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How schools, parents can combat the e-cigarette epidemic

 November 27, 2023 at 12:43 PM PST

S1: It's time for Midday Edition on Kpbs. Today we are talking about the vaping epidemic among kids and teens. I'm Jade Hindman with conversations that keep you informed , inspired , and make you think. While vaping may seem less harmful , do you know what toxins you're exposed to ? A lot of the.

S2: Smaller e-cigarettes , even though they are smaller , they can contain an entire packs worth of nicotine.

S1: And with that comes numerous health consequences. We'll talk about ways to stop and prevent the use of e-cigs and vape pens. Plus , we'll talk about kids and their mental health while online. That's ahead on Midday Edition. In California. If you're not old enough to drink , you're not old enough to smoke. It's illegal to sell tobacco products to anyone under 21. And yet , this year's National Youth Tobacco Survey found nearly 5% of middle school students and 10% of high school students reported using e-cigarettes or vapes. That's in the last 30 days , and this is no surprise. With flavors like bubblegum and unicorn , these tobacco products are being directly marketed to children , and there's big health consequences associated with that. Dr. Laura Crotty Alexander is an expert on the subject matter. As a researcher at the UC San Diego School of Medicine. Dr. Crotty Alexander , welcome to Midday Edition.

S2: Thanks for having me. Happy to be here.

S1: So I mentioned in the introduction. Nationwide estimates on vaping among teens.

S2: When I go out and talk to teenagers and young adults , up to 50% of them say that they vape. So I don't know if that's a San Diego specific sort of higher percentage or if they're just being more honest in person. Hmm.

S1: So so you say when you talk to middle schoolers or high schoolers.

S2: That there's 50% , because high schoolers are the ones that I interact with the most , and they're the ones who are reporting that , like 50% of their friends or the people they see around are vaping in that age group. Yeah.

S1: And , you know , and I thought those numbers would be a little higher. I was like 5%. That's interesting that the numbers are so high.

S2: So it does depend on the e-cigarette. So a lot of the smaller e-cigarettes , even though they are smaller , they can contain an entire packs worth of nicotine. The bigger vapes that can be the size of a big pack of bubble gum can hold up to 8 to 13 packs worth of nicotine.

S1: Mm. And the amount of nicotine in a vape varies by brand.

S2: However , for the last few years , most of the brands have sort of gone towards the high side and really maximizing the amount of nicotine they're allowed to put in there , which is 59mg per mil. So I would say a few years ago there was a lot more variability. But now the companies really focus on the addictiveness of the nicotine , and they want to max it out to try and hook as many people as they can.

S1: And they start young.

S2: Well , I mean , being a pulmonologist , when I speak to my patients , you know , many of them started when they were 9 or 10 or in their teenage years. So historically , people have initiated tobacco early. And maybe that has to do with that period of time where you want to try new things. You are any kind of risk is appealing. Sneaking around and getting something you know you're not supposed to do is appealing. So I think there's multiple factors.

S1: Yeah , well , I mean , how are nicotine products particularly harmful to teens in that age group where they're trying to , you know , experiment and be a little rebellious ? I mean , how is it particularly harmful to them compared to adults ? Agreed.

S2: And this is something I focus on a lot when I'm talking to parents , teachers , and even kids themselves. The kids , and even up until people in their mid 20s , because their brains are still developing , they're actually they have an increased sensitivity for addictive behaviors. And so if they if a person starts an addictive substance in that period of time where their brain is still developing , they're much more likely to have that addiction develop. And for them to initiate other addictive substances , as opposed to a full grown adult where our brains are concrete. If we were to try to start an addictive substance later in life , it doesn't really impact whether we pick up other addictive substances. Hmm.

S1: Hmm. And what about the vapes that don't have nicotine in them ? Those two are harmful.

S2: Luckily for us , a bunch of chemists have bought those nicotine free e-cigarettes , and when they actually tested them , they all contain nicotine , which from a business standpoint makes sense because that's the reason people , um , you know , buy them over and over again is that they use they become addicted and they need them. So they really have no motivation to sell nicotine free e-cigarettes. So that's something I tell people , you know , first is that be very wary of a label that says that it doesn't have nicotine because it probably does. But to circle back to your specific question , the other chemicals in those vapes are toxic. And from our studies and other people studies , heating and mixing those chemicals in the air creates more toxins than it would with the nicotine added. So it's kind of an interesting concept that the nicotine free vapes , if they actually were to exist , would be more dangerous than the ones with nicotine , except for the fact they wouldn't be as addictive. Wow.

S1: Wow. And what are some illnesses that you see and other doctors have been seeing as a result of vaping ? Absolutely.

S2: The first one that always comes to mind is the e-cigarette specific lung disease called e-cigarette , or vaping product use associated lung injury. We abbreviate that to Evali because that's a lot easier to say. So that is the specific disease that can happen when you're vaping something and your lung reacts to it really badly and your lung gets really , really damaged. And the presentation is a lot like severe Covid 19 where somebody can't breathe , they're coughing and they need oxygen and even mechanical support. So that's like the one that really is very stressful for us as clinicians , because we see very young people coming in with Evali , and then they're not able to stop vaping. So they actually come back with that disease multiple times. So that's sort of my top concern. But we also are seeing higher rates of asthma in our vapers , particularly in our teenagers and young adults. And the signals are such that the vaping looks like it's going to drive emphysema and COPD as well. Wow.

S1: Wow. And it's not just like respiratory issues. There's also an impact on the mental health of teens , right ? Absolutely.

S2: And you can tie that back to what we know about the mental health effects of conventional tobacco , in which case people think that the smoking is actually helping their anxiety or depression. But smoking conventional tobacco actually drives anxiety and depression. And that's what we're seeing with vaping as well , that we're seeing these rates of mental health disorders rise in people who are vapers. In parallel , people who vape THC , which is also incredibly common. And in fact , most of the young people that were interviewing are more likely to be using both products than either one alone , and that vaping THC is having those same signals where we know that marijuana can drive anxiety and depression , even though people feel like they're trying to treat it. And similarly , the vaping of the THC is causing those same mental health effects. Wow.

S1: Wow.

S2: The idea that if they start doing it , that they won't be able to stop , that it'll be something that becomes like the boss of them. So I feel like that's a really good thing to focus on. And then the second thing is that idea that it that they're more susceptible to the effects because their brains are still developing. But I think really focusing on an open conversation where you're exchanging information with them and not judging or criticizing is really important. Yeah.

S1: Yeah.

S2: And when I've seen teenagers at high schools put on presentations and having tables to engage with their classmates , that's something they really focus on. And they seem to be very offended by the fact that Big Tobacco , which owns over 80% of the e-cigarette industry , that they are targeting them , and very specific ways to try and get them to , you know , buy their products permanently. I think that does work as a motivator to not have them start.

S1: Yeah , yeah.

S2: And I think , you know , having that discussion with them , you know , as soon as you can , but again , in a safe space where they don't feel attacked and again , bring up like , how do they make them feel ? Like what would they think about stopping vaping ? And , you know , did they think that they could stop if they wanted to , and that might bring to their attention that they can't stop ? Because when I was originally recruiting human subjects for my first e-cigarette study a few years ago , the 18 to 25 year olds recruited , they all thought that they could stop for two weeks , no problem , because that was part of our study. And when we got to that point , only one of them could stop. And that was really surprising to them that they had no idea that they were that addicted until they tried to stop. And so I feel like those are a couple of things that I suggest as a way to sort of get the conversation starting in terms of how to help them stop. Mainly the available support is for smoking cessation , and we're using the same tools for smoking cessation as we are for vaping cessation. And so reaching out to the pediatrician , reaching out to the local American Lung Association chapters , there's a lot of resources out there that parents and health care providers can use.

S1: And California passed a ban on on most flavored tobacco products in 2022.

S2: And maybe that is one of the reasons that we're seeing the percentage of high schoolers at least start to fall. I think that's something we should continue to push for , even though a lot of those flavors are still accessible online and to and through friends and acquaintances. Another thing that we really should be pushing for on the policy level is to decrease the amount of nicotine allowed in the e-cigarettes to decrease their addictiveness. Yeah.

S1: Yeah. Anything else you think should be done to protect young people from these tobacco products ? Maybe some legislation around marketing and advertising. I mean , what do you think ? Absolutely.

S2: So advertising we know works. So if we can limit that that would be terrific. And a final thing is to really prevent vape shops from setting up near schools , because even now they are allowed to set up pretty close to elementary , middle high schools. And if we can keep pushing back on that , that will help as well.

S1: I've been speaking with Dr. Laura Crotty Alexander , a researcher at UC San Diego's School of Medicine , and Dr. Crotty. Alexander , thank you so much for joining us.

S2: Thank you for having me. It was a pleasure.

S1: Coming up , we'll discuss the progressive school policies , helping teens to put vape pens down for good.

S3: So when we use punitive measures , really what we're winding up doing is perpetuating use. First of all , if you send a young person home , you suspend them. Their academic achievement decreases. They also go home and they continue to vape.

S1: You're listening to Kpbs Midday Edition. You're listening to Kpbs Midday Edition. Schools have a big role in preventing vaping among teens. San Diego County schools have tried various ways to curb e-cigarette use. There's anti-drug curriculum in classrooms. There's close monitoring of bathrooms , where teens often go to smoke. Some schools have even installed sensors to detect vape smoke and when all else fails. Some districts , like Sweetwater , have even closed down some of their bathrooms. Jim Crighton from the San Diego County Office of Education , says his office can offer recommendations on how schools can curb vaping , but it's up to individual school districts to decide what measures to implement.

S4: Across the state. There really is a movement and the recommendation is is more along the lines of alternatives to suspension and getting kids into intervention programs. According to code , you probably could still suspend a person for a first time tobacco offense. But really , the recommendation is to not do that. We want to identify the kids that are using and get them in to intervention programs , and really get them the supports that they need.

S1: Some of the programs referred to there were intervention programs developed by Stanford professor and founder of Tobacco Prevention Toolkit , Bonnie Halpern Felker. She's here to discuss how schools across California are addressing the issue of vaping. Professor , welcome to midday.

S3: Thank you for having me.

S1: So glad you're able to join us. You do research on tobacco and cannabis use among youth and then create prevention and intervention programs based on that research. Now , some of those are used across the state and here in San Diego County. So can you tell me about the programs Tobacco Free Toolkit has developed ? Absolutely.

S3: So you are correct. All of our curriculums that we develop are based in research , research that I do within my lab looking at reasons why adolescents are using e-cigarettes , whether it's with nicotine or cannabis or some other , um , ingredient within the e-cigarette. We look at what they're using , why they're using e-cigarettes , the flavors that they're using , and what role marketing plays , and then best ways for us to reduce and prevent their use. So we have developed a swath of various curriculums for schools to use , and also health care providers and parents as well. So within the tobacco prevention toolkit , we have the you and Me together vape free. This is a program or curriculum that's used largely in schools , in classroom settings for elementary , middle and high school students. So we have separate sets of curriculums for elementary school. It's two lessons for middle school and high school students. It's five lessons. And these lessons are helping teachers teach adolescents and children as young as second or third grade , teaching children and adolescents about brains and brain development , and why it's important to keep our brains away from drugs , whether it's nicotine , THC , or anything else. Keep them away from drugs , especially while their brains are developing , because we're so much more likely to become addicted to nicotine or THC if we were to use those drugs before the age of 25. So we talk about brains , brain development , nicotine addiction , THC addiction. We also talk about other health effects , effects on the heart , the lungs , and the rest of the body that may be affected by using e-cigarettes. Then we go into the environment and how the environment and your communities are also affected by using e-cigarettes , whether it's through secondhand smoke or secondhand aerosol or third hand , just what goes on the floor , in the ceilings , in the in the in your clothes and your couches and so on. And then forms the toxicity there. And you can then get it into your body that way. And then the final two lessons ones on marketing. We know that part of the reason why young people to turn to using any drugs is because of marketing. That's particularly true around nicotine and THC. So we have a whole lesson on marketing and how the marketing is really targeting young people , youth , youth of color , as well as LGBTQ and women. So we talk about that and really , really give young people the skills to refuse using should they come across drugs. And then finally , we have a whole lesson in each of our curriculums on stress and coping. We know from other data that came out that young people are incredibly stressed right now. So really helping them understand , identify their stress and think of ways to pivot and engage in activities that are healthier and ways of decreasing our stress instead of going to use drugs.

S1: And you mention a lot of programs. So which of your programs are used here in San Diego County ? Can you tell me about that one specifically ? Absolutely.

S3: In San Diego County , they are using a couple of different programs that we offer. One is our you and me together vape Free. That is our 2 to 5 lesson e-cigarette prevention curriculum used in classrooms. I know that a lot of the schools in San Diego are using that curriculum. A lot of the schools are also using our Healthy Futures alternative to suspension curriculum , that is , for young people who have been caught using e-cigarettes or cannabis on school property , or for students who just may want help quitting. And that is a one on one or small group program could also be self paced that a student would fill out and complete on their own , and that really helps adolescents understand why they're using and help them move towards motivations to quit.

S1: And you mentioned the programs are age specific.

S3: We went to middle and high school students , middle and high school parents , and middle and high school educators and school administrators. And we asked them what would be important to have in these curriculums. What's the pedagogy , the style of teaching ? What's the tone ? And if we were to do it by age groups. So elementary , middle and high school , how should we do that ? What would it look like ? What would you include and not include ? We have a large youth action board , 35 adolescents and very young adults who work with us in the lab to develop all of our curriculums. So they were very much involved in the you and me together vape free and in developing our Healthy Futures curriculums.

S1: And you talked about the program for those caught actually using tobacco or vaping.

S3: We know from studies , first of all , if you send a young person home , you suspend them. Their grades decrease their their academic achievement decreases. They also go home and they continue to vape. We're not helping them stop using drugs. And often parents are working. So they're home on their own , and there's no stopping them from engaging in that or continuing to use e-cigarettes. And instead we're really just giving them the way to be able to continue to use. What we really need to do is help young people stop using help young people quit , help young people cut back , help young people understand that their use of e-cigarettes , whether it's THC nicotine , is hurting their brains and their lungs and the rest of their body. So it's it's really for you're not helping them. You're perpetuating their use. You're hurting them because of their academic achievement goes down. You're also hurting them because it's it's on their record. And unfortunately , I think of this as a social justice issue. A lot of times when young people are suspended or caught vaping , it tends to be those who are from minority populations , youth of color and or low income. And so you're just widening the achievement gap when you sign young people home. And we have young people who are addicted. They are highly addicted to nicotine in e-cigarettes. We need to be more compassionate. We need to have a trauma informed and a justice informed model where we say these young people are addicted , these young people need help. These young people are being targeted by the industry. It's not surprising that they're using. So rather than , yeah , we're going to be upset , but rather than punish them , let's help them become healthier young people to develop into healthier young adults.

S1: Sounds like a good approach.

S3: We certainly need laws and regulations to get these e-cigarettes off the market. In California , we passed Senate Bill 793 , which became proposition 31 , to get flavors out of the hands of tobacco , to get flavors out of tobacco to because we know that young people are using e-cigarettes largely because of the flavors. So that was a really important , groundbreaking policy that California passed. We we also need the Food and Drug Administration and our federal government to get rid of flavors in all tobacco products across the country. We need to enforce tobacco 21. I give talks all the time to parents , educators , health care providers and they do not realize that the age where you're allowed to purchase or be sold nicotine products is 21. That's across the country , not just in California. If they don't know that , how can they help us enforce ? So we need that. We need a nicotine standard in this country. The fact that we can have so much nicotine , there's no there's no ceiling for the amount of nicotine that's allowed in an e-cigarette. That means that we're just increasing the nicotine addiction potential of every product that's out there. So we need a comprehensive approach. We need education. Absolutely. But we also need regulation to really stop the marketing and the products and the product devices that are just attracting our kids. Otherwise , we're just going to keep , keep , keep having this problem that we have right now. Right.

S1: Right. You know , and I guess it does take a different approach. I mean , for years tobacco , it seems , has really been marketed towards children. Correct.

S3: Correct. I mean , if you look at first of all , if you look at the flavors there , I think the study was done at the University of California at San Diego. Account was made. This was a few years ago of 15,000 flavors in e-cigarettes. And some adults will say , and the e-cigarette companies will say , well , we need the flavors for adults to be able to quit using cigarettes. Well , first of all , there's not good evidence that adults quit smoking through e-cigarettes. But even if there was , we don't need flavors like unicorn poop , sugar booger , honey doodoo , chocolate to attract adults. These are attracting our kids. We also don't need marketing that's attracting our kids , young people , or even if it's somebody , a model who's in their 20s , but with a hairstyle and dress and demeanor that is clearly targeted towards young people , or marketing of e-cigarettes that look like juice boxes or monsters , that's attracting our young people. And we we know we need to get these out of the hands of kids , because young people are not starting tobacco through cigarettes. That is absolutely not happening. Young people are starting their tobacco journey through e-cigarettes , through vapes. And if we didn't have flavors , we wouldn't get young people to start and to enjoy it. And if we didn't have as much nicotine as in there , we would not have young people addicted. So we need to completely change the market right now. We're playing Whac-a-mole. The FDA will get rid of one set of products or regulate one flavor , and then another product , another device , another flavor comes up on the market.

S1: You'd think there'd be a law against marketing products that are intended for adults to children.

S3: We would like to see that very much. We've had in our lab , we've spoken to the FTC , the Federal Trade Commission and others around marketing. Now , the FDA is certainly sending warning letters to companies that are selling or clearly marketing to young people. But it's so , so difficult to reinforce right now. And we really need not just the regulators. We need. We need parents , we need educators , we need young people to be really forceful and really get out there and be able to push the information that's out there and help with enforcement and reinforcement of some of the policies. Young people can go into vape shops or 7-Eleven and still buy flavored e-cigarettes or flavored tobacco. That's the fault of the seller. That's the fault of of other people who are allowing that to happen. And we need to stop that.

S1: So going back to what's happening within schools besides anti tobacco , nicotine curriculum , what are other tactics being used to curb vaping ? Yeah.

S3: So some schools are using vape detectors , um , to in their schools to be able to see if it got like a smoke alarm. It goes off if there's e-cigarette aerosol in the air. Um , those those have had mixed effects. They can be very , very helpful. But you have to have somebody who can show up in the bathroom of the hallway within a certain amount of time , because often the students , once they can tell that it's been sounded or that there's an alarm that goes off , then some people , the students , then know to leave and not be caught themselves so they can be effective. But it's a it's a matter of how well they're used and where they're placed. Cameras can be useful. Cameras in the hallways , cameras in bathrooms , cameras in the parking lots , and wherever else young people gather. That could be very helpful as well. I'm not a fan of closing bathrooms. Young people need to be able to go to the bathroom during the day. It's it's a health issue. It is not. It's not healthy for their bodies. It's not healthy for their minds that they cannot do that. So better as I'd like to see better monitoring , I'd like to see cameras. I'd like to see better education. So that way we don't have to worry as much about that. Um , we need more counselors. We need more mental health counselors in California and across the country. Again , young people are often using these products because they're so stressed , because they're anxious , they're dealing with depression. So it's again , it's not one thing. It's all of these together.

S1: I've been speaking with Professor Bonnie Halpern. Fleisher professor , thank you so much for joining us.

S3: You are most welcome. Thank you again for having me.

S1: Coming up , we talk about social media and the mental health of teens.

S5: We know from several studies that the links between social media use and depression are stronger for younger people.

S1: You're listening to Kpbs Midday Edition. Welcome back. You're listening to Kpbs Midday Edition. I'm Jade Hindman. Study after study has shown links between social media use and increased anxiety , depression and suicidal thoughts among American children. Meanwhile , the amount of time teens and tweens have been spending on screens has only increased in recent years. Late last month , dozens of states , including California , sued Meta Platforms Inc. for harming young people's mental health by purposely designing features in Instagram and Facebook that addict children to its platforms. San Diego State professor Jean Twenge authored a book called Igen , in which she talks about the impact of social media on the mental health of teens. She's also the author of a book called generations. We spoke over the summer. Here's our conversation.

S5: We also know that there have been huge increases in anxiety and depression and self-harm among teens and young adults since 2012 , and that's right around the time that social media use became really ubiquitous among teens.

S1: In particular , several studies have identified impacts on girls and young women.

S5: So girls spend more time on social media , and then the time that they do spend is more linked to depression , probably because of things like cyberbullying and also a lot of the pressures around body image and appearance that come up on social media , particularly on Instagram and TikTok.


S5: It's just not quite as strong. But still , if you think about it , if they're spending , say , five hours a day on social media , then they're probably not sleeping enough. They're probably not spending enough time with friends face to face. They may not be getting enough exercise. So there's impacts on all teens.


S5: How many followers do you have ? How many likes do you have ? And it also just really takes that socialization and puts it online.


S5: So around 2012. So teen depression doubled between 2011 and 2019. So before the pandemic , we know the pandemic was not the original cause. It's not just that it happened at the same time. It's also that it's tough to think of anything else other than these new technologies that had such a big impact on teens day to day lives , that they started spending so much more time on line and so much less time with their friends in person. They also started spending less time sleeping. And that's really crucial for mental health. And it makes sense that the causation goes from spending time online to depression because it was the other way around. If it was depression going to technologies , we're thinking about these trends over time. It would have to be okay. Teens became depressed for some completely unknown reason , and that caused teens to start spending more time on social media. It doesn't make a lot of sense.

S1: Right ? I mean , even just , you know , we're talking about smartphones. And every time it pings or dings , you're looking down at it and it's become like the main thing that causes us to multitask. And I would imagine that even that might have an impact on one's mental health. Always multitasking. Yeah.

S5: Yeah. That you feel like you're always on. So teens talk about that quite a bit. And then social media in particular , the algorithms are much more sophisticated now , and they're designed to keep people on the app for as long as possible. And with notifications in particular , keep them coming back as much as possible. So that's one reason why people talk about social media using the language of addiction , even though there's still debate over whether we should call it that.

S1: A lot has been made about the coronavirus pandemic and its impacts on the mental health of young people. But you argue what we're seeing as far as social media and kids really predates Covid.

S5: It absolutely does. So pretty much all the indicators , whether it's clinical level depression , loneliness , self-harm , suicide attempts and as those last two are measured by emergency room visits , they're not even just about symptoms. All of those things started to rise in the early 2010. So more than ten years ago. So yes , there were increases during the pandemic , but they were at about the same pace as had been happening for about a decade. So all this attention to the teen mental health crisis just has to recognize that this is not a pandemic issue. This is something that has been going on for a decade.

S1: And you've studied social media's impact on children for many years. And in that time , social media has evolved so much. Platforms have come and gone , new features and trends have taken hold.

S5: And that clearly isn't safe , because we know from several studies that the links between social media use and depression are stronger for younger people , so they're stronger for 12 year olds than they are for 18 year olds. And it's now really common for 12 year olds to be on social media , even though the minimum age is supposed to be 13 , it's not enforced.

S1: You're listening to Kpbs Midday Edition. This is Jade Hindman. I'm speaking with author and professor Jean Twenge about social media and kids. So , Gene , in your book generations , you delve into some of the characteristics of five generations.

S5: And we see in these big national surveys of teens is these very sudden changes around 2012. So everybody talked about the increases in loneliness and depression. We also see it in terms of expectations. Teens became a lot more less optimistic about their prospects. As you shift from millennials to Gen Z being the teens , they also started to become a lot more pessimistic about the country as a whole and the world. And that makes sense , because depression isn't just about emotions , it's about how you think. It's about how you see things. And when there's more depression , then you're going to get more pessimism and more of a view toward thinking everything is terrible and negative.

S1: And as we touched on earlier , the pandemic has been a defining period of change for Gen Z.

S5: The good news is , you know , there was a really big fear that suicide rates and rates of self-harm and depression were just going to skyrocket during the pandemic for teens. And that that did not happen. So we still have a mental health crisis , but it didn't accelerate during the pandemic. So that's that's one piece of good news that teams seem to be resilient around a lot of those changes that happened during the pandemic , but we don't know the long term effects.

S1: The use of screen time and social media are top of mind for a lot of parents.

S5: I have three kids myself. They are 16 , 13 and 11. So this is my everyday life as well as something that I research. And I really think that we need to raise the minimum age for social media to 16 , and that that includes TikTok. Hopefully that'll happen if our politicians can take action. They've done that in Utah for now , though , as parents were kind of stuck because we don't have much regulation of social media. It's very unregulated. You can easily lie about your age. You don't need parental permission. So it's it's tough. So one thing that helps is to delay getting your kid a full blown smartphone as long as possible. So our 16 year old had a flip phone until a month ago. Our 13 year old has something called a gab phone. Very few functions you can text , you can call , you can take pictures. That's it. So there's no ability to be able to download social media apps. And even for a 16 year old , even though she does have a smartphone now , we put parental controls on it so she can't download apps without parental permission. So then at least there's not an ability for her to download social media apps and get an account on her phone.


S5: So moving away from this model where companies are making money off of our time and attention would be nice.

S1: Earlier you mentioned the idea of preventing kids under 16 from using social media.

S5: There's lots of other ways.

S1: Jean Twenge is a professor of psychology at San Diego State University and author of the book generations. Jean , thank you so much for joining us today.

S5: You're very welcome.

S1: That's our show for today. Don't forget to watch Evening Edition tonight at five for in-depth reporting on San Diego issues. We'll be back tomorrow at noon. And if you ever miss a show , you can find the Midday Edition podcast on all platforms. I'm Jade Hindman. Thanks for listening.

Tobacco products with flavors like "blue razz ice" and "aloe grape" are seen here.
Roland Lizarondo
A supporter of San Diego's ban on flavored tobacco products displays vapes with flavors including "blue razz ice" and "aloe grape," April 25, 2022.

In California, if you’re not old enough to drink you're not old enough to smoke. It’s illegal to sell tobacco products to anyone under 21. And yet, this year’s National Youth Tobacco Survey found nearly 5% of middle school students and 10% of high school students reported using e cigarettes or vapes in the last 30 days.

The chief concern among San Diego city leaders is the peddling them to children, with flavors like bubble gum and cotton candy. It’s against the law to sell flavored tobacco products to anyone, but city officials have said some retailers still have these products in their stores.

“As a mother and a prosecutor, I am appalled by the tactics of the tobacco industry, which continues to manufacture and advertise deadly products with kid-friendly flavors," said Mara Elliott, San Diego's city attorney.

There are big health consequences when it comes to vaping for both kids and adults. There's higher rates of asthma in teens and young adults and signs that the epidemic might increase cases of emphysema and COPD. There's also an e-cigarette-specific lung disease — e-cigarette or vaping product use associated lung injury, EVALI for short.

"Your lung gets really, really damaged and the presentation is a lot like severe COVID-19 or somebody that can't breathe they're coughing and they need oxygen and even mechanical support," said Dr. Laura Crotty Alexander, a professor of medicine at UC San Diego. "That's the one that is very stressful for us as clinicians because we see very young people coming in with EVALI and then they're not able to stop vaping so, they actually come back with that disease multiple times."

On the front lines of the vaping epidemic are schools and parents. In San Diego County, the region's office of education can offer support and resources to schools and parents, but it's up to each district on how they want to deal with the issue.

"Across California, there really is a movement and the recommendation is more along the lines of alternatives to suspension and getting kids into intervention programs," said Jim Crittenden of the San Diego County Office of Education.

"Across California, there really is a movement and the recommendation is more along the lines of alternatives to suspension and getting kids into intervention programs."
Jim Crittenden, San Diego County Office of Education

Intervention programs from Stanford Medicine's Tobacco Prevention Toolkit are being used in San Diego County and across the state. Professor Bonnie Halpern-Felsher founded this toolkit. She said punitive measures end up perpetuating e-cigarette use rather than curbing the habit.

"If you send a young person home — you suspend them — their grades decrease, their their academic achievement decreases. They also go home and they continue to vape," Halpern-Felsher said.

Halpern-Felsher argues that a multi-pronged approach is needed in order to combat the epidemic. Federal policies banning flavored tobacco products and more mental health support for teens are some of her recommendations.

As for parents, what can they do to keep their kids from vaping? Crotty Alexander said it starts with a conversation.

"I think having that discussion with them as soon as you can, but again in a safe space where they don't feel attacked," Crotty Alexander said. "Bring up: Why are they using them? How do they make them feel? What would they think about stopping vaping? Did they think that they could stop if they wanted to?"