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Kousha Navidar: It's The Brian Lehrer Show on WNYC. Welcome back, everybody. I'm Kousha Navidar. I'm filling in for Brian today. Now, let's revisit one of the most debated topics in public health at the moment. It's the safety of vaping. On one hand, trading in your pack of Newport’s for a swanky jewel could be a good idea. You're likely to avoid the major illnesses associated with regular extended cigarette use. Vaping could also help you quit cigarettes more effectively than other interventions. If you did quit smoking, you'd lessen your chances of severe disease and you wouldn't be alone. 1 in 20 people vape in this country, but the jury is still very much out on whether it's safe or even how dangerous e-cigarettes are in their own right.

It doesn't help that in the context of science and research, e-cigarettes are still new. We haven't had time to see how long-term vape usage affects the body. Then there’s the lack of regulation in the market. Local bodegas serve a seemingly endless variety of colorful vapes, most of which lack FDA authorization. These flavored vapes are illegal, and in recent months, we’ve seen the NYPD cracking down on smoke shops for carrying them, but if where to look, you can definitely get a Blue Razz Ice Elf Bar.

A few weeks ago, we on the show had a segment delving into the weeds of the vape market. A lot of you called in with questions about your health and seeking help with quitting. We thought it might be helpful to do a segment on that specifically. Joining me now to answer your medical questions about vaping and offer advice on how to break the habit is Dr. Bonnie Halpern-Felsher, professor of pediatrics and adolescent medicine at Stanford, also the founder and director of the Stanford REACH Lab. Dr. Halpern-Felcher, welcome to the show.

Dr. Bonnie Halpern-Felsher: Good morning. Thank you so much for having me.

Kousha Navidar: It's a pleasure to have you here. We want to open the phones for you listening right now right away. If you're listening, do you vape? What health questions do you have about your habit? Have you successfully quit vaping? What helped you quit? How long did it take? We're taking calls to help listeners who want to quit vaping. Get some advice. Ask some questions. Call or text us at 212-433-WNYC. That's 212-433-9692. Doctor, let's get into the dangers a little bit. How dangerous is vaping?

Dr. Bonnie Halpern-Felsher: Yes. You're right. As you said at the beginning, we don't have years and years and years of evidence like we do with combustible-cigarettes. E-cigarettes came on the market in the United States around 2007, so we just don't have as much data, but we still have lots of new evidence that electronic cigarettes or vaping devices are very harmful to your heart and lungs. We're seeing numerous studies, and we see this just looking at young people.

I particularly specialize in adolescents and young adults in terms of research and prevention and intervention with them. We know that we're seeing a number of young people and adults having lung issues. We know that whether you are vaping or smoking, it could be harmful to your lungs. There are aldehydes in there. There are just the flavors themselves. The cinnamon, aldehyde, vanillin, diacetyl, which is a buttery flavor, all of those can be very harmful to your lungs.

They clog your lungs. They make it more difficult to breathe. We've seen lung collapses. We've seen asthma and bronchitis associated with e-cigarettes. Lots of issues there. Again, no matter what you are using in your e-cigarettes, whether it's nicotine or cannabis or anything else, just the flavors and the propylene glycol and the glycerin, all the other ingredients are harmful.

We also know that there's an issue with your heart. More studies are coming out showing the very high nicotine levels, and happy to discuss nicotine more. Very high nicotine levels can be harmful to your heart. Racing hearts, issues with heart disease that we're starting to see. Then nicotine itself. These e-cigarettes have a tremendous amount of nicotine in them, starting with JUUL. Now, we're seeing any e-cigarette device can have anywhere from one to several packs of cigarettes worth of nicotine. You're looking at issues around heart racing, you're looking at issues around nicotine poisoning, and then for young people, you're looking at addiction, so lots of issues that we're concerned about with e-cigarettes.

Kousha Navidar: I want to make sure that I caught something that you just said. You're saying that compared to cigarettes, the amount, the concentration of nicotine can actually be quite a bit higher in e-cigarettes. Did I hear that right?

Dr. Bonnie Halpern-Felsher: Correct. The more recent e-cigarettes, such as Flum, or Vuse, or Elf Bar, which is very popular, I think it has a new name now-- Elf Bar, for example, has about 650 milligrams of nicotine. That's almost 600 cigarettes worth of nicotine. Now, we're not saying that anybody is using them in a day or in over a week, but a lot of nicotine that's in there. Actually, I've talked to some young people who say that they will inhale one of these devices within a day or two. You're looking at multiple packs of cigarettes with nicotine in these newer e-cigarette devices.

Kousha Navidar: Is nicotine itself the cause of majority smoking-related diseases like lung cancer or emphysema, that we typically associate with cigarettes?

Dr. Bonnie Halpern-Felsher: Not directly. There's some evidence that nicotine can, and we do know that nicotine is a carcinogen. There are concerns around cancer with just nicotine. More is the heart rate increase that we worry about. Then the brain changes around, particularly anybody under the age of 25. We know our brains continue to develop, and we know that most adults who are addicted to nicotine started as teenagers or young adults.

That's not by accident. The tobacco industry and e-cigarette industry target young people because they know if they can get them addicted, they've got them for life. We know as a young person's brains are developing that they're so much more likely to become addicted to nicotine during that time. That's one of the major reasons why we're worried about the nicotine in e-cigarettes, but there are some other health harms.

Kousha Navidar: As well that we worry about, that concentration, that 650 milligrams being equal to 600 cigarettes and hearing that-- At least anecdotally, you're saying that some folks that you've talked to go through that, and you said a day or two days, that that does put into stark contrast. Let's go to Stephen in Westchester. Hi, Stephen. Welcome to the show.

Stephen: Hi. Just wanted to tell you about my experience with it. I started vaping in high school. It was like other people did it, so why not do it? You once you do it, you're in this little underground community in a way, just people that you wouldn't necessarily talk to unless you started vaping.

Kousha Navidar: Steven, do you still vape?

Stephen: I know I've tried quitting a few times. It's on and off. When you go out drinking, you start craving a cigarette or you start craving to vape. I've quit for several months before. How I've done it is just either like I've started doing it just from running just because you noticed your lack of breath.

Kousha Navidar: Doctor, I want to bring it back to you. In that sense, I'm sure that you experience a lot of folks who try to quit and then they come back. Is this similar to cigarettes, quitting vaping, in which it is very difficult to stay with the habits of breaking it off once you start?

Dr. Bonnie Halpern-Felsher: Yes, absolutely. Thank you, Eric, for those comments. One of the comment that he mentioned is about athletics and running, and that is another area that we've seen with lungs that I've actually talked to some people, including adults, who say that e-cigarettes hurt their lungs and their ability to ride bikes or jog more than even cigarettes. As I mentioned earlier, a lot of concerns over lungs, but yes, we are definitely seeing that.

Nicotine is nicotine in any form, and especially when you're inhaling it, whether it's a combustible cigarette or an electronic cigarette, it gets to your brain very quickly. Within 7 to 10 seconds, you're going to feel that buzz, that high, that rush, that feeling. It is in any form, whether it's combustible cigarettes or cigarettes, incredibly difficult to quit.

We did a study. A couple years ago, we published a study where we were trying to compare whether people who were smoking cigarettes or using e-cigarettes had similar rates of nicotine addiction using a standard self-administered survey around whether or not you're addicted or dependent on nicotine. What we found is there were basically no differences. Those adolescents, young adults and adults who were using e-cigarettes were also showing signs of addiction pretty similarly to those who were using cigarettes. We're not seeing much difference in terms of addiction,

In terms of quitting, which your caller said is absolutely true. We're seeing in the research that we do and the people that we talk to in schools, in a lot of the work that we do, that people are having very, very hard time quitting e-cigarettes. Similar to cigarettes, again, the nicotine is not different. If anything, you're looking at more nicotine. It's very difficult to quit. We have said, and we see this with cigarettes.

With e-cigarettes, it could take anywhere from 7 to 11 tries, some people say harder than quitting heroin or cocaine. Something that we really need to be supportive of young people and adults realize that it may not happen the first time, they're not a failure. They didn't do anything wrong and encourage people to just keep trying. If you want, we could talk about different methods for trying to quit, but it is really difficult.

The cues, one of the things he said about going, I think he said to a party, one of the things that we've learned, and we have some quip resources on our REACH Lab website and some interventions that people can use, particularly for adolescents and young adults, but one of the things that we've learned is you're not just changing your physical milieu. You have to change your social milieu. Yes, you can throw away your e-cigarettes, which you should do. You should prepare your environment, have water, have snacks, let everybody around that you're going to quit, but your social piece is important too, particularly for young people. When you go to a party or you're out with friends on a Saturday night or you're in the environment where people are using e-cigarettes, it changes again. Your brain has changed from the nicotine.

When you're in those situations, you're cued in to use again. We often say to people who are trying to quit, it's important to change your milieu. Maybe don't go to that party where somebody might be vaping. Maybe don't go out with those friends who might be using cigarettes around you. That's hard. If you're a young person, changing your peers and your social environment is really difficult. We have to be super supportive and understanding as somebody is going through changing their environment, changing their habits, changing their nicotine use to help them get through this and help them stay quit.

Kousha Navidar: 7 to 11 tries sounds so difficult. We have a caller here, Joseph from Queens. Joseph, hi, you're on with Dr. Bonnie Halper and Felsher. It sounds like you have some experience trying to quit, is that right?

Joseph: Yes. I used to smoke regular cigarettes and then I switched over and then I actually quit regular cigarettes, but then a couple of years later, I picked up vaping and I thought that it would be like healthier, but then that ended up having issues as well. Then when I tried to quit the e-cigarettes, it was nearly impossible. It was like the hardest thing that I've ever had to try to get over, way, way more difficult than quitting cigarettes.

Like the doctor said, I had to take a couple of tries. Once I finally got off the e-cigarettes, the memory of just trying to quit these things over and over and over again just kept me from ever doing it again because like you said, it's so much more concentrated. The withdrawal symptoms, they're both physical and emotional. I really just had to force myself to just push through because it was just really difficult, but once I was off it and once I lost all the cravings for it, the memory of just trying to do that--

Kousha Navidar: Yes. I'm happy to hear that you found some success. It sounds like going through the process was the thing that made a big difference for you. Was there anything else that you did that you feel helped you along that journey to quitting?

Joseph: Honestly? I did pick up exercise. I did try to distract myself. I did allow myself-- I treated myself a little bit more. If I wanted to go buy e-cigarettes, I would buy candy instead. I gained a little bit of weight, but then once I quit, everything balanced out. For me, if I really wanted that particular nicotine hit, I would just try to find something else that I really liked. I would buy a book.

Another thing that they don't mention is that I think over time, e-cigarettes are more expensive than regular cigarettes, You're going through it in about two days, and it's about $20. That's about, what? $40 every four days or something [crosstalk]--

Kousha Navidar: Yes. You could use that money to borrow the parks and recline. Treat yourself. Joseph, we really appreciate you calling in. Wish you the best of luck with, with continuing it on. We have a text here that I want to get to that says, can you talk about the risk for secondhand vapor? we have a caller here who I think might have a follow-up question along those lines. Emily from Brooklyn. Hi. Hi, Emily. What's your question? Welcome to the show.

Emily: Hi. I have a dog and a cat and a roommate who vapes inside. I don't care about myself. I smoked for ten years, and that ship has sailed, but I am worried about the pets, particularly since they exist in the space a little differently. What do we know about secondhand vape smoke and what knowledge is, like, still being built or understanding of, like, being built?

Kousha Navidar: Really important question there, Emily. Thanks so much. Doctor, do you have any research or any insight in that?

Dr. Bonnie Halpern-Felsher: Yes. Those are fantastic questions around secondhand smoke, or we would say secondhand aerosol, because e-cigarettes are actually not vapes. They're actually aerosols. That's important to know. That big lume of smoke, which is really aerosol that comes out of the e-cigarette is harmful, and a lot of people don't realize that, but more research is showing that that big plume of aerosol does have nicotine in it.

The short answer is yes, just like with cigarettes, more and more research is showing secondhand aerosol or secondhand effects from e-cigarettes. That big plume has nicotine in it. It could also have heavy metals. It's important to realize that whether you're inhaling it yourself or somebody next to you, e-cigarettes have lots of little particles in them, ultra-fine particles, metal, plastic that's in there. We also know that that aerosol has, as I mentioned before, aldehydes, and propylene glycol, and other things, some of which are cancerous chemicals. They're volatile organic chemicals. There's a lot that is, and actually, some studies were even suggesting, or some people I've talked to, virologists and others, that there might also be even COVID droplets, coronavirus, in that aerosol that comes out. There's a lot of concern, absolutely, about that aerosol.

If you are standing next to somebody, now, it doesn't smell as bad as does a conventional combustible cigarette, especially if it is a flavored e-cigarettes, talk about flavors and regulation there, but it certainly doesn't smell as bad, but it doesn't matter. That is still an aerosol that is getting into your lungs. We are seeing the effects.

By the way, not just with nicotine. Again, if using cannabis or any other ingredient that's in these e-cigarettes, the other that not many people know about is something called third hand effects. That aerosol has to go somewhere.It goes in the air. What happens? It just doesn't dissipate or disappear. It then falls to the ground. When it falls to the ground, you really look and it changes with the chemicals in the air and really can become toxic. You're looking at effects. It could land on couches, on floors, on toys, on beds, on sweaters. There's a lot of concern.

One of your callers was asking about their pets. We don't have a lot of pet research, but my concern would be not only the air that they're breathing, but are they licking toys or licking the floor that could have the smoke from cigarettes or the aerosol from e-cigarettes? A lot of concerns there as well.

Kousha Navidar: Let's go to Marjorie in Socrates, New York. Marjorie, welcome to the show.

Marjorie: Thank you very much. I wanted to chime in because I am an old person who smoked cigarettes for 45 years. I stopped. I started to vape. Due to the fact that I had to have hip surgery, I was told I could not have any nicotine in any form for three months prior. Now I use JUUL if I could. I don't mean to give him a plug, but what I found is that much of my desire to vape was oral; had nothing to do what was in the cartridge. I carry an empty cartridge in my little JUUL device wherever I go, and I find it will definitely relieve the desire. You can smoke it like you smoked it before, and it doesn't--

Kousha Navidar: Just having it in your pocket, having it available, seems to have the psychological effect. Marjorie, thank you so much. Marjorie, your comment actually brings us to the question that I think would be helpful to leave listeners with here, doctor. Let's say that you have disabilities that you no longer want to vape. Maybe we call that step one in the process just deciding, what would you say should be step two. How would you recommend somebody come up with a plan?

Dr. Bonnie Halpern-Felsher: Absolutely. Marjorie, thank you for those comments. I think that those are fantastic to think about, and that's why we say prepare your environment with snacks as well, and some water and other things that might be there for you.

A few things for preparing. First of all, set your quit date. knowing that you want to quit, that's fantastic. When do you want to quit? Ideally, you start quitting immediately, but some people may need a few days to prepare their environment, so setting that quit date.

Then throw everything away that's related to nicotine. Your lighters, if you're smoking cigarettes, your e-cigarettes, your cartridges. I know Marjorie kept her empty JUUL, but a lot of people do need to get completely throw those away. Then keep yourself busy. I love, I think it was Joseph's idea of treating himself to a candy if he needs it, or figuring out other ways. That's really important.

Spending time in places where you cannot use nicotine. One of the nice things about our smoke-free air laws is you generally cannot smoke or vape inside buildings or in parks. Go to those places because you're going to be in milieus where e-cigarettes are not being used. Have your snacks around, as I mentioned before

Know that you're probably going to go through some withdrawal, both the physical and the social withdrawal. That's important. Now, we didn't talk about nicotine pouches. Excuse me, patches, not pouches, patches. There are some people who have such a nicotine addiction that just simply withdrawing or going cold turkey doesn't work. A few things there.

There are a lot of quitlines. There are a lot of cessation. There's Ny life My Quit for teens. Truth initiative has this this is quitting for teens. They have other programs. I think be an x, Become an X for adults. We have Our Healthy Futures on our REACH Lab website. There are different resources. There are a lot of 1-800 quitlines. Sometimes you may need some go to a therapist, you might need some interventions to help you. Some people need patches, that is, nicotine patches that help you slowly cut down on that nicotine itself.

Unfortunately, we don't have nicotine patches that are approved by the FDA right now for anybody under 18, but often physicians or healthcare providers will prescribe for anybody under 18. They are very effective to be able to help young people and adults quit. You're not going to have one method fits all. Why do we have 7 to 11, or whatever the numbers may be for individual people to be able to quit? There are different methods, but we know that you need to reach out and get the help.

We recently published a study showing that many people are just going cold turkey. We would recommend that that is not what you do. At least set up your milieu. At least be able to get some help, whether it's advice from a parent or a counselor, whether it's breathing exercises. Again, the patches.

Kousha Navidar: Equip yourself. Yes, equipping yourself for the journey that you're saying.

Dr. Bonnie Halpern-Felsher: Yes, really equip yourself.

Kousha Navidar: You mentioned the 1-800 quit lines. You can also visit the New York State Smokers quit line. You can call 866-NEW-YORK-QUITS. That's 866-697-8487. You can apply for a free starter kit of nicotine medications and to talk to a quick coach. For listeners in the area that might be looking for a specific line, that's helpful. We'll have to leave it there. My guest has been Dr. Bonnie Halpern-Felsher, professor of pediatrics and adolescent medicine at Stanford and founder and director of the Stanford REACH Lab. Doctor, thank you so much for coming on.

Dr. Bonnie Halpern-Felsher: Thank you so much for having me. Good luck to everybody who's trying to quit.

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