All right, you ready? Yes, sir. All right. Yes.
Three, two, one. Well, howdy, y 'all. Welcome
back. to another episode of Your Mom on Drugs.
We have today, the son, Josh Klaus, got my master's
in public health, hopefully gonna use that today.
And we have the mom on drugs. Can you introduce
yourself? I'm Jennifer Seltzer. And I'm just
seeing, I'm watching, I'm looking at Josh's t
-shirt and his t -shirt says data greater than
feelings. I'm like, he's a data guy. He's a data
guy, so. I'm a very feelings -based guy too.
He is, yes. Sometimes you just got to follow
the data. And even though you have this strong
intuition that you believe in something, if the
data doesn't support your belief, you got to
abandon your belief. And that's the beauty of
science. So today we are going to be talking
about a topic that my mom and I don't know. We
didn't know too much about just because it's
the topic of vaping and e -cigarettes. Neither
of us are smokers. We never smoked in our life.
But if you've ever walked around lately. You've
probably noticed the big, puffy, white clouds
that people are emitting from these e -cigarettes
as opposed to tobacco cigarettes. And because
they've gotten so much more popular over the
years, and I believe it was inspired by you with
either a family member. or a friend that had
done it. I don't know how you got curious and
wanted to do this. And, you know, I think because
we've done some other topics that were like,
I don't know much about that. I think that's
because you do see, you know, every time you
go to the ice house to pick up something, they're
right there and stuff. You're like thinking,
I don't know. Or, or there's also, there's these
vaping stores, you know, that you'll see in your
towns and stuff. And I'm like thinking. what
do people do in there? I don't really want to
go in. So I thought, well, I'll just research
it instead. Yeah. Instead of going into the store,
we'll just spend copious hours of research on
the topic. Looking for that data. Yeah. Looking
for that data. So I think we'll start off with
maybe just kind of some basic information of
what vaping is. I think maybe people might have
some misperception of what it is. I definitely
did. So maybe you can kind of lead off and talk
about what vaping and e -cigarettes are and maybe
a little bit of background of how we got here
as well. Yeah. And actually, I'd like to take
it one step back from that to talk about really.
tobacco use in general and stuff. And so what,
you know, so we, it was really interesting researching
this. Anytime you, you know, do a presentation
or collect data, you always learn something new.
So we started using tobacco or tobacco was initiated
for use in the United States. I believe it was
in the 1700s, the late 1700s and stuff. So, and
it's now the most preventable. cause of death
in the United States. And so what we've seen
over the last four decades, approximately, is
that the smoking prevalence in adults has decreased
by about 65%. So, you know, pretty significant
drop in smoking combustible cigarettes. Right.
And by combustible, we just mean that you have
a material, like... tobacco right in a piece
of paper that will combust when you put a flame
to it right and then that flame will heat up
that tobacco become combined to some type of
smoke and then go inside of your lungs right
which gets into your body right and i looked
up a stat too at the height of smoking's popularity
which is i think in 1965 42 percent of people
Yeah. Cigarettes. I mean, it's almost half the
population. I mean, both my parents smoked, which
was so weird, you know? So, so yeah. So, yeah.
So now it's really interesting. There are more
people who formally smoked. cigarettes than actually
smoke them now and stuff. But we still have about
11 % or so of our population who smoke. That
translates to about 28 million people. But again,
that rate of smoking cessation has declined over
the last decade. But there are still about, there's
over 480 ,000 deaths associated with cigarette
smoking or secondhand smoke per year in the United
States. So that calculates to about... one in
five deaths annually associated with tobacco.
Man, I kind of want to piggyback off that point
because it's amazing like how small behaviors
every day will lead to deleterious effects in
the future. Almost kind of like financial responsibility.
Like if you want to save for retirement or have
a good savings account. You save a little bit
each day. You'll have a decent -sized savings
account. It feels very boring in the moment.
Same thing with bad things. So Harvard did this
longitudinal study, like a prospective study,
of following a certain group of people over time
and seeing what are some things that make people
healthy in the long term versus not healthy in
the long term. It doesn't really determine causality,
but there were associative factors. And the five
that they really stood out were social interactions
uh minimal alcohol use um lack of smoking uh
daily exercise like 30 minutes of exercise um
and i'm trying to remember the last thing maybe
sleeping or no i don't know what it was what
is the last one oh it's a healthy diet so basically
and obviously that's that's you know i think
what that means is they don't over indulge like
eat within moderation um And if people did these
five things that I just mentioned, they had an
average extension of their lifespan by 14 years,
which is insane. Like when you think about living
from 70 to 84, so smoking plays a huge role in
that. Like mom talked about, it really increases
the risk of certain types of cancer and cardiovascular
disease, which we're going to get into. But I
think a lot of people don't understand how bad
smoking is sometimes. And I think One of the
reasons we did a massive public health campaign
from the 60s onward is because, like mom said,
it's such a preventable behavior and it causes
such carnage in somebody's body and their life.
And obviously it has knock on effects for the
rest of society. Right. Right. So. And not only
does it have health effects, but it has an economic
impact as well, too. So there are from the I
have data from 2010 to 2014, where 11 .7 percent
of all U .S. health care spending went to adult
cigarette smoking. So that means taking care
of people with adverse consequences of smoking.
and stuff so that's crazy you know and then in
2018 the estimated cost of loss of productivity
due to cigarette smoking in the united states
was 185 billion dollars so a lot of people didn't
show up for work you know so crazy um so but
and interestingly too and this is not hard to
understand tobacco use is greater in the economically
disadvantaged because there's a lot of reasons
i mean they may not be able to afford the uh
the uh nicotine patches and things to help the
therapies that would help you to stop smoking.
Or it just may just be just easier. I didn't
really delve into all the reasons why that's
the case. I'm sure there are copious reasons.
I mean, one of the things that I imagine if you're
economically disadvantaged, you're just looking
for little wins. And I think sometimes things
like a puff of a cigarette or a drink or will
just feel good if you feel like your life is
stressed and you're not going anywhere. um i
mean psychologically i'm just trying to think
about that way um if you have no hope in long
-term goals why not focus on the short -term
ones because at least they'll deliver something
yeah so The other thing, too, that came out with
this is that there are about 1 ,600 young persons
under 18 years of age that will try their first
cigarette every day in the U .S. And nowadays,
and so this is going to be our great transition
into our topic for today, a lot of that is due
to what we call electronic nicotine delivery
cigarettes. Electronic... nicotine delivery systems
or e -cigarettes. And the availability of these
systems in pediatric populations could increase
their risk of future combustible cigarette smoking.
So regular cigarette smoking. Yeah, I think that's
the worry is like, is this a gateway drug to
future tobacco smoking? We also want to, just
as a caveat, even though they're called e -cigarettes,
there's no tobacco, at least in some of these.
Pods, it's very variable, this definition. But
most of the time, it is just a nicotine delivering
mechanism with some other things that we'll talk
about that come along for the ride. So the biggest
difference here between regular cigarettes and
e -cigarettes is that one delivers just nicotine,
plus some other flavors that you've probably
heard about. And tobacco cigarettes obviously
deliver, not aerosolized, but smoked tobacco
into your lungs. And it's mainly like the tar
is from that tobacco that have been associated
with increased cancer risk. rather than the nicotine
itself. But nicotine itself does have some effects
in the body, which Dr. Seltzer will talk about.
There you go. The biggest thing about nicotine
is it's very addictive and it's very difficult
to quit smoking. So one of the reasons that we
would hopefully to encourage our young people
not to start. So let's transition a little bit
into what vaping is. And so the definition of
vaping, the official definition that was recorded,
is that it's the use of a handheld electronic
device to breathe a mist or a vapor into your
lungs. Usually it contains nicotine and flavoring.
So that's what vaping is. It simulates smoking,
but like Josh said, it's not an actual tobacco
-containing cigarette. It does have... like nicotine
in it and then some flavorings. Names of things
that are considered e -cigarettes, it's an e
-cigarette or a vape pen or a modifiable device.
Interestingly, these modifiable devices are,
I think they were more popular. earlier on with
vaping but i they still exist there and you can
you can um customize what you put inside your
vape pen and stuff uh so uh as far as the amount
of nicotine and and stuff like that so um so
that's why they're called mods okay that makes
sense um Vaping is similar to smoking a combustible
cigarette, but the difference is it heats tiny
particles out of a liquid rather than burning
tobacco. And the way that a vape pen works is
it's a battery -powered device. That heats the
liquid and it produces an aerosol that resembles
water vapor, but it's not water vapor. It's an
aerosol. And this aerosol, which is tiny particles,
are inhaled into the lungs of a user. And the
aerosol can contain nicotine for sure. And it
contains flavoring. And then it can contain a...
there's greater than 30 different types of chemicals
that can be in this liquid as well, too. There
can be carcinogens in it, potential carcinogens.
There can be chemicals that could be associated
with lung disease. Some people can put cannabis
or marijuana. in the device. There's also more
of a stabilizing agent called vitamin E acetate
that's been linked to lung injury, some heavy
metals in there, and then the ultrafine particles
can deeply penetrate into the lungs. And so we'll
talk about that in a little bit as far as some
adverse effects associated with vaping. Yeah,
that's a good point. I think a lot of times too
is like just because you find certain chemicals
in something, you always want to compare it to
a relative standard. So when I looked at the
amount of carcinogens, specifically formaldehyde
that's inside of that vapor in a low voltage
simulation, which is essentially the, so if you
think about these vape pens, literally like a
pen. And think about the base of the pen. That's
where the battery is. And that is going to provide
the current that supplies the electrical energy
up towards the tip of the pen, which is where
you're going to be putting your mouth and drawing
in. And then in between there is the reservoir
where the nicotine is. And so the current is
providing heat just due to Ohm's law, V equals
IR. And then the resistance creates the heat,
which heats up the liquid. And if you remember
from basic physics or chemistry, if you heat
up a liquid, what does it become? A gas. Oh,
my gosh. And then the gas obviously is a great
thing to go inside of your lungs. And your lungs
essentially are these really, really, really
tiny, tiny, tiny branches with an amazing amount
of surface area. These things called alveoli,
which essentially facilitate gas exchange. So
as you breathe in air, you take in that air.
They go inside of your lungs. Those tiny little
alveoli, which are literally one cell thick,
they will then exchange into the bloodstream
of your body. And then that newly diffused blood
will then go to your heart and then pump. throughout
your body. It's amazing. But if it's small enough,
it'll go across those alveoli and it's not just
oxygen that gets into your blood, which is what
we need. Some of these other things that are
small enough, like nicotine, will get inside
of your blood and obviously cause the effects
that they do. But things like formaldehyde, what
I was going at is like, if you look at just the
average concentration of formaldehyde in just
regular air, there's a small concentration of
it. It's about similar. So in a low voltage environment,
in a vape pen. But if you're going to be doing
that 300 times a day, that is when it gets problematic.
So if essentially just think about it as like
maybe one puff, not too bad. But if you're breathing
in 300 puffs in like the span of a couple of
hours, then you're increasing the risk of accumulating
more formaldehyde in your body. And obviously
the more you do it, the more it increases and
the more you turn up that voltage. the more likely
some of those things like formaldehyde are going
to get into your system. So it really does depend
on how often you're doing these vape pens and
how high you're turning up the voltage. But what
users have reported is like the higher voltage
actually kind of gives this burnt taste and they
don't normally do that. So it's really this low
voltage environment that most users are doing
because that delivers the flavorable smoke. It's
not too harsh on the lungs. But yeah, it can
produce a higher amount. um later on so just
want to kind of give that caveat is like you'll
see a lot of times in studies not just with vape
pens it's like oh my gosh there's mercury and
fish it's like well you kind of have to compare
that to first of all what type of mercury is
it you know there's there's organic versus inorganic
mercury and what is that compared to a normal
diet that you're getting so a lot of times you
really want to think about the dose makes the
poison and the more you're consuming of that
obviously the more poison in you but If it's
kind of normal to your average diet, then not
too much to worry about. So just wanted to give
that as a caveat for vapors. Perfect. The other
point to make too is we've all heard of secondhand
smoke with cigarette smoking. You can also, bystanders
can also breathe in the aerosol that's been exhaled
by the e -cigarette user as well too. And again,
we're going to talk a little bit about what does
that mean in just a few minutes. Josh kind of...
talked about this already, but as far as the
structure of an e -cigarette is concerned, the
earlier ones looked more like a cigarette. Now
they look more like a USB flash drive and stuff.
So they're very small. And they contain a battery
with a lithium rechargeable, the ion battery,
which provides enough current to heat the atomizer,
which is the atomizer is the heating element
coil in the e -cigarette that's going to help
it convert to the tiny air. born droplets that
you can breathe in. An atomizer is like a, it
doesn't turn it into atoms, but like you've,
you've definitely used it. If you've used perfume,
it's like that spray, we call that an atomizer.
Cause it looks like these tiny little droplets
that are just kind of nasal spray. Nasal spray
is a great one. Yeah. And I think that's a great
analogy to what the thing that's going in your
lungs. It's not really water vapor. It's kind
of more of this, like almost like a sticky. vapor
like substance right so um yeah it just but you
think about it's on a really small scale sorry
keep going no no no worries the battery will
heat that atomizer up to 400 degrees fahrenheit
so that it'll get hot so that it will it will
atomize or aerosolize so that you can breathe
it in then that there are some e -cigarette containers
uh that have a an on -off switch. And if it has
an on -off switch, it'll have a sensor on it
so that it senses that you're pressuring it to
turn on. But other ones don't have that and it'll
just turn on when you take your first puff. And
then I said the atomizer is what converts it
to the aerosol liquid. And then it's the cartridge,
which is the... Either it's pre -filled or refillable.
So it's either a one and done or you can refill
your vape pen. The cartridge holds the e -liquid
and most of the time it's combined with the atomizer.
So the atomizer and the liquid are in that cartridge.
And then you've got a mouthpiece to breathe in.
Other names that e -cigarettes go by are, there's
e -hookah, there's hookah sticks, and there's
personal vaporizers as well too. And they're
collectively called electronic nicotine delivery
systems or ENs. The most common products. I've
got a couple. I'm not going to read this whole
list. I've got a little table here, but views
is one. Jewel is probably the one that most people
see. When I was doing some literature, there
was something called an elf bar, but then that
got removed because there was some sort of weird,
illegal things China was doing with elf bars
as far as. tariffs or something. And so now they,
they it's now it's EB create is another form
that you may see as well too. And that, that
tended maybe a number of years ago or several
years ago, that was the most common one to be
used in younger people like middle schoolers,
high schoolers and stuff. So enjoy is another
one and stuff. So, so you, you will have seen
them if you've been in any, you know, ice house,
you know, or convenience store. So grocery store
too. So. Vape terms that you may hear are jeweling,
which is obviously using a jewel brand or a similar
type of a small vape device. And it's the top
-selling pod -based device, and it looks like
a USB flash drive, and it first became available
in 2015. Another way that people might use e
-cigarettes or vape is that they'll take the
liquid from their... uh, the cartridge and you
can drip it on the actual heating mechanism.
And from what I understand, you can get a higher
dosage of nicotine, um, if you want by doing
it that way. Um, and then a person who vapes
is called a vapor, you know, not VAPOR, but VAPER.
So, so anyway, so. And as with everything, practically,
there's always some adverse effects that go along
with what we do, including vaping. So the things
that you'll probably, if you know somebody that
vapes, the most common complaints that they may
cite are going to be coughing, shortness of breath,
they can have eye irritation, headaches, a dry,
irritated mouth and throat, or nausea. And some
of that's going to, a lot of that's... going
to be, I would say, like headaches are most likely
due to the nicotine component. Other things might
be due to the aerosolization of the material
so that your eye irritation and stuff, because
of what you're breathing, it could be due to
that as well. Often, Josh and I always talk about
the risks and benefits of whatever we're discussing.
When I looked at the literature, there's a lot
of risks to vaping and there's not a whole lot
of benefits. I'm going to start with the benefits
first because it's a fairly short list. And basically,
there was a perceived benefit that e -cigarettes
can assist in smoking cessation, but it really
hasn't been proven true because at least one
study has shown that while vaping can... It's
more effective than nicotine replacement therapies
like the gum or the patch in helping people stop
smoking combustible cigarettes. But what seemed
to happen is that the people would continue using
the e -cigarette and they wouldn't stop it. So
that means that they're still getting nicotine.
So while they're not getting burned tobacco and
inhaling actual smoke, which has got its long
list of... adverse events associated with it,
they're still using nicotine long -term. So it's
like, wasn't that the idea was to get rid of
the nicotine ultimately and stuff. And so some
people just, it's like I said, it's a really
hard thing to stop doing. Yeah. I think we'll
probably get into this a little bit later as
well, because, you know, from my ears, that sounds
great. You know, it's like, and we'll get into
some of the numbers of why I think that's great.
But if you can get people to quit. cigarette
smoking and get them to do e -cigarette smoking,
and they're just getting the nicotine rather
than the nicotine plus the carcinogenic chemicals
from tobacco and some of the other deleterious
lung effects, then I say, yeah, let's go ahead
and do that. That's a great trade for me. But
we're going to talk about some of the numbers
later and why that might not reflect reality.
But I mean, just like what mom said earlier,
it's like there are 480 ,000 deaths per year
associated with cigarette smoking and it costs
11 % of our healthcare expenditure. So I don't
think that vaping has that high of a medical
cost. So if we can get those costs down and those
deaths down. And if this seems to be a good replacement
for it, I think that's the thing in question
is like, is it a good replacement? And I don't
think we really know for sure yet. There have
been some preliminary studies, but yeah, I think
at the end of the day, this sounds very similar
to, we can come to this later too. It sounds
like sex education, like abstinence versus safe
sex versus non -safe sex, right? So in a perfect
world, you would have people abstain from sex.
to limit the risk of sexually transmitted diseases,
unwanted pregnancies, and potentially have a
monogamous relationship if you want one with
a person that you love and are committed to.
But that's not realistic. So in lieu of that,
it's like, okay, if people aren't going to be
abstinent, then let's at least educate them on...
preventative measures like condoms and Plan B
or birth control so that we can at least mitigate
some of those secondhand side effects. For me,
I see vaping very much in that space. There are
some other things like nicotine patches and gum
as a way to be like, okay, let's live in reality.
There are people out there who are going to smoke
things. What do we want them to smoke? I don't
know if you have any response to that, but that's
kind of how I see it. Yeah, I understand where
you're coming from. You know, I'd like to, I
want to talk about the risks associated with
vaping so that we've got a whole picture of what,
you know, it's not like, oh, let me start e -cigarettes.
There's no problems because there are some. Yeah,
I agree. Okay, let's do that. So when we compare
vaping to a regular or a combustible cigarette
smoking, both involve inhaling nicotine and other
substances into their lungs. Like we've talked
about e -cigarettes heat liquid, whereas cigarettes
burn tobacco and create smoke. So there are differences
as far as risks associated with both of those.
So I give that to Josh as far as better to inhale
what's going on with an e -cigarette most likely
than the tar that you get from burning tobacco
that you inhale with a cigarette. Because we've
got a lot of data that supports cardiovascular
disease, lung cancer associated with cigarette
smoking. Both vaping and combustible cigarette
smoking are addictive. And it's that nicotine
component. It's just hard to say no. And both
can bring potentially dangerous chemicals into
the body. It is unknown what long -term damage
vaping may cause due to the limited time available.
It was really interesting. I looked back, like
I talked about at the beginning of this podcast,
it was in the late 1700s that tobacco was first
used in the United States. And it took until
the 1900s when we had mass production of cigarettes
that we started seeing the potential carcinogenic
effects of uh, combustible cigarettes. So vaping
hasn't been out that long, maybe 10 years. Well,
the first e -cigarette was developed in China
in 2003, 2003. Okay. So we've got 15 years, maybe,
well, no, I can't do math. 22, 22, 20, sorry.
But to be mass produced and available, I would
say. I would say 10 years. I would say like it's
definitely gotten more popular between probably
the 2010s to now, like over 10 to 15 year period.
So yeah, I mean, you're comparing a couple hundred
years. And I would say even, because we should,
I mean, we could have a whole podcast on this,
but like medicine was not scientific until it's
still, I mean, it's still maybe. the early 1900s.
Like medicine was considered an art. It was very
much like folk wisdom. Apothecaries. Yeah. Like
medicine has taken a, I think we always think
of like, oh, it's, you know, lab coats and hospitals
and, you know, very, you know, regimented procedures.
And it's so hard to imagine that medicine was
nothing like this in pre -industrial revolution
and pre -enlightenment. And it has taken time
to catch up. And as you probably observed in
the medical space, there's a lot of different
types of ways that people like to heal people,
whether it be the traditional or the modern medical
system or homeopathy or alternative medicines
or functional medicine. Now, there's so many
people, obviously, you want to feel better. And
it is very normal for a lot of these modalities
to exist because for the longest time, there's
a difference between feeling better and objectively
being better. Like I think a great example of
this is when you take chemotherapy, like chemotherapy
makes you feel awful, but you objectively can
diminish the size or sometimes even eliminate
the cancer inside of you. So by that metric,
it's like, this is a terrible thing. Chemotherapy.
It's like, well, It's a risk to reward ratio.
Are you willing to take that risk to potentially
get this reward? Whereas there's other things
out there like homeopathy, which is you're literally
diluting a substance sometimes by a million to
10 million fold. It's equivalent to taking like
a piece of Tylenol, like one little pill, and
then dissolving it in the ocean. And that is
the dose that you're getting from homeopathy.
And some people swear. It's like, oh my gosh,
I feel so much better by doing it because it
feels good to take something placebo effect exactly
it takes it feels good to take something that
you think works so i think it's really good to
differentiate just because something feels good
it doesn't necessarily mean it's good for you
just think about all those people on crack cocaine
and uh but and then sometimes taking a little
bit of medicine even though it doesn't feel good
to do it it's or even exercise for that example
or abstaining from that extra dessert that you
want to have it's like But in the long run, it
might be healthy. So I think it's really good
to differentiate between something that feels
good. I went on a long rabbit hole to talking
about the history of medicine and things like
that. Which we're really talking about the fact
is that we don't really know what the long -term
effects of vaping are going to be. Thanks for
landing that point. There you go. I appreciate
that. So, yeah. So, but, you know, and again,
too, I don't know how long it is. I mean, I think
about my late father -in -law. He smoked cigarettes,
you know, until he was 50. And he lived until
he was 95 and developed lung cancer. And he had
not smoked in 45 years. And so it's like, woo,
you know, and stuff. So that's crazy and stuff.
So, um, so you just don't know how long it's
going to take to see some potential adverse effects
from the vaping mechanism. So, yeah, I think
maybe later on in the podcast, we'll talk about
a little bit about basic, basic cancer dynamics.
Cause I think it's important to tell people that
cancer is not one of those things that like you
just suddenly get, it's like a cascade event
that happens, um, from little things over time,
but I'll save my other long, so willow clay for
later in the podcast. This is the Josh hour.
So yeah. Um, so anyway, okay. So let's get back
to some of the other risks associated with vaping.
If you have asthma, which is a, um, uh, uh, restrictive
air disease, um, it affects your breathing. Vaping
can make that get worse. It can also cause lung
inflammation. So it can cause scarring. It can
narrow or irritate your bronchi or your bronchioles
inside your lungs, which are part of the air
sacs inside your lungs that help you breathe.
So when you get scarring or irritation of those
or narrowing, then it makes it more difficult
to breathe. So you can get shortness of breath
and that's a kind of a scary feeling and stuff.
So you can also get lung scarring due to some
of the components inside the liquid that you're
using. that you have for these e -cigarettes.
And so that can cause a popcorn lung and it can
cause some permanent lung scarring as well too.
Now, again, the incidences of these, I don't
have, but, and again, we don't, again, we don't
have as many people vaping as we do cigarette
smoking. So it's going to be lower numbers, but
it can happen. So it's just something to be aware
of. That's a good point. Yeah. I think the epidemiology
is a little in its infancy stage at the moment
due to, for this. So there's probably been observations
like, Oh, here's a person who vaped. they have
popcorn lung but like compared to other populations
yeah we might not have that data yet right um
you can have other organ damage uh you can have
damage to your heart or your brain especially
in adolescents that are using nicotine because
nicotine affects and adversely the brain development
it can it affects the areas that control attention
learning mood impulse control so um that's you
know you can as your young person is continuing
to develop their, you know, brain functioning,
you don't want to put anything, you don't want
them using something that could adversely affect
that. Nicotine, the nicotine contained inside
e -cigarettes can also increase your blood pressure
and it can also narrow arteries. So that can,
that can cause issues long -term. There was,
there, there was a condition called e -cigarette
or vaping product use associated lung injury.
And it was a serious lung condition that was
possibly caused by that vitamin E acetate that's
inside that e -cigarette liquid. And it would
cause widespread lung damage with symptoms like
cough, shortness of breath, chest pain, fever,
vomiting, diarrhea, and a rapid heartbeat. But
the case, it was associated with In the early
2020s, but now I think that the cases have been
declining. I think they've just, maybe they've
improved the techniques for making e -cigarettes.
Well, some places have banned selling vitamin
E acetate along with some of these packs as well
as it's also THC. Those are the two things that
were associated with these EVALI events or EVALI,
which is the acronym that mom talked about. Um,
and it was kind of causing these pneumonia like
symptoms and there was something. So vitamin
E, we often think it's like, oh, that's a great
thing. You put it on your skin, you know, promote
skin health, but inhaling it as a very different
story. It's this, if you've ever used that, it's
a fat. So if you've ever thought about, I don't
know if you've ever tried to wash your hands
with fat on without soap. it's not coming off.
So as you think about that inside of your lungs,
and if that gets on your lungs, then it's not
going to be able to do proper gas exchange. And
you're going to get some of these chronic conditions.
You might have these immune events because your
body's obviously trying to heal itself. So it's
going to attack the lungs and that's going to
cause the scarring. And yeah, so some of these
substances that are dissolved in these cartridges
can be worse than others, which leads to some
of these events. And I think probably they've
declined because some of these I think some people
have caught on, be like, oh, don't do it with
vitamin E. And also some places have outright
banned the sale of that. So it's harder to get.
Okay. Okay. Addiction, we've mentioned, as well
as e -cigarette. If you start with an e -cigarette,
you could transition to smoking regular combustible
cigarettes. The secondhand exposure that may
potentially be associated with e -cigarettes
as well as combustible cigarettes. Interestingly,
and I... I apologize that I don't have an incidence
of this, but because your e -cigarette is battery
operated, there have been some cases of that
battery, the vape pen exploding. And so it can
cause a burn or an injury to a person and stuff.
Yeah, I would say that's true of lithium ion
batteries in general because it's also happened
in tablets and in phones as well as computers.
So if you're going to buy something with a lithium
ion battery in it, if it's not well made. I mean,
it's true of any manufacturing, like you're always
going to get some type of defect and you might
be the unlucky person who gets the defect. Um,
but yeah, I mean, if your, your, your cigarette's
not going to explode, but yeah, this, this e
-cigarette might just cause it has a battery
inside it. Um, we talked about cancer as well
as who is a potential risk. And then, uh, the
death rate that I could find with, um, e -cigarette
smoking were 2019, 2020 data. So now we're five
years out, but there were 68 people that had
died from those E -Valley lung injuries. So,
you know, not the rest of them, but this was
just specifically the E -Valley that was the
most significant lung damage that was found with
vaping. Yeah. And that's why I would argue that's
less people that would die in one week. From
smoking cigarettes. Yeah. So even if you, like
mom said, we don't know entirely the long -term
harms. As we know from living, sometimes death
isn't the worst thing. Like you can definitely
get some long -term consequences that are not
fun to be alive. So that's why we have morbidity
and mortality. So sometimes even the morbidity,
which means like the symptoms that you have to
live with could be slightly worse. I was just
looking to see if I had a new death rate. for
vaping, but it's still that 68 number, 68 people
number. So you can also develop, so there's poisoning
and toxicity associated with vaping as well too,
because those containers that are inserted inside
of a vape pen are concentrated amounts of nicotine.
And if a kiddo got it or you, accidentally spilled
it all over your skin. It can have irritant effects
to your skin, but it could cause nausea and vomiting
and it could potentially cause serious effects
for a kiddo because it's nicotine. And so it
could increase heart rate and blood pressure.
And so it'd be a significant thing. So you got
to be careful. If a kid accidentally drinks it.
Accidentally drinks it because it's a liquid.
Yeah. Because, you know, kids are curious. So
that is one of the things too that could come
with that as well too is that if you use large
nicotine doses, so a kiddo ingests a whole bottle
of an e -cigarette liquid, they could develop
seizures as well too. So an average vape pod
contains the equivalent of 20 cigarettes. Yeah,
this is an important point because I think it's
really one of the hard things to recognize too
is this concept called bioavailability. So what
I mean by that, is that when you ingest a substance
inside of you, it can either be dissolved and
go into your bloodstream and be available for
use inside of your body, or it can be bound to
something else and then not be able to be used
to your body. So the bioavailability is this
thing that can essentially be used by yourselves
or using something else. Due to the delivery
mechanism of cigarettes, versus e -cigarettes.
And also just using another source of tobacco
that delivers nicotine is this stuff called a
snooze, which is essentially like a little tobacco
pack. They're also called zins in the United
States. And you put them on the bottom of your
lip or the top of your lip. Saw them at the ice
house this morning. You can get everything at
the gas station here in America, especially Doritos,
which I love. But you put that in and it's a
slow, it's a slow drip. But we're going to talk
about this too. Okay. I know that's the gut reaction,
but data is greater than feelings. But so when
you are taking nicotine into your body, let's
just use the tobacco, the one that you put on
your upper lip. That is about a 30 to 50 % bioavailability.
So only the amount of nicotine that's in that
pack, only about 30 to 50 % gets into your. bloodstream.
With e -cigarettes, let's just talk about cigarettes.
Cigarettes, it's a lot cleaner. Essentially,
if you take in a cigarette, about 90 % of that
nicotine will get inside of your bloodstream.
Crazy enough, cigarettes are really well regulated,
meaning that you kind of know exactly what you're
getting when you're smoking a cigarette. E -cigarettes,
crazy. I mean, the amount of variability of nicotine
that you get. I looked at these studies where
these people essentially did simulated e -cigarettes.
So essentially they got a machine that kind of
like artificially puffed an e -cigarette and
the amount of nicotine that they got from different
brands and different types of e -cigarettes was
essentially between like 0 .025 milligrams for
every 15 puffs that you like take from the e
-cigarette to 0 .75 milligrams. I know those
are tiny numbers, but if you think about like
that is almost a That is more than a tenfold
difference. I think it's like a 30 -fold difference.
And it just depends because this industry is
so young and it is not well -regulated, especially
in the United States. So essentially, it's kind
of deemed as like a supplement. And you just
don't need to do any testing to determine what
dose is in there. You really don't know how much
nicotine you're getting. So if you buy like a
Juul versus a Vuze versus, what was the other
brand that you told me? The one that rebranded.
Elf Bar, but now it's like EB Create. EB Create.
Enjoy. They are not required to do formalized
testing to basically talk about how much nicotine
is in these pods. And it could be incredibly
variable. That being said. Even if we did the
upper bounds of what these are, you're probably,
if you consumed one Juul pack a day, you'd get
about 40 milligrams of nicotine inside of your
body. So to get that kind of seizure threshold
that Dr. Seltzer was talking about, you would
need to do like two of those a day. And you'd
have to do it in pretty rapid succession. So
if you're a parent and you see your kid or if
you are a person who vapes, If they're doing
two of these a day, that really increases your
risk of nicotine toxicity. That can increase
the risk of a seizure and some of these other
deleterious effects. So doing it quickly and
as well as doing it a lot is obviously going
to increase the amount of nicotine that's in
your body. One Juul pod can, oh, 20 cigarettes.
Okay. So it's 20 cigarettes per one Juul pod.
So yeah. Okay. So, and the amount of nicotine
in one standard Juul. Wait, wait. I'm just saying
the reason that they say that is because. It's
200 puffs. 200 puffs. Yeah, 200 or 300 puffs.
Because people going off cigarettes, because
like mom said, nicotine is so addictive. In order
to get the equivalent of the nicotine delivery,
they have to make it 20 times more concentrated
because the bioavailability in a vapor is very
different than tobacco smoke. Yes. So. Even though
that's a bit misleading to say it's like, oh,
they have 20, it's like 20 times the cigarette.
It's like, well, you have to do more puffs. That
makes a lot of sense. To get the same amount
of nicotine because if you're already addicted
to nicotine, let's say you're a smoker and you're
trying to move to e -cigarettes. Right. You're
going to have to smoke more of the e -cigarette
to get the same nicotine concentration. Right.
And you know what would happen too is that if
you, if they didn't do it that way. You would
just give up. You would just go back to cigarettes
because you're like, oh, I'm not getting the
effect I need. So I'm just going to go back to
my regular cigarettes. Yeah, exactly. So, yeah.
One other issue that's associated with not only
what is associated with e -cigarettes as well
as combustible cigarettes is that nicotine itself
causes fetal toxicity and adverse pregnancy outcomes.
And that's been noted for a long time. So nicotine
damages the fetal brain and the lungs, and it
can also result in low birth weight and preterm
birth. So you want. You don't want to use it
in pregnant women. So, okay, we're going to move
now to talking about, and we've kind of alluded
to this, about using e -cigarettes in youth.
So, and as we've kind of alluded to, using e
-cigarettes or vaping is much greater than other
tobacco products in the U .S. youth. In 2024,
there were 1 .63 million students in the United
States using e -cigarettes. That's 5 .9 % of
our students. 410 ,000 were middle school students,
whereas 1 .21 million were high school students.
And out of all of the students who have used
e -cigarettes, there were 43 % that report current
use. And those with current use are reporting
that they use mostly the flavored e -cigs. And
then about a third of those used an e -cig on
at least 20 out of the last 30 days. And about
one -fourth used an e -cig every day. And disposable
e -cigarettes were used in a little over half.
Females being greater than males as far as using
e -cigs. Juul is the most common brand of e -cig
used in youth. It contains what they call a protonated
nicotine, which... The company claims is associated
with reduced issues with taste, smell, and throat
irritation, which I think that was the deal with
when you'd start, if you were trying to learn
how to smoke a cigarette, you'd breathe it in
and it was really irritating and stuff. So you
had to acquire the ability to do that. And so
I'm sure that maybe other e -cigs. may have that
associated with it, but Juul promotes that they
have less associated with that. And they have
a variety of tastes associated with it, mango
and mint. And so, you know, they make it like
really enticing to get these kiddos hooked on
this stuff. So it increases their desire to experiment.
And like I said, it resembles a USB drive. So
it's really a lot easier to hide from authority
figures or to use in areas where smoking is forbidden.
So they call that stealth vaping. Okay. I mean,
what's not stealthy is that big cloud of vapor
that's going to come out of your lungs. So even
though the device could be hidden, I mean, he's
like, yeah, I see what you're doing. Yeah. Yeah.
New kind of gum. Yeah. So most interestingly.
I found this very interesting. A lot of middle
school and high school students who vape want
to quit and have tried to quit. 2020 data show
us that those who wanted to quit were about 64
% of users and those who have tried to quit is
about 67%. And many use practice dual usage.
So they're using vapes plus cigarettes and or
cigars. That was 2024 data with one in three
middle and high school students doing both. And
also e -cigarettes, depending on the device that
you have, may allow you to be, it may be a delivery
system for other substances like cannabis, like
we talked about, so marijuana as well, too. In
2016, one in three medical school students and
one in four high school students reported ever
using cannabis in their e -cigarette. So, yeah.
Economically, vaping from 2020 to 2024, the unit
sales increased by 34 .7 % from 15 .7 million
units to 21 .1 million units. These were only
brick -and -mortar data. That does not include
online purchases, so it's going to be more than
this. And the percentage of disposable e -cigs
doubled. Over 80 % of the sales are for flavors
other than tobacco. Tobacco is not the favorite
flavor. Usually it's mint or menthol. And the
total cost of e -cig sales in June of 2024 was
$488 .9 million. But you compare that to cigarette
sales from 2023. 2023, you had 7 .6 billion packs
sold for a... price of approximately 106 billion
dollars so what is that um well you think about
it wait i'm not doing math right so think about
it so five it's like let's just round up that
first number it's 500 million that's half a billion
dollars yeah so yeah whoa it's like way less
yeah that's like 2 000 times more yeah and uh
interestingly vaping accounts for about 22 billion
dollars in output or the or 0 .1 % of our gross
domestic product. So they've got about 134 ,000
Americans employed creating vaping devices and
vaping materials. Yeah, you think about not just
the packs, but also the devices. Also, there's
like the shops that people go to. There's like
these vaping bars that you can just kind of hang
out at. So there's a lot of different ways to
do it. Very similar to alcohol. Right. So it's
not providing jobs for a lot of people, but it
does provide jobs for some. Yeah, the growing
industry. Yeah. So we always look at myths and
misunderstand... Myths? and misunderstandings
about our topics. And so vaping is no different.
So like we've talked initially, one of the myths
is that vaping helps stop smoking. And this is
not necessarily true. And the Food and Drug Administration
has showed that people may stop smoking combustible
cigarettes, but they will continue smoking with
an e -cigarette so that people are still subject
to being exposed to nicotine. Yeah. And I think
this is where Dr. Seltzer and I might not see
eye to eye because I don't really, I don't really
care that much if people are addicted to nicotine
because I just think that being addicted to something
is not as, it sounds bad, but there are different
things to be addicted to. So if, if I'm going
to be addicted to smoking, I'd rather be addicted
to the thing that just gives me the addictive
chemical nicotine as opposed to nicotine plus
the tobacco tar. I drink coffee every morning.
I would argue that I'm addicted to coffee. Some
might say I'm addicted to caffeine, but I don't
seek caffeine out in any other variety. I'm sure
there is a way to get caffeine that's less healthy
than coffee. I'm okay with my caffeine addiction
because I know that long -term health -wise,
it's not too bad for me. Whereas if you told
me that there's caffeine in a cigarette, I'd
be like, that's okay. I get my caffeine somewhere
else. So for me, it's all about, can you replace
one thing for another? But I did look up a study
and there was one done in Southern California
where they found students who had never done
e -cigarettes before. And they followed them,
I think over a two -year period. And then they
asked them, have you started smoking regular
cigarettes now? And comparing the students who
had, basically both groups had never done e -cigarettes
and then one started to do e -cigarettes. And
they followed those two groups who never did
an e -cigarette, only did e -cigarettes. Compared
to those two, did you try a cigarette? If you
did try an e -cigarette, you were more, I think
six times more likely to do tobacco cigarettes.
It just seems to be a culture, like people who
smoke together, stick together. And so if you
are going to smoke, you're probably going to
be around other people who do smoke. So I'm not
saying that if you do e -cigarettes, you're never
going to smoke tobacco cigarettes. But for those
of you who are already doing tobacco cigarettes,
can we get you to switch to doing just e -cigarettes?
And even though you might be addicted for life,
if we're going to assume the worst case scenario,
I would much rather that. I don't know if you
have any response to that. I do have a response
to that. So while we know that tobacco smoking
can be associated more, we have. data that support
the relationship between tobacco smoking and
lung cancer development. Nicotine also has an
adverse output on cardiovascular disease. So
if you already have cardiovascular disease and
you take nicotine in, you can worsen it. Or you
could, if you just happen to be predisposed,
taking daily nicotine could also worsen that.
So that's my argument against using nicotine,
you know, on a regular basis and stuff. So even
if you switch from, now. I understand your argument.
We don't know how much, and maybe they're getting
less nicotine with an e -cig. It's hard to say.
Maybe so. So yeah, if you're taking in less and
then you can handle that, that's fine. But it's
not without any risk at all. Yeah, so what you're
saying is you would like people to do neither
behavior. Right. Just from a health standpoint.
Right. But I think all I'm saying is I agree
with you. I think that neither should be done.
But if we had a choice. Right. I would definitely
say just nicotine rather than nicotine plus,
you know, tobacco. Right. Because that has obviously
been shown to cause massive amounts of harm to
people. Cool. That kind of leads us to the second
myth that vaping is safer than smoking. And we
talk about that, but don't forget too that the
liquid that is the solvent for these... the nicotine
for the e -cigarettes contains chemicals and
we're not exactly sure the long -term impact
of those. So we just need to be aware of that.
I agree. Yeah. And that kind of goes to with
the fact that vaping produces harmless water
vapor. It's not water. It's an aerosol that contains
stuff in it, different types of chemicals. So
it's, it's not just, even if you breathe water
inside your lung, that's not going to, that's
not what your, your lungs are not. built for
that so um think about when you like inhale water
from the swimming pool it's not a pleasant experience
so yeah um vaping doesn't create secondhand smoke
and that's not true um it contains it's not smoke
per se but it's an aerosolized vapor that people
can also breathe in it can also land on surfaces
and clothing and it can be breathed in through
that as well too and again we just don't know
what that's going to cause long term Um, it's
easy to quit vaping. It's not easy to quit vaping.
If you, you know, once you start with nicotine,
it, um, it, you, you tend to crave more nicotine.
Um, so it's, uh, that's especially concerning
in our, in our teenagers, uh, that start at such
an early age. Yeah, I agree. And I think that's
why we have a lot of these like replacement therapies.
If you did do cigarette smokes, you have to say
nicotine gum, nicotine patches. Um, actually
I just read the FDA. This is like this past week.
They approved the, not that it's not FDA approved,
but the FDA approved the sale of basically those
pouches that I was talking about. They're called
Zins. Basically as a way to be like a safer alternative
to smoking cigarettes and potentially e -cigarettes
as well. So because what they found, what they
found a lot in Scandinavian countries where that's
this type of. Actually, zins are just nicotine.
It's not tobacco. It's very similar to an e -cigarette
where it's just liquid nicotine. There's basically
liquid pouches and you suck on them rather than
smoke them, which sounds weird, but some people
like it. Whatever. Anyways, they have found in
the Scandinavian countries where it's much more
popular there that that has been shown to be
a great replacement therapy because people get
addicted to these. They call them snus in Scandinavia.
And they're very hard to give up. People love
them because obviously they're nicotine. But
they find that it's a good replacement for when
they're switching from smoking. But they can
still get that nicotine high, which is really
the thing that they want. So they'll essentially
substitute one for the other. So the states have
caught on to this. And the FDA just announced,
I think it was like January 16th. And we're recording
this on the 23rd of January. uh 2025 and uh so
i thought that was really cool that is interesting
uh you know i think two thoughts i have on that
let's see if i can remember my two thoughts um
one is um Oh, yes, I can. Amazingly, I can remember
my two thoughts. First of all, if you do substitute
it with that, then you're not going to have the
secondhand smoke issue or aerosolized for bystanders
and stuff. So that's interesting. My concern,
and I'm thinking the FDA, and again, because
I did not look into this, I saw it, but I thought
we're talking just about e -cigarettes today,
but I appreciate you bringing this up. I know
with snuff, which is pouch tobacco in your gum
line, it does increase mouth cancer. Correct.
So I'm hoping then that it's the tobacco part
of that that does it and not the nicotine part.
That is correct. Because I would be concerned
then with these. pouches of nicotine in your
mouth that we don't want mouth cancer. Yeah,
and it doesn't. If you look at the epidemiology
in Scandinavia where they're done, yeah, especially
if they're ones that are not, they're just nicotine
pouches, yeah, the rate of cancer doesn't increase.
So it's mainly tobacco. Yeah, very interesting.
So you still have the nicotine issue, but yeah.
So it's getting to be a safer, you know, if you
can consider safer. Yeah. It's just lowering,
it's lowering the hazard or risk. It's like,
if I still get my nicotine, can I lower the threshold
of the risk of causing a long -term health outcome?
Yeah. And I think a lot of times people want
to avoid things like mouth cancer and lung cancer
and. Heart disease. Heart disease. Yeah. Cardiovascular
events. Strokes, stuff like that. Also just like.
I don't know if you've ever had a day where you
got an infection, like a lung infection, but
just like not breathing well. It's just like
a really drag on your life. You can't exercise
as well. It just really limits your quality of
life. And you only get two of these little sacks
inside of your body to facilitate gas exchange.
So take care of them. Yeah. Also too, I mean,
I personally hate cigarette smoke and walking
in rooms that are full of cigarette smoke. So
that, you know, would reduce that as well too,
because I mean, it affects me adversely, you
know, and so that's, you know, anyway. I think
one of the greatest public health things we did
is that we created the smoking section only or
banned people from smoking in restaurants, which
I couldn't believe. Yeah. And on the airplanes.
Yeah. It's insane. Yeah. So yeah. Hallelujah.
So. And in hospitals, you used to be able to
smoke in hospitals and now you can't do that
anymore. Thank goodness. So let's talk about
quitting vaping because I don't think it would
be complete without talking about that because
nicotine is addictive. And so. If you want to
know whether or not you're potentially addicted
to nicotine, here's some symptoms or some signs
that might indicate that. First of all, you crave
it, that you're like, I've got to have it. I've
got to have my Diet Coke every day. So I think
I'm addicted to the caffeine in it or the carbonation,
one or the other and stuff. But I don't want
to give it up. But, you know, well, anyway, that's
another story for another day. If you feel like
you're unable to stop using nicotine, you know,
then that's going to be a sign of addiction.
Also, interestingly, too, if you develop a tolerance
to it, that means you need more to get the same
effect. And that's going to kind of indicate
an addictive type of a situation. There are symptoms
with nicotine withdrawal. And so it's kind of
tough to go through. So if you stop vaping, you
could have some withdrawal symptoms, such as
feeling irritable or jumpy or restless, feeling
sad or down, having trouble sleeping, having
a hard time concentrating, feeling hungry or
craving nicotine. But those withdrawal symptoms
will go away over time as your brain gets used
to not having nicotine. If you do want to stop,
then have a plan to quit with goals. Make a list
of reasons to quit vaping. Set a quit date. Talk
to your health care provider so they can help
you. And tell your friends and family so they
can be accountability partners for you as well.
Avoid any temptations or triggers. So don't go
places where you know that people are vaping
so that you would get drawn back into that as
well too. Get some exercise. Getting those endorphins
going helps you to have have a good feeling and
helps your body feel good. So that would be a
good thing. And if you are having some cravings
and experiencing some side effects, you could
use the nicotine gums or patches as well too
to help with that as well too. And then you could
utilize your favorite relaxation technique, either
prayer or meditation or yoga or deep breathing
to help you get through those toughest moments
and withdrawal as well too. Yeah, that's well
said. I think it might. prove useful to talk
why nicotine is so addictive. Okay. So you essentially
have this area in your brain called the ventral
tegmental area, which has a lot of neurons that
secrete this thing called dopamine. Dopamine
is this thing called a neurotransmitter. You
might've heard it in the literature. It's been
known as like the pleasure chemical or the reward
chemical. It's not exactly how it works. It's
actually the anticipation of reward. That is
what It's like the anticipation reward that develops
that feeling because dopamine drives you towards
a goal. So it's essentially wanting you to eat
food. It's wanting you to procreate. It is wanting
you to do the things that an organism does. So
what nicotine does is that it attaches to these
neurons and it basically... releases tons of
dopamine into your system, getting you that feeling
of like, Oh, I'm going to, I'm going to get a
reward. I'm so excited. I'm about to be rewarded.
Um, but it does it so much, um, that essentially
your body can't make more of it. Um, and so that's
kind of the depleted feelings that you're getting,
like what mom, mom is saying, feeling sad or
feeling down or trouble sleeping. It kind of
throws off your. your natural rhythms of these
reward chemicals. There's this great book called
dopamine nation by Anna Lemke that I highly recommend
reading. If you are a person who suffers from
addiction or know someone who does, because I
think it really talks about of all this stuff
that we're saying is like limiting addiction.
It makes a lot of sense. And it makes a lot of
sense that all those kids that they interviewed,
like, do you want to quit? And they go like almost
70 % of them said, yeah, of course I do. But
saying you want to quit and quitting. is so hard
and because it requires a lot of willpower and
it requires a lot of like rewiring your brain
to want something it doesn't want and that takes
a really long time be asking mom to give up her
diet coke it'd be asking me to give up my coffee
and it's like no absolutely i know i could but
it would take a lot of work and it would be like
do i really want to give this up um and i i think
a lot of times um with these chemicals And I
think it's true of a lot of addictive behaviors.
I think we look at people and we think, oh, you
have no willpower. It's your fault. But this
is how your brain was made. And this is how it
does. So I think a lot of times when you see
someone who's addicted to anything, realize that
could have been you. You just have your own addiction
that's more socially acceptable, whether it be
exercise, Diet Coke, or coffee. And when someone's
trying to quit, I think the thing that they need
the most is support. and accountability because
a lot of times like being encouraged, like making
these small steps towards coming through is a
really important thing. So I just wanted to lay
that out because you had some of these chemicals,
things like cocaine and nicotine are really,
really powerful releasers of dopamine in the
brain. And that's why they're incredibly addictive.
Yeah. So, so to wrap up our talk today about
vaping, the conclusions that i've come to after
looking at the literature is that really no tobacco
product is completely safe safe including e -cigarettes
but we've talked about that e -cigarettes may
provide a less risky exposure to nicotine than
a regular combustible cigarette right because
they're technically not a tobacco product right
that that's true so um Nicotine is contained
in most e -cigarettes, and it is highly addictive,
and it is a health danger for pregnant women,
including developing fetuses and the youth. So
we want to minimize use in those patient populations.
The aerosol from e -cigarettes could be harmful
to those standing by, so we want to be respectful
of the people that are around us as well. So
trying to... to encourage youth and young adults
to not start using an e -cigarette so that they
may avoid nicotine addiction in the future and
the transition toward combustible cigarette use
and maybe cannabis use as well is a goal, I think,
as well, because e -cigarettes can be a springboard
for those other mechanisms. So maybe encouraging,
you know, other activities other than e -cigarette
use. And then we don't know really what the long
-term effects of e -cigarette use are. So I think
we just need to be cognizant and be wise and
just be aware of what people are finding out
as far as it's concerned. Because I tell you,
you know, you think about things that you did
when you were younger and then you... reap the
consequences of it when you're older. I think
about me laying out in the sun and as a teen
and listening to my father tell me I'm going
to be sorry. And, you know, now I'm in my 60s
and I wish I'd listened to him, you know, stuff.
So, you know, now I get a, you know, at least
an annual visit to the dermatologist to check
me out for skin cancers because I've already
had one. So, I mean, it's the same thing. It's
like, so we just, you know, we want to be smart
as far as using these products. Yeah, that's
really well said. And especially with something
that has an unknown risk, I think there's going
to be certain persons like, what's the big deal?
We don't know. And then there's going to be the
opposite side of that. I'm going to be extremely
cautious. But I really love the point that you
made about how young people could potentially
become cigarette users from this behavior. And
I think that really hints at an interesting nexus
point with e -cigarettes is that I think what
we want to do is that we want to get adult cigarette
users to start using e -cigarettes as a preferable
alternative. But we also don't want young kids
to start smoking at all. So having policies from
our government or even within our corporations
of like, can we not sell to kids, but can we
sell to adults? And especially adults who are
making the switch from cigarettes. It seems like
a really unique public health problem because
you want to demonize e -cigarettes to young people,
but you also want to highlight their benefits
to adults who are already smoking. And I think
as humans, we have a really hard time being nuanced
and seeing two truths at once. So I'm really
hoping that we can kind of thread that needle.
Because I can't remember the exact survey, but
there's a survey. I think it was one -fourth
or 25 % of people think that e -cigarettes are
more harmful than tobacco cigarettes. So there's
this really kind of anti -vaping campaign going
around because I think it's being targeted to
kids and people think it's being targeted to
kids. And I think rightly so. But I think it's
also missing the bigger message of like, if we
just universally demonize this, we might be causing
more harm because we're going to push adults
back into. uh, traditional cigarette smoking.
Yeah. And you know, we also, we also discovered
too, I mean, again, I, I'm a kind of, I'm pretty
naive. I mean, I, I, I, I lived in a protective
world growing up and I, maybe I still do now,
but you know, in tech and the state of Texas,
uh, vaping materials are not, they're not they're
not supposed to be sold to anyone under 21 years
of age. So then you think, okay, how do you get
all these middle schoolers and high schoolers
started on these things? So those of you that
are providing these to those young people, maybe
you shouldn't do that. So, you know, and I'm
sure, I'm sure there's all kinds of loopholes
and stuff that I just don't even know about because
I'm kept in the dark. But so anyway, so just,
just, you know, be wise. Listen to your mother,
y 'all. Your mom on drugs. Well, we so appreciate
y 'all coming in and joining us for this episode.
I feel like it was a mixture of your mom on drugs
and your son on risk. Yes. It was definitely
a combo today. But we hope that you tune in for
our next episode. And we hope you check out our
back catalog because it's full of good material.
But until next time, I'm the son, Josh. And I'm
the mom, Jenny. And we'll see you next time.
Bye. Bye.