Massachusetts’ four-month ban on the sale of vaping products is now in effect, and other states are thinking about following suit as increasing numbers of people across the country come down with lung illnesses tied to vaping.
While governments are cracking down on the practice, new research from Boston Medical Center and Boston Children's Hospital shows that doctors may not be doing enough when it comes to helping young people quit smoking, whether it's e-cigarettes or traditional nicotine products.
WGBH Radio’s Arun Rath spoke with Dr. Scott Hadland of Boston Medical Center. He's the co-author of the new study on the subject. This transcript has been edited for clarity.
Arun Rath: Do you think Gov. Charlie Baker's plan is the right approach?
Dr. Scott Hadland: I think right now we are experiencing a public health emergency, as the governor has said, and I do think that it's important that we put the brakes on and we try to figure out exactly which products may be causing some of the severe cases of lung injury that we're seeing.
Rath: You've studied the ways that doctors help people quit smoking. A lot of people use e-cigarettes for just that, as a replacement therapy to get them off tobacco. Does a ban like this leave those people in a tough position?
Hadland: Well I do think that we have to consider the fact that there are FDA-approved medications that can be used to help people, including young people. Some of these medications aren't recommended for teenagers, but for many of the young adults that we studied and who did not receive effective treatments for nicotine use disorder, these medications can be very helpful in helping them quit.
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Rath: Well that seems like a great point to get into your study, which is very relevant to all this. First, set up the big picture for us. Has a general decline in smoking continued? Are young people smoking less today?
Hadland: We actually are coming off of several decades of public health success, in which young people are smoking traditional combustible cigarettes at lower rates than ever. Unfortunately, the most recent year for which we have data actually showed a very small but noticeable change in this trend, and it's believed that e-cigarettes may have been contributing to this. There are data to support the idea that e-cigarettes may actually serve as an almost gateway or transitional tool that leads young people to then move on to cigarette smoking.
Rath: So sort of a reverse of what we might have heard, with adults using e-cigarettes to wean off of tobacco?
Hadland: That's right. It's clear, based on some studies, that e-cigarettes are helpful at getting adults to quit cigarettes, but the reverse may be true for young people. Young people who might not have otherwise smoked cigarettes might get to that point by using e-cigarettes first.
Rath: So leaving the e-cigarettes aside for the moment, in terms of the details in your study, what are the kind of things that doctors could be doing to help young people quit smoking that they're not doing?
Hadland: Well what we did was we looked at youth with Medicaid insurance from across the country in the years 2014 and 2015, and tried to figure out what percentage of young people got some of these effective treatments. And the current recommendations are that people should be at a minimum receiving counseling to help quit smoking. And then for many people, it's also suitable for them to receive medication like nicotine replacement or some of the other medications that can help control people's cravings. And what we found is that only a very small minority of young people actually received these. Only about one in 25 young people received any counseling, and only about one in 77 received one of these evidence based medications.
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Rath: And it would seem in terms of a public health thing, you'd expect doctors to be really on top of that. Do we have any sense of why that's not happening?
Hadland: To some extent, this may be a workforce issue — that people who work with young people may not be adequately trained in how these medications work or what sorts of counseling may be effective at helping young people set their own goals and quit smoking.
Rath: So in terms of the takeaways from this for you, it's kind of surprising that we've heard about this big decline obviously in youth smoking, but there's still work to be done, it sounds like. How do we improve upon this?
Hadland: I think that physicians who care for young people need to receive better training in how they can effectively counsel young people and also receive training on how to use these medications that are evidence-based and can be very helpful at controlling nicotine withdrawal and cravings. I think the other thing that we have to consider is that this is really time-urgent. We're right now dealing with unprecedented issues related to nicotine and e-cigarettes. And so we may not have time to wait to do all the careful studies that still should take place to understand exactly how to roll out some of these interventions.
Rath: And so in terms of that uncertainty that we started out talking about with the e-cigarettes, would you recommend to people who are vaping right now as an alternative to smoking to check in with your doctor and get their advice?
Hadland: I think that's an excellent place to start. There are a number of people I know that in my own clinical practice have really struggled with the high nicotine content that they've been exposed to through e-cigarettes, and when they tried to stop using an e-cigarette, they actually experience withdrawal and cravings that drive them then to go back and use. And there are tools, as I've mentioned, these medications that can help with withdrawal and with cravings that doctors can offer to patients. But the first step is to talk to your doctor about these things.
