Start the Conversation: How to Talk to Young People about Vaping Find a seat Greet your neighbors We’ll get started soon! Jenny Best, MS, El Paso County Public Health Grace Houser, MD, Children’s Hospital Colorado
Getting Started Objectives • Recognize emerging trends, culture, and health effects of youth use of e-cigarettes • Use trusted adult principles to have conversations with youth about the use of e- cigarettes What do you want to learn today or have a question about?
The Data 50% of youth currently use e-cigarettes. E-cigarettes: 23% Cigarettes: 7% Other Tobacco Products: 10%
The Data 44% of youth have tried e-cigarettes. Use: E-cigarettes: 44% Alcohol: 60% Marijuana: 39%
The Data 70% of youth perceive vaping as risky. Perceive vaping as risky: 47% Perceive smoking as risky: 87%
The Data Youth who can ask a parent for help as 10% less likely to vape. Youth who can ask a parent for help are 31% less likely to vape.
Discussion- HKCS 2017 23% of youth currently use e- cigarettes (7% cigarettes) 44% of youth have tried e-cigarettes What questions do you have about this data? 47% of youth perceive vaping as risky (85% - smoking) Youth who can ask parents for help are 31% LESS likely to vape Youth who participate in extracurricular activities are 12% LESS likely to vape. LGBTQ Youth have higher rates of use compared to heterosexual peers.
Current Trends & Culture
What We Know Curiosity 43% of young people cite Flavors flavors as the reason they first tried vaping Belief that they are safer than other tobacco products Only 47% of El Paso County youth find vaping to be risky
Electronic Devices • E-cigs • Vapes • Pods • Mods • E-juice • Vaping ● Clouds • JUUL ● Dripping ● Shotgunning ● JUUL’ing
JUULs “The Smoking Alternative, unlike any E- cigarette or Vape” Flavors: Classic Tobacco • Virginia Tobacco • Menthol • Each pod is equivalent to 1 pack of cigarettes or 200 puffs
Marketing • Appealing flavors • Social media - Instagram, snapchat, twitter, YouTube
Marketing “Made for adults to quit smoking” - JUULs “Healthy Alternative” “Stealth” vaping
Stealth Vaping
Stealth Vaping Mods
Health Effects
What’s in them? E-cig juice / e-liquid / vape juice • Nicotine • Artificial flavorings: diacetyl (“popcorn lung”), mint (allergy/asthma), cinnamon (asthma) • Solvents: propylene glycol, vegetable glycerin • Convert to carcinogens when heated and inhaled • Other particles, heavy metals • NOT “water vapor”
Nicotine & The Young Brain • Brain is still developing until about age 25. • Nicotine is highly addictive and has neurotoxic effects on the developing brain • Disrupts the development of the brain circuits that control attention, learning, mood and impulse control • Affects the brain’s rewards system and can lead to increased potential for addiction to other substances
Aerosol – Not Harmless Water Vapor Health Impact • Acute effects: cough, mouth or throat irritation, anxiety, depressed mood, nausea, insomnia • Respiratory: link to asthma, altered immune response • Cardiovascular: links to endothelial cell dysfunction • Neurologic: effects of nicotine • Potential for ingestion, explosions • No evidence for “safety” Second hand smoke effects
EVALI (E-cigarette/Vaping Associated Lung Injury) EVALI • June 2019; peaked in September • Symptoms similar to pneumonia or influenza, but no infectious cause identified • Vitamin E acetate in fluid samples collected from lungs of patients with EVALI, but not in controls -Banned in inhaled marijuana products in Colorado as of Jan 1, 2020
EVALI (E-cigarette/Vaping Associated Lung Injury) EVALI • As of December 2019: about 2200 hospitalized patients nationally -At least 55 deaths -1 teenager required lung transplant • At least 2 cases (but < 5) in Colorado; highest numbers in Midwest • Treatments: supportive care; maybe steroids; smoking cessation
Chronic Lung Disease from Vaping E-cigarette use among adults is a risk factor for development of: Chronic obstructive pulmonary disease (COPD) • Chronic bronchitis • Emphysema • Asthma • Statistically speaking – odds ratios E-cigarette use: 1.3x • Combustible tobacco use: 2.5x • BOTH: 3.3x • Bhatta DN, Glantz SA. “Association of E -Cigarette Use With Respiratory Disease Among Adults: A Longitudinal Analysis.” Am J Prev Med 2019
Policy Efforts
Evidence behind policy change Raising legal tobacco sales age from 18 to 21 reduces the number of adolescents and young adults who start smoking 95% of adult smokers begin smoking before • age 21 Helps keep tobacco out of high schools • Tobacco tax increases reduce smoking rates • 10% increase in cigarette prices → decrease in youth smoking by 7%, decrease in total cigarette consumption by 4% • Increased state revenue, decrease tobacco-related health care costs
National December 20, 2019: Federal law raised the minimum age of sale of tobacco products from 18 to 21 years • No exemptions for current 18 to 21 year old users, or for active military personnel • Effective immediately • Enforcement plan over next 1-2 years Partial e- cigarette flavor ban: “coming soon” • Prohibit e-cig cartridges • Exempt menthol and tobacco flavors • Exempt open tank systems • Health & Human Services • FDA review process
State 2019 Colorado Legislature • Updated Clean Indoor Air Act to include e-cigarettes • Removal of tax penalty for local municipalities to enforce tobacco legislation 2020 Colorado Legislature HB 20-1001: Raise minimum legal sales age of tobacco • purchase to 21; require statewide tobacco retailer licensing system Local communities would be able to implement • stronger ordinances
State Increasing Tobacco Taxes Proposed vaping and tobacco tax (multiple versions) • filed last week • Raise state tobacco tax from 84c to $1.20 - $2.60 (per pack) and add tax on e-cigarette products • Federal tax: $1.10 per pack Would place an initiative on statewide November • ballot Revenue would fund statewide preschool programs • for 4 year olds, as well as: • Anti-tobacco education programs • Resources to help smokers quit • Health clinics
Local Manitou Springs: Tobacco Retail Licensing Ordinance passed January 2020 (effective Feb 5) • Raises minimum legal sales age to 21 • Licensing and enforcement provisions Colorado Springs • Working with City Council on tobacco retail licensing and raising minimum legal sales age to 21 Fountain • Model in Southern Colorado for instituting retail licensing and compliance checks • Working to update ordinance to include e-cigarettes Monument?
Trusted Adult: a parent, guardian, caregiver, teacher, or mentor that is approachable & open to answering questions with accurate information
1. Reflect Reflect on your personal point of view Reflect on your ability to be a role model Reflect on what you want the result of the conversation to be Reflect on the context of the conversation
2. Determine Underlying Question “What is acceptable behavior?” “Do I have your approval?” “Can I shock you?” “What is your personal belief?”
3. Use O.A.R. to Guide the Conversation O pen-ended questions A ffirmations R eflective Listening
O.A.R.: Open-ended Questions Who, What, Where, When, Why and How questions that move the conversation forward Examples: “What do you think about … ?” “How do you decide when to … ?” “How do you feel about … ?” “Help me understand … ?”
O.A.R.: Affirmations Statements to focus on strengths and positive behaviors – no matter how small. Examples: “I appreciate that you’re willing to talk with me about this.” “It sounds like you handled yourself well in that situation.” “That’s a good idea.”
O.A.R.: Reflective Listening Focus on understanding what the person means by: • Repeating and rephrasing • Paraphrasing • Reflecting a feeling. Examples: “So you feel…” “It sounds like you…” “You’re wondering if…”
Talking to your youth by age: Age 10-12 Concrete thinkers • Parental modeling and influence • Age 13-15 High risk takers, unable to anticipate • consequences Importance of clear family boundaries and • enforcing rules Age 16-18 More independent, but still listening to trusted • adults Open ended questions and reflective listening •
What We Can Do 1. Have a Trusted Adult Conversation Resources: Speak Now Colorado TobaccoFreeCO TobaccoFreeKids CDC
What We Can Do 2. Provide education and cessation resources for youth who use tobacco/ other nicotine products. Resources: Second Chance - online tobacco/ • nicotine education program Colorado Quitline • ○ My Life My Quit Smokefree Teen • “The Real Cost” •
What We Can Do 3. Join local community efforts. • Tobacco-Free Alliance • SWAT Club • Nicotine News
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