2. Seeing through the vapour…

3. What is vaping? “Vaping” is the act of using an e-cigarette:
An individual sucks on the mouthpiece activating the heating element.
The liquid in the cartridge heats up, turning it into a vapour to be inhaled.
Vapour is only released when the e-cigarette is sucked on. 1.

4. So… should we be concerned?

5. DEBATE Point/Counterpoint
People who vape are just guinea pigs. Vaping is fine. Everyone is doing it.
******This activity can be done at the beginning of the presentation to get to know where students / class stand********
No right or wrong
3-4 students are neutral and the other students choose a side to defend. So you end up with two teams and 3-4 students in the middle who are undecided. Each team tries to convince the neutral students to switch to their side and join their group.
First, each team gets three minutes to come up with 3-5 key points to share and defend their side.
Then each team shares their points with the whole group. No argument or defending of points can take place at this time.
After both sides have presented their points, they take 2-3 minutes to plan a rebuttal about what the other side has stated.
Each team gets 3 minutes to counter what the other team has stated. After both teams have presented, the 3-4 students that are neutral choose a side. Other students from both teams can also switch sides.
IMAGE:

6. Fact or Myth
Vapour products should be used because they have been around for awhile and are less harmful than regular cigarettes.
Fact
Myth

7. While e-cigarettes may be safer than regular cigarettes, less harmful doesn’t mean safe.
While vapour products may be safer than regular cigarettes, it doesn’t mean that they are not without their own risk:
E-cigarettes have not been completely tested for safety and the short and long-term risks of use are currently unknown. Although some reports have indicated respiratory symptoms after use such as cough, sore throat, aggravation to asthma, sensitivity to scents etc.
At this time, standards do not exist for how and where e-cigarettes (and the solutions) are made, packaged or labelled. This means that there may be no consistency in how devices are made or the chemicals that get added.
NOTE: that with pending changes to the Federal law these products will be regulated better and have to follow standards for packaging and labelling.

8. Fact or Myth
Flavours used in vapour products are harmless and are only used to make it more enjoyable to vape.
Myth
Fact

9. Flavouring in vapour products
Flavours added to vapour products may not be safe for breathing into your lungs.
“Popcorn Lung” (Bronchiolitis obliterans): A serious irreversible disease that results in thickening and narrowing of smallest airways of the lungs.
Symptoms include a dry cough, shortness of breath, wheezing, and feeling tired
Caused by flavouring agent called diacetyl
Flavours added to vapour products are a way that the manufacturers (some being tobacco industries) are enticing youth to use the products.
HOWEVER: Flavours added to e-cigarettes may be approved and safe to actually eat but they may not be safe for breathing into your lungs.
It was discovered when workers in a microwave popcorn factory were becoming sick after inhaling that a flavoring agent diacetyl (2,3-butanedione) – flavouring used to give the popcorn its buttery taste. A
Symptoms may be similar to that of COPD
American Lung Association (

10. Fact or Myth
It’s the other chemicals in cigarettes and the smoke that are harmful - nicotine is nothing to worry about.
It doesn’t matter if you just use a vapour product to do tricks or blow vape rings…. nicotine is a concern!
Myth
Fact

11. The brain is still “under construction” until ~ age 25
Nicotine and the Brain
The brain is still “under construction” until ~ age 25
Nicotine during “construction” can:
> risk for mood disorders later on
> risks for addiction and further substance use
Harm the part of the brain that helps to focus and learn
Sensitive to the rewarding effects of nicotine
Although there are many health effects that we are not sure about in relation to vapour products, there are some harms that we do know about. We know up until about ~ approximately 25 the brain is “under construction” and as it develops, it naturally prunes (or takes out) connections that we don’t use often and strengthens the connections we do use often.
When nicotine or other drugs are introduced at this critical time in brain development, it can disrupt the way these connections are made. During development the young brain is more susceptible to nicotine than adults and once exposed to nicotine it can change the brain and “rewire it”. Youth are then at risk of:
> likelihood of addiction, being heavier smokers and having a harder time quitting as an adult
> risk for addiction and other substance use, including use of combustible nicotine – they may “seek out nicotine” as their addiction grows
Risks for mood disorders later on such as depression and anxiety
Affects the part of the brain related to focus and learning
May have reduce impulse control
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12. Nicotine Concerns
Nicotine in solutions, even in small amounts, can be harmful if swallowed or if it comes into contact with the skin.
There have been reported increases in calls to Poison Control centres in the United States:
1 per month in 2010
215 per month in February 2014 (51% were ≤ 5 years of age, 42% were ≥ 20 years of age)
At least 214 cases per month so far in 2018 (October had 327 calls alone)
Nicotine is absorbed through the skin, this means that if it spills on you can get sick
The solution may not be properly packaged or even childproofed
It is important to note that the incidents were not just with young children, almost half were with adults!
According to the American Association of Poison Control Centres there have been at least 214 cases reported / month in 2018 – October had 327 cases alone.
REFERENCES:
Centers for Disease Control and Prevention (CDC). (April 4, 2014). Notes from the field: Notes from the Field: Calls to Poison Centers for Exposures to Electronic Cigarettes — United States, September 2010–February MMWR, 63(13); Retrieved from
American Association of Poison Control Centres . (Oct 31, 2018). E-cigarettes and Liquid Nicotine Data. Retrieved from:

13. Fact or Myth
Second-hand vapour has some of the same chemicals as tobacco second-smoke.
Fact
Myth

14. Second-hand vapour Second-hand vapour comes from what the user exhales
If you don’t know what they are inhaling, hard to know what is exhaled
Evidence suggests it has some of the same chemicals as tobacco smoke but in lower amounts:
Nicotine, volatile organic compounds, formaldehyde, heavy metals, fine particulate matter
In addition to the products, there is the second-hand vapour to consider
NSRA update on second-hand vapour it gets very hard to determine the extent of the health effects that could come from e-cigarette second-hand vapour. 
Second-hand vapour released from an e-cigarette comes from what the user exhales; since there is ambiguity around what chemicals and how much chemical is being inhaled by the user, there is uncertainty around what is being exhaled. As a result, it can be very hard to determine the level or risk from such variability due to:
Many variations in devices - many devices can be modified to allow for adjustable smoke volume and voltage;
No regulations or manufacturing standards on the product (yet)
No standard labelling making it hard to determine what is in the e-liquid and in what quantities (yet);
Varying puff durations of users (experienced users versus novice users) -the more experienced the users, the more likely they are able to obtain as much nicotine if not more nicotine from an e-cigarette as a cigarette.  
In 2014 Health Canada did a study of e-cigarettes and 50 % of those labelled as not containing nicotine contained it. 
Emerging evidence suggesting that although the amounts may be lower than second-hand cigarette smoke, second-hand vapour may be harmful and contain nicotine and cancer causing chemicals including volatile organic compounds, formaldehyde, fine particulate matter and heavy metals - Even without nicotine or cannabis it is not harmless water vapour
Health effects of the second-hand vapour are unknown therefore, it is especially important for youth, young adults, pregnant women and those planning a pregnancy to avoid exposure.
IMAGE:
It’s not just harmless
water vapour!

15. Fact or Myth
Vaping leads to increased chance of starting to smoke cigarettes
Myth
Fact

16. The Concerning Trend
Strong evidence that e-cigarettes are associated with initiation of cigarette smoking among youth.  
31.5% of students who had smoked cigarettes also smoked e-cigarettes
Electronic cigarette use and smoking initiation among youth: a longitudinal cohort study David Hammond PhD, Jessica L. Reid MSc, Adam G. Cole MSc, Scott T. Leatherdale PhD
COMPASS survey data Ontario and Alberta Secondary School Students
Cite as: CMAJ 2017 October 30;189:E doi: /cmaj

17. Fact or Myth
Vapour products have not been proven as an effective way to quit smoking in Canada.
Fact
Myth

18. Vapour products for quitting
Not proven as an effective way to quit smoking in Canada
Those wanting to quit should use methods approved by Health Canada such as nicotine replacement therapy (NRT) or medications like Champix or Zyban.
E-Cigarettes can make smoking seem normal and can lead people trying to quit smoking to relapse.
Limited data at this point to suggest that these products help people quit smoking. Also no DIN # or even recommendations how to take, how often, safety limits etc.
References:

19. Is vaping legal?
Given the concerns related to vaping and not being proven to help people quit, is it legal? NO
Yes

20. Tobacco and Vaping Products Act
Health Canada’s “Tobacco and Vaping Products Act (TPVA)”, makes it legal for a vapour product to contain nicotine unless it makes a health claim.
In the future this act will protect youth from nicotine addiction and include:
Rules related to manufacturing standards and product and packaging labelling
Restrictions on the promotion of vaping products
Restrictions on the sale of vapour products that may appeal to youth
Banning the use of certain ingredients
Prior to May 23, 2018 it was illegal for a vapour product to contain nicotine. However, as of May 23, 2018 the Federal Tobacco and Vaping Products act replaced the Tobacco Act making it legal for a vapour product to legally contain nicotine; the product just can’t make a health claim.
This change will create a legal framework to protect youth from nicotine addiction that includes:
Not allowing the sale and supply of vaping products to anyone under 18 years of age (19 in Ontario)
Development of rules relating to:
Industry reporting
Manufacturing standards
Product and packaging labelling (for example, health warning messages)
Setting promotion restrictions for vaping products, including promoting flavours that appeal to youth and promotions that could mislead consumers about the health effects of these products
Banning the use of certain ingredients and not allowing the sale of vaping products that have an appearance or functions that may appeal to youth
Reference:

21. Smoke-Free Ontario Act, 2017
Cannot sell or supply vapour products to anyone under 19 years of age (includes e-liquid)
Cannot use an e-cigarette to vape any substance anywhere that you cannot smoke tobacco, such as:
On hospital and other health care facilities grounds
In child care facilities / daycares
Enclosed workplaces and workplace vehicles
Enclosed public places
Common areas in condos, apartment buildings or university / college residences
Reserved outdoor seating venues
In a vehicle with anyone > 16 years of age
In addition to federal vaping laws there are also provincial laws -these came into effect October 17th, 2018 under the Smoke-Free Ontario Act, Under the SFOA 2017:
Cannot sell or supply vapour products to anyone under 19 years of age
Cannot use an e-cigarette to vape any substance anywhere that you cannot smoke tobacco
Hospitals and other health care facilities
Prohibited on hospital grounds
Child care facilities and related places
You cannot smoke or vape in the entire premise of any child care centre or place that provides an early years program or service.
Places providing home child care must be smoke-free and vape-free at all times, even if children are not present. This includes any outdoor spaces that children use.
Reserved outdoor seating venues
You cannot smoke or vape in the reserved seating area of outdoor sports arenas or entertainment venues. The legislation does not address general admission areas.
Vehicles and boats
Drivers and their passengers cannot smoke tobacco or vape anything in a car or other motor vehicle if anyone inside is age 15 years or younger. No one in a motor vehicle (including motorized snow vehicles such as snowmobiles) or boat that is being driven, or is at risk of being put into motion, can consume cannabis in any manner (smoking, vaping, eating).

22. Smoke-Free Ontario Act, 2017
Cannot use an e-cigarette to vape any substance anywhere that you cannot smoke tobacco, such as:
On school property and public areas within 20m of the perimeter of the grounds
Public areas within 20m of the perimeter of the grounds of a Community recreational facilities
On restaurant and bar patios and public areas within 9m of the restaurant or bar patio
On and within 20 metres of children’s playgrounds, sports fields and spectator areas etc.

23. Ooze Egg Vaping PSA stunt
Additional resources that might be helpful if enough time.
Picture retrieved March 7, 2018 from:
References:
Ooze –
Egg -
Vaping PSA stunt -

24. Questions?