• Changed demeanor, like mood swings
   
• Frequently stepping away, like asking to go to the restroom a lot at school

“They want to go smoke because they’re addicted already. They need that time. They have to go hide,” says Thompson, a breast health navigator. “Same thing at home. They constantly go to their room or bathroom.”

• New odors coming from your child or their belongings. Williams, a radiation therapist, notes that the smell could be good, like minty.
   
• Listen for kids using new phrases. Vapes are also called hookahs, pens, tank systems and mods.

Adults should also know the changing look of vapes. Boyd says they could be in plain sight in your child’s room, and you could miss them. Vapes can look like computer flash drives, ink pens, key fobs, candy canisters and even handheld video games.

Talking to kids

First and foremost, Boyd suggests taking a loving tone when talking to kids about the dangers of vaping. Don’t start by accusing them of wrongdoing.

“Gather information. Encourage them to open up. Make it a safe place,” Boyd says. “If they don’t feel comfortable talking to mom or dad, maybe try somebody at church, an older sibling, a school counselor or a teacher. Find those accountability people.”

If your child has a hard time opening up, talk to their pediatrician so they can broach the subject at the next appointment. During the appointment, offer to step out of the room so the child isn’t nervous to talk about their habits.

Thompson adds to keep kids active. If you’re playing backyard baseball with them, you know they’re not vaping.

“We want you to be healthy and live a long life,” she adds, suggesting words to use with your child. Not to mention the money you’ll save.

What about smoking?

How does smoking a traditional cigarette or cigar play into all this?

Boyd says some people see vaping as a way to quit smoking. She says that’s a bad idea. Talk to your health care provider instead about medication and other options.

At OSF Moeller Cancer Center, Boyd, Thompson and Williams offer a smoking cessation program. Providers can refer patients to the program, or they can self-refer by calling (618) 474-6791. OSF then connects the person with resources to quit and provides regular check-ins. Schools, businesses and community groups can also call to see how they can benefit from the program.

“Working on oncology, we see the back end. We see patients who have been 30-year smokers. They have a CT scan, and they find an abnormal mass,” Thompson recalls. “So we try to catch them early. We have younger patients who are seeing their primary care provider. Their provider says they’ve been smoking for five years, and they put the referral in. Well, we just saved them 25 years of smoking if we can get them to stop now.”

“Don’t see it as a failure,” if you can’t quit right away or if you relapse and smoke a few, Boyd adds. “Try again. We’re not all made the same. Quitting looks different for everyone”

Interview clips - Karen Boyd

Interview clips - Heather Thompson

B-roll

On a low-dose CT scan for lung cancer: “It can catch lung cancer early. Lung cancer doesn’t have defined symptoms like colon or breast cancer,” Huelskoetter says. “A lot of times, you catch those nodules early and monitor them yearly or every six months based on what the radiologist finds. Then we can get you scheduled for routine low-dose CTs.”

She adds that this exam is geared toward smokers, but you can always bring it up with your provider.

What about kids?

Huelskoetter says children should see a provider at least once a year for a physical exam and to get caught up on vaccines, if needed.

“Make sure the provider records their height and weight. The provider will do an eye exam, an ear exam and things like that,” Huelskoetter outlines. “We want to make sure we’re not missing anything. A lot of times, eye problems in children can be caught in school. But maybe the child isn’t school age yet. We can get them in, do an exam and maybe catch something early.”

At home

Health care doesn’t end when you leave the clinic. Warm temperatures during spring can bring a renewed sense of optimism about changing daily habits.

“One thing I always tell my patients: move your body,” Huelskoetter implores. “I’m not saying you need to go to the gym and do pushups, sit ups and deadlifts every day. Just move your body. Start at a pace that’s good for you. If you have a sedentary job or lifestyle, get a step counter or smartwatch to track your steps and see where you’re at.”

For example, Huelskoetter says if you’re at 2,000 steps a day, set a goal of 10,000. But start small. For the first month, aim for 3,000 steps a day. Then increase it to 4,000, and so on. You can accomplish this, she says, through 30 minutes of exercise for five days a week.

“This can lead to drastic improvements in your cardiovascular health, your mental health and your overall physical well-being,” Huelskoetter says. “Your joints won’t be as stiff because they’re used to movement.”

Exercise should be paired with healthy food choices, such as cutting back on processed food.

Spring might also be the time you say, “I’m finally going to quit that unhealthy habit,” like smoking.

Huelskoetter’s response? “Now’s the time. Let’s do it,” she says.

“Again, let’s start small. Get an appointment with your provider, and talk about options,” Huelskoetter suggests. “If you don’t feel you can quit cold turkey, which is extremely hard, there are options like Wellbutrin, Chantix or nicotine patches and lozenges. Sometimes we’ll even do cognitive behavioral therapy.”

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"Anyone that has lungs has a chance of lung cancer,” says Jun Zhang, MD, PhD, vice president of oncology research with OSF HealthCare Cancer Institute.

In fact, 10-20% of lung cancer patients are people who have never even smoked, Dr. Zhang adds. 

"Lung cancer is generally referred to as a 'smoker's disease.' But it turns out now that we're seeing more lung cancer patients without a history of smoking," Dr. Zhang observes. "If we put lung cancer in patients who have never smoked in a separate category, this can be listed as the number five cancer killer in the world." 

This translates to roughly 40,000 Americans every year being diagnosed with lung cancer, despite never smoking cigarettes. 

Women of Asian descent who don't smoke tend to be impacted more by this, Dr. Zhang says, compared to the rest of the population. Research shows that 57% of Asian American women diagnosed with lung cancer have never smoked. Based on this, in a recent study called FANS (Female Asian Never Smoker), researchers at the University of California San Francisco (UCSF), UC Davis and Stanford University are investigating why Asian American women who have never smoked develop lung cancer at unusually high rates compared with other populations.

Sadly, Dr. Zhang says, people who present with lung cancer but have never smoked, are presenting at a later stage. 

"Those patients present to us, at least at my clinic, and they already missed the chance of an early diagnosis. Early symptoms can be cough and shortness of breath, but quite often people are not paying attention to this because they don't smoke and they don't have a chance to get screened," Dr. Zhang says. "That's the sad story, that even though they've never smoked, at the time when they're diagnosed with lung cancer, it's almost always at late stage." 

So, why is this happening? Dr. Zhang discusses five main reasons that non-smokers are getting diagnosed with late-stage lung cancer. The top two culprits will be laid out in this article, with three more to come in part two.

#1: PM2.5 (Particulate Matter)

PM2.5 is the top contributor to non-smokers diagnosed with lung cancer worldwide. The U.S. Environmental Protection Agency (EPA) describes PM2.5 as fine inhalable particles, with diameters that are generally 2.5 micrometers and smaller.

"If you inhale the particles, you cannot get them out of your body. It can get into your lungs, be trapped there, and even get into your circulation and cause problems," Dr. Zhang says. "If we're thinking about cigarette smoking as the number one reason for lung cancer, globally PM2.5 is the second most common reason for lung cancer." 

In the United States, the EPA sets and reviews national air quality standards for PM2.5.

The Upper Midwest region has been below the national average for many years, and according to the EPA, has seen an improvement in air quality since at least 2000. The EPA's national standard is set at 9.0 micrograms per cubic meter. Dr. Zhang says for every 10 microgram per cubic meter increase, it increases lung cancer mortality by 20%.

Some areas in the world can be up to 100 micrograms per cubic meter; Dr. Zhang points out. Vehicle exhaust and industrial emissions along with outdoor fires contribute to these levels. 

The American Cancer Society (ACS) reports lifetime exposure to PM2.5 might increase the risk, and even speed up the onset of various cancers, including lung cancer.

#2: Radon levels in the home

While high PM2.5 levels are the #2 cause of lung cancer worldwide, here in the United States, the second-leading cause of lung cancer (next to smoking) is due to high radon levels. 

According to the ACS, radon is a colorless and odorless radioactive gas. Radioactive elements such as uranium found in soil and rock break down, then move the radon gas from the soil and rock into the air, ground water and surface water.

When radon breaks down in the air, it gives off radiation that can damage DNA in our cells.

“Radon is released by radioactive materials underground, but then they accumulate in the house, especially if it doesn't have good ventilation," Dr. Zhang says. 

The U.S. Centers for Disease Control & Prevention (CDC) says testing for radon in your home is the only way to know if levels are high. It’s recommended to get this testing done before or as soon as you move into the home.

Dr. Zhang says findings like this argue for expansion of lung cancer screening criteria. 

He adds that if you have any concerns like lingering cough that lasts for multiple weeks, especially with shortness of breath, talk to your primary care provider (PCP). You can get a chest X-Ray to make sure you don't have pneumonia.

GERD (acid reflux) and some heart issues could also be a possibility, and these are important to check out. If none of these things exist, this is where patients should advocate for themselves and ask for a CT scan to check for lung cancer that can show if a nodule or mass is present.

To learn more about the Lung Cancer Program at OSF Cancer Institute, or to schedule an appointment, visit the OSF HealthCare website.

Video Interview Clips

The Great American Smokeout rolls around every year during the third week of November and it has helped millions of people quit since it started in the early 1970s. The idea is not necessarily to make people stop cold turkey on that day, but rather to have tobacco users begin to think about quitting or to start the process if they plan to make it their quit date.

The campaign is important because according to the American Cancer Society, smoking causes more than 480,000 deaths every year, or about one in five deaths. More than 16 million Americans live with a smoking-related disease.

Dr. Jesse VanLe, a cardiothoracic surgeon for OSF Cardiovascular Institute in Bloomington, Illinois, is a strong supporter of the Great American Smokeout, which will be Thursday, November 18.

Smoking harms almost every tissue and organ in the body, including your heart and blood vessels. Nicotine, one of the main chemicals in cigarettes, causes your heart to beat faster and your blood pressure to rise. Carbon monoxide from smoking also gets into the blood and robs your body of oxygen.

According to Dr. VanLe, those who smoke have good reason to worry about its effect on their health.

“The World Health Organization has estimated that the number of cardiovascular associated events is approximately 17 to 18 million per year attributed to smoking,” he says. “A person who is 40 years old who smokes, they'll have approximately nine years taken off their life by the time they reach 60 to 70. Nine years, which is a lot.”

Despite the data, quitting isn’t easy for most smokers. According to research offered by the Illinois Quitline, it can take the average person five to seven times before they quit for good. Dr. VanLe says it is important not to get discouraged, and suggests surrounding yourself with supportive family and friends and changing habits that can trigger the urge to smoke.

“The population that has the most success would be the one not exposing themselves to the advertisements: other people who smoke for example, not visiting the bar anymore, or they have a very strong family system that helps them out and encourages them to quit. At first it is very difficult, but if you can do it after six months, with strong family support, and change the environment, then you'll be more successful,” says Dr. VanLe.

Over time people who quit smoking see many benefits to their health. According to the Centers for Disease Control and Prevention (CDC), some benefits of quitting even start immediately after that last cigarette. Within minutes a person’s heart rate will drop, in 24 hours the nicotine level in the blood drops to zero, and in a matter of days the carbon monoxide level in the blood drops to a level of someone who does not smoke.

“Some process takes longer than others but we know the chemicals and everything can be reversed within five years. And that's a tremendous amount of reversal in terms of coronary occlusive disease that you can do. So let's start from day one. You can measure the difference,” encourages Dr. VanLe.

Here are some good guidelines for what kind of nicotine replacement therapy you might want to try to address the physical addiction. Along with counseling, the Illinois Tobacco Quitline offers up to six weeks of free nicotine replacement therapy (NRT) to enrolled clients who qualify.

As for using e-cigarettes to quit smoking, Dr. VanLe says there isn’t enough research to know the long-term, potential harmful impact. He also points out the Federal Food and Drug Administration hasn’t approved the devices as a smoking cessation tool because of the lack of research connected with their use.

The Illinois Tobacco Quitline is 1-866-QUIT-YES. It can offer a variety of support and helpful tools. You can also find an OSF HealthCare behavioral therapist or doctor who can help you quit smoking or end smokeless tobacco use.

Interview Clips - Dr. Jesse VanLe

B-Roll - Smoking

A brawl is brewing between government regulators and the manufacturer of the best-selling e-cigarettes in the United States. The U.S. Food and Drug Administration (FDA) has agreed to pause its ban on products from vaping company Juul while the government reviews the company's electronic cigarettes. 

The FDA had banned the marketing and sales of all vaping products produced by the company, a decision that was appealed by Juul, yet applauded by health care professionals. 

“Why would we inhale anything in our lungs except good clean air?” remarks Dr. Patrick Whitten, an OSF HealthCare pulmonologist in Peoria, IL. “So it's just yet another step in the right direction to try to get people not to put anything in their lungs this damaging.”

The FDA claims Juul’s application for authorization lacks enough details about the chemical makeup of its vaping formulas, and doesn’t significantly prove that its e-cigarettes help adult smokers quit or reduce their smoking. 

Another concern of government regulators and health care providers alike is the increase in teen and adolescent vaping, and what Juul Labs, which is owned by Altria Group Inc., the maker of Marlboro cigarettes, is doing to prevent it. 

“The cigarette companies realize that it's important for them to get people hooked on these products because cigarettes kill people and if they kill their consumer, they have to replace that consumer or else they don't have a business model,” says Dr. Whitten. “So this despicable business model is to get younger smokers or younger people hooked on their products to continue to use. If they don't replace their consumers that they're killing off, they have no business.”

As the battle between the FDA and Juul continues in the courtroom, Dr. Whitten urges parents to be proactive at home. 

At high doses, nicotine can cause dizziness and vomiting. Users who refill their own cartridges are especially at risk for unsafe levels of the drug. Even more concerning, young children have been poisoned after coming in contact with the nicotine-containing liquid. Teens who use e-cigarettes may become addicted to nicotine, which can harm their developing brain. There’s also concern they may start smoking regular cigarettes. 

According the U.S. Centers for Disease Control and Prevention (CDC), in 2021, about one out of every 35 middle school students and one of every nine high school students reported that they had used electronic cigarettes in the past 30 days.

Dr. Whitten says a parent’s open and honest communication with their kids can help pave the way to a smoke and vape-free future. 

“Education is the key here,” he explains. “We can all learn things from each other, right? So even for our own kids, who we think are not going to be doing things like vaping, information is so important. So why they shouldn’t do things like that. So it's good to have that open dialogue between the parents and the kids.”

When it comes to both vaping and smoking, the top takeaway, according to Dr. Whitten, is to not start. And if you are a smoker to quit. He says it’s never too late – even for life long smokers. 

“It’s never, never too late to quit. When someone quits smoking, even within hours, some of the respiratory cells start to heal themselves a little bit. And you do reduce your risk for lung cancer over time. It's not back to zero, but you do decrease some of that risk if you quit smoking.”

For help quitting smoking, speak with your primary care physician. OSF HealthCare also offers structured programs to help individuals who want to quit. To learn more visit osfhealthcare.org and search “smoking cessation.”

Interview Clips - Dr. Patrick Whitten