Tailoring Substance Use Prevention & Intervention: Creating Community Solutions to Youth E-cigarette and Marijuana Use

Tailoring Substance Use
Prevention & Intervention:
Creating community solutions to youth
e-cigarette & marijuana use
A collaboration between Orange County Department of Education, the Oakland
Uniﬁed TUPE Program, The L.A. Trust for Children’s Health, and Children’s Hospital
Los Angeles

PRESENTER DISCLOSURES
Robert Dousa
Stephan Lambert
Erika Hernandez
Robert Renteria
No relationships to disclose

WHO IS IN
THE ROOM?
1) Your name + organization
2) Reason you came to this workshop
3) What’s one thing you would like to
learn that would make this a great
use of your time?

Send us your questions!
Go to swiftpolling.com & enter Y8787
Or text (714) 706-0532

not so safeTHE FACTS ABOUT VAPING AND E-CIGARETTES
Orange County Department of Education | Student Achievement and Wellness Unit

Stephan Lambert
Coordinator, Prevention Education
Orange County Department of Education
Training and Technical Assistance
TUPE, AOD and CHKS
Family and Community Engagement

Topics
E-Cigarette Basics
Health Risks
Marijuana Concentrates
Information for Educators
Resources

E-Cigarettes (a.k.a. e-cigs, vapes, JUUL)
Battery-powered devices that heat a liquid and turn it into an aerosol,
in order to deliver nicotine and/or ﬂavorings.

Heating
Element
“E-Liquid” Aerosol

Types of Devices
Cig-a-likes Vape Pens Mods

E-Liquid Ingredients
Nicotine
Propylene Glycol
and/or Glycerol
Flavorings

15,586
e-liquid ﬂavors were available online
as of a 2017 study.

What does e-cigarette aerosol smell like?

Cigarette vs E-Cigarette Use: Orange County
7th Grade
3%
1%
9%
9th Grade
1%
11th Grade
13%
2%
Cigarettes
E-Cigarettes

Myth: Nicotine is harmless.
Why it seems believable:
E-cigarettes don’t create smoke and tar, which
cause many tobacco-related illnesses.
Why it isn’t true:
Nicotine is addictive and can negatively affect youth
brain development.
Lydon, 2014; Yuan, 2015.

A meta-analysis found that youth who reported
e-cigarette use were three times as likely to report
smoking cigarettes at follow-up.
3X
Teen brains are strongly affected by nicotine. It can
negatively affect memory and attention and lead to
addiction, especially when used to relieve stress.
US Department of Health and Human Services, 2016; Holliday, 2016; Soneji, 2017.

Pod-Based “Nicotine Salt” Juice
Benzoic Acid Nicotine Salt

This mango JUUL pod
contains more nicotine
than a pack of cigarettes.

Myth: Nicotine-free e-liquid is harmless.
Unlike nicotine, artificial flavorings are safe to eat
and are used in foods and drinks.
Heating artificial flavorings can create toxic
chemicals that are harmful to inhale.
Barrington-Trimis, 2014; Rubinstein, 2014; Leigh, 2016; Behar, 2016.

Myth: E-liquid is harmless.
Propylene glycol and glycerol are used safely in
plastics, medicines and foods.
Heating propylene glycol and glycerol can create
toxic chemicals that are harmful to inhale.
Kosmider, 2014; Talih, 2015; Salamanca, 2018.

Myth: E-cigarette devices are harmless.
E-cigarettes are modern, USB-rechargeable and sold in
thousands of stores.
The heating element can leach metals into the e-liquid and
aerosol, and faulty batteries can catch ﬁre or explode.
Olmedo, 2018; Rossheim, 2018; Jones, 2018.

Passive (Secondhand) Vaping
Studies have found nicotine,
formaldehyde, metals and other particles
in sidestream aerosol.
Children, the elderly, pregnant women
and those with health conditions should
avoid exposure.
Flouris, 2013; Schober, 2014; Geiss, 2014; Saffari, 2014.

It’s water vapor and it’s not as
bad as smoking.

Key Points
Nicotine and the brain
Chemicals in aerosol
Safer isn’t safe
The tobacco industry

Unit 3: Marijuana Concentrates

Marijuana Concentrates (a.k.a. wax,
BHO, oil, dabs)
Chemically-extracted concentrates of THC and other components of marijuana.

THC Levels Comparison
STIIIZY
Skywalker OG
Average, 1995 4%
Average, 2014 12%
82%

11th Graders: Marijuana Use In Lifetime
Vaping Eating/
Drinking
Smoking
20% 19%
15%

Marijuana affects the parts of the brain that work on learning,
memory and attention and is linked with schizophrenia.
Using marijuana and driving can increase the risk of a crash.
Combining with alcohol worsens the risk.
While only 9% of users become dependent, the risk nearly doubles
(17%) for those who start as teens.

Signs of
Marijuana Use
Giddy and laughing
Impaired memory
Slow and drowsy
Paranoid/anxious
Bloodshot eyes
Drooping eyelids
Unusual hunger or thirst

It’s medicine and it’s legal.

Key Points
Medicine has side effects
Medicine can be harmful
Age & brain development

Unit 4: Information for Educators

Signs of
On-Campus
Vaping
Frequent breaks
E-cigarette odor
Backpacks in students’ laps
Vaping into sweatshirt sleeves

Policies
Marijuana use and possession are
prohibited
E-cigarette use and student
possession of e-cigarettes are
prohibited
No exemptions for medical marijuana
School nurses are not required to
administer medical marijuana

Notifying administrators
Searches and Conﬁscation
Storage and disposal of
marijuana concentrates
Cessation referrals
Protocols

Kahoot!
Go to kahoot.it on your device to play along.

tobaccopreventiontoolkit.stanford.edu

e-cigarettes.surgeongeneral.gov

drugfree.org - Marijuana Talk Kit

FREE tobacco cessation
services for Orange County
residents
● Five-session class series*
● 90-minute seminar*
● 2 x 45-minute seminars
● One-on-one counseling
● Telephone counseling
* Also available for students

Thank You!
Stephan Lambert
Prevention Coordinator
slambert@ocde.us
714-966-4412

The highs and lows of S.B.I.R.T:
Integrating a substance use prevention
intervention at 5 SBHCs

MA
Erika Hernandez
Project Coordinator
Children's Hospital L.A.
MA
Robert Renteria
Program Manager
The L.A. Trust

Objectives
Participants will:
1. Describe the development and use of environmental scans (needs
assessments) to understand the culture and decision-making
structure at each school
2. Explain how substance use screening and early intervention
services support an academic mission as part of comprehensive
health care in school-based health centers
3. Discuss our success through lessons learned from identifying and
then building partnerships with a school system and other key
stakeholders including teachers, parents and youth

Children’s Hospital L.A.
Division of Adolescent & Young Adult Medicine
• Children's Hospital Los Angeles (CHLA) is a
501(c)(3) nonprofit institution that
provides pediatric health care and helps
our patients more than 528,000 times
each year in a setting designed just for
their needs.
• The Division of Adolescent & Young Adult
Medicine @ CHLA promotes healthy
futures by attending to the physical,
emotional, and social needs of young
people ages 12 to 25.

The L.A. Trust for Children’s Health
• Founded in 1991 to support and develop Los
Angeles Unified School District School Health
programs
• Mission: to improve student health and
increase readiness to learn through increased
access to health care, school policy advocacy
and effective programs

Los Angeles Uniﬁed School District
• 643,493 students K-12
● 101,060 enrolled in
independent charters
• Diverse

Health Disparities
• Health disparities mapped in 2006-07 (“Health Hot Spots”)
• Guided investment in Wellness Centers 2009
• Re-mapped health and educational indicators in 2013-14 (“Health
Need Index”)
• Guided LAUSD investment for Wellness Phase 2
(6 new Wellness Centers)
• Now working on remapping with DPH for Wellness Phase 3

Chlamydia Rates/Cases 2006 vs. 2012

Teen Birth Rates 2006 vs. 2012

LAUSD Wellness Centers vs. Needs

LAUSD Wellness Centers vs. Needs
Crenshaw, Fremont, Jefferson,
Manual Arts & Washington Prep HS

Wellness and Adolescent
Substance Use Prevention
Project (WASUP)
Collaborating with five Los
Angeles Unified School District
high school campuses and their
respective Wellness Centers to
support substance use
prevention activities

The Project
• Works with youth, teachers,
parents, and Wellness Center staff
at Fremont, Jefferson, Manual
Arts, Washington Prep and
Crenshaw high schools
• Supports integration of substance
use prevention activities, including
the incorporation of the Screening,
Brief Intervention and Referral to
Treatment (SBIRT) evidence-based
practice into Wellness Center
medical care services

Environmental Scans
Needs assessments conducted to
understand the culture and
decision-making structure at each
school
• Identify key staff at the five
Wellness Centers, the five
school campuses, and
student leaders to help
promote a culture of
wellness
• Identify campus-specific
barriers that may impede
implementation

Environmental Scans
Key Participants: District Liaison, School Principal,
Wellness Center - Clinic Manager
1. School Assets
2. School Challenges
3. Parental Involvement
4. Outside Agency Partners/ Groups
on Campus
5. Substance Use on Campus
6. Substance Use Policy
7. Suggestions for Addressing
Substance Use among Students
8. Perceptions of Wellness Center
9. Referrals to Wellness Center
10. Wellness Center Student Intake and
Assessment Process
11. Additional Wellness Center
Information
12. Obstacles to Wellness Center Use
13. Mental Health Provider Information
14. Trusted Staff/Faculty
15. Who we should talk to
16. Other Suggestions
17. Additional Information Needed

Building Partnerships
Lessons learned:
• Identifying partnerships
○ Patience (who, when)
○ Building trust
○ Personal/Tailored
approach
• Integrating holistic approach
to substance use prevention
conversation
○ Being practical
○ “Real”
○ Having conversations

SBIRT uses a public health
approach to universal screening
for substance use problems
• Immediate rule out of
non-problem users
• Identifies levels of risk
• Identifies patients that would
benefit from further
assessment and
• Further intervention either
brief or by referral to another
professional based on needs
and motivation for change
SBIRT

Providers at all 5 sites were certified
to conduct S.B.I.R.T. as substance
use screening and referrals
• Early intervention services support
an academic mission as part of
comprehensive health care in
school-based health centers
• Identify opportunities to explore
new pathways to move upstream
and strengthen youth health and
wellness through education,
prevention and early intervention
Screening

Capturing Data
● S.B.I.R.T. clinic flow
○ Screening
○ + prompts substance use
re-screening by provider
○ Positive re-screening
prompts BI (motivational
interviewing)
○ RT is internal to mental
health
○ Mental Health refers to
external partners

Capturing Data
● Fremont WC developed data
points in their EMR
(Electronic Medical Record)
to capture and extract
S.B.I.R.T. information
S.B.I.R.T.
EMR
template
S.B.I.R.T.
EMR
Smart
Form

CHLA SYPP 2013
Risk and Protective Factors

Risk and Protective Factors
Things to Consider for Prevention
Protective Factors
● Positive family bonds
● Parental monitoring
● Clear rules of conduct
● Involvement of
parents/guardians in lives
of their children
● Success in school
performance
Risk Factors
● Chaotic home environment
● Ineffective parenting
● Lack of attachment
● Shy or aggressive behavior
● Poor social coping skills
● Affiliation with peers displaying
deviant behaviors
● Perception of approval of
drug-using behaviors

● Impairment Goggles
○ Depth and perception
○ Coordination
○ Condom demonstration
● Wheel of Misfortune
○ Facts on alcohol and
other drugs
Student Activities

FAQs & Talking Points
Conversations around impairment goggles:
- Isn’t this encouraging us to experiment with alcohol since we’re having
fun?
- This isn’t how it is in real life…
- I don’t drink or smoke weed, so I don’t really need to do this activity
Questions after classroom presentations:
- If one standard drink contains the same amount of alcohol, why do
people get drunk faster when drinking shots?

Where Are We Now
With a better understanding of
school culture at each site,
project staff have formed
stronger connections with
students, school administration
and Wellness Center staff.
We are moving to further
educate parents on cannabis
policy and introduce them to
local community partners for the
opportunity to advocate for their
communities.

WASUP
Challenges:
• Schools and clinics have
experienced high turnover of key
staff
• Substance use repercussion at
schools is still unclear to teachers
and students
• Communication between schools
and Wellness Centers is not
consistent
Highlights:
• Student leaders are engaging with
peers through substance use
prevention activities and
presentations
• SBIRT is being conducted at all 4 sites
and WASUP staff is collecting data
including referrals
• Engaging with CA state, local, and
school district partners to address
new cannabis laws which have
commenced in 2018

Other Issues
• Suspension is off the table,
but therapeutic culture is still
not recognized as best
practice
• LASPD still requested and
involved when substances are
present
• Culturally sensitive Substance
Use services not easily
accessible where most needed

Next Steps ● Included a 5th
site (Crenshaw High
School) to implement best
practices and sharpen our toolbox
● Provide Professional Development
with parents and school staff
around Substance Use prevention
and focus on cultural competency
for adolescents
● Working to integrate Best
Practices and lessons learned into
school district and local policy

Questions?
Contact:
ErikHernandez@chla.usc.edu
Robert@thelatrust.org
Thank you!

Ice Breaker
“The MI Change Talk”

STRENGTHS-BASED APPROACHES TO BEHAVIORAL CHANGE
Empowering Conversations & Practices with
At-Risk Youth
Motivational Interviewing:
Providing Relevant Health Education to Drive Behavior Change
ROBERT DOUSA INTERVENTION COACH TRAINER

“Building inner motivation, for those expected to
fail, is the most rewarding experience I know.”
Robert C Dousa
What is my “Why?”

Motivational Interviewing
“FOCUS ON EDUCATION”
● Creating Change Talk Moments
● Relevant Informing to Drive Positive Decision-making

Today’s Objectives
• Supporting the client to find the answers they need to
sustainably address their challenges
• Use MI to provide relevant health education
• Learn Motivational Interviewing Techniques designed to drive
decision-making

Letting the Client Drive
Demonstration

Basic Motivational Interviewing

Principles of Motivational Interviewing
● The Client has the answer inside already
● We facilitate them to find it
● Express and Show Empathy Toward Clients. …
● Support and Develop Discrepancy. …
● Deal with Resistance. …
● Support Self-Efficacy. ...
● Develop Autonomy.

Powering Up Motivational Interviewing
Educating on your CLIENT’s Concerns

Be a Secure Base
Center to Good Energy
● Breathe & Breathe again
● Do what grounds you
● Meditate on your purpose
● Be curiously optimistic
● Look for the good

MI & Coaching as Therapy
Move them from negative behaviors
through deep engagement in building good!

Inspire Client and Yourself by
Focusing on Strengths

Self Advocacy
Supporting Your Client to Make
Their Best Choice

Listen for most Find an
emotional reason Entry Pt for education
(Find strongest
need)
Summarize Pro & Con

Great Listening Precedes the Education
1. Initial Rapport
2. Conﬁdentiality & Rapport
3. Listening to the Whys/Needs & Rapport

Switching Over to the Con Side in MI to
Provide Relevant and Client Centered
Health Education
1. What is client concerned about
2. Explore all that they know
3. Invite Permission to “Add to”
(educate)

Find an
Reasons for using - Relevant education
(Needs) - Explore Client’s
Concerns
-Build their knowledge
Now Summarize Pro & Con

Vaping THC is What Client is Doing
Let’s Use What We Learned Earlier

Let’s Practice
Person A 3 causes for concern;
Person B Reﬂect
Most Relevant Concerns
Reflect Back

Continue Let’s Practice
Person B Explore 1 Concern with A
Person A Say All You Know
Explore the Concerns
Find Out What A Knows

Basic Vaping Key Points for Concerns
● Heart disease due to stimulant
● Aerosol irritates eyes and respiratory tract
● High potency THC/nicotine leading to addiction
● Accidental poison you (or a child) if liquid swallowed
● Harm dopamine receptors altering brain development
● Nitrosamines in E-Cigs can cause cancer
● E-cig batteries can explode in use (hand or face)

Basic Vaping THC Key Points for Concerns
● Breathing Issues: Vaping marijuana can
aggravate asthma conditions. bronchial tubes
spasms
● Cancer Risk: Cancer-causing substances like tars
& tumor inducing chemicals may be released
● Intoxication: The marijuana oils that are
sometimes used for vaping can be highly
concentrated with up to 90% of the drug’s active
ingredient, THC

Basic Vaping THC Key Points for Concerns
● Pre-existing Conditions: If you suffer from heart or circulatory disorders, low
blood pressure, diabetes or schizophrenia, marijuana ingested in any form can
pose a health risk to you. Double heart rates.
● Dependence: Although marijuana isn’t as addictive as tobacco, its use is
known to cause a dependency upon the substance.
● Brain Issues: The THC in marijuana is absorbed into your bloodstream and
carried to your brain where it interacts with cell receptors that control
neurological development and other brain functions.

Continue Let’s Practice
Person B Invite & Educate with partner A
Person A Explore as Interested
Explore the Concerns
Educate in Partnership

Now Summarize & Ask THE Question
Based on what we discussed:
● Keep doing things the same
● Make some changes?
● Make a big change?

If the answer is “Yes to Change!”
Set a strong goal!

Begin Coaching…
SET THE GOAL!
● SMART goal example
● What - How - Measurement?
Jon will only smoke weed on Friday and Saturday this
week BY ...playing basketball with his brother and will
MEASURE his success by putting the money normally
spent, in a glass jar.

Life Skills Coaching…
Strengthen Against Relapse Trigger
● Earlier you had mentioned you needed to
smoke because….
● Strengthen Student to Foster Behavior
Change Success ….
● COACH THE LIFE SKILL NEEDED

New brain cells grow every day – 10,000! – Half to
support current habits, half to support new ones!
LEARNING IDEA:
People can change if they focus their mind on it!
Coach People with New Brain Cells!

Reﬂection
● What did you discover?
● What do you want to keep?
● What will you use at work?
● How will you use it improve outcomes?
● Who else needs to know?

STRENGTHS-BASED APPROACHES TO DRUG PREVENTION & INTERVENTION
At-Risk Youth
ROBERT DOUSA INTERVENTION COACH TRAINER
ASTRENGTHSAPPROACH@GMAIL.COM
925 321-0818

Ice Breaker
“Business Card Party”

STRENGTHS-BASED APPROACHES TO BEHAVIORAL CHANGE
At-Risk Youth
Creating Eﬀective Presentations to Use with Youth
Leaders
ROBERT DOUSA PROGRAM MGR TRAINER

Today’s Objectives
• Determining the “High Leverage” Purpose of the Lesson
• Support the Teacher/Students to Build Knowledge and
Behavior Objectives
• Build Content Rich Outlines
• Be Able to Identify Aspects of the Most Engaging Methods
of Teaching the Objectives

Learning Method of “Teach Others”
What Works in Class, In Group, 1 x 1?

Let’s Dissect a
Vaping Prevention Lesson
“Create a Vaping Prevention PSA Script Activity”

Create a PSA Script Activity
Vaping THC Prevention
1. Educate participants on content
2. Have props available
3. Show participants 2 or 3 examples of PSAs
4. Show sample outline of a PSA
5. Break participants into groups
6. Participants create PSA scripts (outlines)
7. Participants present PSAs

Let’s Dissect a
Vaping Prevention Lesson
From the Beginning….

Determine the “High Leverage”
Purpose of the Lesson
● Research the Needs of Population
● Co-Construct the Mission Statement
How can we approach this?

Collect Data/Info on Population Serving
Interviews
Observance
Other Surveys

Co-Construct a Mission Statement
What
Who
How
Align the mission statement with
your prevention mission
statement and to the school’s

Support the Teacher/Students to
Build Knowledge and Behavior
Objectives
● Establish High Leverage Knowledge
Objectives
● Establish Achievable Behavioral Objectives

Co-Constructing Presentation Outline
What do you want students to know?
What do you want students to be able to do
afterwards?

High Leverage Knowledge Objectives
Examples
1 Vaping sets the brain for addiction
2 Children and even you can be poisoned by e-liquid
3 Vaping causes more heart disease than smoking

High Leverage Behavioral Objectives
Examples
1 Students delay trying vaping
2 Students tell their friends to not vape
3 Students promote healthy stress relieving activities

Learn Aspects of the Most
Engaging Methods of Teaching
the Objectives
● How to make it engaging, fun, & meaningful
○ Identify Best Prevention Teaching Practices
● How to measure eﬀectiveness

Search for Engaging Teaching Activities
Fully Engaged
Relevant
Participants Teach Back
Material Created Can Be Used in School Wide

What Makes Teaching Objectives Fun??
Light Up The Whole Brain
1 Surprising
2 Social/Team
3 Self Esteem Building
4 Sound, Sight, Emotions

How do We Gauge Eﬀectiveness?
What measures do we need to impact?
1 CHKS Data
2 YRBS Data
3 SBHC Data?

Support the Teacher/Students to
Outline How the Lesson Will Be
Taught
● What Activities Will Be Used?
● In What Order?
● How Can We Set Our Audience Up for
Success?

Let’s break into groups
Create some PSA skits!
Let’s perform them!

Nuts and Bolts of a PSA Outline
1) Message: What is the main point?
2) Motivate: What do you want people to do?
3) Brainstorm: What is the story outline?
4) Main Character: What is the struggle/reward?

Instructions:
1) Message
2) Motivation
3) Story Outline
4) Practice

Citations
Hsu, G., Sun, J. Y., & Zhu, S. H. (2018). Evolution of Electronic Cigarette Brands From 2013-2014 to 2016-2017: Analysis of Brand
Websites. Journal of medical Internet research, 20(3), e80. doi:10.2196/jmir.8550.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5869180/
Lydon, D. M., Wilson, S. J., Child, A., & Geier, C. F. (2014). Adolescent brain maturation and smoking: what we know and where we're
headed. Neuroscience and biobehavioral reviews, 45, 323-42. https://www.ncbi.nlm.nih.gov/pubmed/25025658
Yuan, M., Cross, S. J., Loughlin, S. E., & Leslie, F. M. (2015). Nicotine and the adolescent brain. The Journal of physiology, 593(16),
3397-412. https://www.ncbi.nlm.nih.gov/pubmed/26018031
Holliday, E., & Gould, T. J. (2016). Nicotine, adolescence, and stress: A review of how stress can modulate the negative consequences
of adolescent nicotine abuse. Neuroscience and biobehavioral reviews, 65, 173–184. doi:10.1016/j.neubiorev.2016.04.003
U.S. Department of Health and Human Services. E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General.
Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic
Disease Prevention and Health Promotion, Office on Smoking and Health, 2016. https://e-cigarettes.surgeongeneral.gov/
Soneji, S., Barrington-Trimis, J. L., Wills, T. A., Leventhal, A. M., Unger, J. B., Gibson, L. A., Yang, J., Primack, B. A., Andrews, J. A.,
Miech, R. A., Spindle, T. R., Dick, D. M., Eissenberg, T., Hornik, R. C., Dang, R., … Sargent, J. D. (2017). Association Between Initial
Use of e-Cigarettes and Subsequent Cigarette Smoking Among Adolescents and Young Adults: A Systematic Review and
Meta-analysis. JAMA pediatrics, 171(8), 788-797. https://www.ncbi.nlm.nih.gov/pubmed/28654986

Barrington-Trimis, J. L., Samet, J. M., & McConnell, R. (2014). Flavorings in electronic cigarettes: an unrecognized respiratory health
hazard?. JAMA, 312(23), 2493-4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4361011/
Rubinstein, M. L., Delucchi, K., Benowitz, N. L., & Ramo, D. E. (2018). Adolescent Exposure to Toxic Volatile Organic Chemicals From
E-Cigarettes. Pediatrics, 141(4), e20173557. https://www.ncbi.nlm.nih.gov/pubmed/29507165
Leigh, N. J., Lawton, R. I., Hershberger, P. A., & Goniewicz, M. L. (2016). Flavourings significantly affect inhalation toxicity of aerosol
generated from electronic nicotine delivery systems (ENDS). Tobacco control, 25(Suppl 2), ii81-ii87.
https://www.ncbi.nlm.nih.gov/pubmed/27633767
Behar, R. Z., Luo, W., Lin, S. C., Wang, Y., Valle, J., Pankow, J. F., & Talbot, P. (2016). Distribution, quantification and toxicity of
cinnamaldehyde in electronic cigarette refill fluids and aerosols. Tobacco control, 25(Suppl 2), ii94-ii102.
https://www.ncbi.nlm.nih.gov/pubmed/27633763
Kosmider, L., Sobczak, A., Fik, M., Knysak, J., Zaciera, M., Kurek, J., & Goniewicz, M. L. (2014). Carbonyl compounds in electronic
cigarette vapors: effects of nicotine solvent and battery output voltage. Nicotine & tobacco research : official journal of the Society for
Research on Nicotine and Tobacco, 16(10), 1319-26. https://www.ncbi.nlm.nih.gov/pubmed/24832759
Talih, S., Balhas, Z., Salman, R., Karaoghlanian, N., & Shihadeh, A. (2015). "Direct Dripping": A High-Temperature,
High-Formaldehyde Emission Electronic Cigarette Use Method. Nicotine & tobacco research : official journal of the Society for
Research on Nicotine and Tobacco, 18(4), 453-9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6220833/
Citations

Salamanca, J. C., Meehan-Atrash, J., Vreeke, S., Escobedo, J. O., Peyton, D. H., & Strongin, R. M. (2018). E-cigarettes can emit
formaldehyde at high levels under conditions that have been reported to be non-averse to users. Scientific reports, 8(1), 7559.
doi:10.1038/s41598-018-25907-6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5954153/
Olmedo, P., Goessler, W., Tanda, S., Grau-Perez, M., Jarmul, S., Aherrera, A., Chen, R., Hilpert, M., Cohen, J. E., Navas-Acien, A., …
Rule, A. M. (2018). Metal Concentrations in e-Cigarette Liquid and Aerosol Samples: The Contribution of Metallic Coils. Environmental
health perspectives, 126(2), 027010. doi:10.1289/EHP2175. https://www.ncbi.nlm.nih.gov/pubmed/29467105
Rossheim, M. E., Livingston, M. D., Soule, E. K., Zeraye, H. A., & Thombs, D. L. (2018). Electronic cigarette explosion and burn
injuries, US Emergency Departments 2015-2017. Tobacco control, tobaccocontrol-2018-054518. Advance online publication.
doi:10.1136/tobaccocontrol-2018-054518. https://www.ncbi.nlm.nih.gov/pubmed/30219795
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Citations

Nuggets video (5m):
https://youtu.be/HUngLgGRJpo

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https://vimeo.com/191398666

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