Preventing Youth Electronic Cigarette Use: Partnering with Schools

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1 Preventing Youth Electronic Cigarette Use: Partnering with Schools Kris Minard Montana Office of Public Instruction Tobacco Use Prevention Education (406) I work for the State of Montana and have no disclosures.

2 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 of preventable death in the United States Cigarette smoking is responsible for more than than 480,000 deaths per year in the United States1.

3 Tobacco use is still the leading cause of preventable death in the United States Cigarette smoking is responsible for more than than 480,000 deaths per year in the United States Jha P, Ramasundarahettige C, Landsman V, et al. 21st Century Hazards of Smoking and Benefits of Cessation in the United States. New England Journal of Medicine 2013;368: [accessed 2017 Mar 28].

4 That s more than three fully loaded 747 s, crashing every day for a year with no survivors.

5 Youth Tobacco Trends

Ever tried cigarette smoking in their lifetime % of U.S. high school students 100 75 70.4 63.9 58.4 54.3 50 50.3 46.3 44.7 41.

6 Ever tried cigarette smoking in their lifetime % of U.S. high school students Youth Risk Behavior Survey Centers for Disease Control and Prevention 2015

Smoked cigarettes on one or more of the past 30 days % of U.S. high school students 100 75 50 34.8 28.5 25 0 1999 2001 21.

7 Smoked cigarettes on one or more of the past 30 days % of U.S. high school students [VALUE] Youth Risk Behavior Survey Centers for Disease Control and Prevention

8 Not Your Grandfather s Cigar Today s cigars/cigarillos are priced, promoted, packaged and placed in ways that appeal to kids. Tobaccofreekids.org

9 Smoked cigars, cigarillos, or little cigars on one or more of the past 30 days % of U.S. high school students Youth Risk Behavior Survey Centers for Disease Control and Prevention

10 Used chewing tobacco, snuff, or dip on one or more of the past 30 days % of U.S. high school students *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 100 Cigarettes 75 Cigars, Cigarillos Chewing Tobacco, Snuff or Dip 50 28.5 25 8.2 0 23 21.9 20 19.5 8 6.

11 Traditional Tobacco Product Last 30 Day Use % of U.S. high school students 100 Cigarettes 75 Cigars, Cigarillos Chewing Tobacco, Snuff or Dip Youth Risk Behavior Survey Centers for Disease Control and Prevention

12 Anti-smoking campaigns have been very successful.

13 But now we have these

14 What are they? A battery powered, most often nicotine delivering device ENDS Electronic Nicotine Delivery System

15 A variety of ever changing styles U.S. Food & Drug Administration

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

16 "Parts of an Electronic cigarette" by FEMA - Lithium Controls the heater and lights Nothing burns there is no combustion. The E-Juice is aerosolized as it heats.

17 HOW TO VAPE

18 Electronic Cigarettes

19 MODS

20 RDA - Rebuildable Dripping Atomizer

21 Nearly 5 Million Views on YouTube

22 The tobacco industry spends more than $1,000,000 per hour advertising their products Then and now

25 Innovative Marketing Tactics

26 Kalispell Helena and Great Falls Butte Missoula Billings Bozeman

27 KURE Vaporium and Lounge Franchise We are moving light years beyond the traditional vape store concept by offering a revolutionary high-end, in-store retail and lounge experience which appeals to Millennials, Boomers, nascent vapors and vaping enthusiasts alike.

US Vapor Sales 10 $ Billions 8 $5.5 6 $3.5 4 $4.1 $4.4 2016 2017 $2.

28 US Vapor Sales 10 $ Billions 8 $5.5 6 $3.5 4 $4.1 $ $ Bonnie Herzog Wells Fargo E Cigarette Sales and Estimate for ECF Projected 2018

29 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 in Electronic Cigarettes Vapor Acetaldehyde Benzene Formaldehyde Nickel Nitrosamines Irritants found in Electronic Cigarettes Vapor Diacetyl

30 Carcinogens found in Electronic Cigarettes Vapor Acetaldehyde Benzene Formaldehyde Nickel Nitrosamines Irritants found in Electronic Cigarettes Vapor Diacetyl Diethylene Glycol Cadmium Lead Nicotine Silver Tin Toluene Chemical Evaluation of Electronic Cigarettes: Tobacco Control 2014 Tianrong Cheng, Center for Tobacco Products FDA

31 E-Juice (Liquid Nicotine) 1 Teaspoon can kill a child American Association of Poison Control Centers Dec 2014 Press Release Propylene Glycol - Nicotine - Flavoring Child Nicotine Poisoning Prevention Act Enacted by Congress on January 11, 2016

32 DIACETYL

Exposure Calls 2907 3000 2500 2000 1543 1500 1000 500 2696

33 Poison Control Center Calls American Association of Poison Control Centers Liquid Nicotine Exposure Calls Extrapolated

34 R E S E A R C H

36 Explosions

E-cigarettes Are Unsafe for Young People Attention, Learning, Mood Disorders, Impulse Control Adolescent Brain More Susceptible to Addiction Non-smoking

37 E-cigarettes Are Unsafe for Young People Attention, Learning, Mood Disorders, Impulse Control Adolescent Brain More Susceptible to Addiction Non-smoking users likely to try combustible cigarettes Linked to use of other tobacco products, alcohol, marijuana Inhale nicotine, ultrafine particles and harmful chemicals

38 Teens who vape are 3x more likely to smoke traditional cigarettes 1 year later.

39 What s the Appeal for Youth?

40 2015 and 2017 Youth Risk Behavior Survey Questions The next 2 questions ask about electronic vapor products 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 vapor product? (Y/N) Q. In the past 30 days, on how many days did you use an electronic vapor product?

41 Ever used electronic vapor products in their lifetime % of U.S. and Montana high school students 100 U.S. Montana ( ) ( ) 2015 Montana ( ) 4th highest prevalence of use in the U.S 2015/17 Youth Risk Behavior Survey Centers for Disease Control and Prevention

Used electronic vapor products on one or more of the past 30 days % of U.S. and Montana high school students 100 US Montana 75 50 25 0 29.5 24 (22.1-26.2) (27.

42 Used electronic vapor products on one or more of the past 30 days % of U.S. and Montana high school students 100 US Montana ( ) ( ) 2015 Montana ( ) th highest prevalence of use in the U.S 2015/17 Youth Risk Behavior Survey Centers for Disease Control and Prevention

43 Tobacco Product Past 30 Day (Current) Use % of U.S. high school students 100 Cigarettes 75 Chewing Tobacco, Snuff or Dip Cigars, Cigarillos Electronic Vapor Products Youth Risk Behavior Survey Centers for Disease Control and Prevention 2015

44 Yale School of Medicine & National Institutes of Health (NIH) asked 5,400 Connecticut teens to identify what they found "cool about e-cigarettes?" Top 2 Answers: THE FLAVORS THE ABILITY TO DO TRICKS "We expected the flavors were attractive," said Suchitra Krishnan-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 School Adolescents in Connecticut 11/3/2014

49 Cloud Chasing with Mods

52 Underwater Vape Tricks France s Got Talent

53 STILLBLOWINGSMOKE.ORG California Department of Public Health

54 $ pack of pods - $15.99

55 A JUUL Challenge This video contains some strong language.

56 YouTube: Everything Juul

57 Youtube: Juul sesh #7 _Gavinvapes_

59 Prevention Resources Sharing those I know about

60 P R E V E N T I O N R E S O U R C E S

61 New Classroom Resources Grades 6-7 Grades 3-5 Scholastic

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

64 Montana Strategies.. Montana Clean Indoor Air Act Enacted 2005 Tobacco Free Schools Prohibits use of Tobacco Product in a public school building or on public school property "Tobacco product" means a substance intended for human consumption 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.

65 Montana School Districts Primary Tool: SCHOOL BOARD POLICY Adopted and enforced at the school district level Currently 80% of Montana School Districts have been recognized as Tobacco-Free School Districts of Excellence

67 A message from the Surgeon General

69 We hear people say they have used E-cigs to help them quit smoking. Likely safer than smoking Putting known and unknown health risks aside, there s potential to reduce the number of tobacco related deaths Unknown Health Risks Carcinogens have been identified (Why don t we have to prove a product safe before we market it?) Potential for renormalizing cigarette use and something that looks like smoking Appeal to non-smokers, especially youth Addiction to Nicotine Youth are more vulnerable Dual Use

70 Yes, we ve come a long way over many years in tobacco use prevention. With effective prevention strategies we ve changed social norms on smoking. We ve got more work to do.

71 Thank you for your work to help our kids choose not to use tobacco of any kind..for life. Kris Minard Montana Office of Public Instruction Tobacco Use Prevention Education (406)

ELECTRONIC CIGARETTES WHAT S THE BOTTOM LINE?

ELECTRONIC CIGARETTES WHAT S THE BOTTOM LINE? E-cigarettes have the potential to benefit adult smokers who are not pregnant if used as a complete substitute for regular cigarettes and other smoked tobacco