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Lobby

Poll:

How much do you know about e-cigarettes and vaping?

BeginnerIntermediateAdvanced

E-cigarettes and Vaping: The Mechanics of Use, Risks to Youth, and Prevention Efforts Liz Wilhelm & Marina Epstein

June 12, 2019

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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.

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• 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.

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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

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COMBUSTIBLE CIGARETTES VS. E-CIGARETTES

• Contain tobacco leaves, a natural source of nicotine

• Smoke from burning the contents is inhaled

• A significant amount of nicotine is exhaled with the smoke (secondhand smoke)

• Contains some 7,000 chemicals added by the tobacco companies

• Cost: $8.05/20 cigarettes

• Contains nicotine synthesized in the lab, no tobacco

• Nicotine is inhaled along with water vapor, not smoke

• Little nicotine is exhaled• Contains up to 200 chemicals added

by the e-cigarette companies• Cost: $20 for device + $30/4 refills

(~80 cigarettes)

BatteryAtomizer/coil

Absorbent material:Nicotine

Propylene glycolVegetable glycerin

Flavorants

What are e-cigarettes?

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3 basic types of e-cigarettes

Mods or Tanks

Minis or Ciglikes

Mid-size re-chargable,pen

E-cigarettes and youth

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JUUL

Electronic cigarettes: heterogeneity in flavors.

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Why are e-cigarettes so popular?Money spent on advertising

Marketing to youth

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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

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Why young people try e-cigarettes

Cigarette and e-cigarette use among high school youth

0

5

10

15

20

25

30

2011 2012 2013 2014 2015 2016 2017 2018

Per

cent

Year

Trends in Cigarette Use for High School Students

E-Cigarettes C-Cigarettes

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Problem with e-cigarettes?

1.Nicotine use had negative health effects for youtha. Attention and learning problemsb. Nicotine is addictive

2.Nicotine use puts youth in the path of cigarettesa. Once addicted, they may be more inclined to use another

nicotine productb. Using one nicotine product may “renormalize” tobacco

products

E-cigarettes are cool, taste good, less harmful than cigarettes. What’s the problem?

Problem with e-cigarettes?

3. Youth use e-cigarette cartridges to vape marijuanaIn late 2018, JAMA study published that 1 in 11 teenage students used marijuana vapor product.   

E-cigarettes are cool, taste good, less harmful than cigarettes. What’s the problem?

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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

• Listening Sessions with Youth:• Average Age: 15.4 years• “They do it cause their friends are

using it. I’ve heard of a lot of people getting “sucked into it” because they’re at a gathering and all their friends are doing it, so they think “Oh, it must be pretty harmless. It must be really fun, I wanna try it too. That looks really cool.”

68

72

112

189

327

Get High

Curiosity

Access

Self-medicating

Social norms

0 50 100 150 200 250 300 350

2018 Youth Listening Session

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Problem with e-cigarettes?

4. E-cigarettes as a pathway to combustible cigarette use

E-cigarettes are cool, taste good, less harmful than cigarettes. What’s the problem?

11

40

8

31

7

31

10

38

0102030405060708090

100

Did not use e-cigarettes Used e-cigarettes

% u

sed

ciga

rette

s

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

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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

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Why adults use e-cigarettes

Youth and adult patterns of e-cigarette use

67%

13%

33%

64%

20%

0%

20%

40%

60%

80%

Youth Adults

E-cigarette users

Never smoker Current smoker Former smoker

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E-cigarette use among adults and youth: two different public health problems

Youth

• Youth e-cigarette/vapes users are usually non-smokers

• There is a danger that using e-cigarettes/vapes can lead to an uptake in tobacco use

• Goal is to prevent e-cigarette use

Adults

• Adult e-cigarette use are usually current or former smokers

• There is hope that e-cigarette use can help smokers cut down or quit cigarettes

• Goal is to switch users entirely away from combustible cigarettes

What is happening in Washington State?

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WA Healthy Youth Survey 2018: Vapor Products

Perceived Risk of E-Cigarette Use or Vapingstudents who report "great risk" of harm from using e-cigarette or vape pen regularly

(almost daily)

SOURCE: 2018 Healthy Youth Survey

Seattle

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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.

Washington State Tobacco 21 begins January 1, 2020

This includes e-cigarettes.

Prevention of e-cigarette/vape use among youth

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Tools of information and discussion to prevent youth use

• Understand the laws in your state (e.g. Tobacco 21)

• Recognize the power of norms and perceptions

• Identify family risk factors such as family history

• Discuss mental health and behavioral health issues

• Acknowledge the role of impulse control

• Appreciate the power of role modeling• Discuss the influence of other adults,

peers, pop culture, boredom, lack of confidence, instant gratification, self medication, and escape

• Correct misinformation

Youth in King County, WA reported about marijuana during listening sessions

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What can parents do to prevent youth use?

• Express a no use attitude• Continue conversations with your

teen at every opportunity• Don’t make substances available

to your teens or their friends• Practice skills with your teen to

refuse nicotine and other drugs• Have big shoulders to be the “bad

guy” for your teen

• Set clear guidelines and grow them with your teen’s maturity

• Keep track of your teen• Keep lines of communication open• Encourage teens and yourself to

practice mindfulness• Monitor your own behavior

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

Our favorite e-cigs/vapes prevention and cessation resources

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Stanford Tobacco Prevention Toolkit

https://med.stanford.edu/tobaccopreventiontoolkit.html

Liz Wilhelm, M.S., CPP, ICPSDrug Free Communities CoordinatorPrevention WINS CoalitionDivision of Adolescent Medicine | Seattle Children’sLiz.wilhelm@seattlechildrens.org

Marina EpsteinResearch ScientistSocial Development Research Group School of Social Work | University of Washingtonmarinaep@uw.edu

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Last Thing!

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