Teaching with a Twist – Thoughts on E-cigarettes and Vaping

Posted on May 01, 2019   |   

This article was written by Stephanie Williams, BS, RRT. Stephanie is the Director of Community Programs and Volunteer Management for the COPD Foundation.

“Just the facts, ma’am.” Who remembers that line from the good old days of the Jack Webb TV series, Dragnet? I must confess that I am not old enough to have watched it when it aired originally, but because it was a favorite of my dad’s, I have watched my fair share of reruns on late-night cable TV. Those characters are so easy to see in my mind’s eye – dark suits, crisp white shirts, thin black ties, and cigarettes.

One night a few months ago, I was reading an article about the harmful effects of e-cigarettes and vaping. That article was a little frightening. It stated that some of the components of the e-liquid degrade into chemicals like formaldehyde and acetaldehyde – both of which are cancer- causing agents. It also included instances of the lithium batteries that power the devices unexpectedly exploding into the face and eyes of the smoker. This article also linked to another, which pointed to more startling findings, such as some of the flavored e-liquids having been linked to a serious and permanent lung disease called bronchiolitis obliterans (BO) or “popcorn lung.” (Here is more information about bronchiolitis obliterans if you are interested.) Those articles got me thinking about my Teaching with a Twist series and how we might have an open discussion about a touchy subject.

I started reading articles about the impact of popular culture and influential people on the rates of smoking in the U.S. and it took me down some interesting paths. Back in the 1920s through the mid-1950s, advertising for cigarettes was front and center in magazines. Tobacco companies even used phrases that characterized smoking as a wholesome activity. Many advertisements showed pictures of doctors smoking and declaring that they preferred a certain brand over others. Can you imagine going to see your pulmonologist nowand having him encourage you to switch to his favorite brand of cigarettes? No way! But at one time this kind of promotion happened – a lot.

The medical community has data that prove that cigarette smoking or other forms of tobacco use are dangerous and can lead to health problems. We can agree that no doctor will encourage smoking and will even offer advice or programs on how to quit tobacco use. Again, the articles I read about e-cigs and vaping came to my mind, and I wondered what the medical community is saying about those devices.

One article, published on February 1, 2019, in JAMA Network Open, said that American teens who use e-cigarettes are 4 times as likely to light up with a regular cigarette than the teens who had never tried an e-cig. E-cigarette use in teenagers has dramatically increased. Advertising pushes this trend. The risks going forward seem obvious.

And here is an interesting article about the use of e-cigarettes as a tool to help people quit smoking. This article, published in the New England Journal of Medicine, states that e-cigarettes may be helpful in getting people to quit smoking if the individuals only use the electronic device and stop using combustible cigarettes altogether. A major concern however is that those using E cigarettes appear to continue to use those E cigarettes.

By and large, people use e-cigarettes in addition to their regular smoking habits. Maybe it is helpful as a tool to quit smoking, but the misinformation spreads as one person tells another, “My doctor told me to use the e-cigarette” without the full context of what the doctor intended or what the details of using the device to quit tobacco altogether. The listener in that scenario may be left thinking that doctors are condoning the use of vaping devices – which is not the case at all. This is not solving the smoking problem, but instead adding fuel to the fire.

Based on conversations I have with the public, people will say that vaping isn’t as bad for you as smoking regular cigarettes, but honestly, there isn’t enough research to back up that claim. Please don’t mistake the lack of long-term studies for a passive statement that vaping is OK. Remember what I mentioned earlier about the early days of regular cigarettes? How doctors even appeared in advertisements for tobacco products? I believe we need to be cautious and use good judgment about these new devices. If using chemicals for cleaning or air fresheners can cause lung irritation, does it seem reasonable that heating nicotine and other chemicals to turn them into a mist via e-cigarette might also be irritating to the delicate lung tissue?

Some sources are reporting that tobacco products are being seen broadly in a variety of media where children and youth are watching and wanting to do what they see their “role models” doing. This is not terribly different from watching Joe Friday, Rod Serling, Audrey Hepburn, or Shirley MacLaine, but there is a lot more exposure to these influences today than in years past. It worries me that we will have a whole new kind of lung disease in the future - one that will add different types of problems that complicate the treatment of COPD. Then we will have to learn how to treat the more complex breathing problems in the same way that we are learning more about COPD and effective treatments for it today.

Here are a few questions I have for those of you who are former or current smokers:

  1. What do you think when you see young people smoking?
  2. If you could share some ‘quit smoking’ advice with them, what would it be?
  3. What were your reasons to quit? Or if you are trying to quit, what are your reasons to quit?
  4. Are there ways you can share your story to encourage others to quit, or to inform teens to never start smoking?

If you would like to learn more facts about e-cigarettes/vaping and young people, here is a link to the CDC page with more information.

Now for the Twist!

I will put a name of a TV show and a character from that show. The next person will list another TV show/Movie that character was in and so on.

Here is an example:

  • Magnum, PI – Tom Selleck
  • Tom Selleck – Friends
  • Friends – Elliot Gould
  • Elliot Gould – Ocean’s 11

Here we go!

  • The Golden Girls – Betty White


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  • Betty White - Mama’s Family
  • Mama's Family-KenBerry
  • Ken Berry - Dr. Kildare
    • Stephanie - This is such a difficult topic, one that seems to fall under the category of "that's just your opinion", especially when it comes to "vaping". On this site, we've seen how emotions run high when it comes to this topic.

      It just breaks my heart when I see anyone continuing to smoke, regardless of their age. At my last job, I worked with adults who smoked. After I started on oxygen, and came to work with a POC, I had a heart to heart conversation with one them, encouraging her to quit smoking. I heard earlier this year that she was in the hospital with pneumonia, and I hoped for her that this would be her chance to stop. Last I heard, she hasn't quit.

      Just a few thoughts...
      I think education is really good place to start, in the most non-judgmental or shaming method
      - This is what happens to your lungs when you inhale substances.
      - Make it clear that your lungs will not recover from the damage that is done.
      - This is what it feels like to be short of breath on a regular basis.
      - Find ways to demonstrate that smoking is NOT cool or sophisticated.

      I think the biggest thing (and probably the most difficult) for young people to understand is that we are not immortal. Everything that we do everyday matters to our health and well-being.
    • Dr. Kildare - Richard Chamberlain
    • Bourne Identity - Matt Damon
    • From das23....

      Matt Damon - Good Will Hunting
    • Good Will Hunting — Robin Williams
    • Robin Williams - The World According to Garp

    • The World According to Garp - Glenn Close
  • Nicotine & Tobacco research - NO evidence exists that e-cigs lead to permanent non-smoking. {Pulm Paper}

  • 1.) What do you think when you see young people smoking?
    I am scared for them. They can't appreciate or know what it feels like when you can't catch your breath. They don't get it. I didn't get it either. I never thought I would smoke for as long as I did and never thought I would get sick from it, then one day you turn around and well, here I am.

    2.) If you could share some ‘quit smoking’ advice with them, what would it be?
    To paraphrase something a cessation counselor told me: learn how to hit the pause button, don't do the knee j-e-r-k reaction, stop and think about what you really want for yourself. I think another way of saying that is:
    "Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom." Viktor E. Frankl

    Use every resource you can get your hands on, fill up your toolbox. How you quit doesn't matter, the only thing that matters is that you do quit. Just because something doesn't work one day doesn't mean it won't work another day. Understand how the addiction to nicotine works to help you cope with it. Don't assume you know, do your homework.

    3.) What were your reasons to quit? Or if you are trying to quit, what are your reasons to quit?
    Aside from having COPD and feeling that I was too young to die, I didn't want to smoke and was ashamed that I was still smoking.

    4.) Are there ways you can share your story to encourage others to quit, or to inform teens to never start smoking?
    • @clipper - Thanks for using the term "addiction". I think this often gets lost in conversations/discussions about quitting smoking.
    • Great point, Jean.
    • @clipper @JeanO53 I very much appreciate your comments. I was really torn about posting on this topic because it *is* so personal and can be seen as an attack or opinion based as you guys mention. It is an addiction and there is some literature that suggests it is more addictive than heroin. I think if we treat it like an addiction, then it allows the person to get the help they need without the shame you reference. No shame. No blame. No excuses. Just helping people fight the addiction would be a huge step in the right direction.
      This particular trend saddens me because so much work had been done to reduce the number of people who use tobacco products and this just seems to be a huge step backwards.
      Thank you both for your transparency and for being so real with this group.
    • The Mayo Clinic has some good info on nicotine addiction.



      I see three different target audiences; those that are not yet abusing or just started (young people), those that have been inhaling nicotine and want to quit and sadly those that just want to keep on smoking.

      We do need to protect our youth from cigarettes, e-cigs, vaping, and everything else.

      We do need to give people that are trying to quit resources which might include temporary use of e-cigs or vaping as a form of nicotine replacement therapy.

      Make the federal smoking age 21 and only sell cigarettes in liquor stores where it can be better regulated. Volitions lead to loss of both liquor and tobacco license.

      Sell all other forms of nicotine replacement therapy including vaping through a pharmacy where it is treated like an over the counter drug that the pharmacist has to retrieve for you. They should also be available through certified tobacco cessation programs. Of course some like Chantix would still require a prescription.

  • There are such good comments here. I think one of the things that we fail to address is that there is loss when you quit smoking. It's not only loss about what you do with your hands or lips instead, but a loss of great pleasure in your life. It sounds odd, but before it leads to shortness of breath or you (as a former smoker) see it as gross or unhealthy, it is pleasurable. In addition to nicotine withdrawal, quitting removes that from your everyday, too.

    "Just because something doesn't work one day doesn't mean it won't work another day." I loved this, Clipper. Try, try again. Most people fail several times before they are successful at quitting smoking. It's difficult, but if you keep at it, you can join those who can hardly believe they ever felt attached to their cigarettes.
  • Dr. Kildare - Richard Chamberlain
  • Matt Damon--Good Will Hunting
  • I'm a documentary guy, I dont watch movies or any fictional shows, the last movie I saw was mall cop when it came out so I'm not going to have much involvement Lol. I have one of my customers who is a teacher of 5th and 6th grade they have cameras at all the entrances and when they monitor the cameras they have seen 5th graders hitting on vapes or e cigs. I would say it's an issue or topic that should be discussed in the open and not a topic that is just opinion based.
  • Michael Douglas--Streets of San Francisco
  • Robert De Niro - The Mission
  • Lauri
    Ryan Gosling The Notebook

  • There is a article in the current issue of the Journal of the COPD Foundation that reviews several of the most recent research articles published on e-cigarettes, vaping and JUULing:
    Journal Club: Electronic Cigarettes and Vaping as a Harm Reduction Alternative: Really?


    Dr. Balkissoon, the article's author, shares the abstracts from several e-cigarette related studies and provides commentary on each--topics addressed include the European Respiratory Society's recent statement on e-cigarettes, e-cigarettes as a smoking cessation alternative, the toxicity of e-cigarettes and the potential lung damage they cause and e-cigarettes as an gateway to smoking tobacco cigarettes.