Coronavirus

Understanding E-cigarettes and Vaping

Standard

“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

Standard

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. 

Characters of people holding time management concept illustration

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. 
Illustration of clock icon on blue background
  • 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). 
Characters of people and their social network illustration
  • 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. 
Group of people reading and borrowing books

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 

COVID-19 and Tobacco: What You Should Know, and How to Protect Yourself

Standard

 

A month ago we had no idea that life as we previously knew it was starting to change in a drastic way, and that public spaces would close indefinitely. Then COVID-19 came. We are flooded with news articles, videos, and interviews talking about the social and health implications of such a pandemic– so COVID-19 might be the last thing that you want to read about right now. But I believe that we need to fully understand the implications that this virus has on people who smoke, and what can be done to protect yourself if you do smoke. In order to understand why COVID-19 should be a concern for people who smoke, it is important to understand how tobacco affects your immune system.

Tobacco use and your body

Tobacco use causes damage to nearly every organ of your body, and is especially harmful to your upper and lower respiratory systems due to the smoke and many chemicals that are inhaled through your mouth, down your throat and into your lungs. As the various gases (ammonia, formaldehyde, and carbon monoxide to name a few) make their way to your lungs, they cause cell damage and abnormalities.

Even more, as soon as you inhale the smoke from a cigarette, those chemicals cause irritation to your whole upper airway. This causes your nose and sinuses to produce more mucus. With healthy mucus production, the mucous we produce daily drains healthily down our throats and helps to rid our body of bacteria. When we produce an excess that is caused by irritation, our body does the reverse. It starts to build up this mucous in our sinuses and makes us more susceptible to colds and allergies. This can even eventually lead to cancer of the throat and lungs over time.

upper and lower respiratory

Also worth noting, is the fact that cigarette smoking suppresses your immune system by damaging important organs in your body.  This causes your organs to have to work harder and less efficiently than if they were not damaged, in order to carry out normal functioning within your body such as breathing, hormone regulation, and the ability to fight off infections.

What you need to know about COVID-19 if you smoke

Given the facts that smoking causes significant damage to your lungs and other airways, as well as suppresses your immune system there is validity in being concerned about COVID-19 if you smoke and you should be more cautious during this time.

In an article by the American Lung Association, Dr. Albert Rizzo states “COVID-19 is a lung infection that aggressively attacks the lungs and even leaves lung cells and tissue dead,” Dr. Rizzo said. “While it’s important to prevent getting COVID-19 in the first place, it’s also essential that we do all we can to keep our lungs healthy to avoid the worst affects of the disease.”

single cigaretteThe bottom line: If you do get COVID-19, you are at an increased risk for developing more severe symptoms as well as having symptoms for a longer period of time due to tobacco use decreasing the body’s ability to heal itself efficiently. You can read more about COVID-19 here. 

 

What you can do to protect yourself

The important thing to know and remind yourself in the midst of this pandemic is knowing that there’s hope. If you smoke, you can begin to take your health into your own hands by making the decision to quit smoking. This task is difficult, though definitely not impossible. Here are some tips to help you get started:

  • Think about your “why.” What are some reasons today that you would want to quit smoking? Give this some thought and create a list of all of your reasons. Go a step further, and hang that list in a visible spot so that you can see it every day.
  • Keep track of your triggers and plan ahead. One of the most important parts of planning to quit smoking is identifying the moments when you are the most likely to smoke or want to smoke. Do you always seem to smoke after a big meal? Do you get a craving every time you feel worried about something? Take a day or two, before you quit smoking, to keep a journal on you and log each time that you smoke. Before you light up, record what time it is, what you are doing (or just did) and how you feel. Once you’re aware of your smoking triggers, create a plan for alternatives to smoking when these situations arise. For example, common alternatives people direct themselves to after eating instead of smoking are to go for a walk, chew gum, have a mint or brush their teeth.    QuitSmoking613_2
  • Set a quit date. Once you feel comfortable with an alternative for your smoking triggers, it’s time to set a date within the next month of when you will smoke your last cigarette. Be mindful to set your quit date for a time when you have no foreseeable stress, as well as big celebrations, in order to set yourself up for success.
  • Maximize your social support. Tell the people in your life that you are quitting and ask them to help keep you accountable. If you don’t have support from your friends or family, look for support in the form of a quit smoking group. Here are some free online communities with the common goal of becoming and remaining tobacco-free:

QUITLINE

  • Call the Michigan Quitline at 1-800-784-8669 or enroll in their online program to see if you qualify for free Nicotine Replacement Therapy to assist you with quitting. NRT can help significantly ease the feeling of withdrawal symptoms and ween you off of nicotine.
  • Practice mini quits! Pick one day or a few days where you won’t smoke, and take note of how that felt, what you needed to get by, etc. It’s a less intimidating way to get a feel for a tobacco-free life as you prepare for your quit date. This article details more about the benefits of practice quits. 

 

Things you can do right now

In addition to following the recommendations from the CDC (hand-washing, social distancing) wherever you are in your quit smoking journey,  here are some tips to help you stay healthy and build your immune system:

  • Focus on your sleep hygiene. Set a consistent time to go to sleep and wake up each day. This not only helps keep your body physically healthy, but it will help eliminate stress and mild depressive symptoms as well as the anxious feeling of being on quarantine. person wearing black low top sneakers and black jeans
  • Move! From walking to jumping, or doing at home workouts in your living room, any form of moderate exercise is beneficial for your immune system as well as your mental health.
  • Stay hydrated. Drinking water throughout the day won’t only keep you feeling awake and replenish hydration throughout your organs. Drinking fluids also helps flush out bacteria and viruses that could be lingering in your body.  variety of vegetables
  • Eat your vitamins. Literally. While it’s important to incorporate a daily multivitamin to make up for gaps in nutrition, the best way for your body to absorb vitamins and other micro-nutrients is by eating nutrient rich foods such as vegetables and fruit. Organ meat also has a high amount of vitamins, so if you’re feeling adventurous try my personal favorite: liver and onions!
  • Warm your body up by drinking hot tea and honey. Honey is proven to help rid the body of bacteria. Another added bonus- honey helps to break down mucous build up! Many herbal teas also have beneficial affects on the immune system.
  • Laughter is good for the soul (and immune system). Last but never least… LAUGH! During stressful times and when you’re undergoing changes within your routine (such as reducing or quitting smoking), it never hurts to make time for a good laugh- whether that means joking with friends and family, watching stand up comedy, a feel good sitcom, or finding something else to make you giggle a little. It is scientifically proven that laughter is good for your mental and physical health. Read this article by the Mayo Clinic that details all of the long-term and short-term health benefits of laughter.

photo of woman laughing

As we continue to navigate these confusing and uncertain times, please continue to refer to the CDC for information on how to navigate the changing status of the pandemic in your community.

 

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

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

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