1. An Emerging Public Health Threat
E-cigarettes
An Emerging Public Health Threat
Thank you and welcome to this presentation on E-cigarettes.
At some point you’ve probably seen someone smoking an ENDS device. ENDS stands for Electronic Nicotine Delivery System.
Chances are your kids have seen them too.
While promoted to help people quit smoking, e-cigarettes are now being marketed to children with different flavors and used in ways that are appealing to them.
We hope this presentation gives you information to talk with you child about e-cigarettes and the danger they pose.

2. Electronic Nicotine Delivery Systems
-Battery Powered
-Rechargeable
-Disposable
-200 to 1,800 puffs
-Flavored Cartridges
E-Cigs
-Larger Devices
-Higher powered batteries
-E-liquids, dabs used
Vaporizers
Dry vaporizers
That actually heat product
Heat-No Burn
Electronic cigarettes, or e-cigarettes, include e-pens, e-pipes, e-hookah, and e-cigars are known collectively as END. According to the FDA, e-cigarettes are devices that allow users to inhale an aerosol (vapor) containing nicotine or other substances.
Unlike traditional cigarettes, e-cigarettes are generally battery-operated and use a heating element to heat e-liquid from a refillable cartridge, releasing a chemical-filled aerosol.

3. Juul – The iPhone of e-cigs
This is one of the more popular e-cigarettes called Juul. They are dubbed the iphone of e-cigarettes because of their sleek packaging and resemblance to iphone packaging.

4. You can see that this e-cigarette looks similar to a flash drive.

5. These are the cartridges used in the Juul
These are the cartridges used in the Juul. The pods, as they are called, come in different flavors from fruit medley to brulee to cool mint. These are flavors that are clearly appealing to kids and provide that false sense of safety that it must not be that bad since it tastes like fruit or cool mint.

6. So, just how many youth are using e-cigarettes?
This is a national study that shows the number of kids using e-cigs compared to regular cigarettes is more than double for 8th graders, double for 10th graders and higher for 12th grade.
Look who’s using more. It’s boys at double the rate.

7. What’s in E-cigarettes
E liquid – Nicotine
Nicotine is addictive
Varying levels
Some that claim to be “nicotine free” contain nicotine
The main component of e-cigarettes is the e-liquid or e-juice contained in cartridges. To create an e-liquid, nicotine is extracted from tobacco and mixed with a base and may also include flavorings, colorings and other chemicals.
Nicotine is an addictive substance, and almost all e-cigarettes contain nicotine. Even products that claim not to have any nicotine in them may still contain nicotine.
A recent study found that the amount of nicotine in e-liquid refills is often substantially different from the amount listed on the package.
This matters because the more nicotine used, the greater the potential for addiction.
Nicotine also has a negative impact on adolescent brain development
Nicotine use during adolescence and young adulthood has been associated with lasting cognitive and behavioral impairments, including effects on working memory and attention.

8. E-cigarettes National Usage
8th Grade
10th Grade
12th Grade
1 in 16
1 in 6
1 in 5
The percentage of students who reported vaping nicotine in the past 30 days nearly doubled.
1.3M additional adolescent nicotine vapers in 2018.
So, how bad is the problem?
Increases in youth vaping across the country saw the largest year to year increase in substance use ever recorded in U.S. history.
The percentage of 12th grade students who reported vaping nicotine in the past 30 days nearly doubled, rising from 11% to 21% meaning 1 out of 5 12th graders nationally use e-cigarettes.
For students in grades 9 through 12 the increases in nicotine vaping translate into at least 1.3 million additional nicotine vapers in 2018 as compared to 2017.
Source: University of Michigan institute for social research

9. E-cigarettes Arizona Usage
8th Grade
10th Grade
12th Grade
1 in 7
1 in 5
1 in 4
Arizona 8th grade vape usage doubles the national average.
In Arizona the problem is even worse than the national picture with 1 out of 7 8th graders, 1 out of 5 10th graders and 1 out of 4 12th graders using e-cigarettes.
The bottom line is that we have a serious problem in our state.
The percentage of 12th grade students who reported vaping in the past 30 days has, risen from 17.6% to 26.1%.
The percentage of 10th grade students who reported vaping in the past 30 days has, risen from 13.6% to 21.3%.
The percentage of 8th grade students who reported vaping in the past 30 days has, risen from 9.7% to 13.5%
Source: Arizona Youth Survey 2018

10. E-cigarettes Coconino County Usage
8th Grade
10th Grade
12th Grade
1 in 6
1 in 4
Nearly Half 44%
While e-cigarette use has remained steady in 8th grade, it has gone up among 10th and 12th graders.
In Coconino County,
The number of 8th graders using e-cigarettes has remained steady, but that number is still higher than the statewide average.
In addition, the number of 10th and 12th graders has also gone up. 44% or almost half of the 12th graders report regularly using e-cigarettes and 10th and 12th grade use is above the state average which is cause for serious concern.
Notes and percentages:
The percentage of 12th grade students who reported vaping in the past 30 days has, risen from 35.6% to 44.2%.
The percentage of 10th grade students who reported vaping in the past 30 days has, risen from 16.7% to 23.3%.
The percentage of 8th grade students who reported vaping in the past 30 days has, risen from 16.7% to 16.3%
Source: Arizona Youth Survey 2018

11. Here’s what’s concerning also
Here’s what’s concerning also. Youth are much more likely to start smoking regular cigarettes within 6 months of using e-cigarettes. Nearly 1 out of 3 e-cigarette users will begin to start smoking regular cigarettes within six months versus and child that’s never used an e-cig.

12. *What’s in E-cigarettes
We don’t know everything in them
Cancer causing chemicals
-Heavy metals like nickel, tin and lead
Ultrafine particles
Also, e-cigarette use exposes the lungs to a variety of chemicals, including those added to e-liquids, and other chemicals produced during the heating/vaporizing process.
A study of some e-cigarette products found the vapor contains known carcinogens and toxic chemicals, as well as potentially toxic metal nanoparticles from the device itself.

13. In addition to the unknown health effects, early evidence suggests that e-cigarette use may serve as an introductory product for preteens and teens who then go on to use other tobacco products, including cigarettes, which are known to cause disease and premature death. A study showed that students who had used e-cigarettes by the time they started 9th grade were more likely than others to start smoking cigarettes and other smokable tobacco products within the next year.
Also, take a look at what kids say is in their e-cig.
Most of them think it’s just flavoring. But the question is, what’s in the flavoring and what is the flavoring?

14. E-cig liquids - Irreversible lung damage – Popcorn Lung
“This vape is so authentic to your favorite soda pop that you'll think you're sipping it from a straw rather than your electronic cigarette.”
E-cig liquids - Irreversible lung damage – Popcorn Lung
Most vaping-product companies want people to link their flavors closely to popular, brand-named food and flavors, including soft drinks. One vape-products website promises that: "This vape is so authentic to your favorite soda pop that you'll think you're sipping it from a straw rather than your electronic cigarette,”
Flavors in e-cigarettes are also a cause for concern. Not only are flavors used to target kids, but they may be harmful on their own. E-cigarette and flavor manufacturers and marketers may suggest that the flavor ingredients used in e-cigarettes are safe because the flavorings are approved for use in food, but such statements are false and misleading. The reality is that the safety status only applies to food, meaning it's safe to eat, and does not apply to inhaling through e-cigarettes.
Sources:
Diacetyl, (Day-as-Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.
Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.
-tyl) a buttery flavored chemical often added to food products such as popcorn, caramel, and dairy products, has also been found in some e-cigarettes with flavors. Diacetyl can cause a serious and irreversible lung disease commonly known as "popcorn lung."
Stanford Research into the Impact of Tobacco Advertising.

15. The other thing to point out here is that e-cigarettes are also being used to get high. About 6% of kids say they have THC or marijuana in their e-cigs.

16. Warning – Which is Which?
Can you tell which one is marijuana and which one is an c-cig cartridge?
(One on left is THC – marijuana)
The marijuana cartridges are called THC concentrates. They are extremely potent and can range from 40 to 90 percent pure THC.

17. So why is the popularity rising with e-cigarettes and vaping?
Taking a look at what our kids are exposed to.
The 2009 Family Smoking Prevention and Tobacco Control Act prohibits cigarette advertising, but e-cigarette advertising is allowed and our middle school and high school students are seeing it and seeing it a lot with 7 out of 10 of our kids exposed to e-cigarette advertising from the internet to TV to newspaper and magazines.
Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.

18. These are the ads they see.
Free starter kits
Freedom to have a cigarette without the guilt
Rise from the Ashes
All of these are appealing to youth and suggest the devices are safe to use.

19. E-Cig concerns - Poisoning and Burns
Large doses of Nicotine can Cause Poisoning
“It was like a bomb went off.”
Not only is addiction and the flavorings a concern but so is the chance for nicotine poisoning and burns.
Large doses of nicotine have a potential for poisoning, with symptoms beginning with nausea and vomiting in cases of acute toxicity and progressing to seizures and respiratory depression in cases of severe nicotine poisoning. This is particularly true in children as calls to poison control centers have increased nationwide. Tragically, one child died from acute e-cigarette poisoning in 2014, attributed to the ingestion of liquid nicotine from an e-cigarette
If you have internet connection this is a great story.
This girl on is a Valley 17-year-old who was severely burned by an e-cigarette.
"It was like bomb going off," she said.
She was getting ready to use her E-Cigarette when it suddenly exploded. Catching her clothes on fire and leaving her with burns to her chest, arms, side, and hands.
She had to undergo surgery at the burn unit.

20. E-cigarette Bottom line
E-cigarettes are tobacco products
They contain nicotine which is addictive
New rules require a person to be 18 before purchasing
We don’t know what type of health risks are associated with emissions
Talk with your child abut not smoking e-cigarettes the same way you talk with them about not smoking regular cigarettes.
The Bottom line is that E-cigarettes are tobacco products that contain the addictive chemical nicotine. The use of any tobacco product – including e-cigarettes – is unsafe for young people.
It is illegal for anyone under 18 to smoke an e-cigarette
There are no long term studies on the safety of these products on the lungs and body.
We don’t know what type of health risks are associated with second hand emissions
Talk with your child abut not smoking e-cigarettes the same way you talk with them about not smoking regular cigarettes. They carry the same health risks.

21. Thank you