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Start the Conversation: How to Talk to Young People about Vaping
Find a seatGreet your neighbors
We’ll get started soon!
Jenny Best, MS, El Paso County Public HealthGrace Houser, MD, Children’s Hospital Colorado
Objectives • Recognize emerging trends, culture, and
health effects of youth use of e-cigarettes • Use trusted adult principles to have
conversations with youth about the use of e-cigarettes
What do you want to learn today or have a question about?
Getting Started
The Data
50% of youth currently use e-cigarettes.
E-cigarettes: 23% Cigarettes: 7%Other Tobacco Products: 10%
The Data
44% of youth have tried e-cigarettes.
Use:E-cigarettes: 44% Alcohol: 60%Marijuana: 39%
The Data
Perceive vaping as risky: 47%
Perceive smoking as risky: 87%
70% of youth perceive vaping as risky.
The Data
Youth who can ask a parent for help are 31%
less likely to vape.
Youth who can ask a parent for help as 10% less likely to vape.
Discussion- HKCS 2017
What questions do you have about this data?
23% of youth currently use e-cigarettes (7% cigarettes)
44% of youth have tried e-cigarettes
47% of youth perceive vaping as risky (85% - smoking)
Youth who can ask parents for help are 31% LESS likely to vape
Youth who participate in extracurricular activities are 12% LESS likely to vape.
LGBTQ Youth have higher rates of use compared to heterosexual peers.
Current Trends & Culture
What We Know
Curiosity
Flavors
Belief that they are safer than other tobacco products
43% of young people cite flavors as the reason they
first tried vaping
Only 47% of El Paso County youth find vaping to be risky
Electronic Devices
• E-cigs• Vapes• Pods• Mods• E-juice• Vaping • JUUL ● Clouds
● Dripping ● Shotgunning● JUUL’ing
JUULs “The Smoking Alternative, unlike
any E-cigarette or Vape”
Flavors:• Classic Tobacco • Virginia Tobacco• Menthol
Each pod is equivalent to 1 pack of cigarettes or 200 puffs
Marketing
• Appealing flavors
• Social media - Instagram, snapchat, twitter, YouTube
Marketing
“Healthy Alternative”
“Made for adults to quit smoking” - JUULs
“Stealth” vaping
Stealth Vaping
Stealth Vaping Mods
Health Effects
What’s in them?
E-cig juice / e-liquid / vape juice• Nicotine • Artificial flavorings: diacetyl (“popcorn lung”),
mint (allergy/asthma), cinnamon (asthma)• Solvents: propylene glycol, vegetable glycerin
• Convert to carcinogens when heated and inhaled
• Other particles, heavy metals• NOT “water vapor”
Nicotine & The Young Brain
• Brain is still developing until about age 25.
• Nicotine is highly addictive and has neurotoxic effects on the developing brain• Disrupts the development of the brain
circuits that control attention, learning, mood and impulse control
• Affects the brain’s rewards system and can lead to increased potential for addiction to other substances
Aerosol – Not Harmless Water Vapor
Health Impact• Acute effects: cough, mouth or throat irritation,
anxiety, depressed mood, nausea, insomnia
• Respiratory: link to asthma, altered immune response
• Cardiovascular: links to endothelial cell dysfunction
• Neurologic: effects of nicotine
• Potential for ingestion, explosions
• No evidence for “safety”
Second hand smoke effects
EVALI (E-cigarette/Vaping Associated Lung Injury)
EVALI• June 2019; peaked in September
• Symptoms similar to pneumonia or influenza, but no infectious cause identified
• Vitamin E acetate in fluid samples collected from lungs of patients with EVALI, but not in controls
-Banned in inhaled marijuana products in Colorado as of Jan 1, 2020
EVALI (E-cigarette/Vaping Associated Lung Injury)
EVALI• As of December 2019: about 2200 hospitalized
patients nationally
-At least 55 deaths
-1 teenager required lung transplant
• At least 2 cases (but < 5) in Colorado; highest numbers in Midwest
• Treatments: supportive care; maybe
steroids; smoking cessation
Chronic Lung Disease from Vaping
E-cigarette use among adults is a risk factor for development of:• Chronic obstructive pulmonary disease (COPD)• Chronic bronchitis• Emphysema • Asthma
Statistically speaking – odds ratios• E-cigarette use: 1.3x• Combustible tobacco use: 2.5x• BOTH: 3.3x
Bhatta DN, Glantz SA. “Association of E-Cigarette Use With Respiratory Disease Among Adults: A
Longitudinal Analysis.” Am J Prev Med 2019
Policy Efforts
Evidence behind policy change
Raising legal tobacco sales age from 18 to 21 reduces the number of adolescents and young adults who start smoking• 95% of adult smokers begin smoking before
age 21• Helps keep tobacco out of high schoolsTobacco tax increases reduce smoking rates• 10% increase in cigarette prices → decrease in youth
smoking by 7%, decrease in total cigarette consumption by 4%
• Increased state revenue, decrease tobacco-related health care costs
National
December 20, 2019: Federal law raised the minimum age of sale of tobacco products from 18 to 21 years
• No exemptions for current 18 to 21 year old users, or for active military personnel
• Effective immediately• Enforcement plan over next 1-2 years
Partial e-cigarette flavor ban: “coming soon”• Prohibit e-cig cartridges• Exempt menthol and tobacco flavors• Exempt open tank systems• Health & Human Services• FDA review process
State
2019 Colorado Legislature• Updated Clean Indoor Air Act to include e-cigarettes• Removal of tax penalty for local municipalities to enforce
tobacco legislation
2020 Colorado Legislature• HB 20-1001: Raise minimum legal sales age of tobacco
purchase to 21; require statewide tobacco retailer licensing system• Local communities would be able to implement
stronger ordinances
State
Increasing Tobacco Taxes• Proposed vaping and tobacco tax (multiple versions)
filed last week• Raise state tobacco tax from 84c to $1.20 - $2.60 (per pack)
and add tax on e-cigarette products• Federal tax: $1.10 per pack
• Would place an initiative on statewide November ballot
• Revenue would fund statewide preschool programs for 4 year olds, as well as:• Anti-tobacco education programs• Resources to help smokers quit• Health clinics
Local
Manitou Springs: Tobacco Retail Licensing Ordinance passed January 2020 (effective Feb 5)
• Raises minimum legal sales age to 21• Licensing and enforcement provisions
Colorado Springs• Working with City Council on tobacco retail licensing
and raising minimum legal sales age to 21Fountain
• Model in Southern Colorado for instituting retail licensing and compliance checks
• Working to update ordinance to include e-cigarettesMonument?
Trusted Adult:
a parent, guardian, caregiver, teacher, or mentor that is approachable & open to
answering questions with accurate information
1. Reflect
Reflect on your personal point of view
Reflect on your ability to be a role model
Reflect on what you want the result of the conversation to be
Reflect on the context of the conversation
2. Determine Underlying Question
“What is acceptable behavior?”
“Do I have your approval?”
“Can I shock you?”
“What is your personal belief?”
3. Use O.A.R. to Guide the Conversation
Open-ended questions
Affirmations
Reflective Listening
O.A.R.: Open-ended Questions
Who, What, Where, When, Why and How questions that move the conversation forward
Examples:
“What do you think about … ?”
“How do you decide when to … ?”
“How do you feel about … ?”
“Help me understand … ?”
O.A.R.: Affirmations
Statements to focus on strengths and positive behaviors – no matter how small.
Examples:
“I appreciate that you’re willing to talk with
me about this.”
“It sounds like you handled yourself well in
that situation.”
“That’s a good idea.”
O.A.R.: Reflective Listening
Focus on understanding what the person means by:• Repeating and rephrasing• Paraphrasing• Reflecting a feeling.
Examples:
“So you feel…”
“It sounds like you…”
“You’re wondering if…”
Talking to your youth by age:
Age 10-12• Concrete thinkers• Parental modeling and influence
Age 13-15• High risk takers, unable to anticipate
consequences• Importance of clear family boundaries and
enforcing rules
Age 16-18• More independent, but still listening to trusted
adults• Open ended questions and reflective listening
What We Can Do
Have a Trusted Adult Conversation1.
Resources:
Speak Now ColoradoTobaccoFreeCO
TobaccoFreeKidsCDC
What We Can Do
Provide education and cessation resources for youth who use tobacco/ other nicotine products.
2.
Resources:
• Second Chance - online tobacco/ nicotine education program
• Colorado Quitline ○ My Life My Quit
• Smokefree Teen • “The Real Cost”
What We Can Do
Join local community efforts. 3.
• Tobacco-Free Alliance• SWAT Club• Nicotine News
What We Can Do
Engage in policy and advocacy efforts
4.
• Local, state, and federal levels• Write letters to the editor• Communicate with local or state legislators• Vote!• CHCO Child Health Champions:
www.childrenscolorado.org/community/ child-health-advocacy/
