E-Cigarettes Don’t Get Vaporized!

1. E-CigarettesDon’t Get Vaporized! Information for Educators and other Professionals David Suda, M.Ed., LPC Sudad@upmc.edu Clinical Educator Western Psychiatric Hospital, UPMC

2. Objectives • Review the History & Basic Mechanics of the E-cigarette • Difference between an E-cigarette and Traditional combustible cigarettes. • Varieties of E-cigarette devices on the market. • Marketing of the E-cigarettes, use of Media, and rise of local Vape Shops. • Research and Regulations around E-cigarettes. • Strategies for Addressing E-cigarettes with Students.

3. Tobacco:A Small History • Around 1500’s Tobacco was used by Native Americans (Primarily in ceremonies and rituals). • Later found and transported to Europe. Very profitable. • By 17th century smoking became very popular. Nicotine Addiction first noted. • In Europe it became a problem. People were experiencing respiratory issues, coughing.

4. Tobacco:A Small History • By 1800’s Tobacco was a cash crop, continued to be produced, and sold worldwide. • Around 1890’s, with the introduction of automation, cigarettes were being mass produced. • Heavily promoted at the turn of the century -- World War I C-Rations included cigarettes! • For over 100 years the traditional combustion cigarette has dominated the tobacco market.

5. Tobacco:A Small History • In 1880 James Bonsack invented the First Automated Cigarette Rolling Machine. • Can make 200 cigarettes per minute! • Around 100,000 per day! • By comparison only four could be made by hand per minute by a skilled worker. • Revolutionized Cigarette making!

6. Tobacco:A Small History • Sold the machine to James Buchanan Duke – Owner of a Tobacco Manufacturing Company. • Eventually Controlled over 90% of the Market.

7. The Rise of theE-Cigarette • Almost unheard of ten years ago – It’s Just a Trend! • Presently there are over 70 Vaping Shops in Allegheny County. • They are selling Vaping devices and E-Juices. • The juices are the allure and money-maker for Vape Shops. • E-Juices have a high market-up, and big profit margin.

8. Second Largest Manufacturer of Tobacco Products. They make Cigarettes! Sells of Traditional Cigarettes are at the lowest they have ever been. Switching over to E-Cigarettes.

9. E-Cigarettes!!! Phillip Morris Largest Manufacturer of Tobacco Products. They make Cigarettes! Acknowledging that Cigarettes are Harmful…So we need a new product.

10. Moving toward E-Cig Products Moving toward E-Cig Products

11. 2014 Vape Most searched word in 2014 Recognized by the Oxford Dictionary

12. The Vaping Industry • About a $3.7 billion dollar a year industry in the U.S. and growing (Forbes Magazine). • In the next four years, by 2022, it is expected to hit $27 billion. • By comparison, Traditional Cigarettes are around a $95 billion dollar a year industry. • Vape store are mostly private owned, but franchises will become more popular.

13. What Is AnE-Cigarette?

14. The E-Cigarette • E-Cigarettes were first invented in the 60’s – Way Ahead of its Time! • Reintroduced in 2003 – At the Right Time! • Marketed as a way to stop smoking. • Simple Device -- Just a battery, an atomizer (or heating element), and a switch. • They create a vapor that carries the nicotine or flavored liquids. E-Cigs closely resemble traditional tobacco cigarettes.

15. Components of E-Cigarettes

16. Basic Components ofE-Cig Devices • BATTERY……….Can be a single cell (18650), or multiple cells. • SWITCH……….This can be simple button, or puff activated switch. • COIL……….Provides the heat source to create the vapor. This can be made and installed by a user. • WICK………Often made of cotton, and allow the liquid to be absorbed so it can be heated by the coil. • BURNCHAMBER..........This may be interchangeable, pods or plugins, or accessible. Depends on device. • Other Features Include: • Displays that show temperature. • Processors to aid in temperature control (set a certain temp) • Battery Power Indicator

17. Closed vs. OpenSystem CLOSED OPEN • Has interchangeable pods that must be purchased. • Disposable E-Cig • Easier to use, smaller. • Can not be modified – That Easily! • Sold Cheaper. • Allows the user to modify the pen. • Change wicks and coils. • Access to reservoir. • More for the hobbyist.

18. The Vape Pen(The Second Generation) • Similar to the E-Cigarette just bigger. • Larger battery, and most importantly an accessible reservoir. • Vaping is the act of enjoying flavored vapor.

19. Super-SmokerBluetooth vape Pen • Vaping goes with our current technologies that we are very comfortable with. • Though appearing a little absurd we have accepted these devices as part of our life. • Links to other devices. • Can answer calls. • Play Music

20. Vape Pens

21. Vape Box • More for the serious vaper. • More complex. • More customizable. • Larger Battery • Accessible Reservoir • Temperature Control • Modified Coils & Wicks

22. More Vape Boxes

23. Plug-inVape Devices • The Volcano is a plug in device with temperature control. • For Oils, Herbs, and Spices. • Around $500. • Does everything a regular vape devices does – Just bigger and it plugs in!

24. The Juul • Originally manufactured by a company called PAX – Now Juul Labs. • The mission was to design a small device to help others quit smoking. • Marketed in 2015, and now have close to 30% of the market. • One plugin pod contains the equivalent of pack of cigarettes. • Example of closed system design – the Future of the E-Cig? “The I-Phone of E-Cigs”

25. IQOS(I-Quit-Ordinary-Smoking) • Introduced by Phillip Morris it is a “Heat-Not Burn Battery Powered Product”. • Special “Heat Sticks” are used that resemble regular cigarettes, but smaller. • Awaiting FDA approval. • Already available in 26 countries including Japan.

26. Vape Detectors • Some schools use smoke detectors in their bathrooms. • Will Vaping trigger the detectors? More than likely not. • There are certain kinds that are more sensitive and some are designed to detect vaping. • Vapor dissipates quickly so it is harder to detect. • Also no lingering odor.

27. E-LiquidsorWhat’s REALLY in that Thing?

28. Vapor SMOKING VS. vAPING Smoke • An aerosol, small particles, that form when a liquid is heated (not burning). • Does not smell like traditional smoke. Often a pleasant smell, flavored. Dissipates faster. (Harder to detect) • The particles are smaller. They can occur naturally. • Risk Factors vary depending on the content of substance and vapor. • Carries particles, gases, and many chemicals created by the act of burning. • They easily create many health issues. • High Risk Factor for many cancers, heart problems, and of course lung/respiratory issues.

29. What’s Reallyin that Thing? • What are vape juices, liquids, and oils? • Primary ingredients are: • Propylene Glycol • Vegetable Glycerin • Nicotine Concentrate • Artificial Flavoring

30. Primary Ingredients Propylene Glycol • A petroleum by-product. • Fluid has no odor or color, and is less viscous than Vegetable Glycerin • In vaping it is used to provide a ‘throat hit’. • Gives better sensation experienced when smoking tobacco. Vegetable Glycerin • Natural chemical, derived from vegetable oil. • Used in many food products, make-ups, and is considered to be safe. • Commonly used in e-liquid to give a ‘thick’ sensation to vapor. The FDA has deemed these as SAFE! And, proponents of Vaping agree with this. WARNING They were approved for INGESTING NOT VAPING. We Do Not Know the Long Term Effects of These.

31. NICOTINE • Strong addictive naturally occurring chemical. • Stimulant with paradoxical effects. • Interestingly, In pure form can be very toxic (transdermal). • Was used in the past as an insecticide – It drives off bugs! • Nicotine accounts for the addiction to smoking. (Only about 6% of smokers can stop smoking without some kind of aid.) • Creates a calming effect, reduced fatigue, and relaxation.

32. Heath Concerns:Is vaping Safer? • It is certainly safer when compared to Smoking • But, does that mean it is Safe? • There are Health Risks -- Long Term – Probably will be similar to smoking (Primarily Heart and Lung Health Issues).

33. PopCorn Lung • A Phenomenon that came about from those who worked at a Popcorn Factory. They were breathing in artificial butter flavoring. • Many developed Constrictive Bronchitis – difficulty breathing. • The phenomenon was called Popcorn Lung. • What initially appears benign overtime can be detrimental.

34. “Dabs” • Concentrated Marijuana • Butane as a purifying agent. • Special preparation for vaping • Looks like peanut butter, or ear wax • Other Names: Wax, Honey, Hash Oil, BHO.

35. Caffeinated E-Cig • Just about anything can be Vaped – Even Caffeine. • From reports – It Actually Works! • The effects are quick, but short lived.

36. The Vape Device:A drug Delivery Tool? • The capability to vape just about anything from flavored glycerin, to oils, to herbs, to nicotine, to THC, and more!! • The question becomes: WHAT’S INSIDE IT? • The versatility allows for many uses. • Could the versatility of the vape device lead to experimentation? • Is it TOO EASY to increase and vary levels of nicotine? Or, other drugs?

37. FDAPolicy and Regulations • August 2016 FDA extended it regulatory power to cover all tobacco products. This includes traditional cigarettes, smokeless products, cigars, cessations products, and anything that contains tobacco (nicotine). • This includes E-Liquids. • Vape shops that make there own E-Liquids with nicotine were included. • Originally August 2018 was the date all places that manufacturer products, including E-Liquids, needed to file an application with the FDA. • Application fees range from $120k up to $400k. (Covers product testing) • This date was pushed back to 2022. • Several Health Organization sued the FDA for postponing their regulation of E-Liquids.

38. Studies, Research, and Statistics • We have little information Longitudinally. • There is such a wide variety of products. How do you study such a phenomenon? This is a challenge alone! • Current Research is scattered – And we have yet to pull it all together. • We must study the E-Cig separate from Traditional Cigs despite wanting to make comparisons.

39. Studies, Research, and Statistics • As of 2014 more youth have tried E-Cigs than traditional cigarettes. (2014, Allegheny Health Dept) • 20% of Adolescents (14-19) have tried E-Cigs (2015, AHD). • 30% of College students have used E-Cig, while 15% are current users (NY Study, 2015).

40. Studies, Research, and Statistics • E-Cigs are a 80 Billion Dollar Industry that is growing. • Ove 70 Vaping Businesses in Allegheny County. • There is little regulation with E-Cigs. This includes vape juice, vape devices, sales, and service. • In Allegheny County E-Cigs & Vaping is forbidden in public places (the same as smoking).

41. Studies, Research, and Statistics • First time E-Cig use can lead to Traditional Smoking (traditional Cigarettes. (Primack, 2017) • No clinical proof as a cessation device. • Toxic! Not just products, but the metals in the E-Cig device. • May prove to be more toxic than traditional cigarettes.

42. E-Cigarette Users Two Main Groups Quitters (Traditional Smokers) Youth (Teens and Twenty-Somethings) • Marketing being directed toward this population. • The Reduced Harm Argument. • Less than 6% are successful by themselves. • Little Evidence to Support this. • Vaping now considered more socially acceptable than Smoking. • Great area of concern --- The Juul. • E-liquid Flavors are a problem – Kids Like Them. • Again, 2014 E-Cigarette use surpassed Traditional Use. • More Likely to Experiment. • From Nicotine they may move to other drugs. Dual users

43. MarketingE-Cigarettes

44. Target Marketing: Youth A 1974 memo by the R. J. Reynolds Research Department points out that: capturing the young adult market is vital because -- virtually all smokers start by the age of 25 and most smokers begin smoking regularly and select a usual brand at or before the age of 18. • Most advertising today is through Mobile Media and youth are greatest users of Mobile Media. Includes: Snapchat, Twitter, Instagram and YouTube.

45. E-Cigarette Marketing • Vaping has managed to grow with little traditional marketing (TV, magazine, news). • Mainly use of internet, social media, word of mouth, and YouTube. • Similar to ads that ran in the ran in the 50s, 60s, and 70s. Human Relations Media, 2014

46. Helping Versus Hurting • The Vaping Industry stands firmly saying its intentions are good -- We are looking for ways to help people transition to a less harmful alternative to traditional smoking. • The facts do not support that contention. • Most traditional smokers do not find Vaping appealing, and often becoming dual users. • Purchasers of E-Cigs, Vape Pens, and Juices are showing that it is more a youth support industry. The Juul is a an example of this, becoming widely popular with school age children.

47. The Language is Important • The term E-Cigarette is a reminder of older traditional combustible cigarettes. • The industry is working hard to separate itself from smoking, and so Vaping is the new label. • Some say, “I am not Smoking, I am Vaping.”

48. 2013 1958 Tough Guys

49. Sports Sponsorships 2013 1991

50. 1930 2012 Sex Appeal