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

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

What do you hear people say about vaping?

E-cigarette Trends

E-cigarette Use by Age

Minnesota Department of Health

6% 22% 26%

Adults Young Adults (18-24) 11th Graders

MN Adult Vapers in 2014

2014 MN Adult Tobacco Survey

12%

Never Smoker

22%

Former Smoker

66%

Current Smoker

MN Adult Vapers in 2018

44%

Never Smoker

19%

Former Smoker

37%

Current Smoker

2018 MN Adult Tobacco Survey

Dual Use: Cigarettes

60% of high school vapers use both

E-cigarettes Conventional Tobacco

Minnesota Student Survey, 2016

Dual Use: Marijuana

35% of high school vapers also vaporize cannabis

E-cigarettes Marijuana

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

Heating element

(atomizer)

Battery

rechargeable or disposable

Chamber for liquid nicotine

(tank)

Mouthpiece Optional Button

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

60% of high school vapers use both

In large amounts, nicotine is a poison that can cause vomiting, nausea and rapid breathing In 2014 an eighteen month old child died after accidentally drinking e-liquid

Minnesota Department of Health , 2015.

JUUL: Now & Then

2019 2015

JUUL Teams up with Big Tobacco

FDA Regulations

FDA Regulations

Health Risks

• f 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

• f nicotine

Asking the Right Questions

Ask specifically about vaping, in language your patients understand

Do you JUUL? Do you vape?

Assist

Counseling + Nicotine Replacement Therapy / Medications = Success

FDA Approved Medications

Nicotine Gum Nicotine lozenge Nicotine patch Nicotine nasal spray Nicotine inhaler Bupropion

(Wellbutrin)

tablets Varenicline (Chantix) tablets Combination Therapy Examples:

• Nicotine patch in

combination with short acting NRT

• Nicotine patch in

combination with bupropion

• Varenicline in

combination with short acting NRT

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?