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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Emerging Nicotine Products
Tobacco Use Prevention and Control (TUPAC) Program
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Learning ObjectivesAs a result of this presentation, participants will:
▪ Recognize an e-cigarette and where kids like to hide them
▪ Review the latest data regarding e-cigarettes
▪ Understand how kids help market e-cigarettes
▪ Become familiar with the tobacco industry’s marketing tactics
▪ Become familiar with the signs and symptoms of acute nicotine poisoning
▪ Review data and information about how nicotine effects the adolescent brain and social and emotional learning
▪ Review the findings and recommendations of the Surgeon General and Centers for Disease Control and Prevention
▪ Become familiar with campaigns and resources available from TUPAC and other national partners
The TUPAC Program strives to reduce and prevent the harmful and addictive use
of tobacco products outside of its use in traditional Native American practices.
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Anatomy of an E-cigarette
Electronic Smoking Devices, including e-Cigarettes
▪ Battery-operated products designed to turn liquid nicotine,
flavorings, and other chemicals into an aerosol that is ingested
by the user
into a vapor that is inhaled by the user
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Evolution of E-Cigarettes
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Nicotine + Flavor = Pediatric Addiction
All these products have two things in common …
the addictive drug nicotine and candy flavor.
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
(dis)tasteful Findings
NM youth collected 2,481 public opinion surveys from 87 communities across the state to assess what New Mexicans thought about flavored tobacco products.
83% think flavored tobacco products are more
appealing to youth than regular tobacco
products.
85% were more likely to try a flavored cigarillo
than an unflavored one.
17% think flavored tobacco is probably or
definitely safer than regular tobacco
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Flavor Danger
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
1 Product
More than 7 in 10 NM high school youth tobacco
users used a flavored product in past month
72.1%
SOURCE: 2015 YRRS-NM DS
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Nicotine Addiction
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Deceptive Packaging
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
JUUL: Nicotine Delivery in Disguise
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Hidden in Plain Sight
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Peer-to-Peer Marketing: Kids Share
Social Media
▪ Snap Chat
▪ YouTube - Kids provide “instructional” and “aspirational” videos
▪ “How to Hide Your JUUL at Home”
▪ “How to Hide Your JUUL at School”
SOURCE: https://www.youtube.com/watch?v=9n3JdsQlm64
SOURCE: https://www.youtube.com/watch?v=ESmNW1Mp2M4
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
JUUL Use in School Bathrooms and Classrooms
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Nicotine is Poison
Source: https://www.tobaccofreekids.org/press-releases/2015_01_13_poisoning
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
New Mexico Poison & DrugInformation Center (NMPDIC)
The lethal dose of nicotine (1.4 mg/kg) is half that of morphine (2.7 mg/kg) and similar to arsenic.
SOURCE: NMPDIC - Exposures to e-Cigarettes and Liquid Nicotine in NM
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Acute Nicotine Poisoning
Symptoms
▪ Symptoms typically last an hour or two after a mild overdose and up to 24 hours for severe poisoning
▪ Early symptoms can appear within the first 15 minutes to an hour▪ Feeling queasy or throwing up
▪ Stomachache
▪ Mouth watering
▪ Quick, heavy breathing
▪ Faster heartbeat
▪ Higher blood pressure
▪ Pale skin
▪ Headache
▪ Dizzy, off-balance, or confused
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Emerging Data
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
8.2%
9.3%
10.2%
10.6%
24.7%
Spit/Chew
Hookah
Cigars
Cigarettes
e-Cigarettes
SOURCE: 2017 YRRS & 2017 YRBS
U.S. (2019): 27.5% use e-cigarettes and 5.8% use cigarettes
Current Tobacco Use by New Mexico HS Youth 2017
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
NM High School Youth Tobacco Use Trends2009-2017
24.0
18.1
11.8
19.9
15.1
9.5
19.9
14.4
12.3
8.0
21.9
11.410.5
8.7
11.9
24.0
10.6 10.2
8.29.3
24.7
Cigarettes Cigars Spit/Chew Hookah E-Cigarettes
Pe
rce
nt U
se
in
Pa
st M
on
th
SOURCE: 2009-2017 YRRS
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
More HS youth have triede-cigarettes than regular cigarettes
35.3%
Youth who have ever tried cigarettes
51.0%
Youth who have ever tried e-cigarettes
SOURCE: 2017 YRRS
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
12.0%
24.7%
10.6%
3.4%4.0%
10.6%
16.5%17.8%
Mid School High School 18-29 yrs 30+yrs
Age Group
E-Cigarette Cigarette
E-cigarette use highest in HS youth,while cigarette use is higher among adults
SOURCE: 2017 YRRS & 2017 BRFSS
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Emerging Findings andRecommendations
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
CDC Findings and Recommendations
1. Protect Youth
2. Protect Unborn Children
3. Encourage Cessation
4. Protect Clean Indoor Air
5. Enact Rules to Restrict Use and Exposure
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Findings and Recommendations
1. Protect Youth
▪ Nicotine exposure is not safe for youth
▪ Nicotine is highly addictive and can harm brain development,
which continues until about age 25
▪ Nicotine use during adolescence can disrupt the formation of
brain circuits that control attention, learning, and susceptibility
to addiction
▪ Nicotine can train the brain to be more easily addicted to other
drugs
▪ Children are at risk for poisoning by accidental exposure to
e-cigarettes and liquid nicotine
SOURCE: E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
2. Protect Unborn Children
▪ Nicotine exposure is not safe for unborn children
▪ Nicotine can cross the placenta and affect fetal and postnatal
development
▪ The Surgeon General has concluded that nicotine adversely
affects maternal and fetal health during pregnancy, contributing
to multiple outcomes such as preterm delivery and stillbirth
▪ Nicotine is known as a cause of Sudden Infant Death
Syndrome
Findings and Recommendations
SOURCE: E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
3. Encourage Cessation
▪ Although e-cigarettes have been marketed as smoking
cessation aids, there is currently no conclusive scientific
evidence that e-cigarettes promote successful long-term
quitting.
▪ There are proven adult cessation strategies and treatments,
including counseling and FDA-approved cessation
medications.
▪ Electronic nicotine delivery systems may have the potential
to benefit established adult smokers if used as a complete
substitute for all smoked tobacco products.
Findings and Recommendations
SOURCE: E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
4. Protect Clean Indoor Air
▪ The aerosol produced by electronic smoking devices is not
harmless water vapor; it can contain nicotine and other
toxins. Exposure to nicotine can harm adolescent brain
development and can be toxic to fetuses.
▪ The standard for protecting the health of children and
bystanders should be clean air, free of toxic secondhand
smoke, as well as aerosol produced by electronic nicotine
delivery systems.
Findings and Recommendations
SOURCE: E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Findings and Recommendations
5. Enact Rules and Policies to Restrict Use and Exposure
Federal
Tribal
State
Municipal
Schools
Businesses
Homes & Cars
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
The Immediate Impact of Policy
0
10
20
30
40
50
60
70
2012 2013 2014 2015 2016 2017
61
48
41
14
34
22
Nicotine poisoning related calls to the New Mexico Poison & Drug
Information Center, increased from 2012–2014, then began decreasing
after New Mexico legislated child-resistant packaging rules and
established a legal age of purchase in 2015.
SOURCE: NMPDIC - Exposures to e-Cigarettes and Liquid Nicotine in NM
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Surgeon General’s Advisory onE-cigarette Use Among Youth
31
Recommended actions include:
▪ Raise and strongly enforce minimum-age-of-sales
laws for all tobacco products, including e-cigarettes
▪ Incorporate e-cigarettes into smoke-free policies
▪ Reduce access to all flavored tobacco products by young
people
▪ Sponsor high-impact media campaigns to educate public on
harms of e-cigarettes among young people
▪ Increase price of tobacco products, including e-cigarettes
▪ Require tobacco retailer licensure
Source: CDC Surgeon General’s Report, 2016 , https://e-cigarettes.surgeongeneral.gov/documents/surgeon-generals-advisory-on-e-cigarette-use-among-youth-2018.pdf
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
As of December 27, 2019, a total of 2,561 hospitalized EVALI
cases or deaths have been reported to CDC from all 50 states,
the District of Columbia, and two U.S. territories (Puerto Rico
and U.S. Virgin Islands).
▪ Fifty-five deaths have been confirmed in 27 states and
the District of Columbia (as of December 27, 2019).
For more information, visit the EVALI website.
BREAKING NEWSOutbreak of Lung Injury Associated with
the Use of E-Cigarette, or Vaping, Products
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
BREAKING NEWS Federal minimum age of sale of tobacco
products raised from 18 to 21 years
December 20, 2019, the President signed legislation to amend
the Federal Food, Drug, and Cosmetic Act, and raise the
federal minimum age of sale of tobacco products from 18 to 21
years.
It is now illegal for a retailer to sell any tobacco product –
including cigarettes, cigars and e-cigarettes – to anyone under
21. FDA will provide additional details on this issue as they
become available.
FDA updates are available at https://www.fda.gov/tobacco-
products/compliance-enforcement-training.
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
BREAKING NEWSThe FDA to enforce policy on the manufacture, distribution and
sale of unauthorized flavored cartridge-based e-cigarettes
On January 2, 2020, the FDA finalized enforcement policy on
unauthorized flavored cartridge-based e-cigarettes that appeal
to children, including fruit and mint.
Companies that do not cease manufacture, distribution and
sale of unauthorized flavored cartridge-based e-cigarettes
(other than tobacco or menthol) risk FDA enforcement actions.
For more information, visit https://www.fda.gov/tobacco-
products.
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
For products marketed without FDA authorization, FDA intends
to prioritize enforcement against:
▪ Any flavored, cartridge-based Electronic Nicotine
Delivery System (ENDS) product (other than a tobacco- or
menthol-flavored ENDS product);
▪ All other ENDS products for which the manufacturer has
failed to take (or is failing to take) adequate measures to
prevent minors’ access; and
▪ Any ENDS product that is targeted to minors or whose
marketing is likely to promote use of ENDS by minors.
BREAKING NEWSThe FDA to enforce policy on the manufacture, distribution and
sale of unauthorized flavored cartridge-based e-cigarettes
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Emerging Responsibilities
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
What Is My Role?
Parents can:
▪ Learn about the different shapes and types of e-cigarettes
and the risks of all forms of e-cigarette use for young people
▪ Talk to their children about the risks of e-cigarette use
among young people. Express firm expectations that their
children remain nicotine-free
▪ Set a positive example by being nicotine-free
SOURCE: https://www.cdc.gov/tobacco/infographics/youth/pdfs/e-cigarettes-usb-flash-508.pdf
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
What Is My Role?
Educators can:
▪ Learn about the different shapes and types of e-cigarettes
and the risks of all forms of e-cigarette use for young
people
▪ Develop, implement, and enforce tobacco-free school
policies
▪ Reject youth tobacco programs sponsored by the tobacco
industry. These programs have been found to be ineffective for prevention youth tobacco use
SOURCE: https://www.cdc.gov/tobacco/infographics/youth/pdfs/e-cigarettes-usb-flash-508.pdf
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
What Is My Role?
▪ Ask about e-cigarettes,
including devices shaped like
USB flash drive, when
screening patients for the use
of tobacco products
▪ Warn patients about the risks
of all forms of tobacco
product use, including e-
cigarettes, for young people
▪ Provide brief intervention for nicotine users
Pediatric Health Care Providers can:
SOURCE: https://www.cdc.gov/tobacco/infographics/youth/pdfs/e-cigarettes-usb-flash-508.pdf
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Emerging Resources
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
National Campaigns and Resources
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Environmental Strategies that encourage and reinforce tobacco-free
lifestyles and behaviors
Youth Engagement:
Advocacy
Policy Development:
Tobacco-Free High Schools
Policy Development:
Point of Sale
Policy Development:
Tobacco-Free College Campuses
Mass Media:
Awareness and Education
TUPAC Campaigns and Resources
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
TUPAC Campaigns and Resources
Online Training
for Health Professionals
Health Systems Change
Training and Outreach Program
Comprehensive Cessation Services
for those who want to quit—includes
youth protocol ages 13-17
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
WWW.NMTUPAC.COM
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Emerging Questions
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Contact Information
David Tompkins
Community Health Initiative Manager
505-841-5874
www.nmtupac.com