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TRANSCRIPT
Vaping Among Indiana’s Youth
IUPUI
Center for Health Policy, Department of Health Policy & Management,
Fairbanks School of Public Health.
Background & PrevalenceSECTION 1
Vaping among young
people has reached
epidemic proportions• The CDC reports that between 2017-
2018
• Vaping increased by 78% among
high school students.
• Vaping increased by 48% among
middle school students.
Vaping refers to the act of using
electronic nicotine delivery systems
(ENDS) aka e-cigarettes.
• E-cigarettes come in a variety of shapes and sizes.
• All e-cigarettes typically have the following parts:
• A battery, a heating coil, a chamber to hold
liquid (e-liquid), and a mouth piece.
• When activated, the battery heats the e-liquid,
creating an aerosol that a user inhales.
• Can vaporize e-liquid with and without nicotine
as well as other substances like THC
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Vaping rose by 71% among high school and middle
school students between 2017-2018 representing 3.6
million students
National Youth Tobacco Survey
2011 2012 2013 2014 2015 2016 2017 2018 2019
E-cigarettes 6.0% 2.0% 2.9% 9.2% 11.1% 8.1% 7.9% 13.5% 20.0%
Cigarettes 10.5% 9.3% 8.0% 6.2% 6.1% 5.3% 5.2% 5.2% 4.3%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
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Vaping across all grade levels between 2017-2018
was the largest increase in any adolescent substance
use outcome in 43 year history of the MtF
Monitoring the Future Survey
2015 2016 2017 2018 2019
8th 8.0% 6.2% 6.6% 10.4% 12.2%
10th 14.2% 11.0% 13.1% 21.7% 25.0%
12th 16.3% 12.5% 16.6% 26.7% 30.9%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
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Vaping of nicotine has been driving the
increase in vaping across all grade levels.
Monitoring the Future Survey
2017 2018 2019
8th 3.5% 6.1% 9.6%
10th 8.2% 16.1% 19.9%
12th 11.0% 20.9% 25.5%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
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Vaping of THC across all grades increased
significantly between 2018-2019
Monitoring the Future Survey
2017 2018 2019
8th 1.6% 2.6% 3.9%
10th 4.3% 7.0% 12.6%
12th 4.9% 7.5% 14.0%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
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Vaping nearly doubled among Indiana middle
and high school students between 2016-2018
representing an increase of 35,000 students
Indiana Youth Tobacco Survey
2012 2014 2016 2018
Middle School 1.2% 4.9% 2.8% 5.5%
High School 3.8% 15.1% 10.5% 18.5%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
20.0%
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Vaping increased substantially across all grade
levels from 2017-2018
Indiana Youth Survey
2015 2016 2017 2018
8th Grade 10.4% 9.4% 8.6% 11.9%
10th Grade 18.2% 15.4% 14.0% 20.4%
12th Grade 24.8% 21.6% 19.7% 28.6%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
Why do youth vape?SECTION 2
Youth vape for several
reasons:
• Curiosity – 55.3% of middle and high school students who ever tried an e-cigarette did so out of curiosity.
• Flavors - 69.6% of middle and high school students who used a tobacco product used a flavored product, the most commonly used product was e-cigarettes.
• Family & Peer Influence – 30% of youth who ever used e-cigarettes did so because a friend or family did so.
Advertising
• Spending on advertising of e-cigarettes grew from 6.4 million in 2011 to 115 million in 2014.
• Increase in spending correlated to significant increase in e-cigarette use.
• In 2016, 4 in 5 youth (20.5 million) had been exposed to an e-cigarette ad.
• Young people regularly exposed to e-cigarette advertising have a higher likelihood of ever having tried e-cigarettes or of being a current user.
JUUL• Driving increase in vaping among young people.
• New type of e-cigarette known as a “stealth vaporizer”.
• Sleek, techy, and offers high levels of nicotine.
• Advertised aggressively through social media.
• Between 2016-2017 sales increased by 600%.
• By end of 2018, JUUL had captured 76% of retail e-cigarette market.
• In 2018, 6.0% of middle and 24.2% of high school students had used a JUUL in the past 30 days.
Concerns about Vaping
Vaping is a gateway to
combustible cigarette
use.• Youth who reported ever using e-
cigarettes were more likely to have
experimented with cigarettes and more
likely to be current smokers.
• Longitudinal studies indicate that youth
who smoked e-cigarettes at baseline
were 4 times more likely to be smoking
cigarettes at follow up.
Vaping exposes
adolescent brains to
nicotine• The adolescent brain is more sensitive to
nicotine.
• Nicotine impairs development of areas of the brain that control mood, attention, learning, and impulse control.
• Youth who use nicotine-containing products are more likely to develop dependence on nicotine.
• Young people can develop an addiction to nicotine with relatively little exposure, as little as 40 puffs on a JUUL on a daily or near daily basis.
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The contents of e-cigarette liquid exposes
young people to other risks:
1. The components of e-liquid have not been deemed safe for inhalation.
2. When heated, many of the components of e-liquid can form carcinogens.
3. Inhalation of fine particles in e-cigarette aerosol can promote lung disease
like chronic bronchitis and asthma in young people who are regular users.
4. E-cigarette aerosol also contains various heavy metals, all of which can
be toxic when inhaled.
Key Informant Interviews
Background
• Interviews were completed with 9 key
informants.
• Informants were involved with state- or
county-level tobacco control and
prevention efforts.
• The purpose of the interviews was to
better understand how vaping was
affecting Hoosier youth.
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How much of a problem do you think vaping/e-
cigarette use is among Indiana’s youth?1. All informants expressed that vaping was a significant problem within Indiana:
– “I totally agree with the Surgeon General, Dr. Jerome Adams, that it’s an epidemic”.
2. Informants believed JUUL was responsible for the current level of vaping and that it was popular because it doesn’t smell, is sleek, can be used discreetly, and does not carry the stigma of cigarettes but most importantly:
– “I definitely think it is the flavors”
3. In terms of access informants believed that “the majority of youth report getting products from social sources”.
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What groups of young people are particularly
vulnerable to vaping or are vaping at higher
rates?1. While some informants believed that young people in middle school were
most vulnerable, the overall consensus was reflected by one informant
as:
– “I say in every presentation that I give JUUL did not care who it targeted. It did
not target to the African-American or the LGBT community alone. It targeted
to us. I feel it targeted to the poor, to the rich, to the low education, to the high
education, it did not discriminate.
What is vaping problematic and
why should we be concerned about
it?• Similar to what the national literature says, informants
cited concerns that “we are concerned about nicotine on the developing brain…the area that affects learning, mood, impulse control, concentration…” and that it “results in symptoms of dependence”.
• Informants expressed that little is known about the components of e-cigarette liquid and that it “may take years before we understand the health consequences”.
• One informant stated it as:
• “…this generation is the new guinea pig for the tobacco industry and by the time they really get the data and the science behind it…the current generation is already going to be hooked and addicted”.
What would the ideal
prevention/intervention model look
like?
• Informants agreed that following CDC recommendations
and better funding of TPC would be ideal:
• “I think it starts with a well-funded and well-run state
prevention program following CDC best practices. I
think it would also include reaching kids where they
are. A program needs to have community resources,
they need to be staffed. Each community would need
to have resources to help people quit. It’s going to
mean investing in [web-based and social-media-based]
communications. I think policy makers are
uncomfortable investing state dollars that way. We’re
going to have to get over that hesitation if we really
want to reach kids…”
IUPUI
Policy Recommendations1. Ban all non-tobacco flavors in not just e-cigarette products but all tobacco products.
2. Cap the level of nicotine available in e-cigarettes to levels that would reduce the risk of addiction.
3. Tax e-cigarettes and price them at levels comparable to cigarettes.
4. Adopt more comprehensive smoke free laws.
5. Implement public education/media campaigns.
6. Increase restrictions on tobacco licenses and improve enforcement efforts for retailers.
7. Develop effective school-based strategies that de-emphasize suspensions or expulsions while
emphasizing counseling, education, and in-school services for quitting.