Teen Vaping: A new generation of nicotine consumers

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

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

4. 2. Flavours & Aerosol Attractive to youth Harm? 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 • taste good • enticing names • decrease perception of harm • mask the bitterness of nicotine Association Between Electronic Cigarette Use and Myocardial Infarction Alzahrani, Talal et al. American Journal of Preventative Medicine Vol 55 Oct 2018

5. 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. Health Canada: https://www.canada.ca/en/health-canada/services/smoking-tobacco/vaping/risks.html#a1

6. 3. Reversing progress in tobacco control 2020-01-05

7. 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

8. 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

9. 4. Vaping by youth is on the increase 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

10. 5. Conclusion

12. 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.

13. 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.

14. Resources Thank you.