Great American Smokeout 2019 and  Special Edition: Update on Vaping

Great American Smokeout 2019

With the Great American Smokeout 2019 happening tomorrow, November 21, 2019, this is a useful time to post resources and updates on the topic of smoking and other methods of using nicotine, particularly electronic methods. Last year’s Catalyst blog post from CASAT OnDemand, The Great American Smokeout, provides a great description, the most current Nevada-specific data, and introduces the “new threat” that Electronic Nicotine Delivery Systems (ENDS) posed, not just in Nevada and the United States, but all around the world.

ENDS have been in the news more recently for the disturbing number of deaths and illnesses that have occurred in the population using those methods. E-cigarettes, E-cigs, E-hookah, Vape sticks, and Vape pens are just a few of the terms associated with what is commonly called vaping, the use of battery powered electric cigarettes or portable vaporizers to deliver nicotine and other additives in aerosol form into the lungs (Cullen, et al., 2018). The existence of such a variety of slang terms provides a hint of how pervasive the custom of vaping is becoming. A unique subculture has emerged from the practice, and some of the terms used by its members help to reinforce the idea of vaping as trendy, fashionable, cool, and current. In fact, analog has become the new slang term for a regular cigarette, inferring that inhaling tobacco through the use of cigarettes is old-fashioned and out of date…or…analog.  Cigarette smoking is out, and vaping is in, especially among youth.

Vaping Data Update

A recent study of 19,018 high school and middle school students that was published in the Journal of the American Medical Association online on November 5, 2019 asked “What is the estimated prevalence of the current (past 30-day) use of e-cigarettes among US high school and middle school students in 2019?” (Cullen, et al., 2019). The National Youth Tobacco Survey (NYTS) study found that the prevalence of self-reported current (past 30-day) use of e-cigarettes was 27.5% among high school students and 10.5% among middle school students. That amounts to nearly 3 in 10 high schoolers and 1 in 10 middle schoolers. The conclusion was that not only was vaping frequent among students who used e-cigarettes, but:

• 6% of high schoolers and 65.4% of middle schoolers used e-cigarettes exclusively;
• JUUL was the brand used by 59.1% of high school students and 54.1% of middle school students;
• And, “an estimated 72.2%(95%CI, 69.1%-75.1%) of high school students and 59.2%(95%CI, 54.8%-63.4%) of middle school students used flavored e-cigarettes, with fruit, menthol or mint, and candy, desserts, or other sweets being the most commonly reported flavors” (Cullen, et al., 2019).

These results represent the most current findings, and are perhaps the most alarming of the longitudinal prevalence results of the NYTS from 2011-2018, with a change from a paper and pencil survey to an online survey in 2019. What makes these longitudinal data so alarming is that while overall tobacco use declined dramatically between 2015 and 2017, it has risen rapidly-almost doubled, according to the University of Michigan’s Monitoring the Future (MTF) survey- since then, particularly among high schoolers (Meich, et al., 2019). And although the use of regular cigarettes declined, the rise in use of ENDS has led to an overall increase in nicotine use during early adolescence, exposing those youth to harm to developing brains, negative impact on learning, memory, and attention, and increase the risk of addiction to nicotine and other drugs later in life (Cullen, et al., 2019). The National Youth Tobacco Survey is part of an effort by the Centers for Diseases Control (CDC) to gather nationally representative data about the youth in our country and their tobacco beliefs, attitudes, behaviors as well as their exposure to both pro- and anti- tobacco influences. These findings help meet selected Healthy People 2020 goals for reducing tobacco use among youth. These data are available for download for public use and for states to compare estimates of prevalence of youth tobacco use with national data.

To add to the severity of the issue as a public health concern, AmeriSpeak® Spotlight on Health survey from NORC at the University of Chicago found some data that can provide perspective on the alarming prevalence data. According to the survey results, Americans are concerned about the idea of teens developing addiction to ENDS and would support increased regulation, including:

• Regulation of e-cigarette advertising targeting teens (78%)
• Limiting the quantity of nicotine in e-cigarettes (73%)
• Raising the age for purchasing both e-cigarettes and tobacco products (69%)
• Limiting the sales of flavored liquids for use in e-cigarettes

Findings also included the belief by most adults that ENDS enable both youth and adults to begin smoking and access to them should be curtailed. Only 21 percent of adults surveyed understood that ENDS contain more nicotine than traditional cigarettes, and 26 percent believed the amount was the same in both delivery methods. self-funded poll was conducted between February 14 and 18, 2019, during a monthly Omnibus survey. It included 1,004 interviews with a nationally representative sample (margin of error +/- 4.12 percent) of adult Americans age 18+ using the AmeriSpeak® Panel. AmeriSpeak® is NORC’s probability-based panel designed to be representative of the U.S. household population. A comprehensive listing of all study questions, tabulations of top-level results for each question, and detailed methodology is available on this page.

Vaping Related Pulmonary Illness

A Preliminary Report for pulmonary illness related to e-cigarette use in Illinois and Wisconsin was published in 2019 that identified 53 patients who had used ENDS or related products in the 90 days prior to developing lung symptoms (Layden, et al., 2019). In the report, it discussed case reports describing a wide range of pulmonary illnesses after use of ENDS to deliver tobacco and/or cannabis extracts. In July 2019 the Wisconsin Department of Health Services (WDHS) and the Illinois department of Public Health (IDPH) began receiving reports of pulmonary diseases associated with e-cigarette use. The ongoing resulting investigation is described in detail with no product or substance identified as being the cause.

Because of the resulting investigation which began in August of 2019 by the Food and Drug Administration (FDA) and the CDC, and the lack of knowledge as to the cause of the vaping related illness, on August 30, 2019 the CDC issued an Official Health Advisory about severe pulmonary disease associated with using e-cigarette products. On October 4, 2019, the FDA released a consumer warning for people to stop using THC products in ENDS. Then on October 11, 2019 the CDC released a morbidity and Mortality Weekly Report: Update: Interim Guidance for Health Care Providers Evaluating and Caring for Patients with Suspected E-cigarette, or Vaping, Product Use Associated Lung Injury — United States, October 2019.

EVALI

The current CDC web page For Healthcare Providers contains updated guidance based on the most recent results of the investigation into the cause of EVALI (which stands for “e-cigarette, or vaping, product use associated lung injury”). The CDC has found that vitamin E acetate is a chemical of concern among those with EVALI due to laboratory testing of fluid samples from the lungs of 29 patients from 10 states being found to contain vitamin E acetate, although a causal link has not been identified and other chemicals of concern have yet to be identified. According to the CDC web page Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products, the CDC recommends the following:

• Do not use THC-containing products in ENDS
• Do not purchase and ENDS devices or products, or any containing THC, from “informal” sources or online dealers
• Do not modify or add other substances to ENDS
• Adults should not go back to smoking, but should consider only FDA-approved nicotine replacement therapies
• ENDS and products for them should not be used by youth, young adults, or pregnant women

For a complete list of Do’s and Don’ts and key facts about e-cigarettes or vaping products and about vitamin E acetate, visit the CDC Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products web page.

In addition to data and statistics, the CDC also provides many state and community resources to promote effective tobacco prevention and control programs. Cessation materials may be found on their Quit Smoking web page, and the CDC Multimedia & Tools site contains tobacco-related infographics, print materials, and shareable media, such as videos and buttons. The National Institute on Drug Abuse (NIDA) of the National Institutes of Health (NIH) also maintains a data page Monitoring the Future Survey: High School and Youth Trends with data links and an analysis of the most recent vaping increase data among youth in the U.S.

Please access the following resources for the Great American Smokeout and ENDS information:

The Great American Smokeout®

The Nevada Tobacco Prevention Coalition

Tobacco Education Clearinghouse of California

CASAT OnDemand Resources & Downloads

Join the conversation: Do you have tobacco or ENDS resources that you find useful to share? How do you observe the Great American Smokeout?

References

Cullen KA, Gentzke AS, Sawdey MD, et al. e-Cigarette Use Among Youth in the United States, 2019. JAMA. Published online November 05, 2019. doi:https://doi-org.unr.idm.oclc.org/10.1001/jama.2019.18387

Cullen KA, Ambrose BK, Gentzke AS, Apelberg BJ, Jamal A, King BA. Notes from the Field: Use of Electronic Cigarettes and Any Tobacco Product Among Middle and High School Students — United States, 2011–2018. MMWR Morb Mortal Wkly Rep 2018;67:1276–1277. DOI: http://dx.doi.org/10.15585/mmwr.mm6745a5

Layden, J. E., Ghinai, I., Pray, I., Kimball, A., Layer, M., Tenforde, M., . . . Meiman, J. (2019). Pulmonary illness related to E-cigarette use in illinois and wisconsin – preliminary report. The New England Journal of Medicine, doi:10.1056/NEJMoa1911614

Miech RA, Johnston L, O’Malley PM, Bachman JG, Schulenberg JE, Patrick ME. Monitoring the Future national survey results on drug use, 1975–2018: volume I, secondary school students. Ann Arbor: Institute for Social Research, University of Michigan, 2019 (https://www.drugabuse.gov/publications/drugfacts/monitoring-future-survey-high-school-youth-trends).

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