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Bill Klaproth (Host): Tobacco use is started and established primarily during adolescents with nearly nine out of every ten cigarette smokers first trying cigarette smoking by age 18 according to the CDC. That’s why it’s important to stop the bad habit before it even starts. Here to talk with us about preventing teenage tobacco use is Dr. Lauren Jazwick, a resident at the University of Nebraska Medical Center and at Columbus Community Hospital’s Columbus otolaryngology clinic. Dr. Jazwick, great to talk with you today.

Lauren Jazwick, DO (Guest): Hey Bill, it’s great to be here. Thanks for having me.

Host: You bet. So let me ask you this. Can you start off by telling us a little more about teenage tobacco use?

Dr. Jazwick: Absolutely. So tobacco use is actually the leading cause of preventable disease and death in the United States right now. Nearly all tobacco product use, like you said, beings during youth and young adulthood. Unfortunately, tobacco use is much more prevalent today in this population than it was even 10 years ago. In fact, the CDC estimated that there’s about 4.9 million middle and high schoolers that are currently using these products. As a head and neck surgery resident, I get to see these patients with these medical conditions caused by smoking every day. I'm so grateful that I've been given this opportunity to participate in prevention efforts with this podcast. Specifically with this podcast, I’d really like to emphasize the rate of tobacco use in adolescents, discuss some of the new trends on the market, review some health risks associated with it and some myths; and discuss what patients, families, and we are trying to do to prevent tobacco use.

Host: Alright Dr. Jazwick. That sounds good. So the CDC says cigarette smoking actually went down among middle and high school students from 2011 to 2018. But is that rate continuing to drop?

Dr. Jazwick: That’s a great point. Cigarette smoking actually did go down. In fact, it went down pretty considerably. However, in the last couple of years since the e-cigarette industry has really come out, that number has actually be equivalent to where it was in 2011 and has actually grown by one and a half million in the last year. Where we sit today about 1 in 14 middle school students and 1 in 4 high school students have used tobacco in the last 30 days.

Host: So tell us about some of the new trends that may be causing that number to rise again. I know there’s e-cigarettes and many kids are vaping. Tell us about that.

Dr. Jazwick: Certainly. So e-cigarettes have several names and come in several varieties. Some of them are known as vapes, vape pens, hookah pens, mods, tanks, jewels. All of these are designed to use a battery that heats a liquid solution to a high enough temperature that it produces an aerosol. I'm sure we’ve all been in a restaurant and seen this white cloud of smoke come out and were confused about what that was coming from. These specific e-cigarettes come in about 500 brands and 7,000 flavors. The flavors specifically are what is really drawing to the adolescent population because they’ve come out with things like fruit and candy and mint. The industry itself is really aware of these trends and really trying to target their products to this level of consumer.

Host: Right. So can you tell us about the negative effects of these new products? You were just mentioning flavors and e-cigarettes. What’s the negative effects?

Dr. Jazwick: Well, I think it’s important first to start by addressing the common denominator between e-cigarettes and cigarettes themselves. That common denominator is actually nicotine. It’s a stimulant that we’ve heard about for a long time. It’s found in certain plants. Most notably it’s found in the tobacco plant. What this nicotine does is after about 10 seconds of smoking, it can hit the brain. This will trigger the release of some endorphins that create a really pleasurable sensation. That’s specifically what makes smoking such an addictive process.

Additionally, that drug itself, the nicotine, works throughout the body and can cause some blood vessel constriction. And also makes blood a little bit stickier causing more tendencies to clot, and it can also cause more tendencies to have heart attacks and stroke. Nicotine itself works also throughout the body to cause constriction of blood vessels, and also can make the platelets in the blood stream extra sticky. That increases the chance that you're going to form a clot in your blood stream and also can trigger some heart attacks and strokes.

Additionally, as a head and neck surgeon, we also know that there’s several carcinogens, or cancer causing agents, in cigarettes and e-cigarettes that can actually lead to cancer. So for reference, a traditional cigarette has about 7,000 chemicals in it, and about 70 of those are proven to cause cancer. We’re showing similar results with our e-cigarette studies, but this is such a new trend on the market that we don’t have a lot of great data about it yet.

Host: Right. The thought of these e-cigarettes was supposed to be for people to help them quit smoking, but are teens who use e-cigarettes more likely to use other tobacco products?

Dr. Jazwick: Unfortunately, yes. That’s really one of the common myths I hear in the clinic all of the time. Patients are telling me they’re using the e-cigarettes to quit smoking, and that’s just really not how they’re designed to work. They don’t have the same ability to taper off the nicotine that people need. The recent study actually too, by USD, revealed that many actually cause people that do that to use both of them. They also showed that teens unfortunately who were not smoking before and probably wouldn’t have are now vaping.

Host: Well, that’s unfortunate. It sounds like it’s a gateway into tobacco use. So you specialize in otolaryngology, which focuses on the ear, nose, and throat. Can you tell me some of the things you have seen as a result of long-term tobacco use?

Dr. Jazwick: Yeah, certainly. So as an ENT, really the most common complaints we see on a day to day basis are really cough, nasal congestion, and sinusitis. Most also have some taste and smell disorders from using that smoke. They can have some damage to the voice box. They can have exacerbation of their lung disease. Like if they have COPD and asthma. We also specialize, as ENTs, in head and neck cancers. Smoking is known to cause cancers of the mouth and the nose and the throat and the voice box and several other areas of the body. The most common form of that is actually squamous cell carcinoma, and it’s 10 times more likely to develop in smokers than in non-smokers.

Host: Oh, that is not good. So how early can these health problems occur, and do you ever actually see them in teens? Or do they typically present later in life?

Dr. Jazwick: We certainly see them in teens. So as soon as that smokes hits the airway, it damages the cilia. We describe these as the tiny little brooms that keep the nose and the airway clean. When those aren’t functioning, it’s going to lead to more issues with infections. It’s going to lead to, like I talked about, the exacerbations of respiratory conditions. Also, like I talked about before with sticky blood, more clots, more strokes, more myocardial infarctions down the line. They also have started publishing recent data on adolescents specifically with nicotine use. It’s been shown to be linked to learning and behavior problems as well.

Host: So all of that not very good. So let’s shift the conversation to prevention. With social media and advertising companies pushing these products, what is being done to prevent teenage tobacco use?

Dr. Jazwick: Great question. Certainly something that I think we’re all still working on at this point. One of the great things that has come out in the last couple of years is actually more regulations on the e-cigarette industry. So we’ve kind of picked up that these industries are targeting adolescents with their flavors and have started to put bans on them. Specifically, the FDA just recently banned menthol, which is great for us because that flavor is really attractive to young smokers as it numbs the throat and makes it a little bit less irritating. But it’s also really hard to quit. At a school level, we all certainly went through DARE. There are other programs and policies in that place that really stress avoidance of it.

New, since smartphones have been out on the market too, is that there’s several apps designed specifically for adolescents to quit smoking. I think we have a long way to go from a healthcare perspective. We’re still trying to educate ourselves about e-cigarettes and what this really is gonna mean for us and our patients. We really are just gonna have to keep working at that.

Host: So from that healthcare perspective. Is there anything being done medically to help prevent teenage tobacco use?

Dr. Jazwick: Like I mentioned before, we certainly have a long way to go. What we know at this point is really targeting that nicotine. So things that have been developed in recent years have been helping to taper off of that nicotine, to lower the quality and the quantity in your blood so that you don’t have the same withdraw symptoms. Some of those products are the nicotine patches, the lozenges, the things that you can suck on, and also gum that you can chew. They’ve been shown to be effective. There’s also some prescription therapies called Chantix and bupropion that specifically need to be prescribed by a physician, and they’ve also been effective. However, we know that the number one way to quit smoking is to actually combine the medication with counseling and support groups and family influence as well.

Host: Speaking of family, let’s bring it closer to home. What should parents do to help prevent their teens from picking up these really bad habits?

Dr. Jazwick: So, I'm not actually a parent yet myself, and I haven’t had to have these tough conversations with my children yet. But I do think it’s important for families and parents to familiarize themselves with the products and the terminology as it’s everchanging. Certainly in the last 10 years it has really changed. I also think it’s important to recognize that smoking is incredible prevalent in the middle school and high school populations these days. Probably more so than it was when they were younger. So just asking about it, knowing the products, and really knowing the effects that they can have on healthcare in the coming years.

Host: Right, that makes sense. So is there anything else I forgot to ask you today that you wanted to discuss?

Dr. Jazwick: I also wanted to add that in addition to those phone applications that I talked about earlier, there’s also some online and telephone guidance. A lot of them are based through the CDC—the Center for Disease Control. One of them is smokefree.gov. Then there’s also a 1-800-QUIT-NOW number that can help families and also patients get the resources that they need to quit. This is really new for us. The e-cigarette industry is really new, and we just don’t have that long-term data. So I think that over the coming years, we’re going to know more about what effects vaping has really had on health and really where it’s going to lead in our care of our patients.

Host: Dr. Jazwick, do you have that number to give out?

Dr. Jazwick: I do. It’s 1-800-QUIT-NOW.

Host: Very good. Dr. Lauren Jazwick, thank you so much for your time today. For more information on teenage tobacco use or Columbus Otolaryngology Clinic, please visit columbushosp.org. That’s columbushosp.org. As Dr. Jazwick said, you can call 1-800-QUIT-NOW. Be sure to subscribe to our podcast at Apple Podcast, Google Play, or wherever you listen to your podcasts. This is Columbus Community Hospital Healthcasts from Columbus Community Hospital. I’m Bill Klaproth. Thanks for listening.