Vaping Ecigs Vapes ENDS Juuling Jean Schensul Ph

Vaping E-cigs, Vapes, ENDS, Juuling Jean Schensul, Ph. D. , SAPC Co-chair, November 8, 2018

Goals • • • Define vaping and devices used to vape Identify contents of vaps Describe marketing of vapes are marketed Summarize briefly the epidemiology of Vapes Summarize problems associated with vaping – Smoking – Potential long term health problems – Inclusion of other addulteratives, additives, and illegal substances in the device • Describe FDA steps to regulate vaping

What are END-E-cigarettes/Juuls

Marketing and Purchasing • Vapes, vaporizers, vape pens, hookah pens, electronic cigarettes (ecigarettes or e-cigs, Juuls), and e-pipes are some of the many terms used to describe electronic nicotine delivery systems (ENDS). ENDS are noncombustible tobacco products. • These products use an “e-liquid” that may contain nicotine, as well as varying compositions of flavorings, propylene glycol, vegetable glycerin, and other ingredients. The liquid is heated to create an aerosol that the user inhales. • ENDS may be manufactured to look like conventional cigarettes, cigars, or pipes. Some resemble pens or USB flash drives. There are larger devices, such as tank systems or mods, bear little or no resemblance to cigarettes and are more like hookahs. • E-Juice is a liquid mixture of propylene glycol (PG), vegetable glycerin (VG), flavorings, water and nicotine, converted into vapor and specifically for electronic cigarette usage. It comes in different container sizes, costs, sizes and strengths.

Marketing/sales on internet

Flavors (with nicotine) (https: //www. ejuicevapor. com/collections/ejuice Factory E-Liquid AQUA E-Juice Bad Drip Labs Beard Vape Co Big Jugs E-Juice BLVK Unicorn Brew E-Liquids Campfire E-Juice Candy King Carnival Roll Upz Charlie's Chalk Dust Chubby Bubble Cloud Nurdz Clown Liquid Cookie King Cosmic Fog Vapor Cuttwood Director's Cut Donuts E-Juice Drip This Sour Drip'n Vape EJV House Juice Ice Fat Kid E-Juice Food Fighter Juice Frost Factory Fruit Freeze Fruit Twist ELiquid FRYD Liquids Geeked Out ELiquid Glas Basix Series Globs Juice Co HOF E-Liquid Honey Bear EJuice Humble Ice Juice Humble Juice Co Humble x Flawless Jam Monster JRU Tobacco Juice Roll Upz Ice Juice Roll Upz TRPCL e Keep It 100 EJuice Vapetasia VGOD Tricklyf. Marina Vape Marshmallow Man! Melon Twist ELiquid Met 4 Vapor Milk King E-Juice Milkshake Man Kilo E-Liquid Kilo Black Series Kilo Candy Series Kilo Fruit Series Kilo MOO Series Kilo Sour Series Kilo White Series Kronuts E-Juice Lemon Twist Licks E-Liquid Loaded E-Juice Lost Fog Vapor Mad Hatter Juice Mr. Freeze ELiquid Mr. Meringue Naked 100 ELiquid Nasty Juice Nasty x Kilo Collab. Nilla Cakes EJuice One Hit Wonder Overloaded EJuice PACHAMAMA Pop Clouds ELiquid Reds Apple EJuice Ripe Vapes Ruthless E-Juice Ruthless Tobacco Stumps E-Juice SVRF Blue SVRF Red Tailored Classics House That Thai Tea Tho. . The Creator of Flavor The One E-Juice The Pancake House Treat Factory Tropic King Twisted Fruit 120 Uncle Junk's Vape Lemonade Vape BKFST

• Three types of e-cigarettes: – – • • • Innovation in production is rapid. Many global producers E-liquid consists of propylene glycol, glycerin (95%), water, nicotine, and flavorings. More than 8, 000 flavors with standards created by the American E-liquid Manufacturing Standards Association (AEMSA). [105] As of 8 August 2016, the FDA extended its regulatory power to include ecigarettes, e-liquid and all related products. [106] – – • cigalikes, looking like cigarettes; e. Gos, bigger than cigalikes with refillable liquid tanks; mods, assembled from basic parts or by altering existing products. [9] They are mainly pwered by lithium rechargeable batteries. Ingredients Product features Health risks Appeal The FDA has banned access to minors and requires pre-reviews of e-cigs and eliquid products.

ENDS/Devices: some examples

Vap Device Safety Product safety (industry standards) Storage Access to minors Access to children Storage of e-liquids Additives, alternatives, adulterants • Marijuana/cannabis oil • Synthetic marijuana (Spice K)

Vaping and Health Risks • • • Within the past decade or so, e-cigarettes have been marketed as a way to enjoy smoking with fewer of the health risks of traditional cigarettes – for one thing, as e-cigarettes don't burn tobacco, they should eliminate the risks associated with tar. They contain a battery, a metal heating element and a reservoir of liquid, which is converted to a vapour by the heating element and is inhaled by the smoker. The liquid is made up of a solvent, either glycerol or propylene glycol, nicotine, and often food-grade flavourings. So what's the problem with e-cigarettes, if they do not produce carcinogenic tar? Well, nicotine or other molecules found in e-cigarettes can still affect lung health. A significant number of the flavour chemicals used in many liquids are aldehydes, and these are often irritants of the mucosal tissue in the respiratory tract when inhaled. Typical examples are cinnamaldehyde (cinnamon), vanillin (vanilla) and diacetyl (buttery). Tests on endothelial cells, the cells which line the blood vessels and the inside of the heart, show that some e-cigarette flavourings and their constituents (such as vanillin, cinnamaldehyde, diacetyl, isoamyl acetate and menthol) may harm blood vessels. They caused higher levels of an inflammatory marker (interleukin-6) and lower levels of nitric oxide, a molecule with several roles, such as inhibiting inflammation and clotting, and dilating blood vessels. In the body, these two changes are considered to be an early predictor of heart disease. Although the food flavourings are in themselves safe when used in food (as are the solvents) that does not mean they necessarily are entirely safe for a different use, such as in e-cigarettes. Studies have shown that some of these molecules, notably the solvents, can be decomposed when heated to above 300°C by the heating element in the e-cigarette. Three substances, all aldehydes, formed on the breakdown of glycerol and propylene glycol have come in for particular attention – acrolein, methanal and ethanal. You've probably met acrolein (propenal) – it's the chemical formed when cooking oil is heated until it begins to smoke. It is toxic and can severely irritate eyes and nasal passages. Ethanal (acetaldehyde) and methanal (formaldehyde) are also toxic – methanal, in particular, is a well-known carcinogen. These substances may also be formed by decomposition of the flavouring molecules. The verdict So are these molecules produced at dangerous concentrations in e-cigarettes? While use of e-cigarettes has been shown to lead to significantly lower levels of certain carcinogenic metabolites in the urine of their smokers, compared to the levels found in smokers of traditional cigarettes, they have been linked with higher levels of some particulates, including the metals cadmium, nickel, chromium, lead and zinc. These may have originated in the heating coil. There is particular concern that the rapid growth in the use of e-cigarettes has not been accompanied by proper assessment of the risks accompanying their use, especially over the long term. While some reports have said that e-cigarettes are much safer than conventional cigarettes, one study has concluded that regular use of e-cigarettes by young people leads to them becoming heavier smokers of conventional cigarettes; another American studyconcluded that use of e-cigarettes by teenagers doubles the risk of coughs and bronchitis compared with nonsmokers.

Data • More than two million middle and high school students were current users of e-cigarettes in 2017. 1 • E-cigarette use rose from 1. 5 percent to 11. 7 percent among high school students and from 0. 6 percent to 3. 3 percent among middle school students from 2011 to 2017. 1 • According to a 2013 -2014 survey, 81 percent of current youth e-cigarette users cited the availability of appealing flavors as the primary reason for use. 2

• • • In 2016, an estimated four in five (20. 5 million) U. S. youths, including 8. 9 million middle school students and 11. 5 million high school students, were exposed to ecigarette advertisements from at least one source, a 13% increase over 2014. Most exposure is in retail stores. E-cigarette marketing employs strategies similar to conventional cigarette advertising tactics that have been proven to appeal to youths, such as themes of romance, freedom, and rebellion; celebrity endorsements; and health claims (5, 7). E-cigarettes are marketed and promoted using strategies that are not legally permissible for conventional cigarettes, including television, sports, and music event sponsorships, in-store self-service displays, and advertisements placed outside of brick-and-mortar businesses at children’s eye level (5, 10). Exposure to e-cigarette advertising might reduce youths’ perception of harm associated with e-cigarettes and increase their beliefs that e-cigarettes can be used where smoking is prohibited (8). Product design features might also influence use. For example, JUUL, the topselling U. S. e-cigarette brand, ¶ is an e-cigarette shaped like a USB flash drive that has a high nicotine concentration (9). According to news reports and social media posts, students are using JUUL in school classrooms and bathrooms (9). **, ††

FDA Regulations FDA regulates the manufacture, import, packaging, labeling, advertising, promotion, sale, and distribution of ENDS, including components and parts of ENDS but excluding accessories. Examples of components and parts of ENDS include: • E-liquids • A glass or plastic vial container of e-liquid • Cartridges • Atomizers • Certain batteries • Cartomizers and clearomizers • Digital display or lights to adjust settings • Tank systems • Drip tips • Flavorings for ENDS • Programmable software

Juul • Out in past 2 years • Very rapid increase • Advantages are size and appearance, ease of use, • Has twice as much nicotine • By senior year, more than 25% of high school students are juuling. 90% of units have nicotine contrary to common belief each cartridge contains 0. 7 m. L with 5 percent nicotine by weight. By Mylesclark 96 - Own work, CC BY-SA 4. 0, https: //commons. wikimedia. org/w/index. php? curid=47558014 It is illegal for children and teens to vape if they are under the state mandated smoking age. This also applies to the use of ENDS as they could include tobacco. One Juul pod is equivalent to smoking one pack of cigarettes or 200 puffs. But the biggest draw for teens is that the pods come in fun flavors, such as cucumber, mango, and mint,

Where do you think West Hartford kids most often obtain vaping tools such as Juul, Dab Pen, Vape Pen, and/or E-cigs? How much do people risk harming themselves when vaping? Great risk Slight risk 53. 1% of surveyed teens believe that kids most often obtain vaping tools solely from their friends. Moderate risk No risk I don’t know 2% 14% 8% • 26. 5% - Convenience Store/Vape Shop • 6. 1% - Family • 73. 5% - Friends • 20. 4% - Internet *Respondents were allowed to choose more than one sources of vaping tools 29% 47%

Past 30 -Day Drug Trends (All Grades) 2011 2013 2017 Alcohol 30. 3% 25. 0% 26. 0% Marijuana Tobacco (Cigarettes) Electronic tobacco (vaping) 18. 1% 12. 3% -- 17. 7% 9. 4% -- 19. 9% 5. 2% 14. 2% Any Rx medication (1+) 7. 9% 10. 8% 7. 6% Rx Pain relievers Rx Stimulants Rx Sedatives OTC/cold medicine 6. 2% 3. 3% 2. 4% -- 7. 4% 4. 7% 3. 5% -- 4. 9% 3. 8% 3. 6%

What to say to parents www. healthline. com • • • Start early to talk to your children in late elementary and early middle school. Educate yourself first. Get the facts on these products so you know what you’re talking about when you approach the discussion with your kids. Be a role model. Parents are responsible for shaping many of their children’s ideas and behaviors, so set the tone with your own actions. Establish a safe environment where your kids can talk about their feelings and opinions without feeling judged. Really listen and let them tell you what they know. It can sometimes be helpful to give them something to read that you can then discuss together. Help them figure out ways to handle situations where they may be pressured to engage in these behaviors. Create a plan, even specific things for them to say like, “I have asthma and my doctor says I could become very ill if I try this, ” or, “I just don’t think it looks cool. ” Help them understand that using willpower to stand up to peers is really hard, but willpower is like a muscle — the more you use it, the stronger it gets.

Cannabis in Vapes Cannibioid oil preadded or added to vape Vials with dry leaves vape hash oil, wax, budder, shatter, BHO, full-melts, or any other form of THC concentrate Requires an empty cartridge that can be filled by any combination or concentrate,

Posted on Reddit hey reddit, my name is Max. What's and I'm an. Juul 18 year senior in high school. I just wanted to inold. School give some light on what the Juul is like at my high school, because honestly what it has become is truly fascinating. To start, vaping in the Men's bathroom was always a frowned upon activity. Kids would shit on others for it, and even smoking cigs people look down upon (except for the angsty kids that listen to Mac Demarco and such). But what I love about the Juul, is it has become so addicting that it has become seen as cool, almost as a way for people to subconsciously cope with their addiction. Between classes the big bathroom in my school averages 20 -25 kids, and 5 -10 juuls. Kids usually will give you a dollar for a juul rip if you don't know them, if you want to buy a pod for 5$ you just head into the bathroom after lunch. We call the kids in there between every class begging for rips "Juul fiends. " Pod boys are the freshman that say "can i put my pod in ur juul? " and are in there every block. I myself spent about 180$ on mango pods and bought out a store, and sold these pods for 10$ a pod, making myself an absolutely massive profit in literally 9 days. Given because I'm 18 with a car and that's the tobacco age around here, I always get offers to get pod runs or juuls for kids. people even understand the best system to get a head rush in your 2 minutes between classes, is all the juuls at once. So someone yells "GIVE ME ALL THE JUULS" and 3 -7 are passed around, two hits each. This saves us all juice, and gives you a massive head rush. Kids also scratch logos and words onto their juuls to make in their own, every day you can find the pod covers in my student parking lot. I know this sounds exaggerated, but with a school with 1400 kids near the city and juuls being perceived as popular, it's truly fascinating what can happen. Also, one smoke shop had the crisp pear pods, and a kid sold them for 15$ a piece. Those pods are fucking amazing by the way, they taste like a green apple jelly beans. Well, just thought I'd type this out to see if anyone has a similar experience to me in their school or was interested in it, if you have any questions i'm happy to answer. Thanks for reading!

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