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Matt Katz: It's the Brian Lehrer Show on WNYC. I'm Matt Katz. I used to be a reporter here at WNYC and today I'm sitting in for Brian. Smoking cigarettes will eventually kill you. We've known this for years. It's settled. These days, cigarette use, because of that is at an 80 year low, but for vapes e cigarettes and nicotine pouches, health risks are a lot muddier.

Boosters of these products tout all kinds of potential benefits and say they're a lot better for you than cigarettes. At the heart of all of this is nicotine, the famously addictive chemical, but just how harmful is it? Answering that question is difficult. Joining us to explain why is Nicholas Florko, a staff writer at the Atlantic who covers how and policy affect our well being. His new article in the Atlantic is headlined What's So Bad about Nicotine? Hi, Nicholas. Welcome to WNYC

Nicholas Florko: Hi, thanks for having me.

Matt Katz: Let's start by saying what I mentioned at the top, that the science is very settled on cigarettes. Eventually they'll kill you, but you write smoking is so deadly not because of nicotine per se, but because of tobacco. Can you just walk us through the distinction there in the science?

Nicholas Florko: Absolutely. Nicotine is really what people are seeking when they smoke a cigarette or they hit a vape. It's the chemical that gives you that buzz from the product, but there's a lot of misconceptions about the risks in and of itself. Even among doctors, we see surveys showing that they believe nicotine causes the most troubling harms of smoking. Things like cancer, but that's actually not true.

It's really inhaling the tobacco smoke that causes those issues, not the nicotine. Now, again, nicotine is very highly addictive and not really benign, and we'll get into that, but it is certainly not the chemical, it's cigarettes that is causing all of these issues.

Matt Katz: Why is that important when it comes to these new products that are out there?

Nicholas Florko: It's important because those products don't burn tobacco. You can consume nicotine in a pouch by putting it up in your upper lip, and the nicotine will go to your bloodstream or you can inhale these e-liquids, which are essentially water vapor with nicotine within it. You are able to avoid most of those chemicals that you'd be getting from actually smoking a cigarette or chewing on a tobacco leaf for traditional chewing tobacco.

Matt Katz: The FDA concluded recently that cigarette alternatives like these, "Generally have lower health risks than cigarettes, but cigarettes are so bad for you." Do these alternatives really carry a low risk on their own or is it just relative to cigs?

Nicholas Florko: It's definitely relative to cigarettes. Cigarettes are one of the deadliest consumer products in our history. It's a very low bar to be safer than those. No one I spoke to for this story said that nicotine was entirely benign. I think most people would advise you, if you aren't using nicotine already, if you're not smoking cigarettes, don't create a nicotine habit for yourself. We do see that nicotine really the biggest risk here is addiction. We're not seeing the sorts of cancer and cardiovascular impacts that we would typically see from a cigarette.

Matt Katz: Listeners, we can take your calls on this. Do you smoke cigarettes? Do you vape? Do you use these nicotine pouches? If you smoke one but not the other, what's the difference to you? How does it make you feel differently? How does it make you feel when it comes to your health? Did you pick up vaping to quit smoking cigarettes? Did that work? Did you start smoking cigarettes after you started vaping?

Anyone who's quit smoking by vaping, if you then quit vaping, which was harder to quit cigarettes or vapes? Give us a call. You can send us a text, 212-433-WNYC, 212-433-9692. So much of your article centers around how much we don't know about the health effects of nicotine. You walk through a few claims about it and then caveat them pretty heavily. There's a lot of sums and goods and might be in there. Can you tell us about some of these claims? Maybe start with what Joe Rogan and Tucker Carlson said about cigarette pouches.

Nicholas Florko: Absolutely. There has been this increasing push among folks like Joe Rogan to push the performance enhancing aspects of nicotine. Nicotine is a stimulant. It makes sense that you would feel maybe more energized. You'd be able to focus a bit better with a product like this coursing through your, your veins. That being said, I mean, the data here are really mixed.

We see some impacts on certain cognitive tests, but we aren't seeing this shocking, very clear improvement in cognition and performance that would then justify, say, taking up this product as a new habit, because maybe you need a little boost at work. The impacts there just aren't big enough to justify that action.

Matt Katz: Tucker Carson has his own pouches. He promotes his own product.

Nicholas Florko: Yes. He makes a nicotine product himself. He used to be a very prolific Zyn user and created his own product. He's made a number of claims regarding his nicotine use. It's honestly sometimes hard to know which are being made in jest and which aren't. His most recent comment was essentially that nicotine helped him from staying healthy and keep him from getting sick during his show.

Matt Katz: Wow. Lori in the West Village is on the line. I think she had a comment. Hi, Lori, thanks for calling in.

Lori: Hi there. I'm enjoying this. I'm a nicotine addict myself, and I chew the gum. I feel that you're missing a very important part of this discussion in that the additives, which in cigarettes are like 200 different additives, including formaldehyde. I feel like I have no idea what the additives are in the vaping products, but I have a feeling they might be even worse.

I just wish there was more real current muck raking going on. I think it's too simplistic not to be talking about the additives. I know there's an additive that's probably dangerous in the gum. Let's talk about the reality of it. Some people are saying nicotine in itself could be a good ADHD medication or use medicinally for that. If so, maybe that's a worthwhile road to explore and to make it safe. That's one thing I'm just not hearing. There's just not enough of this analysis and funding for these things. Thank you.

Matt Katz: Thanks, Larry. Thanks for calling in. Nicholas, any information that you might have on these additives that she mentioned and then also on any dangers in the gum.

Nicholas Florko: Sure. I think it's important to emphasize that not all vapes are created equal. There are certain vapes on the market, brands like Juul, brands like NJOY that have really been tested and cleared by the FDA to be sold. There's been a lot of work and attention that has gone into vetting the health risks of those products, and the FDA has decided that they are okay to authorize for use, especially for smokers that are trying to get off of cigarettes.

That being said, a huge portion of the products that are on the market right now are being sold illegally, and there is very little oversight into what is in those products. There was recently research that came out, the caller talked about muckraking. I would consider this muck breaking. Researchers at UC Davis actually tested some of these very popular disposable vapes that are being imported from China, and they actually found that they were releasing higher amounts of heavy metals than even cigarettes.

There's definitely a risk there, but it really depends on what product you're using. Usually my advice to a smoker who is thinking, should I try one of these products? It's don't just pick up whatever product looks good to you on the shelf. Find one that at least has been FDA cleared, because then you know that it will have a lower relative risk.

In terms of the nicotine gum and the pouches, I think this is actually just really interesting because we, as a society, we don't stigmatize use of nicotine gum or nicotine lozenges. We accept that those products are safer for cigarette smokers, and we encourage people to actually use them. The pouches, like Zyn, are quite similar in how they deliver nicotine. I think we need to be considering those closer in risk to the nicotine pouches and the gums than we are comparing it to cigarettes for example.

Matt Katz: We have a couple of interesting texts on the vaping. Somebody texted and said that they used vapes to quit smoking. It worked because I could just take a hit or two off a vape rather than smoke the whole cigarette. Allowed me to also smell how gross cigarettes were again and managed to wean myself off the vape, nine years nicotine free. Congratulations to the quitting vapor who texted in.

We have another text on the flip side of that. Vapes are so hard to quit, you can hit it practically anywhere. At least with cigarettes you usually have to go outside. That's true. I've seen people vape in a restaurant just subtly, because the smell doesn't linger. Maybe that makes it harder for people to quit because there's not a socialization element where you have to go outside or you can't do it in certain places. What does the research say about quitting vapes versus quitting cigarettes? Do we know, Nicholas, if one is easier than the other?

Nicholas Florko: I don't think researchers have conclusively said whether one is easier than the other. You just laid out the two facts here that, I'm always weighing when I'm thinking about this. I would just add that nicotine pouches, I think, are even more interesting because these are products when somebody is vaping in a restaurant, for example, usually there's a rule that vaping is not allowed there and if they get caught, they're going to get reprimanded.

The same thing, I was on a plane recently, and they made a very big point to say, if you vape in the bathroom, we will catch you. Our alarm will go off. Pouches, that is not a risk at all. You can pop a pouch every second of the day if you want to, and no one is going to know you have it. It's hidden behind your upper lip. There's no smell. There's no visible vapor. I just think that's another thing we have to keep in mind here.

To the first caller's point, I have talked to a lot of folks who have quit smoking with vaping, and they report that. They report that if they are conscious about lowering their nicotine use over time, that it can help them wean themselves off of it. You could take a hit or two as opposed to smoking a whole cigarette. I definitely have heard people say that that is something that has helped them. Again, it really depends on how you're using these products. If you're deep in a nicotine addiction, there's a big chance that it could get worse if you start vaping or using pouches and you're not careful.

Matt Katz: We have a caller on this. Dino in Brooklyn. Hey, Dino.

Dino: Hi. Can you hear me?

Matt Katz: We can hear you. You were a cigarette smoker, is that right?

Dino: Yes. I started smoking in high school when I was about 14, quit when I was about 24. I picked up vaping when I was in my early 20s. I can't say that the nicotine addiction did get worse with vaping, especially with nicotine salts, which are more addictive. That's what you see, like in the Juuls. It isn't just water vapor. It's probably glycol, vegetable glycerins, all these flavoring additives. You don't really know what you're putting in your body. I regret vaping, but it did help me quit at the end because I was able to lower my nicotine level to zero. I did that for a while.

Matt Katz: How did you lower it to zero? Were you vaping just a Low nicotine vape?

Dino: I was just buying liquids with lower nicotine levels. I did like 6 for a while and I lowered the 3. I would buy like a 0 and mix it with a 3 until eventually I was just vaping 0 for a long time. Then it was just the physical addiction, the hand to mouth that I had to kick. It eventually helped me. I did vape for a lot longer than I ever intended.

It's really easy to underestimate or understate how addictive nicotine really is, because to the addict, all they're really hearing right now is that vaping is safer than cigarettes. They're just hearing that word, safer, and that's all that really matters.

Matt Katz: Thanks, Dino. Thanks for calling in and congrats on finally kicking the habit or the habits. Jake in the Hudson Valley. Hey, Jake, you're on the air with Nicholas from the Atlantic talking about cigarettes and vaping.

Jake: Hey, how's it going? I'm actually like the last caller. I had managed to quit smoking successfully by lowering my nicotine levels down to zero while vaping. I managed to do this within the span of just a year and got to zero nicotine vape.

It was a matter of weeks before I just gave it up and never vaped or never smoked again. It was always a cigarette smoker. The vape was never satisfying. It never gave me any positive feeling. As soon as the chemical addiction was broken, it just left my hand. At the same time as I was going through all this, though, I was actually working in the corporate offices of a smoke shop chain.

I was getting access to a lot of samples, a lot of information, I was talking to salespeople. I remember I tried a Juul with salt nicotine before it was on the market. Just anecdotally, it seemed very wild west like, to me at that time. There was very little concern about safety, about what people were ingesting or taking into their lungs. It's just being on the inside and seeing the people that profit from this industry. It certainly raised concerns for me and I was very happy to quit the cigarettes and then subsequently quit the vape.

Matt Katz: Oh, and then quit the job, too [crosstalk]

Jake: Yes, and moved on to better employment. Of course, at this point, I am no longer with them and much happier.

Matt Katz: Thank you for calling in, Jake. Appreciate it. Nicholas, tell us about the regulations. Where are we at from a regulatory standpoint, because the caller touched on that, and describing it as the wild west.

Nicholas Florko: It is the wild west in a lot of ways. The FDA, like I said earlier, has authorized some vapes for use. We're thinking about brands like Juul, brands like NJOY. These are the sorts of products that you would see at a 711 and are usually next to the cigarettes.

Those products, I feel pretty confident saying they're closely regulated. The industry for years has been crowing about how the regulatory requirements were so onerous and there were so many different studies they had to do to get these products approved. What that says to me is the FDA is doing its due diligence and saying we really need to look at these products before we give anything our stamp of approval. On the flip side, though, the FDA has absolutely struggled for years now with policing this market.

We are seeing vapes just shipped in under the FDA's nose, and these products end up on store shelves. Even the brand right now that is most popular with kids, Elf Bar, it's not FDA authorized. It hasn't been vetted in that same way. Again, it can be the wild west, depending on where you're looking, but there are at this point, at least some alternatives that do seem to be a bit more regulated.

Matt Katz: What is that called? Elf Bar. Is that a vape?

Nicholas Florko: Yes, that is a vape. That is the brand that is most popular with kids right now. I think there's this common misconception that we are still having the epidemic of youth vaping fueled primarily by Juul, but Juul at this point is actually, I believe, it's fifth the most popular product, and we haven't gotten into it yet. I think it's very interesting to just see how the youth vaping epidemic has changed over time.

Matt Katz: And youth vaping more popular than youth smoking cigarettes.

Nicholas Florko: Yes, more popular, but significantly less popular than it was in, say, 2009. I think that that is a big benefit. In 2024, it was less than 8% of high school students regularly vape. That's down from 27% 2019. We are seeing a lot of progress. Credit to all the public health groups that have really tried to communicate the dangers of these products, because, again, we're having this conversation about nicotine and how it might be safer than cigarettes, but does not mean that you should just pick up a nicotine addiction for the sake of it. As we heard from all these callers, it's really addictive. It's really hard to quit.

Matt Katz: Let's take Pat in New Rochelle who has a question. Hi, Pat, thanks for calling in here.

Pat: Hi. I'm currently trying to give up smoking. I'm 77, so I'm probably smoking for 60 years. One morning I woke up and thought, "Let me try." I'm using the nicotine patch. Now the directions on the boxes say use the high one 21 milligrams for two weeks or whatever, however. I've been using the patches now for almost six months and my doctor recommends that I keep using the patch.

It's not covered by insurance. They're not inexpensive. Any information on that? When you're talking about nicotine addiction, it's that nicotine patch that I've been wearing? One of the warnings is if you're getting vivid dreams or whatnot, not to wear it at night. I did. I was astounded. Very vivid dreams. I don't wear it at night.

Matt Katz: Got it. Interesting. Nicholas, you have any information on those patches?

Nicholas Florko: There's good and bad to all these different products. Patches in particular are, I think most people would agree, they're a very low risk option for somebody trying to quit smoking. The problem with a patch, it's a problem, but it's also a benefit. The patch doesn't give a hit of nicotine in the way that a vape or a cigarette would. You're not going to put on a patch and feel that calming buzz of nicotine going through your body. It's releasing at a much, much slower rate.

What that means is that it can keep folks from these troughs of addiction of really needing a product over time, but they're not going to get that same pleasure. There's a very hearty debate right now over whether you need something that matches closer to a cigarette, like a vape, to help people deal with their cravings as opposed to, or in addition to that slow acting patch to try to keep people at a steady level of nicotine so that they're not going through withdrawal.

Matt Katz: Raya in Harlem is calling in. Hi Raya, you're on with Nicolas Florko from The Atlantic.

Raya: Hi. Thanks for letting me call in.

Matt Katz: What's your question [crosstalk]

Raya: Basically, I've been vaping since I was 15 or 16, right when it started. It's been a very interesting phenomenon of my peers being dumb and trying to smoke cigarettes. I've never smoked cigarettes to stop vaping. I find that a very silly threshold of idiot like millennial kids, or even millennials. I'm like, "Wow, that's very ironic." I tried that for a week. I was like, "No, this is so stupid." Then obviously stop vaping. Vaping is very hard to stop. I stop off and on. I'll get six months, and then I'll go on a vacation. Then I'll start vaping. I'll take three months to stop again. It's a very slippery slope.

Matt Katz: Wow. You said you tried to smoke cigarettes for a week, thinking it would be just a way to wean yourself off the vapes.

Raya: I definitely did. I definitely don't think it works, but obviously I've had peers that talked about that. It's very moronic, but it's so silly that that happens. It's very clicky fashion people in New York City, but it's so silly.

Matt Katz: Thank you for calling in, Raya. I wish you the best with that addiction. Nicholas, you wrote at one point that nicotine is just as difficult to quit as heroin, which I guess is what Raya was experiencing, and that addiction to nicotine itself might have downsides even if it's not smoked in a cigarette. What is happening with this addiction to nicotine psychologically?

Nicholas Florko: Basically, you're changing your brain in ways when you're subjecting it to nicotine over and over again. Eventually these receptors in your brain are going to basically start screaming for nicotine more and more, and often you build up a tolerance, and you need more and more nicotine to subdue those urges. I think that's the piece of this.

Like I write in the story that I think is underappreciated is you don't realize how addictive and how disruptive an addiction can be until either you go through it or you know somebody who's gone through it themselves. It might not seem like the worst thing in the world that somebody needs to use their vape every once in a while. If you've ever been in a situation where you desperately need to use your vape and you can't use it, you understand what psychosocial impact that can have on you.

From a long term well being perspective, I think there's a lot of folks that will say it's disheartening to be addicted to something, to feel like you can't control your own urges, you can't make this decision that your doctor, your family, your friends, maybe your significant other all want you to make. I think that's really underappreciated here.

Matt Katz: You mentioned one vape product earlier, but I am curious, what's next with young people? I speak as a father of a 13 year old. In a couple of years, when am I going to catch her smoking, is it a cigarette? Is it a vape? Is it a pouch? What is the hottest trend among kids in high school at the moment?

Nicholas Florko: I think the biggest worry is that it will become nicotine pouches. Now the data thus far hasn't really shown a spike at all in vape pouch use, but we see it everywhere. These companies are aggressively advertising to either the demographic above those kids, like the 20s and 30 year olds. I personally know from experience people that have picked up these pouches who I never thought would smoke a cigarette.

There's a worry that this will then trickle down to the kids because again, these products really, really easy to conceal. A kid can pop a pouch in his mouth without having to go to the bathroom to hide their vaping. That is definitely a concern. The data so far haven't shown a spike, but it's something certainly to keep an eye on.

Luckily, we are not seeing a ramp up in cigarette smoking. I think that is the best news that we can have. There's a national annual survey of youth smoking rates. That survey found in 2024 that just 1.4% of students were reported currently smoking cigarettes, which is actually the lowest it has been since that survey was created nearly 30 years ago. That is good news. At least what we're seeing from the data thus far, don't expect kids to jump back into cigarettes.

These products change all the time. The vapes that we have now are significantly different than the vapes we had five or 10 years ago. I don't think we would have even been talking about pouches back then. This can always change, but that's where the data show us we are right now with kids.

Matt Katz: Is there any data related to the proliferation of the availability of cannabis and the fact that instead of vaping a nicotine product, you might be vaping cannabis and maybe that becomes your smoking habit?

Nicholas Florko: Certainly there's troubling data on cannabis use among teens. The last data I saw, I think was from 2022, said that about 30% of high school seniors were reporting using cannabis in the last year, and about 6% were reporting using cannabis daily. I don't think we have data that can prove that kids aren't picking up a cigarette or aren't picking up a vape because they are using cannabis instead. That doesn't mean that we shouldn't be paying attention to both issues and trying to deal with both.

Matt Katz: You wrote that back in February, the FDA allowed Zyn to be sold, but that same month, the FDA proposed a rule that would reduce the level of nicotine in cigarettes. Those are two different tracks. Yes?

Nicholas Florko: You can see it that way, but they also can be related. We have to think about these products again in a continuum of risk, with cigarettes being the most risky, pouches being significantly below that. When the FDA authorizes something like a pouch to be sold, they are doing so because they believe that that will benefit public health, in that folks that are using cigarettes will likely switch to these products.

You can imagine a scenario, and I think this is where folks want to go, where cigarettes are basically extinct. For the folks that still have a nicotine addiction or trying to quit it, there are these products that are still available. Now, of course, the risk of that is that these products will then just proliferate nicotine addiction. There's this careful balancing act that needs to be done.

I think this is why it's always very controversial when FDA decides to authorize or not authorize one of these products, because there's one side screaming, this is a risk for youth, for people that never use these products, we shouldn't allow nicotine addiction, and there's folks on the other side that are screaming, we need alternatives for cigarettes so that the people that are smoking cigarettes and dying have something to go to, to get them off of this addiction.

Matt Katz: On that note, I'm going to leave you with a text we got from a listener. "Over the course of my life, I've quit meth, nicotine and alcohol, and nicotine was without question the toughest to quit." Nicholas, I think that gets to a lot of what we've been discussing, that it really all does come down to nicotine. Thank you for being here, Nicholas. My guest has been Nicholas Florko, staff writer at the Atlantic, who covers how business and policy affect our well being. His new article in the Atlantic is headlined, What's so Bad About Nicotine? Thanks so much, Nicholas. Appreciate it.

Nicholas Florko: Of course. Thanks for having me.

 

 

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