Lobby Poll: How much do you know about e-cigarettes and vaping? - PDF document

6/12/2019 Lobby Poll: How much do you know about e-cigarettes and vaping? Beginner Intermediate Advanced E-cigarettes and Vaping: The Mechanics of Use, Risks to Youth, and Prevention Efforts Liz Wilhelm & Marina Epstein June 12, 2019 1

6/12/2019 Disclaimer This webinar is being recorded and archived, and will be available for viewing after the webinar. Please contact the webinar facilitator if you have any concerns or questions. Please note, the views expressed in this webinar do not necessarily represent the views, policies, and positions of the Substance Abuse and Mental Health Services Administration or the U.S. Department of Health and Human Services. 2

6/12/2019 • Upcoming Events • Systems Change and Strategic Financing – July 31st • Sustaining Substance Misuse Prevention Efforts – September 6th Marina Epstein is a Research Scientist at the Social Development Research Group. Her research on e- cigarettes focuses on the interplay between e-cigarette and combustible cigarette use among youth and adults and on identifying targets for prevention. Liz Wilhelm is the Prevention Works in Seattle (WINS) Coalition Coordinator and co-designer and trainer of the Washington State E-Cigs: Finding the Truth Among the Vapors Training of Trainers. 3

6/12/2019 Overview • Introduction to e-cigarettes/vapes • E-cigarette/vape and youth • Risks of e-cigarette/vape use • Adult e-cigarette use • What is happening in Washington State • Prevention intervention points and resources What are e-cigarettes? • Battery operated device that vaporizes a liquid nicotine for inhalation • Known by several names: e-cig, vape, Juul 4

6/12/2019 COMBUSTIBLE CIGARETTES VS. E-CIGARETTES • Contain tobacco leaves, a natural source • Contains nicotine synthesized in the of nicotine lab, no tobacco • Smoke from burning the contents is • Nicotine is inhaled along with water inhaled vapor, not smoke • A significant amount of nicotine is • Little nicotine is exhaled exhaled with the smoke (secondhand smoke) • Contains up to 200 chemicals added • Contains some 7,000 chemicals added by the e-cigarette companies by the tobacco companies • Cost: $20 for device + $30/4 refills • Cost: $8.05/20 cigarettes (~80 cigarettes) What are e-cigarettes? Atomizer/coil Battery Absorbent material: Nicotine Propylene glycol Vegetable glycerin Flavorants 5

6/12/2019 3 basic types of e-cigarettes Minis or Ciglikes Mods or Tanks Mid-size re-chargable, pen E-cigarettes and youth 6

6/12/2019 JUUL Electronic cigarettes: heterogeneity in flavors. 7

6/12/2019 Why are e-cigarettes so popular? Money spent on advertising Marketing to youth 8

6/12/2019 Rise in E-cigarette use among youth Poll question: Why do young people try e-cigarettes? • Good Flavors • Friends Use • Curiosity • Smells better than combustible cigarettes • Easy to use anywhere/easy to hide • Healthier/safer than combustible cigarettes 9

6/12/2019 Why young people try e-cigarettes Cigarette and e-cigarette use among high school youth Trends in Cigarette Use for High School Students 30 25 20 Percent 15 10 5 0 2011 2012 2013 2014 2015 2016 2017 2018 Year E-Cigarettes C-Cigarettes 10

6/12/2019 Problem with e-cigarettes? E-cigarettes are cool, taste good, less harmful than cigarettes. What’s the problem? 1.Nicotine use had negative health effects for youth a. Attention and learning problems b. Nicotine is addictive 2.Nicotine use puts youth in the path of cigarettes a. Once addicted, they may be more inclined to use another nicotine product b. Using one nicotine product may “renormalize” tobacco products Problem with e-cigarettes? E-cigarettes are cool, taste good, less harmful than cigarettes. What’s the problem? 3. Youth use e-cigarette cartridges to vape marijuana In late 2018, JAMA study published that 1 in 11 teenage students used marijuana vapor product. 11

6/12/2019 Poll question: Why vape marijuana? • Get higher, faster • Limited odor • More discrete • Ease of any time use • Healthier than smoking • Socially “cool” King County Youth Marijuana and Education Program Regional Network 2018 Youth Listening Session • Listening Sessions with Youth: Social norms 327 • Average Age: 15.4 years Self-medicating • “They do it cause their friends are 189 using it. I’ve heard of a lot of Access people getting “sucked into it” 112 because they’re at a gathering Curiosity and all their friends are doing it, 72 so they think “Oh, it must be Get High pretty harmless . It must be really 68 fun, I wanna try it too. That looks 0 50 100 150 200 250 300 350 really cool.” 12

6/12/2019 Problem with e-cigarettes? E-cigarettes are cool, taste good, less harmful than cigarettes. What’s the problem? 4. E-cigarettes as a 100 pathway to 90 combustible 80 % used cigarettes 70 cigarette use 60 50 40 38 40 31 31 30 20 11 8 10 7 10 0 Did not use e-cigarettes Used e-cigarettes Barrington-Trimis (2016) Leventhal (2015) Miech (2017) Primack (2015) Implications for prevention • Preventing combustible cigarette use remains an important public health issue • Preventing e-cigarette use must be a part of that prevention effort • Educating youth is one aspect of prevention: • Manipulative advertising by e-cigarette companies • Juul and other companies merging with “Big Tobacco” • Dangers of nicotine • FDA regulation of distribution, flavor, and availability of e- cigarettes must be a priority 13

6/12/2019 E-cigarettes and adults Poll question: What do adults say about their use of e-cigarettes? • E-cigs may help in giving up smoking • E-cigs might taste good • E-cigs may be good for my health • E-cigs may satisfy my desire to smoke • E-cigs may be healthier for people in my life 14

6/12/2019 Why adults use e-cigarettes Youth and adult patterns of e-cigarette use E-cigarette users 80% 67% 64% 60% 40% 33% 20% 20% 13% 0% Youth Adults Never smoker Current smoker Former smoker 15

6/12/2019 E-cigarette use among adults and youth: two different public health problems Youth Adults • Youth e-cigarette/vapes users are • Adult e-cigarette use are usually usually non-smokers current or former smokers • There is a danger that using e- • There is hope that e-cigarette use cigarettes/vapes can lead to an can help smokers cut down or uptake in tobacco use quit cigarettes • Goal is to prevent e-cigarette use • Goal is to switch users entirely away from combustible cigarettes What is happening in Washington State? 16

6/12/2019 WA Healthy Youth Survey 2018: Vapor Products Perceived Risk of E-Cigarette Use or Vaping students who report "great risk" of harm from using e-cigarette or vape pen regularly (almost daily) Seattle SOURCE: 2018 Healthy Youth Survey 17

6/12/2019 Washington State Tobacco 21 begins January 1, 2020 Are current Washington State 18-20 year olds “grandfathered” in? Can they continue purchasing tobacco products even though they are not 21 years old? No. Starting January 1, 2020, retailers are prohibited from selling tobacco and vapor products to individuals who are under 21 years of age as of January 1, 2020. This includes e-cigarettes. Prevention of e-cigarette/vape use among youth 18

6/12/2019 Tools of information and discussion to prevent youth use • Understand the laws in your • Appreciate the power of role modeling state (e.g. Tobacco 21) • Discuss the influence of other adults, • Recognize the power of norms peers, pop culture, boredom, lack of and perceptions confidence, instant gratification, self • Identify family risk factors such medication, and escape as family history • Correct misinformation • Discuss mental health and behavioral health issues • Acknowledge the role of impulse control Youth in King County, WA reported about marijuana during listening sessions 19

6/12/2019 What can parents do to prevent youth use? • Set clear guidelines and grow • Express a no use attitude them with your teen’s maturity • Continue conversations with your teen at every opportunity • Keep track of your teen • Keep lines of communication open • Don’t make substances available • Encourage teens and yourself to to your teens or their friends practice mindfulness • Practice skills with your teen to • Monitor your own behavior refuse nicotine and other drugs • Have big shoulders to be the “bad guy” for your teen Our favorite e-cigs/vapes prevention and cessation resources  U.S. Surgeon General’s Report on E-Cigarette Use Among Youth and Young Adults  teen.smokefree.gov quitSTART app and text messaging program (Text “Quit” to 47848)   Adolescent medicine pediatricians  Truth Initiative – What is Juul?  CDC – E-cigarettes and youth people  Partnership for Drug Free Kids National Institute on Drug Abuse  20

6/12/2019 Stanford Tobacco Prevention Toolkit https://med.stanford.edu/tobaccopreventiontoolkit.html Marina Epstein Liz Wilhelm, M.S., CPP, ICPS Research Scientist Drug Free Communities Coordinator Social Development Research Group Prevention WINS Coalition School of Social Work | University of Washington Division of Adolescent Medicine | Seattle Children’s marinaep@uw.edu Liz.wilhelm@seattlechildrens.org 21