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Electronic Cigarettes:What Parents and

Teachers Need to Know

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• The Rise of Flavors and Electronic Products• Nicotine, Addiction and the Teen Brain• What is an E-Cig? A Vape? A Juul? • Health Impacts• Stretch Break!• Advertising and Peer Pressure• Signs a Teen May be Vaping• Talking to Teens• What Can Schools Do?• The Latest News/Resources• Q & A

Agenda

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Do You Remember Your First Cigarette?

How old were you?

Who were you with? What did it taste like?

How did you react?

Did you keep smoking? Why or why not?

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“The juice in my pod was cucumber flavored… It felt as if a tiny ghost had rushed out of the vaporizer and slapped me on the back of my throat. I took another hit, and another. Each one was a white spike of nothing, a pop, a flavored coolness, as if the idea of a cucumber had just vanished inside my mouth.”

Jia Tolention, The New Yorker, “The Promise of Vaping and the Rise of Juul” May 14, 2018

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Q: Why does a deadly addictive product that is supposed to be for adults look and taste like candy?

A: Tobacco companies need newcustomers!

• 480,000 die from tobacco-related deaths in the US every year• Fewer people begin smoking• The tobacco industry needed two things:

• a new product (e-cigs)• a new market (your kids)

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• Menthol Cigarettes

• Cigars

• Little cigars/Cigarillos

• Smokeless Tobacco

• Chewing tobacco

• Dip, Snuff, Snus

• Hookah

• Vapes (E-cigarettes)

Flavors Meet Technology

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4 out of 5 kids who have used tobacco started with a flavored product. – Journal of the American

Medical Association

Why Do Flavors Matter?

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What is a Characterizing Flavor in a Tobacco Product?

“A distinguishable taste or smell other than the taste or smell of tobacco.”

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What Teens Think about E-cigs

Most teens aren’t concerned about becoming addicted to e-cigs because they believe:

• E-cigs aren’t smoking.• E-cigs aren’t tobacco.• E-cigs don’t contain

nicotine.• E-cigs produce a

harmless water vapor.

11Addiction: The compulsive need for and use of a habit-forming substance such as heroin, nicotine, or alcohol.

Juul Use is a Slippery Slope!

“I only Juul at parties.”

“I don’t NEED it. It’s just something I do with my friends.”

“What’s the big deal? It’s not like I’m addicted!”

“It’s not even smoking.”

Flavors and the Addiction Cycle

1. Nicotine changes

the brain, which is why quitting is so hard.

4. Tobacco that tastes like

candy appeals to young people and makes it easier to start and keep smoking until…

2. The tobacco industry

profits off nicotine addiction.

3. The brain’s peak

period to develop addiction is in adolescence. Smokers who start at a young age are more likely to develop a lifelong addiction.

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BatteryAtomizer/coil

Absorbent material/cotton

First Generation Vapes/E-cigarettes

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True or False?

E-cigs produce harmless water vapor.

FALSE. E-cigs produce an aerosol that includes harmful chemicals known to cause cancer.

The difference is that vapor is 100% liquid, while aerosol carries tiny bits of solid with it.

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Chemicals Found in Vape Aerosol

• Propylene glycol

• Glycerin

• Flavorings (many)

• Nicotine

• NNN

• NNK

• NAB

• NAT

• Ethylbenzene

• Benzene

• Xylene

• Toluene

• Acetaldehyde

• Formaldehyde

• Naphthalene

• Styrene

• Benzo(b)fluoranthen

e

• Cadmium

• Silicon

• Lithium

• Lead

• Magnesium

• Manganese

• Potassium

• Titanium

• Zinc

• Zirconium

• Calcium

• Iron

• Sulfur

• Vanadium

• Cobalt

• Rubidium

• Benzo(ghi)perylene

• Acetone

• Acrolein

• Silver

• Nickel

• Tin

• Sodium

• Strontium

• Barium

• Aluminum

• Chromium

• Boron

• Copper

• Selenium

• Arsenic

• Nitrosamines

• Polycyclic aromatic

hydrocarbons

• Chlorobenzene

• Crotonaldehyde

• Propionaldehyde

• Benzaldehyde

• Valeric acid

• Hexanal

• Fluorine

• Anthracene

• Pyrene

• Acenaphthylene

• Acenapthene

• Fluoranthene

• Benz(a)anthracene

• Chrysene

• Retene

• Benzo(a)pyrene

• Indeno(1,2,3-

cd)pyrene

All of these have been found in e-cigarette/vape pen

aerosol

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What are the Health Impacts?Immediate• Irritation to the lungs, nose, throat, eyes• Coughing, shortness of breath, wheezing• Heart beats faster, “fight or flight” response• Nicotine toxicity: headache, nausea, sweating,

dizziness (“Nic sick”)• Explosion and burn injuries: 2,035 in U.S. emergency

rooms 2015 – 2017

Long Term • Nicotine addiction• Damage to the lungs and heart• Problems with learning, memory

and mood• Oral health issues• Cancer? Lung disease? Emphysema?

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True or False?

But Juul is still a safer alternative to smoking, right?

Not necessarily. And…really? Comparing something to the deadliest consumer product ever invented is a pretty low bar!

Second Generation Vapes

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3rd Generation: Sleek and High-Tech

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Anatomy of a Pod-Based System

Cartridges/Pods

Devices with Rechargeable Battery

Covers

PHIX

JUUL

These cartridges/pods do contain NICOTINE!

[20]

Other Vaping Brands

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Related Products

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Stretch Break!

Advertising Targets Youth

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Peer Pressure & Social Media

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Teen Use Data

2018 National Youth Tobacco Survey: 1 in 5 high school students & 1 in 20 middle school students report using an e-cig product.

Teens who have tried e-cigarettes are four times more likely to try conventional cigarettes.

Teens who used e-cigarettes were up to four times more likely to use marijuana later.

Teens also use vape devices to smoke hash oil (marijuana), herbs, and other drugs.

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10 Signs a Teen May be Vaping

1. Cutting back on caffeine. Nicotine plus caffeine can cause anxiety and mood swings.

2. Increased thirst. Vaping removes hydrationfrom the mouth and throat.

3. Desire for flavor. When the mouth is dry, you lose flavor perception, so food is less flavorful.

4. Nosebleeds. Vaping dries the skin of the nose. When the nose gets dry, it can bleed.

5. Acne. Breakouts on normally controlled skin.

(continued…)

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Signs a Teen May be Vaping6. More frequent headaches or stomach aches.

7. Unfamiliar techy-looking devices. USB drives, cords, cotton balls, battery chargers, pliers, droppers…

8. Packages in the mail. They could be ordering products on line.

9. A sweet scent. Thirdhand aerosol remains on clothing, hair, backpacks and furniture.

10. Changes in behavior, grades or friends.

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Talking with Your Teen

Take advantage of teachable moments. Ask what your teen already knows. Counter any misinformation with the facts. Acknowledge peer pressure, but stress that most teens do NOT use e-cigs. Share your values. Explain why you don’t want them to us.

(health/addiction-related issues, role model to younger siblings, consequences at school/work, legal issues, trust, impact on sports, etc.)

Keep the conversation going in person or online.

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E-cigs as a Quit Device?

E-juice doesn’t contain tar, and may have fewer carcinogens than traditional tobacco products. Lack of regulation makes determining their potential as a quit device difficult.

They have not been endorsed by the FDA as quit devices.

Evidence is inconclusive that e-cigs help people to stop using traditional cigarettes and stay off of them in the long run.

Meanwhile, they are enticing a new generation to start smoking.

Historical tension between public health (greater good) and individual rights (personal choice).

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What Can Schools Do?Education and Prevention• Educate parents, students, faculty (Stanford Tobacco Education Toolkit

https://med.stanford.edu/tobaccopreventiontoolkit.html• Life skills: goal setting, decision making, refusal skills• Peer-to-peer outreach• Data collection (Interested? Talk to me!)• Encourage students to do their own research: debates, position papers,

historical reviews, Capstone projects…

Cessation• Refer students to Seven Challenges http://www.sevenchallenges.com/• www.truthinitiative.org Free, text-based quit program tailored by

age group. Text “QUIT” to (202) 804-9884.• 1-800-No-Butts. Phone-based cessation support for all ages.

School-wide policies to reduce the use of e-cigs on campus• Vapor sensors in the bathroom• Bathroom monitors• Restriction of school computers to purchase e-cig products• School-based consequences

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Resources https://e-cigarettes.surgeongeneral.gov/ https://drugfree.org/article/how-to-talk-with-your-kids-about-vaping/ https://www.flavorshookkids.org/ https://www.fda.gov/TobaccoProducts/ Ten Things School Principals Need to Know About Juul

http://www.kdheks.gov/tobacco/download/juul_fact_sheet.pdf Stanford Tobacco Prevention Toolkit

https://med.stanford.edu/tobaccopreventiontoolkit.html https://www.parentsagainstvaping.org www.santacruzhealth.org/tobacco

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Legislative Updates (and other news)November 2018• FDA announced intention to prohibit the sale of menthol cigarettes and

flavored cigars and implement certain restrictions on e-cigarette sales. • Santa Cruz City Council voted to ban the sale of all flavored tobacco

products, including menthol, in the city limits, beginning June, 2019.

December 2018• Members of the California legislature introduced bills banning the sale

of flavored tobacco products, including menthol, and requiring age verification for tobacco products sold on line.

• Tobacco firm Altria (maker of Marlboro) invested $12.8 billion to acquire a 35 percent stake in Juul.

March 2019: FDA Commissioner Scott Gottlieb announces his resignation.

Questions?

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One thing I learned today is….One way I plan to use this information is…

One thing I still wonder about is…

Wrap Up Activity

Tara Leonard, MPH 454-5412Diana Hodge 454-4648

www.SantaCruzHealth.org/Tobacco

www.facebook.com/sctobaccoeducation