Health Voices

The Mysteries of Vaping

• Yale PHC • Season 1 • Episode 4

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How much do you think you know about vaping? Sure, you’ve heard it’s tasty, it’s better than smoking, and you may have tried it yourself. Vaping has become more common as people puff at hookah bars, take a sniff in between classes, etc. However, there’s still a gap in knowledge about the actual health associations of vaping.  And based on the knowledge medical professionals already have, vaping is discouraged. But why do people do it anyway?

To help us fill the gap of knowledge we have on vaping, we will talk with Dr. Stephen Baldassarri, an associate professor of medicine at Yale whose research focuses on the mechanisms of addiction. We talk about marijuana vaping, mental health’s correlation with vaping, vaping economics, and so much more. 

[00:00-01:36]: Introduction 

[01:36-07:22]: The Basics of Addiction and Vaping

[07:22-12:59]: The Complexity of Vaping Culture and Vaping History

[13:00-21:09]: How to Discourage Vaping and Vaping Research

[21:08-23:21]: The Particulars of Vaping Instruments

[23:22-26:02]: The Socioeconomic Indicators of Vaping 

[26:03-30:58]: Relationship between Smoking and Vaping & Vaping Risks

[30:59-39:08}: Government’s Role in Vaping and Vaping Treatment

[39:10-44:10]: Conclusion

Link to Dr. Baldassari's Profile: https://medicine.yale.edu/profile/stephen-baldassarri/?tab=bio

Email us at yalephcpodnews@gmail.com if you have any questions or want to be featured in an episode. Follow us on social media at https://www.instagram.com/yalephc/ and https://www.instagram.com/yphcpodcast/. And please subscribe to our show. 

Speaker 1:

Welcome to Health Voices, a podcast from the Yale Public Health Coalition, where we discuss the breadth and depth of public health and how it actually impacts the individual in the New Haven area and beyond. My name is Fred Salmon.

Speaker 2:

And my name is Frederick Rivas Georgie.

Speaker 1:

And we welcome you to the third episode of Health Voices. In this episode, we want to talk about an issue that has become increasingly prevalent in American culture over the past few years vaping. From vape pens to pod mods to hookah, these items seem to have replaced combustible cigarettes as the go-to nicotine inhaler.

Speaker 2:

The popularity of these devices has only risen over the past couple of years, and in places like New Haven, the percentage of users only seems to be increasing for children and adults.

Speaker 1:

Even though it's been popular, there do seem to be medical and public health risks with these devices. However, since vaping is a relatively new phenomenon, there is a much established knowledge about the extent of these risks.

Speaker 2:

To uncover the truth behind vapes. We're talking today with Dr Stephen Baldassari, who is an assistant professor of medicine at the Yale School of Medicine. His research focuses on understanding the mechanisms of addictions, particularly vaping, as well as the epidemiology of vape use and generally cigarette use. Let's listen in.

Speaker 1:

Dr Baldassari, thank you so much for coming to meet with us today. If you would like to introduce yourself and tell us what you do at the Yale School of Medicine, so I'm Stephen Baldassari, assistant professor of medicine in the section of pulmonary critical care and sleep medicine.

Speaker 3:

I work as a clinician, as a researcher and as an educator. As my clinical role, I take care of patients with imminently life-threatening medical illnesses and lung problems. On the research side, I'm interested in investigating questions relating to addiction and to sleep, and as an educator, I train medical students, residents and sub-specialty fellows.

Speaker 1:

Before we get into, I guess, the weeds with vaping and addiction, I guess I wanted to first ask on the year perspective what is an addiction?

Speaker 3:

An addiction is best conceptualized as an acquired illness of the brain that is profoundly influenced by a person's environment. So the brain is different chemically, it's different structurally, but those differences can't be viewed in isolation. They have to be viewed in the context of someone's larger environment and that will influence how that addiction is manifested. But typically what we observe is a pattern of maladaptive behavior that ultimately leads to serious problems In the context of drug use. Specifically, it's characterized by compulsive use of a drug, including a perceived loss of control, and continued use of the drug despite problems or despite the desire to stop using that drug.

Speaker 1:

So it is based on a mental dependence on what you're doing.

Speaker 3:

Yeah, it's basically that the brain is different, is wired, has been rewired differently and the person's environment is such that the behaviors exhibited become problematic.

Speaker 2:

Thank you very much for your very in-depth introduction to addiction and how it relates to public health as we get into the weeds of vaping, would you be able to describe exactly what is a vape? How does it differ from conventional cigarettes?

Speaker 3:

So vaping is the inhalation of a heated and aerosolized liquid solution known as an e-liquid. That compares smoking, which is the inhalation of a burned solid substance. So the main difference between the two is that smoking is creating a much more complex mixture of chemicals and at a much higher temperature as compared with vaping, and, as a result of this, smoking is much more toxic than vaping on a puff-by-puff basis and carries higher health risks. With that said, both smoking and vaping can be highly addictive, depending on the drug being used and the other unrelated circumstances.

Speaker 1:

You talked about how smoking is based on solid substances and vaping is based on liquid substances, which one is more addictive? Is it based on the substance that is used or is it just based on exposure to a muF?

Speaker 3:

Yeah, so I think that they are similar in terms of addictive risk. The main thing that you think about the things that will determine whether something is going to be addictive. So the first thing you think about is the substance being consumed. So what are the characteristics of that substance? What effects do they have on the person? In the context of this discussion, when we think about smoking and vaping the two the most common drug we're talking about is the drug nicotine, which is the primary addictive chemical in tobacco smoke, and then, less commonly but more increasingly recognized, is THC use, which is the main psychoactive chemical in cannabis products. Again, people will, depending on what effect people are looking for, they may find one or the other substance to be preferable. But the thing that's problematic with regard to smoking and vaping is that you're combining a drug with potent psychological effects with a rapid speed of delivery. So that drug, because you're inhaling it and it's coming in through the pulmonary circulation, which has a large surface area that drug is then being delivered to the brain very quickly.

Speaker 3:

So within a matter of seconds, a person is going to get that rapid effect and so there's sort of a high degree of reinforcement and an ability to titrate the drug to a desired effect. So in other words, if you consume a drug orally, it's going to get in your system, it's going to get partially digested, it's going to take a while for that to take effect and the general effect and the duration will vary depending on person's metabolism, other factors. But when you're smoking or vaping a drug it's again because it's much more rapid onset and rapid offset, there's going to be the potential for more frequent dosing and also for a person's ability to really modify their use moment by moment to get the desired effect. So that's one of the reasons why the inhalational route of taking a drug can be very reinforcing and potentially predisposing people to developing addiction.

Speaker 2:

Yeah, I mean you don't really hear very much, at least in common parlance, talking about the just how, what you've just described, just how addictive smoking and vaping can really be. I mean, people might have a general idea, no, so in that case then, why might it not be considered as much of a public health risk as other use of drugs, even though it's so highly addictive and in some sense, even more accessible?

Speaker 3:

Oh, I think it's definitely considered a major public health risk, just given the prevalence of it. Obviously it's very common and it you know, there's a lot of it's a lot of risk. It's not just addictive risk, it's also toxicity. So when we think about inhaling any substance into the lungs, you're talking about the other many other chemicals that are coming in with that. Again, I'll sort of emphasize that when we compare the two, vaping versus smoking, smoking is definitely going to be the more toxic inhalation. When you consider puff for puff, I can't tell you 100%, definitively if that means that that vaping will reduce harm compared with smoking. That is certainly an idea that is gaining traction and, based on our current level of knowledge, we think that persons smoking and switches over to vaping. They may be able to reduce health risk, but it doesn't mean zero health risk. So I think it's just important to note that those are. Those are some of the issues surrounding those two behaviors.

Speaker 1:

Okay, give us like a debrief of the history of vaping in America, like when did vaping start and when did it start to develop in the stages that we see? Right?

Speaker 3:

now. So it started around 2007. The first kind of vaping devices were credited to a Chinese pharmacist and his motivation was to develop a, basically to develop a smoking cessation product. So the idea was, I guess, mimic the behavioral elements of smoking but have the product be not as toxic, less toxic. That was the original intent. So it was originally intended as a sort of a harm reduction thing. Then of course, once industry takes over and capitalism is what it is, it turns into a much larger drive to make profit and to sell product and so forth. So it kind of started out that way.

Speaker 3:

It came into the US and again was classified as a tobacco product and again that was in part driven by industry. So if it was classified as a medicine it would have been under much heavier regulation. Much earlier on it was classified as a tobacco product and then over time the products just evolved as people discovered ways to modify their ability to deliver nicotine. So the early products they had nicotine in the product but it didn't deliver the nicotine very well. So if you search literature, there's literature describing how these early ECR products were very bad at delivering nicotine. They could kind of relieve withdrawal symptoms because they mimicked some of these behavioral elements and they looked exactly like a regular cigarette. That's how they were designed to look. They'd be like a little red glowing tip at the end of it. And then, over time, people realized that the first thing was that, okay, well, if I make the battery bigger, then person can get a bigger hit and then they can get more nicotine.

Speaker 3:

So that was the first wave of innovation in this space was okay, increase the battery size. So you had these small batteries that weren't very good. Then the batteries became larger and larger and then people were getting more and more nicotine, so the nicotine delivery was getting more efficient. Then there was a shift in the first company to modify the pH of the e-liquids. One of the first one of the biggest was the company Jewel, and they figured out that if you reduce the pH of the liquid, that you can increase the nicotine content of the liquid in the delivery, because it's going to be less harsh and that's.

Speaker 3:

We're working on a similar type of study right now, trying to explore how the pH of these liquids impacts nicotine delivery to people who use them. But once that discovery was made, now the products are much more efficient at delivering nicotine. So studies that came out in the late 2010s look very different than the earlier studies. They report us, included in others, that these products can deliver nicotine very rapidly. So that was kind of the evolution. And then there's been there's likely to be continued sort of changes in the style and nature of the products, but again they're all kind of doing the same thing. It's just a question of how well do they do it?

Speaker 2:

Moving on then, would you be able to tell us a bit more into the research that you've conducted personally about what predisposes people to vape and, through that information, what might public health officials do to dissuade people from vaping or lower people's risk of vaping.

Speaker 3:

Yeah, that's a million dollar question. I can't claim to know exactly the answer for every person and every circumstance. Certainly there are a range of reasons for why a person might choose to vape or choose to smoke. I would say for some people we would look first to the positive effects of the drug being used. So many people who choose to consume these substances, regardless of the root, is they're seeking an effect, and so we think about the drug.

Speaker 3:

Nicotine. That's sort of the more ubiquitous, most common thing that we're going to think about when we think about smoking or vaping. Nicotine is a potent stimulant. It's a drug that will, at least in the short term will elevate mood, will elevate alertness, focus and concentration. So you can think about various settings where individuals will find those effects to be beneficial.

Speaker 3:

In the case of a drug like cannabis or THC, people will generally report seeking relaxation, seeking euphoria, perceptual enhancements, increase in appetite, potentially creativity, and in certain cases there can be short term reductions in pain and improvements in sleep. But again, it's something that will vary by individual. But I think thinking a lot about someone's environment when trying to understand drug use is really, really important, because environment is a major contributor to why someone might want to modify that environment. If there's a stressful environment, for example, people may seek to use drugs for that reason to reduce stress and we know that that may help in the short term. But in the long term it creates, it can create major problems, and that's what the whole addiction risk is all about.

Speaker 1:

Yeah, you referenced, I guess, mental distress and stress that people go through. You referenced Richard's paper that was talking about how, especially, you go through mental distress and then you look to vaping to try, and, I guess, curb the stress that they do feel. Do you believe that this is more of a psychological issue or it's more of an issue that you're trying to address?

Speaker 3:

Yeah, there's definitely a major mental health and wellness issue surrounding vaping and smoking. Again, I think we need to think about people's environments and certainly the stress that a person might be under.

Speaker 3:

Certainly we can imagine if someone's feeling either under threat or feeling depressed or anxious, then it wouldn't be surprising that they would want to consume a substance that made them feel better. And we know, since we know that vaping and smoking deliver that substance quickly, that's seemingly in the immediate setting, that's the quickest fix to those symptoms. So I think when we think about addiction and we think about substance use, the first thing that we want to ask ourselves is whether the individual is under stress and what is their day-to-day environment like, and if those things are difficult and challenging. Certainly in clinical settings, we know that those addictions can be hard to treat because we need to figure out a way to reduce their stress, come up with alternative ways that they can cope and that they can feel normal, feel better.

Speaker 1:

So I was reading a paper that you were referencing that was discussing how adults, when they were treated with marijuana at hospitals, when they return home they were more likely to do marijuana vaping instead of nicotine vaping. So my question is why do adults look to cannabis instead of nicotine vaping to find solutions to, I guess, their problems?

Speaker 3:

So I don't know that they're more likely to do cannabis vaping per se rather than nicotine vaping. We know that people who do one behavior might be more likely to do another one. So one of the common phenomena is that you know many people with addiction. Many people who consume a single drug are not really only consuming a single drug. They may be consuming multiple drugs at different times. We know that a lot of these drugs have opposing effects. So if you know, if nicotine is a stimulant and that's making people more awake and alert, well, the other side of that is that it can interfere with sleep.

Speaker 3:

It can, you know, create other issues and then they might be seeking something like cannabis, or sometimes something like alcohol to basically bring that back down right, and then you see a lot of sort of dual use of different drugs. It's another sort of challenge when we try to treat this issue. People are commonly using more than one substance, and that's an area that you know we're trying to learn more about. It's hard to study because you know you're trying to conduct control experiments but there's multiple variables going on at once. So how do you sort out which effects are due to the drug use, which effects are due to withdrawal from the drug and or use of a drug within opposing a mechanism of action.

Speaker 2:

Well, in that case, it really seems like there's quite a bit of research yet to be done. Particularly, where would you like to see that research go, especially in regards to perhaps creating novel therapeutics towards better understanding the mechanisms of vaping addiction? I?

Speaker 3:

think one of the things we need to figure out is which drug to discontinue first. Right, so it can be kind of a vicious cycle. So imagine that you're using one drug maybe it's the stimulant then you need to come down from that, use the second drug to reduce that, those symptoms, and then you get into a cycle. So figuring out which drug to discontinue first and how do you manage that process, that's the best way to do that. We see this commonly in people who have opioid use disorder. That can be an addiction either to injecting drugs, opioids or taking oral opioids.

Speaker 3:

But there's very high rates of cigarette smoking and or e-cigarette vaping in that population. We know that traditional smoking cessation methods for that group don't work very well. They don't work nearly as well as they do for individuals in the general population seeking treatment for those. So trying to figure out how do we break the cycle of multiple drug use, where do we intervene first, I think would be a really interesting question to answer. But that's part sort of it's a long journey. The other part of it, I think, would be again figuring out whether other wellness behaviors or other modifications to the environment can be effective in reducing drug use.

Speaker 3:

So, again, these are things like better ways to reduce stress, better ways to just live a healthy life daily. Again, it can be really challenging if people are in environments where they may not have the resources or the ability to do those things.

Speaker 2:

Well, thank you so much for your very in-depth introduction of the research that's been done into vaping and vaping addiction. As we get into the weeds a little bit, would you be able to tell us specifically for the audience what exactly considers?

Speaker 3:

a vape.

Speaker 2:

I think when people think of vapes, they might think of many different things, whether a little device that looks like a flash drive, or some might think of an electronic cigarette. What is a vape per se?

Speaker 3:

So they look. They all have a. There's a wide range. So there's a wide range of different designs, different features that they have. They all have some basic similarities. So the key components to them are that there's a battery that supplies the heat, then there's a metal heating element that that battery is attached to and that metal heating element is in contact with a liquid solution. So you activate the battery, it heats up the metal and then it essentially turns this liquid into an aerosol and that's what gets consumed. They all kind of have a different look and feel.

Speaker 3:

So you may have been more familiar with what are called pod type devices. These are things that look like flash drives. They're small, rectangular Sometimes. Those are. Those have gained a lot of popularity in recent years. But there are also larger devices that look more like almost like a deck of cards with a little mouthpiece attached to them. They're much bigger. They also have larger batteries and operated at a higher power and can deliver heavier hits of nicotine from those. And then there are sort of the very old ones that you're not likely to see anymore, that they look and feel like a cigarette and you don't see those because those ones weren't very effective at delivering the drug. People discovered that early on. So there's been many waves of evolution within the industry to try to make the products more effective at delivering the drug. But there's a wide range of the look feel to them, but they're all kind of doing the same thing.

Speaker 1:

I guess in talking about these different vaping of instruments there is a lack of socioeconomic indicators. There was a paper that came out of the School of Medicine that was talking about how vaping didn't have the same social disparities that smoking did and actually vaping was more popular among educated and more affluent. Look, why do you think that is?

Speaker 3:

Yeah, it's a great question. So one thing I can tell you about most people who vape the vast majority have previously had a smoking history. So we're starting to see in the young adult population people who had never smoked and started with vapes. That's a growing cohort, but generally to this point most people started with cigarettes and then if they wanted to try to reduce harm or switch over, they would switch over to vaping products. The issue with vaping products is that before there were disposable products there was a lot more of an upfront cost to purchasing some of these devices, especially the larger devices. There was a little bit more of a larger upfront cost that might have deterred people that had lower incomes because it would be too much to give upfront, and may have been part of the issue. That might change now, now that there's been more of a shift toward disposable types of vaping products that have gained popularity. But I don't fully know the answer to that.

Speaker 1:

Could it be due to the fact that affluent people are more educated of the effects of vaping versus smoking and they are rather attaining to the less comfortable route?

Speaker 3:

It's possible. Yeah, it might be easier for people with more income to simply engage in a behavioral change because, again, less stress, right. So it's harder to make any type of change when you're under stress. So if you have more income, it might simply be easier to shift yourself from smoking to vaping, if that's something that you think might reduce your risk. So that could certainly be part of it. I think, generally, what we know is, again, the more stress you have and the less income, less resources, the harder it is to change your situation. So that could be part of the story.

Speaker 2:

Yeah, I mean we've talked quite a bit about the changes between people going they smoke traditional cigarettes and perhaps move to e-cigarettes besides, as a form of treatment perhaps. What is the research like on that? This has been an issue for I mean, really since e-cigarettes really appeared about 10 years ago their potential therapeutic ability for traditional cigarette smoking. How do people who smoke reacts to treatment with vaping and what else is the research elucidated on this issue?

Speaker 3:

So it's still pretty much outside of the realm of medical practice to do anything under the guidance of a medical professional.

Speaker 3:

So a lot of what happens with regard to switching from cigarettes to e-cigarettes is driven in many ways by individuals themselves.

Speaker 3:

There's growing interest, though, in using e-cigarettes for the purpose of smoking cessation.

Speaker 3:

So the purpose of not using conventional cigarettes and the evidence for the effectiveness of e-cigarettes for that purpose has been growing.

Speaker 3:

There's been one relatively large clinical trial that randomized smokers to either an e-cigarette or conventional nicotine replacement therapy, and they found that the e-cigarette promoted one-year smoking abstinence almost twofold compared with conventional treatment, which would be nicotine patches, nicotine gum. The one caveat to that study was that nearly 80% of the people at the one-year follow-up point were still using e-cigarette products continuously. So it kind of indicated that in order to have successful smoking cessation for many of those people they needed to use their e-cigarette product more on a longer-term basis, which again raises concern for the health effects of e-cigarettes in their own right. So again, when we talk about health effects and risk, we're talking about relative risks and a spectrum of risk. So if you imagine, like on one end of a spectrum we've got a combustible cigarette as a nicotine delivery system, Any cigarette might be lower risk, but then if you compare that with something like, say, smokeless tobacco or nicotine patches, for example, those would be even lower. So it's all sort of one continuous risk spectrum.

Speaker 1:

So I feel like health risks for smoking is a very well-known thing. People know that when you smoke you're going to get lung cancer. Nicotine goes into blood. All these things will affect you if you smoke, but for vaping the health risks aren't that known. So could you maybe discuss what are the actual health risks of vaping?

Speaker 3:

Yeah, definitely. There's definitely health risks. The issue is that the vapes haven't been around for so long such that we can observe things like do they cause chronic obstructive lung disease or do they cause cancer? So we don't know that. We know they certainly cause respiratory symptoms. There's no question about that that they can lead to bronchitis or inflammation of the airways. They certainly again, we don't know specifically about heart disease, but that's an area of concern, given that you're inhaling something into your lungs and then eventually that gets into the small blood vessels in the circulatory system. So is that going to affect the heart? We know that it has effects on the immune system.

Speaker 3:

Certainly in the respiratory tract it modifies the way the immune system works and we know that it can deposit small particles into the small airways in the air spaces of the lung, which again raises that concern of whether it's going to lead to chronic lung disease. Some of the research in terms of understanding the risk is limited by the fact that many people who are vaping had also a smoking history. So when you try to study the effects you don't know if a person developed some condition they were vaping. You don't know. Was it the 10 to 20 years of smoking before that they caused it or was it the vaping? An important group that we'll need to study are the people who have vaped but never smoked a cigarette. When we study those people over a long period of time and see what happens, then we'll get a better sense for what are the actual things that the vaping specifically is causing and how does that compare, both in magnitude and sort of frequency, with cigarette smokers?

Speaker 2:

Yeah, I mean one of the main issues we've come across as well in our other interviews on the podcast as well as a lot of these issues are just very new, right, and there's not quite a bit of, there's just not very much research on them In that regard, right Like, how might the government work on promoting this type of research?

Speaker 3:

as well as in your?

Speaker 2:

you know your experience. How might the government go about limiting? We read an interesting paper. You wrote about the role, for example, that sort of these tax levies had on relatively, relatively not particularly useful in mitigating smoking, I mean in general. What could the government's role be in promoting research or trying to improve the public health in regards to limiting vaping use?

Speaker 3:

Yeah, the government is definitely an active funder of addiction research. We have the National Institute on Drug Abuse, the National Cancer Institute, the National Health Long and Heart Long and Blood Institute. There is a portfolio that they fund for tobacco related research, for tobacco regulatory science, which looks at the specific features of tobacco products for which the government will be able to regulate. It's a long process. So it's the kind of thing again that we need, I think, ongoing work on it, continuing to sort of look and understand what are the major issues and things that cause these products to be both addictive, toxic, and how can we really limit use across the whole population. And again, I think one of the main areas of emphasis has been on.

Speaker 3:

There's two areas of emphasis really.

Speaker 3:

One is in reducing youth uptake, because we know a lot of these problems start in youth, so they start when before kids are grown right.

Speaker 3:

So there might be teens kids age 12 to 18 is a common cohort when these types of problems start. So in many ways we can think of a lot of these drug addiction issues as pediatric conditions that then persist into adulthood. And the other part of it is again in the adult population who smokes, who we know have very high risk of morbidity and mortality. How do we get that population to switch over to something either to discontinue use or, which is less typical generally quit rates? Smoking quit rates are pretty low once you get into adulthood, but if they can't quit, then how do you get them into a harm reduction mode, meaning how do you get them to stop what they're doing but switch to something that is perhaps not without risk but with much lower risk? Those are the types of things I think that government wants to pay attention to and really have policy and fun research to optimize how we're going to accomplish that, because really that's how we're going to get to a much greater state of health collectively.

Speaker 1:

I feel like vaping in comparison to smoking. A lot of people don't really consider vaping as dangerous. Vaping is seen more as a culture thing rather than an actual danger and health risk. So I guess I'm wondering how we get more people to be at first to vaping as you are at first to smoking.

Speaker 3:

Yeah, I think a lot of it is definitely relating to both education. Education is part of the issue, just being aware of the risks, that none of these things are without risk. They all carry risk. But really, again, coming back to figuring out ways to get our environment better, that's a more complicated issue. I know that definitely there's a need to think more about mental health in younger people, especially that critical age in adolescence, when these things tend to start identifying and targeting people who are at risk, trying to intervene and really prevent the problem from happening before it.

Speaker 3:

Once that addiction takes hold, even in a person that's motivated and wants to stop it, can be really, really difficult. So I think to your point. I think we do want to raise awareness of the risks of all of these types of behaviors, but also we have to think about the underlying reasons that are driving it, because it's not just occurring for no reason. There's a reason why people are doing these things, kind of like what we talked about on the beginning of the podcast, but trying to identify what those reasons are and figuring out what better alternatives and what better ways that we can help people to have another path that they can travel on.

Speaker 2:

Yeah, I mean absolutely. I think, as you've emphasized, the best way to prevent or treat this addiction is changing the environment and whatnot. But do we currently, even in that regard, are there any other treatments we might have, like physical, or is it mostly, just as currently, just other methods that people might work with to quit conventional smoking?

Speaker 3:

Yeah, so there's proven treatments for smoking addiction. We've had a lot more research in that problem. Specifically, there are two major ways that we treat that. One is with behavioral interventions and behavioral therapy, which seeks to help people to modify their daily routines, to identify what the triggers are that make them want to do, to engage in that behavior, and then basically figure out alternative routes to take. It's kind of like you want to just go down one path. You're just kind of the automatic behavior in all of us. We all have the habit part of addiction. It's just like you're used to doing something and you associate doing it with these other things and you just do that. So behavioral treatment tries to get you going down a different path. So it's kind of trying to fix the habit.

Speaker 3:

The other component is medication, and so the medication is treating more of the physiologic dependence, the sort of cravings that withdraw symptoms that people might experience when they don't have the drug.

Speaker 3:

Those are sometimes very potent motivators for continuing drug use, and so in the case of smoking any cigarettes, we have various forms of nicotine replacement that are effective to varying degrees for varying people. We have things like nicotine patch, nicotine lozenge gum, so kind of like either. So skin absorption of nicotine or oral consumption as a way to replace that nicotine that they would otherwise get through vaping or smoking. So those interventions haven't really been fully tested in people with vaping addiction, and that's actually something that we're starting to work on here and at other places across the country is trying to figure out what are the best interventions and best ways to treat vaping addiction specifically and that's something that you'll hear a lot more about over the next I think 10 years or so is that people are going to be looking into ways that we can treat this, what interventions that were effective for smoking will be effective for vaping, figuring those out and possibly identifying novel methods for how to do this.

Speaker 2:

Well, yeah, thank you for all your detailed answers. It's always a pleasure to have you on. One thing we really like to do when we have these podcasts is, you know, our goal here with this podcast is to sort of bring these issues, kind of humanize these issues, and ultimately see what the relevance is to people in their day-to-day lives. Right, and so particularly what we like asking is if there's one thing you'd like the audience to know about vaping, what would it be?

Speaker 3:

I think the one thing to know is that it does carry health risk and that when we compare it with smoking, it is likely a much lower risk activity. So there's sort of those two issues so it's sort of like it's not good. But again, if we're looking at smoking as a comparison, then we need to consider that there's again this spectrum of risk and I think the jury is still out on all of the effects that are caused by vaping and that's something that's being actively researched and certainly we're going to be learning a lot more over the next many years on this topic. But I think we just have to acknowledge that it does carry some pretty significant health risks and for people who smoke it might be a way to reduce their harm, their smoking-related harm, if they can't otherwise treat themselves with conventional therapies.

Speaker 1:

All right. The last question we have for you is why are you interested in addiction and why did you want to get into vaping research?

Speaker 3:

I got really interested in addiction from my work taking care of critically ill people. So I was in my training, my critical care training, and it just really started with a simple observation that a lot of really sick people that I was taken care of were suffering these illnesses in large part due to smoking-related illnesses. So they had things like severe end-stage lung disease cancers that were had widely metastasized in their bodies. We had rug overdoses from opioids. We had liver failure from alcohol.

Speaker 3:

It seemed that there was a lot of addiction and a lot of mental health issues that were driving the medical illnesses of many of these patients. And that just got me to really want to learn and want to understand the problem. And what was the driver? Why was I getting these patients and what could I do to prevent their illness? Obviously, once they're in that state, my job is to take care of them in the state they're in, but again taking a step back, thinking about what are the things that are really causing them to become sick and how can I help to have a bigger impact in promoting health. That's one of my goals is to try to promote health, prevent illness. That experience had a very deep impact on the way I understood health, the healthcare system, medical care, and that made me want to study this topic in more detail and learn more and hopefully help advance our state of knowledge.

Speaker 1:

All right, and with that we thank you so much, dr Baldess, for featuring in our third episode of Health Voices.

Speaker 2:

This is Frederick Rivas, georgie from Health Voices. Health Voices is a podcast produced by Spheri and Salmon and Sahil Shabra with support from Yale PHC Vice President Dylan Kim and the entire PHC board. If you have any questions about the podcast or would like to be featured in an episode, please email us at YalePHCpodNews at gmailcom. That is YalePHCpodNews at gmailcom. Thanks again for listening today.