Brendon Stiles, MD is a thoracic surgeon at NewYork-Presbyterian Hospital and an Associate Professor of Cardiothoracic Surgery at Weill Cornell Medicine.
Learn more about Brendon Stiles, MD
Jonathan Avery, MD, is the Director of Addiction Psychiatry and an Associate Professor of Clinical Psychiatry at Weill Cornell Medical College.
Melanie Cole (Host): There’s no handbook for your child’s health, but we do have a podcast. Featuring world class clinical and research physicians, covering everything from your child’s allergies to zinc levels. This is Kids Healthcast by Weill Cornell Medicine, and our topic today is teen vaping, and by guests in this panel discussion are Dr. Jonathan Avery. He’s an Associate Professor of Clinical Psychiatry and the Director of Addiction Psychiatry at Weill Cornell Medicine, and Dr. Brendon Stiles. He’s an Associate Professor of Cardiothoracic Surgery at Weill Cornell Medicine and Chairman of the Lung Cancer Research Foundation. Gentleman I’m so glad to have you with us today, and this is such an important topic right now and so many teens are really getting into vaping thinking that it’s a safer alternative to cigarettes and smoking other things. Dr. Stiles, I’d like to start with you. What is vaping, for the parents that really don’t know and what’s the prevalence and societal impact that we’re seeing from it?
Dr. Brendon Stiles (Guest): Well vaping is defined as a lot of different things, but it’s basically just the inhalation of an aerosol. Generally a lot of these commercially made devices have a heating component that heats a liquid that can be made of anything and then turns it into an aerosol for inhalation. This is often mistaken or just thought to be perhaps water vaper, but it actually consists of lots of fine particles and varied amounts of chemicals. There was essentially no vaping in 2011 and since then it has taken off and grown steadily. There was a recent study just a year ago that showed the rate has almost doubled and at now almost 20% to 25% of 12th graders have tried vaping or even vaped in the last month, and many of these teens think that they’re just using flavors, but about 25% to 30% also use nicotine, rates of which are rising.
Dr. Jonathan Avery (Guest): I’ll add that in the addiction world we were high fiving each other about having decreased use of nicotine products and this surge and the prevalence of youth that are using nicotine again and figuring what it is and how to get off of it and the impact on their health has really exploded over these last couple of years.
Host: Well it certainly has, and I have seen that in my own family, so Dr. Avery, what’s different now about what we know about this habit as you said, that it at first addiction specialists thought this might be a good thing, but what do we know now?
Dr. Avery: Right, we thought it might have a role, and it may have a role helping chronic smokers, adult smokers, get off cigarettes and quit their nicotine habit and sort of viewed it as a nicotine replacement therapy to decrease nicotine over time. What happened though, is that these very attractive devices that looked very friendly in this iPad and tech savvy world, got into the hands of adolescents who found them to be the new sort of coolest thing and now very quickly we’ve had this explosion of youth using it, and using it all the time, and getting into trouble around the use of it.
Dr. Stiles: I’ll totally agree with Dr. Avery on that. I think arguably there was some good intentions when this started really to decrease dependence on traditional cigarettes and on nicotine. That though really – what’s happened now is all of a sudden there’s been an explosion of teen use that has really brought awareness to the problem, but it’s also caused people to focus not just on the positive effects, but on the potential negative effects, which we are really starting to seek them out now.
Host: We certainly are, I mean we’re hearing more about it in the media, and even deaths. Dr. Stiles, tell us a little bit about what’s in the vape juices. Dr. Avery said there are particles now and things that we didn’t think were probably in there, but for parents, they don’t know if these kids are vaping nicotine type products or harmless products or if they’re vaping weed and marijuana. So what is it that they’re vaping?
Dr. Stiles: Well I think you really hit the problem there. Part of the real issue with this is that we really don’t know what’s in individual products and we don’t have a great handle, and certainly teens who are using them don’t. Nicotine is probably the most important and the most addictive element that’s in a lot of the devices, but as you mentioned there’s also THC cannabis potentially in some of these devices as well. In general though there can be lots of things, there’s generally a solvent, which is typically polypropylene glycol or vegetable glycerin and then there’s a flavoring, and then they mix all these together and heat them up, and another part of the problem is, although we understand what goes into it, we don’t really understand what happens when they heat them up and when we aerosolize them and breathe them in. That potentially leads to a lot of unexpected negative effects to compounds that we’re not really sure what they are.
Host: So now I’d like for you both to compare and contrast. As we’ve said, addiction specialists thought it might be good, and even Dr. Stiles, you’re a cardiothoracic surgeon, you might have been happy that it might help people to quit smoking. Is it healthier than smoking cigarettes? Can it help quit?
Dr. Stiles: Well a lot of my life is lived in the lung cancer world, and for that I’m excited about the possibility to help people quit. Tobacco, as Dr. Avery can tell you, is a terrible problem for patients to get rid of. The potential to quit traditional cigarettes with these e-cigarette devices I think is high. There’s been some randomized trials that suggested the quit rate might be higher initially with e-cigarettes, but I think the more compelling problem is that in big population studies that hasn’t born out as well as we would like to see, and the other problem is that even though patients quit with e-cigarettes, they seem to maintain more of a nicotine addiction than with standard nicotine products.
Dr. Avery: I’ll add that as we think about it’s impact on the youth and on adolescents, we were seeing youth not use nicotine product at all, and so it wasn’t about helping them quit cigarettes, they had sort of stopped in the setting of all these public health campaigns and efforts to sort of decrease nicotine use, and so now we’re seeing people use nicotine where there otherwise wouldn’t have been. They wouldn’t have been exposed to cigarettes, and we’re seeing it go the opposite direction where youth that are vaping nicotine, then proceed to using cigarettes themselves. So rather than decreasing cigarette/nicotine use on a population based level, we worry that will increase it overall and lead to long term consequences.
Dr. Stiles: And that’s an incredibly important point I think where most of the public is now concerned. I think what we don’t want to do is repeat the tragic mistakes we made with tobacco where there’s also uptake in use before studying the long term effects. We really don’t have a great handle on the long term effects of these cigarette vapers and the potential damage they can do to the lungs, but there’s been some early studies that suggest precancerous effects are created by even these vapers, so even though they’re safer than tobacco, still the long term use potential for negative effects is high.
Host: Excellent points, both. So Dr. Stiles, tell us – we’ve been seeing it in the media, the recent outbreak of hospitalizations, why are we seeing this? And as we don’t know much about these yet, and you said that it’s going to take us a while to see these long term effects, but right now, people are being hospitalized and there have even been deaths, what’s going on?
Dr. Stiles: Well this is incredibly disturbing and this mysterious lung related illness has really swept the country, and we’re seeing lots of reports day after day now. These patients are generally patients who are young and healthy and have reported recent vaping and they’ve ruled out other causes of lung disease. As of yesterday, I saw that over 300 cases have been reported along with a couple deaths. Many of the cases seem to involve vaping liquids with ingredients containing cannabis or cannabis products, and it’s been suggested that’s it’s a problem with the mixture used to emulsify the cannabis and it’s been suggested that perhaps reusing devices or sort of homemade devices are contributing to the problem, but it was notable that the death that was reported yesterday was a young person who legally purchased and vaped THC from an established distributor. We’re not quite sure, we don’t have a great handle on the acute effects of this, but obviously it’s a big problem right now that’s really taking hold, and I think as people start to recognize it, we’ll see more reports. It’s really very scary for a parent. So Dr. Avery, as a parent, I’d like to know are these things regulated by the FDA and tell parents what we should know about e-cigarettes and the marketing and sales to youth which seems to be so prevalent.
Dr. Avery: Right, I mean parents are sometimes the last to know in terms of their kids’ use of these products and for a lot of reasons, I think one is that they’re smokeless, which you know in the past if you’re going to light up a cigarette, mom and dad would be aware. The smell would be on your clothes or you couldn’t do it in your room without the smoke coming out, and so what happens is that kids can use these now without the detection of they’re parents and they don’t know and so even though the FDA and cities and other local organizations are trying to keep it out of the hands of adolescents, trying to remove flavors, a lot of that is sort of lost on parents who are sometimes not even aware in the first place that their kids are using the device, and so we certainly encourage advocacy and we encourage the FDA to do all they can to get it out of the hands of the adolescents but a lot of the work now with kids and families, given that it’s out there and so many people have it, is letting parents know about these devices, letting kids know about these devices, about the harms, about the risks for addiction, and how it can really go undetected in all sorts of ways if we’re not sort of aware as a family unit, aware as a school unit, aware as a society about the impact of these devices.
Dr. Stiles: Yeah, and I’ll add to Dr. Avery. I think those are all great points. I think the FDA is wrestling with how best to deal with this and they made some good early steps in trying to decrease the sale of flavored devices, to really go in and inspect businesses, and they’ve established a deadline for e-cigarette manufactures to apply, but it’s created a bit of a gray area, and really the holes that come through are what has already happened and how to stop it and get behind it and what the black market is like. I think Dr. Avery hits it right on the head when he says it really becomes a discussion with parents, a discussion at schools, a discussion about potential long term effects. We’ve got to change it from a habit that has all the sudden been seen as cool to one that is seen as potentially deadly.
Dr. Avery: And I’ll add to that point that we know for adolescent substance use, as perceived harm goes up, use goes down, and so there – sometimes we think adolescents are sort of immune to perceived risk, but they’re not. They don’t want to do things that are harmful for themselves and changing the narrative from this as a safe, cool product as something that could lead to downstream effects for them is going to be an important change in the dialogue or an important dialogue that we have to keep talking about.
Host: Well that’s so true, Dr. Stiles, as a parent, again what can we do to help our kids stop if they’ve started?
Dr. Stiles: Well I can certainly give the parent perspective. I have a teenager and we talk about this all the time, talk about other kids in his school who have tried or experimented with it, and talk about what the conversation is at school. I’m a big believer in just talking about it, and I think talking about all the news reports and all the problems that are coming out is a very important part of a parent’s sort of playbook for addressing this problem with their kids. I think we could also do better addressing it on more of a broad perspective through the schools and through community organizations, I’d like to see more of that happening as well.
Dr. Avery: And as an addiction psychiatrist, one of our roles is to make all physicians addiction providers. Our goal is to inform all the clinical community, and so the pediatricians are often the entry point for families and kids to learn about this and so we’re encouraging pediatricians to ask questions about juuling, provide information, know the local resources on how to get people off of these devices if necessary, and so the pediatricians may do a lot of the front line heavy lifting in terms of interacting with parents and kids on the medical side of things.
Dr. Stiles: And I’ll add to that. I just took my 15-year-old to the pediatrician yesterday and the pediatrician apparently grilled him about vaping, which made me very pleased and happy to hear.
Host: As I would be too, and what a great point, getting the pediatricians involved because they see things in our children we don’t always spot ourselves. So let’s give you each a last thought here. So Dr. Avery, I’d like to start with you, as this can be a problem with addiction, and there are so many today, and with our teens it’s so, so scary, what would you like parents to know about vaping and how we can get our kids to not start in the first place?
Dr. Avery: Right, and I mean nicotine is one of the most addictive substances. Once you start it becomes really hard to stop, both from withdrawal symptoms also sort of it becomes sort of the answer to every question, as substances do when you have an addiction. Something to do when you’re bored, at the end of the day, with your friends, going out, and so my wish is that, as we’ve talked about, is that everyone’s informed, that it’s something that we can talk about, not sensationalize things, at the same time not minimize things, and allow – let people know about available resources if they need help coming off or they need more support than just from the school system or from their parents, and not sort of avoiding the stigma, the shame that comes with trying to quit or with substances and really something that we can all embrace as a community to do something about.
Host: Dr. Stiles, last word to you, please tell parents and other providers what you would like them to know about vaping and the dangers and what we’re seeing happening today.
Dr. Stiles: Well I couldn’t agree with Dr. Avery more that half of the battle is just addressing the stigma and really talking about it in open situations. For me, as a lung cancer doctor, I would just hate to see the past repeated. We went through an incredible period where we were unaware or willfully ignored the negative effects of tobacco and then suffered a huge spike in lung cancer deaths as well as heart disease, cardiovascular disease, stroke, at least part from cigarette use. What I would hate to see is us repeat those mistakes of the past, and so I think this problem really needs to be studied, we need to look at the negative potential, both short term and long term effects of vaping and of all the different components and we really need to take a careful look towards regulating it. I think in particular we need to regulate as well as we can for our most vulnerable patient populations, which I think is really teens and adolescents so that we can help take some of the pressure off of them.
Host: I couldn’t agree more, such important information for parents to hear. Thank you to my guests, Dr. Brendan Stiles and Dr. Jonathan Avery, and to our listeners. This concludes today’s episode of Kid’s Healthcast. Please remember to subscribe, rate, and review this podcast, and all the other Weill Cornell Medicine podcasts. For more health tips and updates on the latest medical advancements and breakthroughs, follow us on Facebook and Twitter. Until next time, I’m Melanie Cole.
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