MarylandQuitter

Mark L. Rubinstein, Kevin Delucchi, Neal L. Benowitz, Danielle E. Ramo http://pediatrics.aappublications.org/content/141/4/e20173557 Download the or view the PDF: e20173557.full.pdf Article Information Published online April 02, 2018 Pediatrics Vol. 141 No. 4 April 01, 2018 e20173557 doi: 10.1542/peds.2017-3557 PubMed 29507165 Published By American Academy of Pediatrics Print ISSN 0031-4005 Online ISSN 1098-4275

E-cigarettes are becoming popular among junior high students, so schools are educating them on health risks. By Brynn Twait http://www.newstrib.com/news/surprised-at-how-young-they-are-starting-to-vape/article_7fc2e768-1a68-11e9-9461-27b0307dd6a3.html At what age are kids starting to use e-cigarettes? Some users may be as young as 11. “We’re surprised at how young they are starting to vape,” said Jennifer Kelsey, a pediatrics nurse. “As early as fifth and sixth graders have tried it.” Kelsey works at OSF Medical Group in Ottawa and has been giving presentations at local junior high schools on the harmful health effects of e-cigarettes. She has noticed an increased use of e-cigarettes by her pediatric patients. “The word spread fast that vaping seems to be a problem in local schools,” Kelsey said. “I just wanted to take my message and spread it to the kids as well as my patients.” An e-cigarette is an electronic nicotine device that can look like a pen, computer memory stick, car key fob, or an inhaler. “E-cigarettes use inhaled vapor from the e-juice, which has been heated by a battery powered coil, and that’s where they get that term vaping,” Kelsey said. “The e-juice is flavored, which usually contains nicotine and other harmful chemicals. The juice comes in very tempting flavors like bubblegum and mango that are just more appealing to our youth.” Kelsey spoke last week to sixth and seventh graders at Washington Junior High in Oglesby. Principal Merritt Burns said there were several incidents involving e-cigarettes at the beginning of the school year, so the district has been teaching students about the devices. “E-cigarettes are designed to deliver nicotine into the blood, just like regular cigarettes, by smokers inhaling it into the lungs,” Kelsey said. “With e-cigarettes, the nicotine goes into your mouth, to your lungs, to your bloodstream and then it goes directly to your brain. It affects your whole body.” She said one e-cigarette refill pod has the same amount of nicotine as one pack of cigarettes. “With vaping, you’re not sure how much nicotine you’re actually getting, so you could actually be taking in more nicotine by vaping than you could by cigarettes,” Kelsey said. Kelsey also will give presentations at Trinity Catholic Academy in La Salle. Principal Deb Myers said she has not caught any students with e-cigarettes at school, but she wants to be proactive. “One of my main reasons for bringing in a program is to be able to give students as much information as possible to hopefully prevent students from using the products,” Myers said. “It does seem like it’s an increasing trend with junior high students, pre-teens and teenagers.” “We didn’t think that it would filter down to the junior high level as quickly as it has,” Burns said. “It’s the number one banned product right now that kids are exposed to, more so than alcohol or drugs, even regular tobacco,” Burns said. Kelsey said young people think e-cigarettes are safer than regular cigarettes because they taste good and don’t have a bad smell. However, both contain nicotine, a highly addictive drug. Michael Olson, Putnam County Junior High principal, said the school has been educating students about e-cigarettes in health class as a preventative measure. The school also signed up for the OSF presentation to reinforce students’ knowledge about the dangers of vaping. “We just want them to be fully aware that this isn’t just a cool fad,” Olson said. “There are some very harmful side effects, short term and long-term, with using these.” Burns said a lot of students he talked to at the beginning of the school year did not even realize that e-cigarettes contained banned substances. “Early on, kids were just not educated enough that they were doing it in a public manner,” Burns said. “Some of them were doing it on their walks to school.” Burns said there has been a lot of education over the years to inform people cigarettes are bad for our health, but not as much information has been relayed to the public about the negative health effects of e-cigarettes. “There are no extensive studies that have happened to really showcase the dangers of vaping,” Burns said. “When that knowledge isn’t there for students or adults, that’s where we kind of have to step in and begin that education process.” Toxic traces E-cigarettes contain a lot of toxic chemicals, including the ones listed below. Benzene — It is found in pesticides and gasoline. Short-term exposure of inhalation can cause drowsiness, dizziness, headaches, eye irritation and lung irritation. Long-term exposure can reduce the number of red blood cells that carry oxygen to your organs like your brain and your heart. Diethylene glycol — It is used in anti-freeze. It can cause eye irritation, lung irritation and long-term exposure can cause reproductive side effects. Isoprene — It is made up of natural rubber, and it’s a cancer-causing agent. Formaldehyde — It is used for preserving dead bodies. It’s been classified as a human carcinogen and it can cause nose and mouth cancers and even blood cancers. Nicotine — It is a naturally occurring toxic chemical found in tobacco. It affects the heart and brain. Propylene glycol — This is the ingredient that makes the vapor, or smoke. Long-term exposure may raise the child’s risk of developing asthma. Toluene — It is a poisonous, industrial solvent that is added to gasoline. The central nervous system is the primary target for that. Children that have been exposed during pregnancy can suffer from developmental side effects. They can have facial and limb abnormalities and then attention issues. Acetaldehyde — It is a poisonous solvent found in a paint stripper. Cadmium — It is a toxic heavy metal used in car batteries Lead — It is a naturally occurring element found in the Earth’s crust. It’s very toxic to humans and animals.

Posted 9:01 am, January 17, 2019, by CNN Wires https://fox2now.com/2019/01/17/why-vaping-is-so-dangerous-for-teens/ “We let this Frankenstein loose without knowing what was going to happen,” Levy said. Most of what we know about nicotine addiction in teens, we know from cigarettes. But experts say the technology and chemistry of vaping might pose an entirely different threat. “It turns out that e-cigarette use by kids doesn’t look the same at all,” said Dr. Sharon Levy, director of the Adolescent Substance Use and Addiction Program at Boston Children’s Hospital. “How you’re delivering [nicotine] and how much you’re delivering … everything you change really matters.” Levy said she’s seen vape-addicted kids in her program showing what appear to be psychiatric symptoms rarely seen with traditional cigarettes or among adults. Some have anxiety and cannot focus, for example. Meanwhile, vaping has become ubiquitous in many high schools, prompting the US Food and Drug Administration to tackle “epidemic” levels of use among minors. On Friday, the agency will hold a public hearing to discuss the role of smoking cessation drugs for kids in order to get them off vapes. There currently are no FDA-approved nicotine cessation products for e-cigarette users under 18. Despite early fanfare that e-cigarettes might offer a less harmful alternative to adult smokers, experts say youth are being hit hard by a combination of how vapes deliver nicotine, how kids’ brains are wired and developing, and the gadgets’ unique appeal to kids. Their long-term health effects are still unclear. “We let this Frankenstein loose without knowing what was going to happen,” Levy said. Teen vaping was a ‘predictable problem’ Experts say that one Juul pod — a cartridge of nicotine-rich liquid that users plug into the dominant e-cig brand — contains the same amount of nicotine as a pack of cigarettes. “That may be true, but that’s not the only consideration here,” said Levy, adding that it’s yet unclear “how high those peaks go and how quickly it gets into the bloodstream and into the brain.” Levy said that it’s not uncommon for kids to report symptoms that “sound a lot like nicotine toxicity,” including headaches and stomach aches. She suspects these devices cause nicotine levels in the blood to peak higher than they do with traditional cigarettes — but experts say more research is needed to better understand how vapes work on the body and brain. “These new generations of electronic cigarettes, like Juul … they actually deliver a really high dose of nicotine, probably even higher than tobacco cigarettes,” said Maciej Goniewicz, an associate professor of oncology and pharmacology at Roswell Park Comprehensive Cancer Center who specializes in toxicology. In a study last year, Goniewicz found higher levels of cotinine — a breakdown product of nicotine — in the urine of adolescent vapers than had been reported in prior research of teenage cigarette smokers. According to Goniewicz, vape manufacturers may be able to pack more nicotine into their products by creating “nicotine salts,” which may mask nicotine’s naturally unpleasant taste and lead the drug to be absorbed by the body quicker. The salt is created by combining nicotine — a base in its natural form — with an organic acid, he said. Experts worry that inhaling these and other added ingredients may cause other health problems down the line, but e-cigarettes haven’t been around long enough to know. Beyond the chemistry of the nicotine itself, e-cigarette companies have come under fire for adding pleasant, often sweet flavors to their “e-liquid” that are known to appeal to young people. And the absence of the harshness of inhaling combustible cigarettes may allow vapers to take deeper or more frequent puffs, Levy added. FDA commissioner Dr. Scott Gottlieb proposed in November to strengthen the agency’s policies against flavored e-cigarette products. These proposals could ultimately prompt their removal from shelves and websites that are accessible to minors. But the proposed changes do not include mint, menthol and tobacco flavors. Gottlieb said he wanted to leave the door open for adults who might use these products to quit smoking cigarettes, “but it can’t come at the expense of addicting a generation of kids on nicotine,” he previously told CNN. Leading e-cigarette company Juul, which holds about 75% of the market in the United States, has also maintained that flavors are a useful tool to help adult smokers to switch from combustible cigarettes. Ashley Gould, chief administrative officer at Juul Labs, told CNN last year, “We were completely surprised by the youth usage of the product.” The company has maintained that its product is intended to convert adult former smokers to what Juul describes as a less-harmful alternative, and it says it is taking steps to limit kids’ use of e-cigarettes. But Levy describes vapes’ popularity among teens as an “entirely predictable problem.” Teens’ brains might be more vulnerable to nicotine Levy said the impact of vapes on teens is changing the way people think about nicotine products. Smoking was largely seen as a “medical problem” that could lead to cancer and other physical ailments, she said. Now, vaping is increasingly being seen as a psychiatric problem over concerns that nicotine is cultivating addictive behaviors among kids and interfering with their brain development. “There’s concern that the adolescent brain may be more vulnerable to the addictive effects of nicotine,” said Adam Leventhal, director of the Health, Emotion, and Addiction Laboratory at the University of Southern California. “The circuits underlying pleasure and the pursuit of novel, enjoyable experiences develop much faster than the circuits that promote decision making, impulse control and rational thinking,” Leventhal said. We know from cigarette users that those who try nicotine products early in life are more likely to develop dependence to the drug, said Leventhal. This may also lead to the disruption of brain circuits that underlie attention and cognitive skills, he added. What makes kids uniquely vulnerable to vapes is not merely biological; it’s also psychosocial, according to Leventhal. This may come in the form of peer pressure or stress, which may increase the likelihood of addictive behaviors, he said. More broadly, the cultural and policy shifts that prevent many kids from picking up cigarettes — including FDA regulation and a “long history of prevention programs” — simply haven’t kept pace with the vaping boom, Leventhal added. Kids and adults also tend to vape for different reasons, Goniewicz said. Adults tend to be former smokers who can handle a high dose of nicotine and want to avoid withdrawal symptoms, such as the inability to sleep or focus on work. “They don’t really need nicotine to feel good,” he said. “They need nicotine not to feel bad — because they are already addicted.” But e-cigarettes may be kids’ first experience with nicotine. “Nicotine hits the brain,” he said, tinkering with molecules that affect mood and other pathways. And they aren’t used to it, he said. “Nicotine is a potent chemical that changes our brain.” It’s hard to get kids to quit Levy said that “nearly all” adolescents in her program have some experience with e-cigarettes, but “what’s new is that now, we’re seeing patients in the substance use program whose only substance is nicotine.” Health experts worry that getting hooked on nicotine early in life may be a gateway to cigarette smoking and other drugs, and there are few tried-and-true resources out there for teens. “Kids are often really struggling with this, and there are just not a lot of resources for them,” Levy said, adding that many addiction programs may not be equipped to deal with some of the younger, nicotine-addicted kids she’s seeing. Far better would be to ensure that primary care doctors are equipped to work with kids in their own communities, she said. Some parents have pursued nicotine gum and other cessation tools off-label for their children under doctors’ guidance. Levy said that can be tricky because some kids may use these products as a “bridge” between puffs of vapes and tobacco products. Medications can be important in some advanced cases, but they’re not enough, she said; kids also need “good, solid counseling.” “We end up needing to teach kids how they can deal with cravings, how they can identify high-risk situations, how they can actually deal with being surrounded by people who are using these things,” Levy said. “Because the reality is that, for most kids, we treat them and put them back in school, and then they go to the bathroom, and everybody’s Juuling.” Still, she said kids and their parents seem largely unaware of the potential dangers. “Even to this day, I have kids saying, ‘well, I thought it was safe’ or ‘I know it’s safer than cigarettes,’ ” Levy said. “And ‘safer than cigarettes’ is a really low bar.”

Penn State News https://news.psu.edu/story/527326/2018/07/03/impact/medical-minute-hazards-juuling-or-vaping HERSHEY, Pa. — Mango, mint, fruit medley — these flavors are delicious in a smoothie but dangerous when they introduce youth and young adults to nicotine. A 2009 federal law outlawed the use of flavorings other than menthol in cigarettes, but electronic cigarettes — or e-cigarettes — are unregulated and exploit the flavors to attract young consumers. E-cigarettes are battery-powered devices that allow users to inhale or “vape” into their lungs aerosolized liquid that contains nicotine, and many vaping devices also can be used to vaporize marijuana. These devices often look like pens, USB flash drives and other everyday items. The term "juuling" comes from Juul, a company that markets e-cigarettes that look like USB devices and plug into a computer to charge. The e-liquid in vaping cartridges contains nicotine mixed with a base (usually propylene glycol) and may also include flavorings, colorings and other chemicals. Dr. Shwetha Gurram, a family medicine physician with Penn State Health in State College, said teens are particularly attracted to “juuling” because of the device’s sleek design and fruity or perfume-like odor. “This makes it easy to hide from adults because of the added flavors such as cool cucumber or crème brulee,” she said. In 2017, a Minnesota Department of Health survey reported that almost one in five of the state’s high school students had used e-cigarettes in the past 30 days, and a 2016 report by the U.S. Surgeon General found e-cigarettes to be the most popular tobacco product among American teens. Because vaping can be a gateway to smoking cigarettes, experts are concerned that the increasing popularity of vaping could reverse the longstanding U.S. decline in smoking. “Parents should make sure their kids understand what juuling really is and have an honest discussion about why it’s dangerous in an effort to counteract the messages delivered by attractive advertising, social media posts and peer pressure,” said Gurram. The U.S. Food and Drug Administration does not regulate e-cigarettes, so packaging does not feature warning labels about health risks. Last year, the FDA announced that it would delay until 2022 a pending requirement that e-cigarette companies submit their products for review. Although e-cigarettes are marketed as a safer alternative to smoking, they are still dangerous: Most e-cigarettes contain nicotine, an addictive substance that can negatively impact adolescent brain development. One Juul pod contains as much nicotine as a pack of cigarettes. Side effects include increased heart rate and blood pressure, lung disease, chronic bronchitis and insulin resistance leading to type 2 diabetes. Some e-cigarettes that claim to be nicotine-free do contain the harmful substance. Studies have found toxic chemicals such as formaldehyde and an antifreeze ingredient in e-cigarettes. Almost 60 percent of people who use e-cigarettes also currently smoke conventional cigarettes, according to the U.S. Centers for Disease Control and Prevention. The vapor exhaled by e-cigarette users contains carcinogens and is a risk to nearby nonusers, just like secondhand tobacco smoke. “Most importantly, parents should serve as positive role models by being tobacco-free,” Gurram said. “Give kids a clear message that nicotine in any form is bad for their health.”

By Flint Duxfield Updated 11 Jun 2018, 8:19pm https://www.abc.net.au/news/2018-06-12/not-all-e-juices-are-as-nicotine-free-as-they-claim/9857540 Nicotine, the addictive agent found in tobacco cigarettes, has been discovered in a number of e-cigarette liquids claiming to be free of it. Key points: The sale of liquid nicotine in e-cigarettes is illegal across Australia Six varieties of "nicotine-free" e-liquids have been found to contain nicotine Health experts say the findings highlight the lack of regulation of vaping products in Australia Australian researchers investigating the potential health impacts of e-cigarettes tested 10 varieties of "nicotine-free" e-liquids and found six to contain nicotine. The e-liquid samples, purchased online and over the counter from Australian suppliers, were also found to contain a substance known as 2-chlorophenol, an "acutely toxic" chemical typically found in insecticides and disinfectants. Lead researcher Alex Larcombe of the Telethon Kids Institute said the findings highlighted the risks of "little to no regulation" of vaping products in Australia. "In a lot of cases, people who are using e-cigarettes are unaware of what they're breathing in," Associate Professor Larcombe said." The sale of liquid nicotine is illegal in Australia, meaning vape stores are restricted to e-cigarette devices and "nicotine-free" e-liquids. But inaccurate labeling means vape users may "unwittingly inhale this addictive substance" or retailers may sell incorrectly-labelled nicotine-containing e-liquids to willing customers, according to the study published today in the Medical Journal of Australia. "There is little to no regulation of their manufacture, and potentially dangerous ingredients and incorrect nicotine levels have been identified," the authors wrote. The nicotine found in three of the samples was at levels comparable to those found in low-dose nicotine e-liquids, and at trace levels in the other three samples in which it was present. Potentially harmful ingredients identified Associate Professor Larcombe said he was "surprised" by the discovery of 2-chlorophenol, a known respiratory and dermal irritant. "It was only in there in small amounts, but it was found in all of the liquids that we looked at," he said. "We also found other things — by-products of animal or human bodily functions — which indicates the process of making the e-liquids might not be as clean as you might hope." The samples were also found to contain "relatively benign" chemicals commonly used in foodstuffs, soaps and detergents, as well as common e-liquid ingredients such as flavours and solvents. "Most of these sorts of things are food additives qualified as 'safe to eat', but … it's unknown what the heating process does to the chemical composition of these ingredients, especially when it's being breathed into the lungs," Associate Professor Larcombe said. A 'regulatory no-man's land' Simon Chapman, emeritus professor of public health at Sydney University, said Australia was operating in a "regulatory no-man's land" when it came to e-cigarettes. "Vaping retailing in Australia is a real cowboy … they say they can sell the juice without nicotine, but there's no specification about what can and can't be in it," said Professor Chapman, who was not involved in the study. In Australia, nicotine is classified as a "schedule 7 dangerous poison", with exemptions made for certain nicotine replacement therapies and for tobacco used in smoking. People who want nicotine in their e-cigarettes must order it in liquid form from overseas and add it to the devices themselves. But Professor Chapman, who has been at the forefront of tobacco control in Australia, said it was an "open secret" that you could buy e-liquid containing nicotine, despite it being illegal. "I've also been told there's a fair amount of amateur, backyard lab production of e-juices which are being sold," he said. Last year, health inspectors from the New South Wales Department of Health visited 227 retailers selling e-liquids and found 63 per cent of e-liquids labelled "nicotine-free" actually contained nicotine. Professor Chapman said the lack of regulation and mislabeling of nicotine was a particular concern when it came the use of e-cigarettes among young people. "In the United States, the Food and Drug Administration is currently considering what they're going to do about the regulation of nicotine products … because they've seen an incredible spike in teenagers using e-cigarettes," he said. "We hope that e-cigarettes are less harmful than smoking because they don't contain combusted material ... but there is no long-term evidence about the risks or the benefits of vaping." Vaping as a harm reduction measure Colin Mendelsohn, associate professor of public health at the University of New South Wales, said although more stringent vaping regulations were required, the findings of the research were "relatively unimportant" as a health issue. "The labels are definitely misleading, and these products should certainly be legalised and regulated," he said. "But the average dose of nicotine they found was trivial … and I doubt very much it would be addictive in any way" Associate Professor Mendelsohn, who has long campaigned for the use of electronic cigarettes as a harm reduction measure, said the discovery of other potentially harmful chemicals was "not in itself a concern". "There are chemicals everywhere — we are exposed to them all day long. The harm depends on the level of the chemical and the toxicity of that chemical," he said. "Lots of studies have looked at the chemicals in vaping, and they're way below occupational health standards. I suspect these products would be down at that level." Associate Professor Mendelsohn said the majority of regular vapers were smokers and ex-smokers, and that the health impacts of e-cigarettes should always be compared to those of smoking. "We know vaping is dramatically less harmful than smoking," he said. "I think nicotine liquids should be available for sale for smokers who are unable to quit, because the alternative for these people is to keep smoking — and two out of three will die from that." Professor Chapman, however, said the evidence for people quitting smoking using e-cigarettes was "very poor". "For every person who has a positive outcome, there are more than two people who have a negative one — meaning they switch back exclusively to cigarettes," he said. "It will take decades before we know whether or not vaping is less dangerous than smoking, and by how much, if it all."

Video discusses how e-cigarettes are an ineffective tool at helping most smokers to be able to quit and discusses the Implications of smokers who use e-cigarettes to supplement their nicotine delivery needs at times when they are not permitted to smoke regular cigarettes.

Why users of electronic cigarettes may be having a harder time emotionally with their quits over the longer-term.

There is a real concerted effort out there trying to make vaping seem relatively harmless. This poses a big risk to kids and is leading to the epidemic rates of use that we are seeing now in teens, but also poses a risk to all former smokers who can easily be influenced by these campaigns to experiment with what is being presented as a harmless alternative that is going to cause them to lose their quits. Do not underestimate how many people are seeing these resources. Here is the link to the Public Health England video referred to: https://www.youtube.com/watch?v=RisBe5sLGPc A December 2018 cotton ball comparison video experiment produced by Public Health England will likely leave many viewers believing that vaping is relatively harmless because it doesn’t discolor the lungs the way smoking tobacco cigarettes do. This video explains that when it comes to dangers posed by nicotine delivery systems, it’s often what you don’t see that can still end up harming and possibly killing you. https://whyquit.com/joels-videos/vaping-what-you-cannot-see-can-still-hurt-you/

Video discusses how parents who write off their children's use of nicotine containing products as a minor problem are sending a message that put their children's long-term health and lives at risk. On top of that, by minimizing the dangers of taking up nicotine, they are increasing the risk of their children taking up other drugs that the parents are often more worried about.

By MATTHEW PERRONE - 1/16/19 3:53 PM http://www.tribtown.com/2019/01/16/us-teen-vaping-addiction/ WASHINGTON — The nation’s top health authorities agree: Teen vaping is an epidemic that now affects some 3.6 million underage users of Juul and other e-cigarettes. But no one seems to know the best way to help teenagers who may be addicted to nicotine. E-cigarettes are now the top high-risk substance used by teenagers, according to the latest U.S. figures , which show that Juul and similar products have quickly outpaced cigarettes, alcohol, marijuana and other substances that have been tracked over more than four decades. The handheld devices heat a liquid solution that usually contains nicotine into an inhalable vapor. Federal law prohibits sales to those under 18, though many high schoolers report getting them from older students or online. In recent months, government officials have rolled out a series of proposals aimed at keeping the products away from youngsters, including tightening sales in convenience stores and online. In November, vaping giant Juul voluntarily shut down its Facebook and Instagram accounts and pulled several flavors out of retail stores. But there’s been little discussion of how to treat nicotine addiction in children as young as 11 years old. While some adolescents should be able to quit unaided, experts say many will be hampered by withdrawal symptoms, including anxiety, irritability, difficulty concentrating and loss of appetite. Physicians who treat young people now face a series of dilemmas: The anti-smoking therapies on the market — such as nicotine patches and gums — are not approved for children, due to lack of testing or ineffective results. And young people view the habit as far less risky, which poses another hurdle to quitting. The harshness of cigarette smoke often limits how much teenagers inhale, sometimes discouraging them from picking up the habit altogether. That deterrent doesn’t exist with e-cigarette vapor, which is typically much smoother, according to experts. Kicking any addiction requires discipline, patience and a willingness to follow a treatment plan — something that doesn’t come easily to many young people, experts said. “Teenagers have their own ideas of what might work for them, and they’re going to do what they do,” said Susanne Tanski, a tobacco prevention expert with the American Academy of Pediatrics. “But we desperately need studies to figure out what’s going to work with this population.” Since debuting in the U.S. in 2007, e-cigarettes and other vaping devices have grown into a $6.6 billion business. Driving the recent surge in underage use are small, easy-to-conceal devices like Juul, which vaporizes a high-nicotine solution sold in flavors such as creme, mango and cucumber. Despite industry worries of a crackdown on flavors, the FDA has taken no steps to ban the array of candy and fruit varieties that companies use to differentiate their offerings. E-cigarettes have become a scourge in U.S. schools, with students often vaping in the bathroom or between classes. One in 5 five high schoolers reported vaping in the last month, according to 2018 federal survey figures. Juul and other brands are pitched to adult smokers as a way to quit smoking, but there’s been little research on that claim or their long-term health effects, particularly in young people. Nicotine can affect learning, memory and attention in the teenage brain, but there’s virtually no research on how e-cigarette vapor affects lungs, which do not fully mature until the 20s. “It’s frightening for me as a pediatrician because I really feel like there’s this uncontrolled experiment happening with our young people,” Tanski said. “They don’t perceive the harm, and we can’t show them what it’s going to be.” Tanski and other experts will meet this Friday at the Food and Drug Administration to discuss the potential role for pharmaceutical therapies and non-prescription medications such as nicotine gums and patches. Regulators acknowledge they are starting from square one: The FDA “is not aware of any research examining either drug or behavioral interventions” to help e-cigarette users quit, the agency noted in its announcement. The FDA will also hear from researchers, vaping executives, parents and teenagers. “We want to make sure our voices are heard and that — most importantly — our kids’ voices are heard,” said Meredith Berkman, who plans to speak at the meeting with her 10th-grade son. Berkman said she first realized her son and his friends were “Juuling” last year when she heard them repeatedly opening and closing his bedroom window. With two other New York City mothers, she formed the group Parents Against Vaping E-cigarettes, which is asking the FDA to ban all e-cigarette flavors. “Unless the flavors are off the market, kids are going to continue to be seduced by these highly addictive nicotine-delivery systems like Juul,” Berkman said. Quitting smoking is notoriously difficult, even for adults with access to various aids and programs. More than 55 percent of adult smokers try to quit each year, yet only about 7 percent succeed, according to government figures. Nicotine gums, patches and lozenges are available over-the-counter for those 18 and older, and are occasionally prescribed “off-label” for younger patients. They provide low levels of nicotine to help control cravings. Prescription drugs include Zyban, an antidepressant, and Chantix, which blocks the effects of nicotine on the brain. But neither has shown positive results in teenagers, and both carry worrisome side effects, including suicidal thinking for Zyban and nausea and abnormal dreams for Chantix. That leaves counseling as the go-to option for teenagers trying to quit cigarettes. In November, Colorado dropped the minimum eligibility age for its quit-smoking hotline from 15 to 12, in response to the explosion in vaping among students as low as 6th grade. The state’s underage vaping rate is the highest in the U.S., with 1 in 4 high school students reportedly using the products, according to federal data. The state’s over-the-phone and online programs provide free coaching to help users create a quit plan, manage cravings and avoid relapse. But even counseling has shown only “limited evidence” in helping teenagers, according to an exhaustive review of the medical literature published in 2017. Still, addiction specialists see growing demand for such programs, particularly group sessions that often have the most promising results. Addiction psychiatrist Jonathan Avery says he gets four to five calls a week from pediatricians referring patients or asking about treatment options. One of the biggest problems is an education gap — many doctors haven’t heard of Juul and don’t even recognize the vaping devices brought in by parents. On the other side, teenagers are often “suspicious” when he informs them that they are inhaling a highly addictive substance, said Avery, of New York-Presbyterian Hospital. About two-thirds of U.S. teenagers do not realize that Juul contains nicotine, according to a recent survey by the Truth Initiative, an anti-smoking advocacy group. The U.S. Surgeon General, Jerome Adams, hammered that point home in a rare public advisory last month. He said even his 14-year-old son believed that e-cigarette vapor was essentially harmless. “Youth like my son have no clue what’s in these products most of the time,” he said.

Coming.. tobaccoexplained.pdf

NOPE!

AWESOME!!! You're now a non-smoker. You quit. You're done. It's time now to be vigilant to prevent another relapse.

NOPE

You're doing this the right way; picking a date the following day. Some pick a date after the holidays, after this or that and it's just not necessary. It's like telling a {pick your drug} addict to keep on using until they're more comfortable to stop using. Either way, today is the day. BTW, I had my last cigarette at 7pm the day I quit. You should start a blog today to chronicle your quit. Use it as a journal of sorts because it's another way of keeping yourself accountable to stay nicotine free. The other way of course is one that you've already done; telling the world that you're quitting this evening at 8pm. Trust me, we'll be watching. ?

Welcome to the board, Sparky. It's actually quite simple and not at all unique. You already figured out the trigger which was a stressful week. There are no triggers which cause you to smoke. Triggers only cause a crave but smoking is a choice; a choice which you likely had been entertaining before you took that first puff to relapse. There are no triggers to smoke NOW because your addiction is back in full-force, regardless of how many cigarettes you're smoking on any given day. In other words, you're smoking because you're being chased by the symptoms of nicotine withdrawal. You're not smoking for no reason and instead, your smoking because you're addicted to nicotine. Plain and simple. That's why you smoke. That's why you chose to pick up smoking again after not smoking for over 3 years. We will always be nicotine addicts. Always. This is why it's imperative to to never, ever take another puff OR put nicotine by any means into your body. Don't waste anymore of your time trying to figure out why you only smoke at home and why you don't think about smoking while away from home. Just quit smoking. You don't need to figure out a quit date as you're only giving yourself permission to keep smoking - you're rationalizing smoking until you quit when what you should do is stop smoking this instant and start working on recovery and let your body start purging itself of the toxins so it can work on repairing damage. This group can help you along but first, you have to make a firm choice to stop smoking and accept the fact that your can't ever smoke again because if you do, you may find yourself 10 years from now, still smoking with a new host of problems - problems much more serious than simply wondering why you only smoke at home.

NOPE!!

While filmed on Thanksgiving 2011, video relates to how any holiday or special annual event can result in more smoking thoughts than normal, and the importance of being mentally prepared for the occurrence of such thoughts. https://whyquit.com/joels-videos/holiday-related-resources/

I placed your previous account(s) on post restriction which means a moderator or myself would have to approve any content before it's posted. There never was anything waiting to be approved from any of your accounts as not only did I frequently check, but I also get email alerts if there is any content waiting for approval. You were told more than once about the duplicate accounts. This will be the last account; start another and you'll no longer be allowed to post here. When you post random thoughts they go to the top of the page which causes other members' topics to be pushed down further. Using the free blogging feature for this sort of content is best (I see you've started using it) but you can also create ONE thread to post some of your random thoughts, so long as they're smoking related or relevant to whichever board you're posting it on. This way, there won't be 10 threads all created by you which tend to drown out threads started by other members. If I see this happening, I'll simply delete them because nobody has the time to keep explaining rules and proper posting etiquette in a support group. It's kind of along the same lines of having a dinner and interrupting friends or not letting them talk and taking over the conversation. By all means, keep using the blog you created which can serve as a diary of sorts which can be very useful in your quit journey. Feel free to blog all day/night if you wish. ?

Thank you all for the kind words! ?

This will pass. You're doing all of the right things and that includes pushing through this. Outsmarting this addiction - apply what you know right now - this is where it counts!

NOPE!

I don't remember how long I was irritable after I quit smoking but heck, I'm still irritable and it has nothing to do with nicotine. After I accepted that getting to the point where I no longer would think of smoking 24/7, I was going to have to put in "the time". Once I understood that the more time I put between my last cigarette, the less I would think of it. A lot of the cravings after a certain point are mental, but nonetheless are still cravings and IMO, just as powerful and if not more. However, they're very manageable because you have control over how you act or dwell on thoughts when they enter your mind. Trust me, the more time you put in, the less you think about, much less consider smoking. Remember this is going to take some time because for a long time, everything we did revolved around smoking. Everything.