Hi, I'm Mark Moreno.
I have the privilege of co-leading the MD Anderson
EndTobacco™ Program.
And I'm here today with Dr. Jennifer Cofer, the executive
director of the EndTobacco™ Program.
And this is the Cancerwise Podcast.
Jennifer, thanks so much for being here.
We've been working together on the EndTobacco™ Program for
ten years, addressing the harms, and
the impact of tobacco use on the population and on public
health.
Thank you for having me.
It has been a great ten years of amazing milestones
for the EndTobacco™ Program.
And thank you for choosing this topic to talk to teens
about vaping, specifically what parents can do if their
child is vaping.
Thanks so much. So, today we're going to talk about
vaping among kids and teens.
And to begin our conversation, Jennifer, can you just share
how many young people are vaping today?
Grateful to have the opportunity to talk about tobacco use
and vaping, specifically.
So, I may use those words interchangeably because some
people don't consider e-cigarettes a tobacco product,
but I absolutely do because that's where they're generated
from. But in the United States, when we look at
youth population, we have 10% who are
currently using some type of tobacco product.
I always like to use a statistic, but also a real number.
That's about 2.25 million kids who are using
some type of tobacco product, whether it's oral nicotine
product, a smokeless product, cigars, e-cigarettes
or traditional cigarettes.
Specifically with vaping, to answer your question, we've
seen 1.6 million students
still vaping e-cigarettes as of last year.
It's a decrease from our highest point in 2019,
when we saw an epidemic of almost 30% of our youth
vaping. So, we've made tremendous progress over
the past 5 to 10 years.
But just to repeat, 1.63 million students are
still vaping. And I think that's under-reported because
they're answering a survey in schools.
And so, we know that some students may not be answering
honestly. But 1.63 million students, that's about
6% of our population still vaping.
In Texas, specifically, we have a 14% e-cigarette
rate, and our smoking cigarette rate has dropped to
3.4%. So, we are making great progress
over the past 5 to 10 years.
Very, very encouraging to see that we see
a decline in the percentage of youth that are using
combustible tobacco products.
But unfortunately, we have still at a stubbornly
high rate use of vaping products.
In December 2018, you may recall that then-U.S.
Surgeon General Jerome Adams declared youth vaping
an epidemic, and he did this over the course of a visit
to MD Anderson, which was a real milestone visit.
We were so excited to have our surgeon general here.
Can you talk just a little bit about why is vaping really
so dangerous for kids?
As a public health professional, we were very
grateful he specifically put out an advisory
and a warning to parents, and to policymakers, and to
educators about the highest rates of vaping among
our youth. Twenty-seven to 30% vaping, at
one point, is very concerning.
That could be one out of three students.
So, what's so dangerous about vaping?
First of all, three things come to mind: the nicotine
levels, the flavors in the products and the actual
impact on mental health.
So, I'll dive deep into each of those.
Nicotine disrupts brain development.
Our brains develop up until we're 25 and 26
years old. A lot of high school students think that
they stop growing, their brain has stopped growing, but
that's not the case. Nicotine impacts the synapses
in the brain connections, and that impacts mood, learning,
self-control.
And so, it's really important to not have nicotine in the
adolescence phase at all.
And so, with the level of nicotine that we're seeing in
vaping cartridges at 5 or 6 mg.
A lot of people ask me, "What's that equate to in
cigarettes?" So, we're seeing 5 to 6
mg equate to about 2 to 3 cigarettes.
And we have some students who are vaping a whole device,
and that could be impactful when that accumulates over
time if they're daily vaping or if they're weekly vaping.
But when it comes to flavors, 87% of our
kids say that they're using a flavor.
We know flavors are drawing them in, but it's nicotine that
keeps them coming back to hit their vape.
Flavors come in lots of different variety of
names that are attractive to kids.
A lot of the flavors tastes like cereal, which
of course, kids grow up eating.
So, that's what's drawing them in as well, and fun flavors
that match what they're into as well.
The type of nicotine
has been studied to show mental health impacts,
meaning it's amplifying feelings of anxiety or
worsening symptoms of depression.
There are many researchers looking into this specifically,
but this is what kids are using to cope and manage their
stress. And that's what causes alarm.
Kind of building upon that, how do you talk to your kids
about it? If you're a parent, how do you address some
of these concerns and issues with your children?
It's a great question, and one I want to make sure
we talk through thoroughly, because a lot of the people
in my neighborhood or in my family and friend group have
asked, "Well, how am I supposed to talk to my high school
student, my middle school student, or even my upper
elementary school student?" And it's all about
age-appropriate conversation and engagement.
The first thing I tell parents is to make sure you are
educated on the actual facts.
Ninety-nine percent of the devices on the market
have nicotine. So, when a student or your child says,
"It's just water vapor." Or, "It's just flavored whatever
it is," it's not true.
There's a lot of nicotine in these devices.
Like I said, about 99% of these devices
in our retail markets have nicotine.
So, most everything that they are vaping or in their friend
group is vaping nicotine.
So, be prepared and know the facts, educate
yourself and actually prepare your conversation
because you never know when it pops up with a middle
schooler or high schooler. They could ask a question.
But I actually think about being proactive. So, you're
driving to and fro appointments, or
errands or going to practice, drop your kid off at
practice. If you drive by a vape shop, which there's
unfortunately one on almost every corner, ask
your child, "What do you know about vape?
What do you think they're selling in there?
Or what do you think a vape is?"
And see what their knowledge level is of the product.
You'll immediately know where to engage, depending on that
response.
You can also be non-confrontational and
avoid judgment if they start talking about certain
friends that vape or talk about what
they were exposed to.
Being caught off guard or dramatically
responding is not always going to continue the
conversation, depending again on the age.
A sixth grader is going to be very different than your
senior in high school.
So, I think age-appropriate conversation is important.
But it is very critical you have the conversation
with your child. It is absolutely
known that they have likely been exposed, or it's been
in the bathroom at school where kids are vaping and they're
exposed there, or they're hearing about it in social
settings. But finding the right time, being calm and open,
preparing yourself, making sure you're knowing the facts,
as well as not being dramatic and doing scare tactics of,
vaping is going to wreck your lungs.
But think about what they're into as the conversation
evolves. Are they into sports or are they into band?
And they need their lungs to blow into an instrument?
Think about having that conversation that directs them to
what their interests are, of, why do you think you would
want to vape and put something that would damage your lungs
and that would risk, you know, your ability
to play a sport or play the instrument? So, looping
It back to them and their interest is very important.
I listed off a lot of things.
Anything you want to add as a parent of adult children
who were teenagers at one point?
Our son was an athlete.
And so, really helping him understand the harms of
potentially using those types of products and what that
could do to his performance and his ability to to compete
at the highest level in the sport that he just loved so
much. So, what are some of the signs and symptoms
that parents can look for regarding the use of these
products?
Great question. I think first off, smell.
Second would be some physical symptoms.
And then three, you want to look for devices. So, regarding
the smell, if you've been in a rental car, or
hotel room, or walked past anyone that's vaped,
you definitely can smell fruit or a sweet scent.
That is absolutely the first thing that is an indicator
that your child might be vaping, or their friends might be
vaping. So, that is just a lingering
prominent factor that you could easily find.
The other physical symptoms are actually, it's a long list,
but it's going to vary depending on if they're an
occasional, hitting the vape
once a weekend or if they're actually daily vaping.
If they are daily vaping, you could see impact, and
again, this goes back to the nicotine, impacting their
mood, impacting their personality.
They could be more irritable, they could be more restless
and not sleeping well.
Physically, they could have more respiratory infections,
which could lead to pneumonia.
You can see increased thirst.
There is impact on the oral cavity. So, you could see
more flavoring needing to salt food or add flavor to water
because the vaping can impact their taste buds.
You can also see an impact of voice changes or their
throat, coating on their throat because of the vaping,
again impacting the oral mucosa in the mouth
and the throat.
You could see nosebleeds as well.
So, acute, meaning short-term, symptoms could be ear,
nose, throat-related, respiratory, increased
cough, but also physically,
mood changes, irritability, restlessness, can't sleep very
well. So again, it depends on the amount of nicotine
they're using. And then I'll lead into the device type.
So, if a parent is going to go and look in the room or in
their belongings, it's not a normal
device anymore. They are made into
fun shapes or sizes or devices that look like
a highlighter, like your highlighter.
There's been another device that's been a video game.
The video game is embedded into the device and
every puff is a point, or every puff gets you to the
next level.
We are seeing some changes with those types of devices, but
they are out there.
We've seen hoodies that have hidden pockets for vapes to go
into. So, a student could hit the vape in school and
put it away in their hoodie.
And so, we've seen other types of devices that are, again,
attractive to kids.
I don't find a 40-year-old trying to go get a highlighter
to vape. So, that's one thing out there that
I know was addressed this past session, looking at
technology where vapes are embedded into technology
or devices attractive to kids.
Well, thank you so much for that. And you're so right.
And it really does bring to mind the importance
of policymaking and the role that
regulations or laws can play in curbing behavior
or addressing these kinds of risks, you know, where the
industry has become so creative in developing these
types of devices that are so attractive to our youth.
In the most recently concluded
state regular legislative session.
Our legislature adopted a bill and the governor signed it
into law, which would prohibit the marketing and the
selling of vape products that are disguised
as office supplies, or USB ports, or headphones,
or video games as you just described, or other devices.
Can you talk just a little bit about the impact that
these policies can have on the access and the
use of these kinds of products for our children?
Absolutely. You said the best phrase, policy does shape
behavior. Just like seatbelt laws are now a natural
for helping reduce car-related,
car accidents that impact people.
The same thing with how they regulate e-cigarettes are
going to impact how our youth have access to them.
So, policies do shape behavior, and we're very grateful
these lawmakers saw what we saw in
the marketplace was appalling.
New types of devices trying to attract the kids in.
Again, they're buying them for flavors or the device type.
So, this policy that you referenced helps
reduce the access points where kids can go buy it, or
where their older siblings can go buy it.
The influence of policymakers, the school leadership,
retail outlets, families and friends, all of these are
influential to our kids and keeping them from starting
vaping.
So critically important. And again, another area that's
probably too easily overlooked.
Can you talk just a little bit about what you discovered
through your incredible research in your PhD program, and
how impactful those kinds of policies can be in
this particular instance?
Absolutely. Thank you for bringing that in.
It was a great opportunity to research, actually, did young
adults, 18 to 24, to actually ask
them and have conversations with them individually.
And also a survey.
It was over 5,000 students that took the survey in Texas
colleges.
I asked them what a possible tax number would be that could
impact them to think about quitting or cutting back,
because we do know that tobacco taxes have impacted
youth and young adult consumption as well as adults,
meaning the higher the price, the more we see a decline
among adults using, the amount they use and
even preventing kids from ever starting.
Thinking about a price on anything that you would use, if
it goes up in price, you think about maybe not buying it a
second or third time, if it's out of your range
of your budget. So, the same thing I brought to college
students, who may not have loose change around
if their, just depends on their status.
But most college students I was talking to were working
part-time, and they were really budget mindful, but they
also were vaping. So, we talked about how much it cost,
and I asked them if I put a tax on your product,
would you think about quitting or cutting back?
And it wasn't until we reached a higher level amount of tax
did they say yes they would cut back or quit.
So, that proves again what we know for decades of taxing
traditional products, that if you do add a
price and the price strategy increases, we will see
people decrease the use of these products, which again,
just takes home between these surveys and conversations,
it's an opportunity in Texas for policymakers to
think about establishing a meaningful price on
e-cigarettes. If you think about the tobacco marketplace,
cigarettes are taxed, smokeless is taxed,
but our vaping products are not taxed in the state.
So, it's an opportunity, again, both for public health to
get a meaningful price to help people think about quitting,
but also it could bring revenue in for the state as well.
Thank you so much for that.
And providing just a little, a sort of deeper analysis
into how impactful tax policy can be.
And in Texas, we're making some strides
and they're modest, but we're making some strides.
MD Anderson has been a part of a statewide tobacco
prevention and control coalition, which you help lead, and
our department also contributes significantly
to the development of those kinds of policies for the
state. Now, turning our attention to a little more
touchy subject, and I'm just really curious to hear
your perspective.
How can you look around really in your your kids room or
their belongings if you're a parent or
a guardian to see if they're hiding or if they're
disguising vaping products?
Tell us a little bit about what you think on that.
So, that is touchy.
You don't want to have a gotcha moment, and you don't want
to automatically just lead with punishment.
And you're going to be livid if you find something.
But think about it as an opportunity to see if your
student, your child needs an intervention because nicotine
addiction is very serious.
We don't want this, again, to impact our adolescents
and specifically their adolescent brain development.
So, if you think about, I need to look for these devices
just from that perspective so that we can have an
intervention early.
So again, because it's a serious matter, the earlier
you can intervene in a child's life specifically
for nicotine addiction, the better it will be for their
body to reset and heal when they're fully quit, and have
them on a pathway free of nicotine for their life.
Kind of avoiding it and not addressing it could keep
them leading an addiction to nicotine
for their adult life.
And I know no parent wants that for their child.
So, addressing it early is important.
So, think about I'm going to look through my child's room
just, again, for intervention.
Let me see if I need to notice physically
what's happening to them, or look for devices, again, not
for punishment or a gotcha moment, but an opportunity for
intervention and to reset their health and their mind.
Oh, great points. And what does age-appropriate
intervention look like along those lines?
Definitely different from a sixth grader to, again, a
high schooler, a junior, a senior.
And for again, privacy reasons, the household establishes
their own rules, I would assume, with every parent and
child. But what we can see for age-appropriate
intervention for nicotine addiction,
that is important to bring in your health care provider,
whether it is a pediatrician or a health care provider
that's family practice.
There are guidelines for treating nicotine addiction for 18
and over. But for those that are under 18, there
are some new guidelines out there from the Academy of
Pediatrics we would want to refer to.
There are some medications and interventions that can help
their child quit, depending on their nicotine dependance
level. Again, if they're vaping every day,
multiple devices a day, or if they're vaping on a weekend,
it is dependent on the nicotine level addiction.
But that's where we would highly recommend partnering with
the provider and talking to them about
how much they are vaping.
That's very touchy.
If a child doesn't want to go see the doctor for this
issue. So again, that's where we encourage the parents to
do some intervention.
It also could just be counseling.
We have physical counselors,
we have mental health counselors, the school counselor,
depending on the role that they play.
But counseling could be beneficial as well because they
could be using it to manage stress or to cope
with something else going on in their lives.
And so, having a therapist of some sort,
a licensed professional counselor, is going to be of utmost
importance, too. So, both a health care provider and/or a
licensed counselor.
Complementing, you know, those insights around
interventions, I'd like to maybe spend
a minute or two to talk just a little bit about
resources that are available to parents or
to school leaders.
At MD Anderson, we have our own program that's available
for schools online, and it's free.
It's called ASPIRE, and it's a prevention program to
embed in classrooms.
We also have our own health educators at MD Anderson that
can go out and educate high schools through assemblies
or through small classroom lectures, where they
bring out the pig lungs or the gross mouth, and they can
educate on tobacco harms.
But there's also national programs.
American Lung Association has a vaping conversation
guide for parents, and it's a great tool.
It's free, downloadable on their website, but they had many
important take-home messages for parents.
If this was a podcast that prompted a lot of attention
and you weren't able to take notes, go to that resource
guide for parents.
The other most important program that I'd love parents to
write down this number is a text to quit program called
EX Program E-X Program.
It is a number that they can text for free, confidential
help. It's available 24/7.
It has behavioral health and other mental
health messaging embedded into age-appropriate texting.
It is an evidence-based resource from our colleagues
at the Truth Initiative, and MD Anderson is partnering with
them to promote this key word to help our young
people quit. Anyone over the age of 13 and over
can text this program for support.
They can text the number 887-09
and they put in a keyword "vape free TX"
for vape free TX.
So, that is the keyword.
One more resource that MD Anderson offers in case families
are looking for their own support to quit as adults.
We have studies and trials available for free to help
individuals quit smoking, and in fact, quit all
tobacco products or any tobacco product.
So, I would love for any family to visit our own website
at MDAnderson.org/Tobacco, and that
will route them to any studies or trials they may qualify
for if they need assistance in quitting smoking.
And of course, the national 1-800-QUIT-NOW number is
available for anyone as well.
So, Jennifer, thanks so much for for being here today
and having this discussion.
Again, it's so wonderful to celebrate the 10th anniversary
of the EndTobacco™ Program.
And thank you all for listening to the Cancerwise Podcast
from MD Anderson.
If you enjoyed this episode, don't forget to follow or
subscribe on Apple Podcasts, Spotify,
YouTube or wherever you get your podcasts.
And be sure to comment or review.
For more information or to request an appointment at MD
Anderson, call 1-877-632-6789,
or you can visit MDAnderson.org.