Kris MinardMontana Office of Public InstructionTobacco Use Prevention Education

Kminard@mt.gov(406) 444-0785

I work for the State of Montana and have no disclosures.

PreventingYouth Electronic Cigarette Use:

Partnering with Schools

We’ve come a long way…. A little bit of history

Electronic Cigarettes An explosion …..in more ways than one!

“Harmless Water Vapor?”…… Not

What’s the Appeal for Youth? You might be surprised….

Prevention Resources Sharing those I know about

Tobacco use is still the leading cause ofpreventable death in the United States

Cigarette smoking is responsible for more than than

480,000 deaths per year in the United States1.

1 - Jha P, Ramasundarahettige C, Landsman V, et al. 21st Century Hazards of Smoking and Benefits of Cessationin the United States. New England Journal of Medicine 2013;368:341–50 [accessed 2017 Mar 28].

That’s more than three fully loaded 747’s,crashing every day for a year……

with no survivors.

Youth Tobacco Trends

Ever tried cigarette smoking in their lifetime% of U.S. high school students

70.463.9

58.454.3

50.346.3 44.7 41.1

32.3

0

25

50

75

100

1999 2001 2003 2005 2007 2009 2011 2013 2015

2015 Youth Risk Behavior Survey – Centers for Disease Control and Prevention

Smoked cigarettes on one or more of the past 30 days% of U.S. high school students

34.828.5

21.9 23 [VALUE] 19.5 18.1 15.710.8

0

25

50

75

100

1999 2001 2003 2005 2007 2009 2011 2013 2015

2015 Youth Risk Behavior Survey – Centers for Disease Control and Prevention

Not Your Grandfather’s Cigar

Today’s cigars/cigarillos arepriced, promoted, packagedand placed in ways that appealto kids.

Tobaccofreekids.org

Smoked cigars, cigarillos, or little cigars on one or more of the past 30 days% of U.S. high school students

17.7 15.2 14.8 14 13.6 14 13.1 12.6 10.3

0

25

50

75

100

1999 2001 2003 2005 2007 2009 2011 2013 2015

2015 Youth Risk Behavior Survey – Centers for Disease Control and Prevention

Used chewing tobacco, snuff, or dip on one or more of the past 30 days% of U.S. high school students

7.8 8.2 6.7 8 7.9 8.9 7.7 8.8 7.3

0

25

50

75

100

1999 2001 2003 2005 2007 2009 2011 2013 2015

*Question changed to include more sample products. Loss of trend data, but it looks good!

2015 Youth Risk Behavior Survey – Centers for Disease Control and Prevention

Traditional Tobacco Product Last 30 Day Use% of U.S. high school students

28.5

21.9 2320 19.5 18.1 15.7

10.8

15.2 14.8 14 13.6 14 13.1 12.6 10.3

8.2 6.7 8 7.9 8.9 7.7 8.8 7.3

0

25

50

75

100

2001 2003 2005 2007 2009 2011 2013 2015

Cigarettes

Cigars, Cigarillos

Chewing Tobacco,Snuff or Dip

2015 Youth Risk Behavior Survey – Centers for Disease Control and Prevention

Anti-smoking campaigns have been very successful.

But now we have these………

What are they?A battery powered, most often nicotine delivering device

ENDS – Electronic Nicotine Delivery System

A variety of ever changing styles

U.S. Food & Drug Administrationhttps://www.fda.gov/ucm/groups/fdagov-public/documents/image/ucm491663.jpg

"Parts of an Electronic cigarette" by FEMA - https://www.usfa.fema.gov/downloads/pdf/publications/electronic_cigarettes.pdf.

Controls theheater and lights

Lithium

Nothing burns – there is no combustion.The E-Juice is aerosolized as it heats.

HOW TO VAPE

Electronic Cigarettes

MODS

RDA - Rebuildable Dripping Atomizer

Nearly 5 Million Views on YouTube

Then and now……

The tobacco industryspends more than

$1,000,000 per houradvertising their products

http://tobacco.stanford.edu/tobacco_main/main.php

Innovative Marketing Tactics

Missoula Billings Bozeman

Helena and Great FallsButte

Kalispell

KURE Vaporium and Lounge – Franchise

“We are moving light years beyond the traditional vapestore concept by offering a revolutionary high-end, in-storeretail and lounge experience which appeals to Millennials,Boomers, nascent vapors and vaping enthusiasts alike.”

US Vapor Sales

$2.5$3.5

$4.1 $4.4$5.5

0

2

4

6

8

10

2014 2015 2016 2017 Projected2018

$ Billions

Bonnie Herzog – Wells Fargo E Cigarette Sales and Estimate for 2018 - ECF

“Harmless Water Vapor?”……

What’s often described as a “harmless water vapor” is

an aerosol that usually contains nicotine, ultrafine

metallic particles and low levels of toxins – some

that are known to cause cancer.

Carcinogens found inElectronic Cigarettes Vapor

AcetaldehydeBenzeneFormaldehydeNickelNitrosamines

Metals, Toxins, Stimulants and

Irritants found inElectronic Cigarettes Vapor

DiacetylDiethylene GlycolCadmiumLeadNicotineSilverTinToluene

Chemical Evaluation of Electronic Cigarettes: Tobacco Control 2014 Tianrong Cheng, Center for Tobacco Products FDA

E-Juice(Liquid Nicotine)

1 Teaspoon can kill a childAmerican Association of Poison Control Centers

Dec 2014 Press Release

Propylene Glycol - Nicotine - FlavoringChild Nicotine Poisoning Prevention ActEnacted by Congress on January 11, 2016

DIACETYL

Poison Control Center CallsAmerican Association of Poison Control Centers

460

1543

40233774

29072453

674

2696

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

2012 2013 2014 2015 2016 2017 2018 2018

Liquid NicotineExposure Calls

Extrapolated

RESEARCH

Explosions

E-cigarettes Are Unsafe for Young People

Attention, Learning, MoodDisorders, Impulse Control

Adolescent Brain MoreSusceptible to Addiction

Linked to use of other tobaccoproducts, alcohol, marijuana

Non-smoking users likely totry combustible cigarettes

Inhale nicotine, ultrafineparticles and harmful chemicals

https://www.ncbi.nlm.nih.gov/pubmed/26811353

Teens who vape are 3x morelikely to smoke traditionalcigarettes 1 year later.

What’s the Appeal for Youth?

2015 and 2017Youth Risk Behavior Survey Questions

The next 2 questions ask about electronic vaporproducts such as blu, NJOY or Starbuzz.

Electronic vapor products include e-cigarettes,e-cigars, e-pipes, vaping pens, e-hookahs and hookah pens.

Q. Have you ever used an electronic vaporproduct? (Y/N)

Q. In the past 30 days, on how many days did youuse an electronic vapor product?

Ever used electronic vapor products in their lifetime% of U.S. and Montana high school students

44.951.1

46.6

0

25

50

75

100

2015 2017

U.S. Montana

(48.7-53.4)

Montana – 2015 4th highest prevalence of use in the U.S2015/17 Youth Risk Behavior Survey – Centers for Disease Control and Prevention

(41.9-48.0) (44.4-48.8)

Used electronic vapor products on one or more of the past 30 days% of U.S. and Montana high school students

2429.5

22.5

0

25

50

75

100

2015 2017

US Montana

(27.4-31.7) (20.2-24.9)

Montana – 2015 4th highest prevalence of use in the U.S

2015/17 Youth Risk Behavior Survey – Centers for Disease Control and Prevention

(22.1-26.2)

Tobacco Product Past 30 Day (Current) Use% of U.S. high school students

19.5 18.1 15.710.8

14 13.1 12.6 10.3

8.9 7.7 8.8 7.3

24.1

0

25

50

75

100

2009 2011 2013 2015

Cigarettes

Chewing Tobacco, Snuff or Dip

Cigars, Cigarillos

Electronic Vapor Products

2015 Youth Risk Behavior Survey – Centers for Disease Control and Prevention

Yale School of Medicine & National Institutes of Health (NIH)asked 5,400 Connecticut teens to identifywhat they found "cool about e-cigarettes?"

Top 2 Answers:

THE FLAVORSTHE ABILITY TO DO TRICKS

"We expected the flavors were attractive," said SuchitraKrishnan-Sarin, a psychiatry professor at the Yale School

of Medicine. “But smoke tricks were a surprise to us.”

Oxford Journals: Nicotine & Tobacco Research Volume 17 Issue 7: “E-Cigarette Use Among High School and Middle SchoolAdolescents in Connecticut” 11/3/2014

www.tobaccofreekids.org/research/factsheets/pdf/0382.pdf

Cloud Chasing with Mods

France’s Got Talent

Underwater Vape Tricks

STILLBLOWINGSMOKE.ORG California Department of Public Health

4 pack of pods - $15.99

$49.99

This video contains some strong language.

A JUUL Challenge

YouTube: Everything Juul

Youtube: Juul sesh #7 _Gavinvapes_

Prevention ResourcesSharing those I know about

www.opi.mt.gov/tobaccoed

PREVENTION

RESOURCES

Grades 3-5Grades 6-7

http://www.scholastic.com/get_smart_about_tobacco/

Scholastic

New Classroom Resources

Student Created Skit: Superior, St. Regis and Alberton, MT High Schools

Montana Strategies…..

Montana Clean Indoor Air Act – Enacted 2005

Tobacco Free Schools –Prohibits use of “Tobacco Product” in a publicschool building or on public school property

"Tobacco product" means a substance intended for humanconsumption that contains tobacco, including cigarettes, cigars,snuff, smoking tobacco, and smokeless tobacco.

No E-Cigarette Prohibition* Eight of 56 counties have adopted an

e-cigarette prohibition protocol.

Montana School Districts’ Primary Tool:

SCHOOL BOARD POLICYAdopted and enforced at the school district level

Currently 80% of Montana School Districts have beenrecognized as Tobacco-Free School Districts of Excellence

A message from the Surgeon General

http://e-cigarettes.surgeongeneral.gov/

Unknown HealthRisks – Carcinogenshave been identified

(Why don’t we have to prove a productsafe before we market it?)

Potential for renormalizingcigarette use andsomething that looks likesmoking

Appeal to non-smokers,especially youth

Addiction to Nicotine –Youth are more vulnerable

Dual Use

We hear people say theyhave used E-cigs to helpthem quit smoking.

Likely safer than smoking

Putting known andunknown health risksaside, there’s potential toreduce the number oftobacco related deaths

Yes, we’ve come a long way over many years intobacco use prevention.

With effective prevention strategies we’ve changed socialnorms on smoking.

We’ve got more work to do.

www.opi.mt.gov/tobaccoed

Kris MinardMontana Office of Public InstructionTobacco Use Prevention Education

Kminard@mt.gov(406) 444-0785

Thank you for your work to help ourkids choose not to use tobacco of

any kind…..for life.