Understanding E-cigarettes and Vaping

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“Would switching to an e-cigarette be helpful?” is not an uncommon question to hear working in tobacco treatment, even with the nationwide panic over vaping occurring just under a year ago. Since their introduction into the U.S. market in 2007, e-cigarettes have been seen as a way to potentially aid in tobacco reduction/cessation by many, but most specifically the industry’s marketing teams. Additionally they’ve been marketed towards teenagers and young adults through social media and youth-oriented flavors, and as result we’ve seen major growth in use over the last five to ten years. Because of this, it continues to be important to consider the health risks and concerns that come along with e-cigarette use. 

Background

E-cigarettes are a type of electronic nicotine delivery systems (ENDS), and are also commonly referred to as vapes or vape pens, as well as various brand names (example: JUUL). The devices work by producing an aerosol from a liquid that’s heated within the device by a metal coil, which the user then inhales. “E-liquids” are made up of nicotine, glycerin or propylene glycol, flavorings, and various chemicals. The aerosols that are inhaled may also contain  ultrafine particles and heavy metals like nickel, tin, and lead. 

When they were initially introduced to the market, e-cigarettes looked very similar to combustible cigarettes and were a disposable product. Since then, we’ve seen major changes to both the appearance and functional capabilities of these devices – and not necessarily for the better. E-cigarettes and vapes no longer have one design, instead they now might look like pens, lighters, highlighters, USB devices, or even inhalers. In addition to modern generations being refillable and/or reusable, users can modify what is being put into their e-cigarette which leads to the ability to use marijuana and other substances with these devices

Growth, Marketing, and Current Use

The first time I saw an e-cigarette was at least 10 years ago in a kiosk in the local mall (those who frequented Briarwood mall in the 2007-2010 might have memories of this as well), and what I remember specifically is that they were primarily being marketed as a way help adults who smoked quit cigarettes. At some point the kiosk was changed, and I didn’t really think about e-cigarettes or other ENDS products for many years. During this time, e-cigarette and vaping companies began to make major strides within the market, with focus shifting from current tobacco users looking to quit smoking to youth and young adults .

E-cigarettes are currently the most commonly used tobacco product among youth in the United States, with over 5 million middle and high school students reporting use within the last 30 days in 2019. Specifically between 2011 and 2015 we saw a 900% increase in use within this demographic. Some (and likely most) of this growth can be attributed to the youth-oriented marketing that has been present in the last 5-10 years. Examples of this marketing include brightly colored ads (like the one below), social media use (including hashtags like JUUL’s #vaporized), promotion through celebrities and “influencers”, and youth-targeted flavors (fruit, candy, and mint). These efforts have succeeded in reaching U.S. youth, with more than 5 in 10 (over 14 million) middle school and high school students reporting seeing e-cigarette advertising in 2018. 

People use e-cigarettes and vapes for numerous reasons. For adults these include: to aid in quitting combustible cigarettes, to get around smoke-free laws/regulations in public spaces, and that they view them as a “safer” or “healthier” option. Youth also often believe e-cigarettes and vapes to be less harmful than combustible cigarettes (many are also unaware that these products contain nicotine) and have cited novelty and flavors as additional reasons for use.

Health Risks

Being a “safer” alternative to smoking is a commonly cited reason for using an e-cigarette, as well as being a belief many have seen used to promote these products by companies and other pro-vaping organizations and groups. Something that is seen far less in these promotions is that “safer” does not mean SAFE. There are still health risks and concerns when it comes to e-cigarette and vaping product use, with more research on long term health impacts still needed. These risks include:

  • Nicotine/nicotine addiction – particularly a concern for those under the age of 25 and pregnant individuals as nicotine is associated with issues with attention, learning, mood, and impulse control within the developing brain
  • Harmful chemicals – including cancer causing chemicals and chemicals like diacetyl (chemical flavoring) which is linked with serious lung disease
  • Inhalation of ultrafine particles and heavy metals such as nickel, tin, and lead
  • Increased likelihood for dual use and increased likelihood for using combustible tobacco products later in life 
  • Unintentional injuries – such as explosions and/or fires caused by defective batteries or poisoning caused by swallowing, breathing, or absorbing e-cigarette liquid through the skin or eyes
  • Secondhand exposure to chemicals via aerosol 
  • E-cigarette or Vaping product use Associated Lung Injury (EVALI) – has been linked with vitamin E acetate and THC containing products, and research continues to look into other causes and risks

You can find more information on health risks and resources for discussing e-cigarettes (particularly with youth) on the CDC, Michigan Department of Health and Human Services, and Surgeon General webpages for e-cigarettes and vaping. 

Regulations 

E-cigarettes are currently regulated at the federal level by the FDA, which implemented regulations for sales and manufacturers, and some regulations to ban flavored (non-menthol) cartridges. Additionally, the FDA began recognizing ENDS as a tobacco product in 2016. In Michigan, we have two laws that currently regulate e-cigarette use and sales which:

  • Define “liquid nicotine” and “liquid nicotine container”, as well as establish minimum safety standards for these containers
  • Define e-cigarettes and vaping products separately from tobacco products
  • Requires these products to be stored in a locked case or behind the counter in vape and smoke shops
  • Prohibits sale to minors 
  • Prohibits use/possession by minors

Like the FDA, Michigan and other states across the country have attempted flavor bans or other regulations of flavored e-liquids. Overall there have been issues with these attempts not being strong enough. Menthol and mint flavors are often not being targeted by these bans, and some brands are able to avoid them through device design, allowing for flavors popular with youth to remain on the market. 

It should be noted that due to some of these efforts and restrictions at the federal and state level, there has been a shift in marketing tactics. Specifically JUUL, the largest e-cigarette and vaping company in the U.S., has removed their candy flavored “pods”, cleared out their social media, and given their website a sleeker and more mature look. With these changes, it appears they (along with other companies like IQOS) are now focusing their marketing on adults who currently smoke or adults who are looking to quit smoking. 

Use in Tobacco Cessation 

One of the most commonly asked questions when it comes to e-cigarettes and vaping products, and the question I decided to start this blog off with, is whether or not these devices are useful in quitting combustible cigarettes and other tobacco products. In a world that loves clear-cut answers, this one will certainly be unsatisfactory, and it is: we don’t know. Like long-term health impacts, there is still a need for more research on this topic moving forward. However, it should be noted by all who are considering using any form of these products that there currently is no evidence to support their usefulness in tobacco cessation. There is also concern that dual-use (i.e. use of an e-cigarette/vape and use of combustible cigarettes/tobacco products at the same time) may occur in those who try to use e-cigarettes to quit smoking. Additionally, e-cigarettes have not been approved by the FDA as an aid for quitting smoking, but there are currently seven approved quit medications that you can learn more about on our most recent tobacco blog.

The bottom line is that while these devices may be safer in some aspects, safer does not mean safe. Specifically, e-cigarettes and vapes are not safe for youth, people who are pregnant, and people who do not currently use tobacco products. There are numerous cessation aids and strategies that have been shown to be successful for people looking to quit their tobacco use, all of which should be considered first and foremost.

Have additional questions about a blog topic or just interested in finding out more about Unified’s Tobacco Reduction services? Contact your local Tobacco Treatment Specialist:

Detroit:
Amber Jager – (269) 350-3826
ajager@miunified.org

Ypsilanti/Jackson:
Caitlyn Clock – (734) 489-9916
cclock@miunified.org 

Building Your Quarantine Routine

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It’s fair to say that our lives feel completely different than they did a month ago, with COVID-19 and stay at home orders turning our world upside down. This ever-changing new normal results in the loss of our daily routines and increased uncertainty about what the future may hold. Many of us are experiencing increased feelings of stress, frustration, boredom, anxiety, and depression. As such, it’s important to find a way to establish a sense of normalcy in our daily lives.

COVID-19 and Tobacco Use

For people who currently smoke, there are additional health concerns when it comes to dealing with the COVID-19 pandemic (as discussed in the most recent tobacco blog). COVID-19 is a lung infection, and therefore people who currently use tobacco are at a higher risk of developing more severe and/or prolonged symptoms if they do contract the virus. In addition to physical health, COVID- 19 can contribute to emotional triggers that may lead to an increased want or need to smoke. This can have a negative impact on your goals to reduce or quit your use, or even just increase your tobacco use overall

Why bother with a routine?

Having a daily or even a weekly routine can help support your physical and mental health, and help prevent an increased reliance on tobacco products. For some individuals who smoke, their tobacco use may be seen as one of the only things in their life they have full control of, and a global pandemic will likely only contribute to that. Having a routine may help provide structure to your day and give you a sense of control over your daily life during this time. 

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What should my daily routine look like?

It’s important to remember that your routine doesn’t need to look exactly like anyone else’s, have every minute of every day scheduled, or completely deviate from your current (or non-pandemic) routine. Your routine also doesn’t have to incorporate all of the following components, but rather use them as ideas to start structuring your life during the COVID-19 pandemic. 

  • Maintain a sleep schedule – keeping a consistent sleep schedule is important for your health in general, but during quarantine especially. Waking up and going to bed at similar times each day helps keep your days structured and promotes healthier sleep
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  • Get dressed for the day – when you don’t have anywhere to go it can be very tempting to remain in your pajamas all day. But getting dressed (or at least changing into something other than what you slept in) keeps your mornings consistent and allows for predictability in your life during an unpredictable time. 
  • Socialize while social distancing – perhaps one of the biggest changes as a result of the stay at home order is our new inability to spend time with other people in person (or at least other people who we don’t live with!). Even for those who often prefer to spend time alone, forced isolation can have a huge negative impact on mental and physical health. Fortunately, we live in a very tech-savvy time and physical presence isn’t always required for socializing with loved ones. Make plans with friends or family to have regular calls, text conversations, or video chat sessions. Or plan to read or watch the same books and movies together (Detroit and Ypsilanti public libraries have options for e-book downloads). 
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  • Get moving  for most people, increased time at home means less daily physical activity with most of the time we spend walking to or into different places being replaced by more time sitting or lying down. Finding ways to increase your movement throughout the week is important for your overall health, and can help you manage cravings. Take walks, have dance breaks, stretch/do yoga, go up and down stairs, or anything else that may get you moving.  
  • Don’t forget about meal times – eating meals as normal provides structure to your day. Try and eat around the same time each day and try to move to a new location to eat if you find yourself in one spot for most of the day. 
  • Do activities you enjoy – this is NOT going to be a blog that tells you you should be mastering your second, third, or fourth language by now. But, it is a good idea to try and incorporate activities you enjoy throughout your weekly schedule. Planning out time during the week to read, cook, watch favorite movies, knit, play games, etc. is a good way to boost your mood and keep your mind off smoking. This could be something you do for everyday, or for a few times throughout the week. 
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If you’ve read my previous blog, or if you’ve worked with me in the last few months to develop your tobacco reduction/quit plan, you probably know that I often encourage making small changes and building on those to create a larger, positive change. We’ve been dealing with a major change over the last month, and it’s been overwhelming to say the least. Remember the goal with creating a “quarantine routine” is to help deal with that change, support your physical and mental health, and hopefully keep you on track with your tobacco reduction/cessation goals (even if that goal is to just maintain the amount you’re currently smoking!). Pick one or two of the above ideas and see if they help to start, and go from there. Lastly, remember there are some days where routines will just go out the window, that’s normal and it’s okay to need those days!

Feel like you need to adjust your tobacco treatment plan due to COVID-19 or just interested in finding out more about Unified’s Tobacco Reduction services? Contact your local Tobacco Treatment Specialist:

Detroit:
Amber Jager – (269) 350-3826
ajager@miunified.org

Ypsilanti/Jackson:
Caitlyn Clock – (734) 489-9916
cclock@miunified.org 

Time Management and Tobacco Reduction: Tips to Get Started

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What is Time Management?

In our first tobacco workshop of the year, clients discussed the idea of looking at time management in two different ways:

  1. Having too many tasks, appointments, etc. and feeling as if there isn’t enough time to get them all done.
  2. Having too much free time and not knowing how to fill it.

Both of these situations can be overwhelming, and both can lead to an increase in feelings of stress, anxiety, frustration, and loneliness/depression. Which can result in an increased want or need to use tobacco products. Stress, in particular, is a commonly cited barrier for people attempting to quit their tobacco use, and often plays a role in slips and relapses during quit attempts. 

So how can one start to utilize time management skills in their daily life? Something I noticed when exploring ideas for this month’s blog is that most articles and blog posts offering time management tips revolve primarily around productivity and efficiency in the workplace. While productivity-based skills can be incredibly useful in many settings, they often don’t prioritize an individual’s overall wellbeing. The following list includes my top time management tips.

  • Start Small. It’s important to remember not to overwhelm yourself with major changes, even when they may benefit you in the long run. Scheduling every minute of every day is unnecessary and likely to increase negative feelings if you’re unable to meet those detailed time frames. Start with marking down important appointments and deadlines, and see what else would be helpful from there. 
  • Use a Planner or Calendar. While it seems obvious, using a calendar or planner can help you keep track of appointments, events, and other commitments. Keeping track of these will allow you to make appointments as needed while also helping to prevent you from double or overbooking yourself. Having these things planned out will also allow you to prepare for them.
  • Become a List Maker. Using lists can be incredibly helpful when you feel like you’re just not getting things done that you need to. Not only can they serve as a reminder for what needs to be done today (or tomorrow, or this week, etc), crossing off tasks as you complete them will provide you with a visual of how much you’ve accomplished.
  • Break Up Your Big Tasks. Oftentimes major tasks can seem intimidating and we can end up putting them off to avoid feelings of failure and anxiety. By breaking these big tasks up into multiple smaller ones, you can gain confidence in getting through your to-do list without trying to put them off. 
    • For example: You were sick in bed for a week and missed multiple appointments with your doctor, your case manager, your tobacco treatment specialist, your therapist, and a class. Rather than trying to reschedule everything in one sitting, space the calls (and the appointments) out with breaks in between. 
  • Prioritize! Though time management skills can certainly be helpful, they can’t change the fact that we only have 24 hours in the day and seven days in the week. Take time to determine which tasks are the most important, and which one(s) can wait until you have more time available.
  • Make Time for Yourself. While making it to your appointments and other commitments is important, remember that it’s equally important to set aside time for yourself to do things you enjoy whether that’s reading, taking walks, spending time with loved ones, or watching movies. 
  • It’s Okay to Say No Way. These tips and skills are supposed to help reduce stress, anxiety, and frustration in your daily life. Recognize that it’s okay to let people know when you have enough on your plate for that week and need to schedule for a better time in the future. 
  • Celebrate! With any change in your life, it’s important to remember to recognize your accomplishments even if they seem small. Made it on time to an appointment you’d missed and rescheduled a few times? Have a small treat! Completed a major task that’s been looming over your head for weeks? Give yourself a night where you can focus on relaxing and doing activities you enjoy.

As you begin to plan ways to put some of these tips to the test, remember that different things work for different people. Maybe most of these will work for you, or maybe only one will. Don’t be afraid to adapt these tips to benefit YOU and your time management needs. Ultimately, the goal is to find ways to help manage feelings of stress, anxiety, frustration, depression, and boredom that might lead to an increase in your tobacco use. 

Interested in finding out more about Unified’s Tobacco Reduction services? Contact your office’s Tobacco Treatment Specialist:

Detroit: 
Amber Jager – (313) 446-9800 
ajager@miunified.org

Ypsilanti/Jackson: 
Caitlyn Clock – (734) 961-1077
cclock@miunified.org