Smoking & Vaping Articles

Article / Updated 08-10-2023

Unfortunately, ingesting poison into your system daily for many years takes a toll. We say that not to shame or scare you. Mercifully, we’re keeping some of the gory details limited. The reason it’s important to know about these issues is that it may help give you additional motivation for quitting. The good news is that quitting smoking confers substantial health benefits no matter when you do it. The bad news is that you actually have to quit to get these benefits. So, exactly what can you expect in the relatively near term when you quit smoking? Here are a few of the benefits: If you’re an exerciser, your lung function starts to improve after just a few weeks of not smoking. Fertility returns to normal quickly after quitting. The risk of babies born with low birth weight is the same as nonsmokers upon quitting. Your smell and taste will gradually return after six months or less. You won’t cough as much in the first year or so. Your heart disease risk reduces after the first year and improves to that of a nonsmoker after 15 years. Cancer risk reduction takes longer but declines after five years. Your risk of a stroke declines substantially after five years. Smoking effects on the vascular system The circulatory system includes the heart, arteries and veins and is responsible for delivering oxygen-rich nutrients and removing waste from all areas in the body. In a healthy body, the process of circulation is effortless. Smoking interferes with that process. Cardiovascular disease Heart disease is the leading cause of death for men and women in the United States. About 20 percent of all deaths from heart disease can be directly attributed to smoking. In addition, smokers who have heart disease are more likely to die younger than nonsmokers. Every single cigarette a smoker consumes increases the risk of heart disease. In other words, the more you smoke, the more likely you’ll die of heart disease. What does smoking do to the cardiovascular system? If your health care provider tells you that you suffer from one of the following health issues, you can bet that smoking has contributed to these interrelated diseases: Hypertension (high blood pressure): Smoking increases blood pressure immediately and over the long term. Hypertension causes the heart to pump harder. It damages blood vessels, causing them to narrow, weaken, or rupture. That damage, in turn, can lead to stroke or heart attack. Arteriosclerosis: This disease involves plaque buildup in the arteries which can result in a serious blockage resulting in stroke or heart attack. Heart disease: When the plaque buildup affects the blood supply to the heart or the coronary arteries, it can cause chest pain, shortness of breath, or a heart attack. When a heart is weakened, it can lead to what’s known as heart failure. Heart failure occurs gradually, and symptoms include shortness of breath, weakness, fatigue, wheezing, and retention of fluids, resulting in swollen feet and ankles. Although many pipe and cigar smokers claim that they don’t inhale, some do, and all of them ingest secondhand smoke close up. Smoking cigars and pipes increases both the risk of heart disease and stroke. Cerebrovascular disease Strokes occur when the blood supply to the brain is impeded by a blockage or leakage. The more you smoke, the higher your risk for stroke. In fact, strokes are the top cause of serious long-term disability in the United States. The acronym FAST can help you remember the symptoms of a stroke. Here’s what the acronym stands for: Face: Numbness or weakness as evidenced by a droopy or asymmetrical smile. Arms: Weakness or paralysis on one side of the body, which can be determined by trying to raise both arms at the same time. With a stroke, one arm may not function the way the other one does. Speech: Confusion or difficulty speaking, or understanding may show themselves. Time: If these symptoms appear, call a doctor immediately. Urgent, prompt attention can improve the outcome greatly. Smoking leads to a host of cerebrovascular problems. It also hijacks the mind, body, and soul. Ted’s story, in the nearby sidebar, “Dying for a smoke,” shows how powerfully addiction leads to deterioration in health, but also impedes recovery. Checking for peripheral artery disease With peripheral artery disease (PAD), plaque builds up in the arteries of the outer (or peripheral) part of the body, most commonly the legs. PAD results in pain, cramping, weakness, and numbness in the extremities. If the blood flow is sufficiently restricted, it can also lead to a high risk of infection, which is difficult to treat. Those with severe PAD, can develop gangrene in the affected tissues, which can lead to amputation or even death. Smoking and diabetes are both risk factors for PAD. How smoking affects lungs From the moment a smoker inhales for the first time, the lungs rebel. Most first-timers choke and cough as part of this rebellion. But the lungs adapt after a while and seem just fine again — until they’re not so fine. In addition to lung problems directly caused by smoking, smoking exacerbates preexisting asthma, makes recovery from colds or flu slower, and can increase the risk of pneumonia. See your doctor for any cough that lasts for three weeks or more or immediately if you’re coughing up blood. Confronting coughs Most smokers develop a smokers’ cough. It’s caused by toxins setting up shop in your lungs, which the body tries to eliminate by coughing. In the beginning, it’s a dry, unproductive cough without phlegm. As time passes, it becomes more frequent, gets worse in the morning, and starts producing phlegm. Treatments designed for typical coughs are not particularly effective for smoker’s cough. Eventually, smoker’s cough often leads to more serious conditions. Taking a turn for the worse Many people fear lung cancer as the worst outcome of long-term smoking, and for good reason. However, chronic obstructive pulmonary disease (COPD) ranks pretty high on the list, too. In fact, the U.S. Centers for Disease Control and Prevention (CDC) ranks COPD the fourth leading cause of death in the United States. As COPD progresses, the lungs struggle to function properly. The lung tissues thicken, which makes it more difficult to inhale and exhale. More mucus is also produced as the disease progresses. Again, our intention is not to scare you, but people with end-stage COPD have great difficult breathing and become cognitively impaired due to the lack of oxygen. Most experience substantial anxiety because of being unable to catch their breath, which can turn into feelings of drowning. Although there are medications for easing symptoms for a while, there is no cure for COPD. Smoking causes at least 75 percent of all cases of COPD. COPD is often used as an umbrella term encompassing both chronic bronchitis and emphysema. Chronic bronchitis is bronchitis that persists for months, often recurring over years. Symptoms of chronic bronchitis include Shortness of breath Unusually low energy Cough Overproduction of mucus or phlegm Sometimes fever The most severe symptom of emphysema is shortness of breath. That shortness of breath may appear when going for a long walk at first. However, as the disease progresses, shortness of breath becomes much worse and can be evoked by almost doing nothing, even when sitting. Also, people with advanced emphysema suffer chronic fatigue, poor alertness, and blue or gray fingernails. Confronting lung cancer Eighty percent to 90 percent of all lung cancers appear to be caused by smoking. Most lung cancers are not diagnosed in the early stages, which is why about half of all patients die in the first year following diagnosis. The five-year survival rate is just under 20 percent. We should note that a few new, targeted medications and immunotherapy hold some promise for future improvements in these outcomes. Smoking light or menthol cigarettes does not reduce a smoker’s risk of lung cancer compared to regular cigarettes. However, smoking unfiltered cigarettes doubles the risk of lung cancer for smokers. Filters do not make cigarettes safe in any way, shape, or form. But if you’re going to smoke something, come hell or high water, at least consider avoiding unfiltered cigarettes. Early detection greatly improves survival rates. If you’re a smoker, consider going to www.lung.org for a free quiz that you can use to determine if you’re eligible for a low-dose CT screening exam that could save your life. Normally, the first sign of lung cancer is a cough that doesn’t go away. Hoarseness, shortness of breath, chest pain, coughing up blood, weight loss, and frequent lung infections represent more concerning symptoms. Don’t wait; if you think you’re at high risk or you have some of these symptoms, see your healthcare professional right away. When it comes to your risk of heart disease, stroke, and especially COPD and lung cancer, you may think you’ve succeeded at dodging the bullet if you use smokeless tobacco. Although your risk of lung cancer and COPD may be lower as a smokeless tobacco user, that’s not necessarily the case for many other forms of cancer. In the next section, we look at some of the health risks faced by smokeless tobacco users. HTPs have not yet been linked to lung cancer. And tobacco companies claim that they’re safer than cigarettes. We have two problems with this claim: There have not been any long-term studies of the safety of HTPs compared to cigarettes. You’re inhaling the vapor of the entire tobacco product. Indeed, HTPs don’t involve the range of carcinogenic materials and chemicals of burned tobacco, but they do contain some of the same toxins. Other cancers caused by smoking Smoking not only devastates the lungs and circulatory system but also is responsible for many otherwise preventable cancers. Cancer involves cells going wild dividing and invading healthy tissue. Cancer cells move stealthily through the blood and lymphatic system. Toxic chemicals from tobacco make emerging cancer cells more likely and stopping cancer cells more difficult. Warning signs of cancer include Unexplained weight loss Persistent cough or hoarseness Sores that take too long to heal Unexplained lumps that appear anywhere on the body Bleeding or discharge Fatigue If you have any of the troubling signs above, or significant changes in appetite, bowel or bladder routine, or unexplained pain, see your healthcare provider for a checkup. The more cigarettes you smoke and the more years you smoke them, the greater your risk of cancer of most types. Sending toxic chemicals throughout your body has consequences including a higher risk of the following: Mouth and throat cancer Esophageal cancer Cancer of the larynx Cancer of the trachea Pancreatic cancer Stomach cancer Bladder cancer Kidney cancer Liver cancer Cervical cancer Colon and rectum cancer Leukemia Whether smoky or smokeless, using tobacco causes cancer. For those who smoke pipes or cigars, chew tobacco, or use snuff, the resulting cancer is mainly found in areas that have been directly exposed to the tobacco, such as the mouth, throat, nose, and sinuses. In addition, smokeless tobacco is associated with a higher risk of pancreatic cancer. How smoking erodes overall health Ingesting poison into your body day after day, not only causes cancer, heart disease, and stroke, but a whole lot of other heartache. Smoking negatively impacts every part of your body. Smoking increases the risk for a variety of disorders, from loss of hearing to loss of bone mass. The following problems have been linked to smoking: Hearing loss: Smoking decreases oxygen levels, which negatively effects the blood vessels that keep the critical hair cells in the inner ear healthy. Cataracts and macular degeneration: Smoking tobacco substantially increases the risk of eye problems. Some studies have found that smokeless tobacco also increases risk. Crohn’s disease: Crohn’s disease is a type of inflammatory bowel disease that causes pain, diarrhea, weight loss, and malnutrition. Smoking is a risk factor, and it can lead to more disease. Periodontal disease: This disease involves chronic infections of the gums around the teeth. Tobacco use makes it worse, and chewing tobacco is a particular risk. Type 2 diabetes: This chronic disease impacts health negatively across a variety of domains and is 30 percent to 40 percent more likely to occur for smokers as compared to nonsmokers. Rheumatoid arthritis (RA): RA is a chronic, autoimmune disease, and smoking has been shown to increase its risk and severity. Osteoarthritis: It’s unknown exactly why, but smoking actually seems to confer some small benefit for reducing this disease of the cartilage that protects the ends of bones. Given all the other problems smoking causes, it hardly seems worth going for this mild benefit. Osteoporosis: This disease involves a deterioration of bone density. The more cigarettes you smoke, the more likely you’ll have osteoporosis and break bones. And if you do break a few bones, they’ll heal more slowly. Ulcers: Evidence suggests that ingesting tobacco increases the risk of stomach ulcers and slows healing. You could almost get the impression that the human body just isn’t designed to handle cigarette smoke or tobacco products.

Cheat Sheet / Updated 10-05-2021

Quitting smoking or vaping may be one of the hardest things you’ll ever do, but the rewards will last you a lifetime. In order to succeed at quitting, you need to learn how to deal with your cravings (because you know they’ll hit). You also need the motivation to keep going when the going gets tough. One way to stick with your effort to quit smoking or vaping is to find something healthy to do instead. Many people worry that when they quit, they’ll gain weight, so it helps to find ways to boost your metabolism so you can focus on quitting, not on the number on the scale. Finally, as you’re quitting, you may have trouble sleeping, so knowing how to get a good night’s sleep is key.

Article / Updated 03-27-2020

Quitting smoking is one of the toughest challenges a person can face. It takes the ability to handle frustration, manage intense cravings, break strong associations, and ignore frequent temptations. Having support from family members and friends can improve a person’s chances of success. Being around someone who’s trying to quit smoking presents its own challenges. The smoker may start showing disagreeable behaviors, reactions, and emotions that you’ve rarely seen before. This article helps you anticipate these possibilities and deal with the person you care about during an especially difficult time. Although this article describes helping someone you care about stop smoking, the advice applies equally to those trying to stop vaping, chewing, or other related addictions. Make your home a no-smoking zone The fewer places a smoker has available to smoke in, the better. For smokers, part of the problem is the numerous associations they have between certain environments and their smoking habits. For example, if they always smoke at the dining room table, that location in and of itself tends to trigger strong urges and cravings to smoke. Make your house a no-smoking zone. While you’re at it, make your car a no-smoking zone, too. Eliminating the opportunity to smoke in the house or the car cuts down on the number of available triggers. By doing this, realize that you’re not telling the smoker that he or she can never smoke again (which could lead to unproductive rebellion). Mutually agreeing to a no-smoking zone merely sets the stage for quitting. This action can happen prior to actually setting a quit date. You can help make the case for declaring your home and car smoke-free by explaining that you’re also trying to improve your own health by reducing the amount of secondhand smoke you and your family are exposed to. Clean up the smokey mess Over time, your home has no doubt taken a hit from all the tobacco exhaled into the air over years of smoking by the person you’re helping. Tobacco smell, as well as toxins, permeate the carpet, walls, curtains, furniture, bedding, and clothes throughout the home. Consider the quit date a time for massive spring cleaning, no matter what time of year it is. Removing the odors will also cut down on the associations that trigger smoking. Smokers will hesitate before lighting up in a newly decontaminated environment. Consider opening all the windows and doors in the house to a day or two of completely fresh air. And if you want to really go all out, have your duct work cleaned as well. Don’t forget to thoroughly clean the car. This is a great time to get your car professionally detailed. Remove all ashtrays, lighters, and other paraphernalia from the home. If you can’t stand to throw away your great-great-grandfather’s ashtray, clean it up and store it in a drawer out of sight for a while. Maybe someday, you can use it as a place to put paper clips. But that’ll come well down the road, after months of smoke-free living. Remain positive Helping someone quit smoking, chewing, or vaping can feel like a burden. Plus, when you’re around someone who’s unusually irritable, it’s easy to become crabby yourself. It’s important to work at staying as upbeat as you can. Think about a future when cigarettes and such are no longer a part of your lives. Remaining positive doesn’t mean you put on a sickeningly sweet persona. It doesn’t mean you give in or capitulate to honest disagreements. However, this probably isn’t such a great time to have deep talks about long-term relationship issues or chronically difficult subjects. Postpone arguments if possible. Be sincere in your effort to stay positive. Depersonalize crabbiness It’s hard not to take irritability and cantankerousness personally. But when someone is trying to quit smoking, his or her crabbiness is not about you. Withdrawal from tobacco sets off moodiness and discomfort in most quitters. The person you’re helping probably feels like lashing out at the world and you’re the part of the world that’s most available. This isn’t fair, but the withdrawal symptoms — including the crabbiness — won’t last forever. When you feel like striking back, take a deep breath. Ask yourself what your goal is. Will you really achieve something useful by counterattacking? Probably not. And you’re only likely to make things worse. What you really want, down deep, is a nonsmoker. Play the game for the long haul. Keep judgment at bay Look for ways to express empathy with your family member or friend who’s trying to quit smoking, chewing, or vaping. Empathy is all about putting yourself in someone else’s shoes. If you’re a smoker or a former smoker, that’s probably pretty easy to do — you’ve likely had the same struggle with trying to quit. But if you have never smoked or struggled with an addiction, it can be more difficult to feel empathy. Imagine a time in your life when you were especially hungry, yet you were hours from being able to eat. That’s the kind of feeling quitters face every day. The difference is that you were ultimately able to satisfy your hunger. If a quitter tries to satisfy his or her hunger by smoking or vaping, the battle could be lost — or at least made more difficult. Also, we’ll go out on a limb here and suggest that, because you’re human, you probably have a few of your own flaws. Maybe you eat too much, spend too much, have a quick temper, forget birthdays and anniversaries, leave your house a mess, are late to pay bills — you get the idea. No one’s perfect. So, try to avoid nagging and criticizing. Instead, try empathizing by saying something like the following: I know this is a really hard time for you. Let me know if I can help. I get it that you’re crabby. I would be, too. Quitting is probably the hardest thing you’ve ever done, isn’t it? You look like you’re struggling. How about we go over our list of positive actions? It probably feels like things will never get easier, but from everything I know and have read, you’ll likely feel better in a couple of weeks. Thanks for working so hard at this! Plan distractions It’s likely that your friend or loved one has a list of things to do instead of smoking. That may include chewing hard candy, going to the gym, riding a bike, or going for a walk instead of heading into the breakroom at work, among other things. But it’s also good to develop a list of alternative distractions that the two of you can do together. These could include going to a movie, going to the beach, taking a hike, playing fetch with your dog, or eating out. Get creative! Plan your list together, and make sure to identify distractions that don’t serve as triggers for the person trying to quit. If eating out makes him or her want to reach for a cigarette, skip that and throw a ball for the dog instead. Reduce stress Hopefully, your friend or loved one who’s quitting hasn’t chosen a highly stressful quit date — you know, like the week before income tax forms are due or when you’re putting your house on the market. But no time is stress-free — and you can help. Offer to take on a bit more responsibility for a few weeks. For example, you can help with childcare, meal prep, or the laundry. We’re not giving the quitter an excuse to be lazy, but it takes a lot of energy to stay focused on quitting. Give your friend or loved one all the support you can. This is not a free ride. After a month or so, things should gradually go back to normal. Be clear about what you’re willing to do and for how long. Encourage all attempts Slips or lapses are normal and expected. Try not to catastrophize if your partner slips and has one or more cigarettes. We’re not saying that slipping is good — slips pretty much always make things tougher. But they don’t mean that failure looms on the immediate horizon. So, if the person you’re helping slips, remind him or her that slips can serve as learning opportunities. If he or she wants to talk about why the slip happened, by all means talk and search for reasons together. You can talk about how long he or she was able to go without smoking and all the good reasons for quitting. But don’t criticize, blame, induce guilt, nag, shame, or harass! Even if the slip turns into a total relapse, it’s still important to encourage more attempts when the time seems right. Remind your friend or loved one that most smokers try to quit as many as 30 or more times before finally succeeding. You both need to be patient and positive. Repeated runs at it still have a good chance of working eventually. Check in Some people trying to quit think they should go it alone. They don’t talk about what they’re doing or how they’re feeling. Generally, that’s not such a good idea. Check in regularly with your friend or loved one. Ask about how it’s going. Encourage a discussion about what’s working and what’s not, as well as how you can help. In other words, ask questions about how you can help make quitting easier. Be sure to stay positive and encouraging when discussing the struggles of quitting. Checking in lets the person know that you appreciate what he or she is going through and that you care. Celebrate success Whether the smoker has gone for one hour, one day, one week, or one year, celebrate every successful day without smoking. Here are some ideas: Plan fun activities. Bake a cake. Give a small gift. Send a congratulatory card. Go to a movie. Recognize success even if your smoker relapses. Each smoke-free day benefits health, and getting back on a successful track is always possible. Sometimes after quitting, even after quite a while, cravings come up. So, be sure to continue to notice and celebrate regularly!

Article / Updated 03-13-2020

If you do decide to take up vaping, whether as an aid to quitting smoking or as a hobby or recreational activity, you should at least be aware of what’s currently known about the risks. Again, our advice is to refrain from another, potentially addictive habit — a habit that will cost you time, money, and possibly your health. Ultimately, the choice of whether to vape is yours. The discussion that follows lays out the major, known risks of vaping. Time will no doubt reveal more. When people smoked cigarettes during the Roaring Twenties, they had little concern about the health consequences of their new habit. Serious warnings didn’t start appearing until around 1950. In part, that’s because many of the diseases associated with cigarette smoking take decades to develop. Vaping today is much like smoking cigarettes in the 1920s. Yes, there are far fewer “known” toxins in e-cigarettes, but we just don’t have long-term data to know for sure what the risks are over time. Can you become addicted to vaping? Every morning we drink coffee. And we enjoy coffee. Any morning that our coffee routine is interrupted, we crave coffee. We both consider ourselves “mildly addicted” to caffeine. Not a big deal unless coffee is not available. And we have both had periods of time without caffeine. However, not all addictive drugs are as cheap and readily available and have as relatively high health/safety profile as caffeine. In addition, caffeine’s downside risks are minimal. Nicotine has many similar effects on the body as caffeine. So, why is it such a serious issue to be addicted to nicotine? Part of the concern has to do with the way nicotine is consumed. With cigarettes and vaping, people become enslaved by the routine of having to take numerous puffs all day long. Most people generally drink coffee one, two, or at most, three times per day. That’s partly because caffeine has a much longer half-life than nicotine, meaning that nicotine remains in the body a much shorter time than caffeine does. Thus, to maintain the good feeling, you must replenish nicotine much more frequently. Then, of course, there’s also the hassle factor of nicotine addiction. You don’t see too many “no-coffee” zones out there, and no one else unwillingly consumes your coffee when you drink it. With smoking and vaping, severe limits are placed on where you can consume, and everyone around you inhales some of your nicotine, whether they want to or not. One of the highest risks associated with vaping nicotine is that you’ll become addicted to the substance. Nicotine is one of the most addictive drugs out there (and more so than caffeine). A major characteristic of becoming addicted is that you continue to seek out your drug of choice despite negative consequences. Negative consequences of a nicotine addiction may include significant risks to health. Do you really want your life and the lives around you controlled so much by a drug? Chemical concerns of vaping If you visit a local vape shop and ask what chemicals are in the e-liquid, they’re likely to tell you it comes down to just vegetable glycerin, propylene glycol, and whatever substance you’re wanting added such as nicotine, CBD, or THC. They may inform you that various flavors are in the liquid, too. They’ll likely assure you that the flavors are all safe and that many are FDA approved. (See Chapter 5 for more information about e-liquids or, as they’re also called, e-juices.) What they won’t tell you is that these substances are mainly approved for human ingestion, not inhalation. For example, consider pepperoni pizza. It tastes great, and it’s relatively safe. But what would happen if you liquified the pizza, heated it, and inhaled the vapor? We don’t know the answer to that question, but just intuitively, it seems like it wouldn’t be a good thing to do to your lungs. In other words, most chemicals used in vaping have never been subjected to scrutiny for safety when inhaled. Because literally thousands of chemicals are used for flavoring in e-liquids, that leaves you quite uncertain as to the safety and nature of e-liquids used for vaping. Furthermore, the chemicals that are put into e-liquids can break down and change when heated and vaporized. Just a few of the chemicals and toxicants your body may encounter when vaping include Acetaldehyde Acrolein Acrylamide Benzene Diacetyl Formaldehyde Furfural Nitrosamine Phthalates Various volatile organic compounds And, as we said, these aren’t the only chemicals you could be exposed to when vaping. Some of them are known carcinogens. Sometimes there are chemicals that are not listed on the labels of the e-liquids. Furthermore, toxic substances emitted from e-cigarettes vary with the device used and the contents of the specific e-liquid. At the same time, to be fair, you should know that your exposure to toxins from e-cigarettes is substantially lower than what you inhale from regular cigarettes. Metals in e-liquid Your local vape shop manager probably won’t mention this, but there are studies indicating that e-cigarette aerosol contains metals. Metals are highly toxic and can affect multiple organs. However, this issue is still waiting for answers from good studies to address specific long-term health effects (or lack thereof) from vaping. The levels of metals vary with the type of device in question. Most studies to date have focused on cig-a-like products and vape pens. It’s believed that heated coils and other components of the vaping device are the primary source of these metals, which are thought to leak into the aerosol. A few of the metals that have been found include Aluminum Chromium Iron Lead Manganese Nickel Tin The exact levels and concentrations vary among devices and, thus, long-term health effects are more difficult to definitively ascertain or predict. Cadmium is also found in e-cigarettes; however, at much lower levels than it’s found in combustible cigarettes. Cadmium has high toxicity and causes lung and kidney disease. Getting to the heart of the matter Like combustible cigarettes, e-cigarettes carry nicotine into the lungs and circulate through the cardiovascular system. The nicotine is carried by microscopic particles in the aerosol. These ultra-fine pollutants have been linked to high blood pressure, coronary artery disease, and heart attacks. In a large survey of close to 100,000 participants, researchers found that e-cigarette users had significantly higher risks of heart attack and coronary artery disease than non-smokers or non-vapers. The risk suggested a 34 percent increased chance of having a heart attack for e-cigarette users. This type of study demonstrates a possible association, but it can’t truly establish a causal relationship between vaping and heart disease. Furthermore, the authors acknowledged that regular smoking confers a much higher risk of cardiovascular disease than vaping. One preliminary study indicated an improvement in heart function when combustible cigarette smokers switched to vaping for a month. Once again, more data over long periods of time is needed. Lungs irritated by vaping E-cigarettes have been associated with increased risk of asthma, chronic bronchitis, and pulmonary inflammation. In addition, people who vape have decreased immunity and increased mucus secretion. There is concern that e-cigarette users may be predisposed to respiratory infections. Healthy adults and teenagers have been taken to emergency rooms with shortness of breath, chest pain, and fatigue. Some of them have ended up in intensive care with severe lung damage, and some have died. They all reported vaping prior to their illnesses. People have been vaping in large numbers for over a decade, and these cases have only recently emerged, so it seems likely that new contaminants have gotten into the supply chain. Nonetheless, as of this writing, it appears that the only apparent common denominator for these lung damage cases is vaping. Those stricken reported using various devices with different e-liquids. A substantial majority (over 75 percent) admitted to vaping THC, some obtained legally and many others not. Vitamin E acetate is often used with THC to make a proper vaping consistency. Vitamin E, when inhaled, appears to cause a severe inflammatory reaction. Another possible culprit is contamination from using devices with bad e-liquid mixes and/or problematic flavorings of unknown toxicity. Careful reporting and study will be needed to track down the true source(s) of the problem. The bottom line is that the vaping industry is in dire need of robust study and regulation. While investigating a recent spike in pulmonary illnesses related to vaping, the CDC recently recommended the following: Never buy e-cigarettes or e-liquids off the street. Do not modify e-cigarette products on your own. E-cigarettes should not be used by teens, young adults, pregnant women, or adults who do not currently use tobacco products. If you vape and have concerns about your health, such as shortness of breath, cough, or chest pain, seek immediate medical care. Getting burned Are you someone whose money burns a hole in your pocket? We hope not. But we also hope that you’re not someone whose vaping device burns a hole in your pocket or blows up in your face, hands, or groin. People have shown up at emergency rooms, after vaping devices have blown up, with broken facial bones, severe burns, and extensive lacerations. Vaping devices exploding and burning is not a frequent occurrence, but it happens. In fact, there were over 2,000 emergency room visits due to vaping devices catching fire or exploding in the period from 2015 to 2017. It’s believed that this statistic is an underestimate and that better surveillance procedures should be implemented to track this problem more accurately. You can see the whole exploding vaping device thing on YouTube. Just search for vaping explosions. Not a pretty sight. Most vaping explosions happen due to problems with the lithium ion batteries and mechanical mod systems lacking regulators. In the event that you do experience a vaping fire or explosion, you should seek immediate medical attention if the burn is more than 3 inches in diameter. Do so also if the burn affects your face, genitals, hands, feet, elbows, or knees and the skin is blackened or severely blistered. If your clothes catch fire when your vaping device explodes, stop, drop, and roll. And cover your face. For minor burns, keep the area clean and cover it with a cool compress. Always watch for increasing symptoms of infection, such as redness, swelling, discharge, or fever, and seek medical attention if they occur. Pregnancy and vaping If you’re planning on having a baby soon, our strong advice is to stay away from all nicotine products and vaping of any type. Although vaping may have a somewhat safer profile than smoking regular cigarettes, that does not make it safe — especially when you’re pregnant. Preliminary research on animals links the possibility of e-cigarette use as a cause of birth defects, especially to craniofacial development. It appears that flavors, especially complex mixtures of flavors, have the largest effect on this anomaly. Early research suggests that fetuses exposed to nicotine and/or e-cigarette flavors, have a greater risk of brain or lung damage. Like other risk factors, much needs to be determined through further research. In the meantime, keep your baby safe and avoid all vaping. Seizures caused by vaping A seizure occurs when there is a sudden surge of electrical activity in the brain, which can cause disturbances in movement, behavior, and consciousness. Signs of a seizure may include staring, confusion, or uncontrolled, jerking movements, as well as memory lapses. Most seizures last from a few seconds to minutes. Some reports indicate the possibility of seizures having occurred after vaping with e-cigarettes. The FDA has had reports of seizures from people who just started to vape and regular users of vaping devices. It has been postulated that high doses of nicotine could be responsible for these seizures. And seizures are, indeed, one of the known side effects of nicotine poisoning. This effect would, thus, be in response to having overdosed on vaping if, indeed, vaping was the cause of the seizures. However, a causal link has not yet been established. Some e-cigarettes have very high levels of nicotine. In fact, one e-cigarette, Juul, popular with teenagers has as much nicotine as an entire pack of cigarettes in a single device. Nicotine poisoning Nicotine poisoning is relatively uncommon because most smokers and vapers self-regulate their consumption based in part on how they’re feeling. However, emergency rooms and poison control centers have seen an uptick in nicotine poisoning over the past few years with the advent of vaping devices. E-liquids can contain enough nicotine to kill a small child or pet. Many vapers refill their own devices and maintain a supply of premixed e-liquid formulations or the pure chemicals (including nicotine) that go into mixing the refills. Since 2016, nicotine bottles have been required to come in childproof containers. You can get nicotine poisoning simply by spilling or touching it while refilling your vaping devices. Always wear protective gloves when handling. It should also go without saying that nicotine products should be kept well out of the reach of children and pets. Secondhand vapor What about exposing other people to your vapor? Or what are the risks of being in a room with someone else who’s vaping? The good news is that secondhand vapor is far less toxic than smoke from combustible cigarettes. The bad news is that vaping appears to make the air inside a room lower quality, with small amounts of nicotine and other particles. The health implications of this indoor pollution are unknown. Regulatory guidelines and vaping E-cigarettes first became commercially available in the United States in 2006. That’s a short time span, and the FDA has been slow to catch up in terms of oversight and regulations. In other words, the industry has been largely on its own until quite recently. That means you don’t have great assurances that products contain what they say and in the amounts that are stated. Furthermore, consumers can’t assume that devices have been made with safe, reliable materials and designs. New regulatory guidelines are set to come out soon and should provide consumers with more confidence in what they’re purchasing. These directives should help reduce illegal, online sales of fake products as well. You can’t fully assess a product’s safety without knowing exactly what it contains or how it’s manufactured.

Article / Updated 03-13-2020

Yes, probably — but with numerous caveats. In a head-to-head contest, smoking appears more dangerous than vaping. Think of smoking like playing professional football without a helmet or protective gear. Chances are, you’re going to get hurt. Badly. You may even die. Half of all chronic smokers will eventually die from illness directly linked to smoking. However, if you suit up in appropriate protective clothing and a helmet, you’ll have a much better chance of surviving that football game. Nonetheless, you’ll still be running substantial risks of getting hurt, especially over time. Consider all the serious brain injuries increasingly reported among former professional football players, even though they used helmets. For that matter, even in the short run, it’s a rare NFL game that you don’t see at least one player carried off on a stretcher. So, let’s say that vaping is more like playing football for years with protective gear: safer but far from safe. Yet, many in the public don’t realize that vaping is probably safer than smoking. Surveys have found that increasingly, the public views e-cigarettes as equally, if not more, dangerous than regular, tobacco cigarettes. That may be because of frequent news articles about the dangers of vaping. Relatively few news articles appear that detail the dangers of cigarette smoking. That’s because those dangers have been well known for decades and the topic is neither newsworthy nor controversial. Scientists know that cigarette smoking kills, and the risks are well established. A lot of the damage from regular smoking is caused by the combustion of tobacco, which produces toxins that damage the cell linings of the lungs. That damage makes the cells more vulnerable to the effects of cancer-causing chemicals (some caused by the combustion itself) found in regular cigarettes. Vaping appears safer, but many of the risks associated with vaping are not yet fully known. Long-term studies are sorely lacking because vaping is a relatively new phenomenon. Nevertheless, scientists have reached a reasonable consensus that vaping is safer than regular cigarettes. Although vaping potentially exposes vapers to an array of toxic chemicals, there are fewer chemicals and the levels of those chemicals are much less toxic than those found in regular, combustible cigarettes. You should know that conclusions about the safety of vaping are complicated because of the variety of devices and substances. In fact, there are literally hundreds of different types of vaping devices that produce variable levels of heat and amounts of vapor. There are almost an infinite variety of e-juice combinations. And the concentrations of these substances also fluctuate widely. For example, some e-liquid contains exceptionally high levels of nicotine. Other formulations contain no nicotine whatsoever. Still others deliver various flavors, tetrahydrocannabinol (THC), cannabidiol (CBD), and so on. Different risks likely depend on the actual device and specific ingredients in the e-liquid. Although most forms of vaping appear generally safer than smoking cigarettes, we want to be clear that we do not advocate starting vaping if you’re not a smoker. Using vaping as one means of either quitting smoking or reducing overall harm from smoking is only recommended for the small percentage of people who smoke heavily, have tried quitting by a number of other means, and are either unable or unwilling to quit smoking entirely. Because vaping in the United States is still lightly regulated, using e-cigarettes may confer greater risks than if purchased in the United Kingdom, where there are strict controls over the industry. So, for now, the U.S. Centers for Disease Control and Prevention (CDC) recommends against using vaping to quit smoking. The U.S. Food and Drug Administration (FDA) is often cited as having not found e-cigarettes to be a safe and effective method for smoking cessation efforts. One reason it hasn’t reached this conclusion is that it hasn’t yet studied e-cigarettes for this purpose. In the United Kingdom, the National Health Service (NHS) has assessed the issue and recommends e-cigarettes for the purpose of quitting smoking. More research is badly needed on vaping as a smoking cessation strategy because what we have now is both conflicting and controversial.

Article / Updated 03-13-2020

Most smokers want to know why they smoke. No one starts smoking wanting to become addicted, and most new tobacco users think it won’t happen to them. But for those who continue to smoke after those first early packs, addiction powerfully contributes to why they keep smoking. Experts don’t have a universally agreed upon definition of addiction. That’s because it’s a complex concept that defies easy explanations. Nevertheless, most people have notions as to what they think it is. And perhaps you’ll find it helpful if we describe our way of looking at the phenomenon. An addiction involves powerful feelings that come about from ingesting certain types of drugs or substances. The hallmark of an addiction is using a substance chronically despite harmful effects on a person’s life now and in the future. Using addictive substances generally feels good, and bad feelings abate for a while. Unfortunately, negative feelings return, and the craving for positive feelings increases, culminating in a vicious cycle of addiction. Tolerance is another important aspect of addiction. Tolerance occurs when a substance is used over and over again, and it begins have a reduced impact. More is, therefore, needed to get the same effects. Tolerance develops quickly for most regular smokers — 1 or 2 cigarettes a day quickly turns into 10, 20, or more. Of course, at some point, smokers usually reach a stable level of intake (after all, there are only so many hours in a day!). There are many myths and misconceptions about what an addiction is and isn’t. The following points explain some of these myths: Myth: Addiction is unfixable. Actually, considerable data suggests that many people ultimately are able to break their addiction, whether it’s tobacco, drugs, or alcohol. Myth: All addicts must reach rock bottom before they can break their addiction. Rock bottom is hard to define — it varies from person to person. However, lots of people stop using addictive substances well before hitting anything like a true rock bottom. Myth: Willpower is all you need. Psychologists don’t even fully agree on what exactly willpower is. If you think of yourself as lacking something fundamentally necessary, such as willpower, you’ll never succeed. If you want to quit, it’s worth taking a shot, no matter how much willpower you think you do or don’t have. Myth: Addicts are weak people. People become addicted for a variety of reasons as we explain in the following sections on biological, psychological, and social factors. Being strong or weak has nothing to do with it. Myth: Addiction is simply a choice. Sure, there’s an aspect of choice involved with starting to smoke. However, most addicts would truly not choose to be addicted. Myth: I could never become addicted. Thinking like that could make you more vulnerable to becoming addicted. No one is immune. Myth: Addicts always suffer considerably when they try to quit. Surprisingly, there are a few, lucky people who manage to quit a substance like cigarettes without struggle. But for most people, the more they develop a plan and garner support and help from others, the easier they’ll find quitting. Myth: After you’re detoxed, you’re done with your addiction. Your system clears itself of nicotine in a few days, but cravings are another matter. Those may continue for weeks, months, or sometimes forever (though almost always they lessen over time). Myth: Taking medication to help with addiction is cheating by substituting one drug for another: Medications used to treat addiction, are always safer than the original substance. Even nicotine replacement therapy avoids tars and toxic chemicals that come from burning cigarettes. Furthermore, most people use these medications as a bridge to quit entirely at some point. Does it help to call it cheating? No. Myth: Addicts are bad people. We can’t deny that those who are addicted to almost anything are often shamed and stigmatized by others. But so-called addicts are people just like everyone else. They start out using substances as recreation, response to pressure, or a variety of other reasons. What they don’t do is start out with the intention of becoming addicted. When we use the term addiction, we’re referring only to the response people have to certain substances such as opioids, alcohol, and nicotine. This approach avoids applying the term addiction to behavioral issues such as aberrant sexuality, Internet addiction, and kleptomania, which may actually belong in another category of mental dysfunction that lies beyond the scope of this article. To further understand addiction to tobacco, it’s important to appreciate how an addictive substance affects the body. In addition, it’s useful to recognize that addiction interacts with powerful feelings and emotions. Finally, addiction affects relationships while relationships simultaneously impact addiction. In other words, addiction is driven by biological, psychological, and social forces as explained in the following sections. Biology of addiction Imagine taking a drag on a cigarette. Smoke pours into your lungs while dumping a stew of chemicals into your bloodstream. These chemicals quickly breach the blood–brain barrier and deliver a jolt to the brain, most of which comes from nicotine. It takes less than ten seconds to go from drawing in that first puff of smoke to the brain starting to respond. Nicotine stimulates the effects of dopamine, a brain chemical that increases feelings of pleasure. Dopamine levels also rise after ingesting cocaine, eating a favorite food, and having sex; in other words, stuff that feels good. Nicotine also increases adrenaline, a neurochemical that stimulates the body to increase blood pressure, increase heart rate, and restrict blood flow to the heart. Adrenaline prepares the body for threat — the well-known fight-or-flight syndrome that prepares you to either stand and fight or flee from danger. It also increases focus and causes calories to burn at a faster rate. In addition, nicotine causes the body to dump more glucose (blood sugar) into the blood stream. Normally, when blood sugar rises, insulin is secreted, which enables blood sugar levels to come back to normal. However, nicotine inhibits that process, which leads to higher levels of blood sugar and decreased appetite. So, in ten seconds or less, nicotine delivers pleasurable feelings, increases focus, decreases appetite, and increases energy. What could possibly go wrong? Well, within a few minutes, nicotine levels begin to decline rapidly. Lower nicotine levels elicit feelings of reduced pleasure, increased nervousness and anxiety, diminished energy, a lack of focus, and the emergence of cravings. That’s why most long-term smokers report immediate decreases of anxiety and a sense of great relief when they light the next cigarette. No wonder, the pattern continues throughout the day. But oddly, not through the night. Very few smokers wake up every hour to have another cigarette. And most smokers manage to get through work, movies, and airplane flights without intense distress. So, something more than mere biology must be contributing to the addiction of smoking. Some experts contend that any addiction is a disease of the brain. Although biological factors clearly form part of the picture, that’s not the whole story. Thinking of smoking as a disease minimizes the importance of psychological and social contributors to the problem. Psychological factors of addiction We now turn to psychology to further clarify smoking addiction. People struggle with how to explain why they do things that they know are not in their best interests — smokers are no exception. The following three sections explain. First, a popular metaphor reveals how the mind works. Next, we show you how distorted thinking contributes to difficulty quitting smoking. Finally, we help you see how common associations become triggers for turning to tobacco. Discovering elephants and their riders Think of yourself as having two minds. The first you can think of as your elephant mind, and the second, as the elephant rider part of your mind. To a casual observer, the rider is in charge. The rider directs the elephant to go right, and the elephant usually obeys. However, if a hungry elephant spots its favorite meal on the left (consisting of luscious tree bark dripping with sap), who do you think will win? Think of addiction as the elephant part of your mind, commanded by intense feelings of pleasure, pain, and/or fear. Yet the elephant isn’t that smart and mostly responds to what’s right in front of its trunk. The elephant does a poor job of forecasting the future or learning from the past. Immediate pleasures, temptations, and fears dominate the elephant’s decisions. By contrast, the rider “knows” exactly what to do and is controlled by logic, reasoning, and critical thinking. The rider is no match for the brute strength of the elephant. The elephant part of the mind wants what it wants when it wants it. And the elephant truly does not like to feel one bit of discomfort. So, how do the elephant and the rider parts of your mind dictate whether you’ll smoke? The elephant just wants to have fun. It can’t process and reason about long-term threats to health such as lung and cardiovascular diseases. The rider knows better but can’t seem to control the elephant. The rider tries reasoning, bribes, and persuasion, but the elephant feels bad when it doesn’t smoke and feels better when it does. It’s that simple. Your rider mind can slowly but surely train the elephant to obey commands more often, but the training involves considerable skill, persistence, and patience. See Parts 4 and 5 for ideas about how to gain greater control over your elephant mind. If you’re trying to quit smoking or vaping and you experience a relapse, remember that you’re dealing with a very, very large elephant. It takes time to train the elephant. Be patient with your elephant, and yourself! Adding up addictive thoughts From a psychological standpoint, one of the most problematic factors driving both addiction and emotional distress can be found in the realm of distorted thinking. Distorted thinking causes you to make unwarranted assumptions and inaccurately portrays reality, usually in negative ways. Such thinking can be seen in these examples related to smoking: “I smoke because I’m so nervous. If I quit, I’d be a wreck and never be able to do my job. I’d get fired, for sure.” “I’ll probably gain a hundred pounds if I quit smoking.” If I want another cigarette this badly, I must need it.” “I smoked when I shouldn’t have today. Might as well give up.” “My grandfather smoked two packs a day and died in his sleep at 92. It worked for him; it should work for me.” “Just because countless others have learned to quit smoking, doesn’t mean I can do it.” “I can’t function without a cigarette.” “I’ve tried to quit before and failed, so I might as well give up and enjoy smoking.” These thoughts all contain distortions of reality. And they wreak havoc on people’s attempts to quit. They sabotage quitting efforts by making mountains out of mole hills, ignoring positive evidence, increasing feelings of helplessness, and decreasing confidence. Not exactly a recipe for success. Behavioral associations turn into smoking triggers Do you remember getting thoroughly sick to your stomach after eating something? If so, you probably felt queasy or disgusted when you next encountered that food. Maybe you avoided that food for years or never ate it again. That’s because your mind connected the food with getting sick. The food became a potent trigger for nausea. However, that food might be both tasty and nutritious. You might spend a lifetime not eating a perfectly good, healthy food because of one association. Associations are also formed to protect us. For example, when you smell badly spoiled food, you probably also feel nauseous. That’s a good thing, because the feelings prevent you from eating food that might make you sick. On the other hand, the smell of freshly baked peanut butter cookies might take you back to a pleasant childhood memory. And if it doesn’t lead to binge-eating peanut butter cookies, that’s great. The brain tries to connect experiences that way so that it knows how to make you feel good and avoid feeling bad. And that can be a good or a bad thing. With addictions, these brain connections or associations can work against you. They make you anticipate something very pleasant (we’re talking tobacco here) when thinking about or encountering certain settings, people, activities, or events. Associations can also bring on unpleasant emotions that make you want to smoke in order to feel better. These associations become triggers for smoking. Here’s a list of particularly common triggers that push many smokers to smoke. The first cup of coffee in the morning The sound and smell of someone opening a fresh pack of cigarettes Coffee after dinner Boredom Driving to work After lunch Eating out Driving in traffic Before a job interview After a job interview Break time at work Having a drink After sex Playing cards Getting in trouble After an argument At a party Talking on the phone With certain friends Good grief. What’s a smoker to do? Avoid everything in life? No. But you can see how powerful associations can lead you straight to the next cigarette. Whether it’s to feel good or avoid feeling bad, the influence can be hard to escape. Social contributors to addiction Kids who hang out with smokers are more likely to smoke. Research suggests that adolescents are influenced to smoke by their friends or family who smoke, including parents, siblings, and extended family. That influence happens for three reasons: Modeling: Modeling is referred to as observational learning or imitation. People readily pick up on behaviors demonstrated by important people they relate with. See the nearby sidebar, “Monkey see, monkey do,” for an example. Predisposition: Secondhand smoke from household members may create a biological predisposition for acquiring an addiction to nicotine. Animal studies support that connection. See the nearby sidebar, “Secondhand smoke: Priming kids to smoke,” for an example. Peer pressure: Peers not only model smoking behavior, but also sometimes exert pressure on their friends to do the same. The pressured friends cave in so that they can fit in better and be liked. Adolescents are particularly vulnerable to peer pressure. See the nearby sidebar, “All the cool kids are doing it . . . ,” for an example. The degree to which these influences impact any give person varies greatly. And for some people, all three influences come into play. The following three stories illustrate how modeling, addiction vulnerability due to secondhand smoke, and peer pressure lead to trouble. If you’re a smoker, try to remember your earliest cigarettes. Ask yourself if modeling, secondhand smoke, or peer pressure may have played a role in your becoming hooked on cigarettes. According to the U.S. Surgeon General, the younger you start, the more likely you are to become addicted. Out of every four high school smokers, three will become adult smokers. Sadly, out of those three, only one will quit and another will die early from the health consequences of smoking. On the other hand, not every person with biological, psychological, and social risk factors becomes addicted to tobacco or nicotine. See the nearby sidebar, “The exception to the rule,” for an example. Assess your tobacco addiction It’s easy to deny the idea that you’re addicted or teetering on the edge of addiction to something like cigarettes. If you deny it, you’re likely to fool yourself into minimizing the damage it’s causing in your life. We have a quiz for you that may help you decide if your smoking really is a problematic addiction. How bad is your addiction or how hooked are you? Ponder the following list of questions (our dirty dozen) to help you know. Do you smoke every day? Do you smoke to feel better? Do you have physical withdrawal symptoms such as agitation, restlessness, and increased appetite when you’re not smoking? Do you have emotional symptoms of withdrawal such as depressed mood, anxiety, lack of concentration, or stress when you’re not smoking? Would you buy cigarettes even if you couldn’t afford them? Do you avoid places that don’t allow smoking? Have you tried and failed to quit smoking numerous times? Do you have health problems from smoking? Do you crave a cigarette immediately after waking up in the morning? Do you plan for your next cigarette? Do you sometimes smoke instead of doing something else you need or want to do? Do you continue to smoke even though you know you’re harming others (your kids, spouse, or friends) through secondhand smoke? Do you worry when you’re about to run out of cigarettes? There is no specific cutoff score for this quiz. But obviously, the more questions that apply to you, the more you’re hooked. Even answering yes to two or three of these questions suggests you have significant trouble with smoking. At the end of the day, it doesn’t matter to what extent your addiction is based on biological, psychological, or social factors. Either way, smoking kills, and it’s tough to quit. The power of smoking addiction can’t be overstated. Ask any hospital nurse about patients’ desperate attempts to smoke while hospitalized. You’re likely to hear stories of people suffering from end-stage lung cancer still craving the very thing that’s killing them. One nurse we spoke to remembered a lung cancer patient, too weak to walk, who wanted to be wheeled outside to smoke. When the nurse turned down the request, the patient called 911 to report that he was being abused by the uncaring staff. After the patient’s third phone call to the police, an officer was dispatched to the hospital. Upon hearing his complaint, the officer was less than sympathetic to the patient. No charges were filed. To be clear, we have no intent to disparage this patient. Consider the anguish he must have been feeling over his overwhelming compulsion to smoke. Under such circumstances, all reasoning and common sense are drowned by the intense cravings for a cigarette.

Article / Updated 03-13-2020

Almost a half a million people die from smoking-related illnesses each year in the United States alone. Thousands of young people start to smoke or vape every day. Left unchecked, it’s assumed that about 5.6 million of today’s teenagers will die prematurely from smoking. Smoking costs more than $300 billion a year in both lost productivity and direct healthcare services. Smokers routinely die of lung cancer, cardiac disease, and strokes, among other smoking-related maladies. We give you these facts not with the purpose of scaring you. You already know smoking causes life-threatening illnesses and wreaks havoc. Just consider using this information to inspire your efforts and realize you’re contributing to a healthier society when you stop smoking. Summing up a financial spreadsheet What could possibly be worth spending one million dollars each and every hour of each and every day? Tobacco companies spend that amount of money on promotion and advertising in order to get your business and pump up their profits. What’s more important to you is what it’s costing you. Above and beyond the “mere” price of cigarettes themselves, smoking costs much more. For example: Smokers pay more for health and life insurance. Smokers earn about 80 percent of the earnings of nonsmokers. Some employers, especially in the healthcare industry, refuse to hire smokers. Smokers pay more out of pocket for medical care. Smokers use more sick days than nonsmokers. Smokers spend more time and money on washing and cleaning their smelly clothes, homes, and cars. Comparing costs with vaping Direct comparisons of the cost of vaping with that of smoking regular cigarettes is difficult. That’s because different vaping devices have quite variable costs and e-liquids come in an array of types and container sizes with their own unique costs. Nonetheless, if consumers shop carefully, they’re likely to discover that vaping costs considerably less than smoking combustible cigarettes. The issue of health and life insurance policy costs is completely up in the air. Given that vaping is a relatively new phenomena and few studies have been conducted on its long-term safety, insurance companies have not clarified their rules and fixed different premium prices for vaping versus smoking policyholders. Some insurance companies require a physical exam before offering a policy. Many health and life insurance companies charge a higher premium to smokers. The way insurance companies test for whether you smoke or not is to check nicotine levels. Because most vaping e-liquids contain nicotine, vapers will test positively for nicotine. Thus, smokers who turn to vaping for their reputedly lower risk profile will still face higher premiums. Calculating the ways you want to spend your windfall Savings you accrue from not buying endless packs of cigarettes (or other tobacco or nicotine products) mount up rapidly over time — even if you ignore all the considerable funds that aren’t spent on insurance, lost work, and other indirect costs. We strongly recommend that you start putting aside what you would’ve spent on tobacco or nicotine. Watch it grow! Make a list of spending priorities when it reaches a tidy sum. Post that list in a visible place and look at it often for inspiration. Let’s say that an average cost of a pack of cigarettes in your state runs about $7. If you smoke a pack a day, that comes to about $2,555 per year. The ten-year total accumulates $25,550. You could buy a car with that! There are lots of other things you could do with just one year’s savings, like: Buy a new computer. Buy an amazing TV. Buy a bunch of new clothes. Pay off a credit card. Buy a terrific new appliance. Pay for gym dues for a long time. Take an amazing weekend getaway or a nice vacation. Make a nice donation to the charity of your choice. The really great thing about these expenditures is that you can almost think of them as free money. It’s money you absolutely would not have accumulated without quitting. Stop burning your money! Give it back to yourself. You’ve earned the right to splurge a bit! Some people prefer to invest their smoking savings. You can do that in an ultra-safe savings account or go a little wilder and invest in a specific stock or in a mutual fund. It’s amazing how much more that money can grow to if you put it in and let your gains compound over time. Consider reading Personal Finance For Dummies, 9th Edition, by Eric Tyson (Wiley) for more ideas. Investing for the long term will only work if you find it highly rewarding to watch those returns grow slowly over time. If you’re someone who prefers more immediate gratification, we recommend that you go ahead and be a bit self-indulgent for the highly worthy goal of quitting smoking or vaping.

Article / Updated 03-13-2020

Vaping is a relatively new pastime that has become increasingly popular with young people. In the early years, vaping went largely unnoticed and unstudied. But as more and more teens experiment with vaping, there are mounting concerns. We’re concerned, too. And we have some messages for those who are considering trying it out or who have already started to vape. If you’re a parent or caring adult, and you have concerns that a young person in your life may be vaping or thinking about vaping, see if you can get that person to read this article. If all else fails, use these messages as talking points. Keep the communication door open! Your Lungs Love Air We know your peers (and maybe a dude at the vape shop) have told you that vaping is safe. Many people think that. And it’s true that vaping is “probably” quite a bit safer than regular cigarettes that emit burned tobacco smoke. But that does not make vaping safe. Even the CEO of JUUL recently announced that people who have never smoked or vaped before shouldn’t take up the habit due to the risks involved, which are not yet completely known. Lungs were meant to breath air — not smoke, not pollution, and not aerosol from your vaping device. Sure, most of those delicious flavors are natural and many are approved by the U.S. Food and Drug Administration (FDA). But unless you’re drinking your e-liquids (and we advise against that, too) those flavorings were approved for ingestion not inhalation. The safety of all possible flavoring ingredients has not been established. And the FDA is now moving to restrict flavors. In the meantime, beware. Stay Away from Street Products You can buy fake Rolex watches off the street that look exactly like the real deal to the untrained eye. They’re pretty cheap, too. On the other hand, the gold finish is fake, and the innards are made of cheap materials with questionable reliability. You can buy e-liquids, vaping devices, and chemicals off the street as well. You can also get vaping paraphernalia at unlicensed shops that move often and escape regulatory oversight; they’re no more reliable than street vendors. Contaminated street products and their ingredients are the most likely culprits (there may be others) in the recent uptick of serious lung damage (sometimes resulting in death) showing up among teens and young adult vapers. Kids who started out as athletes are ending up in intensive care or the morgue after using some of these products. We don’t advise you to vape, but if you do, buy your e-liquid and devices at a reputable store — somewhere that has been around a while, has accumulated positive ratings on the Internet, and has no complaints from the Better Business Bureau (BBB). It’s no guarantee, but it’s a start and most likely safer than the street. Your Brain Is Still Changing You’re not going to want to hear this, but your brain is still developing and changing as it processes new information and encounters various chemicals and substances. Given that your brain is the only one you’ll ever get, you need to take really good care of it. Substances like nicotine can permanently affect your memory and concentration, as well as raise your future risk of addiction. Getting Addicted Is No Fun More bad news: Teens’ brains get addicted faster than the brains of adults. With vaping, a nicotine addiction can happen very quickly. Although loading up on an addictive substance often feels really good at first, the long-term effect isn’t so great. It’s easy for your mind and body to focus obsessively on the need for continual buzzes. That crowds out a lot of brain space that could be used for listening to music, watching movies, hanging out with friends, or even acing your exams in school. If you’re addicted, you likely have less interest in pursuing other goals and accomplishments in your life. You become consumed with obtaining what you crave, getting that buzz, and then finding a way to repeat the process again. Addiction can cost you a lot of time and money, not to mention your health. It’s Not Your Parents’ Marijuana Vape pens are a new way to smoke marijuana that has very little smell and can be extremely discreet. However, the market is virtually unregulated right now, and the safety of these devices is highly questionable. In fact, the vast majority of the emerging lung damage crisis from vaping has been associated with vaping THC. Although marijuana is legal in some states, tetrahydrocannabinol (THC) is still often purchased from black markets, which adds to the concern. The potency of THC in many vaping devices is many times greater than what your parents may have inhaled back in the day. Experts worry about the unknown effects of long-term use of excessive THC levels. Concerns have also been expressed about the pesticides used by marijuana cultivators, which are known to kill brain cells and increase the risk of some cancers. We’re not trying to scare you — we just want to give you something to think about. Nicotine Levels May Be Higher than You Think It’s virtually impossible to calculate how much nicotine your body absorbs from a combustible cigarette or from a vaping device — that is, unless you’re in a medical laboratory with sophisticated equipment. Cigarettes vary in their nicotine levels, and smokers vary in how long they hold a puff in their lungs. Vaping devices and the e-liquids they contain vary greatly in terms of the nicotine levels produced. You can easily be getting more than you think. That possibility is especially true with some of the new pod devices that are particularly popular with young people. Don’t Let Frustration Ruin Your Life Psychologists have found that the ability to tolerate frustration is one of the most important skills to acquire during adolescence and young adulthood. It’s a great predictor of future earnings, success, and happiness. Unfortunately, the ability to tolerate frustration is likely to be impaired when you become seriously addicted. So, if you want money, success, and happiness, stay away from vaping. What Would You Tell Your Little Brother or Sister to Do? We know you most likely have an imperfect relationship with your little brother or sister (if you have one). But, on balance, we bet you’d want what’s best for the kid. Would you advise your little bro or sis to take up vaping? Probably not. Why not? You know exactly why not: unknown risks, addiction potential, money, and more. So, if you wouldn’t advise it for your brother or sister, why are you doing it? By the way, your younger siblings look up to you, and you’re serving as a role model — whether you want to or not. Choosing What’s Cool rather than What’s Good for You Teens want to be accepted by their friends. Part of being accepted is doing what the rest of the crowd is doing. Standing up to peer pressure is a struggle that some kids find overwhelming. Many teens succumb and do things like vaping, in order to be cool, knowing deep down that it’s not the right thing to do — maybe not even what they really want to do. Most adults can understand the temptations of following the crowd. Your parents may not know that you vape. Those devices that look like USB drives are pretty easy to conceal. But you probably know that. If you want to quit, consider telling your parents about your desire to quit and you may be surprised by how helpful and supportive they are. If not your parents, talk about your concerns with a school counselor, school nurse, or a coach or teacher you trust. Be smart and do what you know is best. Thinking about the Long-Term Game At your age, it’s really hard to think about next year, let alone the next decade or two. But use your imagination and consider what you want to look like in the future. Do you see yourself blowing smoke from a vaping device around your future family, your kids, or at your workplace? By then, what do you think the science will say about the long-term effects of vaping? No problem? Really? Do you truly think that regularly inhaling chemicals won’t cause a few health issues? It’s your call.

Article / Updated 03-13-2020

It’s important that consumers purchase their e-liquids (often referred to as vapor) from reputable sources because the accuracy of ingredients listed on labels has been a problem. This problem should resolve in the near future; the U.S. Food and Drug Administration (FDA) is in the process of implementing more regulatory authority for e-cigarettes and their contents. All vaping devices contain a liquid which turns into aerosol when heated. Terms for this liquid include E-liquid E-juice E-fluid Vapor juice Smoke juice Vape oil Many of the ingredients found in e-liquids are, by themselves, probably of low toxicity. However, when they’re mixed together and heated, new chemicals can emerge. We simply don’t know how toxic these brews are or become when stored over time. Considerable research will be needed to answer these questions. As a small beginning, ingredients should be listed on the label. Almost all e-liquids contain some combination of the following: Vegetable glycerin: Vegetable glycerin is derived from plant oils. It’s used in cosmetics, food, many pharmaceuticals, and toothpaste. Vegetable glycerin is colorless, has a slight sweet taste, and has the consistency of syrup. Using increased percentages of vegetable glycerin in vape juice promotes more cloud, which appeals to some users. Vegetable glycerin makes vaping smoother and easier on the throat. Propylene glycol: Propylene glycol is a synthetic substance also used in cosmetics, food, and pharmaceuticals. It’s odorless and also slightly sweet. Propylene glycol is somewhat thinner than vegetable glycerin, but slightly thicker than water. Propylene glycol in e-liquid enhances flavor and creates more of what users describe as a desired “throat hit.” Propylene glycol is sometimes used as an ingredient in antifreeze. That fact has frightened some people into believing that vaping propylene glycol could be highly dangerous. However, it isn’t the propylene glycol that makes antifreeze toxic. Of note, propylene glycol is also used in asthma nebulizers. Depending on individual tastes for flavor, throat hit, and amount of vapor, different proportions of vegetable glycerin and propylene glycol can be mixed for e-liquids. Nicotine When people quit smoking, they crave nicotine. They want a replacement for nicotine from smoking and in as similar a form as possible to their old smoking habits. Therefore, many e-liquids provide a jolt of nicotine. Nicotine gets a bad rap among much of the public. That’s because it’s so closely associated with the harm caused by smoking combustible cigarettes. However, as we’ve said more than once elsewhere, it’s the inhalation of burning tobacco and its resulting tar that causes most of the problems from smoking. Nicotine is vastly less harmful, although it is highly addictive. Most, but not all, e-liquids contain nicotine. Some contain only flavors. Nicotine concentrations vary widely among different e-liquid products. We’ve seen a range from 0 to 50 milligrams of nicotine per milliliter. Most smokers wanting to use vaping in order to quit cigarettes need to experiment with different concentrations of nicotine to find what works best to control cravings. Nicotine salt (a form of natural nicotine) is sometimes combined with benzoic acid for vaping purposes. Nicotine salt absorbs more quickly into the bloodstream than so-called freebase nicotine found in most e-juice. It has a smoother hit, allowing users to increase the nicotine concentration they’re consuming. Nicotine salt requires its own type of vaping device such as the Juul or some type of other pod system or fourth-generation vaping device. Juul claims that its device using nicotine salt is absorbed 2.7 times faster than regular nicotine in other e-cigarettes (and similar to that of regular cigarettes). That absorption rate may cause Juul users to become addicted more quickly than those who use other vaping products. Anecdotal evidence supports this increased risk of addiction, although scientific research needs to confirm (or refute) this possibility. Flavoring One of the most seductive parts of vaping rituals is the variety of available flavors. Manufacturers are competing with regular tobacco companies and realize they can enhance the desirability of their product by infusing it with a variety of tantalizing flavors. Unfortunately, some of these flavors have been particularly tantalizing to teens. Some flavors are derived from food extracts. Others are labeled simply as “natural and artificial flavorings.” Natural refers to flavors derived from plants or animals. Artificial can refer to almost anything, and manufacturers rarely disclose specifics. There’s no way to know exactly what’s in those flavorings. Flavoring ingredients as well as many of the flavorings described in the following sections have been tested and approved for ingestion but not inhalation, which could present a quite different risk profile. Currently, there are literally thousands of vape flavors available — everything from banana nut bread to bacon to menthol. Flavors like gummy bears or bubble gum have great appeal to teens and young adults; for that reason, many people have called for banning flavors from e-cigarettes. Under this pressure, Juul has recently (as of this writing) stopped selling vape cartridges containing any flavors other than tobacco or menthol. The U.S. federal government is actively considering whether to ban most vape flavors for other manufacturers as well. At the end of the day, we’re pretty sure a person could find just about any flavor in the world and some that don’t even exist. However, because of unknown risks of flavors and their highly varied ingredients, vapers would be on safer ground if they avoided them altogether. Vaping CBD or THC Cannabidiol (CBD) is an active component found in the cannabis plant. Tetrahydrocannabinol (THC) is the active constituent in cannabis that gives people a sense of euphoria or what’s called a high. Both come as an oil that can be vaped when mixed with vegetable glycerin and propylene glycol. You may wonder what the difference is between cannabis, hemp, and marijuana. Hemp and marijuana are both cannabis plants. To be called hemp, it must contain less than 0.3 percent THC. Marijuana contains more than 0.3 percent THC. Sometimes the two plants crosspollinate and a hemp crop turns into a marijuana crop. Both CBD and THC are, thus, isolated components of two different types of cannabis plant. Vaping CBD CBD burst onto the scene quite recently. The 2018 Farm Bill changed everything. It legalized the production and sale of hemp that contains less than 0.3 percent THC. Today, you can find CBD derived from the hemp plant in everything from lotions to lollipops, water, tea, soft drinks, candy, and vape pens and other devices. You can buy these CBD products at your local drugstore, grocery store, CBD specialty store, smoke shop, vape store, online, and more. You may wonder what made CBD so ubiquitous given that it doesn’t make you high. CBD has numerous purported health benefits. Although the FDA has only approved CBD for the treatment of difficult-to-control epilepsy, claims of its efficacy for other problems abound. A partial list of these positive health assertions includes the treatment and/or amelioration of: Alzheimer’s Anxiety Arthritis Brain injury Cancer Chronic pain Depression Inflammation Inflammatory bowel disease (IBD) Insomnia Migraines Nausea Parkinson’s disease Post-traumatic stress disorder (PTSD) Psychosis onset Skin conditions The value of CBD is recommended for more than humans. You can often buy it at your local veterinarian’s office for your dog or cat. It’s promoted for animals with arthritis, pain, seizures, separation anxiety, and more. If the majority of these purported benefits prove to be valid, most of us will be able to empty our medicine cabinets and fill them with CBD products. Unlikely. Vaping THC California was the first state to legalize medical marijuana, in 1996, followed by over 30 states in the following two decades or so. Colorado and Washington led the way for legalization and/or decriminalization of recreational marijuana and THC in 2012, followed by another ten states and counting. The major advantage of vaping THC over smoking marijuana is that vaping doesn’t involve burning, which by itself produces a variety of additional chemicals of unknown risks. However, whether vaping THC is safer than smoking marijuana is an open question. One serious concern about vaping THC is that it has been implicated as a possible cause of some cases of serious lung damage, possibly due to ingredients mixed with it. Health benefits of medical marijuana have been difficult to firmly establish because federal law made such studies exceptionally difficult to conduct for decades. However, there is substantial evidence that marijuana: Helps with chronic pain Works well to decrease chemotherapy-induced nausea Helps decrease spasticity for people with multiple sclerosis (MS) There is moderate evidence that marijuana improves the sleep of people with: Chronic pain Fibromyalgia MS Sleep apnea There is some (limited) evidence that marijuana helps Decrease anxiety Increase appetite Decrease intraocular pressure associated with glaucoma Improve symptoms of PTSD Improve a few behavioral symptoms of dementia such as agitation and aggression Finally, there is very preliminary evidence that marijuana may help people decrease or abstain from abusing alcohol or opioids and perhaps tobacco. Additional, preliminary evidence has provided hints that THC and possibly CBD may have a beneficial neuroprotective effect following traumatic brain injury. Considerably more research is needed to confirm or refute these exciting possibilities. Even in states where marijuana is legal, a robust black market offers THC for vaping, the safety of which is unknown. And vaping THC has been associated with serious cases of vaping-related lung damage. Never buy any vaping products from the street.

Article / Updated 03-13-2020

E-cigarettes are often described as having come to market in a wave of either three or four generations. There is not a bright line demarcating one generation from the next, but technological advances give you an idea of where the field has gone and where it’s headed. In general, over time, the devices have become more powerful, have more adjustable settings, and some now even track a user’s vaping behavior. The following figure provides illustrations of the four generations of vaping devices. The first generation The first generation of e-cigarettes were quite basic and consisted of a battery, an atomizer, and a cartridge of e-liquid. They’re often referred to as cig-a-likes. They generally look much like a regular, combustible cigarette. They’re also small and easy to conceal. The experience of vaping with a cig-a-like is similar to smoking a regular cigarette and involves inhaling into the mouth first and then into the lungs. Most of the first generation of e-cigarettes are not rechargeable or refillable. They’re fairly cheap and extremely easy to use. Gas stations and drugstores often carry them. They’re activated simply by inhaling, which turns the battery on and usually an LED lights up the end of the stick. Later iterations of first-generation e-cigarettes include options for recharging the batteries and replacing the cartridges. Certain models have a button that you have to press in order to inhale. Some of these e-cigarettes come with a portable battery charger that is about the size of a package of regular cigarettes. We talked informally to a number of vape shop customers who told us that they found first-generation e-cigarettes not very helpful when they were trying to quit regular smoking. They said these devices left them unsatisfied, still craving a regular cigarette. They claimed that later generations of e-cigarettes were considerably more helpful because later-generation devices delivered a higher amount of vape and nicotine. Obviously, these discussions can’t be considered a scientific study, but they’re interesting observations. The second generation The next generation of e-cigarettes is a bit more technologically advanced. They have more power and typically have on/off buttons. They usually look like pens or laser pointers. Generally, batteries can be recharged and sometimes replaced. They have a cartridge called a clearomizer that’s refillable with e-liquid (see the “Atomizers” section, earlier in this chapter). Most second-generation devices have an important safety device in the form of a chip that turns off the device to prevent overheating. The third generation The third-generation vaping devices are also sometimes called advanced personal vaporizers. These devices come in lots of different styles and don’t look anything like traditional cigarettes. They tend to be much bigger than the older-generation products. They have more power and can heat the e-liquid to a higher temperature than older models, which may alter the toxicity profile of the vapor produced. Third-generation devices are rechargeable and refillable. The power section of third-generation devices are called mods. Mods come in two major types: Mechanical: These devices don’t have a circuit board to control temperature or power. They’re simple devices, but they’re more dangerous than regulated mods because they run directly off the battery. The production of vapor declines over time as the battery discharges. Enthusiasts sometimes like to make their own devices, but that can lead to a bad outcome if someone doesn’t have advanced knowledge. Regulated: These devices have a chip that controls temperature and power; they include safety features such as automatic shutoff. Some of these devices allow the chip software to be updated. They don’t resemble combustible cigarettes or pens. There is usually a small screen that provides information about power. The fourth generation Technological advances continually find their way into each new generation of e-cigarettes. The newest e-cigarettes are even more powerful and have more bells and whistles than those that came before. There are more options, allowing even finer adjustments in temperature and power. Fourth-generation e-cigarettes also have airflow slots, which allow adjustments to the flow of the vapor. These devices are usually used by experienced vapers, some of whom participate in competitions involving blowing smoke into various shapes and sizes. Third- and fourth-generation devices are used in these competitions, which are referred to as cloud chasing. For new advanced devices, the cable that comes with the device is for attaching a device to a computer to download updates. A computer’s USB port should not be used for recharging; instead, a standalone charger is preferable. If something goes wrong, you could lose not only a vaping device but a computer as well. Pod systems Pod systems are the newest wave of vaping devices. Pods are somewhat unique vaping devices and are not easily categorized. Some pods look strikingly like computer USB flash drives; others look like pens or cosmetic products. There’s no assembly, and there are no adjustable buttons or switches. However, some devices have a single power button, whereas others are activated solely by taking a drag. Pods are easily recharged with the USB charger they come with. See the following figure for an idea of what some of these systems look like. The devices were designed to be low hassle and easy to operate. They’re small and discrete, lightweight, easy to carry, and produce a minimal cloud of vapor. Pod designers are trying to mimic the experience of smoking combustible cigarettes as closely as possible to make the transition away from regular cigarettes easier. The nicotine in a pod system is absorbed quickly, like that of a combustible cigarette. Juul, one of the first pod system devices, was designed by a startup company which created several e-cigarettes prior to their Juul product. The founders, Adam Bowen and James Monsees, were former smokers and they ostensibly hoped to target the one billion smokers worldwide, most of whom want to quit. The Juul was launched in 2015 and in a few years, the product captured a substantial majority of the e-cigarette market. Although the original market was allegedly for adults wanting to quit combustible tobacco, pod systems quickly became wildly popular with teenagers.