Health

HE A LTH • Winter 2019 9 A Multi- Disciplinary Approach to the Treatment of Migraines Dr. Herbert Markley 508-890-5633 www.nerhc.org New England Regional Headache Center 85 Prescott St. Suite 101 Worcester, MA 01605 the American Center Society's Cancer Action Network, is among those push- ing for legislative changes to push more smokers toward quitting. "We now know that both products are dangerous," Hymovitz said of tradi- tional cigarettes and their newer elec- tronic counterparts. "We hope that people will quit but we know that's very difficult to do." Rising popularity Smoking rates, among both adults and youth, had been on a long and steady downward trend, hitting a record low among adults in 2018, according to the Centers for Disease Control and Prevention. But e-cigarettes – battery-powered devices heating nicotine similar to lighting a cigarette – have undone much of that progress. Most worrisome to health officials has been spiking youth rates, with minors far more likely to vape than adults. Vaping spiked in 2018 among both high school and middle school stu- dents, according to a survey released this spring by the U.S. Food and Drug Administration and the CDC. Among high school students, use more than doubled to 27.5% in just two years, and in middle schools, use tripled to 10.5%. A survey published in November by the Journal of the American Medical Association found high school and middle school students use e-cigarettes more than four times as often as tradi- tional cigarettes. "With the uptick in e-cigarettes, we started to lose that progress, and kids were hooked," Hymovitz said. "It's surprising but it shouldn't be," Hymovitz added of vaping's popularity, "because the tobacco industry – which owns most of the vaping industry – used the same tactics as they have with e-cigarettes: candy f lavors, fruity f la- vors and cheap prices." Dr. Daniyal Siddiqui, a hematologist and oncologist at Saint Vincent Hospital in Worcester, said he's been shocked at how widespread youth vap- ing rates have become so quickly. "They're just very scary numbers," he said. Scott doesn't believe many users are weaning themselves off cigarettes, as Juul has marketed itself as a sort of smoking cessation product. "There must be a big percentage of people vaping who never smoked ciga- rettes," Scott, whose Reliant office is in Southborough, said of youth vaping rates. "To have an alternative access point to get addicted," he said of vaping tak- ing the place of traditional cigarettes, "it's been a tragedy." The CDC says vaping is not safe for kids, teens and young adults, and nico- tine can be especially addictive for younger people into their early or mid- 20s. Flavored products – those receiving the most ire of health officials – have been shown in surveys to be largely responsible, making up most of vaping products minors use. Two thirds of regular e-cigarette users in high school to use fruit f la- vors, according to the Journal of the American Medical Association study. Nearly as many used mint or menthol f lavors. Another Journal of the American Medical Association study in 2016 found a connection between youth vaping and an eventual use of ciga- rettes, and a study published in November in the journal Pediatrics found an association between the use of f lavored vaping products and higher continued usage of e-cigarettes. Massachusetts has among the coun- try's lowest cigarette smoking rates but hasn't been immune to the rise of vap- ing. A 2016 report by the CDC said 4.3% of Massachusetts adults vaped, not significantly better than the national median of 4.7%. An unexpected outbreak A spate of lung illnesses began this spring but peaked in the summer ini- tially stumped health agencies, which noticed patients were all e-cigarette users but couldn't immediately trace a cause. By November, the CDC said it iden- tified vitamin E acetate as a chemical it strongly believed was responsible. But by then, more than 2,000 nationwide had been sickened and more than 40 killed – including a Worcester County man and a Middlesex County woman. "Lungs are very delicate structures," Siddiqui, the Saint Vincent Hospital doctor, said. He compared a lung to a filter used in a home or office building that, unlike a lung, could be changed out if it got dirty. "So we have to take really good care of that filter," he said. "Anything other than air is going to clog it." At the same time the e-cigarette out- break has spread, new research has come in showing the harm of e-ciga- rettes to smokers' health. A study released in November by the Continued on Page 10 50-99 cases • Massachusetts* • Florida* • Maryland • Michigan* • New Jersey* • North Carolina • Ohio • Pennsylvania • Tennessee* • Viriginia* • Wisconsin 100-149 cases • Indiana* • Minnesota* • New York* • Utah* 150-199 cases • California* • Illinois* • Texas* Vaping cases This year, 18 states have tallied at least 50 cases of vaping-related lung illnesses, a condition the U.S. Centers for Disease Control and Prevention has tied to vitamin E acetate and referred to as e-cigarette or vaping product use associated lung injury, or EVALI. *Includes at least one fatality As of Nov. 20, 2019 Source: U.S. Centers for Disease Control and Prevention Dr. Jeffrey Scott, a pulmonologst with Reliant Medical Group, is hopeful a new MassHealth policy waiving co-payments for smoking cessation products can help smokers quit. PHOTO/MATT WRIGHT

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