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.

Some observations on health overseas

My family and I just returned from a short vacation over in London. I was struck by a number of health- and wellness-related observations I made while abroad, so I thought I would share them while still fresh on my mind (fortunately, the jet lag hasn’t been too bad). As promised back when I started this blog, I’m stating up front that these are just my anecdotal observations. Not evidence-based but interesting nonetheless – or at least I hope you think so!

So many steps

I think I broke my Fitbit record for steps this past week – yahoo! Here in the US, I typically struggle to get 10,000 steps before I go to bed at night – and that’s with my 30-60-minute workout each day. In London, I was easily at 10,000 steps before midday tea every day except our travel days. Even with hopping the “tube” around town to visit various sites, there was still a ton of walking to be done. Most of the Underground stations had several flights of stairs or escalators to get to street level. In one older station, the elevators (or “lifts” as they like to call them) were out of order so we had to take the stairs – 193 in total, equivalent to 15 stories (or so said the lovely British woman on the PA system as she broke the news to travelers). I felt the burn that day!

The amount of walking we did in London got me thinking about our life – and lifestyle – here in Raleigh. While sight-seeing in London, we didn’t bat an eye at walking a mile to the next tourist attraction. It just seemed natural and most of the time, quicker than trying to catch the nearest tube. Yet, I realized the movie theater we frequent here in town is about a mile from our house…and we rarely walk to it, even in beautiful weather when we have plenty of time. There’s really no excuse – there are sidewalks almost the whole way and crosswalks at the “busiest” intersections, which really aren’t busy at all when I put it into perspective. We’re just so used to the convenience of our cars. I understand the argument that US suburbs are nothing like high density cities such as London, but bottom line: a mile is a mile. If we can walk it over there, we can walk it over here. I’m going to nudge my family in that direction next time we have plans to catch a flick.

Size matters

Another thing I noticed, particularly as we were riding the subway, was the noticeable lack of overweight and obese individuals. Sadly, the ones we did see often had American accents. I’m guessing that all of that walking around helps the natives manage their weight, as I also noticed the scarcity of gyms and fitness centers around the city. There were some scattered here and there, and I definitely saw women dressed in athletic wear, often carrying yoga mats. But nothing like here where you’ll often find two or three gyms within a mile radius.

Something else my husband pointed out when we were getting coffee near our flat was the distinct lack of choice when it came to cup sizes. In many shops and restaurants where we dined, there was one size and I would say it was on the smaller side compared to back home. I think the coffee cup at our favorite shop was about 12 ounces – not too big, not too small. The business decision behind the cup size was probably more cost-related than health-related, but I imagine it helps keep calorie counts down as well. At most of the nicer restaurants where we ate, the beverage glasses were definitely smaller than those at restaurants here in the states. Prices seemed lower too, even with the British pound to American dollar conversion. Smaller sizes, lower prices – a win-win in my book.

Up in smoke

Lest you think I believe London has a leg up on all health- and wellness-related matters, let me say that they seem to be lagging behind the US in their tobacco cessation efforts.  Although most restaurants and shops were smoke-free inside, smoking was allowed when dining outside, much like it is here in the US. I also saw people smoking regular and e-cigarettes quite frequently while we were sight-seeing. It was rather frustrating to be walking along the Thames River on a beautiful day when suddenly you find yourself trapped in a cloud of vapor emanating from the person in front of you. I did see the usual no smoking signs in public places, but I did not see many anti-smoking messages like we have here in the states.

Media fast

One thing that struck me once we were getting ready to come home was how happy I had been for the four days when I was essentially on a “media fast,” with limited access to news. Here at home, I usually read the Raleigh newspaper every morning and I have two news apps (one local and one national) that I check regularly throughout the day. I didn’t pick up a newspaper once while we were gone. We had a TV in the flat we rented but flipped it on only a few times when we were still adjusting to the time change and needed to just chill out before going to bed. We had chosen to do the “pay as you go” travel plan for our cell phones and thus, limited ourselves to one “activated” phone per day. Even on the days when it was my turn to have cellular turned on – and despite having access to free WiFi almost everywhere we went – I did not have the urge to check on the news like I do back home.

Maybe it was a matter of trying to be truly disconnected from the world, so I could enjoy my vacation, but it made me realize that I can survive (and thrive, really) without the constant need to know what’s happening around me. I pride myself to some extent with being an informed citizen who stays abreast of current events, but to be honest, I’m more often overwhelmed by the sense of information overload I experience when trying to take it all in. I think this vacation demonstrated that being tuned out now and then is not the end of the world and leads to more peace of mind than being in the know every minute of the day. I’m hoping I can continue my limited media exposure as I ease back into my normal schedule, now that I realize it’s better for my mental health.

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Tobacco Cessation

I saw a statistic the other day that made me do a double take. There was an article in the local paper that referenced health research related to tobacco use and it stated that worldwide, tobacco use causes nearly 6 million deaths per year. Wow. That was a shock for me. I think with all the progress we’ve made here in the US in the last decade around creating smoke-free environments in schools, hospitals, restaurants, and so forth, I was under the false impression that tobacco use had declined greatly and just wasn’t a big problem anymore. Clearly, I was wrong.

The public health profession has made great strides in battling “Big Tobacco” at both the policy and individual levels. Overall, there has been a downward trend in cigarette use among students and adults. Data from 2015 indicate that many adults want to quit smoking and/or tried to quit in the past year.  That is great news. On the other hand, we are seeing an increase in the use of e-cigarettes, particularly among young adults, who may believe that they are a safer alternative to traditional cigarettes or smokeless tobacco products. E-cigarettes do not contain tobacco, but according to the CDC, they are not considered a safe alternative to tobacco use.

If you use any form of tobacco products or e-cigarettes, the best thing you can do for your health is quit. If quitting completely seems like too daunting a challenge for you, then consider reducing your use gradually until you are ready to quit. The nicotine available in these products is what causes the addiction and the craving to smoke or use other forms of tobacco. The good news is that there are many tools, resources and medications available today that help make quitting easier than ever. You don’t have to do it alone. In fact, social support is an important factor for anyone who is trying to reduce or stop using tobacco.

If you are thinking about quitting or are ready to make a change now, consider the following resources and strategies to help you on your journey to stop using tobacco:

Talk to your doctor: S/he can talk to you about medications to help you quit and put you in contact with local resources.

Call a quitline: Talking to someone about quitting smoking can be the support you might need to see it through. All states have quitlines with counselors who are trained specifically to help smokers quit. Call 800-QUIT-NOW (800-784-8669) to connect directly to your state’s quitline.

Contact your employer or health insurance company about resources for quitting: Many employers offer free tobacco cessation programs to help employees quit. If you are not working, inquire with your health insurance company as they often have trained specialists available by phone and/or may offer free or low-cost nicotine replacement products. Even Medicare Part B (Medical Insurance) covers up to 8 face-to-face visits with an approved provider in a 12-month period.

Consider behavioral therapy or coaching: This involves working with a counselor or a health coach to find ways not to smoke or use other forms of tobacco. Together, you’ll identify your triggers (such as emotions or situations that make you want to use tobacco) and make a plan to get through the cravings.

Whether you decide to quit cold turkey or use a combination of options to help you on this journey, know that the first few days are the toughest. You’ll probably feel irritable, depressed, and tired, especially if you’re quitting cold turkey. Identify your support system beforehand, whether it be a good friend, a colleague and/or a quitline specialist, and use them in times of need. Once you get past those first days, you’ll begin to feel more normal and your cravings should begin to decrease.

Finally, be sure to build in ways to reward yourself. What you’re doing isn’t easy. When you achieve the smaller milestones on your way to quitting, treat yourself with something you want or enjoy.  Or another idea is to save the money you would have spent on cigarettes/tobacco products and donate it to a favorite charity. This is a win-win situation – you are helping yourself and others at the same time.

Quitting isn’t easy, but 50 million ex-smokers in the United States are proof that it’s possible.  What step can you take today to move you closer to the goal of quitting?

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