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Smoking and Vaping: Cessation and Prevention in the Modern Era

The American Cancer Society's Great American Smokeout takes place annually on the third Thursday in November. For 40 years, smokers across the nation have used this date to make a plan to quit. For many, this will be the day that will end their smoking habit for good.

Mass-produced cigarettes hit the U.S. market more than a century ago in 1881, when the first cigarette-making machine was invented. Productivity suddenly shot up from 40,000 hand-rolled cigarettes to around 4 million in factories.

At the turn of the 20th century, lung cancer was a rare disease. But by the early 1950s, it was the most commonly diagnosed cancer in American men. It would take another decade for scientists and the Surgeon General to formally conclude that smoking is the source of significant health hazards.

Today, more than 50 years after the health risks caused by cigarettes were first recognized, the smoking rate is on the decline, but 40 million adult Americans still smoke, accounting for more than 440,000 deaths annually.

“That first Great American Smokeout took place in 1977, less than 10 years after the link between smoking and cancer was identified,” says Susan Pizzi, a community health educator for Chester County Hospital, who runs the Stop Smoking Now! cessation program. “The Smokeout focuses on cessation, but as educators we understand the equal importance of prevention too. You don’t have to quit, if you don’t ever start.”

When medical research established the link between smoking and cancer, it led to greater public awareness about the health effects of tobacco, motivated the Food and Drug Administration (FDA) to place strict regulations on the industry, and inspired laws about marketing and smoking ages. In fact, New Jersey recently raised its smoking age to 21 years old.

Pizzi says, “Our approach is ‘pro-smoker,’ which shouldn’t be confused with pro-smoking. We don’t chastise or scold people by arrogantly telling them to ‘just stop already.’ Instead, we work with people who want to stop smoking at the mindset they are during their process of quitting. Breaking the addiction of smoking isn’t easy. It takes determination, patience, time and compassionate guidance, and support.”

Even though overall smoking numbers have declined, she worries that millennials and teens are being enticed into the smoking culture through the modern technology of e-cigarettes, which are not yet regulated by the FDA.

E-cigarette products come in a variety of shapes to simulate the tactile feeling of cigarettes, pipes, cigars. Most have a battery, a heating element and a place to hold a liquid, which produces an aerosol when heated. E-cigarettes don’t contain all of the harmful chemicals known to be in traditional cigarettes, however the liquid contains some chemicals and includes the most addictive ingredient – nicotine.

“There are organs in the body that are immune to the effects of cigarette smoke but can potentially be harmed by e-cigarette aerosol,” Frank T. Leone, MD, MS, Penn Medicine’s director of Comprehensive Smoking Treatment Programs, said. “For example, e-cigarette aerosol contains propylene glycol. This is metabolized by the liver into propionaldehyde, which is actually related to formaldehyde. When propionaldehyde accumulates in the body, it increases the potential for liver damage. This chemical also accumulates in the retina, so there’s the potential for retinal damage and blindness"

In addition to this information about health effects, the National Institute on Drug Abuse states, “early evidence suggests that e-cigarette use may serve as an introductory product for preteens and teens who then go on to use other tobacco products, including cigarettes, which are known to cause disease and premature death.” A seminal study published in the Journal of the American Medical Association showed that students who had used e-cigarettes by the time they started 9th grade were more likely than others to start smoking cigarettes and other tobacco products within the next year. 

This month, many Pennsylvania school districts are conducting their bi-annual survey of sixth, eighth, 10th and 12th grade students about their behaviors and habits, including smoking. The Pennsylvania Youth Survey (PAYS) added new questions about e-cigarettes in 2015.The results of that survey showed that 2.6 percent of sixth grade students and 27.0 percent of 12th grade students had tried e-cigarettes within the 30 days before the survey.

The American Cancer Society’s data shows that the use of e-cigarettes (at least once in the past 30 days) has increased most rapidly among high school students, surpassing cigarette smoking in 2014 to become the most common form of tobacco use.

Unlike cigarettes, which have existed for more than 140 years, e-cigarettes have only been in the U.S. for about 10 years. While it took nearly 85 years to understand the health hazards of tobacco products, the long-term health hazards of vaping are yet to be completely understood, but the potential for a life-time of addiction is possible.

“We know that cigarettes are unsafe after 40 years of exposure,” Leone says, adding that “we don’t have 40 years of exposure to e-cigarettes to know what the danger is. We don’t know the safety profile, so we can’t say that e-cigarettes are safer than traditional cigarettes.”

This trend to vaping, which is still in the infancy of its health research, leads to the question…in what year will the first Great American Vapeout take place?


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