E-Cigs: Let’s Clear the Air

Given that you can’t turn on the news or browse the internet these days without seeing stories about recent health concerns related to e-cigarettes or vaping, I thought it was worth taking a moment to share the latest report and recommendations based on what public health experts know so far.

To recap: various local, state and national public health partners, including the CDC and the FDA, are currently investigating a multistate outbreak of lung injury associated with e-cigarette product use. As of September 24th, there have been 805 cases of lung injury reported from 46 states and 1 US territory. Twelve deaths have been confirmed in 10 states; however, I woke up this morning to read that there has been a new death reported in my own state of North Carolina that is believed to meet the case definition so that number will likely increase.

This is what we know so far:

  • Individuals have experienced severe respiratory symptoms, including cough and shortness of breath, as well as fever, fatigue, chest pain, nausea, vomiting and diarrhea. Most of the patients have been hospitalized and have required respiratory support.
  • Most of the reported cases involve males between the ages of 18 and 34.
  • All reported cases have a history of e-cigarette product use or vaping.
  • Most patients have reported a history of using e-cigarette products containing THC, the chemical responsible for most of marijuana’s psychological effects. Many reported using products with both THC and nicotine. Some have reported the use of e-cigarette products containing only nicotine.

Perhaps the most troubling part of all this is what the experts don’t yet know: the specific cause of these lung injuries. The investigation has not identified any single e-cigarette or vaping product or substance (including devices, liquids, refill pods, and/or cartridges) that is linked to all cases. Based on what is known so far, there is no consistent evidence of an infectious cause. Therefore, the suspected cause is a chemical exposure. For this reason, as the investigation continues, the CDC has released the following recommendations:

  • Given the health risks, consider refraining from using e-cigarette or vaping products.
  • If you are an adult who used e-cigarettes containing nicotine to quit cigarette smoking, do not return to smoking cigarettes.
  • If you have recently used an e-cigarette or vaping product and experience symptoms like those reported in this outbreak, see a healthcare provider as soon as possible.
  • Do not buy e-cigarette or vaping products off the street, and do not modify or add any substances to these products that are not intended by the manufacturer.

As a general reminder, youth, young adults and pregnant women should all refrain from using e-cigarette products regardless of the latest concerns. And any adults who do not currently use tobacco products should not start using e-cigarette products.

From the time that e-cigarettes entered the market back in the early 2000s, public health experts emphasized the fact that we just didn’t know enough about the potential short- and long-term effects on health to determine whether they were a safer alternative to traditional tobacco cigarettes. I think what we are seeing now is every public health professional’s nightmare – that these products are indeed not safe and are responsible for unnecessary and avoidable illnesses and deaths.

The good news is we are starting to see action at the national level. The commissioner of the FDA admitted to Congress that the agency “should have acted sooner” to regulate e-cigarettes, and they are finalizing policies that will increase enforcement and potentially remove products from the market. Several large retailers such as Walmart announced they will no longer sell e-cigarettes in their stores. Major media companies including CNN, CBS, Viacom, and WarnerMedia all said they will stop running e-cigarette advertisements on their networks. In response, Juul, the largest e-cigarette maker in the US, announced it too would cease all of its print, broadcast, and digital advertising. And in even bigger news, Juul recently announced that its CEO Kevin Burns was stepping down, no doubt as a result of the intense criticism and investigation the company has been under regarding its marketing techniques, such as using social media influencers to illegally target children.

Although I wish 800+ individuals did not have to suffer illness and death in order for our leaders to be spurred into action, I am encouraged that steps are finally being taken to address the issue of e-cigarettes at the national level. For those of you who may be users of these products, I hope that you will seize this moment as an opportunity to quit for good. Click here for information and resources available to help you on the journey to finally being free of all tobacco and nicotine products.

The Self-Care Debate

Those of you who know me well, know that I am a fervent proponent of self-care. I would go so far as to say it is the cornerstone of my health coaching practice – helping others find ways to prioritize day-to-day lifestyle choices that will optimize their health and well-being. Some people, particularly women, think it is selfish to focus on self-care. I have always argued the opposite – that it is one of the most selfless things you can do, as you can’t take care of others in your life if you are not feeling or functioning at your best. I often use the oxygen mask analogy from the airline safety protocol – put on your own oxygen mask first before assisting those around you. After all, you can’t help your family or fellow passengers if you are passed out – or in this case, burned out or close to it.

I recently had my ideas about self-care challenged at a Sunday service at the Unitarian Universalist Fellowship of Raleigh. We had a guest minister, Rev. Nate Hollister, preach a sermon titled “The Nonsense of Self-Care.” I have to admit that I found myself feeling defensive as soon as I saw the title. How dare this person cut down the work about which I am so passionate and have spent most of my life promoting as essential to health and well-being? However, I reminded myself to keep an open mind and hear what we had to say before making any snap judgments.

Rev. Hollister started off his sermon by acknowledging that we do need to take care of ourselves, but he challenged us to think about how we do so and why. He then addressed three points of contention with what he called the “reigning culture of self-care.” He suggested that we did not necessarily have to agree with his points but that he simply wanted to start a dialogue around the concept. I have outlined his three points as well as my thoughts about them.

Self-care is rooted in classism and consumerism
Rev. Hollister started with the notion that today’s concept of self-care is rooted in classism and consumerism, i.e., only people with time and money can afford to engage in the types of activities that are commonly associated with self-care. Think massages and other spa services. Splurging on a gourmet dinner. Activities that most “blue collar” workers don’t have the luxury of enjoying. He admitted that we all deserve to have access to nice things, but we head into “moral trouble” when taking care of ourselves means consuming material things – especially in a world that is becoming increasingly damaged due to overconsumption.

I would challenge his first point as, to me, self-care means different things to different people and thus, you can’t just lump it all into one generalized category. For example, he defined self-care as indulging in luxurious activities or services that take time and often cost a great deal. Although I agree that these activities can be part of self-care, to me self-care falls more in line with the little things we do (or should do) every day or every week to maintain our health and well-being.

I am more inclined to agree with the idea put forth by Tami Forman of Path Forward – that self-care is not an indulgence, but a discipline. As she so eloquently states, it takes discipline to “do the things that are good for us instead of what feels good in the moment.” She also reminds us that self-care is not something you do every now and then when life gets a little crazy. It’s about “taking care of yourself in a way that doesn’t require you to ‘indulge’ in order to restore balance. It’s making the commitment to stay healthy and balanced as a regular practice.” Thus, perhaps what is needed in our culture is a new image, a rebranding if you will, about the true essence of self-care that falls more in line with these daily habits that help sustain our health.

Self-care as the opiate of the masses
Rev. Hollister’s second point of contention with self-care was that its primary purpose is to “inure us to the injustices of our world” and desensitize us to the current structures of power. In his words, self-care could thus be considered the “opiate of the masses,” allowing us to escape from the harsh realities of the real world. He quoted Dr. Martin Luther King, Jr. who called for the need for “creative maladjustment,” wherein people refuse to normalize inequality and work continuously to expose injustice. Rev. Hollister argued that we are in terrible trouble when self-care keeps us resigned to the way things are, to accept the status quo rather than try to change things.

Anyone who is familiar with the UU faith knows that it is steeped in social justice. Thus, I wasn’t surprised when he made this argument – that for some, self-care is a way to cope with injustice rather than attempt to do something to change it. I’m willing to concede a little more on this point as I can see how some people could use what he defines as self-care activities as a way to soothe themselves when dealing with challenges in their day-to-day lives. It’s a lot easier to have a girls’ night out and complain about the state of politics in this country than it is to volunteer on a political campaign or – gasp – run for office yourself. I would propose that this goes back to my previous point of needing to redefine and broaden the definition of self-care, such as expanding the idea of self-care to include engaging in activities that serve a higher purpose. For example, one could volunteer at a local food bank or donate blood. Do something good for oneself as well as the community. For many people, it takes participating in these types of volunteer activities to truly open their eyes to the inequalities present in our society. After all, awareness is often the first step needed to bring about change – in ourselves and our communities.


Self-care promotes a culture of hyper-individualism
Rev. Hollister’s third and final argument was that the current approach to self-care is steeped in a culture of hyper-individualism, where it is “all about me” and has likely contributed to the recent epidemic of loneliness and separation in today’s society. You have probably heard that despite being more connected than ever through technology, humans in general report feeling lonelier and more disconnected than ever before. Rev. Hollister linked this back to the traditional American story of individualism – that you are essentially on your own and that you need to pull yourself up by the bootstraps in order to succeed. He noted however that this concept is relatively new, that most historical cultures and societies thrived on cooperation, not competition.

Rev. Hollister took a deeper look at this idea and challenged us to shift from the independent philosopher Descartes’ proclamation “I think, there I am” to the more interdependent African philosophy of ubuntu, which can be loosely translated as “I am because we are.” He wrapped things up by reminding us that yes, it is important to take care of ourselves but perhaps it is time to change the whole concept of self-care and move away from the perception that it is all about consumerism and being resigned to the status quo. In his closing words, he urged us to redefine self-care as taking care of one another, as we might survive on our own, but we can only thrive with each other.

By the end of the sermon, after making his final point, I found myself less in a place of defensiveness and more in a state of appreciation for having the opportunity to revisit my own ideas about self-care. Rev. Hollister made some compelling arguments for why we need to shift our perspective about self-care. For me, self-care is still about taking care of yourself so that you are able to take care of others – family, friends, colleagues and even strangers in your community. It is clear now that not everyone sees it that way, so I will do my part to try to help change perceptions about self-care. I am also more inclined to broaden what kinds of activities fall into my own self-care – and encourage others to do the same. Maybe next time I need a little break, it will mean picking up litter when I walk in my local park versus splurging on frozen treats at the local ice cream parlor. This way, I benefit from the walk and we all benefit from a cleaner environment. That’s a win-win situation.

(Note: Click here if you would like to listen to Rev. Hollister’s sermon on self-care.)