Puff, the Electronic Dragon

Tamar was happy to welcome her son Moshe home from sleepaway camp, even given the mountains of stained and pungent laundry stuffed into his duffel bag. After feeding him a much-appreciated Mommy-cooked meal, she began the process of sorting towels and pants. Suddenly a small object slipped out and landed with a clatter on the laundry room floor.

Tamar picked it up. It looked like a flash drive, the kind she used to download files when she had to use a different computer. Why would her son need a flash drive in camp? Then she looked at it more closely, and its true purpose became clear: This wasn’t a flash drive, but a vaping device. Moshe was 11 years old. What was this? Why would he be vaping?

Moshe isn’t a troubled kid, or a rebellious one. He’s simply part of a new trend of vaping among younger and younger kids. Baruch, a kollel yungerman, says that when he was a counselor in a camp five years ago, some eighth graders were thrown out for vaping. Two years later, in a different camp, the sixth graders were doing it. “It’s extremely common, and the age for doing it gets younger and younger,” says Rabbi Gross,* a mechanech in Lakewood. “It became the cool thing, the ‘in’ thing to do, and it’s easy to hide. The devices are small, and vaping doesn’t leave any traces — there’s no smell, or whatever smell there is goes away quickly.”

By comparison, Rabbi Gross says, cigarette smoking is much harder to hide. You have to go outside to smoke, and it leaves an odor on clothing and skin. Vaping, though, can be done anywhere. “The boys can vape behind a sefer in the beis medrash and no one will be the wiser,” he says.

How is it that younger and younger boys are vaping, not to mention the occasional teenage girl? How dangerous is it, and how alarmed should we be as a community? Finally, as parents and educators, what approach should we take in dealing with this trend?

Electronic cigarettes are battery-powered devices that create a vapor inhaled by the user. The liquid inside contains nicotine, flavoring, coloring, and humectants, which produce aerosols that simulate cigarette smoke. You can buy vapes that are prefilled or refillable.

“Many of the vapes come in interesting flavors that attract kids, and lead people to think vaping is ‘natural,’” says Dr. Hylton Lightman, a pediatrician in Far Rockaway. Think mango, mint, peach, or the kid-friendly bubble gum or cotton candy. “The manufacturers don’t list all the ingredients on the packaging, and sometimes label it ‘organic’ so that people think it’s healthy.” The FDA banned the use of cartridge and prefilled vaping products with kid-friendly vaping flavors in 2020, but manufacturers have found loopholes or other ways to allow them to continue marketing flavored products.

Dr. Shalom Augenbaum, substance abuse specialist at Ohel and the author of Inside-Outside Parenting (Mosaica Press), adds that vapes are marketed in ways that appeal to a tech-savvy generation. They look like flash drives or have LED lights that light up when you use them.

Curious to get a sense of the vape trade from the inside, I took a short stroll to one of the many new smoke shops near my Flatbush home (my son-in-law graciously agreed to accompany me since I felt embarrassed to walk in alone). The poster outside advertised all the major brands — JUUL, Myle, ELFBAR — and the store window displayed a variety of hookahs and vaping paraphernalia. Inside, the space was clean and spacious, not at all the seedy dive I’d anticipated. In the middle of the floor were shelves of snacks, including many boxes of kosher Danishes and snack bags from Bingo, a clear sign of a large Jewish clientele. Around the perimeter were cases displaying vaping devices, hookahs, and boxes of cigars. Behind the counter were floor-to-ceiling shelves of vaping materials: stylish, colorful, cellophane-wrapped boxes that looked like a duty-free perfume display.

The long-haired man behind the counter wasn’t terribly useful when I asked what’s popular; he shrugged and said, “Everybody has their own preferences, but ELFBAR is a brand people are buying a lot of lately.” While we spoke, a young man in a polo shirt and yarmulke came in. He matter-of-factly bought some vaping pods and proceeded to deposit the change in a tzedakah box that sat incongruously on the counter (not having seen Jews behind the counter, I didn’t think it was a Jewish business, but apparently someone persuaded the owner to keep a pushke there). I remarked to my son-in-law that the young man seemed so casual about his purchase, and he replied, “He doesn’t think he’s doing anything wrong.”

In New York and New Jersey, 21 is the legal age to purchase e-cigarettes, but it’s not a criminal offense to use them before that. Rabbi Fuchs,* a mechanech in Lakewood, says, “Kids who are 17 or 18 usually manage to buy them anyway. There’s a lot of trickle-down businesses of older kids buying the vapes for younger kids and making a profit.”

Why would an otherwise regular kid get into vaping?

Baruch remembers that when he was a ninth-grader in 2014, e-cigs became “a thing.” “The whole ninth grade was schmoozing about it,” he recalls. “At the time there were these ‘blu’ vapes that supposedly had no nicotine. A year later they started with one- or two-percent nicotine, and the boys would vape to look cool in front of the older guys.

“In beis medrash it was hard to avoid socially. There were hookah groups, and guys who vaped together.”

“Vaping is no longer a fringe, at-risk thing to do,” says Dr. Augenbaum. “You can’t even see it as a form of rebelling. Nobody calls me because they have a problem with vaping, either in my private practice or in Ohel’s Substance Abuse program. It will be mentioned in addition to other, more serious and risky issues, but it’s never the priority.”

“The kids start vaping to look cool,” Rabbi Fuchs explains, “but after a while it becomes an addiction. That addiction has two pieces. There’s the social addiction, getting addicted to the act of vaping and its calming effect, or to the activity of doing it with friends. After that there’s a real physical addiction to nicotine that kicks in.”

Rabbi Fuchs believes the yeshivah world takes a more cavalier attitude toward health compared to Modern Orthodox circles. “The more modern crowd tends to be health-conscious, so they’ll avoid anything that looks unhealthy. They’ll smoke cannabis before they vape, while the yeshivish kids will be more leery of trying marijuana.”

While most of the rebbeim I spoke to believed that vaping is a guy thing, Dr. Augenbaum says many young women are starting as well, beginning in high school (which I confirmed via an unimpeachable source, my 28-year-old daughter, who reported with distaste that she has often seen young women vaping at weddings). “Cigarette smoking was once considered unfeminine; it had a stigma as something that was inappropriate for women,” Dr. Augenbaum says. “But vaping is more discreet and seems more innocent.” There’s no offensive, lingering tobacco smell or mess from cigarette butts and ashes, and the vapes come in feminine colors and pleasant flavors.

While vaping avoids the problem of inhaling burned tobacco, the aerosol produced by e-cigarettes contains — in addition to nicotine — flavorings that have been linked to lung disease; particles from heavy metals such as nickel, tin, and lead; and other cancer-causing compounds. “Even if there’s no nicotine, the aerosol may contain lead, which causes brain damage,” Dr. Lightman says. Vaping makes asthma worse. The aerosol goes into deep portions of the alveoli and can cause lung disease.” Diacetyl, a flavoring that is nontoxic when ingested in food, is also used to flavor e-cigarettes. But when inhaled, diacetyl has been shown to cause lung damage and scarring (it was banned from e-cigarettes in the European Union in 2016).

Many young athletes find that vaping compromises their sports performance. “I like to play basketball, but when I was vaping, I found I was gasping for breath,” Baruch says. “It was a big motivator to stop.” An ABC News report in 2019 followed an 18-year-old named Simah Herman who, after two years of heavy vaping (the equivalent of a pack a day of cigarettes), went into lung failure and almost died. Her chest X-rays showed lungs clouded by particle inhalation. ABC reported six other cases of vaping-related deaths from lung failure among young people. “Vaping scars the lungs, and can leave irreversible damages,” Dr. Lightman says. “We’re seeing some effects that suggest there may be long-term effects on the heart and blood vessels as well.”

He lists other unpleasant side effects of vaping. Some people develop mouth sores or find their tongues and taste buds affected, since vaping dries out the mouth. Heavy vaping may affect fertility in men. Nicotine may yellow the teeth. The worst cases come when kids decide to “experiment.” “Kids will devise ingenious ways of abusing anything,” he says. “Some have even tried to drink the vaping liquid, but it’s poison! You should call poison control immediately if a person does it.”

While the first e-cigarettes contained little or no nicotine, and were designed to wean people away from smoking, today’s vapes contain varying amounts — sometimes quite powerful — and are equally addictive. The problem is that with vaping pods it’s easy to overdo the puffing. Dr. Lightman explains, “With a cigarette, you take ten or 15 puffs and the cigarette is done. But some of the vapes have enough liquid for 600 puffs. That’s like two packs of cigarettes. Eighty-five percent of vapers take 140 puffs a day or more, which is half a pack of cigarettes — in other words, a lot of nicotine, especially for a child.”

Nicotine is a stimulant, and it is addictive. The NIH lists its effects as boosting mood, accelerating heart rate, pulse, and digestion, cutting appetite, and stimulating alertness. Dr. Lightman worries that it can affect the brain development of young boys and teens. “Nicotine affects brain synapses, which can lead to mood or learning disorders and problems with impulse control,” he says. “The more people do it, the more nicotine they need to achieve the buzz they seek.”

Since the legalization of cannabis in many states (2014 in New York and 2018 in New Jersey), it is also possible to purchase vapes that contain cannabis. Does vaping serve as a gateway to cannabis use? “It definitely makes it easier to start,” Baruch says. “I tried cannabis a few times. I didn’t continue because I didn’t like how it made me feel, but I have friends who got into it. The fact that I was already vaping and had become accustomed to inhaling smoke through a device, made the transition easy.”

Rabbi Gross bought a vape for himself when he had a family medical emergency and needed to drive long hours and be awake at all kinds of crazy hours. But after things resolved, he found it wasn’t easy to stop. He felt the symptoms of withdrawal: headaches, cravings, nausea, irritability.

The addictive nature of nicotine, in addition to the habit of puffing that vapers develop, create terrible challenges for frum teens. “On Shabbos vapers feel the withdrawal,” Baruch says. “They can’t wait for it to be over so they can get back to their vapes.” Dr. Augenbaum has found that his clients who are truly addicted aren’t even able to wait for the end of Shabbos. “They don’t want to be mechallel Shabbos,” he says, “but the withdrawal is so uncomfortable they feel they can’t make it without a puff on their vape. They won’t touch their cell phones, but they need that hit of nicotine. I have clients who can’t make it through a session if they forgot to bring their vape with them.” They suffer from both the physical addiction to nicotine and the psychological addiction of depending on vaping to keep them calm, keep their hands busy, or help them focus.

Baruch’s family has a history of heart disease, and after his father, a non-smoker, was hospitalized for a heart attack, he decided it was time to cut back. “I haven’t been able to quit completely, but I got it down to the equivalent of one or two cigarettes a week,” he says proudly.

Shlomo, a life coach, has worked with yeshivah talmidim trying to quit. They often report suffering from headaches, stomachaches, and coughs when they stop. “I try to get to the heart of why they want to quit,” he says. “If you can’t identify the engine behind their drive to quit, you won’t get anywhere. One guy told me he wanted to quit because he really wanted to make his mother happy, plus the health reasons. I supported him through the withdrawal, and we’d focus on those reasons when he was going through a rough moment.

“A lot of rebbeim know good things to say to boys who want to quit vaping, but the key is really to identify the main motivation for quitting and keep them focused on that. If you haven’t identified that, you won’t be able to change anyone.”

Dr. Augenbaum concurs. He reminds us that back in the 1980s, First Lady Nancy Reagan launched an anti-drug campaign called Just Say No. The research indicated it wasn’t effective. “Dr. Twerski z”l used to refer to it and say, ‘Addicts will respond, ‘Why say no? What else is there?’ People need a reason to stop an addiction.

“If a client doesn’t see vaping as an issue, it will be counterproductive for me to make it an issue. As the therapist, I have to align with the client’s concerns, otherwise we just end up in a sort of arm wrestling. If a child is vaping because of peer pressure, I wouldn’t focus on the vaping. I’d focus on the peer pressure: why he can’t say no to his friends, why it’s so hard to be different.”

Shlomo also suggests that counselors and parents propose an alternative to vaping if they want young people to stop. In the same way smokers will replace cigarettes with gum or coffee, vapers need to find something that will give them the same sense of calm, well-being, and in some cases social interaction they get from vaping.

What should you do if, like Tamar, you find your child has been vaping? “Fighting won’t work,” says Rabbi Gross. “You’ll catch them once, but they’ll just learn to hide it better.”

Some parents will bribe their children to stop. “But,” says Rabbi Fuchs, “because vaping is so easy to hide, that may not work either.”

Baruch agrees. “Even if my parents had told me to stop, I would’ve continued,” he confesses. Many boys and teens truly enjoy it, and it’s really hard for parents to pit themselves against peer pressure and the desire of teens to experiment. How do you fight an uphill battle?

Rabbi Gross says that parents need to educate their children about vaping before it becomes a problem, in the same way they’d educate them about drinking, drugs, and cigarettes. “Addiction to vaping is like having a monkey on your back. It owns you, it controls you,” he says. “It’s expensive and bad for your health. But a lot of kids have money to spend, and unless they have a sick relative, they don’t believe anything will happen to them.”

Dr. Augenbaum says it’s good for parents to institute ground rules, such as no vaping in the house. They should start the conversation early, preventively, before vaping becomes an issue. “Do your best to stay educated yourself, and talk about it with your child in an open, curious, nonthreatening way,” he advises. “Mention that you saw an article or heard someone talking about it. Ask them questions and listen without judging or criticizing. Do it in short, impersonal conversational bursts from time to time instead of a major sit-down (they’ll just tune out).”

Of course, such conversations will be doomed to failure if the parentshimself is vaping! In such cases, Dr. Augenbaum advises, a parent has to honest and humble, and say, “I made bad choices, and I don’t want you to pick up my bad habits. I want you to be smarter than me.” Shlomo credits Rabbi Yosef Sonnenschein of Waterbury with offering the advice that it’s even better if a parent tells his child, “I shouldn’t be doing this either. Let’s work on quitting together.”

Once a boy is around bar mitzvah age, and has long hours in yeshivah, parents need to know where he is and what he’s doing. With today’s electric bikes and scooters, a trip that once took 45 minutes can take seven. “If an 11-year-old says he’s going to be learning for three hours, you should verify it,” Rabbi Gross says. “Most boys that age aren’t able to sit and learn for so long.”

Rabbi Fuchs states that while none of the elementary schools permit vaping, responses vary among high schools. “They will all say officially that they don’t allow it. But some are makpid, while others will look away,” he says. “Today there are thousands of good kids who are trying it out — I’d guess 40 to 70 percent.”

Dr. Augenbaum suggests that parents let their children’s yeshivos know they’re concerned, so that parents and yeshivos can be aligned against vaping. “Yeshivos have done a lot to warn students about the dangers of technology,” he says. “Maybe they can also address the dangers of vaping.”

“It’s not the worst thing in the world —there are bigger issues,” Rabbi Fuchs says. “You have to know your kid. Don’t ignore it, don’t give approval, and collaborate with your son’s rebbi and yeshivah to educate them and talk to them.”

We all know which road in life is paved with good intentions. Vaping was actually invented to stop people from smoking.

By the late 1950s, as scientists began to establish causal links between cigarette smoking and lung cancer, people were encouraged to quit. But quitting was hard for many, and in 1963 Herbert A. Gilbert submitted a patent for a smokeless, tobacco-free alternative to cigarettes that was the forerunner of today’s e-cigarettes (vapes). The idea didn’t gain much traction, though. Forty years later, a Chinese pharmacist named Ho Lik developed a similar product, which went to market in 2004 under the name Ruyan. E-cigs caught on and were soon being marketed internationally. Ironically, the NIH reports that while in 2015 only three percent of Chinese people had tried e-cigarettes, during that same year China produced 80 percent of all the e-cigarettes used in the world, a percentage that continues to climb.

E-cigarettes started to become common in the American marketplace by around 2010, with print and other media ads promoting their use. The ads often featured celebrities who encouraged them as a healthy alternative to smoking. A few years later, Internet advertising brought them further into the public eye. By 2016 the CDC reported that 16 percent of high school students were vaping. The most popular brand, JUUL, initiated trendy vaping device styles like flash drive and pen-shaped vapes, nicotine liquid refills called pods (which can contain the equivalent of two packs of regular cigarettes), and produced them in kid-friendly flavors. JUUL also created a new form of nicotine delivery called nicotine salts, which are easier for children to use.

(Originally featured in Family First, Issue 852)

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