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I was on my evening walk the other day and encountered a classic cigarette butt on the curb. I experienced a pang of nostalgia. My great grandmother smoked two packs of unfiltered tobacco cigarettes daily for 30 years. She died from lung cancer. Once upon a time, getting sick from habitual tobacco use took years. Not anymore.

As the manager for the Chronic Disease Prevention Program at the Department of Health, I work with a dedicated team of health educators, nurses and dietitians. We partner with community-based organizations and health care providers to educate the public on the dangers of tobacco product use. We also provide resources for those wanting to quit, and we fight against the youth Electronic Smoking Device (ESD) epidemic.

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Studies show that between 2017 and 2018, ESD use increased 78 percent among U.S. high school students, and one in 20 middle school students reported using ESDs. Today, “tobacco” products are not just unfiltered cigarettes from my great grandmother’s day. They are cigarettes, cigars, pipe tobacco, chewing tobacco, snuff, snus, plus all ESDs, including e-cigarettes, e-hookahs, mods, vapes, vape pens and other vaping devices (such as JUUL), and e-liquids. ESDs are battery-operated devices that produce an aerosol by heating a liquid contained in a pod or cartridge.

The liquid in these products can have highly addictive nicotine, heavy metals, diacetyl, benzoic acid, cancer-causing chemicals and volatile organic compounds. The liquid and ESDs are available in a variety of flavors, shapes and sizes. The most popular products are sleek compact designs that resemble everyday items, like USB flash drives, ink pens or watches, and they charge through a USB port.

While long-term health impacts are yet to be discovered, acute cases of lung injury are associated with the use of these devices. The latest tally from the Centers for Disease Control and Prevention (CDC) in November 2019 indicates that 49 states and the District of Columbia have confirmed over 2,000 cases of illness, and there have been over 37 deaths related to ESD use. Most who became ill report a history of using tetrahydrocannabinol (THC)-containing products, particularly those obtained off the street. New lab testing of biologic samples from patients with these lung injuries identified vitamin E acetate, an additive in some THC-containing products.

Symptoms of acute ESD associated lung injury typically appear similar to severe cold or flu: coughing, shortness of breath, chest pain, abdominal pain, nausea, vomiting, diarrhea, fatigue and fever. Anyone experiencing these symptoms following the use of an ESD should seek immediate medical attention.

Good news! Effective October 1, 2019, the minimum sales age to purchase all tobacco products in Maryland was increased to 21 years of age, except for those who are active-duty military age 18 and older with valid identification. The T21 law includes sales of all ESDs, component parts and accessories, plus all tobacco products and their accessories. The Department of Health partners with local law enforcement to conduct compliance checks at all county tobacco retailers to ensure Maryland’s tobacco

laws and regulations are being followed. Store employees who sell tobacco to minors receive citations and store owners are fined.

By working with the entire community, we can accomplish our countywide goal of reducing the number of county youth becoming addicted to tobacco or other products containing nicotine.

The Department of Health’s Learn To Live program offers free quit smoking and vaping classes and resources. To learn more, call Learn To Live at 410-222-7979 or visit LearnToLiveHealthy.org.

Christine Bloom, RN, is the manager of the Chronic Disease Prevention Program at the Anne Arundel County Health Department.

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