1

ADDICTING AMERICA’S

YOUTH TO NICOTINE

Vaping:

A Public Health Crisis

AMERICAN HEART ASSOCIATION

8/19/2019

2

WHAT ARE THEY

• E-cigarettes vaporize a nicotine solution when the user inhales, which gives a feeling similar to smoking.

• Basic models consist of a battery which powers the unit, an atomizer that vaporizes the nicotine, and a cartridge which houses the nicotine liquid (called e-liquid)

3

ELECTRONIC NICOTINE DELIVERY DEVICE EVOLUTION“Vaping” involves a diverse array of products that typically include a cartridge or tank, a heating element, and a battery.

First

Generation

Second

Generation

Third

Generation

“Cigalike” “Box Mods” “Vape Pen” “Vape Pod”

4

WHAT IS JUUL? • Sold in the U.S. since 2015. JUUL is the

most popular e-cigarette on the market,

accounting for nearly 1 of every 3 e-

cigarettes sold.

• Slim USB flash drive design, vibrant

colors, and palatable flavors.

• Low vaping “cloud” allows for discreet

use.

• JUUL nicotine refills (“pods”) contain as

much nicotine as a pack of 20 regular

cigarettes.

• Nicotine salts in JUUL pods increase the

rate of nicotine delivery and decrease

harsh sensations in the mouth/throat.

• Inspired by JUUL’s success, other

manufacturers have developed USB-

shaped devices containing e-liquids in

pods.

4

5

E JUICE AND NICOTINE

• Nicotine cartridges house the e-liquid or e-juice and can either be disposable or reusable.

• The liquid is generally made up of four chemicals: nicotine, propylene glycol, vegetable glycerin, and flavoring---LOTS of different flavorings! E-juice refill bottles can be dangerous since some have been measured to contain up to a gram of nicotine—almost 17 times the fatal dose for an adult

• Nicotine = addictive chemical in cigarettes.

• Found in most e-cigarettes (even some of those labeled as “Zeronicotine” contained nicotine----which can make them very addictive.

• Nicotine = a relaxant and a stimulant and is responsible for the “buzz” that you get from smoking.

• Higher doses = makes you sick or can even be deadly.

6

HEALTH EFFECTS NICOTINE

• Rapid release of adrenaline

o rapid heartbeat

o increased blood pressure

o rapid, shallow breathing

• A vasoconstrictor - raises blood pressure and cholesterol

o increasing the likelihood of a heart attack or stroke

• Raises blood sugar levels

o increased risk of complications from diabetes, such as eye and kidney disease

o Nicotine itself promotes blood vessel damage ,cellular damage in, promoting plaque formation and promotes inflammation in the body.

• ADDICTION!

• Nicotine: Is and addictive stimulant.

• Meets the criteria of a highly addictive drug. It induces euphoria, serves as a reinforce of its use, and leads to withdrawal symptoms when it is absent.

• Nicotine is also used as an organic pesticide because of its toxic effects (So toxic, in fact, that beginning in 2014 its use as a pesticide was banned)

• The lethal dose of nicotine is about 30-60mg for adults or 10mg for kids.

• One regular cigarette contains 10 to 15 mg of Nicotine.

• A milliliter of e-liquid may contain anywhere from a trace amount of nicotine to 72 mg.

7

NICOTINE CONTINUED

• Nicotine causes apoptosis, which is one of the methods by which the body destroys unwanted cells

• Since apoptosis helps to remove mutated or damaged cells• that may eventually become cancerous, the inhibitory actions of nicotine

may create a more favorable environment for cancer to develop.

• Women who use nicotine gum and patches during early stages of pregnancy can face an increased risk of having babies with birth defects.

• Tobacco workers are suffering from nicotine overdose as a result of handling raw tobacco leaves on a daily basis. ( This condition is called Green Tobacco Sickness.)

8

JUST VAPOR? JUST WATER? SAFETY CONERNS

• E-cig ads say “pure nicotine” and the cloud you see is just “harmless water vapor”.

• The vapor is NOT the same as the cloud that you can see when you breathe on a cold night. Even though normal cigarettes have a lot more bad chemicals than e-cigarettes, the vapor is not “just water”.

• The cloud you see is a mix of whatever chemicals are in the e-juice.

So -- important to make sure that e-liquid and e-cigarettes are made clean.

9

HOOKING THE NEXT GENERATIONMARKETING TO KIDS

How true!

11

Cigarette smoking prevalence reached historic lows among teens in 2018 in 8th, 10th, and 12th grades. The

combined prevalence decreased to 4.6% in 2018, compared to 28.3% in 1997. (Monitoring the Future)

Source: Truth Initiative. Monitoring the Future Survey, 1997-2018 – Youth

Source: National Health Interview Survey, 1997-2018 – Young Adults

12

FLAVORS TARGET KIDS

13

Chart Of Ingredients that is not on the label for EJUICE

• Blue-

what the

bottle

indicated

• Red –

what the

bottle

actually

had.

15

SOCIAL MEDIA INFLUENCEJUUL-related tweets on Twitter, 2015-2017

Huang, J., Duan, Z., Kwok, J., Binns, S., Vera, L.E. Kim, Y., Szczypka, G., & Emery, S.L. (2018). Vaping versus JUULing: how the extraordinary growth and

marketing of JUUL transformed the US retail e-cigarette market. Tobacco Control, 054382.

20,000

40,000

60,000

80,000

100,00

0

120,00

0

140,00

0

160,00

0

YOUTH PAST 30-DAY VAPING BY GRADE AND YEAR

Source: Truth Initiative. Monitoring the Future survey, 2018

JUUL

16

17

RECENT SURVEILLANCE ON YOUTH USE AND INITIATION

• E-cigarettes are now the most used tobacco

product by youth and adolescents.

• Not only are kids using e-cigarettes, but they

are using them more frequently.

• During 2017–2018 alone, e-cigarette use rose

by 78% in high school students and 48% in

middle school students. This is the largest

one-year increase seen for any substance in

the history of the survey.

18

Direct use

• Exposure to toxicants and nicotine in e-cigarette

aerosol is significantly lower for e-cigarettes

than the smoke from combustible tobacco.

• Common adverse events after e-cigarette use

are: mouth and throat irritation, nausea,

headache and dry cough. Popcorn lung,

• Long Term: respiratory damage. and could be

death.

Azzopardi, D., Patel, K., Jaunky, T., Santopietro, S., Camacho, O. M., McAughey, J., & Gaça, M. (2016).

Electronic cigarette aerosol induces significantly less cytotoxicity than tobacco smoke. Toxicology Mechanisms

and Methods, 26(6), 477–491. http://doi.org/10.1080/15376516.2016.1217112

Under vaporizing (vaping) temperatures, both

propylene glycol and glycerol decompose to

formaldehyde and/or acetaldehyde. These

compounds, found in e-cigarette vapor, are considered carcinogens.

E-CIGARETTE HEALTH EFFECTS

19

Popcorn Lung

According to the American Lung Association, using electronic cigarettes or vaping, particularly the flavored varieties, can cause popcorn lung.

"Popcorn lung" is the nickname for bronchiolitis obliterans. That's a condition that damages your lungs' smallest airways and makes you cough and feel short of breath. It's sometimes caused by breathing in a chemical used to flavor microwave popcorn or vaping.

20

Treatment Popcorn Lung

The lung tissue scarring

caused by popcorn lung is

irreversible

No cure for the condition

once it has developed and

begun constricting the

airways.

Popcorn lung is also a

leading cause of death

associated with heart-lung

and lung transplants.

Treatment options for

popcorn lung can

include:

1. Macrolide antibiotics for

the treatment of bacterial

respiratory infections may

work in some individuals

2. Steroids, specifically

corticosteroids to lessen

inflammation

3. Immunosuppressive drugs

that reduce the activity of

the immune system and

limit inflammation

supplemental oxygen

4. A medication called

Singulair (montelukast),

which blocks specific

immune cells that produce

inflammation

5. L lung transplant for very

severe cases

21

CHEMICALS E-LIQUID FOUND IN PRODUCTS

Liquids and exhaled aerosol contain measurable amounts of:

• Nicotine ( addictive)

• Propylene Glycol- Found in deodorant, Soap products,

Toothpaste and House paint

• Glycerin- Aerosol disinfectant, Weed Control, Acne medication

and Soap

• Formaldehyde- Carcinogen- (causes cancer) Cosmetics, Glue,

Rup/Upholstery cleaner and Body wash

• Acetaldehyde (carcinogen

• Acrolein (damages lungs, heart disease)

• Heavy metals (various heavy metals can damage blood vessels;

cause inflammation; and affect the central nervous system

22Source: https://www.eurekalert.org/pub_releases/2019-01/aha-elt012519.php

Emerging research funded by the

American Heart Association.

AHA has the largest study to date

regarding e-cigarette use and stroke,

researchers found that compared to non-

users, e-cigarette users had:

• 71% higher risk of stroke;

• 59% higher risk of heart attack or

angina; and

• 40% higher risk of coronary heart

disease.

Some patients may be using e-cigs

because they believe them to be safer.

E-CIGARETTE HEALTH EFFECTS

“Juul deployed a

sophisticated program to

enter schools and convey

its messaging directly to

teenage children, recruited

thousands of online

influencers to market its

vaping devices...”

New York Times

House Oversight Hearing

Matt Myers, President of the

Campaign for Tobacco-Free

Kids, told Forbes:

“Big Tobacco believes

they can buy protection if

they spend enough

money.”

State and federal health

officials are investigating

almost 100 cases of mysterious

lung illnesses linked to vaping

and e-cigarette use in 14

states, many of them involving

teens and young adults. A

large number of those stricken

ill have been hospitalized, with

some in intensive care and

on ventilators.

24

News Articles On Vaping

18 year old Nelson started getting sick. She started vomiting and having chest pain. On July 27th, she was experiencing severe back and kidney pain, and a high fever. She was admitted to hospital in Payson. Nelson temperature was so high, she said, “my brain just totally shut off”. She thought she was in Payson Hospital 1 day but it was actually 3 days.” Tests after test the doctors determined that Nelson had acute eosinophilic pneumonia, a rare lung illness. Nelson said, “I had fat particles growing inside my lungs that were related to the glycerin in vape juice,” she said. My Lungs were full of fluid and they said that my chest x-rays were some of the worst that they’d ever seen.” The doctors told Nelson that it “was definitely from vaping.”The Centers for Disease Control said that they are investigating nearly 200 reported cases of breathing problems which includes 1 death in Illinois from vaping. https://people.com

25

News Article Vaping

Kevin Boclair is son of Deborah Boclair. Her son ended up in the hospital and on life support. He experienced a coughing spell triggered by asthma caused the formation of tiny holes in his lungs. His condition grew more dire about 10 days ago, and he was transferred to the hospital of the university of Pennsylvania, where is on onheart and lung bypass machine. “The doctors are saying the chemicals in the vape actually changes the tissue of the lungs and it gets damaged. That damaged part actually scars up, and that never gets better,: Deborah Boclair said. www.kjct8.com

26

News Article- Bans Smoking Car

New Illinois law bans smoking in a vehicle with anyone under the age of 18. If caught you will receive a 100 dollar fine, the 2nd infraction is 250 dollar fine. They are worried about 2nd hand and 3rd hand smoke and effects on they youth lungs and possible cancer diagnosis in their future.

27

QUESTIONS• Why may the presence of tobacco-specific nitrosamines in cigarette smoke be

considered toxic?• Tobacco-specific nitrosamines in cigarette smoke are considered toxic because

they may cause DNA mutations• What is the importance of the structural similarity between nicotine and

acetylcholine?• The importance of the structural similarity between nicotine and acetylcholine is

that nicotine can bind to acetylcholine receptors in the brain.• Over time, why do smokers want to smoke more cigarettes?• Over time, smokers want to smoke more cigarettes because nicotine inactivates

the acetylcholine receptors causing a slower response, resulting in less perceived effect of the nicotine and the desire for increasing amounts of nicotine.

• What does research on mice tell us about the effects of nicotine exposure on the prefrontal cortex?

• Research on mice tells us that nicotine alters connections that develop between neurons in the prefrontal cortex, causing changes in the neural connections that are responsible for learning and impulse control.

• What is the concern about student use of e-cigarettes before the ninth grade?• The concern about student use of e-cigarettes before the ninth grade comes

from a National Institutes of Health funded study that found that these students were significantly more likely to smoke regular cigarettes within the next year than non-e-cigarette users.

28

QUESTIONS:• “I think that I’ll try vaping because I don’t want to become addicted to smoking regular

cigarettes.” Studies have found as many as one-third of young e-cigarette users have never tried conventional cigarettes. However, there is evidence that vaping may lead non-smokers to nicotine addiction and they will turn to cigarette smoking as the body craves additional nicotine.

• “I’ve heard that e-cigarettes are much better because the liquid in e-cigarettes is vaporized, so there won’t be any dangerous second hand smoke.” Since there are many different flavored e-cigarettes, the formula of the liquids varies as does the contents of the vapor. E-liquid contains nicotine and the vapor produces second-hand smoke containing carcinogens such as formaldehyde.

• “I like the idea of trying e-cigarettes because there are so many flavors and I understand that many do not contain much nicotine.” Although the levels of nicotine vary in different e-cigarettes, they all contain some nicotine. Thus, people can become addicted and simply need to vape more of those containing a lower concentration of nicotine.

• “Friends tell me that vaping e-cigarettes is a safe alternative to smoking regular cigarettes because there isn’t any smoke to inhale.” When you are vaping, you are still inhaling nicotine vapor and carcinogenic substances into your lungs.

• “Since e-liquid contains only safe solvents, nicotine and flavoring, the vapor from e-cigarettes is pure.” Although e-liquid may sound pure, during the vaporization process at high temperatures, a mixture of gases including formaldehyde and heavy metal nanoparticles is produced.

29

30

31