Prevent disease Protect from injury Promote healthy lifestyles

https://youtu.be/9dzs_rniak0 Prevent disease Protect from injury Promote healthy lifestyles

Objectives 1. Obtain a better understanding of local policies that make a difference 2. Establish a plan of action to address local policies Kye Nordfelt Southwest Utah Public Health Department Director of Health Promotions E-Cigarettes Turns kids into addicts E-Cigs are the future of teen drug use Prevent disease Protect from injury Promote healthy lifestyles

HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

NATIONAL USE RATES 12 th GRADE E-CIG USE INCREASES 300% 30 Day Use 18% 16% 17.3% 14% 12% 10% 8% 12% 10% 2011 2013 2015 6% 4% 2% 4% 1% 2017 0% Alcohol E-cig Marijuana Cigarette Prescription HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

Where are they getting their vape?

HARMS STRATEGY 12 Graders Ever Tried E-Cigs 1 in every 3 youth HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

E-Cigarettes Harm Health HARMS HEALTH KIDS TO ADDICT BIG TOBACCO Prevent disease Protect from injury Promote healthy lifestyles

Mouthpiece Tank Battery Atomizer and Base Atomizer Pre-filled Cartridge Battery Link E-CIGARETTES 101

HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

1980

1992

~2007 Video

HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

Ads for E-Cigarettes Hearken Back to the Banned Tricks of Big Tobacco

Real world example of its appeal

We just don t know enough about vaping yet.

We just don t know enough about vaping yet. YES WE DO!!

E-Cigarettes to Cigarettes 2017 University of Leeds, 2017 University of Michigan, 2016 University Southern California, 2017 University of Pittsburg: 4 studies found teenagers who had tried an e- cigarette were 2 to 4 times more likely to start smoking a conventional cigarette within a year, when compared to classmates who had not. HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

Click Image Click here HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

Lung Disease A 2015 Harvard study found: Diacetyl present in vapor Diacetyl has been directly linked to bronchiolitis obliterans, which in serious cases can require lung transplants HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

Lung Disease 2015 Johns Hopkins study found: Exposure to vapor can compromise the immune health of lungs Vapor can give rise to free radicals, the particles responsible for accelerated DNA damage and cancer growth HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

Lung Disease 2016 University of North Carolina: E-cigarettes alter hundreds of genes important for immune defense. Changes likely increase the risk of bacterial infections, viruses, and inflammation. HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

Lung Disease 2017 UNC School of Medicine Study shows they do not help patients quit smoking and do not reduce harm to lungs for COPD patients. HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

Lung Disease 2016 University of Southern California: Study found that teens, when compared to those who never tried e-cigarettes, the risk of the respiratory symptoms (persistent cough, bronchitis and congestion or phlegm) was. 85 percent higher among past users, and Double among current users "E-cigarettes are known to deliver chemicals toxic to the lungs, including oxidant metals, glycerol vapor, diketone flavoring compounds and nicotine," HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

Lung and Heart Disease 2017 Study: 3 Studies presented at European Respiratory Society International Congress showing E-cigs harm the lungs and heart.," HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

Heart Disease 2016 University of Athens Medical School: Vaping is as harmful to your heart as smoking Nicotine stiffens the heart's vital aorta artery, damaging it like regular cigarettes HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

Heart Disease 2017 Study Researchers from the Karolinska Institute, a medical university in Stockholm, found that vaping devices containing nicotine can result in a stiffening of the arteries, as well as an increase in heart rate and blood pressure. HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

Heart Disease 2017 UCLA Study "Study showed...electronic cigarette use with nicotine increases cardiac adrenaline levels - same pattern that is associated with increased cardiac risk in patients who have known cardiac disease." HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

Oral Disease 2016 ULCA Study: Vaping is not significantly safer than regular cigs Contain toxic substances impacting the top layer of skin cells in the oral cavity. E-cigarettes could increase users risk for oral disease. HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

Oral Disease 2016 University of Rochester Study: EC s equally damaging to gums and teeth as conventional cigarettes. cells release inflammatory proteins, aggravate stress within cells - damage could lead to various oral diseases e-cig contain nicotine - known to contribute to gum disease HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

Bladder Cancer Risk 2017 American Urological Association Study: Researchers compared the urine of people who use e-cigarettes with that of nonsmokers. The investigators looked for five chemicals known to cause bladder cancer and may be found in e-cigarette liquid. Ninety-two percent of e-cigarette users tested positive for two of the five chemicals. HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

E-Cigarettes to Cigarettes 2017 University of Leeds, 2017 University of Michigan, 2016 University Southern California, 2017 University of Pittsburg: 3 studies found teenagers who had tried an e- cigarette were 2 to 4 times more likely to start smoking a conventional cigarette within a year, when compared to classmates who had not. HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

Distilled Water Propylene Glycol Vegetable Glycerin Nicotine Concentrate Artificial Flavoring HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

Toxic chemical that can cause cancer or reproductive harm. Class Action suite against e-cig manufacturers for not warning consumers product has Formaldehyde and Acetaldehyde linked to cancer. HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

Second Hand Aerosol 2017 Virginia Commonwealth University Study: "This study is the first to show that e- cigarette/vaporizer use could pose a potential hazard to a developing embryo and cause craniofacial birth defects. " HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

E-Cigarettes Aren t Helping Smokers Quit Meta-analysis of 38 published articles the largest to quantify whether e- cigarettes assist smokers in quitting cigs. Study concluded the odds of quitting smoking were 28% lower in smokers who used e-cigarettes compared to those who did not. No e-cigarette company has submitted an application to the U.S. FDA to approve e-cigarettes for smoking cession (FDA has approved 7 types of cessation aids. Study out of University of California San Francisco, 2015

Cost to Benefit Ratio of E-cig Not adding up

HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

Assuming teen, light, daily tobacco user $7 $18 E-Cig Cigarette ~ 130 puffs per day ~ 170 puffs per day 5 times cheaper $4.20 p/week $20 p/week $18 p/month $87 p/month $219 p/year $1,022 p/year HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

Turn Kid s to Addicts HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

Nicotine Manipulates Reward Center of Brain HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

According to a 2015 CDC report 7 in 10 $6.4 million in 2011 to $115 million in 2014 300% increase in youth use

HARMS STRATEGY 12 Graders Ever Tried E-Cigs 1 in every 3 youth HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

What if e-cig laws were based on brain science? Brain develops up till mid 20 s - Nicotine damages developing brain - 95% of adult users start ~ 14 yrs old What if preventing addiction among kids was our main goal? HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

E-cigs Connection to Drugs HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

E-Cigarettes to Cigarettes 2017 University of Leeds, 2017 University of Michigan, 2016 University Southern California: 3 studies found teenagers who had tried an e- cigarette were 2 to 4 times more likely to start smoking a conventional cigarette within a year, when compared to classmates who had not. HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

How do we discourage use? HARMS HEALTH KIDS TO ADDICT BIG TOBACCO

What can we do? Education Evidence based cessation, Hard hitting media campaigns Tax as tobacco product, reduce # outlets sold and proximity to school, ban internet sales, restrict advertising, Sell e-cigs only in stores allowing adults Reduce poverty, increase educational and employment opportunities, improve human rights

Clearing the Vapor

Tools

Public Policies Change Tobacco Use Rates More Expensive, Less Youth Use Increase in Tax 12 th Grade Projected Use rates (2017) Status Quo 15% to 24% 10% 13% to 5% 50% 10% to 4.5% 80% 6% to 3.5%

What can Parents do? Bonding Know your teen talk and bond Notice changes in friends, dress, grades, emotions Boundaries Set clear rules regarding drug use Remind and educate your kids regularly Monitoring Look through their phone, show up occasionally at parties, monitor social media Notice unusual smells on clothes.

Federal Needed Ban advertising Restrict colors and flavors Regulate internet sales In Place Review new tobacco products not yet on the market Help prevent misleading claims Evaluate the ingredients of tobacco Communicate the potential risks of tobacco products Back to 2007 State Needed Define e-cigarettes like a tobacco product Tax as a tobacco product Age restricting the purchase of e-cigarette mechanism. Ban Internet sales (partially in place) In Place Labeling Packaging tamper proof Safety warning Local Needed Restrictions on the number of outlets In Place E-liquid manufacturing permit