Convincing the Unconvinced

"You want kids to get vaccinated not just for herd immunity, but [for] their own health."

"Parents may do a different kind of cost-benefit calculus when they are thinking about vaccinating their children."

"[Evidence from some jurisdictions show that] ethically justified legal mechanisms [have an impact on vaccination rates]."

"Get vaccinated and you have access to a 'public good' -- such as a school".

Timothy Caulfield, Canada research chair, health law and policy, University of Alberta

 

"What has changed is those that were unsure. Among those that were unsure in the early days of the pandemic, about half have said they now plan to vaccinate, while the other half remains unsure."

"So, we can expect that while acceptance may have improved somewhat since the early stages of the pandemic, it's likely that this is lower for children than [for] the general population."

Erin Hetherington, social epidemiologist, lead author of study

 

"We have a much more human-rights-based view of children as persons with value unto themselves who are afforded human rights [in Canada]."

"Most 12-year-olds really are quite well informed."

"Sometimes the answer is to say, 'Let's not do it this week. But let's think about it next week'."

"As far as kids are concerned, if it will get them back to normal life, then it's a good thing. We do know that children are struggling with loneliness, depression and anxiety."

Michelle Mullen, bioethicist, Children's Hospital of Eastern Ontario 

Mae Smith, 13, gets her first dose of the Pfizer-BioNTech COVID-19 vaccine at a clinic held at Don Bosco Catholic Secondary School in Toronto on Wednesday. (Evan Mitsui/CBC)

 

Now that anti-COVID vaccination doses are relatively flush in Canada, the gradual opening to age groups for inoculation has finally resulted in most provinces opening their vaccination clinics to all age groups, including children over age 12. Everyone is anxious to see life graduate back to the kind of social routine that is customary. Health professionals worry in particular about people's mental health, struggling with isolation and loneliness. And children are no exception. Schools closed to in-person learning, pivoting to remote learning has been a difficult transition for most children.

They miss the company of their peers, they miss the routine discipline, they miss the casual-by-comparison lives they left behind a year-and-a-half ago through no fault of their own. Other than the fact that transmission of the SARS-CoV-2 virus causing COVID-19, among the young gathered together in school classrooms, despite the exceptional care given to try to maintain distance and to remain in discrete bubbles and to wear masks and observe necessary hand-washing hygiene, remains high. And while children tend to become less ill with COVID, variants arise and transmission from schools to community accounts for a fairly high percentage of COVID cases.

Now that teens are being invited to make appointments for vaccinations, the question arises; how many will respond affirmatively. Initially there was a rush of those committed to gaining vaccine coverage making appointments as recommended. What remains open to speculation is how many teens, including the parents of those teens, will continue to book those appointments? Acknowledged as being key to prevention of the virus spread, plus the variants, it is of great importance that young people be vaccinated. It is also the very way that they will themselves benefit more directly by returning to school, to sports and to normal social activities, to ensure sound mental health.

 

Young people in the 12-16 age cohort got their first doses of the Pfizer vaccine at the vaccine clinic at Don Bosco Catholic Secondary School in Toronto this week. (Evan Mitsui/CBC)

 

While it's true that the COVID experience has demonstrated that children tend not to have serious symptoms of the virus, thus have far less reason to be hospitalized, much less die, if seriously infected, an estimated 83,000 young people under age 20 have tested positive for COVID in Ontario alone since the advent of the pandemic. Four of them have died of COVID-19. Some parents vacillate over vaccination for their children; many are prepared to have their children inoculated, others plan not to, but there is a middling number who remain uncommitted, preferring to 'wait and see'.

A survey was undertaken of 1,321 mothers in Alberta with children aged between nine and twelve who were asked whether they intended to vaccinate their children. Of the total, 60 percent stated their unhesitating intention to vaccinate, and nine percent that they had no intention of doing so, leaving 31 percent who felt uncertain. What did crop up as an anomaly was that only 60 percent of families whose children had complete infant routine vaccinations, agreeing they intended to vaccinate against COVID.

The Centers for Disease Control and Prevention in the United States recommended everyone over age 12 be vaccinated, leading to reports of teens who have been placed in the position of waiting until they turn 18 years of age when they are deemed legally able to make their own decisions independent of parents who will not agree to permit their children to be vaccinated. The legal position of teens in Canada is not the same. Under Ontario's Health Care Consent Act, no age of consent is stipulated; a presumption of capacity rules. The patient is held to understand the nature of the medical treatment under proposal in a way that is appropriate and accessible.

The patient is held to comprehend consequences, positive and negative; the vaccine will prevent serious illness and hospitalization, even while there may be some side-effects and rare reactions. Also understood must be the decision to accept a medical treatment be informed and voluntary. Even should parents reject vaccination, no young person seeking vaccination will be denied. On the other hand, any young person who clearly states they have no wish to be vaccinated, cannot be coerced into inoculation.

In this Wednesday, March 24, 2021 image from video provided by Duke Health, Alejandra Gerardo, 9, looks up to her mom, Dr. Susanna Naggie, as she gets the first of two Pfizer COVID-19 vaccinations during a clinical trial for children at Duke Health in Durham, N.C. (Shawn Rocco/Duke Health via AP)

Vaping Advertisements and Anti-Vaping Campaigns

"The FDA campaign on social media, it's great that it's there, but it's not changing the trend of high prevalence of pro-vaping content [on Instagram]."
"The FDA campaign just becomes a drop in the ocean, practically, because it's so hard to compete with the enormous volume of pro-vaping advertisements."
"That's one of the dangerous things, youth are very susceptible to any type of influence that is so well advertised. Their brains are still developing, it's hard to resist. They want to fit in and they want to be cool. All the marketing strategies are so well crafted in the pro-cigarette message."
Julia Vassey, researcher, UC Berkeley Center for Integrative Research on Childhood Leukemia and the Environment

"It's really concerning because we're worried about a new generation of young people who could become addicted to nicotine."
"We have faith that society and government overall will put the health of young people ahead of the interests of corporation and we'll see regulation in the near future to protect young people."
Lesley James, senior manager, policy, Heart and Stroke Foundation of Canada

A post from British e-cigarette Instagram influencer @elysiaalessia on the #vapenation hashtag page. elysiaalessia/ Instagram

E-cigarettes were originally marketed as a novel invention whose purpose was to help smokers break their addiction to cigarettes. It was advertised as a successful mechanism that, though using nicotine, was less harmful and would help smokers succeed in weaning themselves away from the infinitely more threatening habit of cigarette smoking. Since its introduction to the consumer market its popularity has risen exponentially, particularly among an audience not initially targeted; teens and young adults.

When manufacturers began flavouring e-cigarettes, their audience was definitely not mature adults. Teens were attracted to the fruit flavours, the catchy names and the attractive containers. And Instagram, a popular social web-posting platform, is rife with marketing advertisements, many of which show models and some celebrity figures soft-peddling vaping products. Awareness campaigns launched to warn young people and particularly teens of the injurious aspects of vaping languish in relative obscurity, against the huge proliferation of vaping advertisements.

The products still contain nicotine, a highly addictive substance known for its negative health consequences. The number of high-school students who responded to a recent U.S. National Youth Tobacco Survey, revealed their use of e-cigarettes over-doubled from 12 percent in 2017 to 28 percent in 2019. Repeated e-cigarette use has been shown through research to lead to lung and brain damage, spurring the U.S. Food and Drug Administration to launch a youth-oriented awareness campaign, The Real Cost.

Researchers from the University of California's new study published in Frontiers in Communication, analyzed hundreds of thousands of Instagram posts between 2017 and 2019 to determine whether the FDA campaign made an impact on social interactions with vaping. Lead author Julia Vassey explained that the study discovered the average amount of likes on pro-vaping Instagram posts rose in fact, since the FDA campaign began.

The UC Berkley team placed their focus on Instagram when they were informed from e-cigarette 'influencers' of their growing followers, with some of the influencers sharing their analytics data with the research team which then understood that around 15 percent of followers of pro-vaping accounts were of the ages between 13 to 17. Each pro-vaping hashtag published over 500,000 new posts monthly while #The Real Cost published a mere 50 a month in a like time frame.

Using a "deep learning" software, the research team analyzed over 40,000 vaping posts on Instagram enabling the identification of each image's contents, to discover that the most popular e-cigarette marketing posts featured female models using vapes or alternatively, male models doing tricks with the vaping products.

Add caption

In Canada, Health Canada advertises risks related to vaping on their own website, but in addition hosts seminars in high schools, engaging with teens aged 13 to 18 through activities. Where, since 2018, their advertisements on the dangers in vaping have also appeared on social media sites like Facebook, Snapchat and Twitch. After viewing ads from Health Canada's outreach program, 26 percent of youth responded they would stop vaping, while 72 percent of teens who took part in the in-person school activities stated they were less likely to start using vapes and more likely to stop if they were already vaping.

Its a steep uphill battle in a social media world inhabited by teens, where 11 million posts confront them on line, produced by e-cigarette marketing teams and influencers, purposed to lure them into the vaping market, when posts published to inform the same demographic of the dangers and risks inherent in vaping number 3,000. The odds are 10,000 to one, which goes quite a way to explaining how marketing has made such inroads in the youth population, while health regulators continue to explore avenues to counteract their advertising successes and help teens realize the larger picture and their choices, gambling with their health.

The Online Search for Celebrity, Teen Reality

"There is so little research, good research, that can give answers to [those] questions. The science has simply not been able to keep up with the technology."
"There's a lot more continuity than we thought was going to happen."
"I think there's the automatic danger of trying to prevent your children from using these technologies because of these instances. They're shocking. They capture the imagination. They're the ones that stand out."
"But for the most part, I think, the research suggests children are using technology in normative ways."
Kaveri Subrahmanyam, developmental psychologist, California State University

"I think what we know is that young people have always made poor decisions around their actions and in particular in doing things that excite their peers."
"It's almost heightened the need to perform and engage with your peers through posting and engaging behaviours that they may not do outside of the social media context."
"We're beginning to see this trend where the excitement over the virality of the post and what that can do for your clout is overriding a sense of consequences among young people."
"There is no core curriculum around helping people navigate their digital footprint and what it means to be a citizen of digital society."
"And that, I think, should be over [behaving as though the digital and physical realms are separate]."
Desmond Patton, technologist/intersection of youth violence and social media, Columbia University

From left, Kayden McIntosh, 16, Denali Brehmer, 18, and Caleb Leyland, 19, are arraigned by a Superior court judge in the Nesbett Courthouse in Anchorage, Alaska on Tuesday, June 18, 2019, after a grand jury indicted them on first-degree murder and other charges in the shooting death of 19-year-old Cynthia Hoffman. (Bill Roth/Anchorage Daily News via AP)

This transcends the gawking bystander effect, where people tend -- like cattle curious about what is happening -- to gather around the scene of an accident, getting in the way of those who are actively responding, causing problems by their very presence, complicating the process of addressing a scene of carnage, unwilling when asked to move on and out of the way, as though they are self-entitled to gorge themselves on the gruesome spectacle, as a prize talking point among their friends and colleagues.

Only things have changed. People, mostly very young people, are fascinated in the presence of dangerously harmful incidents, as though they are mesmerized and don't want to miss any of the action, even when this is a scene that will end with someone's death. Teens addicted to photographing and videoing bizarre, grotesque, dangerous, illegal behaviours, posting them to social media sites, drawing attention and hoping for plaudits and admiration. Youth violence taking place, being recorded, shared on any number of media platforms.

It is as though teens are witness to a spectacle that is simply a drama that is being acted out, not enacted in real time, impacting deleteriously on some unfortunate; they are emotionally removed from the harm being done, no need for a conscience, for reaction of any kind that might seek a solution, help to aid those being harmed. And then there are the perpetrators, those visiting harm on others, proud of it, tickled beyond pink because they have caused an online sensation.

Someone is injured, perhaps dies -- and those who not only might have prevented the personal catastrophe for some unfortunate, but who might have had a hand in causing the problem with deliberate intention -- thought of as merely disposable, unimportant, a vehicle to be used to gain notoriety. Research into the phenomenon is only in its early stages in an attempt to try to understand the alienating, irresponsible effects of removing teens' sense of reality that social media casts them into.

But some researchers are stunned to realize that what they see in online behaviour reflects in actual fact, behaviour engaged in offline, in reality. Brutish, psychopathic behaviour making no distinction between social media and real-time life events. There will always be such individuals within any society. The shocking aspect, however is the onlooker effect, those who watch, who witness and from whom there is no reaction other than in fact being an accomplice by their lack of reaction.

This is stupidity, this is cruelty, this is unabridged anti-social behaviour unworthy of any human being, to simply do a mental shrug and move on rather than attempt to intervene, to protest, to make an effort to protect a vulnerable person whose life is ebbing away because of the harm being visited upon them. Like older teens in the presence of a  younger teen who wants to be like them, willing and complicit in his own harm because he wants to be part of the gang.

Being given drugs with the relentless intention of doing harm to someone who tagged along with older teens admiringly hoping to be noticed and accepted only to be accepted as a guinea pig to see how he would react being plied with an overdose so the older boys could jeer and express their contempt, even while watching the younger boy's life ebbing away. Finally becoming so bored after taking enough photographs, just walking away leaving death to nurse the boy toward his final moments.

Like a stone tossed into a tranquil pond, causing ripples to cascade out from the central source of the tumult caused, the footage is aired, the photos published online available for their peers to watch and to post their own personal little dashes of black humour with no one thinking to alert authorities, no one feeling it necessary because after all they had nothing to do with the amusing little incident, so it's no big deal...

Oh, wait when Carson Crimini, 14, in Langley, British Columbia became the latest victim on August 7, of one of these 'events', it appears that there was someone who saw a photo of him on Snapchat and who saw fit to call police. Police however, did not respond until two hours later when a skateboarder found the boy lying next to a chain-link fence, cold, hardly breathing. That's when police showed up. And an ambulance. But the boy's heart had stopped beating and doctors were unable to resuscitate him.

Fourteen-year-old Carson Crimeni died August 7 after trying to fit in with older teens through drug use

Hypothesizing Teen Anguish

"What we found was that yes, incidents of self-harm are increasing, and so are emergency department visits with mental health concerns."
"But I don't think any of the study team members expected such a dramatic rise from 2009 to 2017."
"Engagement with social media could lead to increased rates of self-harm, at least for vulnerable adolescents. This could happen in several ways: by normalizing self-harm, by triggering it, by getting teens to emulate self-harming peers, or by exposing youths to cuber bullying."
"We have hundreds of kids coming to Ontario emergency departments with these problems. The rate is going up every year. The rate is not slowing down."
"But the number of child psychiatrists at CHEO [Children's Hospital of Eastern Ontario, Ottawa] and child psychologists hasn't changed over that period. The number of emergency department personnel hasn't changed. That is really a problem."
"Efforts should be made to increase the supply of and access to evidence-based treatments for adolescents who self-harm or have mental health problems."
"Where possible, it's important to deliver these services to youth before they need to come to an emergency department."
Dr. William Gardner, senior scientist, CHEO Research Institute

CHEO emergency entrance. Wayne Cuddington / Postmedia

The trend toward teenagers turning to self-harm as an expression of their mental health needs being unanswered by health services represents a challenge to any society. Obviously, understanding the motivation or the pathology behind this trend of teens self-harming should be recognized as one of urgent need, both for the medical community and society at large to involve themselves in, since the cost to young peoples' mental health is so grievous and the loss to society of well-adjusted youth is increasing should mark this as a health emergency.

Research, led by Dr. William Gardner and published in the Canadian Journal of Psychiatry, points out that self-harming teen episodes have over-doubled between 2009 and 2017. What, however, is the driver? And until that is understood and measures taken to ameliorate the situation, it is more than obvious that the condition will continue and continue to accelerate. Teens reacting to unidentified stressors have been cutting or poisoning themselves and they are recognized as being at risk for repeated self-harm, and possibly suicide attempts.

There are hints of the increase in self-harm being coincidental in timing with the iPhone's introduction, leading to the ubiquitous use of smartphones in society in general, and among young people in particular. Canada saw iPhones being sold from the summer of 2008 onward and the suspicion among many is that this marked the beginning of increased self-harm among teens. The increased use of iPhones appears to have matched the increase in teens self-harming, according to the research hypothesis.

"Having all these phones in your pocket could be very difficult" for teens who are self-conscious about their social status or appearance to begin with, making them more vulnerable to facing social rejection or being emotionally bullied on-line. The other side of the equation, suggested Dr. Gardner, was that some emotionally unstable youths could benefit through social media, providing them with a venue away from social isolation, encouraging them to look elsewhere for validation, or even realize that they could benefit from health treatment.

The research was based on data retrieved from emergency departments province-wide, between 2003 and 2017, relying on data revealing a trend seen at hospitals and in communities increasingly in recent years.  Rates of youth emergency visits for self-harm happened to decrease by 32 percent between 2003 and 2009, and then swerved dramatically upward by 133 percent between 2009 and 2017. Mental health visits to hospital emergency rooms increased by 78 percent between 2009 and 2017 for all youths, while those linked to self-harm and mental health visits were higher for females, increasing more steadily than for males.

The findings, according to Dr. Gardner, a professor of epidemiology at University of Ottawa, and senior research chair for child and adolescent psychiatry, raise concerns relating to treatment for adolescents who present at emergency departments with mental health issues, where those departments are not equipped to deal with the needs of the teens due to a shortage of appropriate medical personnel. A shortage echoed by child and youth mental health workers province-wide.

As far as the researchers are concerned, emergency departments which represent the first contact in mental health issues for families do not present as an ideal setting for adolescents in crisis, requiring mental health services. Mental health followup through community-sourced medical care where the needs of self-harming teens are the focus remain the most effective source of help. Such followups have been identified with a reduced chance of repeat self-harm by teens, speaking to the success of such community health groups whose critical shortage disadvantages the growing numbers of teens in need.

Really?!!!

"We got the idea that a really useful way to look at people's appearance might be to look at something like acne, because, turns out that acne affects people pretty randomly."
"And we thought that acne was a good vehicle for investigating this relationship [the link between physical appearance and education and labor market outcomes] because a lot of people get acne and it happens to everyone regardless of their socioeconomic status."
"We’re hesitant to say that we find iron-clad proof."
Erik Nesson, economics professor, Ball State University, Indiana

"[Basically, acne] is associated with reduced participation in sports clubs and increased participation in non-sports clubs, suggesting a possible shift from physical to intellectual pursuits."
"Knowledge of long-term benefits associated with having had acne has the potential to reduce teen suicides."
"Our findings are consistent with a mechanism where severe acne limits socialization so much as to affect long-term outcomes that may depend both on studying and on sociability."
"Skin problems are also associated with increases in cumulative overall high-school GPA [grade point average] and cumulative science high-school GPA, and we find some evidence that skin problems are related to cumulative mathematics and science high-school GPAs."
"Skin problems are not consistently related to earnings among the entire sample, but skin problems are positively related to personal earnings for women and white women."
U.S. study, adolescent acne outcomes

"Overall, this is an interesting study in that it suggests that what might be considered as a disadvantage when growing up ends up translating into positive outcomes later on in life."
"In this regard, the finding contrasts with similar studies which show that other kinds of disadvantages [being short or not beautiful] are typically linked to labour market penalties."
Vera Brencic, economics professor, University of Alberta

Many youth need to treat skin conditions such as acne, which can be exacerbated when pores on the surface of the skin become clogged.(Photo11: liza5450, Getty Images/iStockphoto)

 Teens plagued with skin-blemishing acne see no upside in their affliction and would do almost anything to find a miracle 'cure' for their acne. However, two American professors of economics put their heads together, scoured scholarly articles on acne -- and there are plenty of them -- and came to the conclusion that there's an upside for having acne, as long as the sufferer is patient and endures. Their study was published in the Journal of Human Capital in late 2018.

And they found, convincingly enough to write with a  high degree of confidence, that having acne in one's adolescent years was correlated with higher grade point averages alongside a higher likelihood of graduating from college and singularly for women, they detected through their study that evidence exists that having acne is associated with higher earning potentials for women.

There is a rational enough reasoning here, that teens with acne were uncomfortable with their appearance and preferred to shelter themselves from public view as much as possible, meaning they were less likely to socialize and likelier to spend that time on their studies. There you have it: problems with skin blemishes point to a more intellectually-flavoured lifestyle and that in turn equates with improved grades, more intensive academic studies and eventually, higher incomes.

Greatist

That's the good news, and there was no way of ignoring the bad news, that acne strongly correlates with adolescent suicide; the detrimental effect of severe acne even while it seems that lighter bouts of occasional acne result in labour market success. If we're weighing quality of life as opposed to cessation of life, there's really no contest, is there?

The paper and its conclusion is considered one piece of a larger puzzle relating to work that explores how physical attractiveness matches with greater success in life outcomes, a well-studied phenomenon where it is recognized that comely people have a tendency to reach for greater success through their aspirational pursuits.

Professor Nesson partnered for this study with Hugo Mialon, both analyzing data collected by the Eunice Kennedy Shriver National Institute of Child Health and Human development where studies were run of adolescent development in waves from 1994-95. Information was available through that research relating to academic performance, perception of physical attractiveness, acne, and adding research that followed over the years, educational attainment and income.

Having acne through the adolescent years correlates with a 3.8 percent increase in chances of obtaining a bachelor's degree.

Grestist

Abstract
We use data from the National Longitudinal Study of Adolescent to Adult Health to investigate the association between having acne in middle to high school and subsequent educational and labor market outcomes. We find that having acne is strongly positively associated with overall grade point average in high school, grades in high-school English, history, math, and science, and the completion of a college degree. We also find evidence that acne is associated with higher personal labor market earnings for women. We further explore a possible channel through which acne may affect education and earnings.
Hugo M. Mialon
Emory University - Department of Economics
Erik Nesson
Ball State University - Department of Economics

Grooming With Care

"Kids are smart and they're watching everything and everyone."
"The conversations should be about authenticity and honesty."
"There is a difference between discretion and hiding. Hiding encourages stigma because it is something that you keep from people. Having discretion is about responsible use."
"It's maybe not that I don't trust my own kids. I keep it [cannabis] locked and away from them so that they understand that it's an adult-use product."
"My job is to be a responsible user and store it [cannabis] responsibly and have these conversations. I want to have a dialogue with my kids about this."
Ashleigh Brown, founder, SheCann

"I just asked myself, 'I know my adult children are smoking it, so why am I the one hiding it?"
"We're all adults here."
Sabine Dolby, 56, Toronto

"There are downsides to [cannabis use], but if we don't talk about it, how are we really going to know?"
April Pride, founder, Van der Pop, cannabis lifestyle, Seattle

In this post-legalization world of cannabis access beyond medical use and into the recreational sphere parents of teens find themselves suddenly faced with the need to discuss the use of pot with their adventurous children, adolescents forever attracted to the exotic and 'forbidden'. It's good strategy. Just as good strategy and very badly needed, as when parents begin to discuss with their children the ins and outs of intimate sexual relations, how babies are born and how best to deal with one's hormonal cravings to experiment and learn first-hand what all the fuss is about.

In the Toronto of recreational marijuana legality, a recent event titled Women & Weed took place, where a number of speakers addressed the audience interested to hear first-hand from those upon whom they look as 'experts' to guide them in their own perplexing search how best to handle the sensitive issue of parent-child discussions revolving around the use of cannabis. Uppermost in mind of these parents is the certain knowledge that young people will and do extend themselves to discover first-hand what's happening.

That, linked to the medical community warning of the deleterious effects of marijuana use for young people whose brains are still developing and who, with the use of pot, can expose themselves to harm, makes the issue of primary importance. At that event, the founder of SheCann, an online portal enabling women in Canada to share their own use of medical cannabis experiences, emphasized the importance she places personally on making these discussions a continuous dialogue.



Ashleigh Brown of SheCann spoke of her own experience with medical cannabis begun in 2016, using it medicinally giving her children the decided impression that pot was a medicine, nothing more. Then she initiated discussions with her 14- and ten-year-old daughters about cannabis used by different people for a host of reasons; not necessarily confined to health. Both she and April Pride stressed the importance of conversations with children, to prepare them for the inevitability of being knowledgeable to a degree about weed they'll come across in future on the street and at parties.

There is a correlation, they stressed, between advising and discussing with children the effects of recreational alcohol, and no less so with cannabis. And one of the critical issues in such discussions is to explain why it is that marijuana is meant to be used only by adults, and until such time as young people join that category of maturity, its use can present a future health danger. Both women explained that they lock their pot away from their children. Despite which they feel that avoidance of conversation about cannabis use creates an aura of stigma, unhelpful in persuading kids to make considered decisions.


They recommend using resources as for example from Canadian Students for Sensible Drug Policy which views problematic drug use as a distinct issue of health, not an issue for the criminal justice system, advocating instead for harm reduction support. Talking to children about why and how people make use of cannabis is a start. Sabine Dolby who uses cannabis by prescription hid it from her children when they were young. Now, aged 24 and 30, she smokes with her children as a regular user and with legalization, feels relieved not to have to hide her use any longer.

The Canadian Centre on Substance Use and Addiction's position is that consuming cannabis on a regular basis during adolescence has the potential to cause loss of concentration and memory, and reduce thinking to incoherence. In a 2015 report, the Centre stated that regular use of cannabis is associated with experiencing psychotic symptoms and the development of schizophrenia, particularly among those with a family history of the condition.

There is a caveat that connection between cannabis use and mental illnesses, particularly acute anxiety, is not clear entirely, requiring additional research. The general consensus remains, however, that the effect of cannabis on not-yet-fully developed brains -- up to age 21 to 25 -- makes it imperative that such discussions do take place.

Maren Caruso/Offset (leaves); Kichigin/Shutterstock (head); Sergejs Makarovs/Shutterstock (leaf)

Chilling Out With the Latest "Cool"

"The bottom line is the JUUL is the best example of a technology that delivers nicotine more efficiently."
"This is a genuine phenomenon. Everyone would like this to be a fad. The concern is that this fad involves a highly addictive drug in the form of nicotine."
"I've been in a corner store at the Slurpee machine with my kids and there's a 10-foot banner overhead [advertising vaping products]. It took 20 or 30 years to get rid of cigarette displays. They reach everyone who goes into the store."
"Flavour is [a] big driver for kids. It's what gets into their mouths. And then nicotine takes over."
David Hammond, professor, School of Public Health and Health Systems, University of Waterloo

The JUUL vaping device is rechargeable, easy to conceal and has a sleek design, all features that appeal to youth. Julie Oliver / Postmedia

"[JUUL was founded] with the goal of providing a satisfying alternative for adult smokers", the company states, but of course it's hardly debatable that 'adult smokers' would be drawn to such flavours as 'unicorn horn' and 'cereal milk', putting the lie to the company's feeble declaration of honourable intent. While tobacco smoking among adults is no longer as prevalent as it once was, nicotine-product manufacturers have been diligently exploring methods that would be attractive to a new generation.

Formerly known as Philip Morris Companies Inc., now Altria Group Inc., seeing a new wave of users enthusiastic for nicotine delivered in a modern, neat and streamlined package, have responded somewhat predictably by buying in to this new phenomenon through a 35-percent stake in JUUL Labs late last year, paying out close to $13-billion for the privilege. JUUL is a battery-powered, rechargeable device designed to heat a "Pod" or cartridge of "juice" containing flavouring and nicotine; the resulting vapour is what users inhale.

"I don't know if youth know how much nicotine is in them. They're consuming an entire cartridge in one shot."
"It's an emerging issue. We want to tackle it as soon as possible. We don't want to be dealing with it fifty years down the line."
"For some [users], getting fined will be a deterrent. Others can be convinced of the danger of nicotine because their parents smoke, and they've seen what it did to their parents. And some can be convinced that they're the targets of marketing, and they don't like it."
"Each school has its own culture. In some schools, there is little vaping. In some, it's in the bathrooms. In others, it's under the trees."
"For youth, tech is interesting. They can build their own. There are thousands of different kinds of juices and flavours. You can conceal it if you want [clouds of vapour], or don't conceal it if you don't want to."
Dana Periard, project officer, Ottawa Public Health, tobacco control and prevention

Ads for vaping devices in an Ottawa convenience store. Julie Oliver / Postmedia

In the city of Ottawa, Canada's capital city, bylaw officers take "enforcement action" when students are found to be illegally using vaping devices on school grounds. A bylaw office can issue a fine of $490 to anyone selling or supplying a vapour product to someone under the age of 19. The Ottawa Catholic School Board has given the authority to its schools to remove doors from school washrooms to more readily enable staff to determine what is happening there; vapour is a dead giveaway. Schools have also been authorized to issue fines of $305 to students caught vaping indoors.

The Smoke-Free Ontario Act, amended in October to include vaping, enables school principals to call in bylaw officers to attend to vaping students. "I am extremely confident that the removal of washroom doors and the issuing of fines will discourage those tempted to vape or smoke indoors", commented the principle of one school in the Catholic School Board. In contrast to that move, the public school board has no plans to remove washroom exterior doors but does provide evidence statements to bylaw officers enforcing no-vaping regulations.

The new fad of school bathroom vaping seems to have occurred as a virtual overnight sensation as the JUUL brand name made its way into the high school lexicon as a tempting foray into disobeying adult authority to the extent that teens now refer to school washrooms as the "JUULroom". The device is attractive to youth challenging authority; its sleek look, ease of use, readily concealed size make it irresistible to slip in "pods" delivering flavoured nicotine salts.

A single pod contains nicotine equivalent to 20 cigarettes. Teens vaping an entire pod at a time become nauseous from overconsumption of nicotine, leading the new lexicon to expand with the inclusion of "nicking out". Professor Hammond has been receiving emails from school principals across the country seeking advice. Close to 21 percent of high school seniors claim to have vaped in the past month in 2018 where in 2017, that number was 11.7 percent.

The U.S. Surgeon General Jerome Adams in December issued an unusual public health advisory addressing the "epidemic" of e-cigarette use among teens, fuelled by new types of e-cigarettes recently entering the market. He noted that JUUL experienced a 600-percent leap in sales in 2016 and 2017. Health Canada for its part announced a week ago a campaign to warn youth of the risks of vaping.

Recently a province-wide survey of teens and substance abuse revealed that ten percent of Ottawa  high school students in 2017 had vaped. In comparison, six percent of students had smoked. It is Ottawa Public Health's intention to work toward a goal that would see the "de-normalization" of vaping and to that end work with bylaw enforcement along with police and addiction counsellors is proceeding.

Vaping has the potential to assist adults who wish to stop smoking, by weaning them off tobacco, even while it presents as a risk to youth. E-cigarettes and vaping are acknowledged as less harmful than smoking so the potential is there to reduce risk for smokers as long as they commit to transition from cigarettes to e-cigarettes, according to the U.S. Surgeon General. The reality is, however, that a majority of adults who make  use of e-cigarettes do so only to supplement their regular cigarette smoking.

Photographs of JUUL vaping kit Julie Oliver / Postmedia