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President Brian Sandoval: Welcome back, Wolf Pack Family.  I'm your host Brian Sandoval, a proud graduate, and the president of the University of Nevada. In the United States, 490,000 people die from smoking related illnesses yearly, and 10% of high school students in the U.S. use at least one tobacco product, including e-cigarettes. Today's guest has focused her career on the impact of tobacco and cannabis regulation, on consumer behavior and public health. Dr. Jennifer Pearson is an associate professor at the ҹɫÊÓƵ School of Public Health. She has authored over 130 peer reviewed scientific articles on tobacco and cannabis, and was an author of the Surgeon General's Report on e-cigarette use among youth and young adults. Dr. Pearson's background includes a Doctorate in Public Health from Johns Hopkins, a Master of Public Health degree from George Washington University, a Bachelor's degree in English from UC, Santa Barbara, and a High School diploma from our very own Reno High School and Professional Experience with Truth Initiative, The American Lung Association in Nevada, and the Peace Corps. Today's podcast is being recorded in @One in the Matthewson-IGT Knowledge Center, Dr. Pearson, I look forward to exploring your important research and its impacts on the people around the world. Thank you for joining us today. 

Pearson: Yeah, thanks for having me. 

Sandoval: Yeah, really excited about our conversation. So, first question, I would like to start with your background. How did you get into tobacco control research? 

Pearson: It was a long and circuitous route. Like you said, I had a bachelor's degree in English. I thought I was going to be a journalist, maybe go into marketing, and then I went into the Peace Corps. I was a Peace Corps volunteer for two years in Guinea, and I was an English teacher in a high school there in a town called Siguiri, kind of up close to the border near Mali. And while I was there, I have a very distinct memory of sitting in a cafe with a cold Coke, which was really unusual because my town almost never had electricity. So I was like, oh, I got a cold Coke. I ran to this cafe. I knew they had a refrigerator, cold Coke. And I'm sitting there, and these three trucks, white and red trucks roll in and people pop out and they're wearing bright white T-shirts with the Marlboro Chevron on them, and they've got cigarettes, like cartons of cigarettes, and they're going into people's compounds because people in Guinea, they live in little kind of collections of huts and buildings and they have a little fence around them, so people are going into their little compounds and giving away free cigarettes. And I'm just sitting there watching it going – “this seems not right”. This doesn't seem Kosher. And someone actually came up to me and said, here's a free pack. And I was like, no, thank you. And they said, no, no, no it's free. You can take it. I don't want it. And they were like, okay. And they walked away. And that really stayed in my mind that that didn't seem fair to me that I had a real social, I still have a real social justice angle to the stuff that I do, but that really made an impression that Tobacco Companies were doing things in West Africa that they would never do in the United States. They gave up giving away free samples in the 90s because they said, “oh no, we wouldn't want to do that.” We wouldn't want to give free cigarettes to kids, for example. But they were still doing it in West Africa. So, I came home back home to Reno, and it just so happened that the American Lung Association had a job as a Tobacco Education Specialist for Northern Nevada. So, I drove all over Northern Nevada all the way out to Elko, Battle Mountain, Reno, Sparks. Training high school students on how to talk to middle school students about the dangers of smoking. That was super fun, I realized that I could implement other people's ideas, but I couldn't actually lead or come up with my own ideas in public health without a degree in it. So, then I went to do a degree in public health at George Washington. And then while I was at George Washington, I did a little research for my thesis and my mentor was like, this is almost a dissertation. You should go get a PhD. And I was like – I don't think so. You have to be a genius to have a PhD, don't you? And he was like, no, no, no you don't. And he's like, you've almost done it. And so, I applied to a few places and got into Hopkins and was really fortunate to have a mentor that was really involved in tobacco control research. And here I am. 

Sandoval: So, what was your thesis on, and your dissertation? 

Pearson: So, the thesis was on – in 2008, DC was taking all of their bars and restaurants smoke free. So, it was a little pre post analysis of that law, where I ran around DC at 10 p.m. and found non-smoking bartenders and enrolled them in my study. And then back at 2:00 a.m. I found them again and had them chew on this little piece of cotton that to collect their saliva. And I was able to show that these non-smoking bartenders had about a two cigarette per day exposure average before the law, and then after the law undetectable, we couldn't see. So, it's kind of obviously that was going to happen right? It was an evaluation of the implementation and an estimate of the health effects on non- smoking employees. 

Sandoval: Then the dissertation. 

Pearson: The dissertation was multiple papers on different aspects of FDA regulation of tobacco products. This was right when FDA got regulatory authority over tobacco. So, it happened in 2009. My dissertation was in 2011, so it was on people's opinions on banning menthol. It was about people's opinions on reducing nicotine to non-zero, almost non-addictive levels in cigarettes. And then it was also the first nationally representative data on e-cigarette use. I just so happen to have the opportunity to insert some items into a truth initiative survey and leverage that into a paper. 

Sandoval: We may get into the e-cigarettes later on, but that's an incredible journey. And before we talk about your current work, can we briefly discuss e-cigarettes versus traditional cigarettes? Is vaping safer than smoking a normal cigarette? 

Pearson: Yes, it is. But it's complicated. So, for adult smokers who are unable or unwilling to quit smoking, switching completely to e-cigarettes is harm reducing. All of our best data suggests that they will be better off long-term using an e-cigarette than smoking a cigarette. Now, of course, obviously ideally they would use nothing. And for a lot of people, e-cigarettes are kind of a way station between cigarette smoking and complete cessation. 

Sandoval: And I'm going to interrupt you just for a sec. Will you explain what an e-cigarette is? 

Pearson: Oh, yeah, sure. So, it's a product that takes nicotine in solution with some flavorings and some humectants, heats it and produces an aerosol that people then inhale. So, it looks like a piece of electronics. Sometimes they look kind of like thumb drive, sometimes they're larger than that. They come in lots of different shapes and sizes, but that's the basic element. It doesn't have tobacco leaf in it. It has nicotine flavorings and some other junk. So, when you think about the harm of an e-cigarette, you're not inhaling combusted tobacco, you're not getting the carbon monoxide. You are getting some of the carcinogens that you might also see in cigarettes and a few things that you don't see in cigarettes. For example, we're not sure what the long-term effects of inhaling propylene glycol and vegetable glycerin are when those are some things that are like humectants in e-cigs. 

Sandoval: And would you explain what that is? 

Pearson: It's the stuff that makes a visible vapor when you exhale, and it's the stuff that the nicotine is in solution with. Again, it's not harmless. So, for people who are non-smokers, for young adults, for people who aren't daily smokers, I would never say, yeah, sure, e-cigarettes safe, go for it. And for kids, it's a real problem because it is harm elevating and we need to do everything we can to make sure kids and youth do not use e-cigarettes. But on the flip side, again, for adults who are unable or unwilling to quit, it is a harm reduction kind of process. So, for example, for someone who is dependent on opioids, someone who uses heroin, for example, I would say methadone is a good way to go about that. It's a replacement for those drugs. You would never tell someone who's not an opioid user to use methadone. That doesn't make any sense. So, it's kind of the same thing with e-cigarettes. E-cigarettes are harm-reducing, but they're not harmless. And all of this is with the caveat that we don't know 40 years from now, the people who are using e-cigs now will be the people who we can make conclusive conclusions about the long-term health effects. We don't know those yet. We have the short-term exposure studies, which look pretty good, certainly better than cigarettes. 

Sandoval: So less worse, right? 

Pearson: It's less worse. That's exactly right. Less worse. 

Sandoval: Okay. 

Pearson: Yeah. 

Sandoval: All right. No, that's really interesting. And right now you're researching natural and organic cigarette marketing, correct? 

Pearson: Right. 

Sandoval:  And let's start with the obvious question. Are natural or organic cigarettes “healthier”? I'll put “healthier” in air quotes than regular cigarettes. 

Pearson: They are marketed as such, but not directly with kind of a wink and a nod. But the truth is, if you're inhaling any sort of burnt organic material, that's a problem. If you were to light your tie on fire right now and smoke it, that would also be chock-full of carcinogens. It doesn't matter if it's organic, but it has different types of organic pesticides rather than synthetic pesticides. None of that stuff matters. The harm comes from the combustion. I saw a quote from a research participant once that I love, and what the participant said was “Smoking a natural cigarette is jumping off a cliff versus jumping off a building. They're both going to kill you, but one's organic.” 

Sandoval: That's a good one.  

Pearson: That's great.  

Sandoval: But I mean, is that part of an advertising strategy to make people think it's okay? I think everyone knows it's bad for you to smoke, but like I said, maybe another less-worse version?  

Pearson: That's exactly right. It's a less-worse version. That's what people think. So, smokers have what's called cognitive dissonance. I know it's bad to smoke, but I still want to smoke, or I'm still driven to smoke for multiple reasons. So how do you kind of reduce that conflict in your mind? And one of the ways you could do it is saying, well, I'm making the best worst choice. It's not like I'm smoking Marlboro’s. I'm smoking Natural American Spirit, the organic ones, so I'm reducing my harm – Right? And in this case, no you're not. It's all just marketing and one brand differentiating itself from another brand and positioning, and it's a way for them to charge more money for their products. And it does not convey any health protection whatsoever. 

Sandoval: I guess for me, and maybe listeners are wondering, what does that even mean to say it's organic or natural? I mean, tobacco is obviously natural. 

Pearson: So natural is a really squishy term that means little to nothing and has no kind of federal regulatory oversight, over its use. Organic does. It is a USDA certified organic seal of approval. So, you do have to go through certain processes and already use the claim organic. And the main product that uses organic is Natural American Spirit, and they do use real organic tobacco as far as I can tell. But again, that does not translate to any sort of health protection at all. 

Sandoval: So perhaps there's no pesticides associated with a tobacco plant or? 

Pearson: Well, organic doesn't mean no pesticides. It just means not certain types of pesticides that the USDA has deemed not acceptable. There are still organic pesticides. So, you know – that's a common misperception though, fewer chemicals, right? No.   

Sandoval: I'm learning a lot. This is great. So how could findings from your research help improve health outcomes? 

Pearson: Yeah, so my research – recently concluded research. What we actually did is we told people, we brought in adult smokers on campus into my lab, and we actually told them that we were market testing three new types of cigarettes for a new tobacco company. And I totally made up the tobacco company. The funding was from the NIH and the FDA. So, none of this was true, but it was a deception study. We just exposed them to the different types of marketing and natural and organic marketing, and then tried to see if that would affect their perceptions, their experience of smoking, how much they smoked and their chemical exposures. And what we found was that if you tell someone a cigarette is natural or organic, they think they can taste fewer chemicals, they actually smoke more and they have more exposure to harmful effects of cigarettes. So, what we have shown, what my research has shown, is that you can affect people's harm perceptions. I've done that with other studies like experimental studies, but this study specifically also shows that you can get under their skin and actually affect their behavior and maybe affect how addictive it is by maybe encouraging more use and therefore also increasing their exposure. So, the application of this is this data is supposed to be directly informative of FDA regulation of tobacco products. So, the Family Smoking Prevention and Tobacco Control Act of 2009 said that tobacco companies are not allowed to make implicit harm reduction claims. And so this is kind of additional data that would hopefully motivate FDA to say, look, not only are these implicit harm reduction claims, which we have the data for already, but it actually affects how people smoke and their exposures and potentially the addictive potential of this product. So, it's just kind of another piece of data on the scale towards hopefully regulation of these products. And there are multiple brands that make claims like this. One little caveat is that the Center for Tobacco Products that FDA has recently been decimated by changes in DC, including the head of the Center for Tobacco products Brian King was reassigned and has now left his job. And a lot of people who would be the people actually implementing these regulations are gone now. So, I'm not holding my breath, but the data is there. 

Sandoval: So, your research also focuses on cannabis. Can you speak about that area of study and what else you're working on? 

Pearson: Yes. So, I do a lot of cannabis policy research. So right now I am working with economists at Yale, the University of Missouri, and the University of New Mexico and we are doing a nationwide evaluation of how cannabis legalization affects not only cannabis use, but tobacco use as well. So it could be that if you legalize cannabis, some people who would have smoked cigarettes will instead choose to use cannabis, so it displaces tobacco use. In other situations, it may be that legalizing cannabis actually increases tobacco use because their compliments. You increase the use of one product and then the other product comes along with it. So, we are doing a huge, huge analysis of policies in the United States. I'm in charge of figuring out the individual opt-out status of every single jurisdiction and every single state that has legalized cannabis to see whether or not they have opted out of cannabis. So, I'm talking 20,000 jurisdictions, 4,000 places just in Illinois. Illinois is quite challenging. Nevada was pretty easy. I'm done with Nevada. 

Sandoval: So, does that mean communities within a state opt out? 

Pearson: Yeah. So instead of treating the whole state – it's all legal. In reality, if you live in a town that's opted out, your access to cannabis is not the same as if you lived in a different town. So, we have to be a bit more precise about how we categorize people's exposures. So, we've been working on that for two years, and we've got another about six months left, and then we're actually going to finally be able to start doing the analysis. So, we're going to be able to tell regulators, if you regulate cannabis like this, you should expect this type of decrease or increase in cigarette use or this type of decrease or increase in cigar use, for example. Because a lot of people use cigars to make blunts. So, we might be able to come out of this with recommendations too – you know. If legalization increases cigar use, maybe you want to increase taxes on cigars at the same time to decrease use, things like that. All of this is meant to be very directly informative for policymakers. We want to be able to just hand them recommendations and here's the study. Here's all the publications that came out of this, but here's the one pager that says exactly what we recommend doing given our data. 

Sandoval: Wow. No, that would be really helpful. So real quick, we're almost out of time. Your entire higher educational journey was out of state, yet you come to our wonderful University of Nevada. How did that happen? 

Pearson: My grandma said I had sand in my shoes when I was 18, and she was right. I wanted to get out and see the world. I wanted to go to California. I wanted to do the Peace Corps. I wanted to live on the East Coast for a while, and that was fun for my 20s and 30s. But every time I came back to Reno, my parents would look a little bit older and my niece and nephew would be a little bit further along in their development, and I just wanted to be here for all of that. I also missed the mountains, and East Coast mountains are cute, but they're not the Sierra Nevadas. And I wanted to have a big dog and a backyard, and my priorities kind of changed once I hit my late thirties, and so I moved back. 

Sadoval: But we're glad you're home, and unfortunately that is all the time we have for this episode of Sagebrushers. Thank you for joining us today, Dr. Pearson. 

Pearson: Thanks for having me. 

Sandoval: Oh, it was wonderful. Join us next time for another episode of Sagebrushers as we continue to tell the stories that make our university special and unique. Until then, I'm University President Brian Sandoval – and Go Pack!