“A Person’s a Person, No Matter How Small” – Dr Seuss

Aloha Colleagues,

A while ago, I wrote to you about some excellent news: Cigarette smoking among Americans had fallen to its lowest point in recorded history, according to data from the Centers for Disease Control and Prevention. Cigarette smoking is at an historic low in the US, with fewer than 14% of adults reporting that they have smoked in the past month. This data highlights how successful public health efforts have been over the past few decades. Back in 1965, more than 42% of adults in the US smoked.

But now, we face another problem, designated an epidemic by the surgeon general: Children vaping nicotine. Vaping has increased dramatically in the past year with over 20% of 12-graders and 6% of 8th graders reporting that they vaped in the past month.

This is surprising until you look at the vapes’ yummy flavor varieties and candy- and juice-box resembling packaging! Worse, kids think they are vaping “flavors” not nicotine! Yet it is almost impossible to find a flavored vape that does not contain nicotine!

So, exactly what is this vaping? To vape is to inhale vapor from a liquid that is heated inside a device. The devices have many names—vape pens, pod mods, tanks, electronic nicotine delivery devices (ENDS), e-hookahs and e-cigarettes. The liquid they contain also has many names, such as e-juice, e-liquid, cartridges, pods, or oil. Most vape liquids contain a combination of propylene glycol or glycerin as a base, and nicotine or marijuana, and some flavoring chemicals to produce a variety of yummy flavors like mint, candy, or fruit. The devices use batteries to power heating elements made of various materials that aerosolize the liquid. Some contain nicotine salts and others free-base nicotine, the former more highly concentrated than the latter but both highly-addictive. (Nicotine was once thought to be the most highly addictive substance known to man, but recently lost first place to heroin. Either way, it is beyond bad). The vapor produced by e-cigarettes deliver very high levels of nicotine, raising fears about the impact on the sensitive, developing brains of young people, and hooking a new generation on the potent drug.

Since e-cigarettes arrived in the U.S. in 2007, they have been investigated by addiction researchers as possible cessation devices for adults trying to quit combustible, or regular, cigarettes. Sadly this has not been the case.

The FDA’s out-going director, recently announced a plan to crack-down on e-cigarette sales. Both the American Heart Association and the American Lung Association stated their concerns that the proposed new regulations did not go far enough. Meanwhile, children continue to be unknowingly exposed to a highly-addictive substance for the profit of manufacturers.

As nurses, we need to share our awareness of this problem with patients, families, and other staff. One thing our collective health does not need is a boom in nicotine addiction.

Mahalo for all you do!

Leslie

For more information, please visit

https://www.nejm.org/doi/full/10.1056/NEJMc1814130