Youth Vaping Prevention

The Goals of the Youth Vaping Prevention Program

NV SB460, Sec. 9 | 2021 | 81st Legislature | Enrolled

Goal 1: Prevent initiation of tobacco use among youth and young adults.

Strategy 1: Provide consistent and evidence-based messages about health rists of e-cig use and exposure to aerosols.

Strategy 2: Provide evidence-based messaging to youth and young adults on the harms of flavoring in vapor products.

Strategy 3: Use of media communications to educate on the evidence and tactics recommended to protect youth from initiating tobacco and electronic smoking device use.

Strategy 4: Educate parents, teachers, coaches, influencers of youth about the risks of e-cig use among youth/young adults.

Goal 2: Promoting tobacco cessation for youth and young adults to the public.

Strategy 1: Promote Quitline resources that are available and targeted at assisting youth, and young adults quit.

Strategy 2: Promote Quitline resources among youth and young adults of populations burdened by health disparities related to tobacco use and/or vaping.

Goal 3: Lower the Nevada Retailer Violation Rate (RVR) by increasing awareness and knowledge of tobacco retailers and state compliance & enforcement agencies regarding Federal and State Tobacco 21 Law and its regulations.

Strategy 1: Improve the quality, timeliness, and surveillance of statewide media campaigns.

Strategy 2: Engage local compliance & enforcement agencies/facilities/offices to increase awareness and knowledge of Federal and State Tobacco 21 Law and its regulations.

Goal 4: Surveillance and Evaluation.

Strategy 1: Improve the quality, timeliness, and surveillance of tobacco retail sites statewide by analyzing YVP Year 1 processes and results to inform on sustainable STARS efforts.

Strategy 2: Improve statewide retail environments affecting youth initiation and prevalence of vaping and tobacco use, through strategy implementation.

Strategy 3: Conduct STARS data collection to continue building a sustainable tool and process that informs tobacco control efforts.

Goal 5: Infrastructure, Administration and Management

Strategy 1: Maintain consistent communication with CDPHP and create Scope of Work for upcoming fiscal year.

Smoking is the leading cause of preventable premature disease and death in the United States. An estimated 88% of adult daily cigarette smokers report first trying cigarettes before they were 18 years old. Previous reports indicate decreases in current cigarette smoking (i.e., use during the 30 days before the survey) rates among U.S. high school students from a high of 36.4% in 1997 to 8.8% in 2017.

Although cigarette and cigar smoking have been decreasing among U.S. teens, e-cigarette use increased from 2015 to 2019. Comprehensive, population-based tobacco control strategies can help reduce tobacco use among teens

However, there are a variety of tobacco products, including smokeless tobacco products, cigars, and most recently, electronic vapor products (e.g., e-cigarettes).

Electronic vapor products have evolved since entering the U.S. marketplace in 2007. Initial products were disposable, resembled the size and shape of conventional cigarettes, and used free-base nicotine; however, newer products are rechargeable, resemble common objects (e.g., USB flash drives), and typically deliver nicotine salts, which allow higher levels of nicotine to be inhaled more easily by the user. Sales of these newer generation, or “pod-mod,” products have increased in the U.S. in recent years.

E-cigarette, or vaping, products can be used to deliver nicotine, cannabis (THC, CBD), flavorings, chemicals, and other substances. They are known by many different names and come in many shapes, sizes, and device types.

The popularity of these electronic vapor products among youths is likely the result of multiple factors, including advertising exposure, availability of youth-appealing flavors, curiosity, and social exposure through friends and other influential figures.

Tobacco Marketing

The Federal Drug Administration (FDA) implemented many restrictions in 2009 on advertising and marketing of tobacco and tobacco-related products aimed at youth, but these restrictions are specific and only apply to cigarette and other combustible tobacco products. E-cigarette and vape companies have capitalized on this gap in regulations.

The American Academy of Pediatrics recently published a study indicating “a prevalence of cigarette and e-cigarette marketing exposure among U.S. adolescents.” The study states in 2020, 68% of National Youth Tobacco Survey participants self-reported exposure to e-cigarette and/or vape advertisements, mainly through retail store advertisements and internet social media sites.

Current advertisements and marketing conducted by tobacco, e-cigarette, and vape companies are not much different than what they looked like in the past. The use of more traditional tobacco marketing methods includes using social desirability, empowerment, and the appeal of independence to purposely attract youth.

The Campaign for Tobacco-Free Kids reported youth are three times more sensitive to tobacco advertising than adults and more likely to be influenced to initiate use from marketing than by peer pressure. The report also stated one-third of underage experimentation with tobacco products can be attributed directly to tobacco company marketing.

E-Liquid, or E-Juice

E-cigarette, or vaping, products are attractive to youths because of their array of bright colors, sleek designs, and a selection of over 15,000 e-juice flavors to choose from. These flavors are often given flamboyant names, such as:

Blue Raz Cotton Candy
Straw-Melon Slush
Peanut Butter Granola Bar

Youths will often have conversations with their peers about what new flavors they have bought and which ones they plan to try next.

E-liquid is the liquid converted into an aerosol by an e-cigarette, or vaping, device. It is typically a mixture of water, food grade flavoring, a choice of nicotine levels, cannabis (THC, CBD), propylene glycol (PG) or vegetable glycerin (VG).
PG and VG are humectants used in e-liquid to produce aerosols that simulate combustible tobacco cigarette smoke.
The ratio of PG and VG in the e-liquid can change based on whether flavor (higher levels of PG) or plume (higher levels of VG) is desired.
E-cigarette aerosol is NOT harmless “water vapor.”

The e-cigarette aerosol users breathe from the device and exhale can contain known harmful and potentially harmful substances, including:
- Nicotine
- Ultrafine particles that can be inhaled deep into the lungs
- Flavorings such as diacetyl, a chemical linked to a serious lung disease
- Volatile organic compounds
- Cancer-causing chemicals
- Heavy metals such as nickel, tin, and lead

The aerosol users inhale and exhale from e-cigarettes can expose both themselves and bystanders to harmful substances.
It is difficult for consumers to know what e-cigarette products contain. For example, some e-cigarettes marketed as containing zero percent nicotine have been found to contain nicotine.

Youth Curiosity

A study conducted by the University of Michigan in 2015 asked students from 8th, 10th, and 12th grades: “What have been the most important reasons for your using an electronic vaporizer, such as an e-cigarette?” Response options for the survey question included:

To help me quit regular cigarettes
Because regular cigarette use is not permitted
To experiment to see what it’s like
To relax or relieve tension
To feel good or get high
Because it looks cool

To have a good time with my friends
Because of boredom
Nothing else to do
Because it tastes good
Because I am “hooked”
I have to have it

Youth Curiosity

The study found that:

More than half of all students in 8th, 10th, and 12th grades reported curiosity to see what the products were like was a primary reason for use
40% said they used e-cigarettes because they tasted good
About 10% said they used them in an attempt to quit smoking regular cigarettes

Social Exposure

In 2019, among the 32.7% of high school students who were currently using electronic vapor products, 32.6% were frequent users. The high rate of use leads to the assumption youth are constantly exposed to e-cigarette use and vaping among their own peers. The most common source reported by youth regarding how they obtain these products was through “borrowing them from someone else.” Other common sources of access included:

Purchasing them on the internet
Giving money to someone who could purchase the products
Purchasing the products themselves in a retail store
Taking them from a retail store or another person
Some other way

Youth may also be exposed to tobacco product use at home, and/or at family gatherings.

Set a good example by not using tobacco products and talk with any family members who do use tobacco products. Children and teens look to parents and other adults in their life as role models. It’s important to set a good example by being tobacco-free and ensure children and teens are not exposed to the secondhand emissions from any tobacco products, including e-cigarettes.

Additional Resources

Additional Resources
Resource Name/Website Link	Resource Description
State of Nevada Youth Quitline	My Life,My Quit™ is the free and confidential way to quit smoking or vaping. Text "Start My Quit" to 36072 or click to chat with a Coach. We are here for you every step of the way. It's YOUR LIFE and we're here to help you live it YOUR WAY.
American Academy of Pediatrics recently published a study	Tobacco marketing exposure impacts adolescents’ receptivity to and curiosity about tobacco products, increasing risk for initiation and long-term use of nicotine. Further research is needed on tobacco product marketing strategies which rapidly evolve across advertisement venues and types of products.
Campaign for Tobacco-Free Kids	We are fighting for health, for kids, for equity, for change, for you. And together, we are Taking on the Toughest Fights. Through strategic communications and policy advocacy campaigns, the Campaign for Tobacco-Free Kids and the Tobacco-Free Kids Action Fund work to change public attitudes about tobacco and promote proven policies that are the most effective at reducing tobacco use and save the most lives.
American Lung Association	Searching for lung disease cures, addressing the youth vaping epidemic, supporting laws that protect the air we all breathe—see how we work to save lives every day.
Truth Initiative	Truth Initiative is America’s largest nonprofit public health organization dedicated to a future where tobacco and nicotine addiction are things of the past. Our mission is clear: achieve a culture where young people reject smoking, vaping, and nicotine.
Enforcement Priorities for Electronic Nicotine Delivery System (ENDS)	This guidance document describes how the FDA intends to prioritize enforcement resources with regard to the marketing of certain deemed tobacco products that do not have premarket authorization.
Respiratory Illnesses Associated with Use of Vaping Products	Both the U.S. Food and Drug Administration and the U.S. Centers for Disease Control and Prevention are working tirelessly to investigate the distressing incidents of severe respiratory illness associated with use of vaping products.
Summary of Rules that Retailers must Follow	This page offers a summary of the federal rules broken down by different types of tobacco products. You can find comprehensive federal requirements for tobacco retailers in the Federal Food, Drug, and Cosmetic Act (FD&C Act), Regulations Restricting the Sale and Distribution of Cigarettes and Smokeless Tobacco, and the Deeming Tobacco Products To Be Subject to the Federal Food, Drug, and Cosmetic Act.
Tips to Help Avoid "Vape" Battery Explosions	You may have heard that e-cigarettes, or "vapes," can explode and seriously injure people. Although they appear rare, these explosions are dangerous. The exact causes of such incidents are not yet clear, but some evidence suggests that battery-related issues may lead to vape explosions. The safety tips included in this resouce may help you avoid a vape battery explosion. Please report a vape explosion or any other undesired health or quality problems with a vape device to the FDA.
FDA's Deeming Regulations for E-Cigarettes, Cigars, and All Other Tobacco Products	Tobacco use is the single largest preventable cause of disease and death in the United States. Since 2009, the FDA has regulated cigarettes, smokeless, and roll-your-own tobacco. FDA finalized a rule, effective August 8, 2016, to regulate all tobacco products. For background information on this milestone in consumer protection, see The Facts on the FDA's New Tobacco Rule.
Learn More about Each Tobacco Product	Tobacco use is the single largest preventable cause of disease and death in the United States. As part of its goal to improve public health and protect future generations from the risks of tobacco use, the FDA has extended its authority to cover all tobacco products. The fact that FDA regulates these tobacco products does not mean they are safe to use.
Fresh Empire	Preventing cigarette use among at-risk African American, Hispanic, and Asian American/Pacific Islander youth ages 12-17 years who identify with hip-hop culture.
This Free Life	Preventing cigarette use among Lesbian, Gay, Bisexual, and Transgender (LGBT) young adults ages 18-24 years.
Every Try Counts	Encouraging adult cigarette smokers to quit through messages of support that underscore the health benefits of quitting.
FDA Resources for Parents & Educators	Parents and educators can play an important role in fighting tobacco use among youth. FDA offers a variety of free resources about the health consequences of youth e-cigarette use. Use these resources to learn more and to start an honest conversation with your child or student about the dangers of youth tobacco use.
Chemicals in Cigarettes: From Plant to Product to Puff	FDA created these videos and interactive tools to lay the foundation for an important public health goal: we aim to publish a list of the levels of harmful and potentially harmful chemicals in tobacco in a way that is easy for the public to understand. As an important step toward that goal, we invite you to explore the chemicals in tobacco in three stages of cigarettes, from plant to product to puff, in the videos.
Science and research to understand tobacco use and its associated risks	Research programs and projects include, but are not limited to, the scientific fields of epidemiology, behavior, biology, medicine, economics, chemistry, engineering, toxicology, pharmacology, addiction, public health, communications, marketing, and statistics.
Youth and Tobacco	In 2017, the FDA announced a comprehensive plan for tobacco and nicotine regulation that places nicotine, and the issue of addiction, at the center of the agency's tobacco regulation efforts. This plan will serve as a multiyear roadmap to better protect kids and significantly reduce tobacco-related disease and death in the U.S. A key component of this plan is the Youth Tobacco Prevention Plan, which aims to stop youth use of, and access to, tobacco products—especially e-cigarettes.
How Smoking Affects Heart Health	Yes, smoking cigarettes can harm nearly any part of your body, including your heart and blood vessels (cardiovascular system). Smoking cigarettes can permanently damage your heart and blood vessels leading to cardiovascular disease.
Think E-Cigs Can’t Harm Teens’ Health?	Are you aware the nicotine in tobacco products such as e-cigarettes can rewire the teen brain to crave more of the substance and create a nicotine addiction? (1) The types of brain changes that can occur may have long-lasting effects on attention, learning, and memory. (2,3,4) Also, nicotine addiction can lead to regular use of tobacco products, resulting in long-term exposure to toxic chemicals. Because cigarettes aren’t the only tobacco product that can lead to addiction, the FDA is doing what’s necessary to keep e-cigarettes and all other tobacco products out of minors’ hands.