What you should know about vaping and e-cigarettes | Suchitra Krishnan-Sarin

譯者: Lilian Chiu 審譯者: NAN-KUN WU

"It gets easier, right?"

「以後就會越來越容易，對吧？」

These are the words I often hear from young parents

我常常聽到為孩子擔心的新手父母

who are new to the game of worrying about their children.

會說這樣子的話。

I tell them that it doesn't.

我告訴他們，不會越來越容易。

It gets different,

會變得不同，

but there's always something to worry about as parents.

但，身為父母，總有要擔心之處。

I remember how I would lie half-awake at night

我還記得，晚上我會 保持半睡半醒，

listening to my son breathe

聽著我兒子呼吸，

when he was young and had asthma,

那時他很小，又有氣喘，

and then, when he was a teen,

他成了青少年後，

until I heard the front door chime open,

我也要等到我聽到 前門打開的聲音，

and I knew that he was home safe.

知道他安全回家了，才能入睡。

Worrying about our kids comes with the territory.

為孩子擔心，是無可避免的事。

Now, many of these worries are about basic issues,

許多這類的擔心和基本議題有關，

like what they eat, where they are, who they're with.

比如他們吃什麼、他們在哪裡、 他們和誰在一起。

But we also need to keep an eye on new behaviors and fads.

但我們也得要留心 新行為和一時的狂熱。

The latest craze is something that may not yet be on everyone's radar

大家可能還沒有察覺，最新的時尚

as a serious health concern,

其實是個嚴重的健康問題，

and that is the newfound popularity of vaping,

那就是新流行的吸電子菸，

or inhaling sweet aerosols

或是說，吸入電子香菸中

produced by vaporizing e-liquids in e-cigarettes.

電子液體因氣化所產生的霧氣。

E-cigarettes, or "vapes," as they are commonly called,

電子香菸，或一般常說的 「電子霧化器」，

are flying off the shelves like candy.

熱賣的程度不輸給糖果。

This year, the e-cigarette market is expected to drive

今年，預期電子香菸市場會帶動

26 billion dollars in sales worldwide.

全球 260 億美元的銷售額。

Over the next six years,

在接下來六年，

that volume is expected to double.

預期銷售量會加倍。

We have a lot of serious concerns about the health impact of vaping,

對於吸電子霧化器對健康的影響， 我們有許多的重大擔憂，

and unfortunately, not nearly enough answers.

不幸的是，卻完全沒有足夠的答案。

This becomes even more concerning when you think of who uses e-cigarettes.

如果想想是誰在使用 電子香菸，就更讓人擔憂了。

E-cigarette use, at least in the US,

至少，在美國，電子香菸的使用

has grown rapidly among youth and young adults --

有快速成長的族群 包括青年和年輕人——

our kids,

我們的孩子，

our most vulnerable population.

我們最脆弱的人口。

There was a 900 percent growth in the use of e-cigarettes by youth

從 2012 年到 2015 年，

青年的電子香菸使用增加了 900%。

between 2012 and 2015.

The most recent estimates suggest

最近的推估數字指出，

that approximately 3.6 million high school and middle school students

美國有近 360 萬名高中生及國中生

have used e-cigarettes in the US.

使用過電子香菸。

Now, e-cigarettes were originally created

原本發明電子香菸的用意

to offer smokers a cleaner form of nicotine

是要提供較乾淨的 尼古丁給抽菸者，

to help with their cigarette addiction.

來協助他們的菸癮。

In the US, these devices come under the FDA's jurisdiction

在美國，這些裝置受 食品及藥物管理局管理，

as a tobacco product.

分類為菸草製品。

But the science on these devices has not been able to keep up

但這些裝置的科學還無法趕上

with the rapid market growth,

快速的市場成長，

so regulations on the components of these devices and e-liquids

所以，這些裝置的成分 及電子液體的相關規定

are lagging.

是落後的。

Current regulations do restrict sales of these devices

目前的法規確實會限制 這些裝置不可銷售給

to anyone under the age of 18,

十八歲以下的人，

but these do not seem to have had much of an impact

但這些規定似乎不太能夠影響到

on the explosion in the use of these devices by teens.

青少年大量使用這些裝置的狀況。

You know, the first time I heard of and saw an e-cigarette,

我第一次聽到、看到電子香菸時，

I knew right away that teens would love it.

我就馬上知道，青少年會很愛它。

These devices are technology on a stick,

這些裝置是根狀的技術產品，

a perfect fit for the smartphone generation --

完全符合智慧手機世代的喜好——

small, rechargeable, easy to use, easy to modify, nice smelling --

體積小、可充電、容易使用、

容易修改、很好聞——

some even sync with your smartphone to let you know how much you have vaped.

甚至有一些還能和你的智慧手機同步， 讓你知道你吸入了多少量。

Even I was very drawn to these very clever devices.

就連我都覺得這些非常 聰明的裝置很吸引人。

And since I had spent a long time researching teen and adult addictions,

我花了很長的時間在研究 青少年和成人的成癮，

I immediately realized that these devices fit perfectly into the teen psyche.

所以我馬上知道， 這些裝置會非常得青少年的心。

Teens are impulsive, and they love to try new things.

青少年是衝動的， 他們喜歡嘗試新事物。

They're also craving independence, and they love to make things their own.

他們也渴望獨立， 他們喜歡有自己的東西。

E-cigarettes meet these needs perfectly

電子香菸非常能滿足這些需求，

by allowing them the chance to both innovate and personalize

讓他們有機會可以創新

並個人化他們的 吸電子霧化器體驗。

their vape experience.

They can choose from over 15,000 different e-liquid flavors

他們有超過一萬五千種 電子液體口味可以選擇，

and multiple nicotine concentrations.

還有多種尼古丁濃度。

They can even create their own nicotine flavor combination.

他們甚至可以組合創造出 自己的尼古丁口味。

They can change how much vapor is produced from these devices

他們可以改變從這些裝置 產生出多少噴氣，

by modifying the puff volume and the constituents

只要修改噴出量和成分，

and the power and temperature of the devices.

以及裝置的功率和溫度即可。

They can even use these devices for "cloud chasing."

他們甚至可以用 這些裝置來做「追雲」。

Cloud chasing, also called vape tricks

追雲是吸電子霧化器的技倆， 或是抽菸的技倆，

or smoke tricks,

involves producing large vape clouds with quirky shapes and names,

要產生出各種形狀 和名稱的大型煙霧雲，

like rings, dragons, ghosts ...

比如戒指、龍、鬼魂……

Cloud chasers can even participate in cloud competitions

追雲者甚至可以參加雲競賽，

and win prizes for creating the most innovative shaped clouds.

創造出造型最有創意的雲 就能贏得獎項。

Teens can also change the strength and throat hit from the vapor

青少年也可以改變 煙霧的強度和喉韻，

by either vaporizing the e-liquid at higher temperatures

只要用較高的溫度 將電子液體氣化，

or dripping the e-liquid directly onto a heated coil.

或是將電子液體直接 滴在加熱後的線圈上。

They can even use these devices for marijuana vaping.

他們甚至可以用這些裝置來吸食大麻。

And since the devices use lower temperatures

因為這些裝置用的溫度比較低，

and do not combust or burn the marijuana,

不會燒掉或燃燒大麻，

they can do this very discreetly,

所以使用起來能更不易被發現，

without the distinctive smell of burnt marijuana.

不會有燃燒大麻時 產生的獨特味道。

So they can really make these vape experiences their own,

所以他們真的可以製造出 自己的吸入體驗，

which may explain the astounding rise in the use of these devices by youth.

這點或許可以解釋青年的使用量 為什麼會極劇增加。

E-cigarettes are technically a very simple device.

在技術上，電子香菸 是非常簡單的裝置。

There is a receptacle for the e-liquid which can be a tank, a pod or a plug.

有一個裝電子液體的容器， 可能是個槽、煙彈，或栓。

There is a battery that charges the coil, which then vaporizes the e-liquid.

有一個電池，供電給線圈， 線圈接著會把電子液體氣化。

And then there is a mouthpiece,

接著有一個吸嘴，

where the user can actually draw from the e-cigarette.

使用者可以透過吸嘴 來抽電子香菸。

In 2017, there were 466 e-cigarette devices in the marketplace.

2017 年，市場上有 466 種電子香菸裝置。

These range from cigarette-like devices which are also called "cigalikes"

這些裝置從類似香菸的裝置， 也稱為「香菸型電子菸」，

to tank systems, which are also called "pens."

到儲油槽系統， 也稱為「筆型電子菸」，都有。

And then there are modified devices, which are also called "mods."

接著，還有修改過的裝置， 也稱為「改造電子菸」。

Mods look nothing like a cigarette,

改造電子菸看起來完全不像香菸，

and they come in various shapes and sizes,

有各種形狀和尺寸，

with different kinds of attachments and user adjustments.

還有不同類的附加裝置 和使用者調整。

They're very popular for cloud chasing.

它們是追雲用的熱門選擇。

The most recent entrance into the marketplace

最近期才進入市場的是煙彈裝置，

are the pod devices,

which contain the e-liquid in a pod.

電子液體被放在一個艙內。

These are very popular, by the way, among teens.

順便一提，青少年很流行吸煙彈。

An example of this is the Juul,

其中一個例子是 Juul，

which not only looks like a USB device

它不只看起來像是 USB 裝置，

but can also be plugged into a USB outlet to charge.

還能夠透過 USB 來充電。

Many teens do not even think that these are e-cigarettes,

許多青少年甚至不認為 這些東西是電子香菸，

which has led to the use of terms like "juuling" instead of "vaping."

所以他們會說比如「吸 Juul」， 而不是「吸電子香菸」。

Many of these devices are so discreet and produce so little vapor

許多這類裝置考慮周到， 產生非常少量的煙霧，

that teens are using them in classrooms

青少年甚至可以在教室使用，

and hiding them in objects like Sharpie pens, their clothes,

藏在物品當中， 比如簽字筆、衣服、書。

their books.

Now, many teens think that these devices produce water vapor,

許多青少年認為這些裝置 產生的是水蒸氣，

and therefore, they are safe to use.

因此，使用上很安全。

But this could not be further from the truth.

但，這實在是大錯特錯。

What is produced is not even a vapor,

產生出來的根本不是煙霧，是氣霧劑，

it's an aerosol,

and let me tell you, the difference is quite pronounced.

讓我告訴各位，差別相當明顯。

Aerosols contain many finely suspended particles of liquids and gases

氣霧劑含有許多液體 和氣體的微細懸浮粒子，

that are created from whatever is in the e-liquid.

是由電子液體中的成分所產生的。

So an aerosol could contain propylene glycol and glycerin,

所以氣霧劑可能含有 丙二醇和甘油，

which are solvents in the e-liquid.

它們是電子液體中的溶媒。

Now, these solvents are known to be safe for edible use,

我們已經知道食用 這些溶媒是安全的，

so for use in products that you eat,

可以用在你攝入的食物中，

but we know very little about their safety following long-term inhalational exposure.

但如果是長期吸入式的暴露， 我們的所知就甚少了。

The e-liquids can also contain alcohol,

電子液體也有可能含有酒精，

sometimes in high levels,

有時含量很高，

and inhaling alcohol is known to have toxic effects on the brain.

已知吸入酒精對於大腦是有害的。

I told you earlier that the e-liquids contain over 15,000 different flavors.

我先前告訴過各位， 有超過一萬五千種口味的電子液體。

Here are some examples,

這裡有一些例子，

some with very catchy but familiar names like "Skittles" and "Fruit Loops,"

有些名字很容易記但很熟悉，

如「彩虹糖」和「香果圈」，

and others with more exotic names like "Dragon's Milk" and "Tiger's Blood"

其他的名字則比較奇特， 像是「龍奶」、

「虎血」，和「獨角獸嘔吐」。

and "Unicorn Puke."

The e-liquid or the aerosol can also contain metallic particles

電子液體或是氣霧劑 也有可能含有金屬粒子，

like chromium, cadmium and lead.

像是鉻、鎘，和鉛。

These are generated from the heating coil in the devices

它們是因為裝置中的線圈 被加熱而產生出來，

and are also known to have many toxic effects on vital organs.

且已知對於重要器官有害。

So no, let me make this very clear:

所以，不，讓我說清楚：

what is produced is definitely not water vapor.

產生出來的絕對不是水蒸氣。

Exposure of the teen brain to nicotine through e-cigarettes

讓青少年的大腦透過 電子香菸接觸尼古丁

is also very concerning.

是非常讓人擔憂的。

The teen brain is very sensitive to even low levels of nicotine

青少年的大腦對於 少量的尼古丁也非常敏感，

and gets very easily addicted.

且非常容易上癮。

In fact, we have known for a long time

事實上，長久以來我們一直都知道

that 90 percent of smokers start smoking cigarettes prior to the age of 18.

九成的抽菸者在十八歲前 就開始抽菸了。

Those who start early are more addicted and have a harder time quitting smoking.

早開始抽菸的人，比較容易上癮，

且比較難戒除。

In other words, and to quote a past FDA commissioner,

換言之，引用一位 食品及藥物管理局前局長的說法，

"Nicotine addiction ... is a pediatric disease."

「尼古丁上癮……是一種小兒疾病。」

E-cigarettes can expose teens to a lot of nicotine.

電子香菸會讓青少年 接觸到大量尼古丁。

Many of these devices contain the amount of nicotine

許多這類裝置所含的尼古丁量

that is in a full pack of cigarettes.

相當於一整包的香菸。

The more recent pod devices contain a nicotine salt,

更近期的煙彈裝置 含有一種尼古丁鹽，

which has a smoother taste and is much easier to use

它的口味比較滑順， 且比較容易使用，

and can produce rapid increases in brain nicotine levels.

會快速造成大腦的尼古丁量增加。

Teens who use e-cigarettes regularly report symptoms of craving --

使用電子香菸的青少年 通常會有渴望的症狀——

feeling anxious when they don't have their e-cigarettes.

當他們沒有電子香菸時 就會非常焦慮。

All these are hallmarks of a behavioral addiction.

所有這些都是行為成癮的特徵。

E-cigarettes are not only addictive

電子香菸不僅會造成上癮，

but they also affect many other organs in the body.

也會影響身體中的許多其他器官。

So nicotine, which is in e-cigarettes, for example,

舉例來說，電子香菸中的尼古丁

binds to a receptor called the nicotinic acetylcholine receptor,

會和所謂的尼古丁 乙醯膽鹼受體結合，

which plays a key role in the functioning of almost all organ systems

人體內幾乎所有器官的運作，

都和這種受體有密切關係。

in the human body.

And chronic exposure to nicotine changes the functioning of these systems.

長期暴露在尼古丁下， 會改變這些系統的運作。

So as an example,

舉例來說，

chronic exposure to nicotine decreases the flexibility of the blood vessels

長期暴露在尼古丁下， 會降低血管的彈性，

and changes how the heart responds to acute challenges like stress.

且會改變心臟對於 急性挑戰（如壓力）的反應。

The teen brain is not only sensitive to the addictive effects of nicotine

青少年的大腦不僅對於 尼古丁的成癮效應很敏感，

but also to its toxic effects.

也對它的有害效應很敏感。

In adolescent animals, nicotine is a very well-established neurotoxin,

在未成熟的動物中， 尼古丁是眾所皆知的神經毒素，

and it decreases learning, memory and attention processes

它會讓學習、記憶， 和注意力過程下降，

and increases hyperactivity symptoms.

讓過動症的症狀增加。

Teens who use tobacco products are more likely to use

使用菸草產品的青少年 比較有可能會使用大麻和酒精，

marijuana and alcohol

and also develop depression and anxiety as a teen or as an adult.

且在青少年時或成年時， 比較有可能會發展出憂鬱和焦慮。

So nicotine addiction through e-cigarettes could be leading them down the path

所以，電子香菸造成的尼古丁成癮

可能會讓他們產生 其他成癮或心理健康問題。

of other addictions and other mental health problems.

Now, in adolescent animals, nicotine also produces epigenetic changes,

在未成熟的動物中，

尼古丁也會造成表觀遺傳學的改變，

or heritable changes in gene expression,

或是基因表現的遺傳性改變，

for example, in the genes involved in asthma.

比如造成和氣喘有關之基因的改變。

So teens who use nicotine may not only be harming themselves

所以，使用尼古丁的青少年 不只是在傷害他們自己，

but they could be harming their future generations.

也有可能傷害他們的未來世代。

You know, the very existence of e-cigarettes

電子香菸的存在本身

could have led to an entire generation of nicotine-addicted youth.

就有可能造成一整個世代的 尼古丁上癮青年。

Easy access to these devices could have led to more experimentation

容易取得這些裝置， 可能會造成青年

with marijuana and many other vaporizable substances by youth.

去嘗試更多大麻和其他可蒸發物質。

While there is no doubt that providing smokers with a cleaner form of nicotine

雖然無庸置疑，提供抽菸者 一種更乾淨的尼古丁形式

is and should continue to be a critical goal,

是應該持續追求的重要目標，

we still do not know if these devices help smokers quit smoking,

但我們仍然不知道這些裝置 是否真能協助抽菸者戒菸，

and we know very little about the long-term effects of these devices.

且我們對於這些裝置的 長期影響所知甚少。

What we do know is that youth -- lots of youth -- are using these devices.

我們確實知道的是青年—— 許多青年——在使用這些裝置。

In fact, the FDA commissioner recently used the term "epidemic"

事實上，食品及藥物管理局局長 近期使用了「流行病」一詞

to describe e-cigarette use in the US.

來描述電子香菸在美國的使用情形。

While trying to solve one huge public health problem, cigarette smoking,

在試圖解決一個重大的 公共健康問題（即抽菸）時，

we may have created another colossal one.

我們可能造成另一個驚人的問題。

Our lack of vigilance in the earlier years around cigarette smoking

早期我們缺乏對抽菸的警覺，

led to a cigarette epidemic and many, many cigarette-related diseases.

導致香菸流行病 及許多香菸相關的疾病。

We do not want to repeat the same mistakes with e-cigarettes.

我們不會想要 在電子香菸上重蹈覆轍。

So now is the time for action,

所以，現在是要 採取行動的時候了，

for regulations that address the appeal and access of these devices to youth.

建立規定來處理這些訴求 並控管這些裝置的可得性。

Do smokers really need 15,000 kid-friendly flavors to quit smoking?

抽菸者真的需要一萬五千種 小孩很喜歡的口味，才能戒菸嗎？

Do they need so many different kinds of devices?

他們真的需要這麼多種 不同的裝置嗎？

Is it a good idea to have devices which are so easy to hide

發明這麼容易藏起來 且這麼容易使用的裝置，

and so easy to use?

真的是個好點子嗎？

We recently heard that the FDA plans to introduce stricter regulations

最近，我們聽說食品及藥物管理局 計畫要推出比較嚴格的規定，

on sales of these devices that contain e-liquid flavors

來管理這些含有電子液體口味的裝置

in retail locations like convenience stores and gas stations,

在零售地點如便利商店 和加油站的銷售，

and also introduce stricter regulations

也要更嚴格規範

on sales of devices to minors over the internet.

在網路上販售這些裝置 給未成年人的行為。

Is this going to be sufficient to change this rapid increase in youth uptake?

這樣做就足以改變青年的電子香菸 使用快速增加的現象嗎？

We need to ask and answer such critical questions.

我們必須要詢問並回答 這類重要的問題。

Now is also the time for a serious public education campaign.

現在也該是認真推出 公共教育活動的時候了。

Teens and their parents need to know

青少年和他們的父母必須要知道

that while e-cigarettes may contain less toxins than cigarettes,

雖然電子香菸 含有的毒素或許比香菸少，

they're certainly not benign.

仍然對健康一點益處都沒有。

Exposure of their bodies to the chemicals produced by these devices

讓他們的身體暴露在這些裝置 所產生的化學物質之下，

could be changing them in ways they may not like

可能會用他們不喜歡的 方式改變他們，

and setting them up for future unknown toxicities and health problems.

讓他們將來要面對 未知的毒素和健康問題。

You know, when I said earlier

我之前說電子香菸非常 適合智慧手機的世代，

that e-cigarettes were a perfect fit for the smartphone generation,

那不是在開玩笑。

I was not kidding.

We live in a technology-crazed world,

我們住在一個迷戀科技的世界，

where the latest device and technology gets a lot of attention

最新的裝置和技術 都會得到很高的關注，

just because it is technology and because it is the latest thing.

只因為它是科技， 只因為它是最新的。

More and more over the next few years and for the rest of our lives,

在接下來的幾年間， 以及在我們的餘生，

we are going to see technologies coming into the marketplace

我們會越來越常見到 進入市場的技術

that may not raise any health flags at first,

在一開始可能看似不會危害健康，

simply because they don't look unhealthy

只是因為它們看起來並非不健康的，

or they're not a medical device.

或是它們不是醫療器材。

For example, we could see devices

比如，我們可能會看到一些裝置

that may make it easier to go longer without sleep

能夠更容易就延長不用睡眠的時間，

or help us lose weight --

或協助我們減重—— 我的個人目標之一——

a personal goal of mine --

or achieve any number of other goals

或是達成我們消費者

that we as consumers are very, very interested in.

非常感興趣的各種其他目標。

But many of these devices may come with unacceptable risks to our own health.

但許多這類裝置對我們自身健康 所帶來的風險可能是無法接受的。

So if we want to protect our health and the health of our children,

所以，如果我們想要保護 我們及我們孩子的健康，

perhaps we should get out of the habit

也許我們得要改掉一個習慣，

of automatically celebrating such new technology

就是自動讚頌這類新技術，

and get into the habit of looking at them with a critical eye,

還要養成一個習慣， 就是用挑剔的眼光去檢視它們，

perhaps even through a medical lens.

或許甚至用醫學的角度來看。

Because, you know something?

因為，你們知道嗎？

Our health, the health of our children and our future generations

我們的健康、我們孩子的健康， 以及我們未來世代的健康，

is far too valuable to let it go up in smoke --

都太珍貴了，不能讓它們 消逝在煙霧中——

or even in aerosol.

或甚至氣霧劑中。

Thank you.

謝謝。

(Applause)

（掌聲）