Teen Vaping: Epidemic, Effects and Help

Did you know that nearly 5 million teens across the U.S. are vaping and using tobacco? Outbreaks of severe and deadly lung injury has exploded the myth that vaping is safe. Watch this video from our Facebook Live conversation with Dr. Thomas Ylioja, Clinical Director of Health Initiatives at National Jewish Health to learn about the dangers of vaping and the enhanced tobacco cessation program specifically designed for teens.



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Alyssa Paschke: Happy New Year and thanks for joining us for our January discussion about teen vaping. Nearly 5 million teens across the U.S. are vaping and using tobacco products. Recently, vaping related lung injuries and deaths have been reported and scientists are trying to determine the exact causes of these incidents. For teens, there are a few resources out there to educate them about the dangers of vaping and tobacco use and to help them stop. National Jewish Health is leading the way on both research into vaping and a new comprehensive program specifically for youth tobacco cessation.

Alyssa Paschke: Today, I'm joined by Dr. Thomas Ylioja, the clinical director of the Health Initiatives Programs at National Jewish Health. We're going to talk today about what we know so far about the vaping epidemic and how the new My Life My Quit™ program can help teens quit tobacco. If you have questions as we go along, feel free to type them into the comments and we'll try to get to as many as possible. Thanks for joining me this afternoon.

Alyssa Paschke: Vaping has been a big topic of discussion in the news recently due to the reports of lung injuries and even death by some of these different products out there. Can you describe what's currently known about the causes of these incidents?

Thomas Ylioja: Yeah, good question. As of last week, the CDC is reporting over 2,600 hospitalizations.

Alyssa Paschke: Wow.

Thomas Ylioja: Related to e-cigarette or vaping product use associated lung injury or EVALI along with about 57 deaths. It's really an urgent problem that we're trying to address as a public health community to try to let people know about the dangers of vaping. And in particular vaping THC products that might contain vitamin E. That seems to be the biggest culprit for what's underlying it. However, the CDC has also said that there may be multiple products and different chemicals that are responsible. Just because one chemical is the most responsible for many of the cases, it doesn't mean it's the only one. We really still want people to know about the dangers of vaping and letting them know that if they are using them, that we're here to help them stop.

Alyssa Paschke: Why do you think teens are susceptible to try vaping as opposed to let's say cigarettes or other traditional tobacco products?

Thomas Ylioja: Yeah, there's a few unique things about e-cigarettes that really attract teens. One is they're full of flavors and we've known for many years that tobacco companies use flavors to get teens hooked on tobacco products and e-cigarette cigarette companies did that in multitudes. They were out on social media advertising their products. E-cigarettes are also cheaper within many places than combustible cigarettes because they're not taxed in the same way, so that's been a big problem. Also, there are gadgets, so a lot of teens like the new best thing that's on the market, so they were picking them up. They're easy to hide and so it was easier for them to use an e-cigarette whereas combustible cigarettes or traditional cigarettes, it's easier for you to know if somebody is using them.

Alyssa Paschke: Definitely. What are scientists trying to discover right now about how vaping affects your health?

Thomas Ylioja: Yeah, and that's a really good question because if you think about e-cigarettes are really a new product, they've only been around for about 10 years in the US, longer in other places. We just don't know what the long-term effects might be of using these products. We know in the short term that using these products, even if they don't contain nicotine or any other addictive substances, there is harms associated there. They interfere with how the cells are working in the airway, they're damaging.

Thomas Ylioja: Some of the research here at National Jewish and other hospitals has been showing that it does damage the cells, so there is harm associated with using these products. We also need to know what the long-term effects are for people who have already started using them. They're really kind of the guinea pigs for e-cigarette companies in terms of finding out what the health effects of vaping might be.

Alyssa Paschke: Right. And that's good to know that even if it doesn't contain nicotine, there's still other potential harmful chemicals and substances.

Thomas Ylioja: That's right.

Alyssa Paschke: For any parents out there that might be listening this afternoon who may be concerned that their teen is experimenting with vaping products or tobacco or THC. Can you describe some of the signs of the use of vaping?

Thomas Ylioja: Yeah, in particular for nicotine, what parents can look for is an unusual change in behavior, so becoming more irritable than usual. That's hard to sometimes know for teens, but parents know their children, they know what their sort of normal teenage behavior is like.

Alyssa Paschke: Sure.

Thomas Ylioja: If they're unusually irritable or they have had a sudden change in friends, they're having difficulty concentrating. Concentration and memory problems can be signs of nicotine withdrawals. They should ask directly about it. Many parents also tell us that they're finding strange devices, so these electronic devices, parents should become familiar with some of the more popular ones so that they know what they're looking at. It may be as simple as finding a cartridge or the actual battery pack, those kinds of things. Making sure to look up those products and see what they really are because if their teen is using them, they may not be ready to tell them about what product they're actually using.

Alyssa Paschke: Right. Okay. Well I wanted to take a moment and see if any questions have come in from the audience. Okay. Well, I'll keep going. Recently, several states and the federal government have increased the age to buy tobacco products to 21 and then prohibited the sales of a lot of those flavored vaping liquids that you mentioned. Do you believe that these steps will help curb or try and decrease the epidemic of youth vaping?

Thomas Ylioja: Yeah. We're trying some tricks that we used when cigarettes were popular among the young people, which was to try and get them out of their hands. There's many techniques that we can use and that we've used to help decrease the amount of combustible cigarette use that we still need to do for e-cigarettes. Banning flavors is a big step. We know that the majority of youth who start using these products first start using a flavored tobacco or a flavored cigarette product. Removing that from the market is a really big step.

Thomas Ylioja: Increasing the age to 21 to purchase it will help cut down likely on some of the informal ways that people get them. So getting e-cigarette products from a friend. However, we also hear from a lot of young people that they already know where to go and buy these products. We have to do a lot of additional work like retailer licensing, enforcing the laws that are on it, increasing the taxes. We know that young people are very susceptible to price increases in terms of how much they use. We need to make sure that they're taxed the same as other tobacco products to help reduce. These are good first steps, but they're not the end game from what we can see.

Alyssa Paschke: Gotcha. All right, well that's really interesting to know. Recently, I know that you wrote an Op Ed in the New York Times along with the National Jewish Health CEO, Dr. Michael Salem, sounding the alarm about the harmful effects of vaping and the new program that was launched this year called My Life My Quit™. I wanted to get more information from you about what the program is and why it's unique for teens and young people.

Thomas Ylioja: Yeah, we're really happy to be able to deliver this program and it's a dedicated program for youth. It's really the first quit line program that is really dedicated just to young people who are under the age of 18 that also addresses vaping. We're excited about having this program. It's too bad that we have to have a program like this, but at the same time we've been able to do some kind of neat new things whereas our quit lines are usually telephone operated. For the youth program, we were able to figure out how to get them so that they could text message directly to a toll free number or they'll get one of our coaches live so they can engage over text messaging. They can go online to mylifemyquit.com. There's a chat function there or they can call and any one of those ways, they can reach one of our coaches to get started.

Alyssa Paschke: Great. There's a variety of ways to reach out whatever feels most comfortable for you. Has a question come in from the audience?

Cyndy M: Yes. We have a question from Shelby. She asks, on a system level what policies should be put in place to reduce teen vaping use?

Thomas Ylioja: Yeah, so we talked about one of them, which was reducing flavors, getting flavors off the market place. That's a big step. We know that there's some federal legislation that's working its way through or has worked its way through, but we're waiting for implementation of removing all flavored cartridges. But we know that it also exempted e-liquids generally. There are still flavored products that are available. We hear from a lot of youth saying they're just going to use those products instead. We really want to make sure that we're reducing the availability of all flavors that really attract young people to these products.

Thomas Ylioja: Increasing the age to 21 is a start and we hope that that will make some difference. Retailer licensing laws where retailers actually have to have a permit to sell tobacco products and having pretty strict enforcement where if they're caught selling tobacco to minors that they could lose that license. It'd be a pretty significant penalty. Taxation is a big one, so increasing the price of these products using taxable methods to increase prices. That's another strategy. I'm trying to think if there's any other strategies I can think of off the top of my head. A lot of public health education, making sure that people are aware. So, prevention education in schools is really important. I'm supporting those on the state level as well.

Alyssa Paschke: Great.

Cyndy M: Shelby asked a follow up question. Should that include menthol, the menthol flavor?

Thomas Ylioja: It's a really good question. We know that a lot of times tobacco legislation does exempt tobacco and menthol flavored. We know that that's a holdover from the tobacco industry really getting into legislators pockets with big money to let them know that they can to try, and exempt them. The reason they do that is they know that those products appeal to children. If we could get rid of all flavors from the e-cigarette market, I think we could make a big dent on this and we know that we'll face stiff opposition as a tobacco control community to do that.

Alyssa Paschke: Great questions. Thank you so much. Back to the My Life My Quit Program, I wanted to ask you for anybody out there who's a parent of a teen or a teen themselves struggling with vaping and they're looking at ways to quit, how do they access the program and just kind of how does that program work overall?

Thomas Ylioja: Sure. Again, as I mentioned already, one of the nice things about the program is that there's a dedicated toll free number for youth that they can either call or text to get started. If they call, they'll get one of our coaches. They'll walk them through a really quick registration and intake and right into coaching with their first coaching session. If they text in, our coaches are, again, they're live, they're ready to respond. We'll start working with them right away, but we do want them to go online and complete a quick registration online intake form. Online they have some additional tools that they can use to help set up their quit plan. There's also a chat function on the online website. That's all at mylifemyquit.com. The toll free is (855) 891-9989. I hope I got that correct.

Alyssa Paschke: Awesome. Great. So is the program free?

Thomas Ylioja: The program is free. The state Departments of Health as part of their quit line programs partner with us to deliver the program directly to young people. So yeah, always free, always confidential for young people.

Alyssa Paschke: Awesome. Since the program has launched, can you talk about how many teens have enrolled and have you seen kind of an increase due to the vaping epidemic of people utilizing this new program?

Thomas Ylioja: Yeah, there's a couple of questions and there's a couple of different answers. But, so for the My Life My Quit Program and youth programs specifically, so sort of slowly rolled out through several states from July into November. So since July one we've served over 600 young people that come through under the age of 18.

Alyssa Paschke: Wow.

Thomas Ylioja: And well over 1,000 closer to 1,300 young adults who are 18 to 24 year olds. We're really happy that they are reaching out. They're getting the support they need to get on track with quitting. With the people who are under 18 most of them are coming in through the website. Almost all of them start online. We know that about three quarters of them want to text with us and so we're really happy that we have that service available.

Alyssa Paschke: Great. We discussed briefly how parents could be aware of the signs that maybe there's some vaping going on with their teens and how to access the program. Are there any other resources available out there for parents or maybe educators, people in the community, just to kind of spread that awareness, like you said, and be able to have those conversations with their children?

Thomas Ylioja: Yeah, so actually on the My Life My Quit website, one of the first things we did after we launched in July, we heard from a lot of parents, a lot of teachers, a lot of healthcare professionals asking that exact question, where can we find more resources? We've pulled them all together. They're on there.

Alyssa Paschke: Awesome.

Thomas Ylioja: They can go to mylifemyquit.com. There's a little tab for resources. There's resources for parents with some of the information we talked about, how to identify if your child is using tobacco products, how to have the conversation, really good links to other resources like the CDC, the Surgeon General, some other resources specifically for parents. There's resources on there for educators, including how to develop a tobacco free curriculum in their classrooms. There's links to posters that we've created for the program. They can also on the healthcare provider web page, there's links to be able to send in a referral. If there's a healthcare provider working with a young person who's trying to quit, they can send through a referral and we'll reach out to the person directly. Lots of good information, posters, wallet cards that can be printed off all for free.

Alyssa Paschke: Awesome. Well, yeah, unfortunately it's too bad that we have to have this type of program, but that's great that there's all those resources available for people. I wanted to take a moment and see if any other questions have come in.

Cyndy M: Yes, we have a question from Shelby. She's asking is the My Life My Quit Program national and if not, what do teens or parents do who are in states where it's not covered?

Thomas Ylioja: Yeah, great question. It is unfortunately not national at this point. We launched in July. National Jewish operates currently 17 state quit lines across the country and so, in most of those states, I think all but one we offer the My Life My Quit Program. When somebody goes to enroll on the program, they'll see a dropdown list of all the states that are currently in the program. That has the list of them. If they're in a state where we don't offer the My Life My Quit Program, they can call the 1-800-QUIT-NOW phone number. Most states now offer service to people who are under 18, so there is some help. Most quit line operators also have protocols to work with people who are vaping, both for youth and young adults. There's also other programs like the Truth Initiative has a texting program that's also freely available for young people to use and get them started on quitting.

Cyndy M: Here is a question from Kim. She's asking, will you be tracking success rates to show how many who enroll in the program eventually quit vaping?

Thomas Ylioja: Yeah, that's definitely going to be part of it. It's tough to get young people on the phone or even by text to answer a survey for us, but it is certainly a part of what we're planning to do is to make sure that we evaluate the program thoroughly as we continue to roll it out.

Cyndy M: Great. Jane asks, have any formal vaping studies been published? If so, how can we obtain them?

Thomas Ylioja: I'm assuming that question means vaping cessation studies or vaping treatment studies. To my knowledge, there has been no randomized controlled trials the way you can think of as the gold standard for intervention trials or treatment trials that have been published on helping people quit vaping. That's been for several reasons. A lot of the public messaging about vaping has been that they're the safe alternative to smoking and not about quitting vaping. We're trying to get out the message that quit lines and in particular for anybody who's over 18 or available for somebody to help them quit vaping and our My Life My Quit Program is available for young people who are trying to quit vaping as well.

Alyssa Paschke: Great. Question.

Cyndy M: One more question, Samantha's asking, what motivates teens to want to quit or to not start vaping at all?

Thomas Ylioja: Yeah, and so if you haven't felt any bad effects from using a product, it's hard to step away from it. Nicotine is a very powerful chemical that causes strong feelings of euphoria and wellbeing, making people feel really good when they're using it. It's also very addictive for those reasons as well. A lot of times young people don't quite get that they're getting hooked on a substance. Once they start to realize it, and that they are having a hard time quitting that can be sometimes a motivator.

Thomas Ylioja: They do feel the health effects of it though. A lot of times we hear from young people say they feel burning in their lungs and they're using these products. We've been really talking about that a lot more that if you feel burning in your lungs when you're using a product, it's probably not safe to use. The financial impact of using these products. They still cost money and a lot of teens don't have a lot of disposable income. The money factor is a big motivating factor for also for helping people quit, which is why we think the taxation would help a lot with on e-cigarettes. If you can increase the cost of them, young people will use less and many more will not start.

Alyssa Paschke: Great. Any more questions? All right, well I think we're almost at the end of our time here, so I really appreciate you speaking with everybody over Facebook and just kind of getting the awareness out there of this new program. I think this is super important information, given all the recent news events coming out about vaping. If we didn't get your question, if you're watching this video later on, we will reply to your comment directly. Again, I just wanted to share the My Life My Quit website one more time. And that's www.mylifemyquit.com. If you'd like to get more news and information from National Jewish Health, feel free to visit www.njhealth.org. Thank you.

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