Teen Vaping: A new generation of nicotine consumers Dr Meena Dawar Medical Health Officer 4 June 2019

1. Electronic cigarettes: nicotine and non-nicotine delivery systems

2. Flavours & Aerosol Attractive to youth Harm? taste good enticing names decrease perception of harm mask the bitterness of nicotine Likely less harmful than tobacco for tobacco users. Completely safe? No. Nicotine Chemicals of concern Pod = test tube Physiological markers of concern Long term disease outcomes unclear Apple fritter, Blue Raz, Pineapple, Strawberry Lemonade, Pink lemonade, orange mango, frosted glass Association Between Electronic Cigarette Use and Myocardial Infarction Alzahrani, Talal et al. American Journal of Preventative Medicine Vol 55 Oct 2018

Nicotine in e-juice (legal since 2018) Harmful to a developing brain memory and concentration alter teen brain development reduce impulse control cognitive and behavioural problems Highly addictive: “Vaping may predispose youth to nicotine addiction and possibly other drugs” Poisonous, particularly to young children Juul: efficient nicotine delivery, ‘smoother’ hit to throat, 1 pod=1 pack cig, less vapor. cause nicotine addiction among users who would not have started using nicotine otherwise (e.g. smoking) Children and youth are especially susceptible to the harmful effects of nicotine, including addiction. They may become dependent on nicotine with lower levels of exposure than adults.Footnote2 Health Canada: https://www.canada.ca/en/health-canada/services/smoking-tobacco/vaping/risks.html#a1

3. Reversing progress in tobacco control Tobacco company ENDS product(s) Altria: Philip Morris MarkTen, Green Smoke, IQOS Mesh, Juul British American Tobacco (Reynolds American) Vype iSwitch, Vuse, Ten Motives, Chic Imperial Tobacco Myblu, Nixx Reynolds (Lorillard) Blu, SkyCig Now, over 95 percent of the market for e-cigarettes is dominated by five companies: MarkTen, XL, Logic. Vuse, Blu and JUUL. Vuse is owned by R.J. Reynolds Vapor Company, a subsidiary of Reynolds American Inc, which was acquired by British American Tobacco in 2017. Electronic Cigarettes | OpenSecrets https://www.opensecrets.org/news/issues/e-cigarettes/ 19/09/2019

Aggressive marketing, renormalization of smoke Claims: Safer than cigarettes (“clean”) Quitting aid Freedom to use wherever you want Cheaper than smoking Better for others - no odour, no risk from second hand vapour

Transition from vaping to tobacco? Longitudinal studies from US, Canada, Taiwan show that youth who vape are at greater risk of initiating tobacco use. Hammond D, CMAJ 2017 Oct 30; 189:E1328-36. doi. 1503/cmaj.161002 Aleyan, BMJ Open 2018;8:e021080. doi:10.1136/bmjopen-2017-021080; BMJ Open 2018;8:e021080corr1. doi:10.1136/bmjopen-2017-021080corr1 Berry KM, Fetterman JL, Benjamin EJ, et al. Association of Electronic Cigarette Use With Subsequent Initiation of Tobacco Cigarettes in US Youths. JAMA Netw Open. 2019;2(2):e187794. doi:10.1001/jamanetworkopen.2018.7794

4. Vaping by youth is on the increase Overall across Canada, 22% increase in ever use, 67% increase in past 30 day use. Youth: grades 7-9, 30 day use: 5.4 (16-17)up from 3.9 in 14-15. 67% increase Canadian Student Tobacco, Alcohol and Drugs Survey, analysis July 2018, Grades 10-12 https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-survey/2016-2017-supplementary-tables.html **McCreary Adolescent Student Health Survey Students grade 7-12 https://www.mcs.bc.ca/pdf/balance_and_connection.pdf

5. Conclusion Use of nicotine and non-nicotine containing e-cigarettes by youth is a concern.

Tips for Parents & Educators Get the facts, know the risks. Start the conversation. Be patient, ready to listen and supportive Keep the conversation going. Set a positive example.

Public health response Inform youth, teachers, and parents about risks. Presentations to youth, parents, teachers (nearly 100 since 01/19) Materials are being developed in partnership with BC Lung Training of VCH staff Regulations now in place to prohibit sales to minors. Use in public spaces has to be consistent with smoking bylaws. Attention needs to be devoted to restricting product promotion, preventing sales to minors. Advocacy continues to make vaping less appealing by restricting flavours, limit access to adult only shops. Federal govt has restrictions on brand sponsorship, advertisements, display within retail shops. Ont allows in-store promotion.

Resources Thank you.