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

00:00:00.000 | - Welcome to the Huberman Lab Podcast,

00:00:02.260 | where we discuss science

00:00:03.660 | and science-based tools for everyday life.

00:00:05.900 | I'm Andrew Huberman,

00:00:10.220 | and I'm a professor of neurobiology and ophthalmology

00:00:13.380 | at Stanford School of Medicine.

00:00:15.340 | My guest today is Dr. Bonnie Halpern-Felsher.

00:00:18.520 | Dr. Bonnie Halpern-Felsher is a professor of pediatrics

00:00:21.260 | and adolescent medicine

00:00:22.460 | at Stanford University School of Medicine.

00:00:24.900 | A developmental psychologist by training,

00:00:26.700 | Dr. Halpern-Felsher is a world expert

00:00:29.340 | in the risk behaviors that adolescents,

00:00:31.480 | teens, and young adults participate in.

00:00:33.840 | Today, we discuss nicotine use,

00:00:35.520 | both by way of smoking,

00:00:37.140 | as well as vaping and e-cigarette use.

00:00:39.340 | We also discuss cannabis

00:00:40.780 | and some of the correlative

00:00:42.140 | as well as possibly causal data

00:00:44.180 | linking cannabis use to psychosis in young adults.

00:00:47.520 | And we discuss some of the other common risky behaviors

00:00:49.800 | that adolescents, teens, and young adults participate in,

00:00:52.520 | including risky driving behavior,

00:00:54.300 | alcohol consumption, and risky sexual behavior.

00:00:57.420 | We discuss the various factors

00:00:58.660 | that impact whether or not a young person

00:01:00.480 | will participate in risky behaviors,

00:01:02.600 | including the family and home,

00:01:05.100 | as well as peer group and social media.

00:01:07.740 | And as we discuss social media,

00:01:09.540 | we get into a deep discussion

00:01:10.820 | about how marketing is combining with peer pressure

00:01:13.620 | in order to drive youth

00:01:15.100 | toward particular risky behaviors.

00:01:17.060 | By the end of today's conversation,

00:01:18.820 | you will have learned from Dr. Halpern-Felsher

00:01:20.680 | the latest research on risk-taking behavior

00:01:23.160 | in adolescents, teens, and young adults,

00:01:25.420 | and what we can each and all do

00:01:27.480 | to ensure that they either avoid these behaviors

00:01:29.980 | or if they are already engaging in these behaviors,

00:01:32.800 | that we can mitigate some of the potential harms

00:01:34.900 | and potentially get them to eliminate these behaviors

00:01:37.660 | toward having a life of enhanced mental and physical health.

00:01:40.840 | Before we begin,

00:01:41.780 | I'd like to emphasize that this podcast

00:01:43.500 | is separate from my teaching and research roles at Stanford.

00:01:46.340 | It is, however, part of my desire and effort

00:01:48.260 | to bring zero cost to consumer information

00:01:50.180 | about science and science-related tools

00:01:52.260 | to the general public.

00:01:53.740 | In keeping with that theme,

00:01:54.840 | I'd like to thank the sponsors of today's podcast.

00:01:57.740 | Our first sponsor is Eight Sleep.

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00:02:04.820 | Now, I've spoken many times before on this podcast

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00:05:35.160 | And now for my discussion with Dr. Bonnie Halpern-Felsher.

00:05:38.880 | Dr. Halpern-Felsher, welcome.

00:05:41.160 | - Thank you so much for having me.

00:05:43.280 | - We're going to talk about a very important

00:05:45.500 | and sometimes troubling period of life.

00:05:49.440 | Not always troubling, but I think for everyone,

00:05:52.920 | adolescence and the teen years,

00:05:55.680 | youth essentially is a tricky landscape.

00:06:00.680 | - Yes, it is.

00:06:01.560 | It can be.

00:06:02.380 | - Yeah, as our brain and bodies mature,

00:06:05.480 | we have more autonomy in where we take them,

00:06:08.160 | but that means also more exposure to the ideas,

00:06:12.160 | suggestions, actions, peer pressure of others.

00:06:15.320 | And that's sometimes where the problems arise

00:06:18.400 | and who knows, probably also where the solutions come from

00:06:21.120 | too from time to time.

00:06:22.720 | But I think as conscientious people

00:06:26.520 | who mind the wellbeing of others of our species,

00:06:29.580 | we'd all like to know sort of like,

00:06:31.640 | what are the key features

00:06:32.680 | that mark this stage of development?

00:06:34.480 | Maybe we'll just start off by talking about this

00:06:36.880 | through the lens of your expertise

00:06:39.360 | as a developmental psychologist.

00:06:41.160 | You know, what is adolescence in the teen years?

00:06:43.200 | Like what's going on?

00:06:44.920 | What sorts of things are being worked out psychologically

00:06:49.000 | that we might not be aware of?

00:06:50.840 | And then we can talk about some of the common pitfalls

00:06:53.880 | and the risk-taking behavior,

00:06:55.320 | everything from smoking, vaping, drug use, sexual behavior,

00:07:00.320 | addictive behaviors as it relates to social media,

00:07:03.080 | bullying, risky driving, there's so much there.

00:07:06.040 | But maybe we could just look at this stage of youth

00:07:09.920 | through the lens of a developmental psychologist

00:07:11.880 | and share with us anything you feel is worth knowing.

00:07:15.280 | - Sure, so first of all, ages.

00:07:17.520 | Adolescence can be anywhere

00:07:19.560 | from starting roughly around age 10.

00:07:22.720 | Some people would say ending around age 18, maybe 21.

00:07:26.800 | If you wanna go into young adulthood, then maybe mid-20s.

00:07:30.040 | And really adolescence is a wonderful time of,

00:07:33.880 | as you said, exploration.

00:07:35.840 | It's a time when, first of all,

00:07:37.800 | marked by pubertal changes, onset of menses for girls,

00:07:41.680 | and really the pubertal and physical development,

00:07:47.000 | secondary sexual characteristics are coming out.

00:07:50.200 | We also have a lot of emotional development

00:07:52.120 | going on during this time.

00:07:54.360 | Height changes are occurring during this time.

00:07:57.000 | But we're getting a lot of social changes as well.

00:07:59.280 | As you said, peer pressures.

00:08:00.840 | So while misnomer as parents think

00:08:03.120 | that they don't matter during adolescence,

00:08:05.320 | they still really matter.

00:08:06.760 | But peers also come in and matter quite a bit.

00:08:09.440 | And then teens are really trying to figure out who they are.

00:08:13.480 | You get a lot of questions.

00:08:15.200 | Who am I?

00:08:16.440 | Where am I going in life?

00:08:17.880 | What do I wanna do when I grow up?

00:08:20.360 | What's important to me?

00:08:22.280 | How do other people feel about me?

00:08:24.640 | And then how do I feel about other people?

00:08:26.920 | So a lot of the social and psychosocial development

00:08:30.400 | is happening as well.

00:08:32.840 | And you get asynchronous development too

00:08:35.960 | if a young person, for example,

00:08:37.840 | starts puberty at a younger age, say 10,

00:08:40.520 | where they're physically looking older, more mature.

00:08:44.120 | But emotionally and psychosocially,

00:08:46.040 | they still might be young versus the late matures,

00:08:50.280 | physical matures who may be not having

00:08:52.480 | and looking like an older teen or an adult till 16, 17, 18,

00:08:57.480 | but they're more mature emotionally than others.

00:09:00.360 | Then you might have some confusion to that young person.

00:09:03.680 | I look older, but I don't feel older and stuff like that.

00:09:06.880 | But it's really this wonderful time of exploration

00:09:09.120 | for an adolescent and a time of really wanting autonomy

00:09:12.880 | and wanting to make a lot of decisions

00:09:14.760 | that we should let them make,

00:09:16.400 | but there are some risks that we have to be careful about

00:09:18.440 | at the same time.

00:09:19.280 | - I've often heard this word autonomy

00:09:22.480 | as it relates to this stage of puberty in the teen years.

00:09:27.320 | You mentioned that kids of that age

00:09:29.840 | still really need their parents.

00:09:32.280 | You know, in the last, gosh, 20, 30 years in this country,

00:09:35.360 | there's been a marked increase in the frequency of divorce.

00:09:39.200 | Is there any direct evidence that single parent homes

00:09:43.400 | or homes where, I don't know, people are remarried

00:09:46.800 | or just basically divorced homes

00:09:48.560 | are somehow creating more challenges

00:09:51.880 | in terms of risk-taking behavior in adolescents and teens

00:09:54.760 | or not?

00:09:56.200 | Because I know plenty of people who had, you know,

00:09:59.040 | grew up in single parent homes,

00:10:01.400 | sometimes parents remarried and sometimes didn't,

00:10:03.520 | and by my mind,

00:10:05.680 | I can't seem to come up with any direct correlation.

00:10:08.160 | You know, plenty of those kids did fine

00:10:10.600 | and plenty of kids in two-parent homes

00:10:12.480 | that I know had challenges and vice versa.

00:10:15.600 | - Yeah, I haven't contributed.

00:10:17.800 | Actually, I have some of my earlier dissertation work

00:10:20.120 | and I haven't really contributed

00:10:21.320 | to that literature for a while,

00:10:22.640 | but what you're saying is pretty accurate

00:10:24.800 | to what I've seen,

00:10:26.520 | which is really the literature would say

00:10:29.120 | it's not the divorce per se,

00:10:31.080 | it's the conflict that is happening.

00:10:33.440 | So if parents actually get divorced,

00:10:35.600 | usually if the conflict resumes,

00:10:38.200 | teenagers and children generally do well,

00:10:40.520 | and particularly within about two years.

00:10:42.360 | - If the conflict resolves.

00:10:44.640 | - If the conflict resolves, right.

00:10:46.360 | So you can have two parents who are married

00:10:49.440 | and living in the same home

00:10:51.200 | and may or may not be a good relationship,

00:10:53.920 | but living in the same home,

00:10:54.960 | if there's no conflict,

00:10:57.360 | or then generally teens will do well,

00:10:59.920 | or as you're saying,

00:11:01.000 | there's not necessarily a direct correlation.

00:11:03.280 | The problem comes in whether parents

00:11:05.520 | are living at home together or separated or divorced

00:11:08.200 | is if there's conflict.

00:11:09.520 | And then that conflict tends to result in social issues,

00:11:14.160 | emotional issues, a lot of social anxiety,

00:11:17.400 | a lot of feeling like I need to do better

00:11:19.680 | so that way my parents like me more.

00:11:21.840 | And we see that with children too,

00:11:23.120 | that's not just adolescents.

00:11:25.240 | A lot of depression,

00:11:27.240 | and with depression can come self-medication,

00:11:30.200 | self-medicating around other drugs and so on.

00:11:33.280 | But that generally is resolved if the conflict resolves.

00:11:37.520 | But as you're saying,

00:11:38.600 | we're seeing adolescents angst regardless of parenting.

00:11:41.720 | What we really need though,

00:11:43.320 | it's not a matter of just the divorce or not divorce

00:11:46.080 | or the relationship between the parents,

00:11:47.840 | it's parenting that's important.

00:11:50.520 | So parents being good monitors,

00:11:52.760 | being involved in their kids' lives,

00:11:54.640 | not this, oh, you're 16, you have a car,

00:11:56.520 | you can go wherever you want

00:11:57.600 | and we're not gonna keep an eye on you.

00:11:59.320 | We still need parents to monitor, to pay attention,

00:12:03.200 | to find out their kids' friends,

00:12:05.480 | where are they going after school,

00:12:07.320 | that discretionary time when parents are working

00:12:10.160 | and teenagers come home between three and five

00:12:13.120 | or three and six tends to be the most risky couple of hours.

00:12:17.280 | They're, it's called discretionary hours

00:12:20.040 | where there's no parent around

00:12:21.600 | and we don't always know where those teenagers

00:12:23.920 | are hanging out.

00:12:24.760 | So that's more important knowing where their children are

00:12:28.280 | and what they're doing

00:12:29.440 | and that there's some adult presence, some monitoring

00:12:32.320 | than whether or not they're still in a relationship.

00:12:35.520 | - My sense is that smartphones have allowed more

00:12:38.800 | communication and monitoring between parents and kids,

00:12:41.960 | but also more interactions between kids

00:12:44.280 | and other kids and kids and adults more broadly.

00:12:47.320 | So is there any evidence that the advent of smartphones

00:12:52.880 | is directly creating problems for kids

00:12:55.720 | that has to do with just so much more

00:12:58.960 | peer-to-peer interaction or peer-to-peer exposure?

00:13:02.520 | Like when I was growing up, we didn't have smartphones.

00:13:05.240 | If you did something stupid like that,

00:13:07.760 | meaning that kids would laugh at,

00:13:09.760 | it might get told to a small group of people,

00:13:12.720 | maybe a larger group of people,

00:13:13.960 | but in general, it just kind of didn't go anywhere.

00:13:17.600 | You're like, ah, I screwed up

00:13:18.600 | and then you'd get teased a bit

00:13:19.880 | and then it would kind of dissipate.

00:13:21.320 | But now, of course, that can propagate

00:13:23.400 | very, very far, very fast.

00:13:25.320 | Is there any evidence that that mere fact

00:13:28.040 | is creating issues for kids?

00:13:30.720 | - So I would say it's not a blanket statement.

00:13:33.440 | I think it depends on the behavior

00:13:35.360 | that we're talking about.

00:13:36.520 | Bullying, no doubt, and the example that you gave,

00:13:39.640 | no doubt that if you mess up, if you do something stupid,

00:13:43.200 | it's getting filmed and it's gonna go viral.

00:13:45.500 | It will go on social media and then it will perpetuate

00:13:49.920 | and escalate amongst the peers.

00:13:52.840 | That we definitely know is happening.

00:13:55.240 | And certainly in terms of drug use and marketing,

00:13:58.360 | there's definitely some peer-to-peer interaction.

00:14:00.780 | Look how cool I am.

00:14:01.840 | Look at the smoke ring I did.

00:14:03.720 | Look at other things that I've been doing.

00:14:05.960 | There's no doubt.

00:14:07.500 | But in general, there are also some good things about it.

00:14:10.120 | Parent communication.

00:14:11.440 | They can monitor where their children are.

00:14:13.400 | They can put a tracker on the phone.

00:14:16.600 | I know with my own kids,

00:14:17.840 | sometimes it was the best way to say,

00:14:19.760 | you seem a little sad when face-to-face communication

00:14:22.720 | wasn't happening.

00:14:23.560 | I could use the phone to have that conversation.

00:14:26.560 | So yes, there is some evidence that overall phones

00:14:30.380 | and smartphones have increased risk behavior,

00:14:34.320 | but it's more the access to the behavior

00:14:36.880 | and then the viralness of really getting

00:14:39.820 | that information out.

00:14:41.240 | Like you said, if somebody screws up,

00:14:43.920 | somebody dresses wrong, if somebody kisses somebody,

00:14:47.240 | that that could go pretty viral.

00:14:49.600 | I wouldn't say that smartphones and social media

00:14:52.720 | as a whole is the problem.

00:14:54.720 | I think it's situation-specific and behavior-specific

00:14:58.440 | that we're seeing, and particularly around marketing,

00:15:01.580 | for example, that teenagers have more access now

00:15:04.680 | to YouTube, to marketing, that they're promoting,

00:15:08.480 | not only are industries promoting, for example,

00:15:11.360 | e-cigarettes or cannabis promoting to young people,

00:15:14.680 | but teens are promoting to each other.

00:15:16.680 | And that we didn't see before smartphones, right?

00:15:19.080 | We didn't see, I took a picture, or Instagram,

00:15:21.520 | look at me smoking, or look at me dressing sexy,

00:15:25.680 | or look at me looking cool, or anything like that.

00:15:28.480 | That didn't happen before.

00:15:30.720 | It was more just word of mouth.

00:15:32.600 | So that is definitely where we're a lot more concerned

00:15:35.520 | about social media, but more my concern about social media

00:15:40.200 | is the outside world targeting young people.

00:15:43.000 | That's where I've been the biggest concerned about it.

00:15:46.800 | Teenagers targeting each other with bullying,

00:15:49.280 | no doubt, big issue.

00:15:51.120 | But in other ways, there's more support,

00:15:53.120 | there's more social interaction.

00:15:54.900 | The other time I get concerned, though, around teenagers

00:15:58.840 | is more the social piece of sitting around together

00:16:02.320 | at a table, and they're not talking, they're on the phones.

00:16:05.560 | So what we really don't know enough is

00:16:08.320 | how is the not getting out and playing,

00:16:10.640 | and instead playing on a game, not going to the park,

00:16:13.800 | and instead communicating through phones,

00:16:16.520 | how is that changing their social and physical development

00:16:20.720 | is where I'm also very concerned.

00:16:22.920 | - Yeah, I have family relatives who are in their teens,

00:16:29.440 | and it's interesting to see them interact

00:16:33.520 | where they're on their phones a lot of the time.

00:16:36.240 | But I've also noticed that there's a cohort of kids

00:16:38.320 | that are really trying to put their phones away

00:16:39.760 | and just spend time together.

00:16:41.060 | And that was actually directly stated to me,

00:16:43.500 | that, oh yeah, we hang out and we make it a point

00:16:46.000 | not to be on our phones when we hang out.

00:16:48.880 | But then, of course, they'll text or be on the iPad

00:16:51.160 | with one another in the evening when they're apart.

00:16:53.600 | So they're sort of never apart.

00:16:55.120 | - Right.

00:16:56.280 | - But I do think there seems to be at least a sub-movement

00:16:59.200 | of kids and teens that are trying to do

00:17:02.120 | more face-to-face interaction with devices,

00:17:04.220 | at least put aside.

00:17:06.080 | - I think that's a really good point.

00:17:07.040 | I've talked to some teens who say that they all,

00:17:08.880 | they get together and they will deliberately put the phones

00:17:11.640 | face down in the middle, no phones,

00:17:14.480 | and have dinner or have a conversation.

00:17:16.120 | So I think you're right.

00:17:17.220 | I definitely think that that has been a movement

00:17:20.400 | and I really appreciate that and I think that's fantastic.

00:17:23.600 | I've also seen circumstances where two teens

00:17:26.300 | are trying to help each other with homework

00:17:27.880 | and they're texting each other, which is fine.

00:17:30.880 | But I've often said, why don't you just pick up the phone

00:17:32.960 | and call the person and in five minutes

00:17:35.080 | you can figure out the math assignment

00:17:36.600 | instead of 20, 30 minutes of back and forth.

00:17:39.400 | It's just not as efficient unless you're literally copying

00:17:42.000 | and showing the picture.

00:17:43.400 | But is that having a change on their social

00:17:45.240 | or physical development or emotional development?

00:17:47.600 | Probably not.

00:17:48.440 | It's just a different world, the way that they communicate.

00:17:51.800 | And that's why I say, I'm less worried in some ways,

00:17:54.760 | as long as they're still getting out and they're playing

00:17:56.560 | and they're being creative, I'm less worried

00:17:58.560 | about that kind of social interaction

00:18:01.120 | on phones and social media.

00:18:03.480 | It's a different way.

00:18:05.060 | We don't have a lot of evidence to say one way or the other,

00:18:07.480 | but if they're still doing the things

00:18:09.020 | that they should be doing as young people,

00:18:10.760 | my concern is that outside world,

00:18:13.560 | the concern of predatory behaviors,

00:18:17.600 | the concern of industry, the concern of mass media

00:18:21.000 | and marketing to teens.

00:18:22.440 | That's the part that gets me particularly worried.

00:18:25.440 | - Yeah, well, we know for sure that this is the first time

00:18:27.760 | in human evolution that humans have essentially written

00:18:31.440 | with their thumbs.

00:18:32.600 | It's gotta be a massive expansion

00:18:34.240 | of the brain's representation of the thumbs

00:18:36.600 | relative to 20, 30 years ago.

00:18:38.880 | But maybe now would be a good time to talk

00:18:41.720 | about risky behaviors or even just behaviors

00:18:46.200 | that are known to have some detriment to health,

00:18:48.840 | smoking and vaping and e-cigarettes primarily.

00:18:53.840 | And we should be probably distinguishing

00:18:57.520 | between nicotine and cannabis.

00:19:00.480 | Maybe let's just start with nicotine.

00:19:03.200 | What are the statistics on smoking, vaping and e-cigarettes?

00:19:08.380 | Just rough statistics.

00:19:09.500 | I saw a talk that you did online,

00:19:13.000 | decided some pretty outrageous increases

00:19:16.000 | in or shocking increases in smoking and vaping

00:19:19.840 | in the last couple of years, just staggering.

00:19:22.480 | So maybe if you give us the top contour of those.

00:19:25.040 | - Sure, absolutely.

00:19:26.320 | So the good news is smoking rates,

00:19:28.720 | conventional cigarette smoking rates

00:19:30.360 | has gone down pretty dramatically

00:19:31.800 | in the last couple of decades with teenagers,

00:19:34.420 | with all people in the US, which is wonderful,

00:19:37.000 | but teenagers to well below 10%,

00:19:40.120 | if not really well below 5% of teenagers.

00:19:43.440 | That's the good news.

00:19:45.320 | In terms of e-cigarette use,

00:19:46.920 | which I prefer the term e-cigarette use than vaping

00:19:49.560 | 'cause they're not vapes, they're aerosols.

00:19:52.280 | But e-cigarette use has gone up pretty dramatically.

00:19:54.840 | So e-cigarettes came on the market in the US in 2007.

00:19:59.840 | And they were slowed for uptick amongst teenagers.

00:20:03.440 | They look like cigarettes when they first came on the market.

00:20:06.480 | They weren't very popular with teenagers.

00:20:08.360 | They didn't have, they had some flavors, not a lot,

00:20:10.560 | didn't have a lot of nicotine.

00:20:12.560 | It was probably around 2011 to 2014,

00:20:15.360 | we started seeing an uptick,

00:20:16.960 | but then it was really in 2017 to '19

00:20:20.000 | that we saw a dramatic increase.

00:20:22.120 | And that was the statistics there.

00:20:24.560 | We saw upwards of 27 to 29% of teens

00:20:28.280 | using e-cigarettes during those couple of years.

00:20:31.360 | - Daily use?

00:20:32.360 | - Past 30 days, so any use in the past 30 days

00:20:36.400 | was, and daily use will be some smaller percentage of that.

00:20:40.080 | It was something like a 78% increase

00:20:42.960 | in high school student use

00:20:44.280 | and a 48% increase in middle school use

00:20:46.880 | over those couple of years.

00:20:47.960 | So a very dramatic increase in use.

00:20:52.080 | Since 2019, it's gone down, but I'm gonna give a caveat.

00:20:56.680 | It's gone down in 2020 to the national numbers are showing

00:21:00.600 | that went to around 20% and now around 10%.

00:21:03.920 | Part of that was in 2020 we had COVID

00:21:07.080 | and initiation of e-cigarette use really occurs socially.

00:21:12.080 | And going back to socialization,

00:21:14.000 | it's a lot of teens getting together

00:21:16.240 | and it's not peer pressure of you have to try,

00:21:18.560 | come on, try this.

00:21:19.440 | It's more like my friends are using, I'm at a party,

00:21:21.960 | I feel like using, yeah, I'll try it.

00:21:24.560 | Well, during the pandemic and the shutdown,

00:21:28.080 | teens were not at school, they weren't with their friends.

00:21:30.680 | So initiation went down.

00:21:33.200 | Teens who were addicted,

00:21:34.720 | and we can certainly talk about levels

00:21:36.280 | of nicotine in e-cigarettes,

00:21:38.160 | but teens who were addicted continues to use.

00:21:40.720 | Some try to quit, which was great,

00:21:43.000 | but we still saw a fair amount of use.

00:21:45.120 | So part of the decrease in those 2020 to 2021

00:21:49.160 | have to do with just access and socialization had changed.

00:21:53.920 | And so rates went down.

00:21:56.120 | Since then, even we published a paper

00:21:58.720 | showing relationships between COVID and vaping.

00:22:02.120 | We saw EVALI, e-cigarette and vaping

00:22:04.880 | associated lung illness.

00:22:07.040 | So that we think was part of why

00:22:09.320 | we also saw further drops around 2021,

00:22:12.280 | but people were concerned about their lung health

00:22:14.160 | in teens as well, and that's great.

00:22:16.440 | The latest data show that the rates are under 10%,

00:22:21.400 | the national data.

00:22:22.840 | I actually don't think it's true.

00:22:24.400 | And the reason I don't think it's true

00:22:26.480 | is I'm in the schools doing curriculum presentations

00:22:30.960 | all the time where I teach and educate teachers

00:22:33.440 | to use our tobacco and cannabis prevention curriculums.

00:22:37.400 | And we've never been busier than we are right now

00:22:40.480 | with schools just crying for help.

00:22:43.000 | We have another group of teenagers using e-cigarettes,

00:22:47.080 | nicotine or cannabis or whatever.

00:22:49.600 | It's way more than 10%.

00:22:51.240 | I would say schools are telling me it's 40 to 60%

00:22:54.200 | of their students are using e-cigarettes.

00:22:58.160 | - For nicotine?

00:22:59.800 | - We don't know.

00:23:00.640 | It's very hard to know.

00:23:02.160 | It's very hard to know what's in there, but-

00:23:05.000 | - 40 to 60%.

00:23:06.440 | - That's what the schools are saying.

00:23:08.120 | - At some point in the last 30 days.

00:23:09.840 | - At some point in the last 30 days.

00:23:11.520 | They're catching just exorbitant numbers

00:23:14.320 | of students using right now.

00:23:16.280 | And so from a science perspective, is it 10%, 20%, 30?

00:23:20.560 | We don't know.

00:23:21.400 | I can just tell you that the national CDC data

00:23:25.400 | would say 10% and maybe it's a problem with the surveys

00:23:28.240 | or the questions or teens aren't being honest,

00:23:30.960 | but from a school's perspective, it's much higher.

00:23:33.800 | And then we have some national data suggesting

00:23:36.240 | it's more in the 20 to 30 to 40% range as well.

00:23:39.800 | Whatever it is, it's too many.

00:23:41.440 | It's too many teens who are inhaling nicotine

00:23:44.480 | and cannabis as well.

00:23:46.760 | - Well, a lot to unpack there.

00:23:48.400 | First of all, nicotine.

00:23:50.840 | I did an episode of the podcast about nicotine

00:23:54.040 | and a little bit of that got confused

00:23:57.560 | in the way it landed.

00:23:58.640 | So I'll just quickly state that nicotine,

00:24:03.260 | known cognitive enhancer,

00:24:05.440 | also known to dramatically increase blood pressure

00:24:08.680 | and vasoconstriction, not healthy for the body,

00:24:12.200 | just to be clear, it's not healthy for the body.

00:24:14.200 | So when people hear that it's a cognitive enhancer,

00:24:15.880 | increases focus and alertness, that's true.

00:24:19.440 | In the short term, highly addictive,

00:24:21.880 | highly, highly addictive and habit forming

00:24:25.560 | since sometimes those are separated.

00:24:26.960 | Maybe we delve into that distinction.

00:24:29.680 | But by my observation,

00:24:32.120 | very few people can use nicotine occasionally.

00:24:35.920 | People who try it seem to like it,

00:24:40.920 | at least in the short run and keep using it.

00:24:44.320 | So presumably kids are using,

00:24:49.280 | or I should say youth are using nicotine

00:24:51.320 | either by vape or e-cigarette

00:24:53.920 | and they quote unquote like the way it makes them feel.

00:24:57.640 | Who knows, maybe it allows them

00:24:58.880 | to focus on their studies better, I don't know.

00:25:01.940 | But it is known to improve certain forms of cognition,

00:25:06.560 | but only transiently and it's highly addictive

00:25:08.460 | and it's bad for their health, for anyone's health.

00:25:11.580 | So that puts us in a kind of a tricky situation

00:25:14.520 | when evaluating in the statistics that you just laid out

00:25:17.200 | because one wonders, are they taking it

00:25:20.840 | and then continuing to take it because of peer pressure,

00:25:24.280 | because of lack of peer pressure to not do it,

00:25:27.160 | because it helps them with their schoolwork,

00:25:30.440 | because they're naturally a little bit depressed

00:25:32.200 | and it provides a kind of antidepressant signal.

00:25:36.000 | I mean, what do we know about why they're actually starting

00:25:39.640 | and why they're continuing

00:25:41.320 | and why they are reluctant to quit?

00:25:43.120 | Maybe we just parse those.

00:25:44.920 | So why does a teenager try nicotine?

00:25:49.820 | So there are a few reasons why they start

00:25:53.800 | based on the scientific literature and just talking to teens.

00:25:57.760 | One has to do with the marketing, no doubt.

00:26:00.040 | If you look at the marketing, it is targeting young people.

00:26:04.680 | It's targeting them with first of all,

00:26:07.240 | the devices themselves, they are cool looking,

00:26:10.960 | they're easy to hide, they look like USB devices,

00:26:15.520 | they look like highlighters.

00:26:17.280 | In fact, there's a new brand out called Highlight

00:26:19.760 | that is a highlighter, that's a working highlighter,

00:26:22.480 | but it's actually a nicotine e-cigarette.

00:26:24.800 | - So a highlighter pen to study.

00:26:26.920 | - Highlighter pen to study,

00:26:28.920 | but it's actually, you take the cover off

00:26:30.880 | and it's actually a nicotine e-cigarette device.

00:26:33.520 | - Clearly marketed towards students.

00:26:35.560 | - Clearly marketed towards students.

00:26:37.560 | You have, what's it called, boba teas, drinks.

00:26:42.560 | - Oh yeah, the tea with the, yeah.

00:26:44.520 | - Yeah, mimicking that drink that's actually,

00:26:48.880 | that the straw is actually the vaping inhaling there,

00:26:51.960 | little pieces.

00:26:53.120 | You have Star Wars shapes, it goes on and on,

00:26:58.120 | just the cartoon shapes that are clearly being targeted

00:27:02.840 | to not just teenagers, children that we're seeing.

00:27:07.160 | - Children, like young children?

00:27:08.480 | - Children, like young children, so.

00:27:10.520 | - Wait, so I'm shocked.

00:27:14.960 | So kids younger than 10

00:27:18.080 | are having these products push their way?

00:27:20.560 | - They are, and actually I didn't tell you

00:27:22.800 | in the statistics, the statistics I was citing,

00:27:25.560 | I should go back and clarify a couple there

00:27:27.960 | that are even more shocking.

00:27:30.000 | So those are the numbers for middle and high school.

00:27:32.360 | We don't have data from elementary,

00:27:34.600 | but again, the other part of,

00:27:36.160 | in addition to the science I contribute to,

00:27:38.880 | the interventions I do,

00:27:40.760 | I am getting elementary school teachers calling us

00:27:44.720 | for help, they are catching second and third graders

00:27:49.120 | using nicotine cigarettes, I'm not kidding.

00:27:51.760 | And not just one or two, quite a bit.

00:27:55.600 | We said we would never develop an elementary school version

00:28:00.000 | of a vaping prevention curriculum,

00:28:02.000 | that's what we call ours, you and me together, Vape Free.

00:28:04.840 | We would never, we have a middle school and a high school,

00:28:07.200 | we were never gonna do elementary.

00:28:09.320 | We've had so many schools across the country

00:28:13.320 | call us and say, "We need something for elementary."

00:28:16.580 | So we actually created a curriculum.

00:28:18.440 | So we're having, there was a story of an eight-year-old

00:28:22.240 | back east who was caught and using,

00:28:26.360 | and the teachers and police didn't know what to do,

00:28:28.960 | and of course I said, "It's not a police matter,

00:28:31.120 | "why aren't we helping this young person?"

00:28:33.680 | So we are, we're seeing younger now,

00:28:36.480 | sometimes they're starting because their siblings,

00:28:39.640 | older siblings, it's being marketed to,

00:28:44.200 | they don't realize that it's a nicotine e-cigarette

00:28:47.000 | or a cannabis e-cigarette,

00:28:48.560 | they just don't realize what it is.

00:28:51.440 | But the number of these products

00:28:54.080 | that are being targeted to young people

00:28:56.640 | is absolutely ridiculous what they look like.

00:29:00.120 | The pictures are endless, and the problem is

00:29:02.600 | they're coming out with new products every few months

00:29:06.160 | that are targeting kids.

00:29:09.240 | So marketing, and the other is flavors,

00:29:12.640 | and flavors and marketing go hand-in-hand.

00:29:14.880 | If it looks bad, it looks like, or it smells like,

00:29:19.760 | and tastes like nicotine or tobacco,

00:29:22.640 | teens know that that's gross.

00:29:24.680 | That's why we don't have cigarette use anymore.

00:29:26.840 | Teens, we've socialized our country to say

00:29:30.240 | if you smell tobacco, it's nothing that we want to smell,

00:29:33.800 | we walk away from it, you walk across the street,

00:29:36.360 | whatever, we've done a really good job

00:29:38.600 | in tobacco control getting the word out around

00:29:41.240 | that these products, e-cigarettes, smell and taste

00:29:46.240 | like sugar, like sweets, like dessert, like candy.

00:29:51.760 | So you've got, and the names are things like Unicorn Poop

00:29:56.120 | and Sugar Booger and Honey Doo Doo.

00:29:59.440 | That's not for adults.

00:30:00.800 | Those names are squarely for kids.

00:30:03.680 | It's kids who are using chocolate,

00:30:05.520 | it's kids who are using these flavors

00:30:07.460 | that are on the market.

00:30:09.160 | And then the marketing around it are these,

00:30:11.840 | I mean, they're beautiful.

00:30:13.040 | There are these pizazz of pineapple dancing around

00:30:17.440 | or strawberries dancing or whatever it is

00:30:22.440 | that are very animated.

00:30:24.640 | There are juice box style that have come out,

00:30:28.080 | juice box style vaping devices

00:30:30.560 | that are marketed looking like juice boxes.

00:30:33.720 | Again, that's not targeting you and me.

00:30:36.000 | That's targeting a kid.

00:30:37.540 | - Interesting and scary to hear all this.

00:30:42.100 | I'd like to take a brief break

00:30:43.280 | and acknowledge our sponsor, AG1.

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00:30:55.820 | once or twice a day because it gives me vitamins

00:30:58.480 | and minerals that I might not be getting enough of

00:31:00.400 | from whole foods that I eat,

00:31:02.040 | as well as adaptogens and micronutrients.

00:31:04.960 | Those adaptogens and micronutrients are really critical

00:31:07.320 | because even though I strive to eat most of my foods

00:31:09.960 | from unprocessed or minimally processed whole foods,

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00:31:13.920 | especially when I'm traveling and especially when I'm busy.

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00:32:13.480 | - What percentage of adults in the US

00:32:15.760 | vape or use e-cigarettes just by way of comparison?

00:32:18.680 | - So I've seen numbers anywhere from 5% to around 20%,

00:32:22.360 | depending on the statistic.

00:32:23.600 | I actually haven't looked at the latest data on adults,

00:32:26.880 | but the majority of adults who are using,

00:32:32.400 | it's a little bit different to think about it.

00:32:34.880 | Adults are using generally,

00:32:36.840 | they're not initiating tobacco through e-cigarettes.

00:32:40.680 | They're generally, and I'm talking 30 and up,

00:32:43.880 | they generally have been smoking cigarettes

00:32:46.140 | and then maybe they're trying to use e-cigarettes to quit,

00:32:49.280 | which is a whole nother set of literature

00:32:52.540 | that it's not necessarily as effective

00:32:54.440 | as we're hoping that it is.

00:32:55.680 | There isn't good literature on a population level

00:32:58.900 | that e-cigarettes help adults quit cigarettes.

00:33:02.420 | The difference with teenagers

00:33:05.140 | is they're initiating with e-cigarettes

00:33:08.860 | and they're not saying, huh, here's a cigarette,

00:33:11.660 | here's an e-cigarette, which one do I choose?

00:33:14.060 | It's not that they're substituting or replacing.

00:33:16.820 | They're not using cigarettes.

00:33:18.580 | Some are now because they're switching back and forth,

00:33:21.580 | but they're initiating with e-cigarettes.

00:33:23.820 | They're initiating because of the marketing.

00:33:25.860 | They're initiating because of the flavors

00:33:28.420 | and the products and the ability to hide it.

00:33:31.340 | Parents don't know what these products look like.

00:33:34.500 | So the landscape is very different.

00:33:36.740 | - So you were telling us why teens

00:33:40.460 | and adolescents start vaping.

00:33:42.180 | The marketing is clearly oriented toward them.

00:33:44.820 | There are a number of reinforcing factors

00:33:47.020 | that, at least to my mind, as you're describing all this,

00:33:50.420 | make it sound like this stuff is supposed to be,

00:33:53.740 | quote unquote, playful, that it's not a drug.

00:33:58.220 | That sort of thing.

00:33:59.060 | It reminds me a little bit of sugary cereals.

00:34:00.900 | When I was a kid, you'd buy the cereal

00:34:02.620 | 'cause you wanted the taste,

00:34:03.900 | but you also wanted the colorful box.

00:34:06.780 | You had the cartoons that it related to on TV.

00:34:10.100 | And there's usually a toy inside that you wanted,

00:34:12.640 | some surprise that you could then collect across boxes.

00:34:15.740 | So there was a lot of levels of incentivization.

00:34:18.540 | Why do they keep smoking or vaping?

00:34:21.260 | Are they addicted to nicotine?

00:34:23.020 | - Yeah, absolutely.

00:34:24.340 | So the other reason why they start is they like the taste

00:34:28.460 | and they like the rush.

00:34:30.060 | So I've talked to, so that's the other pieces.

00:34:33.100 | So a few more reasons why they start

00:34:34.820 | and then certainly answer your question around the nicotine.

00:34:37.820 | Teens have told me outright that they like the taste,

00:34:42.800 | they like the rush, they like the buzz.

00:34:45.360 | And we could talk about how much nicotine is in there.

00:34:47.500 | It's astonishing and I can explain that,

00:34:49.700 | but they like the buzz.

00:34:53.300 | Another reason, by the way, is stress and coping.

00:34:55.600 | Right now, teens are so stressed out.

00:34:57.780 | They've been stressed out for years,

00:34:59.460 | but they're particularly stressed with the pandemic.

00:35:02.600 | And even though we're a couple years out of the lockdown,

00:35:06.080 | teens are still, they're having socialization issues,

00:35:08.860 | social emotional learning issues.

00:35:10.780 | They're still confused.

00:35:12.460 | They missed a couple of years,

00:35:13.860 | particularly high school students

00:35:14.980 | may have missed part of middle school

00:35:16.360 | where you're learning to socialize with other people.

00:35:19.460 | So they're very stressed.

00:35:20.460 | And we know that there's a pretty strong relationship

00:35:22.520 | between stress, not being able to cope

00:35:25.420 | and using any drug, but including nicotine.

00:35:28.600 | So there's a lot of different reasons why young people

00:35:32.380 | and certainly the peers.

00:35:33.500 | And again, it's not peer pressure.

00:35:35.600 | It's more like a lot of friends are using it.

00:35:37.500 | I've talked to teens who say,

00:35:38.980 | I wasn't intending on, but I tried it.

00:35:41.700 | Wow, I really liked the taste, I liked the flavor.

00:35:45.060 | And then there's the amount of nicotine that's in there.

00:35:48.260 | In 2015, when the newer products came on the market,

00:35:51.980 | it was a salt-based nicotine.

00:35:54.220 | So cigarettes and then earlier e-cigarettes

00:35:57.380 | have a free-based nicotine.

00:35:59.300 | Free-based nicotine uses ammonia and sugar

00:36:02.700 | to bind to the nicotine and the other chemicals.

00:36:04.820 | There's hundreds of chemicals in there

00:36:06.420 | to go through the body, lungs into the brain

00:36:08.740 | and give you that rush.

00:36:09.960 | The free-based nicotine is very caustic.

00:36:14.820 | If you think the litmus test,

00:36:16.100 | it's very much on the basic side of the litmus test there.

00:36:19.620 | And if you're a nicotine-naive youth,

00:36:22.380 | which again, most teens starting with nicotine e-cigarettes

00:36:26.180 | have not used nicotine before,

00:36:28.340 | when you start, you don't want that caustic throat hit

00:36:32.060 | feeling, that's how it's described.

00:36:34.200 | Teens will say they don't like it,

00:36:35.540 | they cough, it tasted bad.

00:36:37.460 | Well, to an adult who's been using cigarettes,

00:36:40.480 | they don't mind that, they're used to it,

00:36:42.200 | but a teen is not.

00:36:44.020 | Well, I will mention Juul here 'cause it's relevant.

00:36:47.500 | Juul came on the market in 2015.

00:36:49.540 | - With a salt-based nicotine.

00:36:51.700 | - Which essentially, for those who aren't familiar

00:36:53.800 | with caustic and litmus tests and things like that,

00:36:57.340 | the salt-based nicotine, as I understand,

00:36:59.400 | is quote-unquote smoother.

00:37:01.660 | - Correct.

00:37:02.500 | - It causes less sort of coughing,

00:37:07.240 | static contraction of the muscles in the mouth and throat,

00:37:11.740 | you know, and so it's basically more palpable

00:37:14.940 | and more of a kind of gradual on-ramp,

00:37:18.380 | which is exactly what a company wants.

00:37:21.060 | If you want somebody to start using something,

00:37:24.100 | you don't want to hit them square in the face.

00:37:26.500 | - That's exactly right, that's exactly right.

00:37:28.260 | So salt-based nicotine generally uses benzoic acid

00:37:31.380 | to move that litmus test needle from the caustic

00:37:34.520 | towards acidic because it's an acid,

00:37:36.940 | but really towards neutral, exactly.

00:37:39.180 | So when you use it, it's smooth, it's easy to use,

00:37:42.820 | you don't have that throat hit, you don't cough,

00:37:45.640 | you don't feel sick from it.

00:37:47.260 | So teens will say, and I've talked to teens

00:37:50.100 | and young adults who tried earlier e-cigarettes

00:37:52.860 | and didn't like it and then tried the salt-based style

00:37:55.540 | and said, "Ooh, I like it," coupled with the flavors,

00:37:59.140 | it's also more absorbent.

00:38:00.740 | So there's some suggestion and some early evidence

00:38:03.380 | that it's also more addictive.

00:38:04.980 | So when those products first came on the market,

00:38:09.620 | before, earlier e-cigarettes had, say,

00:38:12.220 | zero to 36 milligrams of nicotine.

00:38:15.380 | Suddenly we jumped up to 59 milligrams per mil,

00:38:18.900 | which is generally about a 40, 41 milligram,

00:38:22.820 | 'cause it's about a 0.7 mil.

00:38:25.340 | Sorry, a little chemistry and math that we do a lot here.

00:38:28.520 | But you're looking at, basically,

00:38:31.020 | it's anywhere from the nicotine that you see

00:38:33.340 | in either one to two packs of cigarettes.

00:38:35.780 | - Per? - Per device, per pod,

00:38:39.380 | per e-cigarette device.

00:38:41.140 | - And how long does a pod typically last?

00:38:44.060 | Let's say, like, a 15 or 16-year-old kid

00:38:46.140 | who's, you know, taking a hit off the vape pen,

00:38:50.080 | I don't know what, five times a day?

00:38:54.180 | - So I've asked teens,

00:38:56.820 | in some of the earlier publications we did,

00:38:59.140 | now, not with the newer devices, but the older devices,

00:39:02.780 | and they would say that they were using a pod a week,

00:39:05.460 | which is about two or three cigarettes a day,

00:39:07.860 | to one to four pods a day.

00:39:10.520 | - One to four pods a day? - One to four.

00:39:12.420 | Now, these are highly addicted teenagers.

00:39:15.140 | That is one to eight packs of cigarettes,

00:39:17.400 | depending on the debates on how much nicotine is in there,

00:39:19.860 | but you're looking at several packs

00:39:21.140 | of cigarettes worth of nicotine.

00:39:22.780 | - Okay, so just to backtrack a little bit,

00:39:24.860 | 'cause we got a little bit technical, which is great,

00:39:27.920 | but I wanna make sure everyone's on board.

00:39:30.060 | The amount of nicotine in one of these pods

00:39:33.300 | that goes into the vape pen, or e-cig,

00:39:36.140 | is significantly greater than the amount of nicotine

00:39:39.980 | in one pack of cigarettes, in many cases.

00:39:42.380 | - In many cases.

00:39:43.220 | - And there are many youth, so adolescents and teens,

00:39:47.440 | you said before, between the ages of 10 and 21,

00:39:50.860 | roughly 10 to 18, 10 to 21,

00:39:53.060 | that are going through as many as four pods per day,

00:39:57.220 | which has to be at least the equivalent

00:39:59.260 | of four packs of cigarettes,

00:40:00.380 | but could be as much as eight packs of cigarettes per day.

00:40:03.680 | - Correct.

00:40:04.520 | - In terms of nicotine concentration.

00:40:05.740 | - Correct.

00:40:06.580 | - Now, I guess, to be fair,

00:40:08.460 | they are not smoking in the traditional sense,

00:40:11.120 | so that presumably there's some tars and other contaminants

00:40:13.420 | that are not going into their system,

00:40:15.180 | but we know that there are a lot of chemicals

00:40:17.780 | in these pods besides just nicotine,

00:40:20.520 | and I think that's where a big source

00:40:21.900 | of the debate and interest is now,

00:40:25.460 | is how dangerous are those other chemicals?

00:40:28.260 | It's really an interesting question.

00:40:29.860 | - So, a lot of things that you said

00:40:31.900 | are really important to highlight.

00:40:33.980 | Absolutely, now, not all teenagers

00:40:35.940 | are using four pods a day.

00:40:37.260 | These are extremely, very highly addicted teens,

00:40:40.820 | and unfortunately, teens we've seen with lung collapses

00:40:45.060 | and other pretty significant health issues.

00:40:48.640 | Typically, teens are using maybe a pod a day.

00:40:52.020 | The newer e-cigarettes, by the way,

00:40:54.520 | have probably four times that.

00:40:57.840 | They're bigger volume,

00:40:59.220 | so you're looking at 60, 70 milligrams of nicotine.

00:41:03.820 | Some of them are equivalent

00:41:04.980 | to about three to 500 cigarettes worth of nicotine.

00:41:08.840 | Now, are they using them in a day?

00:41:10.280 | Probably not.

00:41:11.220 | We haven't done the studies on that,

00:41:13.500 | but it's really the first nicotine product we've had

00:41:16.320 | that you can use 24/7.

00:41:18.080 | When I've talked to teens,

00:41:19.280 | you know, I wake up in the middle of the night.

00:41:20.480 | I may check my phone and check my email.

00:41:22.800 | Teens are waking up in the middle of the night to take a hit,

00:41:25.760 | and they're hiding them under their pillows

00:41:28.800 | and their nightstands, whatever,

00:41:30.160 | and they're telling me

00:41:31.000 | that they're just using them all the time,

00:41:32.960 | and they could just suck on them all the time.

00:41:35.360 | - Are they using, when you say all the time,

00:41:36.960 | that's interesting, forgive me for interrupting,

00:41:38.880 | but are they using it specifically to wake up,

00:41:41.760 | to study, or just to maintain baseline?

00:41:45.120 | I mean, that's the problem with any addictive substance

00:41:47.600 | or habit-forming substance is that

00:41:49.480 | what starts off as a rush becomes less of a rush,

00:41:52.720 | and then when one doesn't use, they feel below baseline.

00:41:57.720 | I've done a lot of discussions about dopamine and baseline

00:42:00.220 | versus, you know, non-baseline peaks in dopamine,

00:42:03.920 | and some of that is smoothed out for general discussion.

00:42:07.120 | Dopamine does many things besides set up reward systems

00:42:10.000 | and incentives in the brain,

00:42:12.160 | but it's at least one of the things it does.

00:42:14.100 | So are kids starting off taking nicotine

00:42:17.800 | and then, and feeling like, whoa,

00:42:20.480 | that makes them feel really elevated

00:42:22.180 | in terms of mood, focus, and alertness,

00:42:23.840 | and then finding that without it, they're just depressed?

00:42:27.520 | Is that the general thing?

00:42:28.960 | I'm not trying to lead the witness here.

00:42:31.440 | I just wanna know what's going on internally.

00:42:34.000 | - Absolutely, no, no, no, all great questions there.

00:42:37.680 | So what we're finding when we talk to teens

00:42:40.520 | is that pretty rapidly, they're going from,

00:42:42.840 | I like it to I need it.

00:42:44.680 | So, you know, your multi-part question, which is great,

00:42:47.780 | what makes them start and what makes them continue?

00:42:51.040 | They start because of the flavors and the marketing,

00:42:54.120 | and they like the taste and all that.

00:42:56.200 | They continue because of that high level of nicotine,

00:42:58.960 | and we are seeing that teens are addicted.

00:43:02.160 | And we're seeing, we actually published a couple of studies

00:43:04.880 | showing that teens who have been using e-cigarettes

00:43:07.920 | in the past 30 days, that the majority

00:43:10.520 | are showing signs of addiction pretty rapidly, too,

00:43:13.860 | within a few weeks.

00:43:15.380 | It's such high levels of nicotine.

00:43:18.000 | And there are some people who don't believe

00:43:19.540 | that teens are becoming addicted to nicotine

00:43:22.200 | and that the levels of nicotine are not the same

00:43:25.260 | as what we're seeing in cigarettes.

00:43:26.680 | That's actually not the case,

00:43:28.000 | and we've seen more and more studies.

00:43:30.320 | And to the question of using it as soon as they wake up,

00:43:33.960 | there's a study by a colleague of mine

00:43:35.920 | that showed in the last few years,

00:43:38.200 | the data are showing that teens,

00:43:40.400 | a greater percentage of teens who use e-cigarettes

00:43:43.400 | are doing so in the first five minutes, awaking.

00:43:45.960 | That is a sign of addiction.

00:43:47.720 | So you wake up, maybe go to the bathroom, maybe not,

00:43:51.440 | and you take that hit.

00:43:52.760 | And so, and all the national data are showing,

00:43:56.200 | even though initiation may go down,

00:43:58.920 | the percentage of teens who are using daily has gone up.

00:44:02.960 | And I attribute that a lot to the type of nicotine,

00:44:06.200 | the salt-based nicotine,

00:44:07.720 | and to the huge amount of nicotine

00:44:09.520 | that's been on the market.

00:44:11.320 | So yes, teens are definitely feeling it.

00:44:13.920 | They're definitely going through withdrawal symptoms,

00:44:16.920 | that feeling, shaking, the sweats,

00:44:20.700 | all the feelings that they need, lack of concentration.

00:44:24.560 | The problem is when you talk to teens,

00:44:26.360 | they think that e-cigarettes are helping with school.

00:44:29.600 | And by the way, I've not heard a teen tell me

00:44:31.680 | that they started because of school reasons

00:44:34.240 | or concentration.

00:44:35.960 | Maybe they're continuing for that reason,

00:44:38.240 | but teens have said that taking the hit

00:44:40.900 | makes them feel good.

00:44:42.200 | What they don't understand is it's that

00:44:44.040 | it makes them feel not bad, right?

00:44:46.540 | The withdrawal is making them feel bad,

00:44:48.600 | and they don't realize that that hit

00:44:50.880 | and that dopamine rush that they now need it,

00:44:54.920 | that they're going through withdrawal either way.

00:44:58.120 | - I'm wondering where they're getting the money

00:44:59.680 | to pay for all this nicotine.

00:45:03.160 | When I was a kid, I worked.

00:45:05.120 | I had mowed lawns.

00:45:07.280 | I had a newspaper out for a little while,

00:45:08.960 | but mostly started working when I,

00:45:11.960 | I think I was about 14 or so.

00:45:13.720 | Coffee shop, skateboard shop,

00:45:15.160 | bus tables, did that kind of thing.

00:45:18.920 | So I made money and I was able to use that money

00:45:22.240 | on the things that were important,

00:45:23.280 | music, skateboarding, and bus passes and stuff.

00:45:26.040 | That's what it was back then.

00:45:27.480 | Food, et cetera.

00:45:29.980 | Where are 12-year-olds getting the money to buy

00:45:33.960 | four or even one vape cartridge pod,

00:45:37.480 | as you called it, per day?

00:45:38.960 | I mean, someone's got to pay for this stuff.

00:45:42.240 | I mean, unless they're stealing it,

00:45:43.880 | and I can't imagine that they're all stealing it.

00:45:45.600 | Where are they getting it?

00:45:47.040 | How are they getting it?

00:45:48.580 | Yeah, it's a great question.

00:45:49.800 | So there's not one way.

00:45:51.480 | In terms of money, I think there's questions around money

00:45:54.000 | and questions around access, right?

00:45:56.160 | And they're not necessarily the same thing.

00:45:58.080 | Money, babysitting.

00:45:59.440 | The problem is when some of the newer products

00:46:02.380 | came on the market, some of them,

00:46:05.160 | the say 2020, 2021 products were about $1 or $2 per pod.

00:46:10.160 | Compare that with a pack of cigarettes,

00:46:13.400 | which is $10 to $15, depending on the state you live in.

00:46:16.880 | So they are cheap.

00:46:18.740 | They're easy to get.

00:46:20.380 | Now, newer ones and older ones are a few dollars more,

00:46:23.460 | but they're not that expensive.

00:46:24.800 | They started off very expensive

00:46:26.100 | when they first came on the market, but they haven't been.

00:46:28.980 | The other is the sharing.

00:46:30.580 | And we used to hear about pod parties

00:46:32.940 | where somebody buys the device, which is more expensive,

00:46:36.720 | buys the device, and then you bring your own, not beer,

00:46:39.420 | bring your own pod, which is a few dollars,

00:46:41.900 | then you pop it in, and then you share it around.

00:46:46.040 | We've also heard stories of a few teenagers buying them

00:46:49.740 | and then selling for a few cents or a few dollars a puff.

00:46:53.940 | So meet me in the bathroom for 50 cents or a dollar.

00:46:57.020 | You can have a couple of puffs.

00:46:58.980 | So I think teens are getting very creative.

00:47:01.540 | We've also seen, unfortunately,

00:47:02.980 | parents buying e-cigarettes for their teens.

00:47:06.620 | Well, at least they're not smoking cigarettes.

00:47:09.500 | That's not the right comparison.

00:47:11.140 | So I think they're very creative.

00:47:14.340 | They're getting it in many, many different ways.

00:47:16.560 | I've heard students say,

00:47:17.560 | "I'm not using my lunch money to buy lunch.

00:47:20.000 | "I'm gonna use it to buy vapes."

00:47:21.820 | There's no one way.

00:47:24.640 | There's not.

00:47:25.660 | And unfortunately, access is easier than it should.

00:47:31.080 | By the way, one thing I think is incredibly important

00:47:33.880 | for people to understand is across the U.S. in 2019,

00:47:38.000 | December of 2019, the legal age to be allowed to purchase

00:47:41.480 | or to sell nicotine products across the U.S. has become 21.

00:47:46.480 | So many people think it's still 18.

00:47:49.540 | So you go into a vape shop or a tobacco shop,

00:47:52.220 | and if the shop owner doesn't realize it's 21,

00:47:55.260 | they'll sell it to somebody who's 18.

00:47:57.280 | And even if they know it's 21, they're still selling it

00:48:01.260 | because there's not enforcement right now going on.

00:48:04.100 | So we really do need the public.

00:48:06.260 | We need all the parents listening.

00:48:07.980 | We need educators, police officers to really enforce

00:48:11.920 | and regulate this age restriction

00:48:13.960 | because teens are getting them from vape shops really easily.

00:48:17.200 | They're getting it online really easily.

00:48:19.340 | They're buying them for each other.

00:48:23.120 | Somebody's going and buying 10 and then reselling them

00:48:26.440 | if the person looks older.

00:48:28.240 | There's not a lot of carding going on or fake cards.

00:48:31.120 | ID cards is pretty easy still to get.

00:48:34.000 | So unfortunately we have a product

00:48:37.580 | that is appealing to teens

00:48:38.980 | in a very unregulated market right now.

00:48:41.540 | The FDA is not regulating it.

00:48:43.060 | Local shops are not regulating it.

00:48:45.180 | That it's just, it is the Wild West out there.

00:48:47.780 | - So setting aside the issue of whether or not vaping

00:48:51.140 | is "better" for us than smoking cigarettes,

00:48:56.140 | because that argument is a complicated one,

00:49:01.020 | to say the least,

00:49:02.460 | what do we know about the health hazards of vaping per se?

00:49:07.280 | Does it increase lung disease?

00:49:11.600 | Does it increase cancer rates?

00:49:13.400 | I mean, my understanding is that nicotine,

00:49:15.960 | the chemical, is not what causes cancer in cigarettes.

00:49:19.400 | It's the tars and other things that are consumed

00:49:24.240 | or brought into the lungs

00:49:25.760 | and therefore bloodstream when one smokes.

00:49:29.340 | That's not to say nicotine is safe.

00:49:31.160 | I have to be careful here.

00:49:32.420 | Sometimes clips get cut and people run wild

00:49:35.700 | and I'm not saying nicotine is safe,

00:49:37.420 | but what are the problems with vaping nicotine?

00:49:42.420 | Even, let's just say one or two hits per day,

00:49:47.500 | especially in kids.

00:49:49.700 | Are there known challenges for brain development?

00:49:53.580 | Are there known challenges for cognitive development?

00:49:55.620 | Are there known challenges for lung function?

00:49:59.380 | I mean, nicotine is a vasoconstrictor

00:50:01.060 | and it raises blood pressure.

00:50:02.220 | So that's basically stress on the system, chronic stress.

00:50:06.540 | But what do we know about what vaping

00:50:10.360 | and e-cigarettes are doing to malign health?

00:50:13.920 | - Yeah, so first of all, start with the brain and nicotine.

00:50:18.940 | Absolutely, these high levels of nicotine,

00:50:21.100 | and really any nicotine, is harmful to the developing brain.

00:50:24.620 | And our brains continue to develop

00:50:26.260 | until we're around 25, 24, 26, depending,

00:50:29.620 | but to around 25.

00:50:32.180 | So in that process of your brain developing,

00:50:36.940 | of your brain changing, if you introduce nicotine,

00:50:40.660 | you're changing your brain,

00:50:41.660 | you're changing the brain chemistry,

00:50:43.380 | and you're so much more likely to become addicted

00:50:46.500 | as an adolescent and a young adult.

00:50:49.540 | The tobacco industry knows this.

00:50:51.180 | I mean, that's why they target teens.

00:50:53.300 | We've noticed with cigarettes, if we target a teen,

00:50:55.860 | then we're gonna have them for life.

00:50:58.260 | So significantly more likely to become addicted

00:51:02.340 | because it actually rewires your brain.

00:51:04.380 | And there's plenty of evidence for that.

00:51:07.100 | The other pieces that we're worried about is,

00:51:10.840 | now you're right, nicotine in terms of cancer,

00:51:12.880 | although I will tell you,

00:51:13.800 | having talked to some oncologists,

00:51:15.260 | they would say the vast amount of nicotine

00:51:17.900 | still worries them in terms of cancer.

00:51:20.300 | We just haven't had enough research

00:51:21.900 | on e-cigarettes to really know.

00:51:24.040 | Now you're right, e-cigarettes do not have tar,

00:51:26.500 | but e-cigarettes have aldehydes,

00:51:28.500 | and aldehydes have been linked to cancer.

00:51:30.680 | So there's still some concern there.

00:51:33.340 | There's some early anecdotal evidence,

00:51:36.300 | and probably some of my colleagues out there would say,

00:51:37.900 | no, no, there's pretty good evidence around cancer.

00:51:40.380 | We just don't have enough body of research.

00:51:42.640 | But again, it took 50 years

00:51:45.040 | to figure out cancer in cigarettes.

00:51:47.300 | We've not had the amount of e-cigarette use

00:51:51.540 | or that we saw with cigarettes for that long

00:51:54.980 | for that many people to really know.

00:51:57.740 | It's still pretty new.

00:51:59.620 | - I just might wanna just interject that aldehydes,

00:52:02.900 | like paraformaldehyde, formaldehyde,

00:52:05.460 | these are the same chemicals that we use in laboratories

00:52:08.580 | to fix, as it's called, tissues, to make those tissues firm,

00:52:12.940 | so that then they can be cut

00:52:14.340 | and analyzed under the microscope.

00:52:16.460 | Aldehydes cross-link proteins,

00:52:18.940 | basically change the configuration of proteins

00:52:21.260 | and turn what would otherwise be a pliable tissue

00:52:24.260 | into kind of a hard, rubbery,

00:52:26.740 | think of like a dense eraser-like consistency.

00:52:31.180 | And in other words, not the configuration most conducive

00:52:35.060 | for those cells to live and thrive,

00:52:37.660 | actually quite the opposite,

00:52:39.260 | which is why that's for sake of doing anatomy

00:52:43.540 | on, well, any body part,

00:52:45.100 | you use paraformaldehyde, glutaraldehyde,

00:52:48.400 | and formaldehyde to cross-link proteins.

00:52:52.780 | It basically kills tissue by cross-linking proteins,

00:52:55.860 | taking a nice pliable configuration

00:52:58.460 | that's amenable to life and twisting the,

00:53:02.380 | or shearing the proteins, more or less,

00:53:04.540 | relative, cross-linking them,

00:53:05.780 | and making them nice and rigid.

00:53:07.740 | So if that's happening in the living child,

00:53:11.100 | that can't be good.

00:53:12.060 | - That can't be good. - That can't be good.

00:53:13.380 | - Flugs, bloodstream, everything.

00:53:15.540 | - And all the aldehydes are carcinogens.

00:53:17.940 | - Correct. - We know they cause cancer.

00:53:19.300 | - Right, right, and so that's why

00:53:20.700 | there's a lot of concern there.

00:53:21.900 | And when I talk to teens,

00:53:23.940 | and in our curriculum, we often say,

00:53:26.840 | because when you just say,

00:53:28.020 | and you gave a beautiful explanation of the aldehydes,

00:53:30.260 | but for a teenager, what I generally say is,

00:53:33.340 | if you ever dissected a,

00:53:34.900 | had biology and you dissect a frog,

00:53:36.660 | yes, how did it smell?

00:53:37.700 | It was gross.

00:53:38.540 | Well, that's what you're putting into your body

00:53:39.860 | when you're vaping,

00:53:41.420 | because that's exactly the point,

00:53:43.400 | and that kind of helps them understand it

00:53:45.060 | a little bit more.

00:53:45.980 | But there's a lot of concern around the aldehydes.

00:53:49.580 | There's lead, there's cadmium,

00:53:51.800 | there's propylene glycol and glycerin.

00:53:54.620 | So there's a lot of other chemicals.

00:53:56.460 | So no, we may not have the thousands of chemicals

00:53:59.180 | that we have in cigarettes,

00:54:00.420 | but we certainly have hundreds of chemicals

00:54:02.900 | in an e-cigarette.

00:54:03.940 | That's very concerning.

00:54:05.820 | So there are a lot of studies now

00:54:07.500 | really showing pretty significant effects

00:54:09.860 | of e-cigarette use on heart and lungs a lot.

00:54:13.120 | Not only all the chemicals we've mentioned,

00:54:17.300 | but also the flavorants.

00:54:19.060 | There's cinnamon aldehyde, another aldehyde.

00:54:22.160 | There's vanillin.

00:54:23.440 | There's, what is it?

00:54:26.520 | The buttery flavor that's in there

00:54:29.240 | is also a lot of concern.

00:54:31.240 | So that you're inhaling these flavors,

00:54:33.160 | and I often explain, you can take flavors,

00:54:36.720 | you can take butter and heat it to several hundred degrees

00:54:40.080 | and eat it, you don't burn your tongue,

00:54:42.240 | but you then take it and really inhale

00:54:45.680 | the resulting aerosol,

00:54:47.120 | and then we're seeing the lesions on the lungs.

00:54:49.700 | We're seeing young people who have been using e-cigarettes,

00:54:52.740 | having lung collapses, pneumonia,

00:54:55.780 | asthma amongst people who have not had seizures.

00:54:59.100 | One of the teens I know who was using four pods a day

00:55:02.020 | was having seizures.

00:55:03.340 | - Makes sense because nicotine is a stimulant.

00:55:06.980 | - Yes.

00:55:07.820 | - It can cause runaway excitability in the brain

00:55:09.860 | if too much is taken.

00:55:11.880 | If 40 to 60% of kids are using e-cigarettes,

00:55:17.520 | and it's destructive to the lungs,

00:55:20.760 | and it sounds like the brain as well,

00:55:22.320 | where are all the young athletes?

00:55:24.580 | Are they the remaining fraction?

00:55:29.160 | - Yeah, and I should say 40 to 60

00:55:30.960 | is what schools are telling me,

00:55:32.220 | and that might just be using once in a while,

00:55:34.040 | we don't really know.

00:55:35.160 | - But even kids just, like I had to do PE class

00:55:37.860 | when I was in high school.

00:55:39.360 | - Yeah.

00:55:40.200 | - Yeah, we had to run a few laps.

00:55:41.920 | I can't imagine doing that

00:55:43.240 | if your lungs don't function properly.

00:55:47.400 | - No, it is actually much harder,

00:55:49.280 | and teens will say that, and adults I know.

00:55:51.800 | I actually know an adult who said that

00:55:54.400 | when he went from smoking cigarettes to e-cigarettes,

00:55:58.040 | it actually was harder for him to exercise

00:56:00.680 | and to ride his bike and exercise and do other things

00:56:04.360 | on the e-cigarette compared to the cigarettes,

00:56:07.240 | that the impact on the lungs is so strong.

00:56:10.880 | - You're right, it is probably hurting athletics right now,

00:56:14.920 | where actually there are some curriculums

00:56:17.040 | on athletes and vaping, and we're building one as well,

00:56:20.440 | because there's a lot of concern.

00:56:21.680 | And when you tell a teen,

00:56:23.460 | I'm worried about lung cancer in 20 years,

00:56:26.720 | ah, I don't care about 20 years from now,

00:56:28.560 | but you would tell a teen it's harder to run,

00:56:31.000 | they're more likely to listen to you.

00:56:33.160 | - I'd like to take a brief break

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00:57:49.120 | We haven't talked too much about peer pressure

00:57:51.480 | or just social pressure.

00:57:52.840 | I remember when I was a kid,

00:57:55.000 | it was in the just say no to drugs era.

00:57:57.840 | And I remember seeing the television commercials

00:58:01.040 | with the eggs, like two, like really beautiful raw eggs

00:58:04.640 | and it'd say, "This is your brain."

00:58:05.600 | And then it was just your brain on drugs

00:58:06.960 | and it was frying, you know.

00:58:08.440 | Nancy Reagan was everywhere in that time.

00:58:12.360 | You know, just say no, just say no.

00:58:14.480 | In any case, there must be a lot of data

00:58:18.320 | indicating what messages kids respond to.

00:58:20.940 | I was told, and I don't know if this is true,

00:58:22.960 | but I was told by a researcher

00:58:24.680 | that the anti-smoking campaign that was effective in kids

00:58:30.320 | was not one that convinced them

00:58:32.340 | that smoking was bad for their health,

00:58:34.340 | but was one that convinced them that it was

00:58:37.080 | their purchasing and use of cigarettes

00:58:40.200 | that was making other people rich

00:58:43.940 | and then kind of demonizing those people that was effective.

00:58:47.540 | Kind of like show the commercials of these guys,

00:58:51.720 | you know, kind of cackling behind closed doors,

00:58:53.920 | you know, making fun of the people that were,

00:58:57.860 | in their words, you know, not bright enough to know

00:59:02.000 | that they were being taken advantage of.

00:59:04.100 | And then that set a kind of a psychological warfare

00:59:07.280 | between teens and these people that they perceived

00:59:11.060 | as taking advantage of them for money.

00:59:14.400 | - Right.

00:59:15.240 | - And that that was effective in getting them to smoke less

00:59:17.920 | as opposed to telling them,

00:59:19.040 | "Hey, listen, smoking is really bad for your health."

00:59:21.400 | - Right, absolutely.

00:59:22.940 | So first of all, the just say no, not effective.

00:59:26.120 | It's saying just say no around any behavior to a teenager,

00:59:30.960 | whether it's tobacco, cannabis, cigarettes,

00:59:34.940 | and sex does not work.

00:59:37.580 | It does not work.

00:59:38.740 | And for many reasons, first of all, teens are curious.

00:59:42.220 | And when you say, just say no, why?

00:59:44.980 | Well, because it's bad for you.

00:59:46.900 | Well, wait a second, exactly what you're saying.

00:59:48.580 | Just telling me that it's bad for me,

00:59:50.560 | if you tell me I'm gonna get lung cancer

00:59:52.420 | or I'm gonna have lung disease or anything,

00:59:54.660 | and I tried the e-cigarette and I didn't have lung problems

00:59:58.660 | and instead I actually liked it,

01:00:00.940 | then we look bad.

01:00:02.040 | We look like we're lying to teenagers.

01:00:04.880 | And instead, what we were talking about earlier,

01:00:07.800 | the feeling, the rush, the flavor, the taste,

01:00:11.720 | the perceived and real benefits

01:00:14.620 | outweigh the concerns over the risks as a teenager.

01:00:18.760 | So when we say to a teen, just say no, don't,

01:00:22.120 | and they say, well, why?

01:00:23.440 | Well, your brain or your heart or your lungs

01:00:25.800 | or it's bad for you, they don't believe us.

01:00:28.240 | And we absolutely lose credibility.

01:00:30.940 | So when we talk to teens,

01:00:32.140 | and this is based on decision-making research

01:00:34.120 | that I've been doing for 25 years,

01:00:36.100 | we have to help teens weigh the benefits and the risk.

01:00:38.940 | Now, I don't mean that we say, hey, it's good for you

01:00:41.820 | or you're gonna like it, certainly not.

01:00:44.360 | But if we only come from a risk model

01:00:46.820 | and a just say no model, that never works for teens.

01:00:50.140 | We need to help them understand the balance.

01:00:52.440 | And teens know that there are good things

01:00:56.320 | about using some drugs, real or perceived,

01:00:59.540 | and we can't lie to them on that.

01:01:01.980 | So that gets to then how do we have those messages?

01:01:05.740 | And you're right, if we only harp on,

01:01:08.300 | and our research would show this too,

01:01:10.380 | the long-term health risks, your brain on drugs,

01:01:14.700 | those kinds of things,

01:01:15.860 | that's so far in the future are the trach.

01:01:18.380 | You know, you're gonna have a trach if you smoke,

01:01:20.340 | but they're showing the 80-year-old

01:01:21.940 | and no 16-year-old even looks at somebody at that age

01:01:25.220 | or cares about somebody that's so, that other person,

01:01:28.600 | that that's a problem.

01:01:30.240 | So we need to talk about the social aspects

01:01:33.000 | that teens really care about.

01:01:34.780 | You may get wrinkles, although we don't know that so much

01:01:37.060 | with e-cigarettes, but the athletics,

01:01:40.340 | the things that are important to teens.

01:01:42.280 | Now, the campaigns that you're talking about

01:01:45.400 | are really effective as well,

01:01:47.540 | particularly the mass campaign,

01:01:49.220 | which level that we see social media campaign,

01:01:51.980 | which is, do you realize that the industry,

01:01:56.140 | e-cigarettes, tobacco, nicotine, cigarette,

01:01:58.940 | whatever you wanna call it,

01:02:00.180 | is targeting you as a teenager on purpose?

01:02:03.100 | They want you as a smoker.

01:02:05.000 | I used to go to middle school students and say,

01:02:07.260 | before e-cigarettes, when cigarettes were of concern,

01:02:09.680 | and I love saying to young people,

01:02:12.140 | 400,000 adults are dying each year from cigarette use.

01:02:17.140 | You're a replacement smoker.

01:02:18.980 | And it was great 'cause teens would get really angry

01:02:21.420 | and say, wait, this 12-year-old boy was so cute.

01:02:23.700 | Wait, I don't wanna be a replacement smoker, Dr. Bonnie.

01:02:26.500 | It was a big deal to him.

01:02:28.020 | And I don't wanna give money to the industry.

01:02:30.860 | And it's great.

01:02:31.680 | Channel that energy and get young people mad.

01:02:35.160 | That's what really worked.

01:02:37.300 | Showing that the seven dwarfs, we call it,

01:02:40.200 | the seven CEOs of the big tobacco companies at the time

01:02:44.660 | said, nicotine's not addictive, nicotine's not addictive,

01:02:48.300 | our cigarettes are not addictive,

01:02:50.220 | and that clearly they were lying to teens.

01:02:52.580 | You show that to a teen and explain how nicotine is addictive

01:02:56.580 | and they knew it, but they're trying to get you.

01:03:00.160 | Works really well.

01:03:01.460 | And same thing with marketing.

01:03:02.740 | We have a whole lesson on marketing.

01:03:04.880 | Do you think that that candy was for me

01:03:08.340 | as a middle-aged adult?

01:03:10.060 | It's for you.

01:03:10.980 | And that gets them mad 'cause they don't wanna be duped.

01:03:14.100 | They don't wanna be targeted.

01:03:15.700 | That is a much better message.

01:03:17.820 | Now, we still have to tell them about the health risks.

01:03:19.980 | We absolutely do.

01:03:20.820 | They still need the knowledge.

01:03:22.220 | They still need to understand

01:03:23.900 | what they're doing is unhealthy.

01:03:25.900 | But we can't do it in a lecturing way

01:03:27.980 | and we can't do it in a way that makes them feel stupid.

01:03:30.800 | We can't tell them their brains are developing 'til 25

01:03:33.460 | and therefore they're dumb.

01:03:34.980 | Our lessons on talking about brain are more like,

01:03:38.140 | it's really cool that you're developing.

01:03:40.780 | It's why you can do dance.

01:03:42.820 | That's why you can sing better.

01:03:44.220 | You can learn language.

01:03:45.380 | There's so much that you could do that's really cool

01:03:48.140 | that I can't do right now, but because of that,

01:03:52.100 | that's why you're so much more likely to become addicted

01:03:54.780 | and the industry knew that.

01:03:56.960 | That's why they're targeting you.

01:03:58.540 | Those are the messages that work a lot better for teens.

01:04:01.540 | - Sounds like the key is to never undervalue

01:04:04.660 | the spirit of defiance in youth

01:04:07.340 | and perhaps to wager it

01:04:09.820 | against these clearly destructive behaviors.

01:04:13.900 | To be honest, I'm shocked that there's so much

01:04:16.900 | vape use and e-cigarette use.

01:04:19.060 | These numbers are staggering.

01:04:21.300 | Maybe we could weave in a discussion about cannabis.

01:04:24.340 | I did an episode about cannabis.

01:04:26.580 | The landscape around cannabis has changed so much

01:04:28.780 | since I was a kid.

01:04:30.560 | It was highly illegal, at least where I grew up.

01:04:35.300 | Now I think it's been decriminalized certain places,

01:04:39.340 | still illegal elsewhere.

01:04:40.820 | I don't want anyone getting in trouble

01:04:42.620 | as a consequence of not understanding

01:04:45.420 | the laws in their area and outright legal,

01:04:50.420 | pretty easy to get in a lot of the country.

01:04:53.060 | And it's not clear that at least with individual use

01:04:57.900 | that it's being punished nearly as frequently

01:05:02.460 | as it used to be.

01:05:03.580 | So the 10 word summary of the cannabis thing

01:05:08.580 | is that the ratio of THC to CBD is important.

01:05:14.780 | It is true that a lot of cannabis has much,

01:05:16.620 | much higher levels of THC now than in the past.

01:05:19.540 | Although I'm told that high THC level cannabis

01:05:22.660 | always existed, but it seems to be the concentration

01:05:26.740 | of THC that is of, let's just say concern,

01:05:30.860 | as it relates to the potential development of psychosis.

01:05:34.700 | If there's a predisposition in terms of the,

01:05:39.180 | how addictive the cannabis is and so on and so forth.

01:05:42.500 | Which is not to say that CBD is totally innocuous,

01:05:44.700 | but it seems to be like the THC concentration

01:05:47.140 | is the kind of the thing that to mainly focus on.

01:05:50.180 | So what do we know about cannabis in here?

01:05:54.300 | We're going to assume cannabis with a reasonable

01:05:56.300 | to high level of THC in it.

01:05:58.700 | So not pure CBD.

01:06:00.700 | What do we know about vaping and e-cig use

01:06:05.700 | of cannabis specifically?

01:06:07.700 | Is it true that youth that are taking nicotine

01:06:11.300 | by way of vape or e-cigarette then transition

01:06:14.940 | into using cannabis?

01:06:15.940 | Is it sort of a gateway into cannabis use?

01:06:18.340 | And how prevalent is cannabis use in kids aged 10 to 21?

01:06:23.340 | - First of all, you're right.

01:06:25.940 | I mean, THC levels we're seeing today's joint

01:06:29.060 | is about 10 joints when I was a teen.

01:06:31.740 | So the dramatic increases in the potency right now

01:06:35.820 | that we're seeing around THC.

01:06:37.100 | And then you get something like dabbing,

01:06:38.460 | which is about 80% THC versus 20 to 30%

01:06:42.660 | of the more mainstream products that we have in the market.

01:06:46.020 | When I say mainstream, I mean like joints or e-cigarettes.

01:06:50.900 | So the potency has gone up dramatically

01:06:52.980 | and it is of concern.

01:06:54.460 | So depending on the study,

01:06:56.380 | you're going to see anywhere from 10 to 20% of teens

01:06:59.940 | is saying that they're using some form of cannabis,

01:07:03.220 | either smoked or in the form of a joint or a blunt.

01:07:06.940 | And for those who don't know a blunt,

01:07:09.420 | a lot of people don't realize is a combination

01:07:11.780 | of both tobacco and cannabis.

01:07:14.540 | So it's a cigar leaf, or some people buy a cigar

01:07:18.420 | and pull out the tobacco and put in the cannabis,

01:07:21.660 | or they'll just get the cigar leaf

01:07:23.620 | and roll the cannabis flower.

01:07:26.100 | Then you're getting both the kind of the double whammy

01:07:28.140 | and the chaser, the high of both of nicotine and THC.

01:07:32.620 | So we're seeing a fair number of...

01:07:34.220 | It's interesting, even though teens are not smoking cigarettes,

01:07:37.740 | they're still using joints, which is interesting.

01:07:41.140 | But very quickly increasing is e-cigarettes

01:07:45.260 | with cannabis in there.

01:07:47.940 | You can buy a cannabis style e-cigarettes

01:07:52.060 | and that's been around for a long time

01:07:53.580 | with volcano vaporizers and specific cannabis vaporizers.

01:07:58.420 | That's not new, but it's become much, much more popular.

01:08:02.540 | But now we're also seeing teens buy a nicotine e-cigarette,

01:08:07.540 | inhale half of it, and then add the cannabis wax

01:08:12.620 | or oil to it, and then basically get the combination.

01:08:16.380 | I had one young teenager, probably 12, 13, 14 year old

01:08:20.540 | young man who said, "Yeah, I got a cherry nicotine vape

01:08:25.060 | and I inhaled half of it."

01:08:27.300 | Probably didn't use the word inhale, but I used half of it.

01:08:30.140 | And then I added in some cannabis oil

01:08:32.940 | and now I had a cherry flavored cannabis nicotine device.

01:08:37.940 | So we're seeing that more and more.

01:08:39.700 | And even though you're not technically supposed to

01:08:42.100 | when the manufacturers of nicotine e-cigarettes will say,

01:08:44.860 | "Don't open them and add stuff."

01:08:47.180 | A simple YouTube video will teach you how to do it.

01:08:50.740 | And unfortunately the videos are not using gloves

01:08:53.460 | and benzoic acid is covering your skin and things like that.

01:08:56.180 | - Which is bad for...

01:08:57.020 | - Which is bad.

01:08:57.860 | - Does it go transdermally?

01:08:58.700 | Does it go through the skin?

01:08:59.700 | - It supposedly it does, yeah.

01:09:01.820 | - But if the benzoic acid is going transdermally,

01:09:05.300 | presumably when one inhales off one of these pods,

01:09:08.020 | they're also bringing benzoic acid into the lungs.

01:09:10.060 | - Correct.

01:09:10.900 | - And hopefully people realize this

01:09:13.020 | from our episodes on breathing, but if not,

01:09:15.140 | I'll just make it clear now that when you breathe in

01:09:17.580 | a substance, an airborne substance into your lungs,

01:09:22.080 | because of the interface between the vasculature,

01:09:25.980 | the blood supply and the lungs,

01:09:27.700 | I mean, basically things pass from the lungs

01:09:30.220 | into the blood supply very, very readily.

01:09:32.500 | - Very quickly.

01:09:33.340 | - And then if those things are able,

01:09:36.200 | they'll cross the blood brain barrier.

01:09:37.780 | - Correct, correct.

01:09:38.900 | And it only takes about seven to 10 seconds

01:09:40.860 | to go through the whole system and into the brain too.

01:09:42.980 | So it's a very fast process.

01:09:46.060 | So yes, so teenagers are definitely vaping

01:09:49.260 | or using cannabis e-cigarettes.

01:09:52.500 | And the problem is, for one,

01:09:56.900 | teens will think it's healthier than,

01:09:59.140 | just like nicotine e-cigarettes,

01:10:00.820 | they think it's healthier than combustible.

01:10:03.140 | I mean, yes, you're not burning it,

01:10:04.980 | but you're still inhaling and you still are inhaling.

01:10:08.300 | There seems to be the propylene glycol, the glycerin,

01:10:11.020 | the flavorants, all the aldehydes,

01:10:13.500 | even if it's just a cannabis e-cigarette.

01:10:18.500 | So there's a lot of concern there.

01:10:20.180 | And then addiction is still huge.

01:10:21.900 | It's a huge issue when you're talking about cannabis.

01:10:24.820 | The same reasons that we talked about with nicotine,

01:10:27.660 | the brain development and so on.

01:10:29.660 | Psychosis, just a lot to think about here, psychosis.

01:10:35.500 | There's actually some scientists now

01:10:37.220 | who are really strongly saying it's not associated as causal.

01:10:41.860 | That if you are predetermined to have a mental health issue,

01:10:45.660 | psychosis, schizophrenia,

01:10:47.740 | then starting to use or using cannabis

01:10:51.180 | can actually trigger and cause you to become psychotic.

01:10:55.860 | I don't totally understand the mechanism yet.

01:10:57.860 | I don't think we totally do yet,

01:10:59.940 | but that there seems to be more than just,

01:11:02.060 | eh, it might happen.

01:11:03.260 | And it seems to be right in that

01:11:05.500 | older adolescent, young adult timeframe

01:11:08.340 | that it is happening.

01:11:09.660 | So around the same time that the brain's developing

01:11:12.780 | and we're hardwiring the rest of our brain,

01:11:15.220 | that that change is happening

01:11:16.780 | from a neuronal connection perspective.

01:11:21.140 | - My understanding, sorry to interrupt,

01:11:22.740 | but my understanding is that, indeed,

01:11:25.700 | the use of high THC cannabis in youth,

01:11:30.060 | in particular male youth, predisposes,

01:11:33.820 | and you're saying might even be causal,

01:11:35.860 | toward the development of psychotic symptoms

01:11:39.100 | in late teens, early 20s.

01:11:41.700 | And that some of those cases

01:11:44.220 | are ones in which the psychosis is irreversible.

01:11:48.500 | - Correct.

01:11:49.820 | - Is it sometimes the case that

01:11:52.980 | somebody exhibits psychotic symptoms

01:11:54.580 | as the consequence of using THC

01:11:58.060 | and the psychotic symptoms resolve?

01:12:00.700 | Or is it some sort of circuit switch

01:12:03.460 | that is then permanent?

01:12:04.900 | - You know, it's a good question.

01:12:05.740 | I honestly don't really know the answer to that,

01:12:07.700 | of what percentage.

01:12:09.500 | The few cases I know of in talking to the psychiatrist

01:12:13.580 | would say that it's causal and it may be permanent.

01:12:16.060 | Now, it could be managed.

01:12:18.780 | It doesn't mean that somebody is going to be having

01:12:21.100 | psychotic episodes all the time.

01:12:23.060 | I mean, it certainly can be managed,

01:12:24.580 | and certainly we would say,

01:12:25.540 | please don't continue to use, would be very important.

01:12:28.980 | But whether it's completely reversible

01:12:30.500 | is something that I'm not sure of.

01:12:32.420 | Somebody more versed in this.

01:12:34.180 | But what you do in your research,

01:12:37.380 | and what I know is,

01:12:39.020 | changes to the neural circuitry is not changeable.

01:12:43.580 | You know, when we hurt our brain cells,

01:12:46.740 | that is not something that we could recover from.

01:12:48.860 | So that is very much concerning.

01:12:50.660 | - Yeah, as adults,

01:12:52.100 | there are very few new neurons added to the brain.

01:12:55.780 | There is significant plasticity and recovery of function

01:12:58.780 | in some cases, both by virtue of traumatic brain injury.

01:13:03.340 | Certainly people can get over certain behavioral patterns,

01:13:06.900 | and that no doubt involves plasticity, but it takes work.

01:13:10.580 | And when it comes to addiction,

01:13:13.780 | there's evidence that some of the reward circuitry

01:13:15.700 | can adjust, but again,

01:13:17.700 | it takes adherence to specific things

01:13:21.620 | in order to make that happen.

01:13:23.380 | I'm very concerned about this

01:13:25.140 | potentially causal relationship,

01:13:28.340 | but certainly correlation between

01:13:30.940 | high THC-containing cannabis and psychosis,

01:13:35.660 | mostly because we already have a serious problem

01:13:39.060 | with psychosis on the planet.

01:13:40.300 | A lot of people don't realize that, you know,

01:13:42.020 | approximately 1% of the world's population

01:13:44.700 | has schizophrenia.

01:13:46.820 | And by the way,

01:13:47.660 | I have to be careful with the language nowadays,

01:13:48.940 | you know, has schizophrenia or is schizophrenic

01:13:51.340 | or all that language gets murky,

01:13:52.980 | but meet the diagnostic criteria for schizophrenia,

01:13:56.340 | I think is a safe way to put it.

01:13:57.940 | So if one is then adding to that number of people exhibiting

01:14:03.340 | and suffering from psychotic symptoms

01:14:05.580 | that prevent them from having functional work lives,

01:14:08.140 | et cetera, that's an issue.

01:14:11.940 | - How difficult is it for these adolescents and teens

01:14:16.540 | to quit vaping and e-cigarettes and cannabis?

01:14:21.420 | I mean, can they quit just by deciding?

01:14:25.540 | Are there programs?

01:14:26.500 | Are they all going into, you know, recovery programs?

01:14:30.220 | Are there recovery programs in schools?

01:14:32.460 | I mean, how successful are they in stopping?

01:14:35.260 | - It's really difficult.

01:14:38.220 | And maybe I'll talk about nicotine first,

01:14:40.620 | and the same would be true for cannabis,

01:14:42.540 | but a little bit less extent.

01:14:43.820 | I mean, both are addictive.

01:14:45.140 | And interestingly,

01:14:46.180 | not a lot of people realize that cannabis is addictive

01:14:48.620 | and about one in six teens or people who are using,

01:14:52.300 | particularly under the age of 25, do become addicted.

01:14:54.740 | - They don't realize that it's addictive.

01:14:56.540 | - They don't realize it's addictive.

01:14:57.740 | - The argument I often heard was it's not as bad as alcohol,

01:15:02.300 | which is a kind of a lame argument.

01:15:05.420 | I understand why people default to that,

01:15:07.220 | but I mean, getting hit by a car

01:15:09.860 | might not be as bad as getting hit by a train,

01:15:12.820 | but I wouldn't even look at that analogy as accurate.

01:15:16.740 | There's just different levels of destructive,

01:15:19.260 | different types of destructive.

01:15:20.940 | Yeah, these not as bad as blank

01:15:26.420 | doesn't really seem to work.

01:15:27.900 | - No, no.

01:15:28.740 | And, you know, I often say,

01:15:30.660 | people say, "Well, why'd you start studying tobacco?"

01:15:32.860 | I mean, there is no safe level of tobacco use, period.

01:15:36.780 | - Yes, we have very few 30-year-olds

01:15:39.020 | who suddenly pick up a cigarette and become addicted.

01:15:41.980 | You know, at that point, your development of your brain...

01:15:45.580 | Now, if you use regularly,

01:15:47.460 | are you still gonna hurt your lungs and heart

01:15:49.620 | and stuff like that?

01:15:50.460 | Absolutely.

01:15:51.420 | The brain changes may not be there in the same way,

01:15:54.780 | but most people don't pick up a cigarette

01:15:56.900 | or any cigarette for the very first time in their 30s

01:15:59.980 | or 40s and on.

01:16:01.500 | So, absolutely, it's addictive

01:16:03.980 | and it is probably the most difficult-to-quit drug

01:16:09.060 | that's out there.

01:16:09.900 | Whereas alcohol, we don't see.

01:16:11.500 | I mean, yes, we have alcoholism.

01:16:13.180 | I'm not downplaying that.

01:16:14.380 | It's a huge issue in this country.

01:16:16.980 | It's a huge issue on this planet,

01:16:18.900 | but you're not gonna have people in two weeks, three weeks,

01:16:21.500 | suddenly say, "I'm addicted to alcohol."

01:16:23.380 | You are going to with nicotine

01:16:25.780 | and you are with cannabis to some extent as well.

01:16:28.620 | So, yes, nicotine is incredibly addictive

01:16:33.540 | and we have so many teens who are addicted to nicotine

01:16:37.620 | through e-cigarettes and really struggling to get off of it.

01:16:41.260 | I gave a talk recently to a group of parents

01:16:43.860 | and they said, "This is all great information, Bonnie,

01:16:46.180 | "but how do I help my kid?"

01:16:49.180 | And I just felt awful

01:16:50.460 | because there's not a lot that we have.

01:16:52.980 | So, taking a few different things.

01:16:54.980 | First of all, we don't have, there are some programs,

01:16:58.860 | there are inpatient programs, absolutely,

01:17:01.100 | showing some positive. - Inpatient programs.

01:17:03.020 | - There are actually some inpatient programs.

01:17:04.820 | - But those are gonna be expensive or require

01:17:06.500 | that people have insurance that will cover that.

01:17:08.820 | - Absolutely, and they take weeks.

01:17:10.620 | And then you're taking a young person

01:17:12.220 | out of their natural environment,

01:17:13.940 | out of their school, out of their friends, stigmatizing,

01:17:17.460 | which hopefully we're not stigmatizing drug use anyway,

01:17:20.460 | but you take a young person at 12, 14, 16,

01:17:24.140 | you put them in another place,

01:17:25.740 | that's very difficult on them.

01:17:27.420 | And if part of why they're using in the first place

01:17:29.780 | is stress, you're just enhancing that.

01:17:32.900 | Outpatient programs, we have some things,

01:17:36.980 | but the problem is we don't have the best recommendations

01:17:40.380 | because we don't have great research.

01:17:42.420 | So, for example, nicotine replacement therapy, the patch.

01:17:46.460 | First of all, it's not authorized for use by the FDA,

01:17:50.460 | it's not been approved by the FDA for anybody under 18.

01:17:54.180 | And yet we have a lot of teenagers who are addicted.

01:17:57.900 | We just don't have the right studies

01:17:59.500 | and they haven't gone to the FDA for that approval.

01:18:02.420 | Now, a lot of doctors are using nicotine patches

01:18:06.260 | and prescribing them for somebody under 18.

01:18:08.220 | It's considered off-label, but you still can do it.

01:18:11.020 | And most people would recommend it.

01:18:13.500 | The problem is, and I don't mean problem with using them,

01:18:16.300 | I have no problem with, and I've often suggested to,

01:18:19.660 | I don't treat, I wanna make sure

01:18:21.500 | that I'm not misquoted there either,

01:18:23.100 | I don't directly treat and see patients myself.

01:18:25.780 | But based on the evidence

01:18:27.060 | and the American Academy of Pediatrics recommendations,

01:18:29.820 | we should be using a patch with those under 18.

01:18:33.260 | But then the question is, how much?

01:18:35.780 | If a nicotine patch is about 21 milligrams of nicotine

01:18:40.660 | and a teenager's using 40 milligrams in a day,

01:18:44.540 | do you give two patches?

01:18:45.900 | And I've had some doctors say, "Wow, that's a lot of nicotine."

01:18:49.500 | I say, "Well, they're using a lot of nicotine."

01:18:52.860 | What I've heard some of my adolescent medicine colleagues

01:18:55.740 | have suggested is one patch and then supplement

01:18:58.220 | with gums and suckers and lozenges, not as a starting.

01:19:02.260 | I don't mean like what we're seeing

01:19:03.820 | with some pouches out there, like Xen, as a starter.

01:19:07.660 | I don't mean that, I mean as a form of treatment.

01:19:11.540 | - As a way to wean them off?

01:19:12.900 | So reducing the dosage over time?

01:19:14.740 | - Correct, correct.

01:19:16.100 | But then they also don't have the hand-to-mouth piece

01:19:21.940 | that we see that is difficult.

01:19:23.380 | So gum, in this case, I mean non-nicotine gum,

01:19:27.420 | just chewing regular gum.

01:19:29.820 | I've heard teenagers say that their withdrawal

01:19:32.540 | lasts three to four minutes.

01:19:33.820 | So they have a, one teenager said,

01:19:35.500 | "I have a playlist on my phone

01:19:38.100 | "that's each song is three to four minutes.

01:19:39.940 | "And when I start to feel the withdrawal,

01:19:41.380 | "I pop the music in my ears and I go do something

01:19:44.660 | "and I listen to the song.

01:19:45.660 | "And by then that uncomfortable feeling is over."

01:19:48.820 | I've heard teens say that they'll run,

01:19:51.220 | that there's many different things that they'll do.

01:19:53.940 | Chewing on a toothpick, not a nicotine toothpick,

01:19:57.420 | but it's just a toothpick.

01:19:58.780 | Other ways to really get their mind off of that feeling

01:20:03.500 | is really important.

01:20:05.300 | But we also have to know with adults and cigarettes,

01:20:08.620 | it can take seven to 11 tries.

01:20:11.220 | So we can't expect, until they're fully off of a cigarette,

01:20:14.380 | can't expect a teenager to quit overnight.

01:20:17.540 | - Especially with the social pressure.

01:20:18.980 | And again, sorry to interrupt, but I think that--

01:20:20.220 | - No, no, no.

01:20:21.420 | - The seven to 11 tries, I did an episode on nicotine

01:20:25.420 | and I talked about smoking a bit.

01:20:26.820 | And most people fail.

01:20:28.860 | - Most people fail.

01:20:29.700 | - They relapse.

01:20:31.140 | It's very, very difficult to quit smoking.

01:20:33.500 | People that do it and stick to it

01:20:34.940 | are real heroes of the process.

01:20:37.220 | It's not easy.

01:20:38.700 | But that's with a heavy incentive.

01:20:43.740 | Immediate health issues, sometimes it's financial, et cetera.

01:20:48.140 | With kids, it feels like all the pressures

01:20:49.940 | are pushing in the opposite direction

01:20:51.900 | 'cause it's socially rewarded.

01:20:54.100 | They get that elevation of mood and focus.

01:20:57.320 | And there's just oh so much driving them to continue using.

01:21:02.320 | - Absolutely right.

01:21:04.060 | One of the things that we do in our program

01:21:05.740 | to help teens quit is we talk about social withdrawal.

01:21:08.940 | And it was actually one of our,

01:21:10.180 | we have a wonderful group of 40 youth who work with us.

01:21:14.340 | We call it our Youth Action Board,

01:21:15.740 | our YAB, our Reach Lab YAB.

01:21:18.220 | Our YABs say that we need to talk about social withdrawal,

01:21:20.700 | not just physical because of exactly

01:21:22.460 | what you're talking about.

01:21:23.420 | They may not be able to go to that party

01:21:25.140 | on a Saturday night where they know

01:21:27.420 | their friends are vaping because it'll,

01:21:30.180 | and we know the brain cues up,

01:21:32.220 | that they'll see or smell or witness somebody

01:21:35.980 | using an e-cigarette and those cues will happen

01:21:38.460 | and they'll wanna use it.

01:21:39.800 | So they actually have to isolate themselves

01:21:42.020 | from their friend group who is using.

01:21:44.080 | So it's very difficult.

01:21:45.900 | So really setting up your social milieu,

01:21:48.340 | really setting up your friends who are not using,

01:21:51.820 | really trying to talk and have your family around you.

01:21:55.700 | And I really tell parents it's not the time

01:21:58.300 | to get pissed off with your kids for using,

01:22:00.500 | it's the time to really help them.

01:22:02.300 | Let's be in this together.

01:22:04.100 | And often I say the reason why they're using

01:22:06.580 | is that their fault.

01:22:07.420 | Let's go back to the beginning of our conversation

01:22:09.300 | about marketing and that they're being targeted.

01:22:12.980 | And teens didn't even know what was hitting them,

01:22:15.520 | what was going on.

01:22:16.820 | So let's not be mad at them, let's be sympathetic and help.

01:22:21.200 | So they need the combination of nicotine replacement,

01:22:24.160 | they need to change their milieu,

01:22:25.760 | they need to have healthy snacks and water

01:22:28.760 | and exercise and all kinds of things around them.

01:22:31.600 | And they may also need cognitive behavioral therapy

01:22:34.140 | or some other therapy to really get them.

01:22:36.240 | It's not gonna be a one stop.

01:22:38.480 | We need to work with them.

01:22:39.600 | And that's the same with cannabis, by the way.

01:22:41.280 | This is just anti-drugs and just feels so bad.

01:22:44.520 | It is such a problem right now.

01:22:47.240 | When we built our curriculums,

01:22:48.960 | same thing I said I was doing middle and high school

01:22:52.120 | and never thought I'd do elementary

01:22:53.780 | and we have an elementary curriculum.

01:22:55.820 | I thought I was only gonna do prevention.

01:22:58.080 | We now have intervention and moving towards cessation.

01:23:01.280 | That's how many young people are just struggling right now.

01:23:04.380 | - When I was in high school,

01:23:06.480 | there seemed to be a phenomenon of certain behaviors

01:23:10.800 | allowed kids to have some social clout

01:23:14.920 | by virtue of, I guess they used to call it holding.

01:23:18.120 | Like if someone had weed or if somebody,

01:23:21.280 | yeah, if they had weed,

01:23:24.000 | then it sort of gave them a position

01:23:26.640 | in the social structure.

01:23:27.960 | Oftentimes the kids that,

01:23:31.760 | you know, I mean, I was friendly

01:23:33.160 | and knew most people in my high school class.

01:23:35.360 | You know, and a few of them were kind of like

01:23:39.520 | less socially engaged than others.

01:23:41.320 | But then at some point, midway through high school,

01:23:43.820 | one of them was like,

01:23:44.680 | start showing up with weed at parties or something.

01:23:46.880 | And suddenly like they had like a social clout.

01:23:49.180 | It was kind of interesting to see how, you know,

01:23:52.760 | having paraphernalia, having nicotine or cannabis

01:23:56.760 | or whatever it is,

01:23:57.640 | is sort of, I think has long been a kind of like an instant

01:24:01.680 | sort of route to inserting oneself into a social structure,

01:24:08.460 | which is obviously unhealthy.

01:24:10.300 | I'm not promoting this.

01:24:12.380 | And then it is social, right?

01:24:13.860 | That there's sort of an instant substrate for communication.

01:24:16.940 | When I was growing up, I worked at a skateboard shop

01:24:19.100 | and on my break, I would go behind the shop.

01:24:21.020 | There's a little alley there, we'd skateboard.

01:24:22.420 | There's this little bump.

01:24:23.780 | But occasionally like employees would share a cigarette

01:24:28.360 | or you'd ask someone for a cigarette.

01:24:30.180 | This was kind of a way of bridging social gaps.

01:24:35.380 | So again, I feel like it's so hard to be a teenager.

01:24:40.180 | There's so much going on internally and externally.

01:24:43.100 | And everything you're talking about, you know,

01:24:45.420 | in terms of the negative health effects, the paraphernalia,

01:24:48.260 | the marketing, the taste,

01:24:49.620 | the addictive qualities of it, et cetera,

01:24:52.640 | just start to pile on all these challenges

01:24:55.860 | to staying away from it.

01:24:58.220 | But a big one seems to be the kind of instant social cred

01:25:02.860 | that one gets when they participate in something

01:25:05.700 | that other people are participating in.

01:25:07.300 | Because for instance, like a sport,

01:25:09.260 | there's a pickup basketball game.

01:25:10.580 | You have to play reasonably well to get into the game.

01:25:14.340 | Otherwise, it's not gonna be easy

01:25:16.500 | or you have to be very bold, right?

01:25:18.540 | So unless you're engaged in a sport,

01:25:21.060 | you're in theater, you're doing other things,

01:25:22.740 | it's sort of an instant route.

01:25:25.100 | Okay, I think I've made my point.

01:25:27.220 | Is there anything about that,

01:25:30.140 | that by way of understanding,

01:25:32.380 | can help create like replacement behaviors?

01:25:35.860 | I mean, it's gonna be hard to take a kid

01:25:37.300 | whose entire life is hanging out with their friends

01:25:40.080 | and vaping cannabis or nicotine after school

01:25:42.580 | and hanging around and playing on their phone

01:25:44.260 | and saying, "Hey, listen,

01:25:45.100 | "you're gonna quit vaping nicotine.

01:25:46.920 | "You're gonna feel worse.

01:25:48.820 | "Your friends are all gonna be doing it

01:25:50.740 | "and you'll still be their friend,

01:25:53.180 | "but you're not really part of it."

01:25:54.500 | It's almost like you have to create a culture of quitting

01:25:56.680 | before this can really go the other direction.

01:25:58.780 | - You do and what you're saying is so correct

01:26:02.700 | and so relevant and why I feel so bad for teens right now.

01:26:05.940 | And the social media, right?

01:26:07.780 | You put that in there as well

01:26:09.500 | and it's all over the place right now with them.

01:26:12.300 | They're bombarded by all of the different factors

01:26:14.700 | that you talked about.

01:26:16.260 | And it was interesting,

01:26:17.140 | we were talking about earlier around the social aspects too.

01:26:20.180 | I was thinking there was a point where it was so cool,

01:26:23.140 | particularly around Joel,

01:26:23.980 | it was so cool to Joel that I had teens come up to me

01:26:26.620 | and say, "Dr. Bonnie, do you have a fake e-cigarette?"

01:26:30.380 | And I said, "A fake e-cigarette?

01:26:32.300 | "Well, yeah, all my friends are using

01:26:34.540 | "and I don't want to, but I wanna fake it."

01:26:37.540 | And I just felt so bad.

01:26:39.380 | And I said, "Well, I'm not gonna get you a fake e-cigarette,

01:26:42.040 | "but I will help you with refusal skills

01:26:44.180 | "and teach you how to say no,

01:26:46.140 | "but in this case, not just say no,

01:26:47.860 | "but teach you how to feel good about saying no

01:26:50.640 | "to certain things that you don't wanna be doing."

01:26:53.660 | And during that time,

01:26:55.300 | it was very difficult for teens to come up and say,

01:26:58.420 | "I either wanna quit or I don't wanna be a user,

01:27:00.920 | "I just don't wanna start," because that was not cool.

01:27:03.960 | I think we've changed in the last couple years, thankfully.

01:27:07.660 | I think there are more teens who are not using,

01:27:10.400 | who are open to it or who are open to quitting,

01:27:13.060 | a lot of teens wanna quit right now.

01:27:15.580 | So thankfully, we're in a new era where this,

01:27:18.180 | yes, the pressures to use are absolutely there,

01:27:21.940 | but there's starting to be a tide change

01:27:23.900 | where we're getting more teens

01:27:25.180 | who are getting on the so-called bandwagon

01:27:27.500 | to either quit or not use.

01:27:29.160 | I think the social supports are being there

01:27:31.500 | a lot more than we've ever seen before.

01:27:33.480 | We have more youth groups who are getting on board

01:27:36.280 | of either trying to help quit

01:27:38.040 | or trying to make sure that it's okay not to use.

01:27:40.800 | It's still hard and what you're talking about,

01:27:43.860 | so it's our job as adults and healthcare providers

01:27:46.840 | and community partners and educators

01:27:48.780 | to really talk to young people

01:27:50.340 | to set up those social groups

01:27:52.260 | and say, "It's okay not to use.

01:27:55.540 | "It's okay to come on over to this group

01:27:57.680 | "and yeah, maybe you're not gonna be

01:28:00.220 | "with that same social group on Saturday night.

01:28:02.660 | "Let's start a new social group for you."

01:28:05.020 | I'm not saying it's easy.

01:28:06.340 | This is not easy for young people and it's not easy.

01:28:09.460 | Parents are struggling too.

01:28:11.420 | They're struggling to know how to talk to their teenagers,

01:28:14.700 | but this is what we have to work towards

01:28:16.740 | and setting up those social networks of,

01:28:19.740 | it's cool not to use.

01:28:21.440 | One of the other things, by the way,

01:28:23.700 | that we talk about is the environment.

01:28:26.060 | When we talk to teens about not using

01:28:29.380 | and why it's bad for them, heart, lungs, et cetera,

01:28:31.980 | and all the things and being duped

01:28:33.900 | and be marketed to and the money,

01:28:37.040 | the environment piece has also been interesting.

01:28:40.080 | Teens right now may not care about their hearts,

01:28:43.500 | their lungs 20 years from now.

01:28:45.340 | They care about the environment

01:28:46.820 | and there are environmental aspects to these,

01:28:49.900 | the plastics, the pods don't disappear,

01:28:52.900 | the benzoic acid does not evaporate

01:28:55.820 | and we've got secondhand vapor, secondhand smoke,

01:28:59.700 | secondhand and thirdhand.

01:29:01.860 | So what I mean by that is if I were to use

01:29:03.940 | an e-cigarette near you, you would actually get

01:29:07.260 | a lot of the volatile organic chemicals,

01:29:09.940 | a lot of the nicotine is in the air.

01:29:12.260 | Actually, some studies suggest COVID

01:29:13.980 | might even be in those droplets.

01:29:15.700 | There's a lot of issues there.

01:29:17.060 | And then thirdhand is it just doesn't dissipate.

01:29:21.060 | That vapor, aerosol, it's not a vapor,

01:29:23.460 | that aerosol then settles into carpets

01:29:26.500 | and clothes and so on.

01:29:29.200 | And this is toxic to pets, to children, things like that.

01:29:32.860 | So when we talk to teens about that,

01:29:34.920 | that's another way to get young people

01:29:36.900 | to be willing to either quit or to rally around

01:29:40.020 | not using is the environment.

01:29:43.720 | If I wash dishes for too long,

01:29:45.860 | my younger is out of the house,

01:29:47.040 | but when she comes over, I get yelled across the room,

01:29:50.360 | mom, turn the water off, the environment,

01:29:52.340 | we have to save water.

01:29:54.120 | That's what they care about so much

01:29:56.600 | that if we could at least get that

01:29:58.200 | into young people's hands, say, you know what?

01:30:00.920 | You may not care about yourself,

01:30:02.280 | but what about your friends and what about the environment?

01:30:05.400 | I think we can also shift some of the generation right now.

01:30:09.120 | - Interesting, yeah, I think replacement behaviors,

01:30:12.060 | concern for the environment seem like good incentives.

01:30:15.400 | I don't know, I'm hearing all this.

01:30:16.320 | I feel really lucky that I was always obsessed

01:30:18.520 | with something growing up.

01:30:20.640 | Whether or not it was like birds and fish tanks

01:30:22.980 | or skateboarding or prior to that, soccer.

01:30:26.460 | I mean, certainly there were drugs and alcohol around,

01:30:30.980 | but there were always activities that kept us busy.

01:30:34.340 | And I guess I wonder whether or not

01:30:37.700 | the advent of social media has created less interest

01:30:42.000 | in activities, after school activities,

01:30:45.440 | I guess they used to call them.

01:30:46.680 | But I mean, even if it's video games,

01:30:50.000 | if it's playing a sport, if it's theater,

01:30:52.720 | if it's art, if it's music,

01:30:56.760 | presumably kids are still doing all that stuff.

01:30:59.520 | But is it the case that the kids that are vaping,

01:31:02.820 | let's say nicotine, maybe cannabis as well,

01:31:05.160 | are less likely to be engaged in other activities?

01:31:07.800 | I mean, is this thing becoming

01:31:09.000 | just kind of a closed loop of reward?

01:31:11.220 | I mean, that's, to me, the real danger of any substance

01:31:14.920 | that increases the dopamine system activation

01:31:19.920 | without a lot of effort, right?

01:31:22.280 | 'Cause as you and I know, the whole of dopamine circuitry,

01:31:25.860 | as it relates to reward,

01:31:27.520 | is all about effort, reward, reinforcement,

01:31:30.600 | effort, reward, reinforcement.

01:31:32.400 | But the effort piece is key,

01:31:34.920 | and drugs basically bypass the effort piece,

01:31:37.600 | and then you get the reward reinforcement,

01:31:39.560 | and then eventually the rewarding and reinforcing levels

01:31:43.140 | of return on that drug, nicotine, cannabis, et cetera,

01:31:48.140 | diminishes, and then you're just caught in a behavioral loop.

01:31:50.820 | - Right, right, absolutely.

01:31:52.740 | - So, you know, are kids doing less stuff?

01:31:56.900 | Are they studying less as a consequence of this?

01:31:59.460 | Are they playing fewer sports?

01:32:01.700 | Are they less engaged in youth theater and music

01:32:04.340 | and youth groups and things like that?

01:32:06.420 | - When we were talking about cigarettes

01:32:07.980 | when I first started my career up until probably 2014,

01:32:11.580 | I would say, "Yes, you're absolutely correct."

01:32:13.580 | And it was generally the teens who would say, "I'm bored,

01:32:17.200 | "and I didn't know what to do with myself,

01:32:18.920 | "and that's why I picked up cigarettes,"

01:32:21.180 | or, "I'm not an athlete," or, "This was my social outlet."

01:32:26.180 | I haven't seen that as a result as much with e-cigarettes.

01:32:29.460 | Now, as a result of e-cigarettes, yes,

01:32:31.580 | but not as a cause of using, because it's so ubiquitous.

01:32:35.820 | E-cigarettes, we're seeing everywhere.

01:32:37.940 | It doesn't matter if you're, how old you are, male, female.

01:32:41.540 | Used to be more males using,

01:32:42.980 | because some of the earlier devices were tech,

01:32:45.980 | and guys were using it, and some of the females

01:32:49.060 | didn't want to put 'em in their purse,

01:32:50.620 | 'cause it would leak.

01:32:51.660 | We now are seeing more of an equal rate,

01:32:53.940 | if not a little bit more female using.

01:32:56.240 | It's not your so-called bad or good kids.

01:33:00.820 | It's not anything, it's not the young people

01:33:03.580 | who are struggling with school.

01:33:05.380 | It's everywhere right now, independent of location,

01:33:09.820 | race, ethnicity, things like that.

01:33:11.620 | So I don't see so much what you're talking about

01:33:15.020 | in terms of a predictor.

01:33:16.700 | In terms of a result, absolutely.

01:33:19.660 | I mean, then we're seeing teens who become more isolated,

01:33:22.520 | who are not engaged as much, who are more bored,

01:33:25.760 | because they're sitting home and they're vaping.

01:33:28.300 | But I also see a lot of young people

01:33:29.820 | sitting around together vaping.

01:33:32.020 | So I do think that that landscape has changed.

01:33:35.100 | Is it gonna change back?

01:33:36.060 | I don't know, as hopefully we change the culture again.

01:33:39.460 | But it's an interesting thought.

01:33:40.900 | I mean, as soon as you said that, I was thinking,

01:33:42.940 | yeah, I mean, they're certainly not out

01:33:45.340 | as much as they used to be in terms of,

01:33:48.300 | and we were talking about this at the beginning,

01:33:49.820 | we're not seeing them out in parks as much.

01:33:51.800 | We're not seeing them playing pickup sports games

01:33:54.420 | as much as we used to.

01:33:55.860 | But I don't think that's because of e-cigarette use.

01:33:58.260 | I think that's because of social media

01:34:00.180 | and just the whole change.

01:34:01.140 | And honestly, parents being afraid of letting their kids out

01:34:04.140 | for some predatory behavior and in other ways.

01:34:07.380 | - You mean if kids are let out of the house,

01:34:09.940 | they're more at risk to predatory behavior?

01:34:12.660 | But of course, they're also at risk,

01:34:14.100 | but just by use of the phone,

01:34:15.220 | because the phone connects everywhere.

01:34:17.100 | - Absolutely, the phone connects everywhere.

01:34:19.100 | And that's something we try to teach teens as well.

01:34:21.620 | But I think that that's been something

01:34:22.980 | that parents are worried about.

01:34:24.580 | I have to, almost the pendulum almost swung too much of,

01:34:27.780 | now I have to keep my kid in

01:34:29.140 | because I don't want to let them out of the house

01:34:30.940 | and I don't want to let them alone driving

01:34:32.580 | and alone at the park and things like that.

01:34:34.700 | But I think that we've reduced,

01:34:36.460 | you were talking earlier about autonomy.

01:34:38.500 | We've reduced teens just autonomy.

01:34:41.860 | They have to get into a little bit of trouble.

01:34:44.740 | They have to jaywalk.

01:34:45.740 | They have to do, I mean, I'm not encouraging,

01:34:48.300 | but there's some natural amount of getting together

01:34:52.460 | and hanging out and being crazy at the park

01:34:55.220 | and playing and playing games and things like that.

01:34:57.780 | And I think that has stopped or slowed down a lot.

01:35:02.220 | I see it with some people in my own community.

01:35:05.220 | I don't see as much just hanging out in the front yard

01:35:08.980 | and shooting the breeze and instead they're inside

01:35:13.420 | and they're on their phones and stuff like that.

01:35:16.540 | So could that be part of why we're seeing

01:35:18.420 | more e-cigarette use?

01:35:19.780 | Possibly, I just don't have,

01:35:21.620 | I haven't seen the studies on it.

01:35:23.740 | - Yeah, perhaps that's a good segue into risky behaviors.

01:35:28.700 | When I was a kid, I mean, the dumb stuff that we did,

01:35:32.020 | meaning dumb because it was dangerous to ourselves.

01:35:37.180 | I mean, I am not suggesting people do this.

01:35:39.740 | Kids, please don't do this, just don't.

01:35:41.700 | But just the dumb stuff of, you know,

01:35:44.180 | jumping off roofs or between roofs.

01:35:46.400 | I'm not gonna give any other, any anecdotes.

01:35:51.900 | Just, it's amazing that we all survived and some didn't,

01:35:56.940 | but that was largely the consequence of drugs, alcohol,

01:35:59.460 | mental health issues of kids I knew.

01:36:02.300 | But car accidents, actually, I grew up

01:36:07.020 | in the Mothers Against Drunk Driving era

01:36:11.620 | and there was a real discouragement around drunk driving.

01:36:16.260 | I was fortunate that at least in high school,

01:36:18.300 | most of my friends didn't drink or didn't drink much.

01:36:21.780 | But you still heard about fatalities in kids.

01:36:24.820 | Happened, even one is too many, obviously.

01:36:27.980 | What's going on now in terms of risk-taking behavior?

01:36:33.280 | Driving fast, driving drunk,

01:36:34.980 | doing what used to be just described as dumb stuff

01:36:39.540 | that unfortunately sometimes is fatal

01:36:43.300 | or, you know, results in paralysis.

01:36:46.180 | People jumping off bridges into water

01:36:49.740 | without testing the water depth.

01:36:51.620 | You know, we've all heard the stories

01:36:53.220 | and sadly, they're true stories

01:36:56.380 | of people becoming paralyzed, that kind of thing.

01:36:58.740 | Dumb stuff, dangerous stuff, teens do more of it.

01:37:01.980 | Is it still true that males are doing more of that

01:37:06.660 | physical danger stuff than females, or is that not true?

01:37:11.660 | That's what we used to hear, but then, of course,

01:37:14.220 | there's been this big push, importantly,

01:37:16.740 | really to balance out the amount of research on both sexes.

01:37:22.740 | - Yeah, it's a good point.

01:37:23.580 | I mean, some of it has to do with just the methods

01:37:25.460 | of our research to know.

01:37:26.500 | You know, it's interesting.

01:37:27.340 | I haven't seen more recent data in terms of differences

01:37:31.380 | by sex of engagement and risk behavior.

01:37:34.940 | I mean, a lot of what I've seen is balanced out.

01:37:37.280 | I think it's maybe different kinds of risk behaviors

01:37:39.720 | that people do, but we're still seeing it.

01:37:42.980 | We're still seeing teens drinking.

01:37:45.280 | We're still seeing teens going to parties and getting drunk.

01:37:48.420 | We're still seeing teens out on the beach and getting drunk.

01:37:50.940 | I think the big difference now is,

01:37:53.100 | whether it's from mothers against,

01:37:54.780 | now I think it's destructive driving.

01:37:56.660 | - Is that what it's called?

01:37:57.480 | - I think it's now mothers against--

01:37:58.320 | - Destructive driving.

01:37:59.320 | - I think that's what it is.

01:38:00.160 | - So that includes drunk driving and racing.

01:38:01.980 | - And racing and driving under the influence of cannabis

01:38:05.560 | or anything else, which can be harmful.

01:38:08.660 | But at least in a lot of the teens and young adults

01:38:12.740 | I've talked to, at least we've gotten that word out to teens.

01:38:15.540 | So they're still drinking, and they're still doing

01:38:17.780 | stupid stuff when they drink,

01:38:19.660 | but they're not getting behind the wheel as much, much less.

01:38:23.380 | And this idea of a designated driver or a sober driver--

01:38:28.300 | - Uber.

01:38:29.140 | - Or Uber.

01:38:29.980 | Uber's really changed.

01:38:30.800 | - Or Lyft, I guess we should leave there.

01:38:31.640 | - Or Lyft, or any ride share, let's just say,

01:38:34.140 | any ride share has certainly been a game changer

01:38:38.820 | in the landscape of teenagers and young adults right now.

01:38:43.060 | And in fact, I've heard not just a designated driver,

01:38:46.820 | but a designated partner or a sober sitter.

01:38:51.820 | So this idea that you go to a party

01:38:54.200 | and there may be drinking going on,

01:38:55.980 | but you make sure that there's one person

01:38:58.100 | who's sober not just for driving,

01:39:00.060 | but to make sure you're not going home with somebody

01:39:02.140 | you don't wanna go home with,

01:39:03.660 | to make sure that you're not leaving drunk

01:39:06.180 | and falling downstairs,

01:39:07.620 | to make sure that you're not falling out of that window.

01:39:10.260 | So that message we've gotten across really well,

01:39:13.520 | which I'm thrilled about.

01:39:15.760 | Are we still seeing drunk driving in accidents?

01:39:18.060 | I certainly have among some people I know.

01:39:20.500 | Certainly we are,

01:39:21.420 | but I think that the message overall

01:39:23.380 | has gotten out there.

01:39:24.500 | Some people I've talked to said,

01:39:25.740 | "We just don't get behind the wheel," period.

01:39:28.700 | What's also interesting

01:39:29.780 | is more and more teens are not driving.

01:39:33.120 | They're delaying driving more and more,

01:39:35.480 | whether that's because of Uber, Lyft.

01:39:37.540 | I mean, as a parent, it's less expensive

01:39:41.300 | to pay for a ride share

01:39:42.520 | than to pay for insurance for somebody under 25,

01:39:45.200 | or to pay for a car.

01:39:46.140 | So certainly that might be it.

01:39:47.680 | But that is there.

01:39:51.120 | Doing other stupid stuff,

01:39:52.420 | I mean, in addition to drugs, jumping, skateboarding,

01:39:55.600 | certainly we're still seeing that.

01:39:57.300 | - Well, skateboarding is a good sport.

01:39:59.020 | Don't exceed your skill level,

01:40:00.620 | but jumping between buildings, not smart,

01:40:03.700 | unless you're super skilled and know what you're doing.

01:40:07.140 | I mean, there are the parkour kids

01:40:08.700 | and the skateboard kids and the BMX,

01:40:10.380 | 'cause we don't wanna take away

01:40:12.740 | what the incredible things that they can do.

01:40:14.900 | But there's risk there.

01:40:16.700 | I was referring to people who lack the skill

01:40:18.860 | to complete the maneuver and getting badly hurt,

01:40:23.860 | or in some cases, not getting badly hurt,

01:40:27.380 | but you just kind of shake your head

01:40:28.540 | and wonder why you ever engaged in that kind of stuff.

01:40:31.380 | Just so risky.

01:40:32.740 | - Yeah, yeah.

01:40:33.660 | We're definitely still seeing risk behavior

01:40:35.860 | amongst teenagers.

01:40:36.780 | And part of it has to do with impulsivity.

01:40:39.020 | We know that teens up until around,

01:40:41.060 | part of the development, right,

01:40:42.540 | of cognitive and psychosocial and social development,

01:40:45.820 | it's up until around 16, 17, they're still very impulsive.

01:40:50.140 | We know with the brain development, right,

01:40:51.900 | the back of the brain develops faster and first,

01:40:54.980 | and that's our amygdala, our emotional center,

01:40:57.980 | our motor coordination, versus the front of the brain,

01:41:01.460 | which is our executive functioning,

01:41:03.260 | our planning for the future,

01:41:06.820 | our really slowing down and being able

01:41:08.620 | to think of the risks and benefits

01:41:10.740 | and make those decisions a little slower

01:41:12.980 | and a little bit better, more like we would as adults.

01:41:15.300 | So we certainly see impulsive decision.

01:41:18.300 | You know, hey, let's go teepee that house,

01:41:20.740 | or let's go ride on that car,

01:41:22.180 | or let's go do things that probably,

01:41:24.980 | hopefully wouldn't get them killed or injured,

01:41:26.820 | but may get them busted in other ways.

01:41:29.140 | We're still seeing that.

01:41:30.700 | I think there've been more programs

01:41:33.140 | to help teens sort of rehearse in situations,

01:41:36.580 | so they're not, more life skills training,

01:41:38.700 | so they're not making some of those impulsive decisions,

01:41:41.460 | but teens will.

01:41:42.300 | Teens are gonna be teens,

01:41:43.980 | which, by the way, is why we don't put things

01:41:46.660 | in front of them, like, you know,

01:41:49.460 | sugar booger and unicorn kind of marketing

01:41:52.380 | that's going to get teens attracted,

01:41:54.060 | because that is buying into that knee-jerk,

01:41:57.340 | impulsive, it looks cool, everyone's doing a kind of thing

01:42:01.220 | that they can resist.

01:42:02.820 | I don't mean that they can't,

01:42:03.940 | but just buys right into, teens are going to be teens,

01:42:06.700 | and that's what they're going to do.

01:42:08.500 | - What about sexual behavior?

01:42:11.540 | You mentioned that kids are driving less,

01:42:15.100 | are getting their driver's license less frequently,

01:42:18.420 | which, by the way, with respect to teens

01:42:23.020 | wanting to drive less, that just, like, baffles my mind.

01:42:25.500 | I mean, one of the reasons I like skateboarding as a sport

01:42:27.340 | is you could do it anywhere.

01:42:28.660 | It was also transportation, and I like the social milieu.

01:42:31.540 | I loved the social milieu of it.

01:42:34.860 | But getting my driver's license

01:42:36.860 | was, like, one of the most important events of my life.

01:42:39.060 | - Me too, me too.

01:42:39.900 | - I mean, I could drive to Yosemite in the summer.

01:42:42.380 | I could do all sorts of things with that.

01:42:44.340 | I'm so surprised that kids wouldn't want to do that.

01:42:47.580 | Such autonomy there, so much fun.

01:42:49.780 | - Oh, I agree.

01:42:51.980 | - But I've also heard that rates of sexual behavior

01:42:55.700 | are going down, is that true?

01:42:57.820 | - Yeah, stabilizing and going down,

01:43:00.100 | and certainly rates of risky sexual behavior

01:43:02.380 | has also gone down, so we are getting the message across

01:43:05.380 | around condom use, around STI testing,

01:43:09.740 | around birth control, things like that,

01:43:11.460 | which is also really good.

01:43:12.900 | But rates overall have gone down.

01:43:14.860 | - Is teen pregnancy down?

01:43:16.300 | - I think it's down.

01:43:17.260 | Actually, I haven't looked at the latest numbers.

01:43:18.820 | I think it's down.

01:43:20.740 | Certainly I don't think it's gone up,

01:43:22.780 | but I actually would need to look back at those numbers.

01:43:25.340 | It's been a little while since I've looked at them.

01:43:27.260 | - And is what we're talking about today

01:43:29.220 | mostly within the United States and the United States alone,

01:43:32.020 | or does it carry over to other countries as well?

01:43:34.940 | - So it totally depends on the behavior

01:43:37.700 | that we're talking about.

01:43:39.020 | - Let's say vaping or e-cig use of cannabis or nicotine.

01:43:44.020 | - So interestingly, e-cigarette, nicotine, e-cigarette use

01:43:48.860 | has not been as high in a lot of other countries.

01:43:52.380 | It depends on the country,

01:43:53.260 | but for example, the UK or Europe,

01:43:55.500 | we haven't seen the rates as high in the last few years.

01:43:58.700 | Part of it was that a lot of other states

01:44:01.420 | have a nicotine standard.

01:44:03.420 | So that means a minimum amount or maximum amount,

01:44:06.660 | excuse me, of nicotine that you're allowed to have.

01:44:08.780 | So for example, the UK, I think it's around 1.7%.

01:44:12.300 | In the US, we have no nicotine standard,

01:44:15.140 | which is another major issue with regulation.

01:44:18.260 | We don't have, I mean, we have, as I was saying,

01:44:20.620 | 5%, 10% nicotine levels.

01:44:23.740 | There is no regulation about how much nicotine

01:44:26.260 | that you could have.

01:44:27.460 | So in certain countries,

01:44:29.180 | if it's right around the addictive level

01:44:32.020 | or a little bit below it,

01:44:33.580 | we're gonna see fewer teens becoming addictive.

01:44:35.700 | It's still bad at any amount,

01:44:37.140 | but we're gonna see fewer people becoming addictive.

01:44:41.420 | The other is the marketing was not as big

01:44:43.820 | in other countries and really was,

01:44:45.860 | the marketing was e-cigarettes

01:44:47.540 | if you're trying to stop smoking cigarettes,

01:44:50.700 | not marketed to teens.

01:44:52.420 | That has changed in the last year or two.

01:44:54.500 | So in countries I've talked to, for example, the UK,

01:44:57.540 | I've been interviewed by them many times

01:44:59.260 | in the last few years,

01:45:00.100 | that they would say, "We don't have the same problem."

01:45:02.300 | And now they're saying, "Boy, we are seeing

01:45:04.540 | "a pretty significant increase

01:45:06.220 | "in the number of teens who are using."

01:45:09.020 | Part of it is a different landscape

01:45:10.860 | of the kind of e-cigarette that's out there,

01:45:12.980 | the kind of marketing that's out there, whatever it is.

01:45:15.820 | We are now seeing, is it as high as we have in the US?

01:45:18.940 | I don't think so, but it's certainly increasing.

01:45:21.900 | Same thing in other countries

01:45:23.700 | where they actually didn't allow certain e-cigarettes

01:45:26.140 | to be on the market have now come in

01:45:28.860 | and been on the market and infiltrated.

01:45:31.380 | And even in this country, certain e-cigarettes are illegal

01:45:34.820 | and they're coming in illegally

01:45:37.060 | through illicit trading is happening

01:45:38.780 | and crossing the borders.

01:45:41.100 | So e-cigarette, we're still seeing.

01:45:44.420 | Cannabis depends on the country, right?

01:45:47.140 | Whether it's legal or not.

01:45:48.500 | Now, even in the US, I should say,

01:45:50.780 | even states that have legalized cannabis,

01:45:53.820 | you have to be 21,

01:45:55.820 | but we're still seeing underage cannabis use, of course,

01:45:58.660 | just like we're seeing underage drinking

01:46:00.340 | and underage nicotine use.

01:46:01.920 | In other states where it's just really difficult to get,

01:46:05.940 | we're not seeing cannabis as much,

01:46:08.220 | but we still are seeing it.

01:46:09.660 | - We didn't talk about things like Zin pouches,

01:46:14.100 | which are becoming more popular with adults as well.

01:46:17.020 | So no vaping, no e-cig, no smoking nicotine,

01:46:21.460 | but a little pouch,

01:46:23.260 | which is different than dipping tobacco or snuffing tobacco.

01:46:27.020 | As far as I know,

01:46:29.540 | Zin pouches and things similar

01:46:33.140 | deliver nicotine into the bloodstream,

01:46:36.220 | which then crosses the blood-brain barrier,

01:46:37.800 | goes into the brain,

01:46:38.640 | has this effect of creating focus and alertness

01:46:41.380 | kind of a little high,

01:46:42.920 | but doesn't carry the same carcinogenic risk.

01:46:47.980 | But presumably there are other risks,

01:46:51.260 | which include, of course,

01:46:52.460 | the addictive and habit-forming nature of it,

01:46:54.420 | the blood pressure increase, the vasoconstriction,

01:46:56.780 | which is related to the blood pressure, et cetera.

01:46:58.840 | But what do we know about Zin pouch use?

01:47:01.040 | Is it on the rise?

01:47:02.660 | Or is it that there's something so compelling

01:47:05.500 | about vaping and e-cigs that people,

01:47:09.060 | in particular kids, want the physical act of vaping?

01:47:14.060 | - So this is a case where,

01:47:16.580 | I've seen this one other time,

01:47:17.900 | where actually the popular press

01:47:20.000 | ahead of the scientific press

01:47:21.600 | and probably ahead of the science

01:47:23.920 | and teaching us scientists

01:47:25.060 | that we better hurry up and figure this out.

01:47:27.840 | - How is that?

01:47:28.680 | - So the popular press has been talking about Zin a lot

01:47:31.400 | and arguing that it's a very popular product

01:47:34.920 | and that we're seeing,

01:47:36.060 | now this is true,

01:47:36.900 | we're seeing a very sharp increase

01:47:38.840 | in the market share of Zin

01:47:40.480 | compared to other nicotine products.

01:47:42.160 | So we're seeing it on the rise.

01:47:43.440 | What I mean by science hasn't caught up

01:47:44.960 | is we don't have a lot of surveillance data

01:47:46.960 | to show whether or not teens are actually using Zin.

01:47:50.960 | We have some data.

01:47:51.980 | We actually published a study a couple years ago

01:47:53.940 | showing around 20 to 25% of people in general,

01:47:58.340 | adolescents and adults,

01:47:59.640 | and about 11 to 15% of teens are using a pouch,

01:48:03.940 | presumably Zin.

01:48:05.280 | We didn't ask.

01:48:06.120 | We now are looking at our data around Zin use.

01:48:08.540 | But we don't have wide-scale studies.

01:48:12.340 | We do have studies of pouches more generally,

01:48:15.360 | like the CDC showed that about,

01:48:18.400 | I think it was a couple of percent,

01:48:20.200 | one and a half percent,

01:48:21.760 | and that it went up a little bit.

01:48:23.880 | So I think, I can't remember.

01:48:24.800 | It was something like,

01:48:25.640 | I think it went from 1.1% to about 1.5% of teens

01:48:30.400 | seem to be admitting using pouches.

01:48:32.840 | So not a huge increase,

01:48:35.120 | but a few hundred thousand teens are using

01:48:37.760 | across the country,

01:48:38.640 | as opposed to two and a half million plus using e-cigarettes.

01:48:43.880 | But with all those qualifications aside,

01:48:46.160 | yes, we are seeing an increase in Zin use amongst teenagers.

01:48:49.900 | What's most concerning is that it seems like it's teenagers

01:48:54.920 | who are not using it in addition to e-cigarettes,

01:48:58.960 | but new initiates.

01:49:00.220 | So they're now, just like I'm concerned about teens

01:49:02.760 | initiating tobacco or nicotine through e-cigarettes,

01:49:06.200 | now it seems like some are initiating through Zin.

01:49:09.840 | - So Zin is kind of the gateway.

01:49:11.840 | It may be an on-ramp to using,

01:49:14.120 | and the idea is that they're putting it

01:49:16.360 | in between their lip and their gum,

01:49:18.600 | and then each pouch of Zin is three or six milligrams.

01:49:23.040 | It comes in a three milligram pouch

01:49:25.180 | or a six milligram pouch.

01:49:27.120 | Now it is nicotine that,

01:49:28.640 | yes, it's originally derived from tobacco,

01:49:32.160 | but there's no tobacco in the pouch itself.

01:49:35.360 | It's a white powder nicotine.

01:49:38.140 | And I don't know what else is in there.

01:49:40.320 | We are really lacking the research there,

01:49:42.860 | but my concern is we've seen this

01:49:44.720 | with smokeless tobacco for years is oral cancer.

01:49:48.520 | And you're putting this in the mouth

01:49:51.280 | and at the mucosal line,

01:49:53.080 | and are we going to start being concerned about oral cancer,

01:49:56.960 | which we've already been concerned about with other pouches?

01:49:59.360 | - How would you get oral cancer if there's no tobacco

01:50:02.140 | and it's just nicotine?

01:50:03.840 | I was under the impression,

01:50:05.280 | and please tell me if I'm wrong,

01:50:06.440 | that nicotine itself doesn't cause cancer.

01:50:09.160 | - The question is what else is in there?

01:50:10.600 | Is it just nicotine or is there aldehydes

01:50:12.720 | and other chemicals that are cut with it?

01:50:14.600 | So that's why I'm saying we don't know enough about it.

01:50:16.880 | My big concern is exactly what you're saying.

01:50:18.600 | Are we going to start seeing teens using nicotine

01:50:21.560 | and then nicotine pouches and moving on?

01:50:24.140 | But the brain piece, it doesn't matter.

01:50:28.720 | What else is in there?

01:50:29.680 | We are still concerned about the brain development.

01:50:32.020 | And if you're using a three milligram

01:50:34.680 | or a six milligram pouch,

01:50:36.320 | and we know that a lot of teens are using multiple pouches,

01:50:39.880 | our study showed this as well,

01:50:41.740 | multiple pouches throughout the day,

01:50:43.400 | and actually some social media is showing

01:50:45.400 | teens putting in several pouches at the same time,

01:50:48.520 | then you might be getting, again,

01:50:50.240 | as much as a pack of cigarettes of nicotine,

01:50:52.440 | and that's very concerning.

01:50:54.160 | So the whole piece we talked about before

01:50:56.080 | about brain development and are we stunding or changing

01:50:59.560 | or really rewiring the brain with nicotine,

01:51:02.360 | doesn't matter what form it's in,

01:51:04.800 | it is not good and it's not good for teenagers.

01:51:08.280 | - Yeah, I get asked a lot of questions about zinc pouches

01:51:11.900 | and other nicotine pouches.

01:51:13.760 | And one of the more common questions

01:51:15.540 | is related to the fact that a lot of people start

01:51:18.880 | with one or two pouches a day,

01:51:20.520 | quickly moved to four to five.

01:51:21.940 | And the typical ceiling for most people

01:51:25.880 | that at least ask me questions about it

01:51:28.680 | is moving to quickly a canister a day,

01:51:33.280 | which is a lot of pouches.

01:51:35.400 | - I think it's 15 to 20 pouches per can.

01:51:38.920 | - Okay, so three to six milligrams.

01:51:41.600 | - Right. - You can do the math.

01:51:42.560 | - Do the math.

01:51:43.400 | What's that, 60 to upwards of 60 milligrams.

01:51:47.040 | That's three packs of cigarettes.

01:51:50.240 | - You got your step ahead of me, two steps ahead of me.

01:51:52.520 | - Yeah, two.

01:51:53.720 | Let's play it safe, two.

01:51:54.980 | I'll give you, if you know.

01:51:55.820 | - Two packs of cigarettes per day.

01:51:57.040 | - At least two packs of cigarettes worth of nicotine.

01:51:59.360 | And it's interesting, in the old days,

01:52:02.680 | when we didn't have e-cigarettes

01:52:04.120 | and we were talking about cigarettes

01:52:05.660 | and we were talking about adults,

01:52:07.460 | we would talk pack cigarette years, right?

01:52:09.600 | How many packs of cigarettes and for how many years.

01:52:12.120 | And that language kind of reduced for a while

01:52:14.900 | because adults and people weren't using cigarettes as much.

01:52:18.720 | And so we weren't worrying about this concept of packs.

01:52:21.600 | I'm worried about it again.

01:52:22.800 | We're getting so much nicotine now.

01:52:25.200 | Now, yes, not in the form of combusted,

01:52:27.700 | not in the form of burning.

01:52:29.160 | Maybe it's in the form of e-cigarettes or pouches,

01:52:32.200 | but it's still a huge amount of nicotine

01:52:34.480 | that we're seeing that young, very young brains are using.

01:52:38.200 | - Yeah, can't be good, in my opinion.

01:52:40.680 | I spent years studying brain development,

01:52:42.880 | still teach brain development every year.

01:52:45.400 | Can't be good.

01:52:46.680 | The brain doesn't do well developing

01:52:49.640 | with artificially high levels of any neuromodulator.

01:52:55.240 | - And then you go back to the eight-year-olds

01:52:56.680 | we were talking about earlier,

01:52:58.040 | and we have no studies on what does a drug like nicotine do

01:53:03.040 | to not a teen brain, but a child brain.

01:53:07.000 | And clearly is not good, but what exactly is happening?

01:53:10.880 | We don't have those studies,

01:53:12.280 | but it's incredibly scary to think about

01:53:15.200 | what's happening with young people

01:53:17.360 | and getting addicted so young

01:53:19.840 | and then continuing that addiction

01:53:21.560 | of a lifetime of addiction that they might have.

01:53:24.000 | - Seems like it would be appropriate now

01:53:27.040 | to kind of take a step back.

01:53:29.600 | I think everyone agrees that these are major problems

01:53:33.400 | that are in our youth,

01:53:35.400 | and just evaluate messaging and tools

01:53:40.160 | to overcome these issues, right?

01:53:44.880 | So obviously, if you never try a substance or a behavior,

01:53:48.120 | you can't get addicted to it.

01:53:50.280 | But given the prevalence of this stuff,

01:53:52.960 | what sorts of messaging work?

01:53:54.880 | - Earlier, we talked about accessing the rebellious spirit

01:53:58.560 | that is youth as a way to get youth

01:54:02.840 | to engage in healthier behaviors

01:54:04.320 | and abandon unhealthy behaviors.

01:54:06.240 | But there's quitting, there's just saying no,

01:54:09.480 | and then there's harm reduction.

01:54:11.160 | There's convincing people

01:54:15.920 | that some substance is bad for them

01:54:18.960 | and scaring them to the point where they quit.

01:54:21.560 | There's incentivizing them to be healthy.

01:54:23.920 | There's replacement behaviors.

01:54:26.120 | There's just so much in that landscape.

01:54:28.080 | I know you just held a conference

01:54:29.920 | on cannabis and tobacco recently.

01:54:32.120 | I'm sorry, I wasn't able to attend.

01:54:34.440 | It sounds super interesting.

01:54:35.920 | But whether or not we're talking about social media

01:54:37.480 | or cannabis or risky driving behavior

01:54:40.360 | or reckless behavior of any kind, I mean, what works?

01:54:45.360 | And when I say this,

01:54:47.800 | I don't necessarily just mean at the level

01:54:49.720 | of public health discourse, but also parent to child,

01:54:54.080 | peer to peer, sibling to sibling.

01:54:57.800 | What works?

01:54:58.640 | I mean, how should one approach a kid

01:55:01.280 | or an adult for that matter who's vaping cannabis

01:55:04.640 | or is vaping nicotine

01:55:07.160 | and is just clearly gonna be a bad trajectory?

01:55:10.440 | What can one do?

01:55:11.520 | I mean, we all also understand personal accountability

01:55:14.280 | and neuroplasticity generally emerges best

01:55:17.020 | when it comes from within as opposed from the outside.

01:55:19.700 | But what can we do?

01:55:21.380 | - The most important is, and I've said this for years,

01:55:24.760 | have a conversation.

01:55:27.160 | And some people think that having a conversation about,

01:55:32.000 | name your risk behavior.

01:55:34.040 | Drugs, of any sort, alcohol, tobacco, other drugs,

01:55:37.440 | having a conversation about sex,

01:55:39.060 | having a conversation about risky driving,

01:55:41.360 | gets young people curious.

01:55:43.200 | That is not at all the case.

01:55:45.160 | There's nothing we can talk to a young person about

01:55:47.360 | that they don't already know.

01:55:49.240 | We're kidding ourselves to say,

01:55:50.880 | oh, we can't mention drugs to a 16-year-old

01:55:53.400 | because we're gonna get them curious.

01:55:54.960 | They've known about drugs since they were eight years old.

01:55:57.680 | We're not.

01:55:58.520 | And I often say to parents, start that conversation young.

01:56:02.320 | When your kids are really young, four or five,

01:56:04.720 | maybe the conversation is having a cookie

01:56:07.100 | or having some grapes or going to bed now

01:56:10.440 | or going to bed in five minutes.

01:56:11.740 | I used to say that with my own kids.

01:56:13.160 | You wanna go to bed now or in five minutes?

01:56:14.840 | So they felt like they were making the decision.

01:56:16.960 | I didn't really care which decision they were making.

01:56:19.640 | It was not a fight.

01:56:21.040 | We need to start having conversations

01:56:23.440 | around decision-making and healthy decision-making

01:56:26.400 | and not have a confrontation,

01:56:28.600 | but a conversation very young.

01:56:31.280 | Now, I'm not saying that we talk about drugs or sex

01:56:34.000 | when they're very young, although to be honest, I did.

01:56:35.940 | I talked about cigarettes and pubital development

01:56:40.600 | with my kids when they were very young,

01:56:42.600 | but just starting that conversation

01:56:45.320 | so that when you move into more sensitive topics,

01:56:48.680 | more difficult topics, as a child ages

01:56:51.400 | and becomes an older child and into adolescence,

01:56:54.960 | it's not shocking that you're having those conversations.

01:56:57.600 | And this is whether you're a parent, an educator,

01:57:00.480 | or whatever, so just talking, a conversation.

01:57:03.880 | And not scheduling it, by the way.

01:57:07.280 | Not on Saturday at three o'clock,

01:57:09.460 | we're gonna sit down and talk about sex,

01:57:11.480 | or at three o'clock, we're gonna talk about drugs.

01:57:13.560 | That does not work.

01:57:14.880 | You need to, I would joke that I was like

01:57:17.680 | the queen of organic conversation.

01:57:19.560 | You know, I'd see something on TV.

01:57:20.920 | Oh, you know, oh, let's have a conversation about that.

01:57:23.680 | Just making it a natural part.

01:57:25.600 | And you were asking about differences

01:57:27.240 | in cultures and countries.

01:57:29.640 | We don't normalize those conversations.

01:57:32.120 | Other countries do, and we need to be doing that.

01:57:34.600 | So that's one thing. - It sounds like

01:57:35.440 | we don't normalize them or formalize them.

01:57:37.680 | - Correct, we don't.

01:57:39.760 | So that's one thing.

01:57:40.720 | The other is, we're kidding ourselves

01:57:43.160 | if we just talk about the just say no,

01:57:45.600 | as we were saying before.

01:57:46.960 | Of course we want no use.

01:57:49.000 | Of course we want teens to wait.

01:57:51.860 | I mean, I often say, we hope and expect

01:57:54.720 | that most people, if not all, will grow up

01:57:57.420 | into a healthy sexual relationship,

01:57:59.520 | whatever that might look like.

01:58:01.200 | Even a healthy alcohol relationship,

01:58:03.340 | a glass of wine, or half a glass of wine

01:58:05.080 | at night with dinner.

01:58:06.760 | Again, no safe use of a lot of the other drugs,

01:58:10.800 | including nicotine, certainly fentanyl, illicit fentanyl.

01:58:14.720 | I want to make clear, not all fentanyl,

01:58:16.440 | but illicit fentanyl.

01:58:17.560 | But to just simply say no and don't do,

01:58:21.240 | and it's bad for you, is setting up, again,

01:58:24.160 | that failure of your conversation.

01:58:26.000 | Because, okay, well you're telling me it's bad,

01:58:28.360 | but I liked it, or my friend liked it,

01:58:31.240 | and it's not so bad.

01:58:33.360 | So you've lost credibility.

01:58:35.460 | The most important part of harm reduction

01:58:37.320 | is not to do it.

01:58:38.440 | Absolutely, of course.

01:58:39.960 | Not to use, not to have risky sex.

01:58:41.960 | Maybe not to have sex at all until you're older.

01:58:44.280 | Not to use tobacco, not to use any drugs.

01:58:46.960 | But how do we do that with a young person

01:58:49.920 | who you go into a classroom and 10%, 20%

01:58:53.920 | have already started using, or having sex,

01:58:56.720 | or whatever the conversation is,

01:58:58.320 | you shut them down.

01:58:59.440 | Well, they don't understand me,

01:59:01.160 | so why should I listen to them?

01:59:02.960 | They're not talking to me.

01:59:04.400 | And so that no use conversation doesn't work.

01:59:07.960 | There's a continuum, or a spectrum of use.

01:59:10.640 | Everything from no use, to once in a while,

01:59:14.540 | to regular use, all the way up to addicted use.

01:59:17.440 | We're talking about drugs.

01:59:19.420 | So to go in and assume that nobody's ever used,

01:59:23.400 | or nobody wants to use,

01:59:25.400 | you're setting yourself up for failure.

01:59:27.940 | That's the expectation, that's the hope.

01:59:29.860 | But what we really also need to talk about is,

01:59:32.360 | best if you don't use, but if you do,

01:59:35.960 | let's, if you are using, let's help you cut back or quit.

01:59:39.000 | And if you are continuing to use, let's keep you safe.

01:59:42.920 | Let's make sure that you're not gonna die.

01:59:45.160 | And what I'm talking about here is,

01:59:47.700 | you know, when most parents,

01:59:50.480 | if their kids are gonna go to a party,

01:59:52.040 | well, I shouldn't say most parents,

01:59:53.220 | but a conversation often is,

01:59:55.560 | hey, I hope you're not drinking,

01:59:56.880 | but if you are, pick up the phone and I will come get you.

02:00:01.240 | That's harm reduction.

02:00:02.760 | And parents, oh, I didn't think about that.

02:00:04.880 | Well, that's putting safety first.

02:00:06.520 | That is a harm reduction message.

02:00:08.760 | Or saying, you know, you're pretty young

02:00:12.760 | to start having sex, but here's a condom just in case.

02:00:16.200 | Why do schools have condoms in?

02:00:18.200 | Because they know that as much as we say

02:00:20.720 | it's best to delay, teens are going to.

02:00:23.120 | That's harm reduction.

02:00:24.600 | Let's at least reduce risk of STIs, pregnancy, and so on.

02:00:28.320 | - And what do the data say is the consequence

02:00:31.120 | of harm reduction versus the kind of like thick black line,

02:00:35.080 | don't go anywhere near this behavior?

02:00:37.680 | - All the research, or pretty much all the research

02:00:39.680 | that I've read and hopefully will contribute to

02:00:41.880 | shows that those messages, the harm reduction messages,

02:00:45.800 | or what I would say comprehensive,

02:00:47.480 | it really, the harm reduction.

02:00:49.120 | Unfortunately, harm reduction has gotten a bad rap,

02:00:51.760 | partly because of cigarettes versus e-cigarettes

02:00:54.000 | and this harm continuum with tobacco.

02:00:57.760 | So maybe we don't say harm reduction,

02:00:59.240 | we say comprehensive conversations,

02:01:01.120 | comprehensive education from no use all the way up to

02:01:04.260 | what do we do if you are using?

02:01:06.240 | And all the research is really saying

02:01:08.140 | that those messages are way more effective

02:01:11.440 | than not using at all, or than that.

02:01:14.280 | If we tell teens don't use,

02:01:16.240 | and we see this a lot in sexual behavior,

02:01:18.560 | we say do not have sex, period.

02:01:21.040 | Sign a contract that you're not gonna have sex.

02:01:23.760 | And then they're in a situation,

02:01:25.360 | and we don't arm them with the understanding

02:01:27.560 | of how to negotiate, how to have a healthy relationship,

02:01:31.320 | how to have a conversation.

02:01:32.760 | What do they do if they're thinking

02:01:33.840 | that they might want to have sex?

02:01:36.040 | What do they do in that situation?

02:01:37.800 | We then find that we're having teens

02:01:39.740 | who then don't know how to protect themselves

02:01:42.560 | and either have sex that was unwanted

02:01:45.360 | or sex that was unprotected.

02:01:48.000 | And teens want to understand, they want the truth,

02:01:51.920 | they want the knowledge.

02:01:53.760 | I went to a school and asked whether if I came

02:01:56.600 | and talked about cannabis, would they come?

02:01:58.360 | And they said, "Absolutely, I want to understand it."

02:02:02.320 | And there's this great quote that I recently learned

02:02:05.280 | that said, basically the concept is

02:02:09.120 | if you don't teach teens,

02:02:10.200 | they're gonna seek out information.

02:02:11.880 | So the quote is, "Having teens learn about sex from porn

02:02:16.200 | "is like having them learn physics from the Transformers,

02:02:20.460 | "or having them learn how to drive from Fast and Furious."

02:02:23.400 | We need to give teens the information

02:02:25.640 | 'cause they're gonna find it.

02:02:27.080 | - That's right, they're being exposed

02:02:28.320 | to other information elsewhere anyway.

02:02:32.600 | So what you're talking about here

02:02:34.120 | is coming up with counterbalances.

02:02:36.620 | - Counterbalances, real science-based information

02:02:40.520 | that's not overblowing the risks, that's not scaring them.

02:02:43.880 | And then that helps them understand it's best to say no,

02:02:47.400 | but if you do, fentanyl,

02:02:49.600 | let's make sure you're not using alone.

02:02:51.540 | I mean, obviously I don't want somebody using a drug

02:02:54.300 | that hasn't been tested and they got off the internet,

02:02:57.480 | period, because I know kids who have died.

02:02:59.800 | - It's so scary.

02:03:00.920 | We have close friends that, gosh,

02:03:05.720 | I would have never guessed that their kids were using drugs.

02:03:08.540 | And maybe they were using drugs at the frequency

02:03:11.380 | that was always typical of youth, I don't know.

02:03:16.160 | I don't know the situations well enough,

02:03:17.620 | but I would say about once every four,

02:03:21.200 | sadly, once every four to eight months,

02:03:26.200 | I hear about someone's kid or close relative

02:03:30.420 | that died of a fentanyl overdose.

02:03:32.540 | It does seem to be kids, maybe 30 and younger.

02:03:36.740 | - Yeah, it was more in the 20s and 30s.

02:03:39.100 | It's now really getting into the teens and young adults.

02:03:42.220 | You're absolutely right.

02:03:43.100 | And some of the teens I know of and young adults

02:03:46.780 | who have died were not your drug users.

02:03:49.620 | We talked about not stigmatizing.

02:03:51.840 | And that's the other thing.

02:03:52.840 | If we don't talk, then we're stigmatizing.

02:03:54.760 | We need to have those conversations.

02:03:56.640 | But a lot of those teens were not using.

02:03:58.440 | They needed a pill 'cause they were in pain

02:04:00.560 | or they needed something, and they were not told,

02:04:03.520 | and this is, again, that harm reduction

02:04:04.960 | and that conversation, they were not told,

02:04:07.760 | don't buy something off of the internet.

02:04:09.480 | If you do, test it, and test it with a fentanyl strip,

02:04:13.760 | for example, and make sure that you're not using a loan

02:04:16.520 | because if you're using a loan,

02:04:17.920 | we can't then give you Narcan.

02:04:20.300 | We can't do something.

02:04:21.420 | I carry Narcan with me all the time.

02:04:23.820 | - Do you really? - I do.

02:04:24.940 | I have it in my backpack all the time.

02:04:26.660 | - For anyone that you might see that's having an overdose

02:04:29.260 | or kids in particular? - Anyone you might see.

02:04:31.060 | Yeah, thankfully it hasn't happened.

02:04:32.860 | But if it does, and you can't hurt somebody from using it

02:04:37.780 | if that's not what's happening.

02:04:39.180 | So use it. - Should everyone

02:04:40.980 | carry a Narcan pen? - I think everybody

02:04:43.580 | should have Narcan.

02:04:44.920 | I do. - Wow.

02:04:46.380 | - I think every school should have Narcan.

02:04:48.340 | I think every library should have Narcan.

02:04:50.500 | I think every bar should have Narcan.

02:04:53.260 | I absolutely believe it.

02:04:55.400 | Now test strips is an interesting debate that I've had.

02:04:57.880 | So I totally believe in this concept of comprehensive,

02:05:00.980 | if you don't wanna say harm reduction,

02:05:02.500 | comprehensive drug education, comprehensive sex education.

02:05:06.620 | And what I mean by that is both the spectrum of use

02:05:09.780 | or behavior as well as all kinds of drug, sex, rock and roll

02:05:14.280 | that we talk about the whole thing.

02:05:16.700 | But fentanyl test strips has been an interesting dilemma

02:05:20.140 | within myself, and I'll explain why.

02:05:22.660 | I've been working with some groups to try to test

02:05:25.220 | whether we could study whether if we put both Narcan

02:05:29.700 | and fentanyl test strips in schools,

02:05:32.340 | would teens get them?

02:05:33.740 | So my fantasy, bowl of condoms, bowl of Narcan,

02:05:37.900 | bowl of fentanyl test strips, and you have it out for teens.

02:05:41.700 | - Wow, that's a bold statement.

02:05:44.020 | It is a very bold statement.

02:05:45.260 | - What about the argument that I imagine

02:05:47.460 | some people counter with?

02:05:50.540 | I'm not necessarily saying this is my argument,

02:05:52.520 | but just imagining that some people will hear that and say,

02:05:57.140 | having those things visible, freely available,

02:06:01.380 | will create more of an incentive for risk-taking.

02:06:04.660 | - So I've grappled with that.

02:06:05.980 | And with condoms, we know that that's not the case.

02:06:09.260 | It's not going to create teens starting to have sex.

02:06:12.340 | Just going back to what we were saying a few minutes ago,

02:06:14.740 | you're not going to incentivize or create people

02:06:17.580 | engaging in any risk behavior by having the conversation.

02:06:20.980 | But my grappling with the Narcan

02:06:22.900 | and with the fentanyl test strips has been there.

02:06:25.620 | Oh, well, you tell me it's a bad idea to use a drug,

02:06:28.420 | but I'll just test it and make sure it's okay.

02:06:31.020 | Well, I have a couple of problems with that,

02:06:33.580 | even though I still believe in it.

02:06:34.820 | I still believe in having those there

02:06:36.580 | because right now we have an overdose epidemic

02:06:39.740 | with fentanyl and other drugs.

02:06:41.700 | So I'll be honest with you.

02:06:44.380 | I grapple.

02:06:45.220 | If I were in a school and I saw a teenager

02:06:48.180 | taking a fentanyl test strip,

02:06:50.400 | which probably means that they're going to use it

02:06:51.940 | for themselves, is the first thing I want to do,

02:06:54.300 | shake the kid and say, are you crazy?

02:06:56.340 | Don't.

02:06:57.260 | That means that you're thinking about using drugs.

02:06:59.300 | Of course, that's my inclination as a parent,

02:07:01.820 | as a scientist, as a developmental psychologist,

02:07:04.440 | as a human being, you want to say, what are you doing?

02:07:08.380 | So yes, I would grapple.

02:07:10.540 | But at the same time, if I know that there's a chance

02:07:13.900 | that a teen's gonna go to a party or pick up a drug

02:07:16.620 | and not know, would I rather that they're safe?

02:07:20.140 | Yes.

02:07:21.300 | The problem with fentanyl test strips though

02:07:23.420 | is that they're not perfect.

02:07:26.420 | If you are testing the right side of the pill,

02:07:29.300 | but it's the left side that has fentanyl,

02:07:31.780 | you still could die.

02:07:33.020 | And so I don't want to give the impression

02:07:36.060 | that one stop is going to fix anything right now.

02:07:41.060 | It is not.

02:07:42.740 | And that is the issue with the comprehensive

02:07:45.580 | drug education or harm reduction conversations.

02:07:49.000 | I'm not saying that it's perfect.

02:07:50.840 | I'm not saying that it's going to stop young people

02:07:54.300 | from engaging or young people from getting hurt

02:07:57.400 | or unfortunately dying.

02:08:00.620 | But if you have a group of youth who are going to use,

02:08:03.140 | I would still rather arm them with that information

02:08:06.780 | so they don't find themselves in trouble.

02:08:09.340 | That is the biggest part that scares me.

02:08:11.380 | - Is fentanyl making its way into all pharmaceuticals?

02:08:15.820 | Like benzos, MDMA.

02:08:20.620 | I'm thinking about some of the things

02:08:21.540 | that are taken recreationally.

02:08:23.700 | Benzos, MDMA, is it in cannabis?

02:08:27.620 | - So most of what I've seen is either by itself fentanyl

02:08:31.420 | using or that it's mixed into pain pills a lot.

02:08:36.420 | - Why would kids want to take pain pills?

02:08:38.020 | I mean-

02:08:38.860 | - They're in pain, they're stressed.

02:08:40.060 | - I see.

02:08:40.900 | So they're doing it sort of self-directed clinical.

02:08:43.880 | - Correct.

02:08:44.720 | Or Prozac, they're anxious.

02:08:46.340 | - I see.

02:08:47.160 | So it's not like they're doing it

02:08:48.000 | for recreational drug use at parties.

02:08:49.340 | - Some are, some aren't.

02:08:51.100 | I mean, there's been so many different circumstances.

02:08:53.980 | Cannabis and vaping have been interesting debates.

02:08:58.580 | And we actually had this just the other day.

02:09:01.300 | Some of the studies suggest that biologically,

02:09:06.300 | we can't necessarily combine cannabis or nicotine

02:09:09.820 | and fentanyl and have the same reaction on the body.

02:09:12.660 | And some suggesting that the studies haven't been there.

02:09:15.720 | And it's still so new,

02:09:18.260 | but I will tell you that talking to teens

02:09:21.500 | and some studies suggesting that yes,

02:09:24.200 | teens are combining or at least getting.

02:09:26.700 | And a lot of times it's not knowingly.

02:09:28.540 | It's cut, the fentanyl is cutting.

02:09:30.580 | Or the drug manufacturers and sellers

02:09:34.580 | are cutting a drug with fentanyl.

02:09:36.540 | And so they're not even, teens are knowing it.

02:09:38.940 | But that some, I was talking to a person the other day

02:09:42.580 | who said that he has definitely heard of

02:09:45.240 | and seen some teens with fentanyl overdoses

02:09:48.560 | from cannabis or from vaping.

02:09:50.920 | So there's so much studies that are still needed right now

02:09:54.140 | and to understand the biological mechanism

02:09:56.860 | as well as the access to these drugs that we don't know.

02:10:00.480 | But I'm nervous.

02:10:02.240 | So we teach about drug testing.

02:10:04.300 | We teach about not going something off.

02:10:06.420 | It used to be a skittle drug parties.

02:10:10.180 | You'd go with people would take drugs

02:10:12.300 | and all different things and put them in the middle of a bowl

02:10:15.580 | in the middle of the room and just you take whatever.

02:10:18.060 | - Whoa.

02:10:18.900 | - Oh yeah.

02:10:19.740 | - When was that?

02:10:20.560 | - This is not long ago.

02:10:21.400 | Maybe five, 10 years ago,

02:10:22.240 | I was hearing about these skittle parties.

02:10:23.080 | - I never went to a party like that.

02:10:25.420 | - I didn't either, but I didn't go to many parties.

02:10:27.540 | I was a pretty square kid.

02:10:30.220 | - It's interesting.

02:10:31.300 | Maybe it was just, or it was.

02:10:32.780 | I mean, there were certainly drugs around,

02:10:34.620 | but I feel like now recreational pharmacology,

02:10:39.020 | it sounds like it's everywhere.

02:10:40.260 | So different.

02:10:41.260 | - Yeah, and self-medication is everywhere.

02:10:44.500 | - That wasn't common.

02:10:46.260 | - That wasn't as common.

02:10:47.620 | - Or if it was, people weren't talking about it.

02:10:50.220 | - I think it was.

02:10:51.060 | I mean, I remember as a middle school student

02:10:52.980 | walking into the bathroom and somebody had taken,

02:10:55.140 | I think what's called a lewd then and had passed out.

02:10:58.360 | It was certainly around, different drugs,

02:11:02.780 | but not the same that we're seeing now.

02:11:05.100 | And we definitely saw cocaine overdoses when I was younger.

02:11:08.740 | - Yeah, I feel like there was a lot of weed, cannabis,

02:11:12.900 | that is alcohol, psilocybin then as a recreational drug.

02:11:17.900 | Now, obviously it's being explored as a clinical tool,

02:11:21.580 | as is cannabis for that matter.

02:11:23.260 | But hard drugs like cocaine, amphetamine,

02:11:29.540 | PCP were discussed in the media a lot,

02:11:32.940 | and it certainly existed in some high schools and colleges

02:11:35.340 | and things like that,

02:11:36.160 | but it sounds like it's seeping out of everywhere.

02:11:39.260 | - It is.

02:11:40.100 | - And it's in these commercial products.

02:11:41.820 | I mean, I think the picture that has been created here

02:11:43.900 | is kind of an ominous one.

02:11:46.380 | So how optimistic are you?

02:11:49.420 | - I will tell you, I'm optimistic in seeing a change

02:11:53.820 | in the landscape of education.

02:11:56.300 | Now, some people say education doesn't work,

02:11:58.020 | that we need policies, we need both.

02:12:00.580 | I mean, we have federal policies and regulations

02:12:03.420 | that are slipping through the cracks,

02:12:05.380 | FDA with regulation of e-cigarettes,

02:12:09.300 | with cannabis legalization, but not being enforced.

02:12:13.780 | We have age restrictions not being enforced.

02:12:17.320 | So we certainly need education,

02:12:18.740 | and I'm seeing more and more people,

02:12:20.340 | for example, the concept of harm reduction

02:12:23.460 | or comprehensive education, comprehensive sex ed,

02:12:26.220 | not everybody's, of course, up for it or open to it,

02:12:29.160 | but I'm seeing more of a shift

02:12:30.580 | towards understanding the need.

02:12:32.340 | I'm definitely seeing more teens,

02:12:34.180 | as we were talking about earlier,

02:12:35.340 | more teens being willing to say,

02:12:38.260 | "No, that's not something I'm gonna do."

02:12:40.620 | More teens joining youth groups,

02:12:42.620 | more teens speaking out about concerns

02:12:46.140 | and trying to be healthier

02:12:47.460 | and make healthier decisions for themselves.

02:12:49.860 | So I'm optimistic in the human capital

02:12:52.340 | and the social capital.

02:12:54.060 | I'm not optimistic when it comes to the pharmacology

02:12:57.100 | or the drug capital, so to speak.

02:13:00.260 | More and more drugs infiltrating our youth.

02:13:04.140 | I mean, you could vape dot, dot, dot anything nowadays,

02:13:07.420 | and that makes me very nervous.

02:13:09.220 | I do think vaping, and I am using vaping

02:13:11.940 | instead of e-cigarettes there to be more lay,

02:13:14.100 | conversations there or what the culture is saying.

02:13:17.620 | Vaping is just more normalized than we've ever had it,

02:13:22.100 | just like smoking was normalized.

02:13:24.580 | Vaping, and now vaping anything,

02:13:27.140 | is very scary to me and very much normalized.

02:13:29.780 | So that worries me.

02:13:31.540 | Again, the fentanyl, the hallucinogens

02:13:33.940 | making its way more and more.

02:13:36.660 | So the drugs themselves and the new devices scares me.

02:13:41.540 | The social and the human capital gives me optimism.

02:13:45.420 | - Very grateful to hear that you have optimism.

02:13:47.780 | Sounds to me, and correct me where I'm wrong, please,

02:13:50.940 | and add anything, that for parents, for siblings,

02:13:54.580 | for teachers, for educators, or for any concerned citizen,

02:13:58.140 | it seems like having conversations about these things,

02:14:01.580 | the fact that they're happening,

02:14:03.140 | so not turning a blind eye,

02:14:05.100 | the fact that kids are aware of it,

02:14:11.060 | that we're fooling ourselves

02:14:12.220 | if we think that they aren't aware

02:14:13.460 | of these risk-taking behaviors,

02:14:14.980 | they're sort of, they're all around them anyway,

02:14:18.740 | so we shouldn't shy away from those conversations,

02:14:21.060 | and that at least having a conversation

02:14:23.380 | about the difference between avoiding behaviors

02:14:26.340 | and harm reduction is something that one ought to consider.

02:14:29.500 | I mean, obviously, this is a household by household choice.

02:14:32.420 | - Absolutely.

02:14:33.340 | - In some cases, school by school

02:14:34.660 | or classroom by classroom choice,

02:14:35.900 | but certainly household, maybe even parent by parent choice,

02:14:39.000 | but that because of social media

02:14:41.080 | and just because of the nature of youth

02:14:43.000 | that young people are having these conversations anyway.

02:14:46.160 | That's what I'm hearing coming through,

02:14:47.840 | and that you said, don't formalize the conversation so much

02:14:52.180 | that Saturday at three o'clock,

02:14:53.560 | we're gonna have a discussion about drugs,

02:14:55.240 | but make it part of the landscape to create some ease,

02:14:58.080 | make it facile to talk about these things, concerns,

02:15:03.840 | and probably listen to them too.

02:15:05.720 | They're right there in the midst of it,

02:15:08.200 | so they have a dataset internally

02:15:09.960 | about what's actually happening.

02:15:12.560 | - Totally agree, totally agree.

02:15:15.440 | And I often say to parents or educators,

02:15:18.360 | if they're listening to this podcast or anything,

02:15:21.560 | it's actually say, hey, I learned something.

02:15:24.920 | Can we have a conversation about what I learned?

02:15:28.560 | And not confront.

02:15:30.240 | Again, it's a conversation, not a confrontation.

02:15:33.320 | It's let's normalize drug discussions,

02:15:36.200 | let's normalize behavior discussions,

02:15:39.800 | not normalize the use or the behavior itself.

02:15:42.920 | So talk to your teens, you're absolutely right.

02:15:46.040 | Talk to your teens.

02:15:47.120 | This is what I just learned.

02:15:48.640 | What do you know?

02:15:49.740 | Can we find out some information together?

02:15:52.320 | Go on our Reach Lab websites, go on other websites,

02:15:56.680 | go learn information out there, learn together,

02:15:59.920 | and not lecture, but have a conversation.

02:16:03.460 | You may not know right away.

02:16:04.840 | A teen may not tell you right away,

02:16:06.440 | yes, I'm using, or yes, I'm having sex,

02:16:08.480 | or yes, I'm drinking alcohol, or yes, I'm doing something.

02:16:10.880 | That is just a risky behavior.

02:16:13.880 | But that's not necessarily our goal as adults

02:16:16.240 | to find out today whether or not

02:16:18.600 | somebody is doing something.

02:16:20.480 | It's okay to let it be a little bit more organic.

02:16:23.240 | It's okay to start that conversation

02:16:26.240 | and see that you're building trust.

02:16:28.940 | It is parent to parent,

02:16:30.400 | but I would say I'm not gonna bust you.

02:16:32.680 | Certainly I'm not gonna be happy,

02:16:34.320 | but let's have a conversation

02:16:35.640 | so that way we can build the trust,

02:16:37.120 | and I can help you either not use, get help,

02:16:41.680 | stop using, or be safer in using,

02:16:44.520 | or help you prevent from using at all.

02:16:46.800 | So having that conversation, that organic,

02:16:49.400 | and talking to teens where they're at.

02:16:52.040 | As a developmentalist, that's what we do.

02:16:53.960 | Meet people where they're at.

02:16:56.040 | Meet youth where they're at,

02:16:57.400 | whether that's using already, not using.

02:17:00.600 | Don't come at them with your preconceived notions

02:17:02.760 | as an adult because it will not work.

02:17:05.720 | It will backfire.

02:17:07.320 | We need to use the strengths.

02:17:08.800 | Young people are strong.

02:17:10.320 | Young people are smart.

02:17:12.000 | We need to use their strengths, take their lead,

02:17:14.960 | and then use our adult wisdom and experiences

02:17:17.440 | to then turn that into the proper conversation.

02:17:20.400 | - Love it.

02:17:21.400 | Well, on the topic of conversation and communication,

02:17:24.880 | one of the kind of unique features of this podcast

02:17:27.940 | is that we have a large social media footprint,

02:17:32.440 | and inside of that footprint,

02:17:34.520 | we not only broadcast information,

02:17:36.600 | but we get information back.

02:17:37.900 | So in anticipation of this conversation today,

02:17:41.240 | I reached out to followers of Huberman Lab Social Media

02:17:45.240 | on X, formerly known as Twitter, and Instagram,

02:17:48.520 | and they had a lot of questions for you.

02:17:50.460 | We don't have time to go into the many thousands

02:17:52.520 | of questions, but I'm gonna just ask you, if I may,

02:17:55.960 | in kind of a short Q&A format, a few of them,

02:17:59.100 | and if you don't have answers, you can just say pass,

02:18:01.120 | we'll get back to that, maybe we'll do another episode

02:18:03.400 | another time.

02:18:04.560 | Please don't feel obligated to give thorough answers.

02:18:08.780 | This is, we just wouldn't have time.

02:18:10.960 | Yeah, so one of the top questions is,

02:18:13.580 | "Would love to learn more about how to get teens

02:18:17.840 | "to see the longer-term implications of the choices they make

02:18:21.240 | "and the habits they form now.

02:18:23.400 | "Is there any way to get them to understand

02:18:26.520 | "how now leads to later?"

02:18:29.680 | We've done studies where we've asked teens

02:18:32.000 | about their goals, and I wanna be a dancer,

02:18:35.800 | we had one teen tell us, or I wanna be a doctor,

02:18:38.800 | or I want to be whatever it is.

02:18:41.640 | Asking teens about their goals, about their aspirations,

02:18:45.640 | and then connecting their current behavior

02:18:48.520 | and their current risks, and keeping themselves healthy,

02:18:52.240 | and how that plays into their goals.

02:18:54.780 | That tends to work a lot, and we've seen that

02:18:57.240 | in our studies, teens set boundaries.

02:19:00.000 | I don't wanna get pregnant 'cause I wanna be a dancer,

02:19:02.760 | things like that, so really linking what they're doing now

02:19:06.200 | to their ultimate goals is one way

02:19:08.320 | to really help them think that through.

02:19:10.320 | - I like that, how a different, maybe even larger goal,

02:19:14.100 | maybe could supersede these short-term behaviors,

02:19:19.920 | and they could see how those things link up.

02:19:21.680 | - Absolutely. - That's great.

02:19:23.840 | There's another question that came in,

02:19:26.480 | requesting some positive news about teenagers to be shared.

02:19:30.480 | Quote, every discussion is around risk or emotional distress

02:19:33.000 | or social anxiety or phone addiction,

02:19:35.440 | as if they're all dysfunctional because of their brains.

02:19:37.800 | We never dismiss toddlers learning to talk and walk

02:19:40.280 | because their brains are offline.

02:19:41.760 | So I think the point is that, you know,

02:19:44.200 | can we highlight some of the ways

02:19:45.560 | in which the adolescent/teen brain is exceptional

02:19:50.400 | at something that perhaps the rest

02:19:52.160 | of the brains out there are not?

02:19:54.580 | - So I mentioned some of them around our youth group

02:19:57.180 | and about the youth movement now against drugs

02:20:00.160 | and other things.

02:20:01.240 | I think, and it comes to the optimism,

02:20:03.540 | I'm the biggest teen advocate out there.

02:20:06.880 | It's why I study adolescents and I do the prevention

02:20:09.520 | and advocacy work that I do.

02:20:11.680 | Teenagers are fundamentally fantastic.

02:20:15.840 | They're creative, they're passionate.

02:20:19.040 | Teens care about the environment.

02:20:20.920 | Kids really, teens really care about social justice.

02:20:25.340 | Teens do care about our future and our planet.

02:20:28.780 | That is wonderful, well more than do adults right now.

02:20:33.600 | So I think we should be capitalizing on that.

02:20:36.240 | Teens are incredibly creative.

02:20:38.220 | We need to be working with teens and young adults

02:20:41.760 | in everything that we do because they are our future.

02:20:45.420 | And I don't mean that as a cliche, I really mean that.

02:20:48.500 | So having the conversation, let them be part

02:20:51.340 | of that conversation, help them find out what they think

02:20:55.500 | we should do to solve some of the problems.

02:20:57.740 | They're the ones to talk to.

02:20:59.180 | So I am very optimistic about teenagers.

02:21:01.860 | We have 40 teenagers and young adults who work with us

02:21:05.260 | all the time in our work because we trust them.

02:21:08.380 | So I think some people are afraid of teens, I embrace them.

02:21:11.900 | I think they're fantastic.

02:21:13.740 | - Love it.

02:21:15.240 | Do we know how vaping shapes the teen brain?

02:21:17.600 | In other words, are there any known biological changes

02:21:20.540 | in the developing brain as a consequence of vaping?

02:21:23.840 | And here I'm going to assume it's vaping nicotine,

02:21:26.060 | but we talked about cannabis as it relates

02:21:29.700 | to psychosis earlier.

02:21:31.980 | So let's just keep it restricted to nicotine.

02:21:34.780 | - Sure, well we know that during the adolescence

02:21:38.180 | that nicotine changes the brain wiring.

02:21:41.020 | And what do I mean by that?

02:21:42.320 | We're actually born with the nicotinic receptors.

02:21:44.620 | We're born with the ability to become addicted to nicotine.

02:21:47.340 | Same thing with the cannabis you were talking about before.

02:21:50.780 | So if we don't, during the adolescent time

02:21:54.060 | when we're pruning away and getting rid of the connections,

02:21:58.260 | the neurons that we don't need,

02:22:00.260 | what happens is during that process,

02:22:03.100 | anything that we don't use,

02:22:04.260 | that we don't reinforce goes away.

02:22:06.460 | Well, if we introduce nicotine into our brain,

02:22:09.180 | it solidifies, it keeps that receptor there

02:22:12.460 | and also makes it to where our receptor is really kind of,

02:22:15.460 | I think of it as like keys and locks in a key

02:22:18.980 | and suddenly you've got that receptor and it says,

02:22:21.420 | ooh, you're putting nicotine in there,

02:22:23.300 | keep that in there or cups.

02:22:25.260 | It's developing those cups I often think about

02:22:28.260 | and filling those cups with nicotine

02:22:30.260 | and those cups are your receptors that were already there.

02:22:32.940 | You then take away that nicotine and your cups say,

02:22:35.780 | I need more.

02:22:37.180 | So you're rewiring your brain,

02:22:38.980 | you're wiring your brain to be more likely

02:22:40.860 | to become addicted and now you're addicted

02:22:43.740 | and you need to keep feeding those cups with nicotine

02:22:47.740 | or you're gonna go through withdrawal.

02:22:49.340 | And so that is what is happening during an adolescent

02:22:52.580 | and young adult that we don't see in adults.

02:22:55.620 | That's why we really want to keep young people

02:22:57.740 | away from nicotine as long as possible.

02:23:00.540 | - A lot of questions about,

02:23:02.140 | are there negative effects of pornography

02:23:05.300 | on the developing brain?

02:23:06.980 | I imagine there's a lot of literature on that.

02:23:08.620 | - Yeah, I don't know as much actually

02:23:10.460 | in the developing brain, I'm sure there is.

02:23:12.980 | I don't know it, there is,

02:23:14.660 | but there's clear evidence about viewing pornography

02:23:18.660 | around just not having good healthy sexual relationships

02:23:21.940 | because porn is not normal.

02:23:24.060 | It is not a normal relationship between two people.

02:23:27.860 | What you are doing is really making it so that way you,

02:23:31.020 | you're not necessarily developing a healthy relationship

02:23:34.900 | with your partner because you're assuming

02:23:37.100 | some gold standard out there

02:23:39.100 | that may or may not be able to be achieved.

02:23:41.340 | So, and it also is also a problem with body shaming

02:23:45.860 | and the body types that most people don't have

02:23:48.620 | and can't achieve.

02:23:49.620 | And that's another problem out there with pornography.

02:23:54.620 | - A lot of questions about how social media

02:23:57.020 | impacts brain development.

02:23:58.380 | That's probably an entire episode unto itself.

02:24:00.460 | - It is, it is, that we could do another time.

02:24:02.740 | - And we should, and if you'd be so gracious

02:24:05.380 | to come back and do that, we will.

02:24:07.340 | I think as of just a final question,

02:24:10.940 | is there any information about potential causality

02:24:14.740 | between the mental health crisis that we observe in youth

02:24:18.460 | and let's just say substance use

02:24:21.340 | of the sorts that we talked about today?

02:24:25.540 | Obviously the directionality is tricky there.

02:24:27.820 | You can imagine that a lot of high GCC cannabis use

02:24:30.580 | is leading to more psychosis,

02:24:31.700 | but it seems more likely that kids are self-medicating

02:24:35.420 | in the face of like immense challenge,

02:24:37.860 | not just lockdowns and the culture around isolating kids

02:24:42.420 | from other kids and the stress that was on everybody,

02:24:46.160 | stress generally, the sociopolitical landscape, social media.

02:24:51.540 | I mean, it's hard to not feel like it's at least a cloudier,

02:24:56.140 | maybe a darker time than it used to be, but I don't know.

02:24:58.940 | I mean, humans have evolved through a lot.

02:25:01.520 | And I don't know that it's also fair to say

02:25:05.180 | that everyone's bummed out about what they see.

02:25:08.060 | Presumably there's still some optimists out there.

02:25:11.020 | - So absolutely, there are plenty of studies

02:25:15.540 | that show the bidirectional relationship

02:25:18.100 | between anxiety, depression, mental health,

02:25:20.520 | and substance use.

02:25:21.780 | You're right, a lot of teens are self-medicating

02:25:25.140 | by using various substances to reduce their anxiety,

02:25:28.620 | reduce their stress, and also just social lubrication,

02:25:32.220 | right, of going into a party and pre-gaming

02:25:34.900 | or going into a party and using drugs

02:25:36.620 | to make themselves less stiff,

02:25:38.980 | less stressed during that situation.

02:25:41.700 | But more what we're talking about

02:25:43.020 | is that they're self-medicating

02:25:44.140 | because they're feeling sad or uncomfortable,

02:25:46.420 | and this is, they think helping them.

02:25:48.260 | Again, it's not helping, it's making them feel less bad

02:25:50.900 | by continuing to use.

02:25:52.740 | But we also do know that drugs also lead

02:25:55.260 | to suicidal ideations, suicide attempts,

02:25:58.980 | psychosis, and other mental health issues.

02:26:01.420 | We also know that drugs lead to reduced academic achievement

02:26:04.780 | even though there's some potential

02:26:09.100 | cognitive reinforcement that's going on,

02:26:11.660 | there's also some issues with lack of concentration.

02:26:14.640 | The other piece, by the way,

02:26:16.580 | that we don't really talk about a lot,

02:26:17.900 | but it's the co-use, that we're seeing a lot of teens

02:26:20.900 | not just using multiple products, but using them together.

02:26:24.400 | So a lot of teens who are chasing cannabis and tobacco

02:26:27.980 | because it enhances the high,

02:26:29.620 | or they're using cannabis with alcohol

02:26:32.180 | and other mixing of drugs, which is enhancing the high,

02:26:36.380 | but not in a good way and very scary for young people.

02:26:40.100 | And a lot of times, young people don't even realize,

02:26:42.420 | like with blunts, which is truly, as I was saying before,

02:26:45.500 | using nicotine and cannabis together,

02:26:48.040 | that you're actually becoming addicted

02:26:49.460 | to both products really simultaneously.

02:26:53.060 | And that we're seeing young people

02:26:54.860 | who are having mental health issues and depression

02:26:57.740 | were likely to use both products.

02:27:00.120 | So definitely linkages there amongst mental health issues

02:27:04.780 | and multiple products as well.

02:27:06.740 | - So polypharmacology.

02:27:08.500 | - Yeah.

02:27:09.340 | - Well, I don't wanna end on a down note,

02:27:12.620 | but I don't think it's a down note.

02:27:14.520 | I think what you've done today in sharing with us

02:27:18.180 | that the realistic landscape of what's happening out there

02:27:21.380 | and the realistic landscape of what you're trying to do

02:27:24.380 | to ameliorate these issues is nothing short of spectacular,

02:27:29.380 | meaning as cloudy as it may seem in our youth,

02:27:34.820 | there's also great hope in everything that you're conveying,

02:27:40.580 | which is, to put it simply,

02:27:43.940 | why would you be trying so hard to fix these problems

02:27:47.500 | if you didn't believe that they could be fixed?

02:27:49.920 | So I find great optimism in the message.

02:27:52.740 | I also, I like data.

02:27:54.900 | And you've shared with us a tremendous amount of data

02:27:58.460 | about what's happening, what likely needs to change,

02:28:03.300 | and the optimal change and optimal route to change,

02:28:07.500 | as well as some realistic, perhaps less than optimal,

02:28:11.620 | but realistic approaches.

02:28:12.800 | Like sometimes it's just a matter of harm reduction.

02:28:15.180 | We're not gonna eliminate

02:28:16.180 | these potentially dangerous behaviors or dangerous behaviors.

02:28:20.180 | So for all of that, I wanna say thank you.

02:28:22.580 | It's a tremendous gift to us all.

02:28:24.540 | And I know that we have a lot of parents and kids

02:28:27.280 | and non-parents and every age and background

02:28:32.180 | that listen to this podcast.

02:28:33.380 | And what's clear to me is that it's going to be

02:28:35.580 | a community effort to try and face all this.

02:28:38.720 | And I keep hearing in the back of my mind

02:28:40.800 | this thing that you've said several times now,

02:28:42.740 | that kids know what's happening.

02:28:45.900 | We have to have these conversations.

02:28:47.720 | They're hard conversations to have for any of us.

02:28:51.500 | They're uncomfortable for adults to have,

02:28:53.720 | but that until we normalize at least the conversation,

02:28:58.180 | it's unlikely that we're gonna solve these problems.

02:29:00.100 | So thank you for your incredible efforts

02:29:02.260 | in the research domain and also for helping to normalize

02:29:05.980 | and bring about these conversations.

02:29:07.540 | They're oh so important.

02:29:09.140 | Thank you so much.

02:29:10.060 | - Thank you very much.

02:29:11.700 | - Thank you for joining me for today's discussion

02:29:13.580 | with Dr. Bonnie Halpern-Felscher.

02:29:15.660 | Please be sure to check out the links

02:29:17.060 | in our show note captions to Dr. Halpern-Felscher's

02:29:19.620 | laboratory and opportunity to contribute

02:29:21.820 | to the research in her laboratory

02:29:23.340 | and the zero cost resources that she has provided

02:29:25.940 | for adolescent teen and young adult health.

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02:29:58.560 | Not so much on today's episode,

02:29:59.920 | but on many previous episodes of the Huberman Lab Podcast,

02:30:02.680 | we discussed supplements.

02:30:04.020 | While supplements aren't necessary for everybody,

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02:31:11.120 | Thank you once again for joining me for today's discussion

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02:31:19.680 | (upbeat music)

02:31:22.260 | (upbeat music)

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

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