Intro: [music] Welcome back to The Daily Utah Chronicle's opinion podcast. I'm your host, Estella Weeks, and you're listening to Point of View.

Estella Weeks: E-cigarette usage among college students is on the rise. About 24% of students use them, but we can assume that number is much, much higher. The tobacco consumption boom between the 1920s and 1960s has left that generation with severe health concerns. I'm here with Dr Ryan, a cardiologist with the University of Utah Health, and my question for you, Dr Ryan, is history repeating itself, and is vaping the new cigarettes?

Dr. Ryan: I think the concern that we all have is that vaping might lead to the new cigarettes. Vaping, in and of itself, has some consequences. But when you talk about cigarettes, obviously you're talking about in particular things like emphysema and chronic obstructive lung disease or COPD, and then obviously lung cancer in particular. And those, the risks of those really are massively increased by cigarette smoking. But the concern, in particular, with vaping is not necessarily well, part of it is damage associated with vaping, but the other part of it, as I said, is that it may lead to cigarette consumption, to cigarette use. And what's important is that there is no safe level of nicotine use. There is also no necessity for nicotine use. So people, for example, may challenge. They'll say, 'Oh well, you know, [a] can of Coke is more, you know, or drinking lots of Coke is more, Coca Cola is much more, you know, damaging to your health, than vaping' something along those lines. But that might be true if you're drinking 20 cans of Coke for you and for you know, college students, you can absolutely have a can of Coke, it's going to be just fine, but you should not vape. Things will not be just fine from vaping, or in reality, also, I mean nicotine supplements. So I'll see, Zin in particular is popular right now, and kind of other kind of, you know, I will just say, trendy ways of consuming nicotine. The issue in particular is that at some stage that people, what we know from the science is that people will evolve from using nicotine supplements, such as in or or vaping, and then advance onto cigarette smoking to frank cigarette smoking. The other concern that people have is that it may not actually, it has not been shown at all, or at least convincingly, that using vaping instead of smoking, so one of the arguments being, is that, well, 'my uncle used to smoke, he got lung disease, now he vapes, and now he's going to do much, much better.' There's no real convincing evidence to show that that decreases the risk of people going back to smoking, because again, this is not kind of done under medical monitoring. It's not done under the supervision of you know physicians or nurses, etc, or counselors or psychologists or something along those lines. It's independently done as vaping. The question about independently and for for your your colleagues who will say, Oh, well, I'm never going to smoke, first of all, all of us say we're never going to smoke. And but for your colleagues who say, I'm never going to smoke, the vaping, in and of itself, does have health consequences. So when you do use the nicotine, and this is why I said earlier on Estella that there is no safe or beneficial level of nicotine consumption, because nicotine, in and of itself, does narrow the blood vessels in your heart, in your brain, in your peripheries, so your muscles, So and during those acute episodes of inhaling nicotine in the form of vaping, there is a significant what's called vasoconstriction, where the blood vessels get smaller. These are things in most extreme scenarios, which can trigger heart attacks. Now that admittedly, is not common, but I think your generation is so health conscious, and you do so many good things for your health, exercise, yoga, meditation, all the things that you are all so aware of you know your bodies that it is a little hard to understand why you would introduce a compound that is by definition, toxic. The final aspect then, and is that, I'm not saying that you do this, but you know this is that a lot of people mix things in their vaping products. They might mix oils, they might mix marijuana, they might mix both. There is a condition referred to as EVALI, which is e-vaping, acute lung injury, which, funnily enough, was described first here in Utah, where people will vape oils mixed with their other vaping products, and then it causes acute lung injury. So and those people have needed transplants, they've needed lung resections. Those are major, major consequences. And and this is, as you likely know, or you would suspect, this is a common practice among folks who do vape.

Estella Weeks: You kind of mentioned a couple of scenarios where things were happening, are we still like figuring out medical things that are happening to people who are vaping like is because it's not, it's new relatively.

Dr. Ryan: I mean yes, I mean, it is naive for us to think that we have figured out all the clinical consequences from vaping, but I do feel that we have identified enough clinical consequences that continuing to advocate for it or promote it or start using it is ill advised. I will the only people who benefit from vaping are the people who sell you the vape-pens the vape cartridges the companies.

Estella Weeks: The companies, the money.

Dr. Ryan: Yeah, they're the only people who benefit from you vaping.

Estella Weeks: This is kind of a question about those companies, but I've found that, and there's like research to back this up, that it's marketed towards a specific demographic, which is kind of my generation and younger. Do you think that vaping products are marketed towards a younger audience? And why?

Dr. Ryan: So, yes, they are absolutely marketed towards a younger audience in relation to truly, absolutely why? I don't know, but my suspicion would be, first of all, as you, as you do know younger money or, sorry, young people typically have more disposable income and and and are a higher contributor to the you know, you know, the consumer economy. The other is that you are again going back to the issues about your awareness of health and your interest in, you know, eating well, there's much more you your generation or population have much higher vegetarian proportions, vegan proportions, you know, dairy free, gluten free, you know, this kind of so you all and then you have much more exercise percentages than we have, or even we had. Then you absolutely have more yoga and pilates than we have, or you had, and you have more awareness of core exercise, etc. So you all do have a better awareness of health and how to optimize your health, which is, the thing is, your generation is far at least in the college communities, your generation is far more likely to not smoke than my generation. So I think there is an awareness then that. So instead of Marlboro marketing towards you, Marlboro market to a different population. Instead of that, it is, there is a void in the market. You have money, you have health consciousnesses, you're not smoking. This is an addictive compound that has some you know, when you're my age, you say the word cool, you just sound ridiculous. But there is a cool factor to it.

Estella Weeks: The flavor, the colors.

Dr. Ryan: The flavors, the colors, there's kind of that, not necessarily competition. But you know, even you see this again with Zin and Chill and so on, that people will be like, 'Oh, I have coffee flavored and I have,' you know, all these other things, and there's kind of an excitement or a buzz, pardon the double meaning, but there is kind of a buzz around it.

Estella Weeks: So do you think that, because you're saying that our generation is a lot more health conscious than others, is it kind of just like the unknowing and thinking that vaping is the healthier version of a cigarette?

Dr. Ryan: I think so. I think your, I think mind, my suspicion, at least, is that your colleagues and peers do consider it, as I said, do consider it as a healthier version. And if you ask them, and maybe you can, if you ask them, are you ever going to smoke cigarettes? They'll say, 'Oh, absolutely not. It's never going to be something that's going to be in my future, because it's so bad for you, it's filthy, it's disgusting, it smells bad,' and so on and but unfortunately, the literature, the scientific literature, does not support that, and the scientific literature does support that, you will eventually, or typically, people will eventually advance onto vaping, like a gateway, like a gateway, essentially, yeah, and again, it comes down to the fact that, again, there is no, there's no need for you to consume nicotine. There is absolutely need for you to consume sugar, and that's where the analogies with Coca-Cola, etc, are kind of misplaced. And and there is absolutely a safe consumption of Coca-Cola, but there is not a safe consumption of nicotine. And I think that you all kind of have a to a certain extent, and I'm sorry for using this word, Estella, but there is, to a certain extent, naivety that this is not something that's going to progress. I mean, I guess the other thing then would be, I don't actually know, I don't know the cost differential between, you know, some vaping products versus a pack of cigarettes. Do you?

Estella Weeks: Not off the top of my head, no, but I I've done some research on this of like social media, and right now it is really common. There's been a lot of lung issues, yeah, that have gone viral. And the virality of it has kind of shown the population that vapes like, this is something real that we need to be focusing on. And so I think the price difference would maybe be 10 to $15 I'll go in the transcription and put it in there, but I don't know if it's really a issue of price, because, I mean, it sounds like vaping is an addiction. And I know addicts will kind of go whatever to fill their need.

Dr. Ryan: Yeah, I do think, I mean, people appropriately realize that smoking is disgusting. People smell your clothes smell there's massive health consequences associated with it. And you're right, the vaping does not have quite the same acute health consequences, at least not in as much as large a number as there has been. With cigarette smoking. But there's definitely, there can be such as, what you have represented significant health consequences, and there's no upside, aside from, you know, there's no yeah, let me ask you, Estella, what is the upside from vaping?

Estella Weeks: Maybe the social aspect.

Dr. Ryan: Maybe the social aspect, yeah, maybe the social aspect,

Estella Weeks: The trendiness, you could say, of of it, and seeing maybe influencers do it. And yeah, the influence that media has on us is huge, and I guess just the trendiness of it. So I guess my next question for you is a large majority of the college population vapes. I've seen it with my own eyes. It's pretty it's pretty known. Let's say you're a vaper. When do you need to start thinking seriously about it? Like, How late is too late?

Dr. Ryan: In terms of when do you need to start thinking about it, I would encourage, and I think there's plenty of precedent with cigarette smoking. We know, for example, with cigarette smoking, that on average, it takes people six efforts to stop cigarette smoking. So it takes them six times to say, you know, I'm throwing this packet of cigarettes out. I'm never going to smoke again. That needs to happen six times before there is successful or, on average, six times before there is successful cessation of smoking. So on average, obviously, as you know. But just to be specific, some people, you know, they throw them out and they never smoking again. Some people take some 12 times, you know, so, so there is a broad range there. So I would consider, I would consider vaping similar that by vaping, I would anticipate that again, it's take, gonna take six times of just stopping vaping for you to not do it anymore. And no, obviously you have invested money into it with vape pens and cartridges, etc. And forgive me if they're not called cartridges, but whatever the product is called,

Estella Weeks: I'm not sure of the terminology, pods maybe? Yea like JUUL Pods.

Dr. Ryan: Yeah, that sounds right, yeah. And so there's obviously a cost related to that, but I would anticipate that anytime you vape your plan should be for that should be the last time you're vaping. And our generation had this with cigarette smoking as well. No one, or at least very few people, want to smoke cigarettes. But if you have, you are, as you made reference to you are addicted to cigarette smoking. So it's not necessarily a weakness. I think one thing that I do want to emphasize is that, just more broadly, addiction is not a weakness. It's a medical condition, it's a disease. And so there's nothing necessarily wrong with being addicted. And is just like any other disease, like diabetes or cancer or heart disease, it is difficult to treat. There is treatment out there. Some of it is, you know, things like cognitive behavioral therapy or some sort of counseling or emotional support. Some of it is actually true supplementation, such as nicotine gum, which the chal-, the challenge people lay down as well. How is vaping different to nicotine gum? Well, one is the and now the things that you've talked about about the acute lung injury that you get from vaping, and the other is that nicotine gum, we know actually does decrease your risk of going of smoking and reinitiating smoking. So there clearly is a difference there. It's kind of a straw man argument. So I do think that the time to think about stopping vaping is when you're vaping.

Estella Weeks: Now, the time is now to stop okay, and you know, we've kind of seen that with the smoking generation. There's been a plethora of health issues that have hurt that generation. Do you see our generation, in like 30, 40, years, maybe starting to have a significant death rate? Or?

Dr. Ryan: I don't know about death rate, first of all, I don't know about death rate, but I think you will look back in regret, you know, kind of like, why did I do that? And did I do this to my body? And are the lung consequences that I'm having now? Are they from that, and are they worth it? And so I think there will be, I don't anticipate that your generation are going to look back and say, thank God I vaped. That was the best thing I ever did. You know? I think there will be a regret, and I will say, as you do become and even with your career in journalism, that the more you do see with this, with any of these things, the more you appreciate that you are being, you know, manipulated by advertising, social media, platforms, influencers, etc, and so I do. I certainly have, at least in things that I've done in the past, and I probably still am, but in that regard, that's what I mean by you will not look back and say, thank God I listened to that person who was on Instagram that really changed my life.

Estella Weeks: And health wise, what is probably the scariest kind of a maybe fear mongering, but like, what is the scariest thing that could happen if you have years and years of vaping behind you?

Dr. Ryan: I think the scariest is chronic lung disease, I think acute and chronic lung disease, because it is very hard to repair your lungs. And if you if, if we are lucky enough for you to shift careers and join the medical career, you can fix a lot. You know, you can fix coronary arteries to a certain extent. I mean, you might need to do bypass surgery or other things like that, and you can't fix the lungs. It's incredibly hard to fix the lungs. You might be able to decrease the damage, or you might be able to or you might have to transplant. Yeah, you might have to do lung surgery and transplant. And so I don't think I'll push back a little bit. I don't think that's necessarily fear mongering, I think that is a real possibility. I know it's a real possibility in the acute stage, and such as what you've described. And then I do also know it's a real possibility in the chronic stage. So fear mongering, for me, Estella is more just like, oh, this could happen, but it's not real. You know what? I mean? There are enough real consequences that we know of for an organ system that is, it's a beautiful organ system. It's the size of two tennis courts and but all bunched up into your lungs. It is one of the it is an organ system that is always in contact with the outside world. It's not crazy. It's the isn't that crazy, yeah. So it's always in contact with and your skin, yeah, so and but it is much more, higher kind of turnover and so on. So by damaging that, I don't know why you would want to do that. I don't, and maybe I just sound old at this stage, but I don't know, yeah, I don't know why you'd want to do.

Estella Weeks: I agree with you, completely. I think that's why I'm I mean, I remember in middle school seeing like, seventh graders vape, and I was like, Oh my gosh. And I would go home and tell my mom about it, and she was like, Oh my gosh. Like, please never do that. I think that's a reason why I kind of wanted to bring attention to it was because I just think there's kind of like, there's no knowledge about it. You can see all these videos and on the news of all these things that are happening, but like, peer to peer, I'm trying to say that's if I could tell the vaping population, I would just be like, guys, it's not worth it. Like, it's not worth risking all of these medical conditions that you're gonna have to fix one day, and you're gonna have to do it when you're older and you have a family and you have all these other sort of things that you need to take care of. So what would you say to the college vaping population, if you could?

Dr. Ryan: I would reiterate that. So as I talk with the college communities, or say, my niece, right? You know, I'm seeing my niece on Thursday, she lives in London, so I guess tomorrow. As I talk with her, and you know and folks like yourselves, I think the emphasis is to really, you are a very...