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October 25, 2013

STAWAR: e-Cigarettes: Boon or boondoggle

— With everyone talking about how expensive health care is today, it is important to remember one of the major contributors to this problem.

Smoking costs this country more than $96 billion annually for health care and it kills more people than auto accidents, illegal drugs, AIDS, murders and suicides combined. According to the federal Centers for Disease Control, there are more than 44 million smokers in the United States. Unfortunately, until recently, two of them were our sons.

I’m afraid that it’s either my behavior or my genes that are to blame. I smoked incessantly until my late 30s and it ran in my family as well. My mother was a several-pack-a-day smoker and when I was just a small child, she would give me two dimes to run down to the local confectionery to buy her a pack of Lucky Strikes.

I remember the jingle and how the letters LSMFT were stamped on every pack, which stood for “Lucky Strikes means fine tobacco.” Her only concession to the harshness of smoking was her conversion to filter-tipped menthol Kools in later life.

My father didn’t smoke, but he did chewed tobacco — a lot of it. He bought a twist type, called Beeswax, by the case. When he would finish a box, he would paint one side brown, label it with white paint, install a handle and use it for storage.

Eventually, he had an entire wall of these boxes setting on shelves in the garage. They contained nails, screws, washers, motors, electrical plugs and switches, and a variety of other items he saved. Our sons didn’t stand much of a chance given our family’s tobacco legacy.

At the time I started smoking, a pipe was a mandatory accessory for male graduate students in psychology. I was convinced that it made me feel calmer and gave me an extra lift when I was studying. From just carrying a pipe around for show, I graduated to smoking more than two ounces of tobacco a day, or two packs of cigarettes, when I couldn’t get my hands on pipe tobacco. I finally quit smoking in 1987 when three events took place around the same time.

First, our youngest son was born and my wife Diane wanted me to stop smoking around the baby. Up until then, I had been terribly irresponsible, exposing our children to secondhand smoke. Once, my smoking even set off the house smoke alarm. It also affected my work.

When I finished graduate school, the first counseling client I ever saw was a young man who was having school problems. At that time, it was perfectly acceptable for therapists to smoke in their offices. I was anxiously smoking my pipe when this first client entered my tiny windowless office. He seemed to have a hard time talking about things until we broached the subject of his father.

Suddenly, he got all choked up and a tear even rolled down his cheek. In my best empathetic manner, I asked him if he felt upset whenever he thought about his father. He looked at me incredulously and said emphatically, “No, it’s just so smoky in this room, I can hardly breathe.”

When he finally told me why the school had referred him, he said it was because he had got caught smoking at school. Without realizing it, I had been using what was called at the time implosive therapy, or flooding.

The second event related to my quitting was that smoking in offices was banned by law in the state where I was working. In order to smoke, you had to go outside to a small landing by the sidewalk — an area known as “the stoop.” Since I chained-smoked, I was dismayed at the thought of spending all my day at ”the stoop.”

Finally, I cut the Dickens out of my finger while working on a swimming pool filter and when I saw the doctor, my blood pressure was sky high. This doctor ordered an electrocardiogram and was terrifyingly explicit about the negative consequences of my smoking.

I had tried stopping on a few occasions, but had always started up again. For some reason, this time I managed to quit cold turkey. Today, I don’t remember much about it, other than it was hard and I craved tobacco for a long time.

So, I was disappointed, but not surprised, when our two younger sons started smoking when they were in college, despite Diane’s best efforts to dissuade them. I later found out that when our youngest son asked me for $5 to go down to the Circle K to get a Polar Pop, that was actually code for scoring a pack of cigarettes. I always thought those sodas were awfully expensive.

Recently, we had some good news when our middle son told us he had quit smoking. He had tried a couple times before, but now he seems very determined and we’re rooting for him.

As for our younger son — with Diane’s encouragement — I recently bought him and his girlfriend reusable electronic cigarette starter kits. Although the chances are slim, we’d like to think that they might encourage them to at least consider quitting or cutting back.

A Chinese pharmacist, Hon Lik, received the first patent for an e-cigarette back in 2003. After his father died from lung cancer, he was looking for a way to make smoking safer. Ruyan, the company he founded, has already sold more than a million e-cigarettes. Over half of all men in China smoke, and that country is now the world’s largest manufacturer of electronic cigarettes and accessories.

An e-cigarette typically contains a miniature battery-operated heater, which vaporizes a nicotine-laced liquid called smoke juice that smokers inhale. The device sends out a puff of vapor out of the other end that looks like smoke.

Most use propylene glycol, the substance that makes fog in movies. There is no fire and nothing actually burns. The users of e-cigarettes are sometimes referred to as “vapers” to distinguish them from regular smokers. There are both reusable and disposable e-cigarettes that are only good for a few days. The CDC reports that 20 percent of all smokers have at least tried e-cigarettes. In a recent Time article, journalist Eliza Gray says, “For pack-a-day smokers who switch entirely, the e-cigarette is cheaper. They hope that, without smoke and tar, it is healthier too.”

According to Bonnie Herzog, from Wells Fargo, American sales for e-cigarettes have grown from $300 million last year to an estimated $1.8 billion this year. When the federal Food and Drug Administration begins drawing up rules for e-smoking this month, there is some belief that they might prohibit the importation of these devices and related accessories.

Up until now, there have been no federal regulations governing e-cigarettes. State and local laws are also still under development in most places. Many vapers have tried to use their e-cigarettes in places where smoking is usually banned, so far with mixed success.

Electronic pipes and e-cigars are also for sale on-line and I have to admit that I have been tempted to see what sorts of pipes are available. This, of course, is a major danger of e-smoking. These new devices may lure people who have quit back in to smoking or recruit brand new smokers, who believe that e-smoking is safe. The candy like flavors also may appeal to youth.

There is no evidence that e-cigarettes encourage smoking cessation. You are, however, able to control the nicotine dose that these devices deliver. The problem, of course, is that nicotine is one of the most addictive substances in the world — in some ways more addictive than heroin or cocaine.

Also at this point, there is no evidence that e-smoking is really any better for you than regular smoking. Like the no-calorie donut, the safe cigarette may just be a fantasy, but hope springs eternal. Maybe we’ll get lucky and our son will cut his finger on a swimming pool filter some day and talk to the right doctor.

If you don’t want to rely on chance, you can get more information on smoking cessation at the CDC website at http://goo.gl/sA9XG2 and if you need help quitting today, call the Indiana Tobacco Quit-line at 1-800-QUIT-NOW.

— Terry L. Stawar, Ed.D., lives in Georgetown and is the CEO of LifeSpring the local community mental health center in Jeffersonville. He can be reached at tstawar@lifespr.com. Checkout his Welcome to Planet-Terry blog and podcast at www.planetterry.wordpress.com

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