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The Latest on Vaping, Signs of JUULing and Vaping and How to Talk With Your Child

Updated: Jan 29


WHAT'S NEW ON VAPING?

Although e-cigarettes began flooding the U.S. market about 12 years ago, they were not popular with adolescents until just a few years ago. In our 2016 newsletter, BTI reported that vaping and particularly "JUULING" (the verb for using JUUL e-cigarettes - pronounced "jeweling") was just beginning to become popular in our high schools. Since then, JUULING by adolescents across the United States has exploded, resulting in a national epidemic. Big Tobacco is cashing in, acquiring stakes in JUUL Labs and other vaping companies and the FDA, state and local regulators are trying to catch up. Meanwhile, youth vaping rates continue to increase each year.

Adolescent Vaping Rates have Doubled for Past 30-day Use in the Past Year. In December 2018, the University of Michigan's annual Monitoring the Future national survey, sponsored by the National Institute on Drug Abuse, reported the largest annual spike in the

survey's 44-year old history of studying the use of any substance. The study found that over 37% of high school seniors had tried vaping, a 10% increase from a year before. And nearly 21% of seniors reported recently vaping in the past 30 days, compared with 11% in 2017 - doubling in just a year.

Rates for younger kids also dramatically jumped on a national level, doubling from 8% to 16% for 10th graders in the past 30 days, another record setter as the largest percentage increase ever for this age group. Adolescent use has also spread to middle schools, with 10% of 8th graders reporting vaping in the past year.

This all has translated in 1.3 million additional U.S. middle and high school students vaping in 2018 than in 2017.

California. At the local level, the 2017-18 California Healthy Kid Survey (CHKS) results show similarly alarming increases. In Marin County, adolescent vaping rates are even higher than national rates. Of the 11th graders in Marin surveyed, 47% reported that they had tried

vaping, a significant increase from 39% in the CHKS 2015-16 results. Past 30 day use more than doubled in all grades surveyed: from 11% to 28% for 11th graders, from 9% to 20% for 9th graders and from 2% to 5% for 7th graders. It also should be noted that marijuana rates also increased for 7th, 9th, and 11th graders for both lifetime and past 30-day use since legalization in California. CHKS results can be viewed on our website here.

Colorado. In Colorado, vaping rates are also higher than they are nationally for past 30-day use. The 2017 Healthy Kids Colorado Survey (HKCS) results show that past 30-day rates are 18.5% for 9th graders, 25.3% for 10th graders, 31.7% for 11th graders and 33.6% for 12th graders. HKCS results can be viewed on our website here.

Addiction. What is not reflected in this data are the large numbers of youth who have become addicted to vaping, some of whom cannot make it through an entire class without asking to be excused for a bathroom visit to get a fix. See this New York Times article entitled "Addicted to Vaped Nicotine Teenagers Have No Clear Path to Quitting", which features Redwood High School Teacher Jon Hirsch and other professionals discussing students' vaping addictions.

The Nicotine Vaping Industry

JUUL Labs. A JUUL is a long slim vaping device that looks less like an e-cigarette or pen and more like a USB flash drive or cell phone. It is a rectangular prism with a hole for a capsule which also acts as a mouthpiece at one end. It has a charging dock that plugs into a USB port and it takes only about an hour to charge off a computer. Some call it the "iPhone of vapes" because of its sleek and minimalistic design. Introduced by PAX Labs in 2015, the JUUL is by far the most popular nicotine vaping product in the U.S. JUUL Labs was spun off from PAX Labs in 2017, and by September 2018, JUUL had cornered 72% of the U.S. market share.

Not surprisingly, Big Tobacco has gotten in on the action with Altria (formerly Philip Morris) acquiring a 35% stake in JUUL for $12.8 billion in December 2018.

Altria makes Marlboro, Parliament and Virginia Slims cigarettes, as well as the Mark Ten e-

cigarette. JUUL is now valued at $38 billion and had over $1 billion in revenues in 2018, up from approximately $245 million in 2017. It is bigger than companies such as Ford Motor Company, Delta Airlines and Target. And it now has access to Altria's expansive distribution network and extensive legal resources.

Other vape pens with a far less U.S. market share are Vuse (owned by RJ Reynolds, the maker of Camel and Newport cigarettes), Blu (owned by Imperial Brands) and Logic (owned by Japan Tobacco International which has the largest e-cigarette market share in the world). Juul has also inspired a flood of imitators.

JUUL has been criticized for targeting youth by its flavors, slim design, eye-catching colors and intensive marketing via Instagram, YouTube and other social media with young models and imagery appealing to young people, such as JUUL users dancing. Bowing to FDA and public pressure, in November 2018, JUUL announced it would stop accepting JUUL pod retail orders for flavors such Mango, Fruit Medley, Creme Brûlée, and Cool Cucumber.

However, JUUL continues to sell Classic Mint (its most popular flavor, especially with youth), Classic Tobacco, and Classic Menthol flavored pods in retail stores. Moreover, Internet sales have continued, although JUUL did also shut down its Instagram and Facebook accounts. In January 2019, JUUL announced a $10 million ad campaign targeting current adult cigarette smokers in an attempt to rebrand as a product for cigarette smokers to switch. But the damage has been done to youth, many of whom quickly have become addicted. And other companies manufacture "JUUL-compatible" pods in additional flavors.

There are also companies that produce JUUL "wraps" or "skins" which are decals that wrap around the JUUL device and allow users to customize their device with unique colors and patterns (which make an appealing way for younger users to disguise their device).

Following a page from Big Tobacco's playbook, JUUL began efforts in 2018 to expand internationally beyond the U.S., having entered markets in Israel (only to be banned although JUUL is appealing), the United Kingdom and Canada so far. Ninety percent of its sales are made at retail stores such as vape shops, gas stations and convenience stores.

Although a JUUL can be used to vape cannabis by hacking the product to use it with THC oils, Pax Labs already has a product that needs no hacking, the Pax 3, described below.

More on JUULING

JUUL's High Nicotine Levels​. Each JUUL pack of e-juice contains four "pods". One JUUL pod is approximately equivalent to at least one (some say 1 1/2) pack of cigarettes or 200 puffs. Of particular concern is that JUULs can accommodate an especially high nicotine strength, which is more addictive. This is because of its use of nicotine salts found in the tobacco leaf rather than free-base nicotine commonly used in e-juices by other manufacturers, as well as its juice chemistry and delivery system. The 5% concentration of nicotine in each JUUL pod is approximately twice that of many other e-juice nicotine concentrations of other brands of 2.4%. It gives users a strong, fast punch and head rush. JUUL's nicotine salts are said to emit a taste and sensation similar to conventional cigarettes, unlike other e-cigarettes.

Despite these high nicotine levels, an April 2018 national study from the Truth Initiative found that 63% of 15-24 year olds JUUL users did not know whether the product contained nicotine. In a study sponsored by the National Institute on Drug Abuse, when high schoolers were asked what they believed was in the last product they vaped, most said "just flavoring".

Also of concern is that JUULs contain extremely high amounts of diacetyl, the "popcorn lung" chemical discussed in our Blog on "Health Effects and Risks of Vaping".

Stealthy Use. JUULs do not emit voluminous vapors unlike many other brands of e-cigarettes. And the vapor quickly dissipates. This allows teens to easily conceal their vaping and take quick discreet hits at home, in school hallways and bathrooms and even in class (e.g., the "cloud" can be hidden by breathing into a sleeve).

When not hiding their use, many adolescents enjoy vaping trips. The term "Ghosting" used by youth happens when a user inhales and holds the vapor in his mouth until it is swallowed. This means the chemicals in the aerosol not only go through the respiratory tract but the digestive track as well.

The term "Getting Domed" results from breathing in such high intensity nicotine that it causes toxicity in the blood system.

A JUUL starter kit package with the device, four JUUL pods and a charger sells for $49.99 with free delivery.

For more information on JUULs, read this Tobacco-Free Kids Fact Sheet.

Vaping and "Dabbing" Cannabis through Vape and Dab Pens

There is a wide array of cannabis concentrates and extracts which can be smoked through vape and dab pens. These concentrates include liquids, oils, waxes, and other substances. The landscape is always evolving, along with the terminology, and it can all be very confusing. Basically, concentrates can be smoked either in liquid form, such as tinctures and oils, through Vape Pens or in wax form through Dab Pens (sometimes called Wax Pens).

There are two ways to create concentrates, either through chemical solvent (such as butane) or non-solvent (water, temperature and pressure) methods of extraction. Waxes are solvent products and resemble candle wax. There are numerous variations such as Budder, Badder,

Crumble, and Honeycomb. Shatter is a solid substance that when dabbed "shatters" into pieces. Taffy (or Pull and Snap) is similar to Shatter but when pulled it resembles taffy. A Distillate is a honey liquid, used in edibles and vape cartridges and Crystalline are clear crystals. Tinctures are green liquids and Oils are thicker than tinctures. THC Oil is an extracted resin from the female cannabis plant which is dissolved in alcohol. When the alcohol evaporates, a thick syrupy residue results.

Concentrates have one thing in common and that is they have extremely high levels of THC, usually between 60-90% (although Crystalline can be especially potent and up to 99% THC). The high comes on stronger and quicker. This is compared to much lower THC levels in smoked cannabis, which generally max out at 25-30% (and of course the even lower potency levels of 5% THC in the smoked marijuana of the 1960's-'90's).

Before dab pens, it was more common to dab waxes using a dab rig (essentially a bong with a nail instead of a bowl) and superheating the titanium, quartz or ceramic nail with a butane blow torch, then touching ("dabbing") and dropping the wax onto the nail, letting it vaporize, ultimately inhaling the vapor through a mouthpiece of the rig.

Now "dabbing" can be done through a dab pen, which involves inhaling fumes from a heated capsule of THC. The pre-filled disposable THC capsules or cartridges (referred to as

"carts") in dab pens make dabbing considerably less dangerous and involved than using a butane blow torch.

Like nicotine vape pens, cannabis vape pens and dab pens are easy to hide, odorless and aggressively marketed to kids on Instagram and resold by kids on SnapChat Marketplace. The dabbing cartridges or "carts" have brand names like "Mario Carts", "Mac Dre", Warheads", "Supreme" and "Off W".

There is also booming market for cheap counterfeit carts from China which may be purchased off the internet or from dealers in the black market. These can contain dangerous substances such as pesticide-ridden distillate, heavily cut oils, synthetic cannabis, meth and fentanyl designed to mimic cannabis.

PAX Labs. No discussion of Vaping would be complete without returning to PAX Labs, the makers of JUUL. Founded in 2007, although PAX Labs has spun off JUUL, the company continues to grow in its own right as a well-known brand for vaping marijuana. Like the JUUL,

the Pax 3 is described as the "Apple IPhone" of vaporizers and it allows users to vape both dry leaf and wax concentrates. It even includes a free Android or iOS app to control temperature and play free games. Not surprisingly, a complete Pax 3 kit does not come cheap and sells for $249.99.

Less pricey options are of course readily available. For example, a cannabis delivery company called EAZE sells disposable all-in-one marijuana vape pens and cartridges. Flavors include Blueberry Kush, Lemon OG and Mango Passion Fruit. Marketed as wellness products, the advertising reads "Hello Marijuana, Goodbye Hangover" or "Hello Marijuana, Goodbye Insomnia".

As a Rolling Stone magazine article summed it up, vape and dab pens have become the preferred method of "on-the-go" consumption of concentrated cannabis.

A Note on Cigarette Use. As detailed in our Blog, there is increasing evidence that vaping leads to cigarette use, according to recent studies. We have anecdotal evidence of cigarette butts in our local high school parking lots, something that was not seen before.

Additionally, we have seen evidence that while JUULing is especially popular with adolescents in more affluent areas, flavored cigarillos, which are mini cigars, marketed by the usual Big Tobacco suspects, are popular in middle to lower income schools. They are significantly cheaper than JUULs and other e-cigarettes and can sell for around $1.29 for two packs.

Combining Cannabis with Tobacco: Spliffs and Mokes. Finally, another common practice is to combine tobacco and cannabis. A "spliff" is a joint rolled with a mixture

of tobacco and cannabis and a "moke" involves a bong or water pipe with tobacco and cannabis. Dual use (of cannabis and tobacco) with these products increases the likelihood of future use of another. This mixture produces its own high: tobacco increases the vaporization efficiency creating more available THC so that the user feels the effects of cannabis more quickly. This results in a special kind of head rush with the tobacco stimulating adrenaline production.

SIGNS THAT YOUR TEEN MAY BE VAPING Vapes or e-cigarettes are composed of a liquid cartridge, an atomizer, a rechargeable battery and a mouthpiece. The liquid cartridge is the flavored part of the pen used to create vapor; it is also the part of the pen that typically contains nicotine. The atomizer heats the pen when the user inhales and is charged by the battery. Here are some subtle signs that your teenager might be vaping:

  • Fruity Aroma. E-cigarettes don't smell like smoke from combusting tobacco. Instead, most e-liquids have flavors that usually smell pleasant like candy, mint, vanilla, fruit punch, etc. If you catch a sudden whiff of any of these aromas, but none of them is around, consider this a red flag.

  • Unfamiliar Handheld Gadgets. E-cigarettes come in various shapes, from cig-a-likes to box mods. However, as described, the JUUL resembles a flash drive. If you see such a gadget or pen that isn't a pen or flash drive, be aware that it could be a vaporizer. The easiest way to spot such a device is to look for holes on each end of the device.

  • Batteries and Chargers. Just like you have to charge your smartphone every day,

vaporizers need to be charged on a regular basis. While some e-cigarettes (including JUULS) can be charged by a USB cable, some the other e-cigs like box mods require batteries. If you see unfamiliar batteries on the charger, take a look around and you might find a vaping device.

  • Metallic Wires and Cotton Wicks. If you find cotton, empty plastic vials or thin metallic coils lying in your child's room, this is another red flag.

  • Discarded Atomizers. The atomizers are a vital part of e-cigs as they turn e-juice into vapor. However, some of these are disposable and after a while they burn out. If you come across a discarded atomizer in your kids' trashcan, it's a clear indication that he/she has been vaping.

  • Health Issues. Signs of general e-cigarette use include increased thirst (the propylene glycol in the devices can because dry mouth), a persistent cough, bronchitis, congestion, phlegm, a new sensitivity to caffeine and possible nosebleeds.

  • Withdrawal Symptoms, described in our Blog entitled "Health Effects and Risks of Vaping".

HOW TO TALK WITH YOUR TEEN ABOUT VAPING (and other topics) Before you discuss vaping with your teen, it is best to familiarize yourself with the topic, including the health risks to adolescents. However, the research consistently shows that having good information doesn't necessarily lead to making wise choices. Adolescents (and adults) often act in a way they know to be unhealthy. While we should ensure that our teens are aware of the facts about all risky behaviors, we should not assume that simply dropping information on a teen, especially as a way to jumpstart a conversation, will achieve your goal. Be Curious and Get Their Perspective. Instead of leading with facts, start with genuine curiosity and open ended questions without sounding judgmental, Ask questions like "What do

you think about e-cigarettes?" or "Are a lot of kids vaping?" or "Hey, I just read about this thing called a JUUL. What have you heard about it?" Finding out what your teen already knows and thinks about vaping will determine how the rest of the exchange might proceed. If your teen wrinkles her nose and says, "I tried it and didn't like it", you're going to have a different conversation than if she responds "Lots of kids are doing it and its not a big deal". Asking teens what they know about a topic increases the chances that they will want to hear what we know about that topic too. To get our teens to take our concerns seriously, its best to recognize that their first hand experience or observation of others may have led to their own conclusions already. Also, acknowledging the allure of vaping (e.g, the stimulant quality of nicotine, the thrill of defying authority, fitting in with their crowd, the desire to sample tempting flavors, or try tricks done with exhaled vapor) makes it easier for parents to give their opinion. Share your Concerns. Teens can be quick to tune out adults when we treat all risky behaviors the same. We may point out that while experimenting with conventional e-cigarettes is less harmful than experimenting with other illegal drugs, it is not without its risks. The biggest risk is that nicotine is highly addictive and the developing brain is a lot more susceptible

to addiction. And even if you don't get hooked, we can warn them that it can affect the way the brain is developing (see this Blog). Other serious health risks of e-cigarettes include lung problems, discussed in our Blog. Even vaping solutions without nicotine sometimes contain compounds that may become toxic or even carcinogenic when vaporized. See below for effects of known chemicals in flavorings. In addition, metal micro particles that are released by the e-cigarette's heating coils can put kids at risk for reactive airway disease, asthma and even emphysema. Point out that there is still a lot we don't know yet as to the long-term impact of inhaling chemicals and metal particles. Acknowledge your Teen's Autonomy and the Limits of Your Power. State your expectations (e.g., "vaping isn't harmless so I hope you will stay away from it") but concede that you don't have the power to make your teen's decisions for them and they must make those choices themselves. You can add that "if we find out you are vaping, there will be consequences." Discuss your Childhood Environment. Teens like hearing about their parents' personal experiences. While it is not wise to overshare or tell war stories, it is helpful to get their attention by sharing the environment you navigated as a teen and comparing and contrasting it to theirs. These communication tips apply not only to vaping but to discussing alcohol, marijuana and other drugs as well as other risky behaviors. The bottom line? Our kids care what we think and take fewer risks when we keep the lines of communication open. We increase our chances that they will listen if we talk with them, not lecture at them.

Source: New York Times, How to Talk with Teenagers About Vaping.


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