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Vaping

SD 71

Jan 8, 2020

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• Key Components:

• Device heats a liquid, turning it into an aerosol

• Vaping”: inhaling an aerosol produced by an electronic cigarette

• No burning, no carbon monoxide

• No one size or shape

Vaping

Basics

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• Chemicals in liquid absorbed through lung, throat and oral tissues

• “E-Juice” contains:

– Propylene Glycol

– Vegetable Glycerin

– Flavour additives

– Nicotine (usually)

• JUUL: slim, easily concealable, non-refillable cartridge system

– Nic salts

• Other brands: SMOK, Vype, Logic, Aspire, Suoirin

Vaping Basics

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E-Cigarette Epidemic in

Adolescents

• The 2016-17 Canadian Student Tobacco, Alcohol and Drugs Survey: the prevalence of ever trying an e-cigarette increased to 23% (approximately 470,000 students). This is pre-legalization of nicotine containing e-cigs.

• Frequency of use is increasing amongst users.

• Potential for delivery of high level of nicotine – tasteless and odourless with even brief experimentation leading to dependency.

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2018 BC Adolescent Health Survey

Overall decrease in youth who had smoked tobacco: 21% in 2013 to 18%

in 2018

Significant increase in e-cig use for students who had smoked: 16% in

2013 to 64% in 2018

This means, 21% of all BCstudents are vaping with nicotine and

19% without nicotine.

Among youth who had never smoked 11% vaped with nicotine, and 13%

without nicotine in the past 30 days.

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Youth vaping

Reasons for use

• The flavours are appealing and the devices look cool

• It makes them feel rebellious: they vape in places that are not allowed as it is easy to conceal

• Their friends are vaping, it helps them fit in

• Curiosity and/or boredom

• They consider the vapour to be less harmful compared to tobacco smoke

• They like the “hit” they get from nicotine

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Health Concerns:

Nicotine

• Teens are most at risk due to

developing brains – nicotine changes the way synapses are

formed, that can last a life time.

• Brain risks: decreased attention, impulse control, decision making, cognitive performance, depression, nicotine withdrawal

• Respiratory symptoms: chronic cough, bronchitis, asthma, serious lung disease.

• Impacts will be in all organs/systems with nicotinic receptors.

• Nicotine dependence - No data on how to treat but if analogous to tobacco a struggle with high relapse rate

• Increased risk to use other substances such as alcohol and cannabis.

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Health Concerns: Other

• Vaping liquids: typically include glycerol, flavours,

propylene glycol. Long term health effects of

inhaling these substances is unknown.

• Vaping (heating), causes reactions and create new chemicals such as formaldehyde and acetaldehyde.

• Vapour: heavy metals (chromium, nickel and lead), VOC, particulate matter.

• Flavours: meant to be eaten not inhaled so we do not know what impact they will have short and long term

• Dental Health: excess bacteria, dry mouth, inflamed gums, cell death due to DNA damage (periodontal disease, bone loss, tooth loss, tooth decay).

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Principle of Toxicology

“The dose and the route make the poison”

no long term vaping toxicological/safety studies have been done in humans

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Tobacco Cigarette Initiation

• “E-cigarette use was strongly associated with cigarette smoking behaviour, including smoking initiation at follow-up.”

Hammond D, Reid J, Cole A, Leatherdale S, Electronic cigarette use and smoking initiation among youth: a longitudinal cohort study, CMAJ October 30, 2017 189 (43) E1328-E1336

“e-cigarette use is

associated with

increased risk for

cigarette initiation and

use, particularly among low-risk youths”

JAMA, 2019

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•

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Vaping is not for youth or

for non-smokers

• We need to stop the message that vaping is a safer alternative.

• At the moment all we can say is e-cigs are a less harmful alternative to those adults with a nicotine addiction.

Absence of evidence of harm is not evidence of absence of harm.

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Big Tobacco

• Philip Morris bought 35% of JUUL at 13 Billion

• Big tobacco is duping a generation into a life long addiction

• Big Tobacco using advertising/marketing techniques that converted millions to smokers

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A Word to the Wise – the tobacco

industry is out to ‘win’

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• Federal TVPA:

– “Legalized” sale of vaping products to adults in 2018 (Bill S-5)

– Some vaping ads/promotions permitted unless aimed at youth or lifestyle advertising

– Flavour marketing restrictions

– New Federal rules pending:• Prohibitions on advertising/ marketing

• Mandatory health warnings on vaping product packaging

• Nicotine level limits

– Additional rules likely in future

The Law:

Federal

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• B.C. TVPCA/TVPCR:

– Access restricted to 19+

– No ads/promotions in-store

– No vaping on school property (TVPCA s.2.2(3.1))

• Nov. 15, 2019: Provincial Government announced 10-point plan to tackle youth vaping, including:– Restrictions on access to flavours

– Advertising and labelling restrictions

– 20% tax on vapour products

– Toolkit for schools

The Law: Provincial

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• EDUCATION of risks of vaping from Board level to boards, schools, students, parents

– Incorporate vaping education into regularly scheduled school meetings

– Circulate vaping information to students and parents

• Develop consistent policies to deal with vaping on school grounds– Clearly communicate policy and

consequences of violations to all school employees, students, parents and visitors

– Visible, unambiguous signage

SCHOOLS

&

SCHOOL BOARDS

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• Learn about the risks of vaping and share that knowledge and those resources with your children

• Don’t underestimate or downplay the power of nicotine addiction

• Be patient and listen

• If you smoke or vape, talk to you children about it and think about quitting yourself. If you and your child are both addicted to nicotine, talk about quitting together

• Don’t buy your children vapes

• Manage your child’s expectations about quitting

WHAT CAN PARENTS

DO?

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What to do for youth with a

nicotine problem

• Prevention, prevention, prevention– Effort and attention into the younger grades and those not

vaping important

– Emphasis on resiliency and critical thinking skills

• Interventions:– Quitnow offering phone and live chat to youth 15+

– Motivational Interviewing and client-centred

– Some therapies for tobacco not applicable to nicotine addiction secondary to vaping:• NRT (gum, patch, lozenges, inhaler)

• Prescription drugs: Champix or Zyban

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Resources

• B.C. Ministry of Health. Vaping info, legislation, tools.

https://www2.gov.bc.ca/gov/content/vaping

• Island Health. Electronic Cigarettes and Vaping. Resources links. https://www.islandhealth.ca/learn-about-health/smoking-tobacco/electronic-cigarettes-vaping

• Health Canada. Talking with teens about vaping. https://www.canada.ca/en/services/health/publications/healthy-living/talking-teen-vaping-tip-sheet-parents.html

• BC Lung Association. Vaping cessation and information.https://bc.lung.ca/how-we-can-help/vaping

• BC Centre for Disease Control. Vaping and Severe Lung Illnesses. http://www.bccdc.ca/health-info/prevention-public-health/vaping

• Surgeon General. Facts About Vaping.

https://e-cigarettes.surgeongeneral.gov/

• Netflix: Show: Broken. Episode: Big Vape.

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Summary

1. Vaping amongst youth is a rapidly growing phenomenon

2. Vaping is not harmless. Long term health risks will become clearer with time.

3. Addiction to nicotine may have a dramatic effect on public health. We do not have any evidence based interventions for youth that are addicted.

4. “Big Tobacco” is the main promoter and seller

5. We need to apply the knowledge and regulatory tools learnt with tobacco but we need to move faster

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Scott RiddellEnforcement Officer/

Reduction Coordinator

North Vancouver Island

250.331.8589

David.Riddell2@viha.ca

Charmaine Enns, MD, MHSc, FRCPC

Medical Health Officer

North Vancouver Island

250.331.8591

charmaine.enns@viha.ca