VAPING AND THE CRISIS WITHIN OUR SCHOOLS Ranayda Drayton, CHES, CSAPC, LCSW-A Youth Tobacco Prevention Coordinator Pine Lake Prep January 16, 2019
FAQ By Parents • What exactly is vaping? • What might explain the dramatic rise in teenage vaping? • Some products do not contain nicotine. How are such products dangerous? • How can vaping impact the teenage brain? • What is Juul? What does Juul’s look like? Smell like? Why are they so popular? • How can vaping products be disguised? • What are the signs that your child is vaping? • Is vaping addictive? • Is vaping a gateway drug to other types of drug use? • How are institutions such as the FDA and law enforcement agencies addressing the teenage vaping issue?
We’ve made a lot of progress on Smoking Rates In NC ~50% ~17.9% 2016 1945
90% of tobacco users start before the age of 18 95% before 21 Should We Be Worried? YES!
Cigarette e smokin ing h has d decr creased ed a amon ong y youth th PERCENTAGE OF STUDENTS Cigarette Use in Past 30 Days, NC YTS, 2017 35 31.6 27.8 30 27.3 25 20.3 19.0 20 16.7 15.5 15.0 13.5 High School 15 11.3 9.3 9.3 8.9 10 5.8 Middle School 4.5 4.3 4.2 5 2.5 2.5 2.3 0 1999 2001 2003 2005 2007 2009 2011 2013 2015 2017 2017 North Carolina Youth Tobacco Survey Results
Overall N NC youth tobacco u use continues t to trend h high PERCENTAGE OF STUDENTS Use of Any Tobacco Product in Past 30 Days, NC YTS 45 38.3 40 35.8 33.7 High School 35 29.7 28.8 28.5 27.6 30 26.6 25.8 25.8 25 18.4 Middle School 17.4 20 14.3 15 11.6 10.7 10.5 10.5 9.9 9.1 8.6 10 5 0 1999 2001 2003 2005 2007 2009 2011 2013 2015 2017 2017 North Carolina Youth Tobacco Survey Results
E-cigarettes are still the #1 product used by youth Use of Tobacco Products in Past 30 Days, NC YTS 2017 5.3 E-cigarettes 16.9 3.8 Cigars/cigarillos/little cigars 12.7 2.5 Cigarettes 8.9 2.3 Chewing tobacco/snuff/dip 6.3 2.5 Hookah 4.5 2.0 Roll-your-own cigarettes 3.4 0.8 Snus 3.7 PERCENTAGE OF STUDENTS Middle School High School 0 5 10 15 20 25 2017 North Carolina Youth Tobacco Survey Results
Between 2011-2017 Current Use of E-Cigarettes Increased: 894% 430% High Middle School School 2017 North Carolina Youth Tobacco Survey Results
Risk and protective factors for e-cigarette use YDS, 2018
What are E-cigarettes? Temp Control Box Mod (4 th Generation)
Electronic Nicotine Devices (ENDS) Electronic cigarettes • E-cigarettes • Hookah Pens & Juul considered • Cigalike • Personal Vaporizers “tobacco products” • E-cigars • Mods “The nicotine is derived • E-pipes from tobacco” • JUUL • E-Hookah • Sourin Drop / Air • Vape Pens
It’s an Aerosol, Not a Vapor Image Credit: via thenounproject.com
E-Liquid or E-Juice Currently • Over 460 brands (Zhu et al., 2014) UNREGULATED • 7,764 unique flavors 15,500 • Not approved for inhalation • Contain Nicotine • Are poisonous • Pose safety concerns
What are E-liquids? % Propylene Glycol (PG) % Vegetable Glycerin (VG) Flavorings Nicotine (0, 6, 12, 18, 24, 36 mg/ml) Hadwiger, Michael E., et al. "Identification of amino-tadalafil and rimonabant in electronic cigarette products using high pressure liquid chromatography with diode array and tandem mass spectrometric detection." Journal of chromatography A 1217.48 (2010): 7547-7555.
99% of e-cigarettes sold in US convenience stores, supermarkets and similar outlets in 2015 contained nicotine. US Centers for Disease Control and Prevention, 2015
How Addictive is Nicotine? 23
Your Gut Can Handle More Than Your Lungs Some e-cigarette manufacturers claim flavorings are safe because they meet the FDA definition of “Generally Recognized as Safe” (“GRAS”) GRAS does not apply to products that are not food
Flavors, including many with diacetyl, are Flavors associated with respiratory irritation and disease. Employee wearing protective gear MMWR, 2007 Apr 27;56(16); Farsalinos, K.E., et al (2015). Nicotine & Tobacco Research; Tierney, P. A., et al (2015). Tobacco Control
Common E-cig Flavors Benz nzalde dehyde de Benz nzyl a l acetate Vanil nilli lin Cinna nnamaldehyde de Isoamyl acetate
Res esea earch a at UNC-CH H School o of Me Medicine (TCORS RS)
What are the Long-Term Effects? When Inhaled: • Irritation to the lungs, nose, and throat • Coughing, shortness of breath and even wheezing When Exposed to Skin: • Cracking and drying • Little research; what are the long term effects? Addiction
2015 FDA Deeming of Tobacco Products Became Effective August 2016 The rule includes currently marketed products: Electronic cigarettes, all ENDS products, including all the parts/components, but not Hookah tobacco, water Liquids/e-liquids accessories pipes Certain dissolvable tobacco Cigars Pipe tobacco products (i.e., dissolvable products)
WHY DO TEENS USE E-CIGARETTES?
1 in 3 1 in 4 Middle School students say High School students say they use e-cigarettes they use e-cigarettes because of FRIENDS because of FLAVORS About 40% of middle and high school students report getting e-cigarettes from their friends 2017 North Carolina Youth Tobacco Survey Results
Safety Concerns Explosions and Fires Kristie Wolff –Manager Tobacco Prevention and Advocacy American Lung Association in ND
From: Electronic Cigarette Fires and Explosions in the US 2009-2016 , FEMA, July 2017 195 incidents
https://www.youtube.com/watch?v=AFOpoKBUyok
JUUL Now at 76.1% market share $15 Billion Company As of 4 week period ending November. 8, Wells Fargo Securities analyst Bonnie Herzog: https://www.journalnow.com/business/juul-s-leading-e-cig-market-share-may-be-leveling/article_375135d7- e5bf-57ab-a8b6-0463e6b6a04b.html
JUUL’s Sleek Design The JUUL device, with its sleek design that resembles a flash drive, is a special hit with teens. Teens say: • "It's definitely more discreet" • "JUULs are so simple and easy to use" • “JUUL has multiple flavors” A starter kit sales for $49.99
Stronger E-Cigarette/Vape salt-based freebase nicotine nicotine anywhere 59 mg of from 0 to nicotine 36 mg of per ml nicotine per ml refillable pods not tank refillable tobaccopreventiontoolkit.stanford.edu Image Credit: https://vaping.com/blog/wp-content/uploads/2017/06/ING_18993_01762.jpg
Just How Much Nicotine? 5% on box is misleading The JUUL pods contain 0.7 ml of e-liquid with a big kick of 5% nicotine by weight. 59mg/ml = pack of cigarettes
What’s in that JUUL pod? • Nicotine • Benzoic Acid • Glycerol devices and pods • Propylene Glycol produced • Natural Oils • Extracts and Flavors • ???
JUUL pods and Flavors Virginia Tobacco Mango 5 flavors in so-called “pods” Crème Brulee Fruit Medley Pre-filled JUULpods sold in Cool Mint flavors $15.99 per 4-pack of JUULpods
JUUL pods and Flavors New pods with lower nicotine levels of 3ml. being introduced 3 additional flavor “pods” added: Classic Menthol to market in August 2018 Classic Tobacco (limited) with October full Cool Cucumber implementation
JUUL Capturing Mainstream Youth Audience Teen Quote: "People who JUUL can be normal people, but people who vape are like a certain crowd." "I know it's an e-cigarette, but I don't like to call it that because you can JUUL and not be addicted to nicotine. I don't smoke cigarettes, and I don't think I ever will.” Source: https://www.npr.org/sections/health-shots/2017/12/04/568273801/teenagers-embrace-juul-saying-its-discreet- enough-to-vape-in-class
JUUL look-a-likes
blu Launches New Design Source: Convenience Store Decisions, Feb. 2018
Suorin drop $27.99 Suorin air Suorin drop 52
Notice the pattern? The tobacco industry is making tobacco products that are easily disguised as other things…
About half of students who use tobacco, use more than one product 2017 North Carolina Youth Tobacco Survey Results
Dual Use • 11.6% of all • 3.5% of all middle high school students used more school students used than one tobacco more than one product in the past tobacco product in 30 days. the past 30 days. 2017 North Carolina Youth Tobacco Survey Results
E-cigarettes and Marijuana “E-cigarette products can be used as a delivery system for cannabinoids and potentially for other illicit drugs.”
FDA Actively Moving to Address Youth E-Cigarette Epidemic NORTH CAROLINA
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