istockphoto.com / Yana Tikhonova

When it comes to alcohol, vaping and smoking marijuana, kids typically begin experimenting in middle school. What are the signs that your kids may be drinking or trying e-cigarettes or cannabis and how addictive and dangerous is this experimentation? We asked Laurie Herrick, Middlesex County’s Regional Chronic Disease Coalition coordinator for the Middlesex County Office of Health Services, about the short- and long-term effects of substance use, the likelihood that cancer and other chronic health conditions may develop, and how you can talk to your kids about the dangers of overuse and addiction.

New Jersey Family: When do kids generally begin trying tobacco products? And what prompts them to want to experiment?

Laurie Herrick: Usually it starts in middle school, so typically between ages 11 and 13, which is sixth to eighth grade. Some schools have reported vaping earlier in about fifth grade; some of the cutoffs for elementary schools are fourth grade so when they move to fifth grade and are with sixth or seventh graders, there are reports of fifth graders vaping or having access to products.

The reasons that kids decide to use tobacco or vaping products are to look cool, because people in their family do it, or peer pressure because their friends do it. Social media is big right now since it glamorizes smoking.

It’s a stage of independence and trying to find out who they are so they feel like “I’ll use it once” or “I’ll try it and I probably won’t do it again,” or “Maybe I won’t like it.” Then they may continue to like it. Nicotine is a highly addictive substance.

Kids may feel that if they’re having stress or anxiety smoking helps because that’s what they’re told. We know that’s not true; when you smoke, it actually accelerates your heart rate. You’re putting more pressure on your heart and different parts of your body. For kids, they feel that using a substance makes them feel better in the short term, so that’s what they do. It could be used to cover or mask what they’re feeling, and it can also lead to long-term use of tobacco, alcohol, or other drugs.

NJF: What are the signs of substance use (tobacco, vaping, alcohol, or more) parents should look out for?

LH: If you find any cigarettes in their bag, if their hair and clothes smell, if they have bad breath or stained teeth, or frequent cough and shortness of breath…that can all be attributed to cigarette smoking.

Signs of vaping are coughing or wheezing, dry mouth, and increased thirst because it’s inhaled. You may notice a sweet or strange odor, somewhat similar to perfume. Also, your child can have increased nosebleeds.

With alcohol, you may find it in their belongings, or you smell it on them. Using alcohol brings about changes in mood. Sometimes that can include anger and irritability, academic problems, or behavioral problems in school. Maybe your teen is trying to rebel a little more. You notice maybe a little more talking back or not engaging with you as they used to, changing groups of friends, losing interest in activities, or maybe their appearance. It also causes speech and coordination problems.

Sometimes rebellious or irritable behavior can be a healthy and normal part of being a teenager. When these behaviors seem extreme or out of character for your teen, this may be a good time to check in with them and provide an open dialogue that is supportive.

It is important to be aware that e-cigarettes come in many sizes and shapes and some that are commonly used by youth can look like pens, highlighters, USB flash drives, and other commonly used school supplies. They have a very discreet look, but these products need to be charged so if you suspect your teen may be vaping, look for items that have buttons, lights or need to be on a charging device.

NJF: We know smoking is linked with lung cancer. What other diseases are linked to smoking?

LH: Besides lung cancer, tobacco use is a known risk factor for many diseases including many other cancers, heart disease, stroke, diabetes, and COPD. It also increases the risk for cancers of the mouth, the larynx, esophagus, kidney, cervix, liver, bladder, pancreas, stomach, colon, rectum, and even breast cancer.

Tobacco use is the leading cause of preventable death in the United States. Tobacco smoke is made of more than 7,000 chemicals. There are so many different types of carcinogens (cancer-causing chemicals) in smoking. Some substances are nicotine, tar, carbon monoxide, formaldehyde, lead, ammonia, and that’s just a few.

NJF: Vaping has spiked in popularity among teens. When are kids or teens typically exposed and how early do they begin experimenting with vaping?

LH: E-cigarettes are the top product currently used among high school students. Although the State of New Jersey banned all flavored e-cigarettes in 2020 for all ages, young people still have access to them.

The New Jersey Youth Tobacco Survey said that about one-third of kids who vape said they were able to purchase e-cigarettes themselves by going to a gas station, convenience store or vaping tobacco shop. About another third of kids say they get it from their friends. We also know that they have access to them through online retailers. Access is a problem, and 76 percent of students who vape say they use disposable products; usually they’re referred to as Lava and Flair. They’re cheap and marketing companies realize that it’s easier for the kids to have something that’s disposable. They go to the store, buy it, use it, and then throw it out.

The products are colorful with fun flavors and names that are very attractive to kids, like cotton candy. They look like a juice box or a highlighter or a little USB drive. Sixty-four percent of kids who vape say they use fruit flavors.

NJF: Many kids believe vaping is not as dangerous as smoking. How would you address this?

LH: These vaping products are harmful. Unfortunately, many kids don’t understand the risks associated with vaping. They think it’s just water vapor and flavoring or that the product they bought says it doesn’t contain nicotine. That’s not true, because most of the ones that are tested that say no nicotine have nicotine.

The FDA didn’t really regulate it because it was seen as part of smoking cessation. But now that they’ve seen the harmful effects and know that it’s being marketed toward young people. They’ve started to review more about what’s in them, what the actual ingredients are, and what is being listed on the packaging.

Because the FDA does not regulate vapes, there is limited testing of them currently. We don’t know if what they put on the label is completely true. Independent agencies have purchased products, sent them out to test, and they almost always contain nicotine. One flavoring is called diacetyl, which is a chemical linked to serious lung disease; and heavy metals such as nickel, tin, and lead.

Other issues with e-cigarettes can be that they overheat, explode, and can cause a fire. There have been instances where devices have exploded, while in someone’s pocket, or it’s in their hand and they’re using it and it causes burns.

Also, for both tobacco and vaping, nicotine has harmful effects on the brain. We believe the adolescent brain is developing until age 25. Using any type of nicotine can harm parts of the brain that look at controlling attention, learning, mood, and impulse control. By using these products, young people are starting to change the makeup of their brains, and that can affect their learning and development.

The poison hotline has seen an increase in calls due to young people 5 and younger getting a hold of these products and thinking that, due to the marketing, it’s a juice box or something they can eat. The same goes for pets. The chemicals can affect your breathing if you absorb them through your hands or your eyes if you’re able to get it open and get to the liquid.

NJF: What is the connection between vaping and cancer?

LH: Scientists and researchers are still learning about the long-term health effects of e-cigarettes when it comes to cancer. The FDA does not currently require testing and most products don’t list all of the harmful or potentially harmful substances. Some products are also labeled incorrectly. We do, however, know that the products the aerosol vapors give off contain carcinogens, such as formaldehyde. We’re seeing some of the same possible risks as with people who smoke because the same chemicals are used.

ScreenNJ is a statewide service the provides education about cancer prevention and detection to the community and for professionals. ScreenNJ supports NJ residents to obtain cancer screening through navigation and mobile health services regardless of ability to pay. For more information about ScreenNJ visit screennj.org.

NJF: Is smoking marijuana safer than using tobacco products?

LH: Since it’s still illegal at the federal level, it’s really challenging for scientists to be able to study. At this time, it’s hard to look at the long-term effects of cannabis or marijuana smoking.

Tobacco smoke and marijuana smoke share many of the same carcinogens and toxins that are harmful to your lungs and cardiovascular system, so inhaling any kind of smoke is harmful to your health.

NJF: What message is most important for parents to share far as prevention and screening?

LH: The important message is prevention: if you don’t smoke, don’t start. As soon as you start, you’re causing health risks to your body. The sooner you’re able to stop, the better.

It is important to encourage your kids to talk openly about whether they are smoking or vaping, so that they can understand their own lifetime health risks. Any history of smoking or vaping, even in youth, could influence your child’s preventive care for the rest of their life. Even if they stop smoking as an adult their doctor may recommend yearly screening for lung cancer. It’s a low-dose computerized tomography (CT/ CAT Scan) test, which uses X-rays to take pictures of your lungs.

NJF: What about alcohol? What are the ages kids and teens typically start drinking? 

 LH: Alcohol is the No. 1 drug of choice for young people. Research indicates that the average first-time use of alcohol in the country as a whole is around age 11. I think in New Jersey it’s a little higher around 12 or 13.

Underage drinking is usually a behavior that attracts many adolescents because it’s glamorized in movies, TV and social media, so they’re exposed to it a lot.

As children mature, it’s natural for them to want to assert their independence and seek new challenges. Sometimes that means engaging in risky behavior, which peer pressure can play a role in. Teens are impulsive and don’t really recognize it’s possible for delayed effects on their health and behavior.

Around 2021, a study showed adolescents around age 14 who reported drinking in the past month said they were able to get it for free. Usually, they were able to obtain it from their house or their friend’s house, so usually it’s something that’s easily accessible.

Interested in learning more or getting screened but not sure where to start? Contact ScreenNJ patient navigators for free help scheduling your cancer screening regardless of your income or health insurance status. Email patientnavigation@cinj.rutgers.edu or call (833) 727-3665 or text SCREEN to 43386.

NJF: What is the link between alcohol use and cancer?

LH: Consuming alcohol increases your risk of some types of cancer: mouth and throat, esophagus, colon, liver and breast.

There are also studies that support that consuming three or more alcoholic drinks per day can increase the risk of stomach and pancreatic cancers and that excessive alcohol use can also lead to the development of some chronic diseases. Those are high blood pressure, heart disease, stroke and liver disease. Then we also look at long-term use weakening the immune system, mental health challenges, and alcohol use disorders.

Thinking about screening for yourself or someone you love? Start by talking to your primary care doctor about screening options or contact ScreenNJ, a cancer prevention, screening, and early detection program brought to you by Rutgers Cancer Institute of New Jersey, the NJ Department of Health, and healthcare and community organizations statewide. 

NJF: We know teens are prone to experimentation. What is the most effective way for parents to educate their teens? Is there such a thing as too early to have these conversations with kids?

LH: It’s never too early to start talking to your kids about tobacco and alcohol use. Kids want to hear from you. Continuing an open dialogue and encouraging them to come to you with questions, even after you’ve had a discussion, is important. You want to keep your lines of communication open.

Talk to your kids using facts. Talk about how nicotine is addictive. A lot of kids don’t think about long-term effects because they’re not really concerned about what’s going to happen to them in the future.

It’s important to be clear about your expectations. If smoking or drinking is something that as a parent you will not tolerate, you want to explain to them what the consequences of their actions will be. Be calm and be able to listen and have a safe space.

If you suspect that your child is experimenting with substances, prepare a plan before you speak to them. Talk in a very calm way and encourage them to be honest. If you have specific details, like, “I found this in your bag,” or “I found this in your room” you want to tell them because you want to be able to substantiate what you’re saying. You want to be upfront with them. Don’t leave these conversations unsaid, leaving with just a suspicion that they are doing something.

Try to learn why they have started these behaviors. How are peers influencing their choices? What kind of stress are they experiencing? Is something going on? Are they concerned about something? Are they feeling overwhelmed? Say, “We’re going to talk about this. I understand that you’re going through something or maybe there’s a reason that you …” If they say there’s a reason, say, “I want to be able to be there to help you.” If needed, seek professional help. You can ask family members, a health care provider, therapist, or school counselor for assistance if needed.

I think it’s also important to practice refusal skills with your kids. They need to be able to say no and they need to practice saying no. A lot of kids feel they need to give a reason, so their friends won’t stop liking them anymore, or they don’t want somebody to laugh at them. Role-playing is a great technique. You can tell them, “Use me as an example.” Say, “If somebody asks you if you want to vape, say, ‘No. If my mom found out, she would kill me,’ or, ‘If I got caught vaping, I’d be kicked off the team, or I wouldn’t be able to be in drama club.'” Be able to use an example and have them practice it.

You can say, “You’re going to smell. Your clothes will smell and nobody is going to want to be around you.” If they participate in sports, tell them, “Smoking or vaping can negatively affect your breathing.”

Then emphasize also making good choices. Discuss with them how getting good rest and eating healthy and exercising make your body feel good. Don’t always emphasize or talk about “Don’t smoke” or “Don’t do this.” Focus on what they can do that’s positive because they’ll get that message, too.

NJF: If your kid does get addicted, what can be done?

LH: For smoking, cessation programs may help. You can seek a counselor, coach, or medication, and there’s also nicotine replacement therapy, such as using the patch or the gum.

It’s important for adults who are trying to quit to be patient with themselves. It usually takes many attempts to quit before they’re successful. One of the biggest quick resources is the New Jersey Quitline, a free 24/7 telephone and web-based service that’s dedicated to helping New Jersey residents quit using tobacco products. It’s multilingual. There is also a “This is Quitting” program that is designed to help young people quit vaping. This program provides text message support and resources to youth ages 13 to 24. Those interested in seeking help can test VAPEFREENJ to 88709.

For alcohol, sometimes intensive outpatient rehab programs may be necessary.

If you suspect your teen is struggling with substance use that is interfering with home, school, or other parts of their life, don’t wait for an emergency. Call the statewide service, PerformCare at (877) 652-7624 to see if your child can benefit from this FREE service for all New Jersey youth regardless of income or health insurance. This phone line is available 24/7 and you do not need to be actively experiencing a crisis when you call.

NJF: If someone smoked, vaped, or drank alcohol as a teen or young adult but no longer does so, are they still at an increased risk for cancers and other chronic health conditions?

LH: As a former smoker, your risk is lower than that of a current smoker; but unfortunately, the risk of cancer remains higher than a non-smoker. Even if you’ve quit, you always have an elevated risk. Talk to your primary care provider if you are a former smoker to see if certain cancer screenings would benefit you, based on your smoking history.

If you were a former smoker, especially if you started young or smoked for a long time, your doctor may recommend that you have annual lung cancer screenings. Then for drinking, drinking excessively in early adolescence and young adulthood increases your risk of certain cancers later in life.

Laurie Herrick is currently a Health Educator/ Regional Chronic Disease Coalition Coordinator for Middlesex County Office of Health Services. The coalition implements evidence-based strategies of the NJ Comprehensive Cancer Control Plan and works to implement policy, environmental, and system change that supports and reinforces healthy behaviors, lowers the risk of chronic disease, and works towards the prevention and control of cancer. As a health educator, she focuses on the prevention of substance misuse, improving mental health, educating people with the intent of preventing the spread and contraction of disease or other health-related issues, and equipping people with information to make healthy choices. She has a Bachelor of Science in Public Health and her master’s degree in public health with a concentration in Social and Behavioral Sciences and is a Certified Health Education Specialist.