vaping: the new social phenomenonlifestepscouncil.org/.../06/vaping-and-e-cigs.ed_.pdf · southwest...

Vaping: The New

Social Phenomenon Julie Stevens, MPS, ACPS, LCDCi

PREVENTION ROCKS

[email protected]

E-Cigs: Electronic Nicotine Delivery

Systems

What are they?

• Electronic cigarettes (also called e-cigarettes or electronic nicotine delivery systems) are battery-operated devices designed to deliver nicotine with flavorings and other chemicals to users in vapor instead of smoke. They can be manufactured to resemble traditional tobacco cigarettes, cigars or pipes, or even everyday items like pens or USB memory sticks; newer devices, such as those with fillable tanks, may look different. More than 250 different e-cigarette brands are currently on the market.

• Julie Stevens, MPS, ACPS, LCDCi

Why are they?

• While e-cigarettes are often promoted as safer alternatives to

traditional cigarettes, which deliver nicotine by burning

tobacco, little is actually known yet about the health risks of

using these devices.


How do e-cigs work?

Most e-cigarettes consist of three different components,

including:

• a cartridge, which holds a liquid solution containing varying

amounts of nicotine, flavorings, and other chemicals

• a heating device (vaporizer)

• a power source (usually a battery)

In many e-cigarettes, puffing activates the battery-powered

heating device, which vaporizes the liquid in the cartridge. The

resulting aerosol or vapor is then inhaled (called "vaping").


Microprocessor-controlled, variable-

voltage/wattage, personal electronic-

cigarette with LED digital display


How to Use an Electronic

Cigarette


You Tube (2016). Vapinlizards: How to use an electronic cigarette.

Retrieved from: https://www.youtube.com/watch?v=xPJxBRxLIfs

Playboy Vapor E-Liquid, E-Juice


Are E-cigarettes safe?

• Although e-cigarette vapor does not contain the tar currently responsible for most lung cancer and other lung diseases, it has been shown to contain known carcinogens and toxic chemicals (such as formaldehyde and acetaldehyde), as well as potentially toxic metal nanoparticles from the vaporizing mechanism. There are currently no accepted measures to confirm their purity or safety, and the long-term health consequence of e-cigarette use remain unknown. NIDA is developing research programs to help answer these questions.


Tobacco and the Brain – Here is

what we know

• Cigarettes and other forms of tobacco—including cigars, pipe tobacco, snuff, and chewing tobacco—contain the addictive drug nicotine. Nicotine is readily absorbed into the bloodstream when a tobacco product is chewed, inhaled, or smoked.

• Upon entering the bloodstream, nicotine immediately stimulates the adrenal glands to release the hormone epinephrine (adrenaline). Epinephrine stimulates the central nervous system and increases blood pressure, respiration, and heart rate.


Teens Using E-cigarettes More

Likely to Start Smoking Tobacco


You Tube (2015). NIDA: Teens Using El-cigarettes More Likely to Start Smoking Tobacco.

Retrieved from: https://www.youtube.com/watch?v=t6VgxxIbTwg&feature=youtu.be

• Similar to other addictive drugs like cocaine and

heroin, nicotine increases levels of the

neurotransmitter dopamine, which affects the brain

pathways that control reward and pleasure. For

many tobacco users, long-term brain changes

induced by continued nicotine exposure result in

addiction—a condition of compulsive drug seeking

and use, even in the face of negative

consequences. Studies suggest that additional

compounds in tobacco smoke, such as

acetaldehyde, may enhance nicotine’s effects on the

brain


Chart showing various toxicants as

measured in cigarette smoke and e-

cigarette aerosol

Poison control center calls in the US related to

e-cigarettes was one call per month in September

2010 to over 200 calls per month in February 2014.


Fires, explosions, and other

battery-related malfunctions

You Tube (2016). Inside Edition: Man Who Survived E-Cigarette Explosion: These Things are Deadly.

Retrieved from: https://www.youtube.com/watch?v=xu13u-jWasg


Bad News: 2014 Monitoring the

Future Survey results In 2014, more teens use e-cigarettes than traditional,

tobacco cigarettes or any other tobacco product—the

first time a U.S. national study shows that teen use of e-

cigarettes surpasses use of tobacco cigarettes.


Losing Ground

• E-cigarette use among youth offsets a long-term decline in the use of tobacco

cigarettes, which is at a historic low in the life of the study—now in its 40th year.

In 2014, the prevalence of smoking tobacco cigarettes in the past 30 days was 8

percent. This is a significant decline from 10 percent in 2013, and is less than a

third of the most recent high of 28 percent in 1998.

• In 2014, only 23 percent of students had ever tried tobacco cigarettes, as

compared to 56 percent in 1998. Of particular concern is the possibility that e-

cigarettes may lead to tobacco cigarette smoking, and reverse this hard-won, long-

term decline.

• "Part of the reason for the popularity of e-cigarettes is the perception among

teens that they do not harm health,“

http://www.monitoringthefuture.org/pressreleases/14cigpr.pdf


Better News: 2016 Monitoring

the Future Survey

Drug Time

Period

8th Graders 10th Graders 12th Graders

2013 2014 2015 2016 2013 2014 2015 2016 2013 2014 2015 2016

E-

cigarette

s

Past

Month - 8.7 9.5 6.2 - 16.2 14 11 - 17.1 16.2 12.5


Nicotine Use, E-cigs, and Hookah


YouTube (2016) Dr. Wilson Compton on MTF and Nicotine Use

Retrieved: https://www.youtube.com/watch?v=k-BzUz0RsDk

Hookah Pens

• Enter the hookah pen, a re-imagined e-cigarette. This is very brightly painted, an almost psychedelic contraption that is reminiscent of 1970’s rock album art. But the hookah pens advertise that the liquid burned in the device has no tobacco, no nicotine and no tar resins.


Research article - Association of Electronic Cigarette

Use With Initiation of Combustible Tobacco Product

Smoking in Early Adolescence

• These data provide new evidence that e-cigarette use is prospectively associated with increased risk of combustible tobacco use initiation during early adolescence.

• Among high school students in Los Angeles, those who had ever used e-cigarettes at baseline compared with nonusers were more likely to report initiation of combustible tobacco use over the next year.

Leventhal AM, Strong DR, Kirkpatrick MG, Unger JB, Sussman S, Riggs NR, Stone MD, Khoddam R, Samet

JM, Audrain-McGovern J. Association of Electronic Cigarette Use With Initiation of Combustible Tobacco

Product Smoking in Early Adolescence. JAMA. 2015;314(7):700-707. doi:10.1001/jama.2015.8950


E-Cigarette Ads and Youth

• Tobacco product advertising can entice youth to use tobacco, and spending to advertise e-cigarettes has increased rapidly since 2011. About 69% of middle and high school students were exposed to e-cigarette advertisements in retail stores, on the Internet, in magazines/newspapers, or on TV/movies. Exposure to e-cigarette advertisements may be contributing to increases in e-cigarette use among youth. Efforts by states, communities, and others could reduce this exposure.


Youth are vulnerable to e-cigarette ads.

• 18 million youth were exposed to e-cigarette ads in 2014.

• More than 10 million high school students and nearly 8 million middle school students were exposed to e-cigarette ads in 2014.

• More than half of high school students (about 8 million) saw e-cigarette ads in retail stores, and more than 6 million saw them on the Internet.

• More than half of middle school students (6 million) saw e-cigarettes ads in retail stores, and more than 4 million saw them on the Internet.

• About 15% of all students reported seeing e-cigarette ads from all four sources, including retail stores, the Internet, magazines/newspapers, and TV/movies.


E-cigarette use has increased considerably among U.S.

youths in recent years and corresponding increases have

occurred in e-cigarette advertising expenditures.


Exposure to e-cigarette ads may

contribute to youth e-cigarette use:

• E-cigarette companies have rapidly increased advertising

spending, from $6.4 million in 2011 to $115 million in 2014.

• Many of the themes used in advertising for cigarettes are also now used to advertise e-cigarettes – including sex, independence, and rebellion.

• During the time e-cigarette ads have increased, there are also increases in e-cigarette use among US youth. From 2011-2014, e-cigarette use in the past 30 days increased from less than 1% to almost 4% among middle school students and from less than 2% to 13% among high school students.


E-Cigarette Policy


Southwest Airlines E-cig Policy

• Electronic Cigarettes (E-Cigs) or Vaporizers

Because these articles are designed to operate by creating

heat, they must be transported in one of the following ways:

• The battery can remain installed but must be placed in

carryon baggage or carried on your person only. The item

cannot be used onboard the aircraft.

• Spare batteries must be protected from short circuit and

carried in carryon baggage or on your person only.


CITY OF GEORGETOWN, TX:

ELECTRONIC CIGARETTES ADDED TO

SMOKING PROHIBITIONS

“Electronic cigarettes have been added to City of

Georgetown rules that prohibit smoking in indoor

public places and businesses. The ordinance also

prohibits the sale of electronic cigarettes to persons

under 18 or their sale in vending machines. The City

Council approved the second and final reading of the

revised smoking ordinance at their regular meeting on

Tuesday. The ordinance takes effect April 23. (2014)”


E-Cigarette Regulations - Texas

• Are e-cigarettes in any section of the state’s statutes included in the definition of "Tobacco Products"? No

• How does the state define an e-cigarette? E-cigarette means “an electronic cigarette or any other device that simulates smoking by using a mechanical heating element, batter, or electronic circuit to delivery nicotine or other substances to the individual inhaling from the device [including products sold as] e-cigarette, e-cigar, or e-pipe or under another product name or description [and including any] component, part, or accessory for the device [whether or not] sold separately . . . .” Vapor products means “Electronic cigarettes (e-cigarettes) or any other device that uses a mechanical heating element, battery, or electronic circuit to deliver vapor that may include nicotine to the individual inhaling from the device, or any substance used to fill or refill the device.”



• Is there a state excise or special tax (non-sales tax) placed on e-

cigarettes? N/A

• What regulations are in place for e-cigarette packaging? Liquid nicotine sold as an accessory for an e-cigarette must be sold in a child-resistant container unless prefilled and sealed by the manufacturer and not intended to be opened by a consumer.

• What restrictions are in place for retail or youth access?

• Sale/distribution of e-cigarettes to persons under age 18.

• Persons making delivery sales of e-cigarettes must register and comply with certain reporting requirements.

• Purchase/possession/use of e-cigarettes by persons under age 18 years prohibited unless possession occurs in the presence of “adult parent,” guardian or spouse.

• Self-service/vending sales of e-cigarettes restricted to locations inaccessible to persons under age 18.



• Is a retail license or permit required to sell e-

cigarettes? No

• What smoke-free restrictions exist for e-cigarette use?

• Use of e-cigarettes restricted to designated areas in schools, elevators, enclosed theaters, libraries, museums, hospitals, certain buses, planes and trains.

• School trustees must prohibit e-cigarette use and student possession of e-cigarettes at “a school-related or school sanctioned activity on or off school property.”

• Use of vapor products is prohibited inside Department of Criminal Justice facilities, but permitted in designated outdoor areas.


FDA Regulations - Vaporizers, E-

Cigarettes, and other Electronic

Nicotine Delivery Systems (ENDS)

• Vaporizers, vape pens, hookah pens,

electronic cigarettes (E-Cigarettes), and e-

pipes are some of the many types of

Electronic Nicotine Delivery Systems

(ENDS).

These products use liquid containing nicotine, as well as

varying compositions of flavorings, propylene glycol,

glycerin, and other ingredients. The liquid is heated into

an aerosol that the user inhales.


http://www.fda.gov/TobaccoProducts/Labeling/ProductsIngredientsComponents/ucm2019416.htm

FDA Statistics about ENDS Use

• More than 3 million middle and high school students were current users of

e-cigarettes in 2015, up from an estimated 2.46 million in 2014.1, 2

• Sixteen percent of high school and 5.3 percent of middle school students

were current users of e-cigarettes in 2015, making e-cigarettes the most

commonly used tobacco product among youth for the second consecutive

year.1

• During 2011-2015, e-cigarette use rose from 1.5 percent to 16.0 percent

among high school students and from 0.6 percent to 5.3 percent among

middle school students.1

• In 2013-2014, 81% of current youth e-cigarette users cited the availability of

appealing flavors as the primary reason for use.3

• In 2014, 12.6% of U.S. adults had ever tried an e-cigarette, and about 3.7%

of adults used e-cigarettes daily or some days.4


http://www.fda.gov/TobaccoProducts/Labeling/ProductsIngredientsComponents/ucm456610.htm#references





FDA Regulation of ENDS

• In 2016, FDA finalized a rule extending our regulatory

authority to cover all tobacco products, including vaporizers, vape pens, hookah pens, electronic cigarettes (E-Cigarettes), e-pipes, and all other ENDS. FDA now regulates the manufacture, import, packaging, labeling, advertising, promotion, sale, and distribution of ENDS. This includes components and parts of ENDS* but excludes accessories.

• However, products marketed for therapeutic purposes (for example, marketed as a product to help people quit smoking) are regulated by the FDA through the Center for Drug Evaluation and Research (CDER). FDA recently proposed a rule clarifying the jurisdiction over tobacco products, drugs, and devices.


http://www.fda.gov/Drugs/default.htm

http://www.fda.gov/Drugs/default.htm

http://www.fda.gov/TobaccoProducts/Labeling/RulesRegulationsGuidance/ucm462957.htm

Definition of “Components”

*“Components” or “parts” include, among other things, software or an assembly of materials intended or reasonably expected alter or affect the tobacco product’s performance, composition, constituents, or characteristics; or to be used with or for the human consumption of a tobacco product. Examples of components and parts of ENDS include, but are not limited to:

• E-liquids

• A glass or plastic vial container of e-liquid

• Cartridges

• Atomizers

• Certain batteries

• Cartomizers and clearomizers

• Digital display or lights to adjust settings

• Tank systems

• Drip tips

• Flavorings for ENDS

• Programmable software


Nicotine Warning Statement

Beginning in 2018, the product packages and advertisements of all newly-regulated covered tobacco products must bear the following warning statement:

• “WARNING: This product contains nicotine. Nicotine is an addictive chemical.”

If the tobacco product manufacturer submits a self-certification statement to FDA that the newly-regulated tobacco product does not contain nicotine (and that the manufacturer has data to support this assertion), then an alternate statement must be used on product packages and advertisements:

• “This product is made from tobacco.”


Safety, Regulation and Quality

Concerns

• The World Health Organization warns that nicotine exposure, whether through inhalation, ingestion, or skin contact, can be hazardous to the health and safety of children, young people, pregnant women, nursing mothers, people with heart conditions, and the elderly. E-cigarette users refilling their own cartridges handle potentially dangerous concentrations of nicotine.

• The American Association of Poison Control Centers has been tracking adult and child poisonings from e-cigarette components and refill fluids. E-cigarettes also pose consumer safety concerns, having caused fires and injury to users.


Growing Market for E-cigs

• Ploom, a loose-leaf vaporizer that heats small pods of

tobacco. – Japan Tobacco International

• iQos – Philip Morris, Int.

• Voke – Nicoventures Limited, London


E-Voke Becomes First E-Cigarette to

be Awarded Medical License in the

UK

• This means that physicians could now prescribe the

e-Voke as an aid for people looking to quit smoking

and the UK’s National Health Service (NHS) could

offer them for free.


New Trends in Cannabis Use

Some models of e-cigs for vaping (a) ground

marijuana head tops; (b) cannabis wax (butane honey

oil concentrate (BHO)), or (c) cannabis e-liquid.

Cannabis Oil

• Cannabis oil is the extracted THC (Tetrahydrocannabinol) from the bud and vegetable matter of the flowering female cannabis plant. It is typically extracted using some sort of solvent, usually either high-pressure butane gas forced through the material or by a process of washing the material in isopropanol.

• It comes in a variety of colors and textures from a dark molasses type tar to a golden light honey kind of oil, all depending on the quality of herb and the process that was used to extract the oil.

• Basically it is a concentrated extract, normally between 60% and 90% THC. This compares favorably to herbal cannabis, which has an average THC content of 12-20% and commercial grade hashes with an average THC content of 35-40%.


Vaporizing Dry Herbs

• Vaporizers designed to heat the cannabis in its raw, bud form are known as dry herb vaporizers. Dry herbs of all sorts have been used for centuries for meditation, relaxation and medicinal purposes. Certain flowers and herbs (including cannabis) can dried, crushed and then inserted into a vape pen that is dry-herb capable. The vape’s oven chamber will heat up the dry herbs which will release a vapor which can then be inhaled. To get the most out of your vaporization experience, be sure to grind your material using an herb grinder to break your material down to create more surface area for the heat to reach.

Vaporizing Concentrates

• Waxes, shatters, crumbles, and oils are a concentrated form of cannabinoids and terpenes and are therefore referred to as cannabis concentrates. Due to these products being a concentrated mix, you have the benefit of only needing a very small amount to get the same effect as you would with larger amounts of a less concentrated mix. If you are looking to vape concentrates you will need a vapor pen that is capable of doing so as not all vaporizers have this functionality. In fact, many vaporizer manufacturers now offer special attachments to convert standard ovens to be compatible with concentrates but it often costs extra.


Available on Ebay

http://www.ebay.com/itm/Vape-Juice-Cannabis-Flavor-10ml-/181634253294


Supposed “Advantages of

Vaporizing Medical Marijuana”

• 1. Eliminates harmful toxins

• 2. Healthier for your lungs

• 3. Faster relief

• 4. Fewer side effects

Leaf Science (2013). The Advantages of Vaporizing Medical Marijuana. Retrieved from: http://www.leafscience.com/2013/11/09/advantages-vaporizing-medical-marijuana/


Vaping Recreational Drugs with

E-Cigarettes • In addition to cannabis, e-cigs can also be used to vape any

type of psychoactive drugs, such as methamphetamine,

cocaine, heroin, or bath salts (cathinones).


In Conclusion

• The new culture of vaping can weaken the efficiency of anti-smoking campaigns.

• New technology can attract young people and thwart cannabis prevention efforts.

• Early, chronic use by adolescents is correlated with a lower volume of the brain’s grey matter, cognitive decline, and performance impairment.

• The social phenomenon of vaping may slide from nicotine towards other psychoactive drugs.

• We must have scientific investigation and risk assessments where young people are concerned.


What Can Be Done?


The Federal government is

• Supporting state tobacco prevention and control programs to prevent any youth use of tobacco products, including e-cigarettes.

• Tracking e-cigarette use; supporting research on the health effects and factors contributing to youth e-cigarette use; and providing information to the public, including health care providers.

• Developing regulations for e-cigarettes and other currently unregulated tobacco products to reduce the disease and death from tobacco use, including by preventing youth tobacco use.

• Funding and promoting campaigns that inform people about the dangers of tobacco use, such as FDA's The Real Cost and Fresh Empire for youth and CDC's Tips From Former Smokers for adults.


States and communities can:

• Fund tobacco prevention and control programs at CDC-recommended levels to

prevent youth use of all tobacco products, including e-cigarettes.

• Work to limit where and how all tobacco products, including e-cigarettes, are sold to

reduce youth e-cigarette use, as well as ad exposure.

• Requiring age verification to enter e-cigarette vendors' websites, make

purchases, and accept deliveries of e-cigarettes.

• Restricting the number of stores that sell tobacco and how close they can be to

schools.

• Requiring that e-cigarettes be sold only through face-to-face transactions, not

on the Internet.

• Limiting tobacco product sales to facilities that never admit youth.

• Support efforts to implement and sustain proven youth tobacco prevention actions

such as tobacco price increases, comprehensive smoke-free laws, and high-impact

mass media campaigns.


Pediatricians, nurses, and other health

care providers can

• Ask about youths' e-cigarette use and counsel them about

the dangers of nicotine, e-cigarettes, and all other tobacco use.

• Ask all patients whether they use tobacco products, encourage those who do to quit, and provide help with quitting.

• Ask about youths' media and Internet use. Advise parents and caregivers to take an active role in deciding which websites and media children may view and teaching critical viewing skills.


Parents and caregivers can

• Set a positive example by being tobacco-free. For free help, call 1-800-QUIT-NOW or visit www.smokefree.gov

• Talk to youth about why they shouldn't use any tobacco products, including e-cigarettes.

• Know what media their children are viewing, and decide what programs and websites are appropriate for their age. Watch programs together and discuss content.


http://www.smokefree.gov/

vaping: the new social phenomenonlifestepscouncil.org/.../06/vaping-and-e-cigs.ed_.pdf · southwest...

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