Not Just Blowing Smoke: Making Headway in the Teen Vaping Crisis

By Rabbi Maury Grebenau
Principal of Yavneh Academy of Dallas

The Current Situation
Unfortunately, the teen vaping situation is getting worse. The most recent numbers from the Center for Disease Prevention and Control (CDC) indicate that more than a quarter of high school students have vaped in the last 30 days. The nicotine found in many e-cigarettes is habit forming particularly for adolescents and is specifically dangerous to the growing adolescent brain.

E-cigarettes and vapes can also be used to deliver other drugs, including marijuana. In 2016, approximately one-third of U.S. middle and high school students who had ever used an e-cigarette reported using marijuana in their vape at some point. Rates of 12th graders who vaped marijuana in the last 30 days have doubled since a year ago. Some evidence points to the fact that recent lung failures connected to vaping may be specifically tied to instances of vaping marijuana.

Last year, I attended a bar mitzvah in a large Jewish community and was approached by a friend who had seen my earlier article on vaping. “You need to talk to my middle school son about this! It is all over the place!” he told me. While there is more awareness of the fact that vaping is a serious issue, federal and state policy has moved slowly in addressing these developments, and many remain uneducated about vaping risks.

Dangers
Despite the absence of tar in e-cigarettes, they have been shown to cause serious health issues including impairing cellular metabolism, cardiovascular disease and, most recently, lung failure. In addition, e-cigarette vapor contains vaporized trace metals and other carcinogenic chemicals, even when they are nicotine-free. More specific dangers are documented in my initial article.

In the summer of 2019, more than 200 teens were hospitalized with breathing issues tied to vaping, a condition now being called Vaping Associated Pulmonary Illness (VAPI). By the end of November, the CDC had received reports of at least 2,172 cases, from 49 states, of lung injury, with 42 cases of death, all tied to e-cigarettes. Initial findings, published in the New England Journal of Medicine, found that the injury to the lungs presented as a chemical burn from an inhaled substance. Vitamin E acetate, a thickening agent added to some vaping liquids, has been identified as a possible cause, and the CDC recommends that vitamin E acetate no longer be used as an additive. 

Gateway Hypothesis
Vaping may also make it more likely that teens will smoke traditional cigarettes, referred to as the gateway hypothesis. Although some argue against the veracity of the gateway hypothesis, most large studies have shown that students who have engaged in vaping are indeed more likely to smoke traditional cigarettes in the next year than peers who have not engaged in vaping.

Some research has found evidence that the gateway hypothesis applies to drug and alcohol use as well. Evidence that points to the gateway theory’s application to future marijuana use includes a review of clinical studies showing that nicotine use (including through e-cigarettes) increases the likelihood of future marijuana use for adolescents. A longitudinal study also found that e-cigarette usage increases the likelihood of future marijuana use in adolescents, and heavy future use when the e-cigarette use takes place towards the beginning of adolescence.

Jewish Day School Responses
The challenge of student vaping on and off campus are, at this point, a real issue for every middle and high school. Having spoken to a number of Jewish day schools, I found that much of the response is in the form of education for students and parents about the dangers of vaping. This includes sessions to educate parents on vaping and on how to speak to their children about this phenomenon. In addition, schools have clear consequences, and many use vape detectors that can be purchased and installed in areas where vaping is most likely to occur. 

It is critical that schools communicate their policies to students and parents. Making sure that lines of communication are open in school and at home is also an important part of helping teens avoid this risky behavior. Part of this effort is ensuring that parents are educated and feel able to discuss vaping with their children. A parent of a student who was found with vaping liquid equivalent to a dozen packs of cigarettes in their bag told me that he needed to google vaping to find out what it was. It is very concerning when a student has a clear problem and the parent is not educated on the subject.

These steps are part of a clear message that vaping is something that is not acceptable in our schools and that schools partner with parents in keeping their children safe. Faculty, students and parents must be educated about the true dangers involved in vaping.

State Resources

Several states have websites dedicated to guiding schools to resources. In aggregate, these state sites provide significant material for educating students, staff and parents about e-cigarettes, as well as resources to minimize the workload around crafting and rolling out policies for schools.
The most common elements suggested for schools are:

• Evaluating current e-cigarette policies within the school
• Educating staff, students and parents on vaping and the potential dangers
• Using signage or posters around the school

Informational resources provided on these state sites include fact sheets or reports from the Surgeon General, CDC and American Lung Association focusing on the risks of e-cigarettes, tobacco addiction and substance abuse on adolescents’ developing brains. Here are several of the most robust sites.

Curriculum for Schools
There are free programs available for educating teens about the realities of vaping. The tobacco prevention toolkit from Stanford Medicine has the most robust resources for educators, including clearly mapped-out lesson plans with PowerPoint presentations and Kahoot interactive online quizzes to assess student understanding for each lesson. These resources can be utilized in schools to integrate information about e-cigarettes into the existing health curriculum.

E-cigarette Educational Programs

Conclusion
There is a misnomer that if our children and students know about vaping it means they will be more likely to engage in vaping. The research has proven this assumption to be false. In fact, it is critical for children to understand what vaping is and why it is harmful for them. We want our children to be armed with accurate knowledge about this dangerous behavior before they are first offered an e-cigarette. 

In fact, research shows that when teens understand that vaping nicotine can be highly addictive and that it is dangerous, they are much less likely to engage in vaping. The Surgeon General concluded that there is sufficient evidence that school-based programs can produce at least short-term reductions in adolescent tobacco use. Schools should make educating adolescents about vaping an important part of their health education programs. 

The CDC recommends that school-based programs be undertaken along with community-based tobacco prevention strategies, in order to be effective. As a Jewish community, we would be wise to follow this suggestion and take steps together to partner with schools in addressing teen vaping.

Rabbi Maury Grebenau received an MA in Jewish education and his ordination from Yeshiva University. He has been leading Jewish schools for the past ten years and is currently the principal of Yavneh Academy of Dallas. Rabbi Grebenau has written numerous articles on educational leadership; current issues include teen health and school technology use. His articles have been published in Phi Delta Kappan, Principal Leadership and HaYidion, among others. He is currently pursuing an EdD at Northeastern University.