Blue Promise: Blowing Smoke: How Society Underestimated the Impact of Vaping

Do you know someone who uses e-cigs? Recent deaths associated with vaping have made it a public health concern. Learn more about the dangers in this Blue Promise with Dr. Philip Huang, Director of Dallas County Health and Human Services.  

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Blue Promise is a podcast and online video blog that aims to address complicated health issues with candid conversations from subject matter experts. New editions are published regularly and are hosted by Dr. Dan McCoy, President of Blue Cross and Blue Shield of Texas. 

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SHARA: Is your teenager vaping? Or maybe your spouse has picked it up because they finally kicked the habit of smoking. If you're like other Americans, you probably thought vaping was relatively safe. But recent reports are revealing the dangers behind e-cigarettes. Find out more in this episode of Blue Promise.
SHARA: Thanks for tuning into Blue Promise. Where we're committed to addressing complicated health care issues with candid conversations from subject matter experts. I'm Shara McClure, Divisional Senior Vice President of Blue Cross and Blue Shield of Texas. I'm sitting in for our host and President Dr. Dan McCoy. Today I'm here in the studio with Dr. Phillip Huang, Director of Dallas County Health and Human Services. Thank you so much for being here Dr. Huang.
PHILIP: Thanks for having me.
SHARA: So, vaping is becoming more of a public health issue. There are many stories that are actually kind of frightening that have come out recently. I think we just lost our third Texan to vaping. Is there anything that really strikes you about some of these stories that are coming out?
PHILIP: Yeah. Well, you know what's so tragic. I mean it is primarily in youth that we're seeing this. In our case, it was a 15-year-old who died from this. And again, you know we have these, in many cases, previously healthy teenagers who then are winding up intubated and on mechanical ventilation as a result of vaping. I know that our particular individual had some other underlying conditions but still these are just tragic.
SHARA: They are tragic, and we hear of isolated incidences. But can you tell me, how many people are really affected by this vaping disease?
PHILIP: Ok. Well, you know just nationally in terms of use of the e-cigarettes, it's I think in 2018 it was estimated over three point six million youth were using e-cigarettes and vaping. But with this latest severe respiratory illness, it's been over twenty-five hundred nationally that have been hospitalized. And in Dallas County, I think we're up to 53 now in terms of hospitalized, confirmed, and probable cases.
SHARA: That that's pretty severe and wide spread. And you mentioned how youth are affected. Is it only youth or are others affected by this disease?
PHILIP: The predominance, in terms of the number of cases, is almost half of the cases we've seen in Dallas County that have been under age 21. But still, we have a range of ages also, but I think that reflects that the usage and the pickup of e-cigarettes has been primarily among youth. I think between 2017-2018 in the United States, there was a 78 percent increase in youth rates of use of e-cigarettes.
SHARA: That's interesting because it seems to me like vaping was designed as an alternative to smoking. And so, you wouldn't necessarily think that people would pick it up initially.
PHILIP: And that's what's been very concerning. The marketing of the products. I mean the flavorings that have been out there. There's bubble gum. There's gummy bear. You know it's not like 50-year-olds wake up one morning and say, hey, I want to use gummy bear e-cigarettes. But that's what's been concerning. And from a public health perspective a lot of the concerns that we've had. Because if it were only the case where it were adult people who are using combustible tobacco products, that then switch to that instead of using that, then that might be ok. I mean that might be better. But then again, we've got these three point six million new youth that are starting the products, that haven't used any other products. And now we're getting this generation of kids who are addicted to nicotine.
SHARA: And that's the concern and it could also have some long-term concerns. There was a headline today that came from the American Cancer Society that actually showed that we had another leap in fatalities from cancer. Much of that was because lung cancer deaths are down. And I know that these diseases are more immediate than something like cancer, but could we see a reversal long term because of the uptake of youth vaping?
PHILIP: That is, you know definitely one of the concerns. Again, you're getting these kids addicted to nicotine and then many of them then moving on also to combustible cigarettes. And the impact also for you know, people think these e-cigarettes are good for cessation. Well they are not approved for cessation. That's, you know, that's not clear that they help with cessation. And in fact, what's concerning is that many people who use combustible products, if they try to use the e-cigarettes, are using them in times when they can't use the combustibles. But then they're using both of them at the same time, dual use. And so, you might have many people who would have otherwise quit using combustibles now, that are using the e-cigarettes as a bridge and keeping and continuing to use both.
SHARA: I'm sure that's very concerning for the medical community. Do you think the medical community really has an understanding of what makes vaping so dangerous?
PHILIP: You know I think there's certainly more information to be learned by the medical community and we're all sort of looking and learning from this. I think again we've had the concern from the start that we really need to look at the population effects of this. And how does this, because you know our experience even previously with combustible cigarettes. It took, you know, several years for people to understand what the long-term health effects and the problems with that were.
SHARA: So, as a practitioner, if someone comes to a physician's office that might have this disease, what kind of symptoms might they be experiencing?
PHILIP: So, the symptoms is you know people who have the history of using the e-cigarettes, and then there's respiratory symptoms: cough, shortness of breath, even chest pain, and then there's also been G.I. symptoms associated with this. So, nausea, vomiting, diarrhea.
SHARA: So, to the public. I mean I think that the first Texas case was back in October here in Dallas. This has escalated rapidly but I can imagine that the conversation has been going on among public health professionals like yourself for a while. What kind of conversations are going on in the state of Texas to try to prevent or lessen the impact of e-cigarettes?
PHILIP: Sure. As you said, I mean you know there's been sort of ongoing concern about the long-term effects. That we didn't know what long term effects of vaping might be. But then now with the short-term effects that are being seen. And we just had one of our latest cases was in a teenager, I think who had just picked up e-cigarettes in the last month. So, this is continuing. You know, we're still seeing, continuing to see new problems. And so, you know a lot of the discussions I think the deaths, this short term severe respiratory illness that's being seen is it's not just you know, 20 years down the road some of these problems and cancers and things. But even short-term having very severe problems. So, there's actually been a lot of policy interest. I was actually testifying a couple of weeks ago down at the Senate Health and Human Services Interim Committee in Austin. So, the state legislature you know local policymakers are looking at what needs to be done.
SHARA: So, what kind of ideas are local policymakers considering?
PHILIP: Well, you know one of the things that just happened last week, the announcement at the federal level that there would be restrictions on the flavorings. And so, some of those policies have been discussed at local levels also and some have been implemented in some other states. It's also you know the whole marijuana aspect and THC, some of the states now that have that legalized. So, there's different you know sort of policy considerations that are being made.
SHARA: Is it too early to determine what's worked yet for certain states?
PHILIP: From the restriction standpoint and policy, yeah. Yes, you know I mean I think the way I've felt about like the FDA announcement. Anything that we can do to try to reduce the youth usage of e-cigarettes is a good thing. So, you know again if you restrict, you're not going to be able to do gummy bears and bubbly bubblegum flavorings. I think that there is some concern that they're still allowing the menthol flavorings and still you know. So, there's more to be done certainly and more to learn about what policies are effective. But again, I welcome anything that can be done to try to impact this.
SHARA: And so, like you mentioned, we don't quite know what the long-term impacts are but in your opinion as a public health official, what's worse, smoking or vaping?
PHILIP: Well, again you know if it were just someone who used combustible cigarettes and they just switched entirely to e-cigarettes and didn't do combustibles. For that individual, that might be a good thing. That might be preferable, but that's not what we're seeing how things actually play out.
SHARA: Dr. Huang, and speaking of public policy, we've come a long way in banning smoking in public places like restaurants and places of business. I've been around long enough to where I remember when people used to actually smoke in their offices. And I actually, not here at Blue Cross Blue Shield, but in another office just in the past five years. I've been around someone who was actually smoking and or using an e-cigarette in their office. Can you comment a little bit about public policy in public places?
PHILIP: Sure. That's definitely a policy change that has is being implemented around the country. I know where I was in Austin, they passed that just adding e-cigarettes to the restrictions of anywhere that regular smoking is restricted, or tobacco use is restricted to make sure that e-cigarettes are included in that policy. So, that's definitely a very viable and policy that's out there.
SHARA: So just not necessarily non-smoking but also non-tobacco products, which would include that. That would be a good policy.
PHILIP: Exactly.
SHARA: And I think we know now that even if we are not smokers. If I'm individually not a smoker, I could still be affected by being around someone who is a smoker because of secondhand smoke. Could you potentially see any dangers of being around people who are vaping from a secondhand perspective?
PHILIP: You know, I mean again, we really don't know. It's still early. I haven't seen studies looking at that specifically, but we know that the you know the aerosol that comes out of that, it's not harmless water vapor. I mean this is not like when you're in the shower and there's steam coming out. So, we know that there are a lot of different constituents in that aerosol but again I don't think there's research at this point showing that effect.
SHARA: Ok so maybe if I'm around someone who's vaping, I'll just hold my breath for a minute.
PHILIP: Yeah.
SHARA: So, Dr. Huang, this is probably not the last time a new product is introduced to the public where the public really doesn't know what the hidden dangers are. What's your advice to your average American as they look at a product that could potentially be harmful to their health so that history doesn't repeat itself?
PHILIP: Right. We really need to be cautious and you know not jump into these things and not embrace these things quickly and understand it's going to take a lot of time. We won't know the long-term health effects of these but really go in very cautiously.
SHARA: Well Dr. Huang, thank you for everything you're doing for Dallas County as a leader in public health. And thank you for being our guest today.
PHILIP: Thank you for having me.
SHARA: Thank you, also to our listeners, for joining us for this episode. Don't forget to subscribe to the podcast or videos from wherever you listen or watch. You can also leave a review, which will help people like yourself find this content. Thanks for tuning into Blue Promise.

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