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The Best Way To Help Teenagers Stop Vaping Still Unknown

About two-thirds of U.S. teenagers do not realize that Juul contains nicotine, according to a recent survey by the Truth Initiative, an anti-smoking advocacy group.

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In this April 11, 2018, photo, an unidentified 15-year-old high school student uses a vaping device near the school's campus in Cambridge, Mass. Health and education officials across the country are raising alarms over wide underage use of e-cigarettes and other vaping products. The devices heat liquid into an inhalable vapor that's sold in sugary flavors like mango and mint — and often with the addictive drug nicotine. VOA

The nation’s top health authorities agree: Teen vaping is an epidemic that now affects some 3.6 million underage users of Juul and other e-cigarettes. But no one seems to know the best way to help teenagers who may be addicted to nicotine.

E-cigarettes are now the top high-risk substance used by teenagers, according to the latest U.S. figures, which show that Juul and similar products have quickly outpaced cigarettes, alcohol, marijuana and other substances that have been tracked over more than four decades.

The handheld devices heat a liquid solution that usually contains nicotine into an inhalable vapor. Federal law prohibits sales to those under 18, though many high schoolers report getting them from older students or online.

In recent months, government officials have rolled out a series of proposals aimed at keeping the products away from youngsters, including tightening sales in convenience stores and online. In November, vaping giant Juul voluntarily shut down its Facebook and Instagram accounts and pulled several flavors out of retail stores.

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Customers puff on e-cigarettes at the Henley Vaporium in New York City. VOA

But there’s been little discussion of how to treat nicotine addiction in children as young as 11 years old. While some adolescents should be able to quit unaided, experts say many will be hampered by withdrawal symptoms, including anxiety, irritability, difficulty concentrating and loss of appetite.

Physicians who treat young people now face a series of dilemmas: The anti-smoking therapies on the market — such as nicotine patches and gums — are not approved for children, due to lack of testing or ineffective results. And young people view the habit as far less risky, which poses another hurdle to quitting.

The harshness of cigarette smoke often limits how much teenagers inhale, sometimes discouraging them from picking up the habit altogether. That deterrent doesn’t exist with e-cigarette vapor, which is typically much easier to inhale, according to experts.

Kicking any addiction requires discipline, patience and a willingness to follow a treatment plan — something that doesn’t come easily to many young people, experts said.

“Teenagers have their own ideas of what might work for them, and they’re going to do what they do,” said Susanne Tanski, a tobacco prevention expert with the American Academy of Pediatrics. “But we desperately need studies to figure out what’s going to work with this population.”

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Nicotine vaping on rise among US teenagers: Survey. Pixabay

Youth Use

Since debuting in the U.S. in 2007, e-cigarettes and other vaping devices have grown into a $6.6 billion business. Driving the recent surge in underage use are small, easy-to-conceal devices like Juul, which vaporizes a high-nicotine solution sold in flavors such as creme, mango and cucumber. Despite industry worries of a crackdown on flavors, the FDA has made no effort to ban the array of candy and fruit varieties that companies use to differentiate their offerings.

E-cigarettes have become a scourge in U.S. schools, with students often vaping in the bathroom or between classes. One in 5 five high schoolers reported vaping in the last month, according to 2018 federal survey figures.

Juul and other brands are pitched to adult smokers as a way to quit smoking, but there’s been little research on that claim or their long-term health effects, particularly in young people. Nicotine can affect learning, memory and attention in the teenage brain, but there’s virtually no research on how e-cigarette vapor affects lungs, which do not fully mature until the 20s.

“It’s frightening for me as a pediatrician because I really feel like there’s this uncontrolled experiment happening with our young people,” Tanski said. “They don’t perceive the harm, and we can’t show them what it’s going to be.”

Tanski and other experts will meet this Friday at the Food and Drug Administration to discuss the potential role for pharmaceutical therapies and non-prescription medications such as nicotine gums and patches.

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In this Feb. 20, 2014 file photo, a customer exhales vapor from an e-cigarette at a store in New York. A growing number of e-cigarette and vaporizer sellers have started offering college scholarships as a way to get their brands listed on university websites. VOA

Regulators acknowledge they are starting from square one: The FDA “is not aware of any research examining either drug or behavioral interventions” to help e-cigarette users quit, the agency noted in its announcement.

The FDA will also hear from researchers, vaping executives, parents and teenagers.

“We want to make sure our voices are heard and that — most importantly — our kids’ voices are heard,” said Meredith Berkman, who plans to speak at the meeting with her 10th-grade son.

Berkman said she first realized her son and his friends were “Juuling” last year when she heard them repeatedly opening and closing his bedroom window. With two other New York City mothers, she formed the group Parents Against Vaping E-cigarettes, which is asking the FDA to ban all e-cigarette flavors.

“Unless the flavors are off the market, kids are going to continue to be seduced by these highly addictive nicotine-delivery systems like Juul,” Berkman said.

Quitting smoking is notoriously difficult, even for adults with access to various aids and programs. More than 55 percent of adult smokers try to quit each year, yet only about 7 percent succeed, according to government figures.

Nicotine gums, patches and lozenges are available over-the-counter for those 18 and older, and are occasionally prescribed “off-label” for younger patients. They provide low levels of nicotine to help control cravings. Prescription drugs include Zyban, an antidepressant, and Chantix, which blocks the effects of nicotine on the brain. But neither has shown positive results in teenagers, and both carry worrisome side effects, including suicidal thinking for Zyban and nausea and abnormal dreams for Chantix.

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Many people may be vaping nicotine through e-cigarettes, smoking. Image source: post-gazette.com

That leaves counseling as the go-to option for teenagers trying to quit cigarettes.

In November, Colorado dropped the minimum eligibility age for its quit-smoking hotline from 15 to 12, in response to the explosion in vaping among students as low as 6th grade. The state’s underage vaping rate is the highest in the U.S., with 1 in 4 high school students reportedly using the products in the last month, according to federal data. The state’s over-the-phone and online programs provide free coaching to help users create a quit plan, manage cravings and avoid relapse.

But even counseling has shown only “limited evidence” in helping teenagers, according to an exhaustive review of the medical literature published in 2017.

Still, addiction specialists see growing demand for such programs, particularly group sessions that often have the most promising results.

Addiction psychiatrist Jonathan Avery says he gets four to five calls a week from pediatricians referring patients or asking about treatment options. One of the biggest problems is an education gap — many doctors haven’t heard of Juul and don’t even recognize the vaping devices brought in by parents.

On the other side, teenagers are often “suspicious” when he informs them that they are inhaling a highly addictive substance, said Avery, of New York Presbyterian Hospital.

Also Read: Due To The E-Cigarette ‘Epidemic’ US Restricts Its Flavours

About two-thirds of U.S. teenagers do not realize that Juul contains nicotine, according to a recent survey by the Truth Initiative, an anti-smoking advocacy group.

The U.S. Surgeon General, Jerome Adams, hammered that point home in a rare public advisory last month. He said even his 14-year-old son believed that e-cigarette vapor was essentially harmless.

“Youth like my son have no clue what’s in these products most of the time,” he said. (VOA)

Next Story

The Mental Health ‘Epidemic’: About Six in Ten Teen Say, They Feel A Lot Of Pressure To Get Good Grades

The American Psychological Association found that almost one-third of teens say they feel sad or depressed and overwhelmed due to stress.

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Today, one in three teens between the ages of 13 and 18 has an anxiety disorder. Pixabay

Nineteen-year-old college student Margaret Pisacano can usually feel a panic attack coming on; her thoughts start to spiral, her breathing speeds up, and her heart races.

“It’s as if a tornado and a tsunami of emotions just like overcame your body and you couldn’t control anything,” Pisacano says. “It was like almost a total loss of control over any feeling or thinking in your body.”

The Arizona native, who attends college in Florida, was first diagnosed with general anxiety disorder in middle school. She is among millions of stressed-out members of Generation Z — the group of young people born roughly between 1995 and 2015, who are currently between 4 and 24 years old.

A report released Thursday by the American Psychological Association finds the rate of adolescents reporting symptoms of major depression increased 52 percent between 2005 and 2017 — from 8.7 percent to 13.2 percent — among youth from the ages of 12 and 17.

The increase was even higher — 63 percent from 2009 to 2017 — among young adults between the ages of 18 and 25.

The survey examined data from 611,880 adolescents and adults. The researchers did not find a similar increase in adults older than 26.

Today, one in three teens between the ages of 13 and 18 has an anxiety disorder.

“The current rate of anxiety is 31 percent in adolescents,” says Dr. Elena Mikalsen, head of the Psychology Section at the Children’s Hospital of San Antonio in Texas. “It’s an epidemic. It’s a mental health emergency.”

Margaret Pisacano, 19, focuses on where she is in the moment to deal with anxiety about how her past affects her present, or how her present affects her future. (Photo courtesy of Margaret Pisacano)
Margaret Pisacano, 19, focuses on where she is in the moment to deal with anxiety about how her past affects her present, or how her present affects her future. (Photo courtesy of Margaret Pisacano). VOA

Everyone gets anxious some of the time, but that anxiety is usually temporary. However, for a person with an anxiety disorder, the feeling doesn’t go away and can worsen over time to the point where it might trigger headaches, chronic pain, stomach issues, immune system suppression and disrupted sleep.

School and the pressure to get good grades appears to be the leading source of stress for many young people.

“We see all of our anxiety referrals very clearly as soon as the school year starts, almost like from the first week and until the school year ends and then we see none of them in the summer,” says Mikalsen. “The worst is the end of May when all of the teens get their grades…they’re just panicking terribly. We hospitalize kids for all kinds of medical issues because they get their grades and their immune system just collapses. The highest rate of suicide is in April and May when they’re having finals, when they’re having exams.”

The American Psychological Association found that almost one-third of teens say they feel sad or depressed and overwhelmed due to stress.

Claire Taylor, a 17-year-old high school junior in Massachusetts, was diagnosed with generalized anxiety a couple of years ago, but didn’t have her first panic attack until she started visiting colleges ahead of her scheduled high school graduation next year.

“For my whole life, college has kind of been my end goal…It kind of hit me that college is not the end, and that there’s more after that,” Taylor says. “I’m really not sure what I want to go to college for and so just the whole prospect kind of freaked me out…I was shaking and crying and I couldn’t quite articulate why until after the fact.”

College-related anxiety is rising, according to a 2017 report from the Higher Education Research Institute at UCLA. The institute surveyed 8,264 incoming first-year students at 30 U.S. colleges and universities and found that 39 percent reported frequently feeling anxious, but fewer than half of those students say they sought personal counseling in college.

Tarek Saoud, 22, began suffering from panic attacks after he went to college and felt the mounting pressure to set a course for success in life.

“I tried switching my (college) majors a few times, but I really did not like anything,” he says. “Not being able to find something was a big issue for me…Where I grew up here in Northern Virginia, it’s very expected to be either a businessman, a lawyer, a doctor, a scientist, something like along those lines. Those are what is seen as successful.”

Tarek Saoud, now 22, in a photo taken at Ohio State University on the day he decided which college to attend. (Photo courtesy of Tarek Saoud)
Tarek Saoud, now 22, in a photo taken at Ohio State University on the day he decided which college to attend. (Photo courtesy of Tarek Saoud). VOA

Getting an appointment at the on-campus mental health center proved almost impossible, according to Saoud, who recounts a near-suicide attempt that was interrupted by a concerned friend who came looking for him.

“I’d been thinking about suicide for months at that point…there’s this big ledge I was sitting on with this big fall under it. I was just kind of sitting there thinking about, ‘Could I do this right now? Like, do I have everything in order? Did I forget anything that would get anyone in trouble and what not?’ Not like sad about it, just getting my things in order,” he says.

“I kind of felt crazy in my own head,” Saoud says. “When I was getting anxiety, super-irrational thoughts were running through my head all the time. Things like, ‘You’re never going to be happy, things are never going to get better’…It’s really easy to mask whatever inner issues are going on by being a super social, outgoing person, drinking a lot.”

He left school in Ohio during his sophomore year in college, returning home to Northern Virginia where he was eventually diagnosed with anxiety and clinical depression.

There are two new stressors impacting young people that are perhaps a sign of the times. Mikalsen says more of her patients are concerned about school shootings and the lockdown drills they practice at school.

“I’ve been a psychologist for about twenty years and this is the first year that I now have patients who have Post Traumatic Stress Disorder from school lockdowns,” she says. “Before, it was you hide and now the hiding is not working, so now it’s attack the shooter and everybody’s like, ‘I can’t attack anybody. I’m too scared.’ And they’re supposed to be climbing on desks and throwing things and they’re practicing that in the classroom.”

Graphic: Pew Research Center
Graphic: Pew Research Center. VOA

The way their parents use social media is also causing stress for some teens.

“There is a problem happening right now with parents wanting to videotape their children and take pictures of their children in vulnerable moments. Like when kids are really stressed out, like when they’re anxious, when they’re upset,” says Mikalsen. “There’s a general lack of boundaries now because we’re all on social media…and I think it’s become a really big problem for kids that their information is just shared out there everywhere with everybody, causing stress and anxiety.”

Saoud says learning to express his feelings has helped get his anxiety under control, but not all young people feel free to be candid about their mental health.

“I don’t think a lot of my friends know because I don’t talk about it that often,” says Pisacano, the 19-year-old Florida college student. “It feels like they don’t want to hear me talk about it almost. It’s almost like I want to shield them from discomfort. I’m not uncomfortable talking about my mental health issues, but I think my friends are uncomfortable that I’m mentally ill.”

Taylor, the 17-year-old Massachusetts high school student, feels that she has generally accepted her anxiety as a fact of life. But she does feel regret when her mental illness stops her from doing things she would otherwise enjoy, like an exchange trip to Spain that she passed on due to her fear of flying.

“Even though I had a lot of great friends on the trip, I was still too afraid,” she says, “so in that sense, like I wish that my anxiety either manifested itself differently, or that I didn’t have anxiety, because I think it would have been really fun to go on the trip and it would have been an experience that I would remember forever, but usually I just kind of accept it as part of who I am.”

Also Read: New Zealand Government Puts Immediate Ban on Guns Used in Mosque Attack

Saoud is attending community college for now and intends to transfer to a four-year college soon. Still on medication and seeing a psychologist, he doesn’t say he’s ‘cured,’ but feels there’s been a huge improvement