Episodes

Nearly 70% of young people say they want to quit nicotine this year. But as the market rapidly evolves, quitting is becoming more complicated.

Hosts Mark Masselli and Margaret Flinter speak with Kathy Crosby, President and CEO of the Truth Initiative, about a growing disconnect between regulation and reality in the e-cigarette market and what it means for youth addiction.

New data highlighted in the conversation underscores the scale of the issue:

• Between 2017 and 2022, disposable e-cigarettes nearly tripled in nicotine strength;
• Quintupled in e-liquid capacity; and
• Dropped in price by almost 70%.

At the same time, Crosby explains that the vast majority of these products do not have FDA authorization, making their presence on store shelves illegal. Yet they remain widely available.

“I would say, you know, as wonderful a job as the public health groups have done in driving down smoking, the industry continues to innovate in a way that’s very appealing to youth,” Crosby says, pointing to flavored products, “smart” vapes with screens and gaming features, and social media influence as key drivers of continued use. This episode includes the latest examples of Truth’s bold ads that aim to help young people quit vaping.

Mental Health’s Role in Quitting Vapes

Crosby notes that mental health is now a central factor, especially among younger users. That insight is shaping how cessation efforts are designed. Truth Initiative’s evidence-based programs focus on meeting people where they are, combining behavioral support and clinical approaches to help users break the cycle of addiction. As Crosby puts it, “We are all day, every day behavior change to help people live healthier lives.” She explains their free EX Program to quit smoking, vaping, and other tobacco.

There are 24 states that have legalized recreational marijuana in recent years and a man who once was at the center of the nation’s drug control efforts says he’s “really disturbed” at what he’s seeing as a result. “The health impacts on [people]…the increasing psychosis…the visits to emergency rooms,” says former Acting Drug Czar Richard Baum. He shares that there are increasing cases of patients under the influence of marijuana showing up in emergency rooms with “screaming and vomiting,” known as “scromiting.”

Baum joins hosts Mark Masselli and Margaret Flinter to discuss his new book, “Inside America’s Opioid Crisis: 12 Hard Lessons for Today’s Drug War,” and what decades of federal drug policy experience have taught him about prevention, treatment and the unintended consequences of major policy shifts.

He acknowledges that opioid deaths have begun to decline in the United States, but believes the country still has not applied the lessons needed to prevent the next wave of addiction.

Baum’s White House Perspective

Drawing on nearly three decades at the White House Office of National Drug Control Policy across five presidential administrations, Baum argues the United States already has the research and evidence needed to address addiction but has not yet committed the sustained investment required to implement it.

 “I believe a stronger national investment in prevention infrastructure could be more impactful,” Baum says, pointing to the importance of early intervention programs, school-based prevention efforts and community engagement strategies that have proven effective in other countries. He explains to the hosts how much more federal dollars he wants spent on prevention.

Baum also talks about promising models for prevention and recovery, including youth-focused programs in Iceland, Recovery High Schools designed for students in recovery and emerging innovations that could reshape addiction treatment.

Americans have more economic anxiety about health care costs than anything else, according to a KFF poll. “Conversations on Health Care” hosts Mark Masselli and Margaret Flinter are at the Reporters’ Roundtable to break down the policy debates and real-world impacts behind those concerns.

Joining the roundtable are: Nada Hassanein of Stateline, Michael McAuliff of Modern Healthcare, and Sandhya Raman of Bloomberg Law, who share what they’re seeing in Washington and across the states.

• McAuliff explains why some affordability proposals may not translate into meaningful relief for people facing premium hikes and everyday out-of-pocket costs. As he puts it, “It doesn’t seem like it has really broad implications for most people.”
• Raman previews what to watch as the current administration’s budget request takes shape, including potential cuts at the Department of Health & Human Services and its agencies. “Every president uses their budget request as kind of a wish list,” she notes, setting expectations for what Congress may actually advance.
• Hassanein brings the conversation back to consequences on the ground, including new research on breast cancer survival rates in Medicaid expansion states and the fallout after enhanced Affordable Care Act subsidies expired. She also details emerging state strategies to address enrollment drops, premium hikes, and access gaps, including a growing push toward public option models in some states.

The roundtable also explores Medicaid fraud scrutiny, rural health transformation funding, insurer resistance to covering non-opioid pain medications, and what policy debates are on the horizon, including physician pay and the direction of public health messaging.

Research just out shows new blood tests can now detect Alzheimer’s-related changes years before symptoms begin. Dr. Suzanne Schindler says these findings help estimate how long that window may be.

Once Alzheimer’s-related changes begin to rise in the blood, “it creates kind of a clock for us,” Schindler, a clinical neurologist at Washington University School of Medicine in St. Louis, tells hosts Mark Masselli and Margaret Flinter.


The timeline is not exact. Current estimates carry a margin of error of about three years. Schindler describes the model as “version one,” but says advances in technology and artificial intelligence will quickly improve its accuracy.

“Given how fast our technology is advancing,” coupled with the rise of artificial intelligence and other factors, “I think that pretty quickly, we’ll be able to refine these models, so they’re even more useful.”

Schindler notes several factors that affect memory apart from Alzheimer’s disease: medications that patients are taking, or if they have other neurological disorders, for example.

“In the past, we just thought of memory problems, cognitive decline as a normal part of getting old,” Schindler says. Also, as testing improves – and particularly as reimbursement becomes more common – the initial blood test can serve as a spark for lifestyle change.

So what should a person do if their “clock” shows they are getting closer to experiencing full on symptoms?

 “Exercise is definitely helpful, even just walking is helpful … cognitive engagement. If you have hearing loss, getting hearing aids. I mean, there’s many different things, reducing alcohol intake. Fortunately, we have a rich pipeline of treatments,” she says but stresses the new medications only work for those in the early stages of the disease.

Six years after the pandemic began, millions are still living with Long COVID. New research shows why recovery looks so different from person to person.

Dr. Bruce Levy and Tanayott Thaweethai, Ph.D., of Mass General Brigham, speak with hosts Mark Masselli and Margaret Flinter about their National Institutes of Health-funded RECOVER study published in Nature Communications.

Following patients from the time of infection, the team found eight distinct long COVID trajectories over 15 months.

“We identified these really unique patterns. There was a lot of variability. Some participants had consistently high and persistent symptom burden over time. Others oscillated around the threshold. And there were profiles where symptoms appeared to be getting worse over time,” says Thaweethai.

The outcomes confirm that Long COVID is not a single clinical experience. Patients with persistent high symptom burden were more often female and more likely to have been hospitalized during acute infection.

Understanding these trajectories is essential for designing effective clinical trials and targeting support services.

“If we have patients getting worse and others getting better, we need to understand that in order to design properly informed clinical trials,” says Dr. Levy.

The guests also push back on official denials of Long COVID’s existence and explain the status of current research funding.

A total of $10 billion of federal dollars is flowing to states right now as they seek to implement the first year of the new Rural Health Transformation Program. The early reports from the National Rural Health Association show promise and concerns.

Carrie Cochran-McClain, NRHA’s Chief Policy Officer, says, “I’ll be honest. We were hearing from members and from the public about whether these awards would be politically influenced. [The Centers for Medicare and Medicaid Services] moved quickly to issue a thorough funding notice and stuck closely to the criteria that were laid out.”

But the fact remains the RHTP dollars will never fill the gap caused by the federal Medicaid cuts. Instead, RHTP’s goal is to “strengthen, modernize, and sustain rural healthcare delivery.”

Cochran-McClain explains, “This money is being proposed to be used in some really important ways because we do have long-standing disparities in health outcomes and life expectancies in rural communities.”

Nearly one in five Americans lives in a rural community, yet rural hospitals and clinics continue to operate on thin margins. Hosts Mark Masselli and Margaret Flinter ask Cochran-McClain to provide an overview of how states are using the funds at this critical time.