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What do you know about these products???

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Slide for Warm up Activity and Introduction�

Activity guide for facilitator:

What comes to mind when you hear these words? Vaping, E-Cigarettes, Cigarettes

Ask the group to shout out what the words “vaping,” “e-cigarette,” and “regular cigarette” mean to them going through each word one by one starting with the word vaping.
It’s helpful to ask students to elaborate. For example, if one says “Vape tricks” probe “What do you mean by vape tricks?” What are types of vape tricks? Probing questions such as “who uses vapes? What do they smell like? Where do you see them?

Define “regular cigarettes” for the group.

The official term is “combustible cigarettes.”
We will just call them “regular cigarettes” in the lesson plan.

Group Discussion after brainstorm:

Ask students: What is the “vibe” of each brainstorm?

- (You will likely see a theme of positive, fun, young people with vaping, little or confused understanding of what e-cigs are, and robust negative responses such as “cancer, “and negative themes around “cigarettes.”)

Ask: What’s the difference between these products? Similarities?

- Ask students to compare how they reacted to each product and what similarities and differences they noticed describing the three products.
- Similarities: These are all tobacco products. Vaping and e-cigs are same product marketed to different audiences. Juul, Smok, PuffBar, Loon, Esco, Elf Bar, etc. are all types of e-cigarettes.
- They all contain some form of nicotine. (Note that some e-juice claims to contain 0 mg. Nicotine but we will discuss all of the chemicals in e-liquid in slides.)

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What’s in an e-cigarette? �(And are there any health harms from inhaling this stuff?)

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67 known chemicals

Vape aerosol contains many of the same CANCER-CAUSING CHEMICALS that are in cigarettes, like formaldehyde, heavy metals like lead, and ultrafine particles.

Thousands of unknown chemicals�

“We don’t even know what they are,”.... They’re not even in the normal list of chemicals that we can quantify or name in the lab, and these are going directly into the lungs of people that are vaping.” - 2021 study co-author and John Hopkins assistant professor Ana Rule

Slide 2 for “What is in an e-cigarette?” discussion

Talking points for facilitator:

Almost all vape liquids contain nicotine, and we are going to talk in detail about nicotine. But first, let’s look at all of the other chemicals that we know are in e-liquid.
Besides nicotine, e-cigarette aerosol can contain cancer-causing chemicals, heavy metals, and ultrafine particles that can be inhaled deeply into the lungs and harm your body.
There are 67 known chemicals in vape aerosol and thousands of unknown chemicals (read quote).
And even though e-cigarette aerosol generally contains fewer harmful chemicals than regular cigarettes, safer doesn’t mean safe.
This applies to both people using e-cigarettes, as well as people who may be exposed to secondhand aerosol (the “white cloud of smoke/vape” the user exhales) from other people using e-cigarettes.

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E-cigarette Aerosol Composition

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Propylene glycol
Glycerin
Flavorings (many)
Nicotine
NNN
NNK
NAB
NAT
Ethylbenzene
Benzene
Xylene
Toluene
Acetaldehyde
Formaldehyde
Naphthalene
Styrene
Benzo(b)fluoranthene

Cadmium
Silicon
Lithium
Lead
Magnesium
Manganese
Potassium
Titanium
Zinc
Zirconium
Calcium
Iron
Sulfur
Vanadium
Cobalt
Rubidium

Benzo(ghi)perylene
Acetone
Acrolein
Silver
Nickel
Tin
Sodium
Strontium
Barium
Aluminum
Chromium
Boron
Copper
Selenium
Arsenic
Nitrosamines,
Polycyclic aromatic hydrocarbons

Chlorobenzene
Crotonaldehyde
Propionaldehyde
Benzaldehyde
Valeric acid
Hexanal
Fluorine
Anthracene
Pyrene
Acenaphthylene
Acenapthene
Fluoranthene
Benz(a)anthracene
Chrysene
Retene
Benzo(a)pyrene
Indeno(1,2,3-cd)pyrene

All of these have been found in e-cig aerosol

Med.Stanford.edu/tobaccopreventiontoolkit

Compounds in yellow are from FDA 2012, Harmful and Potentially Harmful Substances – Established List

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E-cigarette Aerosol Composition

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Med.Stanford.edu/tobaccopreventiontoolkit

Propylene glycol
Glycerin
Flavorings (many)
Nicotine
NNN
NNK
NAB
NAT
Ethylbenzene
Benzene
Xylene
Toluene
Acetaldehyde
Formaldehyde
Naphthalene
Styrene
Benzo(b)fluoranthene

Cadmium
Silicon
Lithium
Lead
Magnesium
Manganese
Potassium
Titanium
Zinc
Zirconium
Calcium
Iron
Sulfur
Vanadium
Cobalt
Rubidium

Benzo(ghi)perylene
Acetone
Acrolein
Silver
Nickel
Tin
Sodium
Strontium
Barium
Aluminum
Chromium
Boron
Copper
Selenium
Arsenic
Nitrosamines,
Polycyclic aromatic hydrocarbons

Chlorobenzene
Crotonaldehyde
Propionaldehyde
Benzaldehyde
Valeric acid
Hexanal
Fluorine
Anthracene
Pyrene
Acenaphthylene
Acenapthene
Fluoranthene
Benz(a)anthracene
Chrysene
Retene
Benzo(a)pyrene
Indeno(1,2,3-cd)pyrene

Compounds in yellow are from FDA 2012, Harmful and Potentially Harmful Substances – Established List

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Propylene glycol - main ingredient in most vapes

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Slide 6 for “What is in an e-cigarette?” discussion

prow·puh·leen glai·kaal - Click through photos on slide.

Talking points for facilitator:

Propylene glycol is a colorless and odorless liquid created from petroleum.
Propylene glycol is one of the main ingredients in all e-liquid because it produces vapor when heated.
It’s approved by the FDA to put on your skin -It’s in many lotions, shaving cream and soaps and to eat - [click] it’s in food coloring, cough medicine, cool whip and [click] it’s also in antifreeze for your car, but of course you wouldn’t eat or use antifreeze to wash your hands.It’s an effective humectant (keeps things moist), solvent (you can dissolve things in it) and preservative (keeps things from decomposing)
BUT, when heated and vaped, propylene glycol changes… (go to next slide)

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What happens to propylene glycol (hint: it’s a liquid) when it’s heated?

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Image from: DontTakeTheVape.org.

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Chemicals used to create vape flavors can damage the lungs, regardless of nicotine content.

Breathing in flavored e-liquids can damage your lungs by killing cells and blocking the ability to clear away bacteria.

Chocolate and banana flavors were found to be the most

damaging to the lungs.�

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Macrophages - the body’s street sweeper for the lungs

Slide 9 for “What is in an e-cigarette?” discussion

Talking points for facilitator:

Flavoring chemicals can damage the lungs, regardless of nicotine content.
Nearly all e-cigarette liquids are flavored. To create these flavors, companies add multiple chemicals to get the flavors they make. It’s not strawberries that make strawberry vape smell and taste like strawberries!
A 2020 study found that these chemicals can be toxic to the lungs.
When inhaled, they affect macrophages (ma·krow·fay·jiz) which help keep the body's immune system on track and clear away bacteria.
Macrophages are like street sweepers for the lungs, they are powerful immune cells that continuously clear away inhaled bacteria and other foreign matter that enters the lungs.
The study showed chocolate and banana flavors, in particular, were the most damaging to the lungs.

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Nicotine

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Some disposable vapes have even higher levels of nicotine

For Example:

Newer disposable vapes can�exceed

= 300 mg of nicotine

or 300 cigarettes

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�“Nic sick” - Symptoms of Nicotine Poisoning from Vaping

“I've currently been experiencing feelings of nic sick. I would describe it as the worst nausea, the worst headache, dizziness; I felt like I was going to faint,"

– Blaine, MN High School Junior describing her addiction to e-cigarettes.

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��Nicotine and your Brain

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•Adolescence is a critical period of brain development.

•The “risk taking/pleasure” part develops before the “judgement” part.

•No amount of nicotine is safe for youth.

•Nicotine is highly addictive.�

•Youth exposed to nicotine are more likely to use other substances.

Slide 5 for Nicotine Harms discussion

Talking points for facilitator:

We are going to talk about nicotine’s impact on the adolescent brain:

Ask: Does anyone know what age your brain is fully developed?
Answer: 25
Adolescence is a critical period of brain development.
The brain develops from bottom up, both physically and functionally. The emotional part and rational part of your brain aren’t synced up yet. This is something that develops over time and is super hard for adults throughout their lives, and even more difficult as a teen when you haven’t experienced having to make smart choices when emotions are high.
Taking risks as a teen is a normal part of development. But you have the power to decide which risks you are willing to take with your body, and gathering factual information can help you make informed decisions when you are tempted to make an impulsive choice that may have serious consequences.
Ask: What is the impact of nicotine on the brain?
Answer: No amount of nicotine is safe. Nicotine can interfere with brain development and can have long-term effects on cognitive development (thinking) and mental health.
Nicotine is highly addictive. Because their brains are still developing, adolescents can become addicted to nicotine more easily than adults. Especially with vape products that have such high levels of nicotine that were shared in previous slides. The more nicotine in a vape product, the more addictive a person can become to it. Nicotine increases risk of smoking conventional cigarettes and youth are more likely to use other substances.
Ask: What does addictive mean?
Answer:That means that once you use it, your body will continue to want more. People with an addiction will feel a compelling need to use a drug which can be alcohol, the nicotine in tobacco, or an illegal chemical such as cocaine or heroin, even when the user knows that doing so risks severe health or legal consequences.

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How much nicotine e-liquid would a small child or pet need to swallow to cause severe harm or death?

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Photo credits: www.medscape.com, https://truthinitiative.org

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�Why do teens vape?

In one or two words:

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What stresses you out?

What’s one of your favorite ways to cope with stress?

Turn and talk activity

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Vaping & Stress

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FACT: Vaping doesn't reduce stress, and nicotine can make the stress you �already feel worse.

Slide 3 for “Why Do Teens Vape” discussion

Talking points for facilitator:

Many young people vape because they believe it makes them feel less stressed out. Actually, the nicotine in vapes makes the stress you already feel worse.
When you vape or smoke, nicotine is sent to your brain. It attaches to nicotine receptors and releases a chemical called dopamine. This triggers a rewarding effect on the brain. But because the inhaled nicotine creates this immediate, huge hit of dopamine, continued use (it doesn’t take that long) can lead to addiction, and other harms like disrupting your sleep, and increasing depression and suicidal thoughts.
Drugs such as cocaine, nicotine and heroin cause huge boosts in dopamine. The “high” people feel when they use drugs comes partly from that dopamine spike. And that prompts people to seek out those drugs again and again — even though they are harmful because their brain is telling them they need more of this chemical to trigger their reward center in their brain.
Studies show that youth who become dependent on nicotine have more stress the more they use it. When a person becomes addicted to nicotine, they get irritated when their nicotine levels are low, and they need to inhale the nicotine to remain feeling normal.
Our brains also release dopamine naturally and increasing our dopamine levels naturally is important for our health. We can increase our dopamine levels with activities like exercise, meditation, sleep, listening to music and eating certain foods. Activities that you all just described as your favorite ways you cope with stress. Increasing dopamine levels naturally has been shown to improve mood, reduce stress and help with focus and concentration. Finding ways to cope with stress, is no easy challenge, but the more you can introduce stress-relieving practices into your everyday lifestyle, the more you’ll be prepared to care for your body during times of increased stress.

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I vape and I can’t stop. Now what?

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Nicotine addiction is a medical condition. Many teens who vape may already be addicted to nicotine so simply telling them to stop probably won’t work.

Studies have shown that nicotine is just as addictive as heroin.

When it becomes “not an option to stop vaping.”

– 11^th grade high school student from MN who became addicted to Juul.

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Available for Minnesota youth: My Life, My Quit

Available to youth ages 13-17�
Youth may enroll without parental consent�
5 coaching sessions through text to chat, online chat,

and phone calls, as well as youth-specific materials. �

Youth under the age of 18 will not be able to get nicotine �replacement therapy (NRT).�
Text “Start My Quit” to 855-891-9989 or call to talk with a coach �who is ready to listen and cheer you on

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Slide 7 for “Why Do Teens Vape” discussion

Talking points for facilitator:

The best quit vaping tool is never starting in the first place. There is no quick and easy fix to a nicotine addiction. We are not here to judge, we are not here to make you feel bad. If you do vape and you want to quit, we want to help you find resources that can help you.
Talk to a trusted adult – When you have a problem or something is going wrong in your life, again, think about who you would turn to for help.
It can be hard to start a conversation that you need help. We don’t want to disappoint the people in our lives who we look up to. But, the trusted adults in your life- school guidance counselor, parent, teacher, coaches – care about you and can support you.
There are also quit vaping tools and resources for teens. My Life, My Quit supports teens ages 13-17 in MN who are trying to quit nicotine, including vaping, smoking, and chewing.

It was created with the help of youth and makes it easy to text or call a coach. Individuals who sign up for this program will receive:

Confidential help through up to five coaching sessions with a real live coach and
Youth-specific support materials

Teens can connect by online chat, text, or phone and can enroll twice per year. They do not need parent permission to enroll. This program is available to all Minnesota teens, regardless of insurance status.

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Tobacco Industry Targeted Marketing

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What are these ads trying to sell you?

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Pop Quiz!

How much money did the tobacco industry spend in Minnesota on tobacco product advertising in 2020?
$100,000
$576,000
$25 million
$112 million�

Hint - Each year, the tobacco industry spends $9.5 billion on marketing in the U.S. That's over $23 million a day or about one million dollars every hour.

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What could you buy with $112 million?

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112,000

iPhone 14 Pros

8,000,000

10.18 million people could go see a movie

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