The Journal of the Arkansas Medical Society Med Journal Sept 2019 FInal 2 | Page 8

others, fails to pass these regulations which have
been regularly introduced … The saddest thing
about these choices is that we allow the ongoing
predatory practices of these businesses to addict
children and sentence them to poor health and less
economic options going forward for their futures.”
following suggestions may help clinicians as they
broach the subject with patients:
“When counseling, choose messages that
resonate with adolescents … consider talking about
the expense of e-cigarettes or the loss of freedom
that occurs when you’re addicted to nicotine. Talk
with them about the tobacco industry’s efforts to
target them with misinformation and advertising.”
“Arkansas Week” also featured Appathurai
Balamurugan, MD, the deputy chief medical
officer and director of Chronic Diseases for ADH.
“For both users and non-
“Our fight against tobacco use has
users, mention the dangers of
been a long, drawn-out one, and it’s
secondhand e-cigarette exposure,
been challenged now with the new
and advise teens to avoid secondhand
tobacco products – like e-cigarettes
e-cigarette aerosol, and to discourage
and vaping,” he said. “E-cigarettes
others from using e-cigarettes around
and vaping products have made our
them. For teens who babysit or have
continued public health efforts in
young siblings, explain that e-liquid
tobacco prevention and cessation
is poisonous and can be fatal if
more essential. To that end, physicians
ingested. Ensure that e-liquid is kept
Appathurai
need to ask their patients about
in childproof containers, and out of the
Balamurugan, MD
e-cigarette or other vaping product
reach of children.”
use at every office visit and offer counseling similar
The AAP’s fact sheet also suggested evidence-
to smoking cessation.”
based tobacco interventions that can be adapted
Dr. Balamurugan also spoke about ADH’s new for use with e-cigarrettes. The U.S. Public Health
“Be Well Arkansas” program. Be Well Arkansas is a Service’s “5As” Tobacco Cessation Intervention can
holistic approach to addressing tobacco cessation be used to guide your e-cigarette conversation with
(including vaping and ENDs), high blood pressure, parents and with youth:
and diabetes and includes positive messages
• ASK about e-cigarette use.
about living well. The state’s Be Well call center
• ADVISE against e-cigarette use and about
is available to assist Arkansans trying to quit
avoiding secondhand vapor exposure.
tobacco use – including e-cigarette and vaping
product use. Physicians are encouraged to refer
• ASSESS whether teen is ready to quit using
patients to the call center for help as they talk to
e-cigarettes .
patients regularly about the hazards of all forms
• ASSIST them in quitting by setting a quit
of nicotine ingestion. “The toll-free phone number
date and giving them practical advice
that patients can call is 1-833-283-
for a successful quit attempt and for
WELL,” explained Dr. Balamurugan.
prevention of secondhand exposure
“Also, if people call the 1-800-QUIT-
by non-users.
NOW, the national tobacco quit line
• ARRANGE follow-up to check on the
number, they will now be routed to
teen’s progress with quitting.
Be Well Arkansas. Call is answered
during normal business hours from
Here at home, Arkansas Surgeon
8 a.m. to 4:30 p.m. Calls received
General Greg Bledsoe, MD, worries
after hours will receive a call back
not only about the dangers of vaping,
within one business day. You may also
Greg Bledsoe, MD
but also the dangers of using vaping
text 501-588-8445 Monday-Friday
devices with other drugs. He offered
between 8 a.m. and 4 p.m. There is a new website, the following key points to Arkansas physicians to
www.bewellarkansas.org, with updated resources use in their discussions with patients.
for patients and providers, and an online chat
1. Vaping is unsafe.
component for cessation services.”
“In advising your young patients about the
The 2016 U.S. Surgeon General’s report about dangers of vaping and ENDS, it’s important to
youth and electronic cigarettes (e-cigarettes) understand that many young (and some older)
contained useful information. To help pediatric patients still assume that vaping is safe. We’re
clinicians interpret its findings, The American finding out that it’s as unsafe [as cigarettes], just in
Academy of Pediatricians Julius B. Richmond different ways. You don’t have the same chemicals
Center of Excellence created a fact sheet. The as you have with a cigarette, but you have other
56 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY
chemicals that are super-heated and inhaled
deeply into the lungs. That’s a problem for anyone
but particularly in young people whose bodies are
still developing. When you couple that with the
nicotine addiction, it’s a major issue.”
2. In combination with cannabis, vaping in
young people carries developmental risks.
“The other troubling aspect is that there are
young people who are using vaping technology to
consume cannabis and various marijuana products.
This is very concerning because the evidence is
very clear that people under the age of 25 who are
using marijuana once per week never regain their
full cognitive function. They’re permanently altered,
so even if they stop later in life, their IQ is already
stunted.”
The evidence is clear. Once again, our country’s
citizens, especially our youth, are at grave health
risks from nicotine, but unlike 40-50 years ago,
we know this time around the severity of the risks
involved. As physicians on the front line of public
health, you can do something about it. Talk to your
patients. Their future depends on it..
*Sources for Further Study
• https://www.aap.org/en-us/advocacy-and-
policy/aap-health-initiatives/Richmond-Center/
Pages/Understanding-the-2016-SGR-Fact-
Sheet.aspx
• www.cdc.gov/tobacco/data_statistics/fact_
sheets/youth_data/tobacco_use
• https://e-cigarettes.surgeongeneral.gov/
resources.html
• http://www.arkleg.state.ar.us/
assembly/2019/2019R/Acts/Act580.pdf
• https://www.ama-assn.org/delivering-care/
public-health/vaping-epidemic-and-fda-must-
act-physicians-say
• https://www.npr.org/sections/health-
shots/2018/12/18/677755266/surgeon-
general-warns-youth-vaping-is-now-an-
epidemic
• https://e-cigarettes.surgeongeneral.gov/
documents/surgeon-generals-advisory-on-e-
cigarette-use-among-youth-2018.pdf
• https://www.clarkcountymedical.org/news2/
the-vaping-epidemic
• https://www.fda.gov/news-events/press-
announcements/statement-fda-commissioner-
scott-gottlieb-md-proposed-new-steps-
protect-youth-preventing-access
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