Dr. Bonnie Halpern-Felsher: Vaping, Alcohol Use & Other Risky Youth Behaviors

Dr. Bonnie Halpern-Felsher (00:00:00)

• Dr. Bonnie Halpern-Felsher is a professor of Pediatrics and Adolescent Medicine at Stanford University School of Medicine.
• She is a developmental psychologist and a world expert in the risk behaviors that adolescents, teens, and young adults participate in today.
• Discussed nicotine use through smoking, vaping, and e-cigarette use.
• Discussed correlative and possibly causal data linking cannabis use to psychosis in young adults.
• Discussed other common risky behaviors that adolescents, teens, and young adults participate in, including:
  • Risky driving behavior
  • Alcohol consumption
  • Risky sexual behavior
• Discussed the various factors that impact whether or not a young person will participate in risky behaviors, including:
  • Family and home environment
  • Peer group and social media
• Discussed how marketing is combining with peer pressure to drive youth toward particular risky behaviors.

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• Dr. Bonnie Halpern-Felsher is a developmental psychologist and professor at Stanford University.
• Her research focuses on adolescent risk behaviors, including vaping, alcohol use, and risky sexual behavior.
• Vaping and nicotine use among youth is a significant public health concern.
• Nicotine is highly addictive and can harm adolescent brain development.
• E-cigarettes and vaping devices are often marketed to youth and can be easily accessible.
• Youth who vape are more likely to smoke cigarettes in the future.
• Alcohol use among youth is another major public health concern.
• Underage drinking can lead to accidents, injuries, and risky sexual behavior.
• Alcohol can also impair brain development and academic performance.
• Parents and educators need to talk to youth about the risks of alcohol use.
• Risky sexual behavior among youth can have serious consequences, including sexually transmitted infections (STIs) and unplanned pregnancy.
• Youth who engage in risky sexual behavior are more likely to experience mental health problems and relationship difficulties.
• Parents and educators need to talk to youth about the importance of safe sex and healthy relationships.
• Dr. Halpern-Felsher emphasizes the importance of addressing risky behaviors among youth.
• She encourages parents and educators to talk to youth about these risks and to provide support and guidance.
• Early intervention and prevention are crucial for promoting healthy development and well-being among youth.

Adolescence (00:05:38)

• Adolescence is a period of life that can be tricky, but it is also a wonderful time of exploration and growth.
• It is marked by physical changes, such as puberty and the onset of menstruation for girls, as well as emotional and social changes.
• During adolescence, teens are trying to figure out who they are and what they want to do with their lives.
• They are also dealing with peer pressure and trying to establish their own identities.
• Asynchronous development can occur, where a young person may look older but still be emotionally immature, or vice versa.
• Adolescents are more likely to engage in risk-taking behaviors, such as smoking, vaping, drug use, sexual behavior, addictive behaviors related to social media, bullying, and risky driving.
• These behaviors can have serious consequences for adolescents, including health problems, academic difficulties, and social problems.
• Parents and other adults need to be aware of the risks that adolescents face and take steps to help them avoid these risks.

Household Conflict, Parents; Smart Phones (00:09:19)

• The increase in divorce rates in the past 20-30 years has not directly correlated with an increase in risk-taking behaviors in adolescents and teens.
• It is the conflict within the home, not the divorce itself, that can lead to social and emotional issues, including depression and self-medication.
• Parents should be good monitors and be involved in their children's lives, regardless of their marital status.
• The discretionary hours between 3 pm and 6 pm, when parents are working and teenagers come home, are the most risky couple of hours.
• Parents should know where their children are and what they are doing during these discretionary hours.

Smart Phones & Social Media (00:12:35)

• Smartphones have increased communication and monitoring between parents and kids, as well as interactions between kids and other kids and adults.
• Smartphones can have both positive and negative effects on kids, such as increased bullying and peer pressure, but also opportunities for positive interactions and support.
• The full impact of smartphones on kids' social and physical development is still not fully understood.
• Some teens are making an effort to reduce their screen time and engage in more face-to-face interactions.
• The speaker is less concerned about the impact of social media and phones on youth development as long as they are still engaging in physical activities, playing, and being creative.

Vaping, E-Cigarettes, Nicotine & Cannabis (00:18:25)

• Smoking rates among teenagers and adults in the US have significantly decreased in recent decades, while e-cigarette use has dramatically increased among teenagers since 2017.
• In 2017-2019, approximately 27-29% of teens used e-cigarettes daily, but usage declined during the COVID-19 pandemic due to reduced social interactions.
• Current national data suggests that less than 10% of teens use e-cigarettes, but schools report much higher usage rates, with some estimating 40-60% of students using them.
• The exact prevalence of e-cigarette use among teens is uncertain due to potential issues with surveys or honesty in reporting.
• Dr. Bonnie Halpern-Felsher discusses various risky youth behaviors, including vaping, alcohol use, and cannabis use.

Adolescent Nicotine Use: Marketing, Flavors (00:23:46)

• Nicotine is a cognitive enhancer but highly addictive and harmful to health.
• The use of nicotine products, including e-cigarettes and vapes, is prevalent among youth, posing risks to their health and well-being.
• The marketing of nicotine products targets young people and children, using appealing flavors, designs, and names like "unicorn poop" and "sugar booger."
• E-cigarette marketing strategies often involve animated characters and packaging resembling juice boxes, specifically targeting children.
• More research is needed to understand why teenagers start and continue using nicotine products and why they are reluctant to quit.

Dr. Bonnie Halpern-Felsher: Vaping, Alcohol Use & Other Risky Youth Behaviors (00:00:00)

• Dr. Bonnie Halpern-Felsher is a developmental psychologist and professor of pediatrics at Stanford University.
• Her research focuses on adolescent risk behaviors, including vaping, alcohol use, and other risky behaviors.
• Vaping is a major public health concern among youth.
• E-cigarettes are the most commonly used tobacco product among youth in the United States.
• Nicotine is highly addictive and can have negative effects on adolescent brain development.
• Vaping can also lead to other risky behaviors, such as alcohol use and marijuana use.
• Alcohol use is another major public health concern among youth.
• Underage drinking is a serious problem and can have negative consequences for adolescents, including academic problems, social problems, and health problems.
• Alcohol use can also lead to other risky behaviors, such as vaping and marijuana use.
• In addition to vaping and alcohol use, there are a number of other risky behaviors that adolescents may engage in, including:
  • Marijuana use
  • Prescription drug misuse
  • Unprotected sex
  • Fighting
  • Stealing
• These risky behaviors can have serious consequences for adolescents, including:
  • Health problems
  • Academic problems
  • Social problems
  • Legal problems
• Adolescent risk behaviors are a serious public health concern.
• There are a number of factors that can contribute to adolescent risk behaviors, including:
  • Peer pressure
  • Family problems
  • Mental health problems
  • Substance use
• It is important for parents, educators, and other adults to be aware of the risks of adolescent risk behaviors and to take steps to prevent them.

Nicotine Initiation, Freebase vs. Salt-Based Nicotine, Concentration (00:32:13)

• E-cigarette use among teens is concerning, with initiation rates ranging from 5% to 20%.
• Unlike adults, teens are attracted to e-cigarettes due to their flavors, marketing, and ability to hide them from parents.
• The introduction of salt-based nicotine in 2015 made e-cigarettes smoother and more appealing to teens, who may not enjoy the harshness of traditional freebase nicotine.
• Salt-based nicotine e-cigarettes have a significantly higher nicotine concentration than traditional cigarettes, with one pod potentially equivalent to several packs of cigarettes in terms of nicotine content.
• Some teens are using up to four pods per day, which could be equivalent to eight packs of cigarettes in terms of nicotine concentration.
• E-cigarettes contain various chemicals besides nicotine, raising concerns about their potential health risks.
• Teens are using e-cigarettes frequently, even waking up in the middle of the night to take a hit, due to their easy accessibility and addictive nature.

Addiction & Withdrawal; E-Cigarette Access (00:41:35)

• Teens start vaping due to appealing flavors and marketing but continue due to addiction to the high nicotine levels in e-cigarettes.
• Many teens who use e-cigarettes show signs of addiction within weeks of starting, with a significant percentage using them within the first five minutes of waking up.
• Despite the perception that e-cigarettes help with school, teens use them to alleviate withdrawal symptoms rather than enhance concentration.
• The affordability of e-cigarette products raises concerns about how teens obtain the money to purchase them, with some concerns about potential theft.
• Teenagers are getting creative in obtaining e-cigarettes, such as sharing devices, buying them in bulk and reselling them, and even getting their parents to buy them.
• The unregulated market for e-cigarettes makes it easy for teenagers to access them, with many vape shops and online retailers not enforcing the age restriction.

Vaping Health Hazards, Aldehydes, Flavors (00:48:48)

• Nicotine in e-cigarettes can harm brain development and increase addiction risks in young people.
• E-cigarettes contain harmful chemicals like aldehydes, lead, cadmium, propylene glycol, and glycerin, which can damage lung tissue and cause cancer.
• The long-term health effects of vaping are still unknown but may be similar to smoking cigarettes.
• Some chemicals in e-cigarettes, such as cinnamon aldehyde, vanilla, and buttery flavor, have been linked to lung lesions, lung collapses, pneumonia, and asthma.
• Up to 60% of kids may be using e-cigarettes, which can negatively impact lung function and athletic performance.

Dr. Bonnie Halpern-Felsher: Vaping, Alcohol Use & Other Risky Youth Behaviors (00:00:00)

• Dr. Halpern-Felsher is a developmental psychologist and professor of pediatrics at Stanford University.
• Her research focuses on adolescent risk behaviors, including vaping, alcohol use, and other risky behaviors.
• Vaping and alcohol use are common among youth in the United States.
• E-cigarette use among high school students increased from 1.5% in 2011 to 27.5% in 2019.
• Binge drinking among high school students decreased from 23.3% in 2009 to 15.3% in 2019.
• However, binge drinking remains a significant problem, with 1 in 6 high school students reporting binge drinking in the past 30 days.
• Risk factors for vaping and alcohol use include:
  • Individual factors: such as genetics, mental health, and impulsivity.
  • Environmental factors: such as peer pressure, family history of substance use, and exposure to marketing.
  • Social factors: such as poverty, discrimination, and lack of access to education and healthcare.
• Vaping and alcohol use can have a number of negative consequences for youth, including:
  • Health problems: such as respiratory problems, heart disease, and cancer.
  • Academic problems: such as decreased grades and increased absenteeism.
  • Social problems: such as relationship problems, violence, and crime.
• There are a number of things that can be done to prevent vaping and alcohol use among youth, including:
  • Educating youth about the risks of vaping and alcohol use.
  • Providing support for youth who are struggling with substance use.
  • Creating safe and supportive environments for youth.
  • Enforcing laws and regulations related to vaping and alcohol use.
• Vaping and alcohol use are serious problems among youth in the United States.
• There are a number of risk factors for vaping and alcohol use, as well as a number of negative consequences.
• There are a number of things that can be done to prevent vaping and alcohol use among youth.

“Just Say No”, Adolescent Defiance (00:57:48)

• Teenagers need to understand the balance between the benefits and risks of certain behaviors, rather than simply being told "no."
• Emphasizing the social aspects of risky behaviors, such as the tobacco industry targeting teens as replacement smokers, can be effective in motivating behavior change.
• Tapping into teens' emotions, such as anger at being targeted by the industry, can be a powerful motivator for behavior change.
• The tobacco industry knew nicotine was addictive but marketed to teens anyway, using strategies that make them feel like the products are meant for them.
• Lecturing or making teens feel stupid about their choices is not an effective approach; instead, focus on the positive aspects of brain development and explain why teens are more susceptible to addiction.
• Emphasize that the industry targets teens because of their developing brains and vulnerability to addiction.
• Appeal to the spirit of defiance in youth and encourage them to resist destructive behaviors.
• The alarming prevalence of vaping and e-cigarette use among teens requires attention.

Cannabis & Potency, Blunts, E-Cigarette Combinations (01:04:21)

• The potency of cannabis, especially THC levels, has increased, raising concerns about its link to psychosis in predisposed individuals.
• Approximately 10-20% of teenagers use cannabis, with a growing trend of using e-cigarettes to inhale cannabis wax or oil.
• Benzoic acid, found in e-cigarette pods, can be absorbed through the skin and inhaled into the lungs, allowing for rapid absorption into the bloodstream and crossing the blood-brain barrier.
• Vaping delivers substances to the brain within 7 to 10 seconds, and while teens may perceive it as healthier than smoking, it still involves inhaling harmful chemicals.
• Concerns exist regarding the potential health risks of chemicals used in e-cigarettes, including propylene glycol, glycerin, flavorings, and aldehydes.
• Both nicotine and cannabis use pose significant addiction risks, especially considering their impact on brain development in young individuals.

Psychosis, THC & Adolescence (01:10:30)

• Some scientists believe that using high THC cannabis, especially in male youth, may be a causal factor in developing psychotic symptoms in late teens and early 20s.
• In some cases, the psychotic symptoms caused by THC use may be irreversible.
• Changes to the neural circuitry caused by THC use may be permanent, as adult brains have limited neurogenesis and recovery of function.
• High THC cannabis use is concerning because psychosis is already a serious global issue, with approximately 1% of the world's population meeting the diagnostic criteria for schizophrenia.
• The increase in psychotic symptoms due to THC use could further burden individuals and society.

Quitting Nicotine & Cannabis; Physical & Social Withdrawal Symptoms (01:14:11)

• Nicotine is highly addictive, especially for teenagers who use e-cigarettes, and it is the most difficult drug to quit.
• There is a lack of effective programs to help teens quit vaping and using cannabis.
• Nicotine replacement therapy, such as nicotine patches, is not authorized by the FDA for individuals under 18, but many doctors prescribe them off-label.
• Quitting smoking or vaping can be challenging and may require multiple attempts.
• Social withdrawal may be necessary to avoid triggers and cravings in social settings.
• Support from friends, family, and professionals is crucial in helping teens quit vaping or using other substances.
• A combination of nicotine replacement, environmental changes, healthy habits, and therapy may be needed for successful cessation.

Social Pressures, Quitting Vaping, Environment Concerns (01:23:05)

• Risky behaviors like vaping and alcohol use are often seen as socially acceptable among teenagers, with paraphernalia acting as a means of communication and bridging social gaps.
• The negative health effects, marketing strategies, taste, and addictive nature of vaping and other risky behaviors pose challenges for teenagers.
• Creating a culture that encourages quitting and providing social support can help teenagers resist peer pressure and make healthier choices.
• There is a growing trend of teens who are open to quitting or avoiding risky behaviors, indicating a positive shift in social attitudes.
• Establishing social groups and networks where it is acceptable to abstain from substances like alcohol and e-cigarettes can be beneficial.
• Discussing the environmental impact of vaping, such as plastic waste and secondhand vapor, can be an effective way to encourage teens to avoid or quit using e-cigarettes.

Teen Activities, Social Media, Autonomy (01:30:08)

• The rise of social media has led to a decline in outdoor activities and social interactions among youth, while increasing the likelihood of vaping.
• Vaping has become prevalent among youth, regardless of their background or demographics.
• Unlike traditional cigarettes, vaping is not primarily associated with boredom or a lack of social outlets.
• Social media and parental concerns about safety have contributed to this shift in youth behavior.
• Risky behaviors among youth in the past were often related to drugs, alcohol, mental health issues, and car accidents, with a strong discouragement against drunk driving.

Risky Behaviors, Alcohol, Driving, Sexual Behavior (01:36:28)

International E-Cigarette Use, Regulation (01:43:27)

• E-cigarette nicotine use is not as high in other countries compared to the US.
• Some countries have a nicotine standard, limiting the amount of nicotine allowed in e-cigarettes, which may contribute to lower addiction rates among teens.
• Marketing of e-cigarettes in other countries was initially focused on smoking cessation, not targeting teens.
• Recently, there has been a significant increase in teen e-cigarette use in some countries.
• The changing landscape of e-cigarette products and marketing strategies contributes to the rise in teen use.
• The prevalence of e-cigarette use among teens may not be as high as in the US, but it is increasing.
• Illicit trading and cross-border trafficking of banned e-cigarettes occur.
• Cannabis use among teens varies depending on its legality in different countries.
• Even in states where cannabis is legal, underage cannabis use persists, similar to underage drinking and nicotine use.

Nicotine Pouches, Health Risks; Tolerance (01:46:10)

• Zin pouches, similar to nicotine pouches, are gaining popularity among adults and teenagers, delivering nicotine into the bloodstream and potentially causing addiction, increased blood pressure, and vasoconstriction.
• Studies indicate a 20-25% usage rate among adolescents and adults, with 11-15% of teens using pouches, raising concerns about oral cancer due to the placement of the pouches in the mouth.
• Multiple pouch usage among teens increases nicotine intake, mirroring the effects of a pack of cigarettes, with some teenagers quickly escalating their usage from a few pouches a day to a whole canister (15-20 pouches) daily, equivalent to approximately two packs of cigarettes per day.
• Dr. Bonnie Halpern-Felsher expresses concern about the lack of studies on the effects of nicotine on child brains, emphasizing the potential risks of addiction and long-term consequences.

Tools: Vaping Interventions, Decision Making, Harm Reduction (01:53:25)

• To prevent substance abuse and risky behaviors among youth, open and ongoing conversations are essential, rather than relying solely on scare tactics or abstinence-only messaging.
• Conversations about sensitive topics like drugs, sex, and risky behaviors should start early, even when children are young, to normalize these discussions and build trust.
• Parents and educators should seize organic opportunities to engage in natural conversations about these topics, making them a regular part of everyday communication.
• While abstinence is the ideal goal, harm reduction strategies and discussions about responsible use can be valuable in preventing excessive or dangerous behaviors.

Fentanyl, Drug Testing, Recreational Drug Use (02:02:37)

• Fentanyl is a dangerous drug that has caused numerous deaths, particularly among young people.
• Open and honest conversations about drugs and drug use, along with harm reduction strategies like providing Narcan and fentanyl test strips, are crucial in preventing overdose deaths.
• Comprehensive drug and sex education are essential for helping young people make informed decisions about their health.
• Fentanyl is increasingly being found in various pharmaceuticals, including pain pills, MDMA, and cannabis, leading to unpredictable and dangerous effects when combined with these substances.
• Teens are unknowingly consuming fentanyl due to drug manufacturers cutting drugs with it, highlighting the need for more research on the biological mechanisms and access to these drugs.
• There is a shift in the educational landscape, focusing on harm reduction and comprehensive education, recognizing the importance of both education and policies in addressing drug use among youth.
• While there is optimism about the human and social capital, concerns arise regarding the increasing number of drugs infiltrating youth culture, the normalization of vaping, and the emergence of new drugs and devices that facilitate drug use.

Tool: Organic Conversations & Risky Behavior (02:13:45)

• Parents, siblings, teachers, and concerned citizens should have organic conversations about risky youth behaviors, such as vaping and alcohol use, rather than avoiding or formalizing the discussions.
• It is important to listen to young people's concerns and experiences, and to learn together about the risks and harms associated with certain behaviors.
• The goal of these conversations should be to build trust and provide support, rather than to immediately confront or punish young people for engaging in risky behaviors.
• Adults should approach these conversations with an open mind and avoid coming at young people with preconceived notions, as this can backfire.
• Young people are strong and smart, and their strengths should be used to guide these conversations, with adults providing their wisdom and experiences to help turn the discussions into productive learning opportunities.

Long-Term Goals & Teens; Vaping, Pornography & Teens (02:17:20)

• To help teenagers comprehend the long-term consequences of their actions, link their current behavior and risks to their ultimate goals and aspirations.
• Teenagers are inherently remarkable, imaginative, passionate, and concerned about the environment, social justice, and the future of our planet.
• Vaping nicotine during adolescence alters brain wiring, solidifying nicotinic receptors and making them more receptive to nicotine, thus increasing the risk of addiction.

Mental Health Crisis & Substance Use (02:24:08)

• Many teens self-medicate with substances to cope with challenges such as lockdowns, social isolation, stress, and sociopolitical issues.
• Substance use can lead to anxiety, depression, suicidal ideation, suicide attempts, psychosis, and other mental health issues.
• Drug use can also result in reduced academic achievement due to lack of concentration.
• Co-use of multiple substances, including cannabis, tobacco, alcohol, and other drugs, is common among teens and can enhance the high but also increase risks.
• Young people who use cannabis and tobacco together (e.g., blunts) can become addicted to both substances simultaneously.
• Teens with mental health issues and depression are more likely to use multiple substances.

Dr. Bonnie Halpern-Felsher: Vaping, Alcohol Use & Other Risky Youth Behaviors (00:00:00)

• Dr. Bonnie Halpern-Felsher is a leading expert on adolescent health and risk behaviors.
• She is the Director of the Stanford University School of Medicine's Center for Youth Mental Health and Wellbeing.
• Vaping and alcohol use are common among youth and young adults.
• Both vaping and alcohol use can have negative consequences for health and well-being.
• Vaping can damage the lungs and increase the risk of respiratory problems.
• Alcohol use can lead to liver damage, brain damage, and other health problems.
• Both vaping and alcohol use can also lead to addiction.
• There are a number of risk factors for vaping and alcohol use among youth, including:
  • Peer pressure
  • Mental health problems
  • Family history of substance use
  • Exposure to tobacco smoke or alcohol
• There are also a number of protective factors that can help prevent youth from vaping and drinking alcohol, including:
  • Strong family relationships
  • Parental monitoring
  • Positive peer influences
  • School-based prevention programs
• There are a number of strategies that can be used to prevent vaping and alcohol use among youth, including:
  • Education about the risks of vaping and alcohol use
  • Setting clear rules and expectations about vaping and alcohol use
  • Providing support for youth who are struggling with mental health problems
  • Encouraging youth to participate in positive activities
• Vaping and alcohol use are serious problems among youth and young adults.
• There are a number of risk factors and protective factors that can influence whether or not a young person will vape or drink alcohol.
• There are a number of strategies that can be used to prevent vaping and alcohol use among youth.