Transcription:
Kids and Vaping

Introduction: This is BayCare HealthChat, another podcast from BayCare Health System. Here's Melanie Cole.

Melanie Cole: As cigarette smoking seems to be on the decline, another method of nicotine use has managed to hook today's youth. This is BayCare HealthChat. I'm Melanie Cole and today we're discussing vaping and our kids. Joining me is Dr. John Prpich. He's a Pediatric Pulmonologist with BayCare. Dr. Prpich, I'm so glad to have you with us. And as a parent of two teens, this really is a pretty scary situation for other parents that really don't understand what it is. Tell us what is vaping and what's different now about what we know about this habit? Give us a little history of it?

Dr. Prpich: Sure, absolutely. You know, I feel like it seems like it's something that is a new development with all of the publicity that really kind of was on the news. It seemed like these devices were something that were brand new, but really they've been around for a very long time. In fact, even the first patent for an electric vaporizer was actually filed in the thirties. And so these have been around for a while, but they just weren't successfully marketed. And in fact, the first successful marketing was over in China, actually in 2003 with a pharmacist who actually developed the device or was marketing the device because his father had died of lung cancer. And I think he might have even had some, some intentions of trying to help other people quit smoking, but unfortunately it's just not really not really been that kind of device that I think he was hoping for.

But it really was in the middle, you know, sort of 2007 or so when it was first introduced in the United States. And then of course in 2019 was when we first started seeing some of the really negative outcomes in the United States. But you know, when we talk about vaping and we can talk some more in a little bit about some of the different devices, cause things have really changed rapidly. Of course, as people have developed new devices, I think just the real basics, just kind of understanding what we're talking about really is talking about using an electronic device that super heats a liquid and creates ultra fine particles, very, very small particles. And these devices they'll come in a wide range of shapes and a wide range of sizes. And there's the cartridge, of course, that holds the liquid and then there's the heating element. And then there's a source of power to help power that, that heating element. And then there's the mouthpiece. But they can take so many different shapes.

And then usually the user will puff on the device that activates the heating element and then inhales the vapor, which is of course, you know, where it gets the term vaping. The scary thing though, is that the variety of these devices has really made it hard, I think for adults, or even for people, especially when we're talking about children and adolescents and middle schoolers and high schoolers vaping, it's made it very hard for us to identify what these kids are doing. And some of these devices can look like almost like USB memory sticks. They make them to hide actually there's websites that you can, they make them to look like Sharpie pins, or they make them to look like, I've actually seen some that are made to look like an asthma inhaler. So you think the child is using a medicine and then believe it or not, they've even made some that are built into a like a kind of a hoodie sweater and the child can, can inhale through the kind of elastic string at the top. And so, the devices and the manufacturers have found lots of ways to sort of allow people to use these devices kind of in a sort of stealth mode.

Host: Wow. I had never heard about some of those versions of vaping before. That's just, it's just really scary for parents. Tell us a little bit about what you said, these aerosolized particles and that, what is the e-liquid, is this nicotine, are they vaping marijuana or versions of that? What is it that they're vaping?

Dr. Prpich: That's been a big part of the marketing and a big part of the misinformation around vaping is that people considered it, and it was first marketed as a healthier alternative because people would say, there's less compounds than are in regular cigarettes. The list of things is less than it's all, you know, it's all natural, or there's a whole host of sort of misinformation sort of mistruths that have been put out there. But really the liquid contains nicotine. And then it also contains either something called propylene glycol or a vegetable glycerin, and then there's flavoring. And so, although it doesn't seem like there's much that are in those liquids the amount of those different components will vary as well as the different flavorings. And there's somewhere around 7,000 or more different, unique flavors that are made from different associated chemicals that help to create that flavor.

The other important thing is that the amount of nicotine in these devices can range a lot, right? So, they were originally marketed or at least sold to people as a smoking cessation device. Now we've not really seen any studies or anything, anything that's been actually reproducible that actually shows it's effective at smoking cessation, but also importantly, what they've done is they've found ways to actually increase the amount of nicotine in these, you know, liquid cartridges. So, rather than trying to wean people off of the addictive component of cigarette smoking or vaping, they've just tried to create stronger and stronger, you know, liquids that contain more and more nicotine with, you know, a light level of nicotine, just being three to six milligrams per ML, but some of the Juul pods. So, you know, one of the most popular kind of pods can contain as much as 59 milligrams.

And so one of those cartridges that you're inhaling can contain the same amount of nicotine as an entire pack of cigarettes. And of course it's the nicotine part that's addictive. And so these, the vaping is almost an easier way. And unfortunately what we're doing is creating a whole new generation of addicts to nicotine. The other piece that's important to realize too, is that these devices are very efficient at creating these ultra fine, very small particles. And so even a much more efficient manner or method of delivering all of these different chemicals and compounds very far down into the airways, which is also very scary and part of how we're just now scratching the surface and just now figuring out and understanding what effect potentially these different chemicals and compounds have on airways and on lungs.

Host: So I'm wondering, is it healthier than smoking cigarettes and based on what you're saying, cigarettes are insidious, but they seem to take longer. This seems to be killing our youth much quicker. And, but I mean, for people that really need that nicotine, Dr. Prpich, is it any healthier at all?

Dr. Prpich: It is not. In fact, there's, you know, as we're, you know, trying to catch up, if you will, to the epidemic of vaping, in terms of research, we're finding that these devices are not safer than cigarettes. These chemicals still have impacts on the lung epithelium. They still have a concern or potential to be carcinogenic, and they still can have impact on growth and development, as well as the immune functions of the lung. And, you know, it also, I think it's deceiving because people look at that list of compounds or, you know, list of chemicals and just say, well, there's a few things in there. The problem is, you know, I had mentioned the device heats up the liquid, as the person is using the device. And so as that liquid is heated, the chemicals change. And so the rates, you know, how hard the person is inhaling, how big a breath they're taking, and how hot the liquid is getting will also create different amounts of kind of degradation of those chemicals, creating a whole new host of other much more volatile, organic compounds, such as formaldehyde and heavy metals, as well as carcinogenic compounds. And so it really is a, it's a very complicated system and it's part of why it's made it harder for us to really fully understand the true dangers. And, but unfortunately it's been, it's such an efficient way at delivering, you know, these different compounds to the lower airways, we're seeing the negative outcomes you kind of play up right in front of us.

Host: It's so interesting to me. So tell us as parents, how do we know if our kids are vaping? How do we figure it out? Because it doesn't smell like cigarettes in their rooms, or if they come in from outside or any of those things, how are we to know? And what do you want us to tell our kids about this? They don't always want to hear the science, but we do need to tell them something. So they realize how dangerous and addictive this can be. So give us some tips to talking with our kids about it and tell us how as parents, we can even recognize that our kids are doing this.

Dr. Prpich: Absolutely. So I, you know, it is so hard, like I mentioned earlier sometimes to know, because these devices can be hidden so well. And like you mentioned, then there's not the odor that went along with, you know, standard smoking. And unfortunately, the other very scary thing is that we've just talked about some of the chemicals and compounds that are commercially available, but if you do a quick Google search, it is actually horribly frightening how quickly and how easily you can find a wide range of sort of homemade recipes that people have out there available for people to try and to use in some of these cartridge systems that you can fill back up. So really, you know, it's just the tip of the iceberg. And unfortunately, you know, especially with some of the more severe lung damage and, you know illnesses that we saw in 2019 there's a huge shift into, and use of marijuana and cannabis containing liquids in the vaping devices as well.

And so when you're looking for signs, unfortunately, even if they're not, you know, vaping, marijuana or other list of substances, you still may see signs of addiction. I actually had a mom in clinic who had no idea until they went on vacation. And then she realized that her son was going through withdrawal because he was having sweats and he was feeling jittery and he was irritable. And that's when he finally came out and told his mom that he was vaping, just the standard nicotine containing cartridges. So, so keeping an eye out for signs of addiction or even withdrawal, of course, you know, spending an increasing amount of time alone or in their room or, outside or things like that can be a tip off as well. You know, sometimes even looking at their Google search history, looking for you know, if they're searching for recipes and ways to make some of these e-liquids. And then of course, if they are beginning to make some of those custom liquids or move into the marijuana containing liquids, then you're going to see some of those other signs and symptoms of addiction, including just altered, you know, alertness, awareness, lack of motivation, distancing from their friends and their peers, or a complete change or shift, you know, in their peer group.

If they're now all of a sudden hanging out with a whole new group of friends, sometimes that's a red flag to that, you know, something else about their behavior has changed. And, you know, I think just having an open discussion with them and asking them is at least a good place to start. It really depends upon the relationship you have with your teen coming into this. But just getting it out into the open, because very often they have no idea, right? Their friends were doing it at school, they tried it, they didn't even realize a lot of times you know, studies show that the teens, especially the middle schoolers and the younger kids don't even realize that there's nicotine or there's addictive substances in these devices. It smells like bubble gum, or it smells like cotton candy. And so they didn't realize that there was something that would get them hooked on it either. And so, you know, beginning to just have that conversation in a nonthreatening manner, seeing their friends doing it, asking them if they themselves have tried, it might be a good way to at least open up that conversation and get them talking. Cause, you know, like I said, often they're not even aware of what they're doing and what kind of risk they're placing themselves at.

Host: Well, that certainly is true. And open lines of communication are key when we're talking about this kind of thing. As we wrap up, Dr. Prpich, and it's just such an important topic, please reiterate and reinforce for parents about having that discussion about the dangers that e-cigarettes and vaping can have on their children and really how we can get our children to stop. What do you want us to know?

Dr. Prpich: Absolutely. So, you know, and I think, of course in 2019 was when this really hit the news, because we were having those cases of significant lung injury, the e-cigarette associated lung injury that was landing people in the hospital, right. We had at least back, as early as December, there were close to 2,711 cases identified in the US, so really it just skyrocketed, it was an epidemic. Thankfully that's leveled off and decreased in terms of instance, but really, you know, that's what I think really brought it to the forefront and began to at least move some awareness regarding the epidemic within middle school and high schoolers. And so it's really key though, to understand that these devices, especially, you know, it seems being, you know, to be related to you know, using some of the liquids that contain, you know, marijuana, or at least contain cannabis it's not been an entirely clear signal, not all of the individuals that you know, ended up in the hospital or ended up having a significant lung injury.

It's not completely clear that all of them were using liquids that contain marijuana. So talking to your kids and making sure that they don't think that just because they're not using pods or, you know, liquids that are, you know, since they're using some that are marijuana free, that they're safe. Because there were still individuals that had significant lung injury that did not have any evidence of, or any reported use of the marijuana liquids. But there does seem to be some something with regard to the solvent or the liquid that they were using to dissolve the things in the liquid that was causing significant lung injury. And so these, we don't realize what the long-term impact or damage is going to be, right. We, you know, 10 years from now, 20 years from now I'm a little scared that I'm going to have, or actually my adult colleagues, my adult pulmonary colleagues are going to have clinics full of people with chronic obstructive pulmonary disease. Something sort of similar to what some of our miners and, and people that worked in the mines and were exposed to asbestos and things, right. That we're going to have this whole cadre of individuals with long-term lung damage. And it's going to end up getting linked back to this early use of vaping. And so, it's really as critical, like always, and like with a lot of social issues with our kids, open communication is key. But realizing that this really is just a wide open field and we need to identify, and we need to really talk to our teens and our middle schoolers and find out if they're doing this because they really are causing significant damage to their lungs.

Host: Well, thank you so much because hopefully parents hearing it from an expert like Dr. Prpich, who is a pulmonologist will help to convince your kids. And it is about that open line of communication. Thank you so much, Dr. Prpich, for joining us today and sharing your incredible expertise on this. To learn more about BayCare's Children's Health Services, please visit baycare.org. That concludes this episode of BayCare HealthChat. Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts. I'm Melanie Cole.