trust is vital in a positive parent-teen relationship but when it comes to your child's safety, it's not just that simple ...

About Me

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Paul Dillon has been working in the area of drug education for the past 25 years. Through his own business, Drug and Alcohol Research and Training Australia (DARTA) he has been contracted by many organisations to give regular updates on current drug trends. He has also worked with many school communities to ensure that they have access to good quality information and best practice drug education. His book 'Teenagers, Alcohol and Drugs' was released nationally in February 2009. With a broad knowledge of a range of content areas, Paul regularly appears in the media and is regarded as a key social commentator, with interviews on television programs such as Sunrise, TODAY and The Project.