Playa Vista smoking cessation clinic tailors program to e-cigarette users trying to quit

By Gary Walker

Cedars-Sinai pharmacist Ching Chow is tailoring smoking cessation classes to help people hooked on vaping Photo Courtesy of Cedars-Sinai Medical Center

Vaping — the use of electronic cigarettes for tobacco and marijuana consumption — is up 135% among teenagers in Los Angeles County over the past two years, according to the American Lung Association, fueling a public health crisis facing doctors and government officials.

The shift in how people smoke is also impacting how people quit.

Cedars-Sinai Medical Group clinical pharmacist Ching Chow has been holding smoking cessation programs in Playa Vista and Culver City for several months, and recently added vaping cessation amid news reports of a spike in serious lung injuries among e-cigarette users. The classes cost $25, and so far she’s had about 60 takers.

“Vaping has just increased our patient population that we need to help with quitting,” Chow said. “People do understand more [of the dangers] now, especially with recent news reports. It seems that vaping is causing more health issues with patients ending up in the hospital on ventilators. The ingredients in the oils that are vaped seem to be more harmful than cigarettes.”

Cessation techniques are similar for vaping and smoking, but one major difference is that it’s harder to know how much nicotine a vaper has been ingesting, which requires Chow to be very detailed in her conversations with patients.

“It’s easier to quantify with cigarettes because you just count the number of cigarettes smoked each day. With vapers, it varies depending on how many cartridges they go through, the brand and concentration of nicotine,” she explained.

Chow says a small percentage of patients are in their forties, but the vast majority of them are people in their twenties who initially believed vaping was safer than smoking. According to the Pew Research Center, about 20% of Americans ages 18 to 29 reported using e-cigarettes, compared to 8% of those ages 30 to 64 and and fewer than 1% of those 65 and older. In the same study, those who believed vaping is “less likely to be harmful to one’s health” than smoking tended to be in the 18
to 29 cohort.

“We must be crystal clear with young people: e-cigarettes and vaping products are not a healthy alternative to smoking. They can be dangerous, cause injuries and illnesses, or even death,” said Vanderbilt University Medical Center Dr. Kaitlyn Works, the lead author of a recent American College of Emergency Physicians study on vaping.

Late last year the Los Angeles Unified School District sued JUUL Labs Inc., accusing the Bay Area e-cigarette company of contributing to a rise in student absences, which results in losses of state funding for the district.

LAUSD Supt. Austin Beutner told The Argonaut that some students commonly refer to school restrooms as the
“JUUL room.”

“It’s an epidemic in our schools. We hear from our educators how [vaping] is taking time away from student learning, and we see it when students are in rehab and are absent. We hear from students that their peers are struggling with this epidemic and we feel that we have an obligation to do what we can to help our students and their families,” Beutner said. “We’re frustrated that policymakers haven’t taken a more proactive approach.”

Meanwhile, proposed legislation authored by state Sen. Jerry Hill (D- San Mateo) would outlaw the sale of all flavored tobacco products, including e-cigarette products such as JUUL pods.

Assemblyman Richard Bloom (D- Santa Monica) is a co-author of that bill and is disturbed by the vaping-related surge of young tobacco users.

“We know that it has a very deleterious effect on a young person’s health. It’s disheartening because we’re in an ongoing battle with the tobacco industry. We’re making great progress on getting people to stop smoking, and then along comes the industry with vaping,” Bloom said.

Chow’s vaping cessation strategy includes identifying triggers for vaping such as anxiety, boredom, peer pressure or environmental factors and creating an individual plan to reduce nicotine reliance on the path to quitting.

“We tell people not to quit cold-turkey because it’s much harder,” she said. “We address their physical addiction, talk about ways to avoid certain triggers and develop individual plans to quantify how much a person is using in order to
taper down.”

Chow might recommend nicotine replacement gum, patches or lozenges, and sometimes she’ll seek out a prescription for the antidepressant Wellbutrin, which is commonly used by smokers trying to quit but is considered an “off-label” use for vaping cessation and requires consultation with a primary care physician.

As with cigarettes, vaping withdrawal symptoms include headaches and anxiety swings, and Chow acknowledges some of her patients relapse but many who do stick out the program ultimately succeed.

“Most people are able to quit smoking or vaping after one or two months in our classes,” she said. “Motivation is an important factor. You have to be ready to quit.”