What should parents say when their teen says "But it's not smoking" when they find out they're vaping?

I've been working with schools for a long time now and have seen many alcohol and other drug trends come and go. New substances come onto the market and often disappear just as quickly as they hit the streets, while older drugs, once relatively popular, may see a resurgence in use after some time away from the scene. The substances most likely to cause significant harms are rarely used by school-based young people, however when it comes to vaping and the use of e-cigarettes, anecdotal reports suggest that's just the group that are most likely to be picking up the practice.

About ten years ago an increasing number of reports of vaping started to come out of the US with headlines like 'E-Cigs Timebomb', "Hooked on Vaping' and 'Sales of Smokeless E-Cigs Catch Fire'. By 2015 I was asked to give a series of presentations across the country on 'novel ways of smoking' and included a section on vaping and e-cigarettes. At that time there were very few reports of vaping by teens but as so called 'shisha pens' (disposable devices that produced flavoured vapour when inhaled) became more widely available across the country (often sitting on the counters at convenience stores and petrol stations) I began to get schools asking me for more information on this new phenomenon. Young teens started to bring these devices to school and when caught using them, usually in the bathrooms, explained them away by claiming that they weren't the same as cigarettes and that vaping wasn't as bad as smoking.

The Americans call it a 'vaping epidemic' and have been struggling to deal with the issue of young teens and the use of e-cigarettes for quite some time, particularly in schools. It certainly feels like the problem is hitting its peak in Australian schools at the moment with hardly a day going by when I am not contacted by principals and teachers asking for assistance in how to deal with the vaping that is occurring in their schools. Is it just a 'fad' that will simply disappear over time or are we seeing the beginning of a new generation of nicotine-dependent young people?

I recently gave a series of talks at a school and, as I always do at the moment, I covered vaping. After I finished the first presentation (it was just after recess), the Deputy took me into his office and asked me whether I would like to know just how big a problem this was becoming. With that he grabbed the small rubbish bin under his desk, turned it over and six small disposable 'vapes' fell onto the floor. "They're the ones that I've confiscated today and I've already suspended a number of students as a result," he said. "The sad thing is that I can almost guarantee that when they return to school at least one of them will return with a parent who will tell me that I'll be suspending them again by the end of the day as they are addicted to nicotine and won't get through a day without vaping."

Parents are also struggling in this area. When they discover that their child is vaping and they challenge them about their use of the product they are often met with a series of responses that they feel ill-equipped to deal with appropriately. Some of the things teens are likely to say when they are caught vaping may include the following:

• "But it's not smoking!"
• "It's just flavour, I don't vape nicotine."
• "Vaping is safer than smoking - wouldn't you rather me vape than smoke?"
• "I'm not hurting anyone, it's just water vapour."

There are no perfect responses to any of these but parents need to remember to be honest in their discussions with their child when it comes to alcohol and other drugs. Ensure that you have the most accurate and up-to-date information on hand and do not try to use 'scare tactics' to frighten them off from experimenting with whatever ... When it comes to vaping we are talking about something so new that it is simply not possible to know what the potential long-term harms could be and that 'lack of certainty' about the possible risks is scary enough. With that in mind, here are some possible responses that parents could possibly use to address their teens in this area:

"But it's not smoking!"

That's correct, vaping is not smoking, but that does not mean that it is a 'safe' thing to do. E-cigarettes were invented to help smokers quit their habit. Tobacco smokers are highly likely to become addicted to nicotine and many try for years, some never succeeding, to stop smoking. E-cigarettes are another way of smokers getting their nicotine-fix without smoking - they are devices designed to deliver nicotine into a person's body. It doesn't matter whether that nicotine is smoked or vaped - when you're young and your brain is still developing, nicotine can do lasting, even permanent, damage. You may not be smoking but the earlier you start vaping nicotine, particularly in your early teens you're going to have a much harder time quitting the drug in the future. Do you want to vape for the rest of your life?

"It's just flavour, I don't vape nicotine."

Around 90% of all e-cigarettes are made in China and it is not a well-regulated industry. The liquids are often not accurately labelled and even though nicotine may not be listed on the packaging a NSW Health study tested a range of products and found that 70% of them actually contained high levels of nicotine even though the label did not state nicotine as an ingredient. 

You need to remember that most of the vaping companies around the world are now owned by tobacco companies. Not so many people smoke as they did in the past and these companies need to continue to make money. Adding flavours, particularly those that are attractive to young people, to their products is one of the best ways to get new customers. You may think that you're just vaping a flavour but there is no way to be absolutely sure, not even if you look at the packaging.

"Vaping is safer than smoking - wouldn't you rather me vape than smoke?"

Vaping may be 'safer' than smoking but what does that really mean? Getting hit by a car is most probably 'safer' than getting hit by a truck but would you want either of those things to happen to you? Just because one activity is possibly safer than another doesn't mean that it is a good idea to do it ... It's important to remember that it took us hundreds of years to find out about the dangers of smoking and millions of people died over that time due to smoking-related illnesses. Vaping has only been around for less than 20 years (the first one was invented in 2003), we have no idea about the long-term harms associated with the practice. When you ask me whether I'd prefer that you vape rather than smoke I have to be honest and tell you that I'd rather you do neither - I love you and I want you to be safe and healthy. In 50 years we may find out that there are no problems with vaping at all, but there is also the possibility that in the next five years we discover a range of cancers linked to e-cigarettes and the e-liquids that are used in them. We just don't know ...

"I'm not hurting anyone, it's just water vapour."

Originally we used to think that it was just water vapour but we now know it is actually aerosol containing metals (including chromium, nickel and lead), ultrafine particles and a range of toxic chemicals. This is now referred to as second-hand aerosol (SHA).  When the vapours' contents, including nicotine, are absorbed by the environment, sticking to clothing, carpet and other fabrics, this is called third-hand aerosol (THA). Nicotine poisonings can occur when those materials are touched by babies and children, as well as pets such as cats and small dogs. 

Vaping also produces particulate matter (PM) - very small solid particles and liquid droplets suspended in the air. Being exposed to PM increases the risk of developing asthma and heart disease. We're learning more and more about the contents of the vapour that is exhaled by users. It's most probably a lot safer than second-hand smoke but that does not mean it's not a problem and it's certainly not just water vapour.

Although anecdotal reports from schools suggest that we are now beginning to see students who are regularly vaping and becoming nicotine dependent, we do not have the research to support this. Although the evidence is mixed, some studies have found that many teens use e-cigarettes for a short time and then stop using altogether and that this group are less likely to use nicotine when vaping. They also suggest that those young people who experiment with vaping are those who were more likely to try smoking anyway. That said, vaping does not seem to be going away and schools and parents are struggling with how to best deal with it - being able to respond to some of the statements they are likely to use when trying to justify their use of e-cigarettes may help just a little ...