Monday, March 11, 2019

Teens who use flavored e-cigarettes more likely to start smoking

Are you taking care of someone who seems to be against you? This can be the experience of taking care of a family member with post-traumatic stress disorder — PTSD — and it can take a huge toll on everyone involved. At the same time, caring for a person with PTSD can be an act of love and courage.
What causes PTSD?

PTSD can develop when people experience massively stressful events that involve childhood physical or sexual abuse, being sexually assaulted, or narrowly escaping getting killed or severely injured, whether from accidents or violence or military combat. PTSD can also be caused by witnessing these kinds of things, by them happening to a close friend or relative, or by learning about them in the course of one’s work, such as being a first responder or a social worker helping victims of abuse.
What are the effects of PTSD?

Whether caused by experiences during military service, abuse as a child, being the victim of assault as an adult, or as a side effect of jobs that deal with trauma, the effects can be lifelong. It’s a medical problem, not a weakness. Adrenaline levels stay elevated, causing anxiety, irritability, and hypervigilance (being on guard even in safe places). People with PTSD may become snappy and even physically aggressive. Little, everyday sounds may make the person jump. The ability to feel positive emotions like love and happiness is diminished, and people with PTSD may drink or use drugs to avoid painful feelings and memories. People with severe PTSD may isolate themselves, lashing out and showing little affection toward people they care about, and who care for them. Conflict with family members and coworkers is common.
Caring for a person with PTSD

It can be hard for caregivers not to take it personally. They feel that their loved one doesn’t love them anymore (and indeed it’s difficult for some people with PTSD to feel and express love). The fun is gone, and in romantic relationships so is the intimacy. The family member with PTSD may not be comfortable going out in public or being touched. Caregivers can feel lonely and abandoned, and divorce is common in relationships where a partner has PTSD.

Watchwords for caregivers are self-care, limits, and realistic expectations. It’s a balance: you want to help your loved one but you can’t do that if you’re impaired yourself. So, self-care is important. Figure out what you need to have a happy and healthy life and make an effort to keep those things in your life. Eat right, get exercise, take time off from caregiving, see friends. When you’re healthier, you’ll be better able to help your family member to be healthier.

Set limits. You want to offer gentle support, but not tolerate things that are out of bounds for you in any other relationship, such as abusive language or actions, or heavy substance abuse. Couples therapy can be tremendously helpful when one member of the couple has PTSD.

Expectations need to be realistic. Just as other medical disabilities can limit the activities of people who have them, you may need to adjust your expectations about your loved one’s engagement in “regular” family things like going on outings, to restaurants, to parties, to your kids’ games. You may need to take more of a lead in the relationship than you used to or expected to, such as in managing finances, making plans, and getting things done.
The good news? There are effective treatments for PTSD

The good news is that we live in a time when effective PTSD treatment exists. PTSD is best treated through cognitive behavioral therapies, particularly exposure therapy and cognitive processing therapy. These are specialty treatments and not all mental health clinicians are trained in them. A loved one with PTSD may be reluctant to seek treatment, and gentle encouragement can be helpful. You can find therapist referrals at the International Society for Traumatic Stress Studies and the Association for Behavioral and Cognitive Therapies.

PTSD symptoms may not completely go away, but they can be reduced. Just like turning down a volume knob, constantly high levels of anxiety or irritability can be lowered, and the power of memories and reminders of trauma can be reduced. Just like in the rest of your body, advancing years can take a toll on your brain function. Much of this slowing down is predictable and can be chalked up to normal aging. However, when thinking skills become increasingly fuzzy and forgetfulness gets to be a way of life, an early form of dementia known as mild cognitive impairment may be setting in.

Often, the first reaction is to attribute these changes to the beginning of Alzheimer’s disease. But blood flow problems may be to blame, as well. “An estimated one-third of all cases of dementia, including those identified as Alzheimer’s, can be attributed to vascular factors,” says Dr. Albert Hofman, chair of the department of epidemiology at the Harvard T.H. Chan School of Public Health.
Heart health and brain health are connected

Vascular — blood vessel — problems include atherosclerosis (the buildup of fatty plaque in the arteries) and arteriosclerosis (the stiffening of arteries with age). Both are well-known contributors to heart disease. These same processes can also damage brain function by interfering with the steady supply of oxygen-rich blood that nourishes brain cells.

In the case of a stroke, sometimes called a “brain attack,” large swaths of brain tissue die when a blood clot in a major brain artery abruptly halts the flow of blood. In addition to suffering immediate damage from a stroke, roughly one in three stroke survivors will eventually develop dementia.

More subtle injuries are caused by tiny blockages in the small vessels deep within the brain. These silent strokes are 10 to 20 times more common than overt strokes. The microscopic damage they leave behind also raises the risk that dementia will emerge at a later date.

Having blood vessels compromised by plaque buildup can also pave the way for Alzheimer’s. The accumulation of deposits of a protein known as beta-amyloid — the hallmark of the disease — is a direct consequence of what doctors call hypoperfusion. This means the brain is not getting a sufficient supply of blood over the long term. Because of these overlaps, says Dr. Hofman, it doesn’t make sense to draw sharp distinctions between Alzheimer’s and vascular dementia.
Protect your heart and your brain

As with heart health, a key step in maintaining your cognitive abilities is to reduce your major cardiovascular risks. This includes getting regular physical activity, quitting smoking, managing blood sugar and blood cholesterol levels, eating a healthy diet, and maintaining a healthy weight.

Of particular importance is keeping high blood pressure in check, especially in middle age. High blood pressure is the leading cause of stroke. It is also thought to stimulate the growth of micro-injuries in the white matter of the brain. The presence of these lesions can slow thinking and hasten the loss of cognitive function that accompanies Alzheimer’s. When I talk to teens in my practice about cigarettes, what I hear from lots of them is that the smell is what keeps them from smoking. They don’t want to smell like cigarette smoke, and they don’t want that taste in their mouth, either.

But what if the smell, and the taste, were good? What if they tasted like bubble gum, or chocolate?

In a study published in the journal Pediatrics, researchers looked at data from the 2014 National Youth Tobacco Survey. They found that among teens that had never smoked cigarettes, 58% of those who had used flavored e-cigarettes planned to start.

That number was 20% for teens who had never used e-cigarettes. It was 47% among those who had used non-flavored cigarettes, which is a high number too. Clearly, teens that use e-cigarettes are more likely to start smoking.

But when the e-cigarettes were flavored, the teens were less likely to think of tobacco as dangerous.

E-cigarettes and tobacco are different, of course. E-cigarettes do not have many of the carcinogens that cigarettes do, and could be useful for smokers who are trying to quit. But for teens that have never smoked, it’s a different story. The “vapor” of e-cigarettes doesn’t have to contain nicotine, but it can (it does contain chemicals such as formaldehyde that could have long-term health consequences) — and nicotine is addictive. Using e-cigarettes is physically close enough to smoking cigarettes that moving from smoking one to smoking the other could easily happen.

The use of e-cigarettes among youth has grown tremendously over the past few years — and e-cigarettes are being marketed to them. We don’t know what the consequences of this will be. It could be that we will end up with more smokers — or that we’ll end up with fewer if teens decide to stick with e-cigarettes, especially if they choose to stick with the nicotine-free kind. But we can’t just sit back and wait to see what happens.

Recently the Food and Drug Administration extended its tobacco regulations to include e-cigarettes and other nicotine delivery systems, which among other things, requires that there be warning labels and that you have to be at least 18 years old to buy them. This is a good start, and will help us look more carefully at how e-cigarettes are being marketed, too.

We need to do more research to understand the short-term and long-term effects of e-cigarettes on our youth. We need more information in order to make the best policy and parenting decisions.

All of us who are raising or interacting with teens need to talk with them more about e-cigarettes. We need to understand how teens think about them, and why they might choose to use them; when it comes to teens, listening is really important. And along with listening, we need to help teens understand the risks involved. We can’t let them get distracted or seduced by marketing and flavoring; we need to help them make the best choices for their health.

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