The nation’s top health authorities agree: Teen vaping is an epidemic that now affects some 3.6 million underage users of Juul and other e-cigarettes. But no one seems to know the best way to help teenagers who may be addicted to nicotine.

E-cigarettes are now the top high-risk substance used by teenagers, according to the latest U.S. figures, which show that Juul and similar products have quickly outpaced cigarettes, alcohol, marijuana and other substances that have been tracked over more than four decades.

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The handheld devices heat a liquid solution that usually contains nicotine into an inhalable vapor. Federal law prohibits sales to those under 18, though many high schoolers report getting them from older students or online.

In recent months, government officials have rolled out a series of proposals aimed at keeping the products away from youngsters, including tightening sales in convenience stores and online. In November, vaping giant Juul voluntarily shut down its Facebook and Instagram accounts and pulled several flavors out of retail stores.

But there’s been little discussion of how to treat nicotine addiction in children as young as 11 years old. While some adolescents should be able to quit unaided, experts say many will be hampered by withdrawal symptoms, including anxiety, irritability, difficulty concentrating and loss of appetite.

Physicians who treat young people now face a series of dilemmas: The anti-smoking therapies on the market — such as nicotine patches and gums — are not approved for children, due to lack of testing or ineffective results. And young people view the habit as far less risky, which poses another hurdle to quitting.

The harshness of cigarette smoke often limits how much teenagers inhale, sometimes discouraging them from picking up the habit altogether. That deterrent doesn’t exist with e-cigarette vapor, which is typically much easier to inhale, according to experts.

Kicking any addiction requires discipline, patience and a willingness to follow a treatment plan — something that doesn’t come easily to many young people, experts said.

“Teenagers have their own ideas of what might work for them, and they’re going to do what they do,” said Susanne Tanski, a tobacco prevention expert with the American Academy of Pediatrics. “But we desperately need studies to figure out what’s going to work with this population.”

Since debuting in the U.S. in 2007, e-cigarettes and other vaping devices have grown into a $6.6 billion business. Driving the recent surge in underage use are small, easy-to-conceal devices like Juul, which vaporizes a high-nicotine solution sold in flavors such as creme, mango and cucumber. Despite industry worries of a crackdown on flavors, the FDA has made no effort to ban the array of candy and fruit varieties that companies use to differentiate their offerings.

E-cigarettes have become a scourge in U.S. schools, with students often vaping in the bathroom or between classes. One in 5 five high schoolers reported vaping in the last month, according to 2018 federal survey figures.

Juul and other brands are pitched to adult smokers as a way to quit smoking, but there’s been little research on that claim or their long-term health effects, particularly in young people. Nicotine can affect learning, memory and attention in the teenage brain, but there’s virtually no research on how e-cigarette vapor affects lungs, which do not fully mature until the 20s.

“It’s frightening for me as a pediatrician because I really feel like there’s this uncontrolled experiment happening with our young people,” Tanski said. “They don’t perceive the harm, and we can’t show them what it’s going to be.”

Tanski and other experts will meet this Friday at the Food and Drug Administration to discuss the potential role for pharmaceutical therapies and non-prescription medications such as nicotine gums and patches.

Regulators acknowledge they are starting from square one: The FDA “is not aware of any research examining either drug or behavioral interventions” to help e-cigarette users quit, the agency noted in its announcement.

The FDA will also hear from researchers, vaping executives, parents and teenagers.

“We want to make sure our voices are heard and that — most importantly — our kids’ voices are heard,” said Meredith Berkman, who plans to speak at the meeting with her 10th-grade son.

Berkman said she first realized her son and his friends were “Juuling” last year when she heard them repeatedly opening and closing his bedroom window. With two other New York City mothers, she formed the group Parents Against Vaping E-cigarettes, which is asking the FDA to ban all e-cigarette flavors.

“Unless the flavors are off the market, kids are going to continue to be seduced by these highly addictive nicotine-delivery systems like Juul,” Berkman said.

Quitting smoking is notoriously difficult, even for adults with access to various aids and programs. More than 55 percent of adult smokers try to quit each year, yet only about 7 percent succeed, according to government figures.

Nicotine gums, patches and lozenges are available over-the-counter for those 18 and older, and are occasionally prescribed “off-label” for younger patients. They provide low levels of nicotine to help control cravings. Prescription drugs include Zyban, an antidepressant, and Chantix, which blocks the effects of nicotine on the brain. But neither has shown positive results in teenagers, and both carry worrisome side effects, including suicidal thinking for Zyban and nausea and abnormal dreams for Chantix.

That leaves counseling as the go-to option for teenagers trying to quit cigarettes.

In November, Colorado dropped the minimum eligibility age for its quit-smoking hotline from 15 to 12, in response to the explosion in vaping among students as low as 6th grade. The state’s underage vaping rate is the highest in the U.S., with 1 in 4 high school students reportedly using the products in the last month, according to federal data. The state’s over-the-phone and online programs provide free coaching to help users create a quit plan, manage cravings and avoid relapse.

But even counseling has shown only “limited evidence” in helping teenagers, according to an exhaustive review of the medical literature published in 2017.

Still, addiction specialists see growing demand for such programs, particularly group sessions that often have the most promising results.

Addiction psychiatrist Jonathan Avery says he gets four to five calls a week from pediatricians referring patients or asking about treatment options. One of the biggest problems is an education gap — many doctors haven’t heard of Juul and don’t even recognize the vaping devices brought in by parents.

On the other side, teenagers are often “suspicious” when he informs them that they are inhaling a highly addictive substance, said Avery, of New York Presbyterian Hospital.

About two-thirds of U.S. teenagers do not realize that Juul contains nicotine, according to a recent survey by the Truth Initiative, an anti-smoking advocacy group.

The U.S. Surgeon General, Jerome Adams, hammered that point home in a rare public advisory last month. He said even his 14-year-old son believed that e-cigarette vapor was essentially harmless.

“Youth like my son have no clue what’s in these products most of the time,” he said.
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A recent vaccine scandal in eastern China’s Jiangsu province, where 145 children were confirmed to have received expired polio vaccinations, has once again exposed the country’s poor vaccine management and lack of systematic regulatory oversight, a former Chinese health official said.

 

To eradicate such lapses, Chen Bingzhong, ex-head of China’s Health Education Research Institute, calls for a nationwide probe, in which, third-party stakeholders such as parents, lawyers or reporters should take part to ensure transparency.

 

“There should first be a thorough probe into the cause of the Jiangsu case, which serves as another wake-up call. But who should launch the investigation? Local health departments alone won’t work because they are the ones who cause the problem and should be held responsible. An [unbiased] third party has to be involved,” Chen said.

 

Expired vaccine probe

 

Jiangsu police, on Monday, began an investigation after the local government in the province’s Jinhu County concluded that “only 145 children” were orally administered with polio vaccines that expired on December 11, 2018.

And so far a total of 17 officials have been punished, including the deputy head of Jinhu County.

The local government has also promised check-ups on all affected children.

 

Tao Lina, a Shanghai-based vaccine expert, blamed the county’s online registration system, which she said failed to alert doctors about expired vaccines or registered the wrong expiration date, according to a Global Times report.

 

A cover-up?

 

But many worried parents are skeptical of the official findings and suspect a larger-scale cover-up.

 

The case came to light on Jan 7 when a parent — a retired hospital worker — discovered that oral vaccine given to her grandkid was nearly a month out of date, according to local media reports.

 

Many parents, who picked up the news on social media, followed suit to check batch numbers on their children’s vaccination history and found that expired vaccines include not only polio vaccines, but also diphtheria-tetanus-pertussis (DPT), hepatitis B and varicella.

 

And the problem dates back to a decade ago, which is further fueling suspicion that the majority of the county’s 20,000 children under the age of 14 may have been exposed to faulty vaccines. The case in Jinhu is the latest in a string of similar scandals in China.

 

Late last week, hundreds of anxious parents gathered in front of Jinhu government offices, demanding answers.

 

Violent scuffles

 

Video footage that has gone viral on the Internet showed repeated scuffles between angry crowds, besieged government officials and squads of mob police, which continued into the night.

 

Three parents ended up being arrested and local residents have expressed difficulty in uploading videos of the protests to social media.

 

On Weibo, the equivalent of Twitter in China, some urged parents in Jinhu to stay calm, but many more shared their anger.

 

“The government’s credibility is overdrawn and the people’s tolerance is being put to the test,” one Weibo user said.

 

“To be honest, our regulators are all façade with little function,” another complained.

 

Public outcry

 

Parents elsewhere complained of governments of all levels’ inaction to address the country’s vaccine problems including appropriate compensations to those who suffer adverse effects.

 

A father from Fujian province surnamed Lin told VOA that the local government there has done nothing to help this teenaged son, who experienced severe adverse effects from vaccines at the age of three.

 

“They [the Fujian government] keep patronizing me and passing the buck,” he said.

 

“Two to three years ago, my kid was identified to be suffering adverse reactions from vaccines, which is extremely rare. If the government can help deal with it, we have nothing to complain. But it’s been ten years, the government hasn’t even tried to take up a [responsible] stance, which I find very hard to accept. My child is now in a [brain-damaged] state,” he added.

 

A series of vaccine scandals in China including years of illegal sales of improperly-refrigerated vaccines and locally-produced substandard vaccines, which respectively came to light in March and July last year, have seriously undermined public confidence in spite of repeated calls for tightened regulation.

 

Vaccine management law

 

Wang Yuedan, deputy director of Peking University’s immunology department, however, insisted that the Jiangsu case is an isolated misconduct of local medical staff and the upcoming passage of a law on vaccine management will help address regulatory loopholes.

 

To tighten supervision on vaccines, Beijing released a draft Vaccine Management Law this month and is seeking public opinions until next month.

 

“I believe, once the law takes effect, there will be harsher punishments [on lawbreakers] to prevent such lapses. Among past expired vaccine cases, the punishment imposed on officials [in Jinhu] this time have been the harshest-ever,” he said.

But Chen disagreed.

 

He asked why many people from local medical staff to regulators in Jiangsu, who are responsible of tracking vaccine flows, have failed to sound alarm bells over expired vaccines?

 

That shows a systematic regulatory negligence — serious flaws that legal revisions alone won’t cure if few profit-driven lawbreakers and officials who helped cover up the crisis have been held responsible, he said, adding a nationwide probe will find parents in Jiangsu aren’t alone.

 

Regardless of how harsh the punishments will be, what’s more important is no more faulty vaccines used on their children, many parents said.

 

 

 
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Healthy forests are key to a healthy planet. But climate change is putting forests under stress. A new system aims to track the trees’ vital signs. VOA’s Steve Baragona has more.
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Addicted to social media? That’s not just an expression anymore. Scientists have found a connection between excessive social media use and behavior associated with substance abuse.

Researchers at Michigan State University and Monash University in Australia found that heavy social media users tended to make riskier decisions usually seen in drug addicts.

“Around one-third of humans on the planet are using social media, and some of these people are displaying maladaptive, excessive use of these sites,” said Dar Meshi, the study’s lead author and assistant professor at Michigan State University in the U.S.

“Our findings will hopefully motivate the field to take social media overuse seriously,” Meshi said.

Meshi and his team had 71 participants take the Iowa Gambling Task, which is used to measure decision-making abilities in substance abusers and non-abusers.

“Decision-making is oftentimes compromised in individuals with substance use disorders. They sometimes fail to learn from their mistakes and continue down a path of negative outcomes,” Meshi said.

At the end of the exercise, Meshi and his team found that heavy social media users took greater risks even while knowing that they came with negative consequences, the same way drug addicts do.

The participants also reported that they constantly think about the platforms when not using them and that they lose sleep because of their online activities.

“I believe that social media has tremendous benefits for individuals, but there’s also a dark side when people can’t pull themselves away,” Meshi said. “We need to better understand this drive, so we can determine if excessive social media use should be considered an addiction.”
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No city experiences a shutdown quite like Washington.

Besides the economic impact, a shutdown warps the nation’s capital on a cultural, recreational and logistical level — touching everybody from garbage collectors to young parents, prospective newlyweds to aspiring Eagle Scouts.

The current partial shutdown , now in a record fourth week, has also provided a quiet boon for Mayor Muriel Bowser’s government, which rushed into the void to claim unprecedented new powers while making a public show of literally cleaning up the federal government’s mess.

The economic situation is, of course, brutal. Recent surveys estimate that the federal government directly employs more than 364,000 people in the greater Washington area including northern Virginia and southern Maryland. The District of Columbia alone — population 700,000 — contains more than 102,000 jobs in agencies that are now without appropriations funding.

Deputy City Administrator Kevin Donahue made the analogy to the main plant shutting down in a factory town — with the subsequent knock-on effect through the service industries like restaurants, food trucks, entertainment and taxis.

“What keeps us up at night is not the work we know we have to do in weeks one and two,” Donahue said. It’s the unpredictable impacts of weeks four and five and onward, he said, with the potential for mass restaurant closures or residents missing payments on rent, mortgages, car loans or school fees.

Most immediately, the shutdown created a logistical and public health problem. The district is riddled with National Park Service land, ranging from the National Mall to urban green spaces like Dupont Circle and dozens of neighborhood parks.

Washington sanitation crews now empty the trash bins at 122 separate NPS sites — three times a day in the case of the bins at the National Mall. It’s costing at least $54,000 per week in overtime, and Donahue said there’s a handshake agreement dating back to previous shutdowns that Washington will be compensated when the government reopens. The NPS recently announced it would tap into other funds to resume its own trash pickup at some — but not all — of the Washington sites.

“There’s a past practice of reimbursement,” Donahue said. “But they don’t have a legal obligation to compensate us.”

Given Washington’s tortured relationship with the federal government, which can essentially alter or block any local law, city officials have seemingly relished the chance to highlight the ironies of the moment. They frequently claim they are treated by Congress as if they can’t handle their own affairs; now they’re taking over and covering for a dysfunctional central government.

“When the federal government shuts down, we step up,” Bowser said during a Jan. 4 news conference with Washington’s nonvoting congressional delegate, Eleanor Holmes Norton, to announce a renewed push this year for district statehood.

The shutdown cuts a cultural swath through the lives of city residents. The entire Smithsonian network of museums, including the zoo , closed their doors about a week into the shutdown, and quasi-federal entities like the John F. Kennedy Center for the Performing Arts have severely cut back their hours.

On a recent weekend, the usual Saturday morning kids’ drumming workshop at the BloomBars cultural center in Columbia Heights drew nearly triple the usual crowd, with parents and strollers lined halfway up the block in the rain. The reason: desperate parents searching for something to occupy their kids in a city where more than a dozen free museums and the zoo have been shuttered.

“It happens every time,” laughed BloomBars founder John Chambers, who recalls an identical spike during the 16-day 2013 shutdown. “But this time it feels like there’s more of a panic among people because (this shutdown) genuinely seems open-ended.”

The district is littered with shutdown specials — offering furloughed federal employees discounts on everything from food and drink to live theater and medical marijuana .

Examples of unexpected shutdown fallout are all around. High school senior Yosias Zelalem was all set to secure his Eagle Scout rank with a project to repair park benches along the Mount Vernon Trail. But his liaison at the NPS has been furloughed and the project is frozen.

“I didn’t really think about it until New Year’s came and went,” said Zelalem, who needs to complete the project before he turns 18 on March 27. “I honestly didn’t expect it to go on this long. Now everybody’s talking like this could go for months.”

One of the more random side-effects of shutdown: the closure of the marriage bureau.

Bowser told The Associated Press that even she was surprised to learn that local couples couldn’t get their marriage licenses because Congress funds the local court system. Divorce proceedings, however, were unaffected.

Bowser quickly tapped allies on the Council of the District of Columbia to pass emergency legislation called the Let Our Vows Endure (LOVE) act, which granted her administration the right to issue marriage licenses. In addition to an enjoyable public victory that drew national attention, Bowser’s administration just stepped into the federal void to claim a whole new power ahead of an impending district statehood push.

At a recent event to sign the LOVE act into law, Bowser – flanked by grateful newlyweds – said, “Just so my team knows, we’re probably going to want to keep that power.”

Nobody laughed and she didn’t seem to be joking.
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Preliminary numbers from the U.S. Department of Agriculture (USDA) suggest that the population of domesticated US honeybees is still declining. The loss in pollinators is due in part to the effects of pesticides but also to natural stressors like the varroa mite, which can infect whole bee colonies. To learn more about how to monitor the health of hives, researchers and the computer technology company Oracle are joining forces. VOA’s Kevin Enochs reports.
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