When Sophia Thomas, DNP, FNP, PNP, FAANP, recently saw a 16-year-old patient suffering from a chronic cough, she immediately considered the possibility that vaping could be the source of the problem.
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Sophia Thomas, FNP[/caption] Thomas, who works at a Daughters of Charity Health Center in New Orleans, knew the parent in the room might not be aware -- or pleased -- that the teen was using e-cigarettes. So Thomas took the patient aside to broach the subject. The teen was, in fact, vaping, and Thomas took the opportunity to explain the vaping health risks. "I think many nurses, doctors and parents underestimate how many people are using e-cigarettes," said Thomas, who is also president of the American Association of Nurse Practitioners.
According to the 2018 National Youth Tobacco Survey, more than 20% of high school students reported they had used an e-cigarette within the past 30 days. This was nearly double the percentage from 2017, and the increase may be due in part to the flash drive-like e-cigarettes popular among youth, according to the study authors.
Vaping health risks include lung injury
The negative health consequences of using these products has surfaced in recent months, with the Centers for Disease Control and Prevention reporting a total of more than 2,000 cases of e-cigarette, or vaping, product use associated lung injury, or EVALI, and 39 confirmed deaths as of Nov. 2, 2019. For perspective, as of Oct. 28, 2019, the number of lung injury cases was 1,479 and the number of confirmed deaths was 33.
More than half of the patients with lung injury were 24 years old or younger.
Statistics like these highlight the importance of educating both patients and larger communities about vaping health risks, said Jenny Prochnow, DNP, MBA, RN, a nurse who has led presentations about this topic at schools, police agencies and healthcare organizations for the past several years. Prochnow, an associate professor in the graduate nursing program at Winona State University in Minnesota, was motivated to increase awareness about the dangers of this trend when she discovered many providers didn't have answers to the questions parents were asking about e-cigarettes.
One of the most common public misconceptions is that vaping products are safe, said Prochnow, yet they contain cancer-causing chemicals, heavy metals such as lead and nickel and ultrafine particles that can be inhaled deep into the lungs, according to the CDC.
Most e-cigarettes also contain nicotine, which can harm parts of the brain that control attention, learning, mood and impulse control in the developing adolescent brain, according to the CDC. "I talk to teen patients about the fact that brain development continues into the mid-20s, and nicotine is highly addictive," Thomas said. "It can increase the risk of using cigarettes in the future." [caption id="" align="alignright" width="200"]
Pamela McGee, FNP-BC[/caption] Although the CDC is still investigating the causes of vaping health risks, many of the patients who suffered lung injuries reported a history of using tetrahydrocannabinol (THC)-containing products, though some had used products that only contained nicotine. "Some of these patients experienced significant lung injury, and we still don't know if they will suffer longer-term damage," said Pamela McGee, EdD, FNP-BC, CNE, an assistant clinical professor at Drexel University College of Nursing & Health Professions in Philadelphia. McGee recently published a paper in the Journal of Pediatric Nursing about what nurses need to know about vaping health risks.
The prevention window
Although it's critical for nurses to educate current e-cigarette users about vaping health risks, there's another large population that needs to be reached: youth who haven't started yet. "My focus is prevention among never users among teens and young adults," said Sally Huey, DNP, APRN, FNP-BC, an assistant professor at the Georgetown University School of Nursing & Health Studies in Washington, D.C., who published a report about the health hazards of vaping in the Journal of Clinical Excellence. "They are the potential collateral damage from a product that was unregulated and lacked safety data when it went on the market, and now we are seeing a new generation that is addicted to nicotine," Huey continued. She encourages nurses to familiarize themselves with e-cigarettes by visiting a vape shop to see what the products look like, the available flavors and the names of different brands.
"The appeal is that these products can remain hidden," Huey said. "They look like flash drives or pens and don't smell, so teens can keep them in their pockets."
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Sally Huey, APRN[/caption] To initiate discussions about the risks of these products, nurses can ask patients what they are seeing at school or in their communities related to vaping, Huey explained. Thomas starts educating patients about risks of vaping when they are 12 or 13 years old, and she often uses visuals such as photos of youth who are on ventilators as a result of vaping. "Visual media often helps patients better understand the consequences of their choices," Thomas said. "I use the same strategy when I talk about immunizations, and 10 out of 10 times they are more open to getting the vaccine after seeing a photo of someone with the disease."
Influencing health policies
The upcoming flu season likely will provide opportunities for patient education because the symptoms of vaping-related lung injury, pneumonia and influenza are similar, Huey said.
"It's going to get tricky because all three illnesses can present with coughing, shortness of breath and chest pain," she explained. "But the lung injury from vaping is very distinct on a chest X-ray. It may have the appearance of a 'ground glass' consolidation."
Nurses not only have an opportunity to leverage their clinical expertise to educate individual patients, but also affect large-scale policies related to vaping health risks. Huey has written letters to legislators about pending bills related to vaping, and Prochnow lobbied for laws that would prohibit vaping indoors in public areas. She and other members of the Ramsey Tobacco Coalition in St. Paul, Minn., initially advocated for law changes at the city level. After a number of cities started prohibiting vaping indoors, the coalition began lobbying for counties to follow suit. After more than half of the counties in Minnesota changed their laws, the coalition convinced state legislators to pass a law in Minnesota that banned e-cigarette use indoors.
Known as the Minnesota Clean Indoor Air Act, the law went into effect Aug. 1, 2019.
"Vaping, especially among youth, has become a public health crisis, and nurses should find ways to get involved in their communities to advocate for regulations that better protect consumers," Prochnow said. "They have the ability to affect policies in their own cities, counties and states."
Take these courses to learn more about tobacco use and dependence:
How Can We Reach Teenage Smokers? (1 contact hr) According to the U.S. Department of Health and Human Services, every day about 3,200 youth under the age of 18 smoke a cigarette for the first time. These statistics are of even greater concern with the emergence of new tobacco-containing products, such as e-cigarettes, vape pipes and water pipes (hookah), which are being used at increasing rates among middle- and high-school students. This program will educate clinicians about evidence-based methods for reducing tobacco use in adolescents. Treating Tobacco Use and Dependence (1.5 contact hrs) One study reported that patients with tobacco-related diseases were asked about their smoking status 90% of the time, and that tobacco cessation counseling was provided in 70% of visits to the clinic. But tobacco users treated for a nonpulmonary reason were not questioned or counseled about their tobacco use. This module will familiarize nurses and respiratory care practitioners with information about tobacco use and dependence so that they can address this issue with their patients. Smoking Cessation: Developing a Workable Program (1.7 contact hrs) The Centers for Disease Control and Prevention estimate that nearly 40 million adults in the U.S. smoke, and 16 million of those adults have a serious illness attributable to their smoking habit. This course provides an overview of the need for smoking cessation, components of a successful program, the process for working as an interprofessional team, stages of readiness during the smoking cessation process, and how to help patients at each stage, including a discussion on smoking cessation aids and their benefits and risks.
