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Vapes and E-Cigs: 101
- 2. Today’s Discussion The Riseof E-Cigs and Vapes The Problem of Vapes and E-cigarettes E-cigarette or Vaping-Associated Lung Injury (EVALI) Public Health Solutions
- 3. KAHOOT Download the KahootApp on your phone to play!
- 4. The Rise ofE-Cigs and Vapes Advertising, New Products and Nicotine Addiction
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- 8. “Yes! We’ve almostwon!!!!” said public health professionals everywhere
- 9. Big Tobacco wasasking, “Who is going to replace the old smokers?” During our Victory Lap...
- 10. 88% of adultsmokers started before 18 YOUNG PEOPLE
- 12. Juul enlisted youngcustomers to be “Peer Influencers” and brand ambassadors on social media.
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- 16. 99% of juscontains nicotine. Youth are not aware that e-cigs contain nicotine Juul has the highest level of nicotine of any e-cig brand. Juul is 3x the nicotine of any product allowed to be sold in UK.
- 17. Freebase – Lotsof jus to get the fix. Harsh. Used in High Wattage mods/tanks. $$$ Salt-based – Potent, and smooth. Works in Low wattage device created by Juul Labs
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- 19. • Inhaling andexhaling the aerosol (often called vapor) produced by an e-cigarette or similar battery-powered device. • Electronic nicotine delivery systems (ENDS): e-cigs, dab pens, vape pens, e-hookahs, tanks, mods, or vapes • Sometimes referred to by brand names such as JUUL (Juuling), Suorin, Blue, and others
- 25. Just Water Vapor? NOPE! Waterdoes not work in vaping devices
- 26. Compounds in yelloware from FDA 2012, Harmful and Potentially Harmful Substances – Established List • Propylene glycol • Glycerin • Flavorings (many) • Nicotine • NNN • NNK • NAB • NAT • Ethylbenzene • Benzene • Xylene • Toluene • Acetaldehyde • Formaldehyde • Naphthalene • Styrene • Benzo(b)fluoranthe ne • Cadmium • Silicon • Lithium • Lead • Magnesium • Manganese • Potassium • Titanium • Zinc • Zirconium • Calcium • Iron • Sulfur • Vanadium • Cobalt • Rubidium • Benzo(ghi)perylene • Acetone • Acrolein • Silver • Nickel • Tin • Sodium • Strontium • Barium • Aluminum • Chromium • Boron • Copper • Selenium • Arsenic • Nitrosamines, • Polycyclic aromatic hydrocarbons • Chlorobenzene • Crotonaldehyde • Propionaldehyde • Benzaldehyde • Valeric acid • Hexanal • Fluorine • Anthracene • Pyrene • Acenaphthylene • Acenapthene • Fluoranthene • Benz(a)anthracene • Chrysene • Retene • Benzo(a)pyrene • Indeno(1,2,3- cd)pyrene All of these have been found in e-cigarette/vape pen aerosol
- 29. Understanding the problem Who isusing? Are they safe? Do they help adults quit? Where are they getting the products? Why is nicotine a special problem for youth?
- 30. Nationally, 28-30%of high school youth and 11% middle school report regular use of e- cigarettes (CDC,2019) 7 in 10 youth ages 7-12 have tried it at least once (ACS) Higher rates among white and Hispanic but truly effects everyone 40% of e-cig youth users have never used a cigarette 50% of those ages 18-24 are current users There is a product for every demographic (kids pay $1 for a hit off of a Juul). Flavors are a driver – 91% of youth that use, use flavors
- 31. If adults usee-cigs alone, there may have modest benefit in cessation and less harm than combustibles However, using 2 or more types of tobacco products is common Dual use raises blood toxicity to levels equal with smokers Not FDA approved for cessation Harm reduction conversations should be with adults NOT kids
- 32. Easy to Get Most buy their vapes in retail stores (75%) Others from family and friends Few order on-line Some sell “hits” to recoup cost Easy to Conceal Small and sleek design Do not look like a cigarette Do not smell like a cigarette Small cloud can easily be hidden Products to help you hide your vape are on-line
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- 34. SURGEON GENERAL WARNING Nicotine exposurein teens harms the developing brain and increases the risk of addiction later in life Exposure to the developing fetus can result in SIDS, altered corpus callosum, deficits in auditory processing, and obesity Ingestion of e-cigarette liquids that contain nicotine, can cause poisoning and death
- 35. The humanbrain develops around age 25 Using substances of abuse before the brain is fully developed strengthens the dopamine pathway A strong dopamine pathway increases the likelihood of addiction later in life.
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- 39. E-cigarette or vaping product-related lunginjury The latest from CDC What we know What we are not yet SURE about
- 40. Over 2291hospitalized victims* 48 deaths since March* Some had seizures 16% patients are in high school 38% patients are 18-24 years old Most lung samples show Vitamin E Acetate (VEA) residue VEA can be found in legal and illegal, THC and Nicotine vape jus. *As of 12/3/19
- 41. EVALI Symptoms If you usede-cig or vape product in the last 3 months watch out for: cough, shortness of breath, chest pain nausea, vomiting, abdominal pain, diarrhea fever, chills, or weight loss
- 42. Dr. Hassan Nemehof Detroit’s Henry Ford hospital points to an image of the transplant patient's damaged lungs on the left, beside an image of typical healthy /Henry Ford Health Systemlungs.Facebook After doing transplants for 20 years, this Michigan surgeon had NEVER seen lungs as badly scarred as this 16 year old’s lungs. E LUN GS!
- 43. DO NOT VAPE– because really, CDC is not 100% sure what’s causing this and there are NO SAFE Tobacco products DO NOT VAPE EVER if you are a youth, young adult, or pregnant woman DO NOT CONSUME THC with any electronic cigarette or vaping device
- 45. Public health solutions Prevention, Education,Policy Change, Community, Parent and Youth Youth Led Prevention Education /Cessation vs Suspension Cessation for adults and youth
- 46. T-21 in Ohio RaisePrices Flavor Bans Limit/ License retail outlets ID scanners Smoke Free Environments/Workplaces Advocate for FDA to restrict on-line availability Strict enforcement to ensure compliance
- 47. Teen vapingis an epidemic Schools have drawers full of confiscated vape devices Suspension without cessation does not address the public health issue. Example policy https://www.lung.org/assets/documents/ast hma/tobacco-free-school-campus.pdf Tobacco policy that includes: prevention, access to cessation parent involvement
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- 50. CATCH MY BREATH•Meets ODE Standards • Grades 5-6, 7-8, 9-12 • Peer-facilitated cooperative learning groups • Teacher Training: 3 Parts WITH Certificate! • Parent/Community Resources • Educator 411: Additional Resources
- 51. PREVENTION: BEFORE THEY STARTPAX Good Behavior Game Asset Development – SEARCH Institute Life Skill Development – Botvins Life Skills Training Youth Led Prevention Peer to peer education Peer mentoring Parent and Community Education Culturally Appropriate Media Environmental Strategies
- 52. MY LIFE, MY QUITNo NRT or treatment is approved for adolescents Counseling works for adults, not sure about youth Truth Initiative https://truthinitiative.org/ Text “ditchjuul” to 88709 My Life, My Quit – Live Coaching and text support www.mylifemyquit.com Text “Start my quit” to 1-855-891-9989 Also offers proof of enrollment/completion to teen Do not JUST discipline – You cannot punish away addiction Schools should modify policies to include cessation, not just suspension.
- 53. PARENTS ARE THE#1 INFLUENCE The average age of initiation is 12 Parents are the #1 influence Talk Early and Often about e-cigarettes and other drugs Youth whose parents talk with them about drugs are 50% less likely to use.
- 54. CDC: Office ofTobacco Control NIH Drug Facts:Vaping Devices US Surgeon General Advisory on E-Cigarettes SAMHSA: Why you should talk with your kids about alcohol and other drugs American Heart Association: The Ugly Truth about Vaping Addiction Policy Forum Interact for Health: Reducing Tobacco Use Fairfield Prevention Coalition: These Slides #Quitlying Tobacco 21 Cincinnati FDA: Tobacco Products RESOURCES
- 55. HTTPS://WWW.SURVEYMONKEY .COM/R/SZK6YTC Evaluation: Please letus know how we did. Deborah Neyer, M.Ed, OCPS Fairfield Prevention Coalition fairfieldcoalition3@gmail.com www.fairfieldcoalition.org Kristina Latta-Landefeld, M.A., OCPS Envision Partnerships klatta@envisionpartnerships.com www.envisionpartnerships.org
Editor's Notes
- #3 Outline: I. Evolution of tobacco industry Brief history of Tobacco advertising and products Today’s generations of products (definition and Essential parts of a –e-cig) How a nearly tobacco free generation became addicted in 10 years (ads, flavors, and nicotine salts) II. The Problem Are E-cigs safe? Do they really help adults quit? Why are youth using and Why is nicotine addiction a special problem for youth? What do we know about who is using? Where do they get the products? III. E-cigarette, or vaping, product use associated lung injury (EVALI), (aka. Vape Lung) Symptoms The latest morbidity and mortality data from CDC What we know, what we don’t know IV. The Solutions Universal Prevention Education Policy Change Community Education Parent Education – essential messages for parents Youth-Led Prevention Selective Prevention Education/Cessation vs. Suspension Parent and Youth education Indicated Prevention and Cessation Cessation for Adults Cessation for Youth What do we know about e-cig cessation for youth? Tools
- #5 Evolution of tobacco industry Brief history of Tobacco advertising and products Today’s generations of products (definition and Essential parts of a –e-cig) How a nearly tobacco free generation became addicted in 10 years (ads, flavors, and nicotine salts)
- #8 CDC – NSDUH 2018 (above chart) 14% of adults smoke 2018 Interact for Health Survey – 2018 Regionally our progress lags behind… at 19%
- #10 Teacher Talking Points: The e-cigarette/vape pen industry knows that many of their customers are getting older and need to be replaced with new customers so they can make more profits Who do you think they see as the ideal customer?
- #11 Teacher Talking Points: (Click) Young people like you! The e-cigarette/vape pen industry sees young people as the perfect replacement customers They know if young people get hooked to their products early in life, they’ll have them as customers for years to come It’s well-known by health professionals and the e-cigarette/tobacco industry alike, many current smokers started smoking before adulthood So if you take a closer look at e-cigarette/vape pen marketing, you’ll notice the industry’s attempts to make e-cigarettes/vape pens trendy and appealing to youth
- #12 68% of youth have been exposed to advertising in retail stores.
- #13 MARKETING TACTICS Recent reports have found that e-cigarette companies are using scholarship offers as a way to recruit youth users. Individuals aware of e-cigarettes report that the most common ways to hear about e-cigarettes are through in-person communications, by seeing them for sale and by seeing them in online and TV ads, in which some celebrities have endorsed the products. E-cigarettes are promoted heavily online43 through e-cigarette company-sponsored advertisements, and on YouTube and Twitter. More recently, mobile ads have become a popular place to advertise e-cigarettes. Mobile ads, or paid advertisements on smartphone applications and websites optimized for mobile, have the potential to reach millions of young people. Teacher Talking Points: e-cigarettes/vape pens companies try to recruit new customers by sponsoring events that are popular among young people, like (click) music festivals Sports fan are targeted through (click) brand sponsorships or (click) by indirectly attempting to associate e-cigarette and vape pen products with sports themes
- #15 Flavors – are the way they start and a primary influencer for youth use – they are trying to justify them to say that adults need flavors to quit but this is not rooted in research Michigan is moving forward with NOT selling flavors. The Gut can handle more than the lungs so GRAS (Generally Accepted as Safe) flavors are approved for ingestion, not inhalation Some e-liquids have been marketed to look like common food items, many of which appeal to kids. Examples include marketing e-liquids as “Thin Mints,” like the Girl Scout’s cookie, and “Tootsie Roll.” Those e-liquids were removed, or at least renamed, after the companies owning those copyrights took action to protect their intellectual property. Other food and candy flavors remain on the market. In May 2018, the FDA and the Federal Trade Commission took joint action against several e-liquid companies that marketed their products to look like candy or other kid-friendly food items, such as Reddi-wip, Nilla Wafers and Warheads candy. Teacher Talking Points: Besides the large aerosol clouds that can be made with e-cigarettes/vape pens, the 7,000 e-juice flavor options are a marketing strategy to lure new customers (click)Who do you think is most likely to be attracted by these flavor options? It’s no coincidence that flavorings in tobacco products can make them more appealing, especially among young people your age
- #16 Teacher Talking Points: And I wonder what age this is targeted to? Clearly, young people are the target audience for these types of products
- #17 e-cigs may be harder to quit than regular cigarettes because of the concentration of nicotine. Use of products 1-2 days per month can cause nicotine withdrawal Nicotine is a drug found in tobacco plants. It’s also frequently used in insecticides to kill bugs. When you are hanging out with your friends, would you want to take a puff of insecticide? Also, you should know that nicotine is the drug found in tobacco products that makes them addictive. That means that once you use it, your body will continue to want more. When you use e-cigarettes, nicotine is quickly absorbed into your body and goes directly to your brain. Nicotine activates areas of the brain that make you feel satisfied and happy. Putting nicotine in your body is dangerously addictive, and it can also prime your brain for addiction to other tobacco products, or even harder drugs, like cocaine. Some of you may have taken chemistry already, or you might be taking it in a few years. So you may know about the pH scale, which measures what chemicals are in liquids, such as in a swimming pool or a hot tub. So why are we showing you this? Well, pH matters when it comes to how harsh nicotine is on your body, particularly your throat when you’re inhaling it. Most nicotine in cigarettes and e-cigarettes is what we call free-base nicotine, which means it’s very blue on the pH scale. The more blue on the scale, the more volatile or crazy it’s going to be, which means that it will be harsher on your throat. But get this: manufacturers of JUUL have found a way around the harshness factor. They added a chemical to the nicotine, which causes it to become more red on the pH scale. By making it more red, it then becomes what we call nicotine salts, rather than free-base nicotine.
- #18 Nicotine salts are the key to making it smooth and HIGH in nicotine without the harshness Free base nicotine – It is overly alkaline and harsh when it burns. To get higher levels of nicotine to user they added acid and it made it smoother. In the past flavors have masked harshness but now that is not necessary. Jus contains high levels of vegetable glycerin and makes large clouds. Nicotine Salts - Juul invented the technology but others will follow the trend of higher nicotine levels. Nicotine salts are less harsh on your throat. This is of particular concern for young people because it allows for nicotine to be used more easily, which increases the likelihood of trying an e-cigarette and getting hooked. Smaller Clouds because pod jus is thinner and does not contain as much vegetable glycerin. Salt-based nicotine, also known as nicotine salts,nic salt, or salt nic, is a fairly recent thing in the world of vaping. Before that, e-liquids strictly contained freebase, a type of nicotine that was created in the 1950s by tobacco companies to be more potent. Freebase is essentially nicotine that’s extracted from the tobacco leaf and chemically modified to be stronger. Unfortunately, freebase can feel a bit, well, harsh. When it’s used in a high-wattage box mod setup, it can burn the throat a bit. That’s why users had to go with super low concentrations of nicotine when using sub-ohm systems. This low concentration prevented the nicotine from destabilizing and feeling harsh along the throat when inhaled. Salt-based nic, on the other hand, is a purer form of nicotine, not to mention more stable. It’s taken from the tobacco leaf and combined with an ingredient called benzoic acid. This combination is perfect for vaping because it allows users to get a nice, potent hit of nicotine while using a low-wattage device, and the hits almost never feel harsh against the throat.
- #19 Who is using them? (see slide) 78% increase in a single year 2017-2018 among high school students. Surgeon General this is the single greatest increase in the history of drugs EPIDEMIC! This is the F word of epidemiology. 50% increase in 12-14 year olds in same time period These are NOT kids that were already at risk – see state map Use of products 1-2 days per month can cause nicotine withdrawal 1/3 who have used e cigs have tried marijuana in them including 20% of middle schoolers Dual use - no net benefit of using – blood levels of toxins are equal to just smokers Only using just e-cig has benefit for adults – and this is NOT happening. 40% of e-cig youth users have never used a cigarette.
- #21 No matter what you call it, it’s an e-cigarette. E-cigarettes are known by many different names. You’ve probably heard them called “e-cigs” or “vapes” or just “JUUL.” E-cigarettes are devices that heat a liquid into an aerosol that the user inhales. E-cigarettes come in lots of different shapes. Some e-cigarettes look like regular tobacco products, such as cigarettes. The open system: The “APV” (advanced personal vaporizer) or “mod” (modification): These e-cigs have a rechargeable battery and refillable cartomizers($$ But in recent years, we’ve seen e-cigarettes that look like other things, including USB flash drives, pens, and other everyday items. JUUL is one of the most common e-cigarettes shaped like a USB flash drive. The closed pod system: Contain a rechargeable battery, pods are disposable. But regardless of what you call it, these are all e-cigarettes and none of them are safe for young people to use.
- #23 Most e-cigarettes consist of four different components, including: a cartridge or reservoir or pod, which holds a liquid solution (e-liquid or e-juice) containing varying amounts of nicotine, flavorings, and other chemicals a heating element (atomizer) a power source (usually a battery) a mouthpiece that the person uses to inhale In many e-cigarettes, puffing activates the battery-powered heating device, which vaporizes the liquid in the cartridge. The person then inhales the resulting aerosol or vapor (called vaping).
- #24 • Open systems require the user to add the e-juice, which can be a substance other than nicotine. • Closed systems (those that use pre-filled pods) can also be altered to vape substances other than nicotine
- #26 Teacher Talking Points: For so many years consumers were told that the clouds made by e-cigarettes/vape pens was ”just water vapor” Do you think that is true? (click)
- #27 Teacher Talking Points: At least 60 chemical compounds have been found in e-liquids, and more are present in the aerosol produced by e-cigarettes. Researchers have identified several substances which are either harmful or potentially harmful to e-cigarette users, including delivery solvents and propylene glycol, which can cause dry mouth and upper respiratory infections (Truth, 2019) E-cigarette flavors — even those approved for ingestion — have not been studied for toxicity if inhaled over long periods of time. Many e-cigarette flavorings contain chemicals that are known to be respiratory irritants, and research has found that some flavors are potentially more toxic than others. For example, researchers found that exposure to increased cinnamon flavoring caused significant cell death, compared with other flavors. Additionally, mixing multiple flavors can be more toxic to cells than exposure to just one flavor at a time. The repercussions of long-term exposure to the chemicals found in e-liquids and produced by e-cigarettes are not yet known, since products have not been on the market long enough to conclusively study their effects. (click) Here is a list of chemicals, which of these do you think are found in the e-cigarette/vape pen aerosol? Teacher Talking Points: (click) All of these chemicals have been found in in the e-cigarette/vape pen Aerosol (click) The ones in yellow are known to be harmful And while we did not know this at first, Many of these are the same chemicals found in traditional cigarettes Simply put, E Cigs produce a vapor/aerosol that often contain propylene glycol, glycerin, flavorings, and nicotine and many other harmful chemicals and toxins, some known to cause cancer Nicotine itself is a highly addictive compound And while not all contain nicotine, all have many of these chemicals and toxins .
- #28 The Gut can handle more than the lungs so GRAS flavors are approved for ingestion, not inhalation Generally recognized as safe (GRAS) is a United States Food and Drug Administration (FDA) designation that a chemical or substance added to food is considered safe by experts, and so is exempted from the usual Federal Food, Drug, and Cosmetic Act (FFDCA) food additive tolerance requirements.
- #29 Pair and Share: 60 seconds or less explain to the other person what has allowed this epidemic to emerge?
- #30 II. The Problem Are E-cigs safe? Do they really help adults quit? Why are youth using and Why is nicotine addiction a special problem for youth? What do we know about who is using? Where do they get the products?
- #31 We often want to be data driven but that sometimes lands us in a reactionary spot as public health people MMWR – American Cancer Society E cigs are addicting to young adults. 7 in 10 have used it at least once 50% of 18-24 current e-cigarette use flavors are a driver – 91% of those that use, use flavors packaged like an i-phone Butler County As I was getting the vaping data for you this popped up in my inbox so I thought I'd share it with you in case you did not already have it. In 2017-2018 Note I would have included 30-day use but it wasn't separated out by type of tobacco product only annual use was. 16.6 of youth surveyed reported using electronic vapor products in the past year 37% of 7th graders perceive e-vapes as very harmful while 35% of 12th graders perceive e-vape use to have just some harm. 40% of 12th graders felt that e-vape products were very easy to get Of youth surveyed e-vapes were used in cars or at parties and use most on the weekends There is very little gender discrepancy in e-vape use FAIRFIELD – down 3% from 13.7% to 10.8% - new data due in February 45% believe it is harmful
- #32 e-cig use among adults is decreasing – CDC also acknowledges their usefulness in cessation 2/3 adult use is juul Research so far suggests that vaping is less harmful than combustible cigarettes when people who regularly smoke switch to them as a complete replacement. But e-cigarettes can still damage a person's health. Vaping can lead to nicotine addiction and increased risk for addiction to other drugs. Vaping also exposes the lungs to a variety of chemicals, including those added to e-liquids, and other chemicals produced during the heating/vaporizing process. More research is needed to determine if vaping nicotine can be as effective as smoking cessation aids already approved by the FDA. NIH Review of the literature 2018: RESULTS: Search revealed a total of 40 articles out of which 29 were included in the review. ECIGs achieved modest cessation rates with benefits of behavioral and sensory gratification. On the contrary, in many studies where ECIGs were introduced as an intervention, participants continued to use them to maintain their habit instead of quitting. A total of 22 toxic substances apart from nicotine were reported in liquid of ECIG cartridges and its emissions. Many compounds had lower concentrations in ECIG compared to tobacco smoke. Some people believe e-cigarettes may help lower nicotine cravings in those who are trying to quit smoking. However, e-cigarettes are not an FDA-approved quit aid, and there is no conclusive scientific evidence on the effectiveness of vaping for long-term smoking cessation. It should be noted that there are seven FDA-approved quit aids that are proven safe and can be effective when used as directed. Vaping nicotine has not been thoroughly evaluated in scientific studies. For now, not enough data exists on the safety of e-cigarettes, how the health effects compare to traditional cigarettes, and if they are helpful for people trying to quit smoking.(NIDA)
- #33 According to the 2018 National Youth Tobacco Survey (NYTS), 14.8% of middle and high school e-cigarette users under 18 report obtaining e-cigarettes from a vape shop in the past month and 8.4% from a gas station or convenience store.3 Another national study, the 2017 Youth Risk Behavior Surveillance (YRBS) survey of high school students in grades 9-12, found that 13.6% of current e-cigarette users aged < 18 years had directly purchased their cigarettes from a store (convenience, supermarket, gas station, and vape shops), with over 22.9% of all 12th grade smokers aged <18 years making such direct purchases. JAMA Pediatrics found that I California, e-cigarette sales to minors violations are significantly higher in tobacco and vape shops than in any other type of retailer with 44.7% selling to underage decoys.
- #35 4000 poison control calls per year mostly among kids under 5 from ingesting nicotine. One baby death and one suicide from injection
- #38 Overall, ESDs are a new source of Volatile Organic Compounds (VOCs) and ultrafine/fine particles in the indoor environment, thus resulting in “passive vaping.”32 The World Health Organization (WHO) recommends that ESDs not be used indoors, especially in smokefree environments, in order to minimize the risk to bystanders of breathing in the aerosol emitted by the devices and to avoid undermining the enforcement of smokefree laws.33 The National Institute for Occupational Safety and Health (NIOSH) recommends that employers “establish and maintain smoke-free workplaces that protect those in workplaces from involuntary, secondhand exposures to tobacco smoke and airborne emissions from e-cigarettes and other electronic nicotine delivery systems.”34 The American Industrial Hygiene Association (AIHA) also recommends that ESDs be included in smokefree laws: “Because e-cigarettes are a potential source of pollutants (such as airborne nicotine, flavorings, and thermal degradation products), their use in the indoor environment should be restricted, consistent with current smoking bans, until and unless research documents that they will not significantly increase the risk of adverse health effects to room occupants.”35 The American Public Health Association adopted a resolution, “Supporting Regulation of Electronic Cigarettes,” that outlines seven action steps including, “States and municipalities [should] enact and enforce laws…prohibiting the use of e-cigarettes in all enclosed areas of public access and places of employment. These standards should be incorporated into existing clean indoor air laws.”36 The American Association for Cancer Research and the American Society of Clinical Oncology supports prohibiting the use of ESDs in smokefree spaces until the safety of second- and thirdhand aerosol exposure is established.37 ESD aerosol is a new source of pollution and toxins being emitted into the environment. We do not know the long-term health effects of ESD use and although the industry marketing of the product implies that these products are harmless, the aerosol that ESD emit is not purely water vapor.
- #40 E-cigarette, or vaping, product use associated lung injury (EVALI), (aka. Vape Lung) Symptoms The latest morbidity and mortality data from CDC What we know, what we don’t know
- #41 16% of patients were under 18 years old; 38% of patients were 18 to 24 years old; 24% of patients were 25 to 34 years old; and 23% of patients were 35 years or older 1,782 hospitalized patients had complete information* on substances used in e-cigarette, or vaping, products in the 3 months prior to symptom onset, of whom (as of December 3, 2019): 80% reported using THC-containing products; 35% reported exclusive use of THC-containing products. 54% reported using nicotine-containing products; 13% reported exclusive use of nicotine-containing products. 12% reported using cannabidiol (CBD)-containing products; 1% reported exclusive use of cannabidiol (CBD)-containing products. 40% reported both THC- and nicotine-containing product use. 5% reported no THC-, nicotine-, or CBD-containing product use. Among hospitalized EVALI patients who reported using THC-containing e-cigarette, or vaping product brands: The most commonly reported product brand included Dank vapes (56%), followed by TKO (15%), Smart Cart (13%), and Rove (12%). However, regional difference in THC-containing product use were noted.
- #42 The persistent decline in number of cases reported each week since mid-September, coupled with the declining percentage of recent cases reported weekly, suggest that the outbreak may have peaked around September 15. However, states continue to report new cases, including deaths, to CDC on a weekly basis.
- #45 Reflect, Pair and Share: Write down 1 thing that surprised you, alarmed you, or hit you hard? Turn and share it with your neighbor
- #46 The Solutions Universal Prevention Education Policy Change Community Education Parent Education – essential messages for parents Youth-Led Prevention Selective Prevention Education/Cessation vs. Suspension Parent and Youth education Indicated Prevention and Cessation Cessation for Adults Cessation for Youth What do we know about e-cig cessation for youth? Tools
- #47 Research shows that making obtaining tobacco products as inconvenient, difficult and expensive as possible for kids reduces both the number of kids who try or regularly use tobacco products.12 To the extent that these measures directly affect youth who buy their own e-cigarettes or be sources for other youth, then they could also reduce the supply to other kids For each of these policies, it is important to have strict enforcement to ensure high retailer compliance, including penalties on the tobacco retailer.
- #49 Be sure your school has a 100% Tobacco-Free Policy THAT includes e-cigarette use • Develop and implement strong enforcement policies that include ALTERNATIVE TO SUSPENSION • Develop educational opportunities for students & staff to learn about the dangers of use of e-cigarettes • Provide help to quit for those who need it
- #51 Informational video available on you tube or catchmybreath.org
- #53 Science is not there to show that traditional meds work for e-cig cessation. There are docs that are writing scripts though. Quit lines are expanding but right now the behavioral counseling seems to be where its at. Welbutrin did NOT help kids quit