By Gene Beresin, Executive Director and Khadijah Booth Watkins, Associate Director

Posted in: Podcast, Teenagers

Topics: Addiction & Substance Misuse

In 2024, the CDC reported that 1 in 29 middle school and 1 in 13 high school students vaped in the past month. This statistic is especially troubling, given that 9 in 10 adults who smoke daily first tried smoking by the age of 18.

In this episode of Shrinking it Down, Dr. Randi Schuster, Director of school-based research and program development at the MGH Center for Addiction Medicine joined Gene and Khadijah to help educate parents and caregivers to best recognize the signs and symptoms of teen nicotine use and restorative strategies being used in schools.

Media List

• Randi Schuster, Ph.D.  (Center for Addiction Medicine)
• Center for Addiction Medicine (MGH)
• iDECIDE
• Truth Initiative: freedom from nicotine addiction
• Smoking and Tobacco Use | Smoking and Tobacco Use (CDC)
• Tobacco/Nicotine and Vaping | National Institute on Drug Abuse (NIDA)
• Highlights for the 2021 National Survey on Drug Use and Health (SAMSA)
• My Life My Quit

Episode Transcript

SPEAKERS: Gene Beresin, MD, MA; Khadijah Booth Watkins, MD, MPH; Randi Schuster, PhD

[INTRO MUSIC PLAYS]

Randi Schuster 00:01

And now all of a sudden, we’re seeing this resurgence of teen nicotine addiction, which is, you know, really reverse decades of public health progress. And it’s, it’s coming through multiple angles. So you, you noted social media. Social media is a huge point of exposure for kids.

[INTRO MUSIC ENDS]

Gene 00:28

Welcome back to Shrinking It Down: Mental Health Made Simple. I’m Gene Beresin

Khadijah 00:32

And I’m Khadijah Booth Watkins.

Gene 00:35

We’re two child and adolescent psychiatrists at the Clay Center for Young Healthy minds at the Massachusetts General Hospital.

Khadijah 00:42

In 2024 the CDC found that one out of every 29 middle school students and one out of every 13 high school students reported electronic cigarette use in the past month, and of those who use more than 1-in-4 currently use an e-cigarette product daily. And if that’s not bad enough, they also estimated that 8% of all middle school and high school students have used a tobacco product in the past month. So, these numbers are really, really kind of jarring

Gene 01:11

Yeah, and you know, it’s especially troubling since 9-in-10 adults who smoke daily first tried smoking at the age of 18, and we can ask our special guest about this, but I even when I was in high school, if, if you started smoking in high school, it was, it continued, but, but let’s, let’s see.

Khadijah 01:35

I mean, so this really tells us that the vast amount of people who are using, like you said, start as teenagers. And I think this really gives us a quite a bit of a runway to be able to think about, how do we engage in preventative strategies and intervene early when kids are using so that we can kind of curb these numbers and bring them back.

Gene 01:53

Yeah, and here to help us explore this super important issue is Randi Schuster. Dr Schuster is director of Neuropsychology and director of school-based research and program development at the MGH center for addiction medicine, as well as Associate Professor at Harvard Medical School. Dr Schuster’s work aims to define the cognitive predecessors of adolescent substance abuse, the effects of substance use on cognitive performance, and that generally means how one thinks and the result of their thinking processes, and how these other factors affect treatment engagement and functional outcomes such as academic performance. So Randi, welcome.

Randi Schuster 02:37

Thanks. Thanks for having me.

Gene 02:39

Did I get anything wrong?

Randi Schuster 02:41

Sorry sorry for the mouthful. Excited to be here.

Khadijah 02:45

Well, we have a lot to talk about, so we’ll just jump right to it. And I and so we talked about the statistics and how sobering they are. But I bet parents want to know, what should they be looking out for? Like, what are the signs or symptoms that their child might be addicted to nicotine or even use it?

Randi Schuster 03:05

Yeah, it’s a great question. And, you know, I think it’s important to know that, you know, the way that nicotine addiction, or the way that nicotine use looks in kids right now looks a lot different than I did when many of us were growing up, but the signs and symptoms of addiction are the same. The products have changed, but the signs and symptoms look awfully similar, and it really can sneak up on people. So identifying early signs is in is critically important for, you know, for for breaking it early and for long term treatment outcomes. So alright, so what does it actually look like? One of the first things to look for is craving. This is one of the biggest red flags. So if your team finds themselves reaching for a cigarette or a vape or a pouch first thing in the morning or struggling to get through a day without it. It’s a strong sign of dependence. You know, in in my work, one of the telltale questions, the most important questions that we ask is, How soon after you wake up do you want to hit your vape? And we find that kids who say that they want to hit their vape within 30 minutes of waking up, are more likely to meet criteria for dependence than those who don’t feel that that craving early in the morning withdrawal is another thing to look for. So, when someone goes too long without nicotine, they might feel irritable or anxious or have trouble concentrating. Some people experience headaches, trouble sleeping, increased appetite. The the other two things that I would say to be on the lookout for our tolerance, so meaning, over time, if you feel like you need more nicotine to get the same feeling than you did when you first. Started using that can be a strong symptom of probable addiction, and the last is unsuccessful quit attempts. So a common myth is that kids who are using nicotine don’t want to stop, and what we find is that actually most kids who are using nicotine products regularly know that it’s a problem and actually want to make a change, and have tried to make a change, but have a challenge, really struggle to do that. So those unsuccessful quit attempts can also be another major symptom of the probable addiction.

Gene 05:40

So I’ve noticed with many of my patients that the parents don’t know that the kids are using they hide it. They’re good at hiding it, and now there are some that actually are open and have conversations with their parents. And I recommend to all the young people that I see that they actually, you know, come clean. But what do you look for if, if, if a kid is doing it, you know, secretly,

Randi Schuster 06:10

It’s a great question. So a few things. So one, you know, in terms of products, devices, things in their room that look unfamiliar, especially with vapes, a lot of vapes are masquerading as common household goods, so things in their room that don’t don’t look familiar to you, are often a way to prompt a conversation unusual spending habits. So if you’re if your teen has a job and is often short on cash, having conversations around where those that money is going, I think is a good starting point. The main thing that I tell parents and caregivers, though, is really thinking about the phrase that I often use with caregivers is really thinking about addiction as often the smoke and not the fire itself. So really thinking about what are the other signs and symptoms that they might be bringing to the table, thinking about symptoms of depression, anxiety, ADHD, all of the other things that might be a reason for kids reaching for a vape or reaching for a drink or reaching for their cannabis use and and using that as an entry point to start a conversation. You don’t necessarily need to see the vape in somebody’s hands to start a conversation around risk for addiction.

Gene 07:38

So but when you say, look for other things like depression or anxiety or other other behavioral problems, but it sounds to me like this is very much like dual diagnosis in alcohol misuse or In various other kinds of disorders, where addictive disorders that are often coupled with psychiatric problems, would you say that that there is a higher rate of depression, anxiety, obsessive compulsive disorder, PTSD, the whole range of psychiatric problems In kids that that are, that are using tobacco products.

Randi Schuster 08:23

100%, 100% yes, we actually published a paper in JAMA Pediatrics in last year where we surveyed kids in middle school and high school kids in Massachusetts, and looked at the relationship between frequency of alcohol, cannabis and nicotine use and expression of CO occurring other mental health concerns, and we focused on depression, anxiety, ADHD symptoms, unusual perceptual experiences or psychotic experiences and suicidal thoughts and behaviors. And we found across the board that as kids engaged in more frequent substance use, and it didn’t matter whether it was alcohol, nicotine or cannabis use, their expression of all of these mental health symptoms also increased, or the risk for those symptoms increased. And this has become a really important conversation. I do a lot of school based work in our my conversations with schools, and so, you know, I do a lot of thinking with schools around alternatives to punishment, and that if we catch a kid, you know, vaping in the bathroom or in violation of school substance use policy, that we really should be using that as an opportunity to talk about all the other things that might be going on in that kid’s life that might serve as a risk factor for initiating substance as well as progression of substance use. So absolutely, you know, we see increased risk for multiple different psychiatric concerns in kids who are vaping nicotine, and whether that’s cause or effect, there’s a that’s a long conversation that. Uh, maybe we’re going to engage in today, but, but it almost doesn’t matter. At the point in time when you have somebody, you have a kid who’s vaping, we need to be thinking about substance use along a mental health continuum, and thinking about what are the reasons why they’re using and a lot of kids, a lot of the kids that I work with, are increasingly saying that they’re using nicotine vapes. They’re smoking cannabis to attempt to alleviate some sort of adverse emotional experience, whether or not it’s effective or not. Again, a longer conversation, but a lot of kids are increasingly saying they’re using because they think it’s their medicine, rather than, you know, they just love the feeling of the buzz, right? And hearing that as much.

Khadijah 10:47

And I think that really takes us back to that earlier point where there’s just so much room here and opportunity to really engage early and educate early and use some of these kind of missteps, is teachable moments to kind of teach the kids to the about the risk, the risk, and try to identify what else is kind of playing into this picture. But, but with that, you know, all of these kids finding out about these products, you know, I think you know, there’s definitely, and I’m sure there’s advertising and social media and their peers, but we also know that, you know, Instagram and other social media platforms have banned advertisement and formal promotion of like nicotine and nicotine devices, but the policies aren’t really enforced, and then you have these kind of this informal promotion through through, you know, influencers and the like. So, so how do we take all of this into account when we’re thinking about how our kids are being exposed and they’re being kind of alerted to the newest and latest devices to use to partake in nicotine, yeah,

Randi Schuster 11:51

I mean, I mean, you hit on a really important Point, which is the ubiquity of exposure to nicotine products, which has increased, I think, in in recent years. And you know it, we really are in kind of unprecedented and unprecedented times right now where, you know, we came a long way with the prevention of teen cigarette use. You know, 50 plus years of tobacco control policy, which nearly eradicated cigarette Use in Teens, when we were seeing use at historic lows before Juul entered the market in 2015 and now all of a sudden, we’re seeing this resurgence of teen nicotine addiction, which is, you know, really reverse decades of public health progress, and it’s, it’s coming through multiple angles. So you noted social media. Social media is a huge point of exposure for kids. And yes, they have. There have been new policies that have restricted kind of formal advertising to kids, but you know, we’re seeing influence influencers and viral content really kind of doing the bidding here of tobacco companies, you know. So as teens are scrolling through their feed, they’re going to come across someone that they admire, an influencer, a musician, you know, even just an older, cool peer, casually vaping in a video or posting about it. And, you know, it’s not always outright promotion, but the message is clear, which is, this is, you know, you can’t see me here, but you know, quote, unquote, normal or trendy, right? And they’re viewing this not as advertising. Kids are viewing this not as advertising. They’re viewing this as lifestyle, right? Which is becomes a, you know, more challenging message to intervene upon. And I’ll note, these are strategies, albeit not through social media, but this idea of likening nicotine use with lifestyle choices is exactly the same thing that big tobacco did decades ago, right? We’re seeing the strain same strategies really ripped out of the pages of the Big Tobacco playbook.

Gene 14:14

But is it okay? I mean, are they abiding by, you know, there was the big tobacco settlement, you know, what, $300 million and and they couldn’t advertise, and it was banned. And then we saw a second wave of of not being able to smoke in public places, and secondhand smoke was, was, was forbidden. So how do they get around those regulations in terms of media? I mean, we don’t see it on TV, is it’s largely in digital media and, and, and what’s the justification for these tobacco companies to actually promote these products in terms of having, for example, celebrities vaping? Or using whatever.

Randi Schuster 15:04

So we’re not seeing that as we’re not seeing as much of the paid advertisements, right? And the way that we did, like when in the with the vaporized campaign, of when jewel entered the market, where it was, you know, these really slick advertisements. And you really can do a side by side comparison of, you know, the Virginia Slims advertisements and the Marlboro advertisements. And what we saw with the jewel, bright colors, cool teens really like, again, it’s, it’s all about, all about lifestyle as I think we gained increasing awareness of that, these were dangerous tactics that were being redeployed there. There was a crackdown on that. And so now what we’re seeing is this informal advertising where it is, you know, the the the the horses out of the stables at the same the something’s out of the something stable bar, and I’m gonna mess it up, Mike and but now, now teens are doing the advertising for the companies, right? And that that’s not something that you can police in the same way, or that you can regulate in the same way, as saying, you know, vaping Company X, you can’t pay for these advertisements anymore. It’s really kind of the we’re doing it for, for ourselves at this point.

Gene 16:37

Are they influenced by any outside folks other than themselves, who’s just losing them?

Randi Schuster 16:49

I mean, sure. I mean, you think about, I remember watching the was it the Oscars A few years ago, and Leonardo DiCaprio is gets up and accepts his award and hits his vape while he’s accepting an award on stage. You know, this is or you drive out, I remember for a while you drive out of, you know, Logan Airport, and the first billboard that you saw driving out of Logan, stop there right now, but was smile, Boston, weed is legal, right, you know. And so it’s you. We’re just seeing this proliferation of normalization of of cannabis and nicotine use, and those really are kind of being yoked together because of common modes of use, right? A lot of kids, when we’re talking about vaping, we should also be clear, you know, we’re we have, we often kind of think about it as nicotine use only, but a lot of kids are vaping cannabis as well, and sometimes it’s difficult to know even what what products they’re being exposed to.

Gene 17:50

So so do you think that the legalization of of marijuana, of cannabis, actually resulted, inadvertently in increased use of tobacco. And that’s a leading I know that’s a leading question. Is that a leading question?

Randi Schuster 18:09

And there’s so many layers to that question, Gene I think the commercialization of cannabis led to and will continue to lead to a decreased perception of harm. And we know that decreased perceptions of harm often predate increases in use. What we’re seeing, you know, look the data on the impact of cannabis legalization on Team substance use. I’ll say that pretty broadly, it’s really missed. It’s very messy, and there are a lot of reasons why it’s messy, and it’s in part because, even though legalization often happens at a state level, there’s a lot of heterogeneity, or a lot of variability in how it’s actually implemented at a local level. So there was really, there was a paper that was published, oh, what I say was November last year, that really last year I was in 2024 in the American Journal of Public Health, that really knocked me off my seat, where I was looking at Data, Kaiser Permanente data in California, and looking at the impact of in the years following cannabis legalization, the impact of local policy, right, how the local jurisdiction enacted that, that legislation on teen substance use, and what they found is, while they’re not seeing increases in use in the in the state as a whole, in towns and communities that allowed dispensaries in towns and communities that had closer proximity of the dispensaries to schools in towns that allowed delivery of cannabis products or storefront advertisement, storefront advertising. Increases in both substance use and problematic substance use. So, you know, I think, you know, we could debate all day, I think on the you know, whether or not cannabis should be legal or not. And I really probably could argue both sides of the coin there, certainly, you know, decriminalized, but the commercialization, I think, is a whole, an entirely different beast. And we just, we know, we know from decades and decades of public health policy work that the more that you tie a substance to, you know, appearing cool and trendy and sexy, the less harmful kids are going to view it to the

Gene 20:49

so do you think like back back in the days when we were when there were the campaigns for not smoking in public places and secondhand smoke, and there were all kinds of, I remember the ads. I mean, they were just like gruesome, I mean, about death and lung cancer. I mean, do you think that that’s that we need more of a campaign to show the dangerous impacts of nicotine? And perhaps, you know, and again, cause and effect is hard to determine. It whether it’s a gateway to use of other substances or whether the other substances lead to this nicotine use. Do we need to do? We need to have public health campaigns about the dangers and the harms of nicotine use.

Randi Schuster 21:41

You know, I mean, I mean in, I tend to, in my I work with teenagers mainly. And I, you know, I often find that this, the scare tactic approach, often, is not the best strategy with teenagers, particularly once they have already started to use. I think honest education is critical, I think, and I think honest education, and especially, you know, with nicotine, vaping and with cannabis, this is we don’t have any long term data on the long term impacts of high potency cannabis products or vaped nicotine on the developing brain? The data just don’t exist, because these are novel products. So I am we certainly could speak to the dangers of nicotine addiction, right? But I do think we need to be really careful to make sure that our messages do align with the science. We know that when we overstate the science or misrepresent it, we lose credibility. So I think it’s really important to, you know, have quote, unquote Honest, honest advertising here to me, where I think our biggest room for improvement both as as you know, I’m a parent, and as you know, as a mental health professional and in work with schools, is education and education early, you know, I’m doing a lot of work right now, right now, on an elementary school universal prevention, substance use prevention curriculum, right I have a daughter who’s in first grade right now. I hope she has never been exposed to cigarettes or vapes, but they’re starting to talk about risk factors for right? So a prevention curriculum, a substance use prevention curriculum, doesn’t need to necessarily, you know, can be developmentally tailored, right? But thinking about resiliency and social determinants of health and and mental health promotion, right, early self advocacy skills, right, conflict management resolution skills, all of these things that we know are risk factors for later initiation. We need to be starting that early. The other thing that I think we really need to be doing differently is we have come a really long way, I think, in destigmatizing or reducing stigma around many forms of mental illness, we have not done a proportional effort in reducing stigma around substance use, and I think creating more, really working to realign substance use along a mental health continuum and addressing what are, as we were talking about before, what are the mental health risk factors and consequences of substance use. I think it’s just so cannot be understated here.

Khadijah 24:45

And we keep going back to over and over again, the importance of, you know, early prevention, which really comes through education and educating kids and families as possible. And we’ve been talking about these numbers, which are really. Really again, super concerning. But do you really think, and we you and I talked about this a little bit offline before we started. Do you really think the levels of e cigarette use has increased compared to the past decade or so? Or do we think that due to the ease of access and how easily it could be done covertly, making us see it a little bit differently, if you will, you know, so now that we are seeing it more prevalently, like kids are smoking in schools, they’re in the movie theater smoking there. You can see them on the playground, you know, it’s odorless, it’s somewhat smokeless, and so it’s so easy to conceal. So do you think that is really what’s happening? Because when I did some research, I was a little bit shocked to see that it appeared that the numbers or the rates were going down. And if that’s true, how do we reconcile how much we are talking about it and seeing it to the fact that it’s actually going down? Like, what do we contribute that to? If that, if that’s true?

Randi Schuster 25:54

Yeah, I mean, I think that’s that’s, you raise a number of good points there, and the I’ll start by saying the rates certainly skyrocketed for no other reason, other than these products were not around before. You know, Jewel entered the market. I think we can fact check me here, but I think it’s 2015 is when jewel first entered the market. It changed the game for for teen nicotine use and you know, if I need to pull my numbers again, but I want to say 20. The rate of change from 2017 to 2019 was the largest increase in youth substance use in for any one substance in recorded history, right? It was an enormous uptick in kids who are were reporting that they were engaging in current e cigarette use. Since then, rates have come down a bit, which is, I think, you know, a testament to this was an emergent problem, and it has rallied a lot of public health support and advocacy and changing legislation, which is great, and even though rates have come down, it is still A pervasive problem, and we have a bit of a whack, a mole problem emerging under our feet here, which is there has been increased regulation around e cigarettes, and now new products are sneaking their way in, right? So now we’re

Gene 27:34

Like pouches, like pouches like Zyns. Yeah, so called Zins. Have you seen an increase since they came out?

Randi Schuster 27:42

Yeah, we have. And if we thought the the discretion that came with E cigarettes was a problem that’s going to be dialed up even further with sins, because these are just little pouches you can park in your mouth, and there’s no device, there’s no vapor, there’s no and so all of the work that schools have done in terms of increasing ways of detecting and responding to E cigarettes, now we’ve got a new product. And the problem with, you know, the the you know, I you know, I hope this isn’t too much of the you know, this isn’t an overstatement, but you know, we have a problem where we have this just monumental increase in nicotine addiction in a way that we hadn’t seen in for years prior. You then make those products more difficult for kids to access without providing increased access to treatment for these kids who are now addicted to nicotine, they’re going to look for other ways for managing symptoms of, you know, their craving and their withdrawal. Nicotine is a highly, highly addictive drug. It’s the most difficult drug on the platelet to quit using, right? So it’s, you know,

Khadijah 28:58

it’s, it’s, and so at the Clay center, we typically talk about the three W’s, you know, what to look for, when to worry, what to do. And we talked a little bit about earlier, like, what to look for, what parents can look out for. But what can parents do, and how do they help their young person, you know, stay away or abstain from from nicotine, or in these other kind of dangerous habits that they can pick up, or if they’re already using, how can they support their young person and help them to to get to the place to quit. And then you mentioned that there is more and more availability and access, but there’s fewer and fewer programs and options for them if they do want to quit. And so how, what are parents to do in this kind of conundrum?

Randi Schuster 29:38

Yeah, so, I mean, I think a few things. So one, and I have this conversation with a lot of parents and caregivers, is being aware of their own habits and their own you know, whether they are vaping or smoking or using cannabis? But being mindful of what they are modeling and bringing to the table. Kids see this, and it is a way of normalizing use so I think if that is, you know, one of the first things I talk about with caregivers, if you know, to the extent to which that’s relevant, is making sure caregivers are getting the support that they need. So that way, that they are bringing that home of normalizing, that it is okay to B, to talk about this and to seek support. I think the other thing to be aware of, which is, again, as as a parent, a very challenging thing to implement in practice, but making sure that you’re having conversations when you are not at an 11, right? And so you know, if you find a vape in your kid’s room or or you know you are suspicious that they are vaping, making sure that you are doing what you can to regulate your own emotions so that you can have a constructive, empathic conversation, and you are not leading with anger and accusations. We really do want to be leading with compassion and curiosity, and that can be really hard to do around topics such as substance use. So seeking the support that you need practicing those conversations. There are a lot of resources out there around how to have those types of productive conversations around something that has historically been linked with punishment and breaking of rules. And so, you know, again, really just seeking that support, and then in talking to professionals. So while this is an area that where treatments are emerging, there are, you know if, if, if you worry that your teen is addicted, or your teen expresses concern that, that, that they might be struggling with addiction, there are resources out there. They’re free texting programs that have been found to be effective through the truth initiative. We have a paper that hopefully will be coming out very soon, really supporting the the effectiveness of different medications for helping kids reduce craving around nicotine, nicotine addiction through vapes. There are things out there, so I think starting a conversation with your pediatrician or your kids mental health provider is a great a great place to start. I just

Khadijah 32:22

want to circle back to Conversations, because I think we talk a lot at the Clay center about having these conversations with your kids, and there’s no quicker way to shut down a conversation or to have a kid just kind of close off if you’re super angry or super judgmental. But we also talk a lot about having these conversations before there’s a problem, kind of like Heidi mentioned about the curriculums in school, but talking to your kids about, you know, what is out there, what kids are doing, you know, maybe, you know, re review the email that maybe was sent for school that was warning parents and kids about the use and, you know, talk to them about what their friends are doing and kind of get a sense to see, you know, what they know. What do they know about the dangers. I think there’s also this false, this false understanding or misconception that the smoking is not dangerous because it’s not a cigarette, and not not being aware of the, you know, the other kind of, not the nicotine per se, but the other things that could be done so long within your body, for some of the other kind of things that come with the smoke. So just having these conversations early on, like in the cracks, like, you know, on a walk in a drive and and on commercial breaks, little by little, so that these conversations also, when you do have to have the uncomfortable conversation, it doesn’t feel so so far out of left field.

Randi Schuster 33:34

I love that idea of having those conversations in the cracks. I’ve worked with a lot of my work with schools is around little I interventions, right? Like, what are the little moments where you can, where we can really create a foundational culture that is conducive to mental health promotion, right? And it’s not waiting for crisis to emerge where, that’s where all the resources get rallied around. But how can we start to, you know, my daughter’s school, I love this. At least they start each day with a mindful moment on the intercom after the Pledge of Allegiance, they do a mindful moment, right? And it’s just these little things. And I’m not suggesting that that’s, that’s, that’s a cure for nicotine addiction, but there are ways to set the stage at school at home that clearly communicate that one what our shared expectations are, what are the rules, right, and that it’s okay to talk about this. And I think you know that one of the things you know we also talk about with parents is also correcting the misconception that talking about this is going to introduce an idea that they may have not already had. I just this is going to look very different in different households, but being able to control the narrative a bit and being able to introduce coping. Strategies and you know, talking about myths and facts before they’re learning it from their peers is, I think, a really important way of also establishing you as the caregiver, as a reliable, non judgmental source of information and support, which also means get good information, right? There is a lot, especially around nicotine and cannabis. There is a lot of misinformation out there. There is also a lot of really good science. So increasing kind of your own scientific literacy skills, taking the time to learn the basics. You don’t have to become, you know, you know, get your PhD in biology to be able to have this information, but understanding the basics and being able to tease apart, what is the difference between, you know, high CBD, medical cannabis. You send high THC, potency, heavy cannabis use in kids with, you know, with, you know, ongoing brain development, getting the basics. So that way, if your kid comes with you to you with questions, you either have the answers or know that you you know, know that you feel confident in being able to get the answers or direct them to somebody who does so.

Gene 36:23

One thing that our audience always asks about is, what are the trusted resources? So what? What can you name a few sites on the web or organizations where parents can actually get some some of this basic information that you’re talking about, so that they have it, they have it in their pocket, and they can use it.

Randi Schuster 36:50

I’ll do a shameful plug for our website so, but

Gene 36:55

it’s not shameful. It’s not shameful because it’s trusted. It’s a trusted resource.

Randi Schuster 37:01

And we often, we use our website to at least pull together a lot of the resources that are out there. So we, you know, we have a program in Massachusetts schools called I decide. So our website is, idecidemyfuture.com or.org There are a lot of resources out there on that site for caregivers. Aside, some of us, plenty of other the truth initiative has great resources available. NIDA has a ton of excellent resources specifically geared towards a caregiver audience, the CDC, the FDA, SAMSA has some great resources available. But, you know, again, in an era where misinformation is, you know, I think, really dominating the market, and in an era where adolescent addiction has been driven by profit, really making sure that you’re getting your information from, you know, from scientific backed agencies is just, just essential. So those, to name a few, and all of those have you know, I think they’ve done a really nice job of curating their resources. The same information if it’s needs to be presented to kids, the same information, if it’s presented for teachers, the same information if it’s going to be presented to caregivers. So highly, highly recommend checking those out

Gene 38:30

And beyond that, are there things that parents and caregiver, or all of us can do at a community level? I mean, what going beyond the conversations, and I think perhaps they’re the most important to keep things local, but what are the things that could be done at a bigger level?

Randi Schuster 38:53

So, you know, I think advocacy, and as I mentioned, I think I mentioned before, when I was talking about, you know, the how cannabis legalization has looked very different, community by community. So too does access and availability of tobacco retailers in community by community. So, talking to your local government around, you know, zoning regulations and you know, different ballot initiatives, I think it’s just really important to get involved at at a local level, talking to your schools. And really think schools, whether they like it or not, have really been positioned to stand up the mental health prevention, the prevention arm of our mental health system, schools play really powerful role in creating safe spaces for kids, and so as I mentioned before, a lot of the work that we’re doing, and this has been driven in large part by the voices of caregivers, has been really changing. Uh, responses to substance use infractions at school. So, talking to your schools around, what are they doing when one to address nicotine addiction before it’s a problem. What is their universal prevention curriculum and approach look like? Right? Reading their school policy. Do they have alternatives to punishment lined up. What does it look like? You know, how are we educating? And we’ve been and embracing restorative approaches rather than punishment.

Khadijah 40:27

So, so we’ve been talking a lot about, you know, the nicotine and how bad of a habit it is. And I know we’re a little bit removed from the New Years. But you know, this is the time where we usually kind of set our New Year’s resolutions, and we try to kind of curb some of our own bad habits. Do you have any habits that you have sought to change in this new year that you’d like to share with us? And if you did, how did if so, how did you change it?

Randi Schuster 40:57

Oh, boy. How time do we have left? Well, I’ll share the one that feels actually most present for me most and this is one that my actually, my four-year-old daughter, has made very abundantly clear, which is my connection to my devices and my phone. This is very hard to not be connected to work at all points of time right now. And so, one of the things I’m really working on this year, and again, this is that strict demand of me for my four-year-old call you out. Oh, man, she’s honest. God, brutally honest. Is that what I’m trying to be when I’m home I’m home and really trying to be much more intentional with my technology use, and unplugging and unplugging from work, and plugging into my family when I’m home, and really making sure that I’m getting quality time both at work and Quality time at home. And you know, as I said, in recent years, finding it harder and harder to you know your time is split, and your attention is always, always, my phone has made that even harder. So, one of the things I’m really trying to do, we put it’s all these simple things, simple strategies. Strategies can be recycled for so many different, different habits, but we have technology free zones, so like the dinner table, no phones, no devices. So, we just know, like, that’s our that’s our space where, or bedtime, my kids still, I still put my kids to bed every night, and that’s phone stay out of, out of the room during bedtime, we have technology free times of the day. And you know, really, just trying to, trying to model for my kids that it’s okay to put, put the devices down, and it’s also okay for that to be really hard, because I screw up on the end a lot. And so also trying to normalize talking about that and I got more if we got, if we have time all day talking about my dad.

Khadijah 43:16

Thank you sharing Gene. Did you have a habit that you tried to change or that you’re, you’re working on,

Gene 43:23

Oh man, well, I the device is absolutely, although I’m, I think they’re, they’re still winning. But I’m trying. I think I work to learn to say no. I mean, it’s taken me a long time, but, I mean, there’s so many incredible opportunities, you know, particularly that are work related, or that are field related, you know. But I have to, and I’ve said yes to so many things that it’s just kind of made my life too complicated and too time consuming, so that I don’t, I don’t have time to do the things that I really want to do, like play the piano, like compose, like ride the bike. You know, take a walk, you know, go out and play frisbee with my dog. I mean, see my grandchildren. I mean, there’s just, if I could just learn to cut back on these other things that I have filled my plate with, I think that’s what I’m trying to work on. How about you?

Khadijah 44:45

I love both of those, and I really, I think I’m still working on that too. Gene, and someone told me, and I tell the fellows all the time, you know, saying no allows you an opportunity to be open for something that you really want to do and that you really can, you know, give 100% to. And. Opposed to, you know, being spread out too, so thin over many things that you are, you’re, that are important to you, but maybe that you’re not passionate about. But that is so hard to say no, because we tend to be passionate about so many things. And I’m also working to be more present at home. My kids are older, so they don’t really want to be so present with me at home when I’m working on on that as well. Like I feel like the home life balance, the constant balancing and rebalancing, but the one small habit that I’m trying to work on is at least going to the gym for 20 minutes a couple of times a week, and I’m really just being deliberate about it, setting my alarm clock, not taking no for an answer, like talking myself through all of the excuses that I know I’m already going to give you know, and troubleshooting those in advance. And so in doing so, I’m able to, like, at least three or four times a week go to the gym for 20 minutes, and I’m not doing anything outrageous, like I’m walking on a treadmill at an incline for 20 minutes, and I feel like that’s me, at least starting my health kick. So

Gene 45:58

We have to wrap up, Randi thanks so much for all of this.

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I’m sure that this is going to be super important to a lot of folks who are listening, and there’ll be lots more questions, I hope so maybe you know we can come back and do a bit more about this, and that’s great. So, for those of you at home, if you like what you’ve heard today, consider leaving us a review. If there’s things about substance use, tobacco you know, or anything in the habit, habits, just let us know. And as always, we hope that our conversation will help you have yours. I’m Gene Beresin.

Khadijah 46:40

And I’m Khadijah Booth Watkins until next time.

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Episode music by Gene Beresin

Episode produced and researched by Spenser Egnatz