Vaping: What Health Professionals Should Know Kate Feuling Porter, - PowerPoint PPT Presentation

Vaping: What Health Professionals Should Know Kate Feuling Porter, MPH Program Manager Twin Cities Medical Society

Objectives Discuss policy Describe Describe Identify & community strategies for vaping trends health risks based discussing strategies to in adults and associated vaping with adolescents with vaping address patients vaping

What do you hear people say about vaping?

E-cigarette Trends

E-cigarette Use by Age 26% 22% 6% Adults Young Adults 11th Graders (18-24) Minnesota Department of Health

MN Adult Vapers in 2014 66% 12% 22% Current Never Former Smoker Smoker Smoker 2014 MN Adult Tobacco Survey

MN Adult Vapers in 2018 44% 19% 37% Never Former Current Smoker Smoker Smoker 2018 MN Adult Tobacco Survey

Dual Use: Cigarettes 60% of high school vapers Conventional E-cigarettes Tobacco use both Minnesota Student Survey, 2016

Dual Use: Marijuana 35% of high school vapers also Marijuana E-cigarettes vaporize cannabis Minnesota Youth Tobacco Survey, 2017

New Tobacco Users

Health Risks of Nicotine

Nicotine Addiction

Minnesota Department of Health Highly addictive Harms brain development during adolescence Harmful to fetal health during pregnancy

The Rise of Vaping

How E-cigarettes Work Mouthpiece Chamber for Heating element liquid nicotine (atomizer) (tank) Optional Button Battery rechargeable or disposable

E-liquids & Flavors Propylene glycol + Vegetable glycerin + Flavoring chemicals + Nicotine (extracted from tobacco)

The Problem with Flavors

Then and Now JUUL Vape

How much nicotine is in one JUUL pod?

JUUL: A New Kind of Nicotine

Nicotine Poisoning / Sickness In large amounts, nicotine is a poison that can cause vomiting, nausea and rapid breathing 60% of high school vapers use In 2014 an eighteen both month old child died after accidentally drinking e-liquid Minnesota Department of Health , 2015.

JUUL: Now & Then 2015 2019

JUUL Teams up with Big Tobacco

FDA Regulations

FDA Regulations

Health Risks of Vaping: What We Know

There are Still Many Unknowns • The harms of cigarettes have a long latency period • E-cigarettes are very new • Huge amount of variation in e- cigarette devices and liquid

EVALI E-cigarette or vaping product use-associated lung injury

From the CDC: Symptoms & Recommendations Symptoms include: Gastrointestinal, respiratory, and non-specific constitutional • symptoms Can develop over a period of days or over several weeks • Recommendations: Ask all patients with symptoms about vaping in a non-judgemental • way Close follow up within 24-48 for outpatient cases • Corticosteroids may be helpful • Influenza testing should be strongly considered • Provide cessation / addiction services • CDC

Early Evidence: Respiratory Health • Increased chronic respiratory illnesses • Hampers mucus clearance from airways • More frequent and severe asthma exacerbations • Aldehydes exposure → acute lung injury, lung disease, and cancer • Vapor disables key protective cells in the lungs and boosts the production of inflammatory chemicals Scott et al., 2018, Chung et al, 2019, NASEM, 2018, McConnell, 2017,

Early Evidence: Cardiovascular Health • Vapor decreases the production of nitric oxide, which contributes to heart and blood vessel damage • Vaping impairs endothelial function, which often precedes cardiovascular diseases • Single use of nicotine-free vape reduced blood flow American Heart Association, 2018, Lee et al., 2019, Caporale et al, 2019

Early Evidence: Carcinogens & Other Harmful Chemicals • E-cigarettes deliver many of the same cancer-causing chemicals that are in cigarettes • Heavy Metals (lead, chromium, nickel) → lung, liver, heart and brain damage • New case study of hard-metal pneumoconiosis • Volatile organic compounds → carcinogen • NNN → oral + esophageal carcinogen Rubinstein, 2018; Salamanca, 2018; Bustamante, 2018, Olmedo et al., 2018

But “nicotine-free” vapes are safe, right?

Vaping, Cessation and the Clinic

Vaping & Tobacco Cessation • E-cigarettes are not approved by the FDA as a cessation device • Mixed research on the efficacy of vaping for cessation • Vaping may interfere with quitting all nicotine NASEM

If Your Patients Vape Educate clients on health • impacts so they can make an informed decision Monitor nicotine intake and • work toward completely quitting nicotine Work toward completely • quitting vaping, regardless of nicotine

Asking the Right Questions Do you JUUL ? Do you vape ? Ask specifically about vaping, in language your patients understand

Assist Counseling + Nicotine Replacement Therapy / Medications = Success

FDA Approved Medications Combination Therapy Examples: Nicotine Nicotine Nicotine Gum inhaler nasal spray Nicotine patch in • combination with short acting NRT Varenicline Bupropion Nicotine Nicotine patch in • ( Chantix ) ( Wellbutrin ) lozenge combination with tablets tablets bupropion Varenicline in • combination with Nicotine short acting NRT patch

Tobacco Treatment Resources Free quit help for all Minnesotans, including phone counseling, email program and nicotine replacement therapy www.quitplan.com

Youth and Young Adult Tobacco Treatment Free texting program and peer support specifically for teens & young adult vapers www.thisisquitting.com

Policies that Protect Kids

Take Action

Questions?