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TRANSCRIPT
Understanding & Preventing Youth Vaping
Bonnie Halpern-Felsher, PhD
Professor of Pediatrics
PAUSD
January 22, 2019
What I Will Cover
• An introduction to e-cigs/vaping– What they are
– How they work
– What is in them
• National usage rates
• Health effects
• Why youth are using vapes
• What you can do!
Take Home Points
• This is BIG TOBACCO 2.0
• Nicotine is extremely addictive, more addictive than heroin
• Really important to keep your kids from getting addicted before their frontal cortex is fully formed, so they don’t have a predisposition towards addiction for the rest of their lives
• The people behind these vaping companies are great marketers who are targeting our kids and actively trying to cloud the narrative around these facts.
• These vaping companies are using tools and practices that many of us don’t understand and don’t see. We need to be vigilant, stay informed, and stay active!
Good News…
McKelvey & Halpern-Felsher, 2017
Changing Landscape of Tobacco Use
Bad News:
Terminology
E-Cigarettes (Formal/Scientific)Vapes (Colloquial, from Industry)
1st Generation 2nd Generation 3rd Generation Pod-Based Devices
Electronic Smoking Devices
E-Cigarettes&VapePensGenerations
VapePens
Thesehavebatteriesthatcan
reachhighertemperatures,haverefillablee-liquidcartridges,andallowuserstoregulatethefrequencyofinhalations.
Mods
Largesize,modifiablee-
cigarettesallowformoreaerosol,
nicotine,andotherchemicalstobebreathedintothelungs,atafasterrate.
Pod-Based
Thesee-cigarettesare
shapedlikeUSBsandcontain
podswithhigheramountsofnicotinethanprevious
generations.
Variations
Variationsonthefirste-cigarettesincluded
productslikee-hookahandrechargeableversions.
Cig-a-Like
E-cigarettescameontothemarketaround
2007.
Mostdeliverednicotineand
weredisposable.
TobaccoPreventionToolkitDivisionofAdolescentMedicine,StanfordUniversity
Formoreinformationgoto:www.tobaccopreventiontoolkit.stanford.edu
E-Juice/E-Liquid
Pod-Based E-cig Devices
Pod-Based E-cig Devices
National Rates of E-cigarette Usage
National Rates of E-cigarette Usage
14
Trends in 30-Day Prevalence of Use for Grades 8, 10, and 12 Combined
NIDA. "Teens using vaping devices in record numbers." National Institute on Drug Abuse, 17 Dec. 2018, https ://www.drugabuse.gov/news-events/news-releases/2018/12/teens-us ing-vaping-devices-in-record-numbers. Accessed 21 Dec. 2018.
5.4 5.4
3.4
12.0
14.5
3.64.6
5.5
2.7
19.2
14.6
5.7
0
5
10
15
20
25
30
Cigarettes Cigarillos Hookah Vaping Marijuana Vaping MJ
Per
cen
t
Adolescent Use in 2018
2017
2018
Cigarettes Blunts Hookah Vapes with Nicotine
Marijuana
Dramatic Increase in Youth E-Cigarette Use: 2017-2018
• High school students’ e-cig use increased by 78%• 1 in 5 high school students currently use e-cigarettes
• Middle school students’ e-cig use increased by 48.1%• 1 in 20 middle school students currently use e-cigarettes
Cullen KA, Ambrose BK, Gentzke AS, Apelberg BJ, Jamal A, King BA. Notes from the Field: Use of Electronic Cigarettes and Any Tobacco Product Among Middle and High School Students — United States, 2011–2018. MMWR MorbMortal Wkly Rep 2018;67:1276–1277. DOI: http://dx.doi.org/10.15585/mmwr.mm6745a5.
What are E-Cigarettes?
How Do E-cigs Work?What is in E-cigs?
BatteryAtomizer/coil
Absorbent material/cotton:Nicotine
Propylene glycol
Vegetable glycerin
Flavorants
Nicotine aerosol
Anatomy of an E-Cigarette
Image Credit: Dr. Gideon St. Helen
Anatomy of a Pod-Based System
Cartridges/Pods
Devices with Rechargeable Battery
Covers
tobaccopreventiontoolkit.stanford.edu
PHIX
JUUL
These cartridges/pods do contain NICOTINE!
Chemicals Found in E-Cig/Vape Pen Aerosol
Compounds in yellow are from FDA 2012, Harmful and Potentially Harmful Substances – Established List
• Propylene glycol
• Glycerin
• Flavorings (many)
• Nicotine
• NNN
• NNK
• NAB
• NAT
• Ethylbenzene
• Benzene
• Xylene
• Toluene
• Acetaldehyde
• Formaldehyde
• Naphthalene
• Styrene
• Benzo(b)fluoranthene
• 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
What’s in Vape?
Diacetyl
(butter flavor)
Benzene
(gasoline)
Cadmium
(batteries)Formaldehyde
(dead tissue preservative)
Lead
(car batteries)Nickel
(cheap jewelry)
Toluene
(paint thinner)
N-Nitrosonornicotine
(pesticides)
Nicotine
(tobacco)
What’s in that Pod?
• Salt-based Nicotine
• Benzoic Acid
• Glycerol
• Propylene Glycol
• Natural Oils
• Extracts and Flavors
• ???
Why Should We Be Concerned?
Why Should I Care about Vapes?
Amount Equivalent
1 pack cigarettes 20 cigarettes(contains 8mg per cigarette, but only inhale 1mg)
1 JUULpod 0.7 mL pod"5% nicotine by volume"
1 PHIX pod 1.5 mL pod"5% nicotine by volume"
1 Suorin pod 2 mL cartridge"5.4% nicotine by volume "
NOTE: ALL SALT-BASED E-JUICE/LIQUID CONTAINS NICOTINE!
Nicotine Levels in Pod-Based Products
The Body on Nicotine
The Body on Nicotine
Brain development
Nicotine Effects
➢ Highly addictive substance
➢ Causes changes in brain chemistry –
stimulates pleasure centers, alters
normal brain function
➢ As nicotine levels in brain drop, brain
craves nicotine to feel pleasure and
relieve feelings of anxiety and stress
(withdrawal)
Nicotine Effects
❖ Nicotine addiction
❖ Slows development of learning, memory,
attention and behavior
❖ Mood disorders like anxiety and
depression
❖ Permanent lowering of impulse control
❖ Increased risk of other addictions
Until about age 25 the brain is still growing
“My parents just think it’s a flash drive”
Why Youth are Vaping
• Flavors
• Changing social norms and misperceptions
• Marketing
• Cost
Why Youth are Vaping
• Flavors
• Changing social norms and misperceptions
• Marketing
• Cost
Flavors of Vapes
JUUL Flavors
Role of Flavors in Tobacco Usage
“Oh, I used that all day. I’d just keep it with me in my pocket and when I felt like having a taste of something flavor-y or something, I’d just take a hit… when you smell like blue raspberry and green apple, no one is going to question why you smell like that.”
Ramos, Ramamurthi, Roditis, & Halpern-Felsher, In progress
Why Youth are Vaping
• Flavors
• Changing social norms and misperceptions
• Marketing
• Cost
From the Teens Themselves
“…It's really hyped up, like, ‘No nicotine.’ That's what
everybody's saying. ‘There's no nicotine.’ ‘It's good for you.
Cuz it's vapor.’ The water vapor...”
Roditis & Halpern-Felsher, 2015, JAH
E-Cigs are Cool
E-Cigs are Cool
From the Teens Themselves
“I like that I didn’t have to always go outside to smoke a
cigarette or have to light it or deal with ash and the harsh odor
on yourself. Cigarette smoke stays on you and the e-
cigarettes don’t at all because there’s no scent on them really.”
Ramos et al., In Progress
From the Teens Themselves
“I guess after I tried the actual cigarette I felt like I wanted
something, but not something harmful, that harmful at least,
so I went to the vape store with my friend. We went to the
smoke shop…and they were able to let us try out some of
them and they recommended a model and they let us try it.”
Ramos et al., In Progress
From the Teens Themselves
“People always tell you smoking's bad, and cigarettes and
tobacco's bad, but if you just smoke regular with just water,
it's not bad. Because you take out the tobacco and the
cigarette stuff. That's what people think. It's better than
smoking.”
Roditis & Halpern-Felsher, 2015, JAH
PAUSD Students’ Perceptions of HarmCompared to Cigarettes if use
Occasionally
Aaaa Grade 7 Grade 9 Grade 11
Great/moderate harm
72% 69% 64%
Slight/no harm
28% 30% 36%
PAUSD Students’ Perceptions of HarmCompared to Cigarettes if use
Several Times a Day
Grade 7 Grade 9 Grade 11
Great/moderate harm
86% 80% 80%
Slight/no harm
15% 20% 20%
Why Youth are Vaping
• Flavors
• Changing social norms and misperceptions
• Marketing
• Cost
JUUL Nation
Who’s the Target Audience?
Why Youth are Vaping
• Flavors
• Changing social norms and misperceptions
• Marketing
• Cost
Cost and Accessibility
JUUL
• JUUL Device: $34.99; 4 JUULpods: $15.99
• Cigarettes: $9.55 per pack x 4 = $38.20
• $15.99 vs. $38.20
JUULpods cost LESS than cigarettes!!!
JUUL
• JUUL Device: $34.99; 4 JUULpods: $15.99
• Cigarettes: $9.55 per pack x 4 = $38.20
• $34.99 vs. $19
JUULpods cost LESS than cigarettes!!!
What about Access?
• PAUSD students’ perception of ease of obtaining e-cigarettes:–Grade 7: 19% easy or very easy to obtain–Grade 9: 46% easy or very easy to obtain–Grade 11: 67% easy or very easy to obtain
What YOU Can Do?
What YOU Can Do?
Parents/Caregivers…
• Stay informed
• Talk to your children
• Be an advocate
• Talk to healthcare providers
• Drug testing
• Talk to your children
Stay Informed…
Behavioral Indicators
• Change in clothing
• Depression and withdrawal
• Moodiness and irritability
• Reduced communication with family members
• Deterioration in school performance and/or truancy
• Physical changes
Talk to Healthcare Providers
• Treatment/referrals
– Nicotine replacement therapy (off-label)
– Cognitive behavioral therapy (CBT)
• Drug testing– Providers CANNOT drug test your child unless child gives
permission (sensitive service laws)
– You can test at home
• Subject to false positives and false negatives
• Talk!
– See our discussion guides
Starting the Conversation
• Goal: to have a conversation, not a lecture
– Find the “right time”
– Be patient and ready to listen
– Avoid criticism and encourage open dialogue
• Avoid “we need to talk,” instead “What do you think about…”
• Avoid “you don’t vape, right…”
• Use the right words! (vaping, Juuling)
• Continue the conversation
⎻ In-person, or via text/email, etc.
• Sharing articles is a great way to stay engaged
Stay Informed, Stay Active
• https://www.parentsagainstvaping.org
Stay Informed, Stay Active
Submit a public comment!
The Tobacco Prevention Toolkit
Interactive
Online
Free
Tobaccopreventiontoolkit.Stanford.edu
Stay Informed, Stay Active
• Follow us to stay up to date with relevant news, curricula
updates, and new activities at:
• www.facebook.com/TobaccoPrevToolkit/
• www.twitter.com/StanfordTPT
Take Home Points
• This is BIG TOBACCO 2.0
• Nicotine is extremely addictive, more addictive than heroin
• Really important to keep your kids from getting addicted before their frontal cortex is fully formed, so they don’t have a predisposition towards addiction for the rest of their lives
• The people behind these vaping companies are great marketers who are targeting our kids and actively trying to cloud the narrative around these facts.
• These vaping companies are using tools and practices that many of us don’t understand and don’t see. We need to be vigilant, stay informed, and stay active!
