1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

Emerging Nicotine Products

Tobacco Use Prevention and Control (TUPAC) Program

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

Learning ObjectivesAs a result of this presentation, participants will:

▪ Recognize an e-cigarette and where kids like to hide them

▪ Review the latest data regarding e-cigarettes

▪ Understand how kids help market e-cigarettes

▪ Become familiar with the tobacco industry’s marketing tactics

▪ Become familiar with the signs and symptoms of acute nicotine poisoning

▪ Review data and information about how nicotine effects the adolescent brain and social and emotional learning

▪ Review the findings and recommendations of the Surgeon General and Centers for Disease Control and Prevention

▪ Become familiar with campaigns and resources available from TUPAC and other national partners

The TUPAC Program strives to reduce and prevent the harmful and addictive use

of tobacco products outside of its use in traditional Native American practices.

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

Anatomy of an E-cigarette

Electronic Smoking Devices, including e-Cigarettes

▪ Battery-operated products designed to turn liquid nicotine,

flavorings, and other chemicals into an aerosol that is ingested

by the user

into a vapor that is inhaled by the user

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Evolution of E-Cigarettes

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Nicotine + Flavor = Pediatric Addiction

All these products have two things in common …

the addictive drug nicotine and candy flavor.

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

(dis)tasteful Findings

NM youth collected 2,481 public opinion surveys from 87 communities across the state to assess what New Mexicans thought about flavored tobacco products.

83% think flavored tobacco products are more

appealing to youth than regular tobacco

products.

85% were more likely to try a flavored cigarillo

than an unflavored one.

17% think flavored tobacco is probably or

definitely safer than regular tobacco

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Flavor Danger

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1 Product

More than 7 in 10 NM high school youth tobacco

users used a flavored product in past month

72.1%

SOURCE: 2015 YRRS-NM DS

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

Nicotine Addiction

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Deceptive Packaging

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JUUL: Nicotine Delivery in Disguise

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

Hidden in Plain Sight

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

Peer-to-Peer Marketing: Kids Share

Social Media

▪ Snap Chat

▪ Instagram

▪ Twitter

▪ YouTube - Kids provide “instructional” and “aspirational” videos

▪ “How to Hide Your JUUL at Home”

▪ “How to Hide Your JUUL at School”

SOURCE: https://www.youtube.com/watch?v=9n3JdsQlm64

SOURCE: https://www.youtube.com/watch?v=ESmNW1Mp2M4

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

JUUL Use in School Bathrooms and Classrooms

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

Nicotine is Poison

Source: https://www.tobaccofreekids.org/press-releases/2015_01_13_poisoning

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

New Mexico Poison & DrugInformation Center (NMPDIC)

The lethal dose of nicotine (1.4 mg/kg) is half that of morphine (2.7 mg/kg) and similar to arsenic.

SOURCE: NMPDIC - Exposures to e-Cigarettes and Liquid Nicotine in NM

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

Acute Nicotine Poisoning

Symptoms

▪ Symptoms typically last an hour or two after a mild overdose and up to 24 hours for severe poisoning

▪ Early symptoms can appear within the first 15 minutes to an hour▪ Feeling queasy or throwing up

▪ Stomachache

▪ Mouth watering

▪ Quick, heavy breathing

▪ Faster heartbeat

▪ Higher blood pressure

▪ Pale skin

▪ Headache

▪ Dizzy, off-balance, or confused

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

Emerging Data

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

8.2%

9.3%

10.2%

10.6%

24.7%

Spit/Chew

Hookah

Cigars

Cigarettes

e-Cigarettes

SOURCE: 2017 YRRS & 2017 YRBS

U.S. (2019): 27.5% use e-cigarettes and 5.8% use cigarettes

Current Tobacco Use by New Mexico HS Youth 2017

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

NM High School Youth Tobacco Use Trends2009-2017

24.0

18.1

11.8

19.9

15.1

9.5

19.9

14.4

12.3

8.0

21.9

11.410.5

8.7

11.9

24.0

10.6 10.2

8.29.3

24.7

Cigarettes Cigars Spit/Chew Hookah E-Cigarettes

Pe

rce

nt U

se

in

Pa

st M

on

th

SOURCE: 2009-2017 YRRS

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

More HS youth have triede-cigarettes than regular cigarettes

35.3%

Youth who have ever tried cigarettes

51.0%

Youth who have ever tried e-cigarettes

SOURCE: 2017 YRRS

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

12.0%

24.7%

10.6%

3.4%4.0%

10.6%

16.5%17.8%

Mid School High School 18-29 yrs 30+yrs

Age Group

E-Cigarette Cigarette

E-cigarette use highest in HS youth,while cigarette use is higher among adults

SOURCE: 2017 YRRS & 2017 BRFSS

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

Emerging Findings andRecommendations

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CDC Findings and Recommendations

1. Protect Youth

2. Protect Unborn Children

3. Encourage Cessation

4. Protect Clean Indoor Air

5. Enact Rules to Restrict Use and Exposure

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

Findings and Recommendations

1. Protect Youth

▪ Nicotine exposure is not safe for youth

▪ Nicotine is highly addictive and can harm brain development,

which continues until about age 25

▪ Nicotine use during adolescence can disrupt the formation of

brain circuits that control attention, learning, and susceptibility

to addiction

▪ Nicotine can train the brain to be more easily addicted to other

drugs

▪ Children are at risk for poisoning by accidental exposure to

e-cigarettes and liquid nicotine

SOURCE: E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

2. Protect Unborn Children

▪ Nicotine exposure is not safe for unborn children

▪ Nicotine can cross the placenta and affect fetal and postnatal

development

▪ The Surgeon General has concluded that nicotine adversely

affects maternal and fetal health during pregnancy, contributing

to multiple outcomes such as preterm delivery and stillbirth

▪ Nicotine is known as a cause of Sudden Infant Death

Syndrome

Findings and Recommendations

SOURCE: E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

3. Encourage Cessation

▪ Although e-cigarettes have been marketed as smoking

cessation aids, there is currently no conclusive scientific

evidence that e-cigarettes promote successful long-term

quitting.

▪ There are proven adult cessation strategies and treatments,

including counseling and FDA-approved cessation

medications.

▪ Electronic nicotine delivery systems may have the potential

to benefit established adult smokers if used as a complete

substitute for all smoked tobacco products.

Findings and Recommendations

SOURCE: E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

4. Protect Clean Indoor Air

▪ The aerosol produced by electronic smoking devices is not

harmless water vapor; it can contain nicotine and other

toxins. Exposure to nicotine can harm adolescent brain

development and can be toxic to fetuses.

▪ The standard for protecting the health of children and

bystanders should be clean air, free of toxic secondhand

smoke, as well as aerosol produced by electronic nicotine

delivery systems.

Findings and Recommendations

SOURCE: E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

Findings and Recommendations

5. Enact Rules and Policies to Restrict Use and Exposure

Federal

Tribal

State

Municipal

Schools

Businesses

Homes & Cars

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

The Immediate Impact of Policy

0

10

20

30

40

50

60

70

2012 2013 2014 2015 2016 2017

61

48

41

14

34

22

Nicotine poisoning related calls to the New Mexico Poison & Drug

Information Center, increased from 2012–2014, then began decreasing

after New Mexico legislated child-resistant packaging rules and

established a legal age of purchase in 2015.

SOURCE: NMPDIC - Exposures to e-Cigarettes and Liquid Nicotine in NM

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

Surgeon General’s Advisory onE-cigarette Use Among Youth

31

Recommended actions include:

▪ Raise and strongly enforce minimum-age-of-sales

laws for all tobacco products, including e-cigarettes

▪ Incorporate e-cigarettes into smoke-free policies

▪ Reduce access to all flavored tobacco products by young

people

▪ Sponsor high-impact media campaigns to educate public on

harms of e-cigarettes among young people

▪ Increase price of tobacco products, including e-cigarettes

▪ Require tobacco retailer licensure

Source: CDC Surgeon General’s Report, 2016 , https://e-cigarettes.surgeongeneral.gov/documents/surgeon-generals-advisory-on-e-cigarette-use-among-youth-2018.pdf

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

As of December 27, 2019, a total of 2,561 hospitalized EVALI

cases or deaths have been reported to CDC from all 50 states,

the District of Columbia, and two U.S. territories (Puerto Rico

and U.S. Virgin Islands).

▪ Fifty-five deaths have been confirmed in 27 states and

the District of Columbia (as of December 27, 2019).

For more information, visit the EVALI website.

BREAKING NEWSOutbreak of Lung Injury Associated with

the Use of E-Cigarette, or Vaping, Products

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

BREAKING NEWS Federal minimum age of sale of tobacco

products raised from 18 to 21 years

December 20, 2019, the President signed legislation to amend

the Federal Food, Drug, and Cosmetic Act, and raise the

federal minimum age of sale of tobacco products from 18 to 21

years.

It is now illegal for a retailer to sell any tobacco product –

including cigarettes, cigars and e-cigarettes – to anyone under

21. FDA will provide additional details on this issue as they

become available.

FDA updates are available at https://www.fda.gov/tobacco-

products/compliance-enforcement-training.

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

BREAKING NEWSThe FDA to enforce policy on the manufacture, distribution and

sale of unauthorized flavored cartridge-based e-cigarettes

On January 2, 2020, the FDA finalized enforcement policy on

unauthorized flavored cartridge-based e-cigarettes that appeal

to children, including fruit and mint.

Companies that do not cease manufacture, distribution and

sale of unauthorized flavored cartridge-based e-cigarettes

(other than tobacco or menthol) risk FDA enforcement actions.

For more information, visit https://www.fda.gov/tobacco-

products.

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

For products marketed without FDA authorization, FDA intends

to prioritize enforcement against:

▪ Any flavored, cartridge-based Electronic Nicotine

Delivery System (ENDS) product (other than a tobacco- or

menthol-flavored ENDS product);

▪ All other ENDS products for which the manufacturer has

failed to take (or is failing to take) adequate measures to

prevent minors’ access; and

▪ Any ENDS product that is targeted to minors or whose

marketing is likely to promote use of ENDS by minors.

BREAKING NEWSThe FDA to enforce policy on the manufacture, distribution and

sale of unauthorized flavored cartridge-based e-cigarettes

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

Emerging Responsibilities

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

What Is My Role?

Parents can:

▪ Learn about the different shapes and types of e-cigarettes

and the risks of all forms of e-cigarette use for young people

▪ Talk to their children about the risks of e-cigarette use

among young people. Express firm expectations that their

children remain nicotine-free

▪ Set a positive example by being nicotine-free

SOURCE: https://www.cdc.gov/tobacco/infographics/youth/pdfs/e-cigarettes-usb-flash-508.pdf

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

What Is My Role?

Educators can:

▪ Learn about the different shapes and types of e-cigarettes

and the risks of all forms of e-cigarette use for young

people

▪ Develop, implement, and enforce tobacco-free school

policies

▪ Reject youth tobacco programs sponsored by the tobacco

industry. These programs have been found to be ineffective for prevention youth tobacco use

SOURCE: https://www.cdc.gov/tobacco/infographics/youth/pdfs/e-cigarettes-usb-flash-508.pdf

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

What Is My Role?

▪ Ask about e-cigarettes,

including devices shaped like

USB flash drive, when

screening patients for the use

of tobacco products

▪ Warn patients about the risks

of all forms of tobacco

product use, including e-

cigarettes, for young people

▪ Provide brief intervention for nicotine users

Pediatric Health Care Providers can:

SOURCE: https://www.cdc.gov/tobacco/infographics/youth/pdfs/e-cigarettes-usb-flash-508.pdf

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

Emerging Resources

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

National Campaigns and Resources

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

Environmental Strategies that encourage and reinforce tobacco-free

lifestyles and behaviors

Youth Engagement:

Advocacy

Policy Development:

Tobacco-Free High Schools

Policy Development:

Point of Sale

Policy Development:

Tobacco-Free College Campuses

Mass Media:

Awareness and Education

TUPAC Campaigns and Resources

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

TUPAC Campaigns and Resources

Online Training

for Health Professionals

Health Systems Change

Training and Outreach Program

Comprehensive Cessation Services

for those who want to quit—includes

youth protocol ages 13-17

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

WWW.NMTUPAC.COM

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

Emerging Questions

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

Contact Information

David Tompkins

Community Health Initiative Manager

505-841-5874

David.Tompkins@state.nm.us

www.nmtupac.com