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To Vape or Not to Vape?

To Vape or Not to Vape? That is the question many youths are asking themselves. But, often they don’t know what they need to know to make that decision. Nor do their parents or teachers have the expertise to guide them in that decision process.  Let’s take a test:

1. True or False.  6 out of 10 youth believe that occasional use of E-cigarettes causes little or some harm?

2. Which of the following is a risk to youth and young adults who use nicotine?

     a. Depression, anxiety, and other mood disorders

     b. Nicotine addiction

     c. Difficulty paying attention and concentrating

     d. Reduced impulse control

     e. All of the above

3. Your brain continues to develop until what age?

     a. 12

     b. 18

     c. 22

     d. 25

     e. 30

4. Which of the following tobacco products is most commonly used by U.S. high school students?

     a. Cigarettes

     b. E-cigarettes

     c. Little cigars

     d. Hookah

5. Which of the following are reasons youth and young adults use E-cigarettes?

     a. Availability of E-cigarettes in candy, fruit, and alcohol flavors.

     b. A belief that E-cigarettes are safe

     c. Curiosity

     d. All of the above

Answer key:  1:True; 2:e; 3:d, 4:b; 5:d

Let’s answer some basic questions. When did E-cigarettes enter the market and when did its use spread to middle school, high school, and college students? E-cigarettes entered the U.S. marketplace around 2007, and since 2014 have been the most commonly used tobacco product among U.S. youth. Student use of E-cigarettes increased by 900% between 2011-2015.  In 2018, more than 3.6 million U.S. youth, including 1 in 5 high school students and 1 in 20 middle school students, used E-cigarettes.

How do people use E-cigarettes? In the twelve years since E-cigarettes entered the market, the delivery system has rapidly changed. There are e-pipes, e-cigars, large vaping devices, rechargeable e-cigarettes. They are known as e-cigs, e-hookahs, mods, vape pens. Recently a product called JUUL that looks like a USB flash drive was introduced into the market. It has become increasingly popular among youth due to its minimal exhaled aerosol, reduced odor and small size, making it easy to conceal. It experienced a 600% surge in sales during 2016-2017, giving it the most significant market share of any E-cigarette in the U.S. market.  JUUL comes in a variety of colors and flavors and can be connected to a USB port to recharge the battery for use.

What drugs can be used in E-cigarettes? All E-cigarettes contain nicotine (except as listed below). A JUUL cartridge or ‘pod’ contains about as much nicotine as a pack of 20 regular cigarettes. Most people use a ‘pod’ per day. The nicotine salts allow an unusually high level of nicotine to be inhaled more efficiently and with less irritation than the free-base nicotine in regular cigarettes. Despite this, approximately 2/3’s of JUUL users aged 15-24 do not know that JUUL always contains nicotine.  In addition to nicotine, liquid marijuana, bath salts (a synthetic drug with mood-altering and stimulant properties), Flakka or ‘gravel’ is a more potent form of bath salts, Hash Oil that contains a higher concentration of THC (ingredient in marijuana, Spice or K2 (a synthetic form of marijuana), and psychedelics like DMT that gives hallucinations like LSD can be used in E-Cigarettes.

Why do people use E-cigarettes? They were initially introduced for adults to use to quit smoking regular cigarettes. It works for some adults, but a majority use both E-cigarettes and regular cigarettes depending on where they are. In surveys of youth, they use E-cigarettes for curiosity and wonder what it would be like to use them. Some use it because you can get ‘super buzzed’ off of it. The advertisements for E-cigarettes are not regulated and contain all of the same tactics the regular tobacco companies used for years. E-cigarette packaging and design come in bright colors with flavors like fruit, candy, and alcohol. Many advertisements include sexuality and popularity in their content to appeal to youth. Nine of ten youth who use E-cigarettes used flavors as their choice of product. There is also the belief that E-cigarettes cause little or no harm.  3 of 5 youth think they cause little damage. And, 1 of 5 youth thinks they cause no harm.

The truth is, they do cause harm. Flavoring chemicals in E-cigarettes may induce genetic changes in the bronchial epithelial cells. In test-tube experiments, hundreds of genetic variations were induced in the cells impairing their ability to function correctly. All E-cigarettes contain nicotine. And, it is easier to become addicted to it since the adverse effects of smoking, like smell, cough, and nausea, are not present with the aerosol form of nicotine. The nicotine and other chemicals affect the way the brain develops, leading to impacts on learning, memory, and attention. It also leads to increased risk for future addiction to other drugs. There is moderate evidence that E-cigarette use increases the frequency and intensity of regular cigarette smoking in the future. The aerosol also includes harmful substances, including heavy metals, volatile organic compounds, and ultrafine particles that can be inhaled deeply into the lungs. E-cigarette products have also been found to be contaminated with bacterial and fungal toxins. There is emerging evidence that E-cigarettes can lead to alcohol and other drug use and dependence.

So, despite the risks, who uses E-cigarettes? Since JUUL was introduced, high school students who have ‘ever’ used E-cigarettes went from 11% in 2013 to 37% in 2015. At the same time, Middle school students’ use went from 3% to 11% during the same time frame. High school students who ‘regularly’ use E-cigarettes went from 4% to 16% during those two years. Middle school students went from 1% to 4%.

Where do youth use E-cigarettes? Because of their sleek design and resemblance to USB drives, JUUL products are natural for students to conceal and use in school—sometimes even in the middle of class. They are used in restrooms and hallways because the aerosol quickly evaporates and there is minimal smell. The youth also use E-cigarettes when gathered together. YouTube videos are showing how to do tricks, like blowing rings and ‘ghosting,’ slang for exhaling a plume of vapor and quickly drawing it back in the mouth. Tips are shared about how to conceal JUULs like sleeves, hoodies, and even hollowed-out markers. There are unique Vaprwear hoodies where the device is built into what would typically be the strings of the hoodie.

To vape or not to vape. It is an important question. The surgeon general said, “I, Surgeon General of the United States Public Health Service, VADM Jerome Adams, am emphasizing the importance of protecting our children from a lifetime of nicotine addiction and associated health risks by immediately addressing the epidemic of youth e-cigarette use. The recent surge in e-cigarette use among youth, which has been fueled by new types of e-cigarettes that have recently entered the market, is a cause for great concern. We must take action now to protect the health of our nation’s young people.”

What can you do? Have a frank and open conversation with the youth around you. Give them the facts. There is an organization called ‘Catch My Breath’ that developed a ‘Youth E-cigarette and JUUL Prevention Program.’ It is a series of modules that can be used in classrooms, church groups, or families to spread this information. 7 of 8 students said they were less likely to use E-cigarettes after taking the classes.  It is designed so that it could be incorporated into health classes in the schools. Be aware: “E-cigarette use poses a significant—and avoidable—health risk to the young people in the United States.”

Establishing a Family Social Media Plan

Several weeks ago, I was talking with one of my teenage daughters while she was on her smartphone browsing her social media. I asked her how her day went at school and then she smiled and laughed about something that was posted on her social media. I mentioned to her that I didn’t think she was really listening to our conversation. Suddenly, she put her phone down and told me that in school that day one of her teachers taught her class about proper etiquette for smartphone use. This wise teacher asked a class member to come to the front so that she could ask a few questions. After asking a question, she looked down at her phone while this student answered her question. Then she put her phone down, asked this student a question, and listened intently. The class responded that they felt like their teacher was really listening to this student only after she had put her phone down. After my daughter related this experience at school with me, she put her phone down and we had a meaningful conversation, uninterrupted by social media.

As parents of 10 children who now range from 8 to 26 years of age, my wife and I have had many discussions about the appropriate use of social media within our family and our specific circumstance. As our family has grown over the past 28 years, social media has vastly expanded its influence in our society. As such, we have come to realize that having a family social media plan is essential in helping our family function. Parents have the responsibility to lead by example and model the appropriate use of social media. One important way that we can guide our children in their proper use of social media is to have a family social media plan.

Ideas to consider in a family social media plan could include the following:

I have found it beneficial to spend moments of one-on-one time with my children in simple activities that involve the use of our hands while still being able to carry on a conversation. This removes the distraction of social media on our devices, invites eye contact, and facilitates listening that has strengthened our relationships. Activities such as playing ping pong, playing basketball, swinging at the park, playing a duet on the piano, throwing a softball, doing the dishes together, preparing a family meal, or working together on household chores enables us to pull away from our devices and social media to spend time communicating and talking together.

Children can be encouraged to spend a portion of their own money to purchase their smartphone and then to pay some of the monthly costs associated with their having a phone with internet access. This can help children understand that constant access to social media involves the costs of money as well as our precious time.

Designate media-free times such as breakfast or dinner.

Place our phones down or set our computers aside when we are talking with each other.

Provide supervision such as co-viewing and time limits that work for each family’s individual needs. The American Academy of Pediatrics (AAP) recommends that parents and caregivers develop a family media plan that takes into account the health, education and entertainment needs of each child as well as the whole family. At www.HealthyChildren.org/MediaUsePlan, the AAP has prepared The Family Media Use Plan tool to assist families.

Developing and implementing a family social media plan can strengthen your family and personal relationships by setting appropriate limits for social media use. For me and my family, this endeavor has been challenging, but it has also been worth the effort.

The Myth of Social Media

Last year at about this time I wrote an article entitled “Does Your Phone Have a Bedtime?” It was about the importance of monitoring and actively limiting our children’s use of smartphones. Even more has been discovered and published on this topic since then, especially regarding the use of social media. Most of the studies have looked at young adults, but the findings are likely applicable to both the younger and older generations as well. Social media use is an area in which we can often see the problems in our children, but are blind to them in ourselves.

I’ve long called apps like Facebook, Twitter, Instagram, Snapchat, Tumblr, etc., “antisocial media.” I believe the term “social media” to be an intentional misnomer invented by the developers of these platforms. More and more, it seems like the real intent of social media outlets is to create digital dependence or addiction. The literature is now bearing this out. Some argue that they can be used to keep in touch with family members and connect with friends. But is that really keeping in touch and connecting? I would argue that social media use is an isolating experience, typically done alone, and does not generally create any meaningful interpersonal interaction, in and of itself.

It may be helpful to look more closely at the word “social” in order to make my point. Here are several definitions from Dictionary.com: (and, yes, I first looked these up on my phone)

1. relating to, devoted to, or characterized by friendly companionship or relations: a social club.
2. seeking or enjoying the companionship of others; friendly; sociable; gregarious.
3. of, relating to, connected with, or suited to polite or fashionable society: a social event.
4. living or disposed to live in companionship with others or in a community, rather than in isolation: People are social beings.
5. involved in many social activities.

Does social media use actually do anything that meets the definition of social?

Let’s examine what happens when you use social media. You pull up an app, typically on a smartphone, and scroll through numerous posts from various people, companies, institutions, and virtually all kinds of entities. You read words and look at pictures. You may like or even reply to some. The person or entity who posted may or may not see or acknowledge your reply. You may learn something through the posts, but who knows if the information presented is useful, meaningful, or even truthful? Has any real interpersonal interaction taken place? Has any connection been made? Has there been companionship? Can the most basic definition of the word social apply – the presence of more than one person?

The literature bears out that rather than creating a sense of camaraderie and connectedness, social media use tends to create a false impression of what other people’s lives are like. It often creates and/or worsens the fear of missing out (FOMO) from which most young people suffer, to begin with. It also tends to create feelings of isolation, loneliness, depression, anxiety, and even suicidal thoughts. The effect has been found to be proportional to the amount of social media use in which one engages. It is the feeling of some experts that the rise in suicidal ideation and other self-harming behaviors is due, at least in part, to the increasing prevalence of social media use in teens and young adults.

So what is to be done? I’m not advocating the puritanical approach to social media use, namely “because it can be bad, it’s all bad, and must be avoided entirely.” That is unrealistic for most teens, young adults, and even older adults at this point. Most of the guidelines and expert advice in this arena focus on two broad goals: 1) Create responsible and appropriately limited patterns of social media use; 2) Create opportunities for social interactions among families and friends. The following is far from a comprehensive list, but hopefully, these ideas will be helpful with regard to not only our children’s use of social media but also our own:

Create responsible and appropriately limited patterns of social media use

Set appropriate limits
The amount of time spent on social media is important, but the frequency with which we check social media may be an even more sensitive indicator of how dependent we are. One study indicated that young adults who used social media, even briefly, dozens of times per day, tended to feel more loneliness, anxiety, and depression. It’s a good idea to limit both total time spent on social media use and the frequency of use. Twice a day may be a reasonable frequency, once in the morning and once in the evening. And remember, the rule of “no screens in the bedroom” applies to pocket screens as well.

Don’t allow children to start too early
While there is no consensus on the minimum age to allow the use of social media, many experts suggest that at least 13 years of age make sense. Others feel that 15-16 may even be more reasonable, due to the added maturity and sense of responsibility at those ages. Regardless, it’s hard to imagine a grade-schooler being able to appropriately handle a smartphone, let alone social media. And there’s certainly no need for it at that age.

Use privacy settings and filters
While these are far from foolproof, they can certainly help to protect our children from some of the unsavory and even predatory influences they may encounter online. All accounts should be private, to the extent possible, and personal information such as addresses should never find its way onto social media platforms.

Be a friend and follower
This is a great way to keep track of our children’s social media use. And it will often affect what they post and type, knowing that mom and dad are going to see it too. If your teen refuses to friend or allow you to follow them, that should be the end of their social media use. There should be no compromise on this one.

Teach respect for others (and self)
Discuss with your children the importance of being kind and respectful to others, including online. Sometimes the appearance of anonymity, or the fact that the person being addressed is not physically present, emboldens the user of social media. A good rule of thumb is that if you wouldn’t say it out loud or to someone’s face, don’t text, tweet, post, or snap it.

Those physically present are more important than anyone on social media
There are many stories of young people sitting in a room together, each on his or her phone, and not interacting at all with each other. In essence, they’re alone together. No wonder feelings of loneliness can result from too much or too frequent social media use. We must emphasize the fact that part of common courtesy is engaging with those in our physical presence, and paying more attention to them than to the latest post or snap. Are we ever guilty of breaking this rule? That question is worth some thought.

Lead by example
As in most aspects of parenting, the attitude of “Do as I say, not as I do” will not have the desired effect when it comes to social media use. If we, as parents, are consumed by our use of social media, or even frequently distracted by it, at the expense of more important responsibilities, then why would we expect any better from our children?

Create opportunities for social interactions among family members and friends

Spend time together
Despite the busy nature of modern life, we must carve out time for meaningful social interaction. Whether it’s walking, playing games, golfing, hiking, camping, sports, or just riding together in the car, many activities lend themselves to conversations with our children. Most of us can do far better in our efforts to schedule the activities which help us to interact and connect.

Return to the family table
For years now, many experts have called for a return to the family table. This is for a variety of reasons, but one of the more important ones is that it is often around the dinner table that we can feel a sense of connectedness, talk and laugh together, and meaningfully communicate about our lives. Social graces and good manners are also learned in this often neglected or overlooked setting. Whenever possible, eat dinner together as a family, and ensure that far more than just eating takes place as you do so.

Encourage in-person communication
With modern digital technology has come the ability to communicate with nearly anyone, anywhere, at any time, without ever saying a word. What an amazing thing! However, if that is the only way a young person communicates, he or she may not feel very comfortable talking with others, even peers. The important subtleties of nonverbal cues, facial expressions, eye contact, and tone of voice can only be mastered and understood through the practice of in-person verbal communication. We must make sure our children are spending time with others, and actually talking together, not just playing on their phones.

Talk to them, and let them know you care
Consider the past 24 hours, and think of how much time you spent talking to your pre-teen or teenage son or daughter. Now think of how much time you spent on any type of social media or electronic device. Is there a problem? For most parents, the scales are tipped heavily in favor of the electronics. Granted, for many, this is by necessity. But nearly all parents can determine to simply talk more to their children. This is a great way to show our love and caring concern for them, and that we’re interested in the details of their lives. At first, it may be like trying to draw water from a stone, and our efforts will be met with silence. But with persistent effort, the ultimate payoff will be well worth it. Remember, they won’t care how much you know unless they know how much you care. And they won’t know unless you tell them, with actual words, coming from your mouth.

Finally, there are numerous resources available to help in creating a family media plan, including rules about social media use. Some are listed below in the references, but there are many others. The first step may be to realize that there’s a potential problem and that it may not be just with our children. Hopefully, we can convey to our children the right messages and show them a good example regarding social media use, digital courtesy, and electronic responsibility in general. In the end, it will likely be the combination of what we say and what we do that will have the greatest impact on the next generation.

References:
www.healthychildren.org/English/news/Pages/Managing-Media-We-Need-a-Plan.aspx
www.healthychildren.org/English/news/Pages/Study-Examines-Suicides-Publicized-on-Social-Media-Teens-ER-Visits-for-Suicidal-Thoughts-and.aspx
www.commonsensemedia.org/blog/practical-tips-for-easing-kids-social-media-anxiety
www.aap.org/en-us/about-the-aap/aap-press-room/aap-press-room-media-center/Pages/Texting-Social-Media-and-More.aspx
www.aap.org/en-us/about-the-aap/aap-press-room/Pages/Social-Media-and-Kids-Some-Benefits,-Some-Worries.aspx
www.aap.org/en-us/about-the-aap/aap-press-room/news-features-and-safety-tips/Pages/Talking-to-Kids-and-Teens-About-Social-Media-and-Sexting.aspx
www.healthychildren.org/English/family-life/family-dynamics/Pages/Mealtime-as-Family-Time.aspx
“Problematic social media use and depressive symptoms among U.S. young adults: A nationally-representative study,” A. Shensa, et. al.
“Use of multiple social media platforms and symptoms of depression and anxiety: A nationally-representative study among U.S. young adults,” B. Primack, et. al.
“Social Media Use and Perceived Social Isolation among Young Adults in the U.S.,” B. Primack, et. al.

School Success

With the return of the new school year, young students all across Utah County are hitting the books once more. A very common question I receive this time of year, “How do I help my child be successful in school?” I must admit if I had the perfect answer I would have likely published a New York Times Bestselling book by now and be on a lecture tour, but with that said – while every child is unique there are some things that tend to be true for all children.

Getting children ready for school starts even in the first years of life. In all the research that has been done on getting children ready for learning, the number one thing a parent can do is read with their child. I think that it is interesting that in this day and age with all of the movies, video games, and apps that are available, reading and talking with your child has the greatest effect on verbal development and school readiness. It is also important that a child sees their parents, mother, father and meaningful adults in their life read as well, as a child’s natural tendency is to model the behavior they see.

In older children, it is often important to help them develop good study habits. Things a parent can do is set aside a place in the home where a child can do their homework with minimal disruption. A consistent workspace has been shown to help decrease distractions and thus improve learning and information retention. Along with this, it is important to schedule enough time for homework and study. This is something for you and your child to consider as you pick which after school activities to participate in.

When it comes to such things as TV, smartphones, and computers it is important to know that once a person is distracted it generally takes 15 minutes and sometimes longer before they are fully re-engaged in what they were doing before. So taking time to silence phones and other distractions will make study time more efficient. Along these lines, it is important for parents to monitor internet use, for while there is wonderful and mind-expanding information to be found there, it can also be a place where unexpected dangers exist.

One topic that is often overlooked is the need for adequate sleep. It is during sleep that information we have received during the day is processed and transferred from our short term memory to long term storage. Lack of sleep is associated with lower academic achievement in middle school, high school, and college as well as higher rates of missing school altogether. In most teenagers (13-18 years of age) recommended amount of sleep is generally between 8-10 hours; in younger children, it tends to be about 1-2 hours more.

When academic struggles do occur, I encourage speaking with teachers early, as they often have the best insight into what is going on and can offer immediate recommendations that may help a child succeed. If your child continues to struggle despite your best efforts or you have concerns that your child is having learning or focusing difficulties, please contact us at Canyon View Pediatrics. We are ready to offer any assistance that we can.

If you would like to read additional tips from the American Academy of Pediatrics about going back to school, please click here.

Skin Protection – For More Fun in the Sun

Spring – a common time for sunburn

Spring is a wonderful time of year for many reasons. The days are getting longer, the winter illness season is coming to an end, and many outdoor activities are beckoning once again. However, it is also the time of year when many severe sunburns occur. There are several reasons for this:

  1. Many people’s skin is quite pale after the long winter, and more vulnerable to burn.
  2. The air is generally cooler than in the summer, so it is more difficult to feel when a burn is occurring.
  3. The sun is getting higher in the sky, so the rays are becoming more direct, and are therefore more likely to cause skin injury.
  4. Spring sports and yard work can abruptly increase the amount of time people spend outdoors.
  5. Some people are anxious to get tan after winter and try to do it all at once.
  6. While we associate many summer activities with the need for sun protection, spring activities often don’t trigger this thought.

Preventing sunburn is important

There are many health hazards associated with sunburn, the most serious is the aggressive form of skin cancer known as melanoma. Occasionally, this type of cancer is diagnosed in people in their teens. Exposure to the sun’s radiation increases the risk of genetic mutations in our skin cells which can lead to this dreaded condition.

But that’s not the only reason to avoid getting burned. These are true burns and can range from superficial first degree burns with only mild discomfort, to deep second degree burns with blistering, extreme pain, and sometimes permanent skin changes. The younger a child is when sunburn occurs, the more severe the damage is likely to be.

Another concern with sunburn is the increased risk of other heat-related injuries. Someone with a severe sunburn is more likely to suffer heat exhaustion or heat stroke, which can lead to severe illness and even death. Occasionally, sunburns can affect a large enough portion of the body to cause the serious conditions associated with other significant burns, including susceptibility to infections and temperature regulation problems.

How to protect our children (and ourselves)

As with many things relating to our health, an ounce of prevention is worth a pound of cure. We should think about sun protection every day. Here are a few specifics that may help:

  1. Sun protective clothing and hats are usually the most effective means of preventing skin injury due to the sun, especially in infants and toddlers.
  2. Sunscreen, with an SPF of at least 30, is important to use on exposed skin.
    • It should be applied about 20-30 minutes before sun exposure, sweating, or getting wet.
    • Be sure to use enough. For an adult, this might mean up to 1-2 ounces per application.
    • Reapply after getting wet, even if the sunscreen claims to be waterproof.
    • Sunscreen can be used on babies, but the time spent in the sun should be very limited in this vulnerable population.
    • Remember that sunscreen and insect repellent often don’t go well together, and may even inactivate each other. Read the labels carefully.
  3. Beware of the reflected sun, whether from snow or water or even concrete, as this can greatly increase sun exposure, especially in young ones.
  4. Pay attention to the UV index, found on most weather reports and apps, to know when the sun will be most likely to cause harm.
  5. Avoid being outside between the hours of 10:00 AM and 3:00 PM as this is when the UV index is typically highest.
  6. Wear sunglasses which block 100% of the UVA and UVB rays, because eyes can get sunburned too.
  7. Avoid the use of tanning oils and creams as these do not block the sun’s harmful rays.
  8. Never use tanning beds, especially children and teens, as this direct exposure to harmful UV rays greatly increases the risk of the problems mentioned above.

As pediatricians, we strongly encourage outdoor activities because of the many health benefits they provide. Most adults and many children would do well to spend more time out of doors. We should also focus on doing so in a safe manner, so as not to cause unintended harm. By keeping these simple ideas about sun protection in mind, we can all better enjoy this wonderful spring season and the summer which is just around the corner.

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