board members that are present and we have to go over there thank you i'd also like to thank all of our panel participants this evening when kimball from the prince and public schools dr candy shop from princeton day school o from the hon school robert and so on it's from the stuart country day and our david erickson he's director of clinical operations at corner house i want to acknowledge your partners for the program this evening the prince and police department the a prince and health department and the corner house student board for conducting a local high school student survey presented this evening by student board member madison richmond a special thank you to the following planning committee members for keeping our minutes and keeping us on track in the planning process and we want to thank the tram very alliance for donating the street drugs books to see things that are available in the back so wonderful resource for parents to have to be aware of what we're seeing and what you might be seeing in your home in the community so we will now ask madison richmond a member of the court house order to present the findings of the board  hi so i'm part of corner house student board and we conducted a survey to four area high schools so and talk about some of the results and overall findings so the survey began with the grade level of like the survey takers so as you can see it was kind of evenly spread out so this might be a little hard to follow but basically if the students did not they they just clicked you know and the survey ended so that seventy four point seven percent of respondents and if they did obviously you can see twenty point five four point eight so then the next part of the surveys just for those that responded th ey do currently so when did you start these results were a little surprising because the majority is middle school and that's very very early kind of alarming  in what setting the majority with friends and alone and then with friends comes second not many people do it alone how often so what we found was people either do it very infrequently or very frequently so there is there's not much in between that's an interesting kind of like observation to think about might show kind of the addictive properties of nicotine or other substances do you own a wii so more said yes and no but a lot said no so now maybe people use their friends a lot question there was an open ended like option but there were also some multiple choice obviously the number one is i like the sensation number two i think it's a cool thing to do so that sheds a lot of light on this very thing culture that we have in kind of why people do it in the first place  last questions what is your perception of a ping so the first option the blue is vague does not impact my health the majority of people said that they think has minimal impact on their health and then twenty four point five said it hasn't had a significant and some people were unsure and then there are myriad other reasons why like other people's perceptions of a being some of them are jokes but some people are actually honest  and yes so that was our survey and then from the previous slide we ok do you smoke cigarettes so a lot of people said no small amounts are used to yes and now they're still at twelve percent that smoke cigarettes with the that could be people to believe that maybe the  like they being of nicotine actually lead to cigarette smoking but that's kind of like for your petition these are all of our survey questions it's interesting to kind of take a look at what the princeton high schoolers of princeton kind of answer to the and maybe this can kind of help alleviate some of the issues we have with it being in princeton thank you thank you madison well tonight speaker we're very lucky to have her she comes to us at the recommendation of when kim and we're very lucky dr richter oversees the policy  research projects at center for addiction and substance abuse a work focuses on integrating addiction care into mainstream medical practice educating the public and health professionals about evidence based addiction care translating the science of addiction for lay audiences understanding the substance related attitudes and beliefs of both the general population and health care professionals and improving substance use in addiction prevention and treatment  particularly among young people and women she received her b a in psychology from brooklyn college of the city university of new york and her ph d in social psychology from the university of maryland her research topics include the science of addiction prevention treatment substance related attitudes and beliefs substance use and special populations and integrating addiction care into mainstream medicine please join me in welcoming dr rector statistics because it could get boring but the statistics i do show on a national level you know if it doesn't feel relevant to you i think your surveys really those were great questions i think they were very illuminating findings and i hope that my talk of give some context to what you've presented so thank you so i'm really delighted to be here and to have the opportunity to share some important information with you about a pinger you cigarettes and really how we should be responding to this trend i'm aware most of you know plenty about it so forgive me if i'm repeating things you already know but i'm going to give some background and hopefully it'll be helpful to you  so here are some of the things that i would like to cover with in my time with you today sorry i'm just getting used to this i think it's important to be very well informed about one of the most popular substance use behaviors that teens and young adults are engaging in now it's very important to have accurate information as you'll see there's a lot of misinformation and confusing information out there and it's important for parents to be able to have honest and accurate conversations with their kids about this and to know how to respond effectively not to freak out but just to be calm and get it right and i'm so pleased to see so many students in the audience i don't usually talk straight to students so i hope it's interesting to you but i think it's really important for students to know what they're introducing into their bodies what effects it might have on them and how it can affect their functioning in their ho it's really very hard to get the right information about this topic as i said so here are a couple things i'd like to cover just quickly what is vague being what are they products look like how do they work why is there so much confusion over the past few years about these products how many kids and who are using these products how to kids get them where did they get them from where did they use them why did people they why should you be concerned about it and what can you do about it because you should be concerned so let's get into it so what is a ping just real quick it was invented in two thousand and three by a chinese pharmacist who watched his father with a very heavy smoking habit you know developing diab lung cancer and he really had good intentions he wanted to try and find  alternative to cigarette smoking by two thousand and seven the cigarettes were marketed in europe in the united states as an alternative to smoking some tobacco smoking and as you see here cigarette or any kind of a ping device we all know they don't produce tobacco smoke which is a good thing but the term they ping is misleading because of a ping sort of implies water vapor which makes it feel kind of pure and clean and not so bad the truth is as you'll see there's a lot of stuff in that vapor aerosol that's actually not that the nine it has many chemicals and little tiny particles like get right into your lungs and many of them are toxic and dangerous and some cause cancer so what do they products look like there's been several generations of these products and devices over the years that have emerged originally they looked like cigarettes that was good and bad it was good because for adult smokers because it was sort of an easy transition they're still holding something that looks like a cigarette the bad part of it if you're trying to quit is that visual cues and sort of how things feel kind of bring on the cravings the smoking so it kind of had you know good and bad side to it but they've really evolved since then although some people still use the they used to be called say the likes things that look like cigarettes tank systems very elaborate you could do all sorts of things with the often referred to as electronic nicotine delivery systems and popular culture they're just called they surveyed being devices and i'm sure you guys know a million other names from them that i don't even know but in terms of appearance they can resemble like i said a cigarette a pan a lighter that's weird sort of ten contraption and a number this is what's kind of concerning a number of other everyday products including an i phone an eraser or a high r flash drive sticks of gum and we're going to talk about why these sort of subtle and cool designs compose a problem even though they are cool looking so how do they work  basically in general of a ping device has a mouthpiece that heats a liquid called an aegis which contains flavoring chemicals a couple of other chemicals including propylene glycol which is used in antifreeze and other industrial purposes glycerin which is used in soaps and moisturisers and almost always nicotine and it heats that liquid or oil until it turns into an aerosol we're going to talk some more about the ingredients in these devices later but let's just now say they're not as harmless as they sound just what is a basic component of how they work though there are many different types but if you look at the inside there you know basically has a liquid cartridge a heating element known as an atom eyes or which heats the liquid produces the ara saul and a battery that's usually rechargeable that powers the heating device they want on the bottom is a jewel the one on the top is more of like a classic a cigarette design so let's talk about jewels terminix has those are the most popular right now and ones you probably heard about the most lately so what's the big deal about you'll well they were created by two former stanford university design students as an alternative to cigarette smoking again probably with very good intentions they're marketed clearly as an ad device for adult smokers who want an alternative to cigarette smoking they currently account for more than half of the market share the cigarette products in the united states it's the fastest growing product in the cigarette brand in the u s with unit sales increasing more than six hundred percent over the last year it's small enough to feel fit  of appealing flavors and this is very important to know and as you'll see a lot of people don't know this all jewel devices contain nicotine and lots of it there is no nicotine free jewels there are no nicotine  so what is the nicotine content in jewels a single cartridge roughly equal the amount of nicotine that's in a pack of cigarettes or about two hundred parts on a cigarette  so more specifically it has fifty nine milligrams of nicotine per milliliter which is really on the upper end of all cigarette products it also has some unique compositions composition it uses  salt based nicotine which delivers nicotine in a manner that's more similar to how cigarettes the liver it more concentrated in potent and kids are very aware when i say kids sorry i mean teenagers young adults middle school students are very aware of joules one national survey found that a quarter one in four respondents aged fifteen to twenty four recognized it right away when they were shown a photo of it but here's what's important only  at of the people shown the photo two out of three sixty three percent didn't know that jewels necessarily contain nicotine so most did not know that it contains a nicotine so the package very sleek and simple the labeling is very straightforward it has the product name the flavor and then it has a statement of five percent strength what does that mean i  now so according to the company what it means is that a single jewel pod or the flavor pack contains point seven million years of nicotine with five percent nicotine by weight do you know what that means now yeah me neither and it's kind of like you know two percent milk or two percent of what happens to be two percent of the daily recommended allowance for most people don't know that either so the fact is that the five percent strength really i think is designed to kind of make you feel like there's not that much nicotine in there because the reality is like i said it contains fifty nine milligrams of nicotine which is an extremely high amount it would even be a strong h smoker so we're going to talk soon about why such a high level of nicotine is concerning so that element of like having five percent strength on the package you know sort of trying to muddy the waters about why you should care about this is really kind of very typical of how these products have been marketed and sold and confusion and sort of misinformation is really a recurring theme when it comes to cigarettes and the information that's been available about them it's really very hard to know what to believe in general my approach when it comes to trying to help kids and young people stay away from addictive substances whether it's nicotine or alcohol or prescription drugs illicit drugs is you know to avoid being alarmist and to kind of just the recommendations on solid research evidence rather than anecdote but this is been very hard to do when it comes to cigarettes because the scientific research has been all over the place until very recently it's a new product and for years they've just been sort of the small one shot studies and the findings have been like some have found them to be dangerous some have found them to be not so dangerous but in the past two years the longer term studies have started to come in and the picture is getting much more clear it's really not a great idea to rely on information that's available on the internet or a new stories even or from friends it could be tricky because there's a lot of good and information out there but there's also a lot of not so going to information and even physicians doctors have been really confused by this not knowing whether to recommend the cigarettes as an alternative to their patients who smoke their adult patients or to be particularly concerned if a younger patient you know admits to using it they just don't know like there is a sense that well it's better than cigarette smoking so that's good it might help people quit smoking that's good information just has not been consistent enough for them to know what to do so i think that the most of the confusion has derived from really two main factors that i just want to talk about briefly at this point given our current knowledge it's true that  cigarettes appear to be less harmful than regular conventional cigarettes mostly because they don't burn tobacco tobacco burning accounts for a good chunk of the risk associated with smoking that sa tobacco cigarettes are literally one of the most harmful substances on earth so signal wrote cigarette smoking as you all know i don't have to go on about it is the leading preventable cause of disease and death in the entire world it's a major contributor to four out of the five leading causes of death heart disease cancer lung disease and stroke but if those accidents but just because something is less harmful than cigarette smoking is hardly a glowing recommendation for that behavior it's kind of like saying it's better to jump out of a window from the forty fifth floor of a building than the fifty third floor of a building you know you really wouldn't want to do either of them so the aerosol is produced when you see cigarettes contains many harmful substances number one nicotine again i'm going to go into it a bit more later but despite the fact that most people think they're not vaporing nicotine and that it's just flavors or just water vapor the c d c found the centers for disease control and prevention found that ninety nine percent of even products containing that's almost all of them even if they're labeled nicotine free they're not regulated by the u s government so they can kind of say whatever they want on the products so almost all of them have nicotine in it at varying levels they also have as i said before these ultra fine little particles that when you when you breathe in and hell they are sol they go deep into your lungs and they have been found to cause respiratory illnesses and damage one of the ingredients in all of these products is flavors well flavors are made up of chemicals and some of the chemicals that are in the flavorings have been linked to some serious lung diseases and other problems as all start kinds of volatile organic compounds and cancer causing chemicals as well and also has some dangerous heavy metals in them such as nickel tin and lead but anyway we'll talk more about those shortly so now back to why there's been so much confusion about them so again number one because they're less harmful than cigarettes so that sounds good but the second contributing factor to the misinformation and confusion is that they're very very highly profitable especially to the tobacco industry so the tobacco industry has recognized the importance of this market for their continued survival why do they need it because people are really smoking cigarettes as much as they used to especially young people because young people got smart and said i don't want to kill myself and smoke cigarettes so the market share has gone down for cigarette smoking and traditionally to back the tobacco industry has really relied on young people starting to smoke to keep their customers around because their usual regular long term smokers tend to die young and they stop buying their products once they die so they need new ones so as you can see here east cigarette sales are projected to overtake cigarette sales by twenty twenty which is very soon so it's a very important category for the big tobacco comp and they have entered the market jewel is not owned by one of the big they recognize and they know that by planting the seeds of nicotine addiction as early as possible they're going to have a tremendous incentive to bring the baby market to kids and they're using their years and years and years of tremendously successful marketing expertise and experience and insights into promoting these products right now and lucky for them unlucky for people who use it it's working not only are young people who are in recent years with sort of scoff at the idea of smoking cigarettes now eagerly puffing away on these nicotine products what you're going to see soon is that they ping is actually leading more and more kids back to cigarette smoking so madison's finding was not just unique to your town it's it's a real thing so why young people and we kind of said some of that but they're really the perfect replacement customers if young kids get hooked on it on an addictive product or stay loyal in the stay with it for years and it's well known by health professionals and by the tobacco industry that the vast majority of people who become regular smokers are nicotine users started in adolescence basically nine out of ten people who are smokers began smoking when they were kids and nearly all people who are addicted to nicotine started as an adolescent or young adult this is this is physiological in part you guys have probably heard the serenity the brain continues to develop until a person reaches their mid twenty's while the brain is developing it is uniquely vulnerable and susceptible to addictive products  so how many kids let's just move on from that for a minute we'll go back to some of that and a bit how big is the trend how many people are doing it and the answer is many it's the most commonly used to back a product among kids  in two thousand and sixteen which is the most recent national data more than two million middle and high school students in the u s said they put in the past thirty days that's a typical marker of what's called a current user someone who you know is using it and regularly not someone who just used it once or twice that's four point three percent of middle school students and eleven percent of high school students there are other data sets that have slightly different numbers but they're all in this general ballpark what's interesting is that part point three percent of middle school students and the eleven point three percent of high school students are both higher than the three point two percent of adults who reported a ping in the past thirty days so quick review who are the main users of these products are they youth or adults they're more kids than adults who vapor right are they cigarette smokers or nonsmokers actually most kids who most young people who use the cigarettes have never smoked a cigarette so despite jewel and other cigarette products being marketed as an alternative for adult smokers the fact is that the majority of people using these products are neither adults nor smokers so how to kids get them probably knows better than i do but federal law prohibits any kind of sale of any kind of tobacco product including cigarettes to anyone under the age of eighteen some states and some cities have you know set the age limit at twenty one including new jersey and princeton as well unfortunately these age limits are very easily bypassed a lot of these products are bought online it's very easy to get through the ages you know the age gates that they put up there basically are you twenty one yes and then you're in one study found that ninety four percent of online purchase attemp kids age fourteen to seventeen were successful so that's the online market if a kid has access to a parent's credit card there you go their own credit card and in terms of buying in a retail stores some retailers and force a lot but many don't so you can often just walk into a store and buy it and other ways that some people get it is from their older friends so you know where young adults or someone of legal age i purchase so where the kids baby right in front of you everywhere they are used in classrooms school bathrooms kids homes outside wherever they're very discrete they're easy to hide they look like common household devices as we've seen and teachers now are recognizing member for a long time they weren't smoke detectors don't really pick up the aerosol there's very little order or the order is just sort of a subtle fruity flavor it's are just very hard to detect so let's say why do kids bathe this is the part that i'm kind of interested in so c d c survey of middle and high school students who reported ever having used the cigarettes in two thousand and sixteen when asked why they did it so the most common reason was because friends or family members were doing it or curiosity you know they've seen others doing it they wanted to give it a try  thirty one percent said it's the flavors the flavors as we'll see our marriage really interesting they come and men candy fruit chocolate and all sorts of other interesting sounding  things and about twenty percent said that they believe that they're less harmful than other forms of tobacco use which cigarettes they're also advertised and promoted all over the place and there's a lot and information about them and misperceptions about their safety some people who smoke use them to get around smoking bans so they might smoke cigarettes in places where they can live a where they're not allowed to smoke which kind of compounds them out of nicotine you're ingesting and then one very important reason which we'll get to is addiction once you use a mirror ingesting lot of nicotine you become addicted and it's hard to stop in the face of all this is very limited government regulation sort of controlling it so one thing is that the design of these products can be very appealing to young people i mean these are not the typical way that they're sold but you can get them in things that have like pictures on them mickey mouse or whatever robot thing that is they're very they could be very pretty sorry and the jewel that when showed us had like cute little stickers on it yeah so they're very appealing both in terms of how they look and also and how they taste so as i said they come in more than fifteen thousand five hundred flavors right now and counting the companies keep putting out new new flavors four out of five kids who have ever used to back up products especially cigarettes started with a flavored product and using a flavored product is associated with a greater risk of starting to smoke cigarettes that's because the flavors give the perception that these are not particularly harmful and that the behavior is not particularly harmful and these are sort of subtle effects i mean everybody knows smoking bad for you but it all contributes to this like lower perception of harm or risk from tobacco use also know that sweet and fun flavors are associated with kind of the good feelings of childhood and treats and parties and love and affection and celebrations and they keep putting out new flavors so that people feel like hey i never tried that one let me try that next one that sounds  there are also as i said very cool ads and promotions around these products and they're kind of everywhere advertising and marketing even though none of us believe it affects us a lot they're very powerful they know what they're  doing in among middle school students in high school students over a two year period recently the number of kids that were exposed to cigarette ads increased from sixty nine percent to seventy eight percent people see the ads in retail stores a lot on the internet social media television newspapers magazines and there is research that shows that exposure to these ads actually do increase arrests not only abusing you cigarettes but eventually smoking cigarettes as well one thing that happens is that when the ads feature flavored products again it reduces the perceptions of harm of these products because you kind of process the advertisement of the product as something sort of oh  it's skittles it's jolly pops it's blow pops it's you know kind of a heart it gives us harmless air about them and also to divert your attention away from the warning labels if there are any on the product there's a lot of you tube videos of kids  trying different products and show and sort of videotaping their first experience with it and they kind of become very popular some of those kids if they do it enough they get paid by the manufacturers of the  products so just back to back oh industry for one more minute so as they did for cigarette ads for years and years they use celebrity spokespeople to advertise their products they feature good looking and sexy models they sponsor sports events musical festival and they appeal to girls and women and why are these companies allowed to advertise to kids cigarette companies are you know cigarettes are not allowed to be marketed directly to young people at all there are heavy restrictions but the family smoking prevention and tobacco control act of two thousand and nine that bans the promotion of cigarette flavors and marketing to kids does not apply here has not been applied to cigarette products after promising to introduce regulations that would apply to the cigarettes and it was supposed to go into effect this year the f d a decided last year to allow the cigarette companies to avoid the regulations until twenty twenty two which is four years later than it was supposed to go into effect and thirteen years after the agency was actually given authority to regulate these products so they have been able to do it since two thousand and nine they just have not currently that decision to to delay the regulation to two thousand and twenty two is being challenged by several public health and medical organizations that realize that the manufacturers are promoting these baby products without consequences so in the meantime the industry is going to town advertising and glamorizing these products as you just saw and while the f d a sort of is figuring out what to do an entire generation of young people have entered and left their teenage years without any oversight of these products jewels for example are the most popular brand among kids as we said and they say they only sell to people over twenty one but most of their sales take place in retail stores where anyone age eighteen or older except in some states are allowed to get that and this the new popularity of jewels is coming to the attention of the f d a and they've had a lot of pressure so recently they have decided to take some action and develop some sort of plan to keep kids from using these products about eleven lawmakers sent letters to the c e o of the jewel company to the f d a saying they want more information about these products what's in them how they're advertising to kids what they're going to do about it and one of the main concerns is the availability of flavors which the research evidence is just you know over overwhelmingly demonstrating that that has a tremendous effect on the use of products among young people so we talked about the misinformation around these products and we talked about how two and three kids who use jewels don't even know that they have nicotine in them we there's other research that shows that three quarters of teens who use these cigarettes don't think they're harmful and that was madison's finding as well and many people believe that it just produces harmful harmless water vapor and other reason people keep use it and continue to use it again is because of addiction  people become addicted to them and kids themselves some kids themselves who they acknowledge that and they say they can't stop using it so the new york times paris study sorry had an article on the cigarettes and they products and as part of that they invited comments from students or you know teenagers to talk about their experiences with it and this is just one quote from a girl named zoe she said looking back i never thought i was addicted to nicotine because it sounds so severe but they'll be times even now when i'm like my really wish i could jewel right now a lot of people in the city go through a pot a day or pot every two days remember a pot is equivalent to a pack of cigarettes that signals that you have an addiction but people don't look at it like that because it looks so cool and it's discrete and why and why is it addictive because nicotine like all drugs changes the structure and function of the brain and it makes quitting very very hard and as we said before the tobacco industry innovating in the street profits off addiction because it keeps the customers coming back for more and the peak vulnerability to addiction is during adolescence so it's really no coincidence that these products taste like candy and a marketed as fun and cool the growing they being industry has many items in campaigns that seem to spiels appeal specifically to youth i don't know if you guys i'm sure you've heard about the beeping cloud contests where expert papers become celebrities because they do cool things with ping smoke there are companies that sell apparel and other accessories that allow you to kind of hide your bay products in your hoodies or in your or in your backpacks and there are all sorts of ish fun looking wrappers that you could put your baby products in that you'd use and here's jolly rancher so while should we be concerned about this because as i said the chemicals in the aerosol are actually very harmful nicotine itself is very harmful there's a strong link to cigarette smoking which you're going to get into in a second dual use most people are many people who vapor also you end up using cigarettes and continuing to do both at the same time which compounds the risks and like any other kind of substance abuse and addiction i'm sorry and it's linked to other kinds of s addiction so here are just some of the chemicals or many of the chemicals that can be found and a cigarette aerosol these are some nasty things  and there are some serious health consequences the chemicals and they products and several studies this is not just like one little study here or there are these are well established that is published in very well respected journals have found links to cancer the cancer link was interesting it was a study of sixteen year old who had inhaled he said carette vapor and then they had their urine tested and they found high levels of five cancer causing chemicals right then and there in the lot of the chemicals could damage the cells in your body and lead to cancer even if they're a nicotine freak because these chemicals are in the flavors there's been connections to lung disease you may have heard of something called popcorn long it's a disease that people who  work in but with those microwave popcorn plants would get because those chemicals would get into their lungs and it was it's a very serious disease it has that chemical in many of the products have that chemical and them and it's been linked to heart disease these are recent studies one of nearly seventy thousand people who found that daily cigarette use can double the risk of a heart attack and if a user continues to smoke cigarettes who are also using the cigarettes the risk of a heart attack goes up to five and despite what people think and this is something i hear all the time nicotine nicotine itself is not harmless it's a stimulant in one of the most addictive drugs that's available more so than heroin or cocaine it's highly highly addictive it increases your heart rate it causes respiratory and long damage and it can affect your rep reproductive organs it's especially well the younger you are when you're trying to get seen the more likely you are to become addicted as i said earlier it's a very very strong finding  there's just so many studies right now that are laundry to your no meaning long term studies that are coming out almost daily about the link between using the cigarettes and using conventional tobacco cigarettes it is a gateway to smoking it's highly addictive because the nicotine is addictive use the products for a while and then you want something else you also it also kind of makes the act of smoking seem less you know or weird because you're doing something like it and you kind of get used to the behavior demystifies it and makes it seem less harmful many many kids and adults who use the products and of smoking and the more they weigh the more they do so there are there are a verity of studies but the general range is that if so if you're using the cigarettes regularly or a two to three times the risk of ending up smoking cigarettes and that's over the course of like six months to a year it's doesn't take long we're not talking about like once you're an adult there are some studies that go up to twelve times the rest but probably the range is two to four times the and what's really interesting is that in all these studies they take a look at they measure whether the they follow kids over time and they measure whether they're susceptible to cigarette smoking there are measures of that and most commonly the people who end up smoking cigarettes had no intentions to ever try or use a cigarette at first had no signs of susceptibility the way they measure sect ability is like how you respond to an advertisement or whether you're interested in getting some of the promotional materials they have all kinds of measures of it so people who end up smoking cigarettes for the most part were not susceptible to smoking at all so these are these are not people who would have smoked otherwise and what ends up happening to both young people and adults alike is when they they they also end up smoking and doing both at the same time and using some other tobacco products such as who garcia gars or pipes cigarette smokers who generally are not more likely to reduce or quit smoking cigarettes most become dual users and as you can imagine multiple nicotine product use really raises your risk of nicotine addiction other  of using marijuana one year later this is especially true of the younger teenagers why that is could be several reasons it could be there is risk taking behavior anyway it could just be that the nicotine itself affects the brain in a way that makes it more vulnerable to other use but there have been several studies that have come out recently that have shown a strong link to marijuana and cocaine and other substance use as well this is a visual from a study that we did on people age twelve and older it's not just teenagers but  it looks at the rates of alcohol and drug use disorders which means meeting clinical criteria for addiction among people with and without nicotine addiction and you can see there's quite a  difference not to give people new information if they don't already have it but there are actually increasingly dangerous ways to vapor so sometimes people kind of take apart the products and what you could do is if you drip the liquid nicotine on the battery directly produces a more potent and powerful effect one in four teens who they have done this it produces more harmful chemicals because the heating is higher and also risks  increases the risk of sort of spilling some of that oil or liquid on your hands which could be poisonous and toxic and people also vapor other drugs besides nicotine liquid t h c which is the psycho active ingredient in marijuana t there they kind of optimize the absorption of the cannabis to levels as high as ninety percent but it's difficult to measure how much t c is in these products and it's not regulated it's not legal so there's no amounts on it so you kind of don't know if you're overusing or not and they also don't have smoke or odor so they're very hard to detect younger kids are actually more likely to try it than older te and other psychedelic drugs and i think i mentioned this already but despite all of you know the original purposes of these do these products they're turning out not to really be particularly beneficial even to adult smokers despite the years of haarp and harm hype and harm reduction arguments people who end up using the cigarettes actually have for the most part a lower chance of successfully quitting cigarettes than people who don't and one study only ten percent of smokers who used the cigarettes had quit smoking after six months compared to twenty seven percent of smokers who didn't use them or their research shows a similarly negligible or detrimental effects of the cigarette use on smoking cessation and why is that because most people end up using both they don't stop the cigarette smoking just because they start beeping increasing their total nicotine intake and therefore perpetuating the nicotine addiction so generally i think the consensus is starting to come around that you cigarettes has backfired as a public health strategy this is a really interesting recent finding an estimated two thousand and seventy adult cigarette smokers in the united states quit in two thousand and fifteen with the help of cigarettes cigarettes or some people who quit but during that same time period an estimated one hundred sixty eight thousand teens and young adults who never smoked cigarettes most of whom never intended to have become daily smokers after having used the cigarettes so that's eighty one times as many young people who've aped and moved on to regular smoking relative to the number that quit number of adults who quit and other thing that's important and has been very helpful to reducing cigarette smoking and kids over the years has been increasing the prices of cigarettes through taxes you know young people are very price sensitive they don't have the money to spend on it so when taxes were increased smoking went down that was one of the main causes of the reduction in smoking cigarettes but let's look at this now the cost of a rechargeable leaping device ranges from twenty five dollars two hundred forty five dollars and the nicotine pads costs about forty three dollars a month the average cost of a pack of cigarettes in the us in a varies a lot by state is about seven dollars or eight dollars so a cigarette ironically can now be a cheap products flavor is another issue that sort of you know was meant to be a benefit to the public health flavors in these baby products that will attract smokers to move away from cigarettes to they've been products but it ended up really mostly attracting young people a recent study found that over eighty percent of tobacco users use flavored products and three quarters of them said they would no longer use the product if it wasn't flavored so flavors are very very powerful so here's sort of like your basic classic plan to prevent substance use in young people you know there's public awareness campaigns there's policies and regulations that curb use it's important to detect risk early and intervene early and to do so with a health based approach so there you go but what can parents actually do you know i always feel like there's a lot of pressure on parents  and that's in the face of really terrible government regulation this issue there is tons of irresponsible and clever marketing out there young people have a natural tendency and it makes sense and there's nothing abnormal about it so want to try things that are sort of exciting or risky so then it's up to parents to deal with that so coming today to learn the facts is a grace great first step it's really important to be informed about the risks you really want to kind of know all the signs of a being so that you're not clueless because as madison and her group survey found most kids think their parents have no idea that they pay so there are ways to kind of know about it or try to at least you should know what to look for should know where your kid spending money is going these are expensive products and they're getting the money from somewhere but most importantly you should kind of take it seriously don't assume it's a harmless rite of passage we say that about all kinds of substance use by really this is one as well it's important to realize you can't control everything your kids are too and that's a lot of pressure but you do want to make it clear that it's not acceptable it's not healthy it's something you hope and expect them not to do and you want to keep the lines of communication open talk about it regularly don't freak out don't be alarmist it's not the end of the world not everybody  once experiments is going to end up becoming addicted to nicotine in a pack a day smoker but actually many well so you kind of want to listen you want to talk about it and you want your kids to come to you as a resource not hype things from  you and most the best way to do that is to kind of be honest you don't have to have all the answers you don't have to know everything but just be there and to for those who this is helpful for let your kids use you as an excuse to not do this or other kinds of substances and most importantly set a good example if you're smoking or using these products it's kind of hard to make the case that you shouldn't but your child shouldn't  as powerful as a tobacco industry and clever marketing and peer pressure are none of the matches the power of a concerned parent so years of working in this field of prevention for kids has led me to a very important conclusion and it's really backed up by the science which is parents actually are have the single greatest impact on their kids decisions and choices when it comes to substance use and a whole range of other things as well obviously not in every case but for the most part so i'm a parent of two thirteen year olds it hit me like a ton of bricks when they went from twelve to thirteen and middle school and all the center and all these things were an issue and i had this feeling like ok i felt like i had control all these years and then you sort of assume that you're now kind of helpless and the peers take over but every now and then you kind of get these indications that that might not be the case and you kind of have to cling to those and believe it because it's really true that parents play a big part in what their kids decide to do it's not to say it's easier even fair that parents have to shoulder this burden on their own but it's important our main goal is to keep our kids safe and healthy and we have to keep doing that so other than parents work at schools and communities do so while the federal government is asleep on this issue schools and community should be helping parents ensure that the kids have the right facts about the now why young people are especially vulnerable to su and its affects make sure you're getting the kids perspectives about why they're doing this and help them weigh the risks and benefits challenge the perceived norms you'll hear kids say everyone's of aping you know the survey shows really not three quarters of the kids say they've never done it so that's not everyone is a ping you may hear that at home but it's not the case and a lot of the kids when asked say that they do it because they're bored and there's nothing else to do and why not so people really need alternative and safer means of having fun taking some risks pissing off their parents whatever it is but let's hope it's not that ok what about teens themselves i'm so happy so many of you are here wake up now because i'm going to talk to you for a second please so my main message is don't fall for it it sounds cool it looks great but it's the big businesses like the tobacco industry that's banking on you guys falling for it and it's your health that's at stake you're at this age or a now where all the elements that your parents and grandparents and aunts and uncles are always complaining about you guys don't have that yet you're healthy so you know keep your bodies healthy and don't be fooled by the celebrity and social media promotions those are paid mostly those are paid people they're paid by the companies to promote their products they're not just showing you what they think is so fine and great for you they don't have your interests in mind it's important to make smart and healthy choices only have one brain one body you don't want to mess with it and if you're worried about peer pressure totally understandable but if a friend's going to drop you because you're not a thing obviously that's not a friend you need to have and they don't do that this isn't the one nine hundred seventy s where kids were that mean and bullying right i don't think people are like i'm not your friend because you don't ba so what's the bottom line almost than you cigarettes do you have some potential to benefit adult smokers who are not pregnant if they use them as a complete substitute for regular cigarettes so if they completely replace smoking cigarettes with a pain then there is some benefit other than that you cigarettes are not safe for young people for pregnant women or for adults who don't smoke cigarettes and while they have the potential to benefit some people and harm others there's still a lot to learn about what the long term effects are so the bottom line is if you've never smoked or use a tobacco product don't start and if you do use one g help and get off them because you don't want to be using things that are promoted and designed by the tobacco industry to help you get off cigarettes i we just had a conversation with the head of the truth initiative which is a great public health organization that you know combats cigarette smoking and other kinds of tobacco use and he said don't buy a fire extinguisher from a from an arsonist i thought that was really a good one so anyway thank you so much sorry for the c says my e mail address if anyone has any questions or wants any other information i have the sources of all the studies and all that i present and i'm happy to share those with you and that's our organization's website we have tons of information about prevention in general not just so the microphones are fine if you just hit the button if they're all on you can just speak right into the microphone i guess what our plan was is to have each kind of let's talk about just a few minutes about what you're seeing in the last year or two so we are doing a lot of training with teachers and a lot of training in freshman health classes and getting some training done at the seventh and eighth grade level corner house providing our patients treatment over the last certainly over the last five years if not ten what we've seen is just a huge increase among eighteen to twenty five year olds who are now coming into treatment for an addiction problem and you know sort of on break or outside of are certainly seeing an increased demand a number of as opposed to smoking cigarettes nicotine use substance abuse is not something that we don't talk about at present day school and it's not something that we're not affected we start and we talk from fifth grade on because we reflect what the national averages are both from our internal surveys and the national surveys that we've that we've participated in we have had to amend our school policies to reflect what they are bait being and substances on campus during field trips and dances and any school sponsored event so it is unfortunately a reality that we as a community see every  day at stuart besides serving as this isn't a school boy serve as the middle school division head and i heard the kind of gas when the students presented the data and saying that you know quirk first or in middle school and i can tell you firsthand in talking with students that in teen or anything else it's really you know it's the same issue just two different formats of how do you teach kids to slow down think and think long term about the choices they make but it's out there and they're dealing with  at home this week and their freedom from chemical dependency an outside organization to help us educate our students on substance abuse ok thank you well we're going to open it up for questions from the audience par just this is one question is done but is there at dr richter are there any second hand effects for people if you have to be sitting next to somebody on a train or anywhere at any second hand health impacts for that as question one and then this might be your panel but in terms of the survey that you all did did it have any breakdown in terms of gender and did you also have a breakdown of which schools you're seeing the numbers at but i have to check that i th ink our student who did the survey has left so we'll have to get that information for your second question i can give you the national data which is it's slightly higher among boys and girls yeah i wouldn't jump to that conclusion there are three to four national surveys conducted by the us government they come out they come out with different numbers and a little but it depends on the methodology how they're getting how the students are responding whether it's in their homes or in schools how anonymous they feel the surveys are i would just kind of look at it more so that's sort of the ballpark and it does not necessarily i wouldn't necessarily compare your results to the national averages unless the surveys were conducted with the same  then i don't know if there's been any more recent surveys but it probably would be closer to the princeton average our survey was in the last three days so why do you think the f d a hasn't done anything by be afraid relation i know you said they could have done something starting two thousand and nine but they didn't so that's the first question second is is there anything that we can he used to work for the cigarette companies so i think that might have played a role but i don't know for sure actually a lot of the cigarette related regulations that are effective are done on the local and state levels actually to do a lot in new jersey has done a lot it's one of the better states and i don't know about you know princeton's regulations i'm sure you could speak to that princeton regulations you have to be over twenty one advertisements on new jersey transit new york city doesn't have a health department nurse or is there anything you want to palm and you can do it there is a distinctive click but you have to be kind of close to actually hear it that's the cartridge deploying but other than that i mean especially again if they're flavors like tutti colada some kind of unicorn something something in there you might have you might actually smell something a little bit sweet but it's very nonspecific the adults in the room may actually not notice unless you're specifically thinking about it and looking for anyone else there's also a habit that it's called ghosting where they will take the aerosol and hold it in for a while before they will let it let it out and i think that reduces the amount of vap well for for us it comes under our smoking policy it's more in our procedures where they come in same way they get their devices confiscated their parents get called they have a meeting with me and if they have a second or third policy a vial violation it kind of increases as as it goes up but there are a number of schools in new jersey having the conversation about changing some of those policies and not just sticking it in with the smoking tobacco policy it's just an early conversation  we have falls under our tobacco policy which means that it's the student meets with me as the dean of students the student will then go to the discipline committee which is a committee made up of two faculty members three students and myself typically the results of that meeting would be a one day suspension plus a health and wellness remediation plan that's run through our counseling office and often partnering with corner house to make sure i we were sitting here looking at some of the information we got from the sides and there wondering what the caffeine sensibility is sensitivity is and also as a mother of a teenager in a local school  told me that the kids are blowing it down their long sleeves and it dissipates while it's in their sleeve and the the pipe spit in their sleeves as well so they can smoke that way sometimes their looks like they're chewing on a pen so they can smoke that way and they have inhalers that are they pipes and they also have credit card looking ones too so this industry is very creative  yeah there's been some evidence that if a person has you know usually drinks a bit of caffeine and they kind of become more sensitive to it when they pull out of the sense they don't want it as much not quite sure why it could be too many stimulants at once gives you an implied that the leader was somehow bias what have you if you had a representative from the f d a here given the fact that it was overwhelmingly negative against b p and here with studies you refer to what would a representative from the f d a who was here how would they react to what you said tonight i can only guess i would i would say that it would be that they've been waiting for the evidence to come in it's the public health issue that for years people have said  cigarettes and babying are a potentially good harm reduction approach for cigarette smokers they're very they were very reasonably concerned about regulating it to have a leak because that might have an effect on people who are trying to use them to cut back on cigarette smoking which is a known danger so so you disagree with them in the sense that you think there's enough evidence that would imply imply that they ping is bad so you would disagree on from a scientific data evidence based scientific studies correct i think that years ago there was maybe reason to kind of wait and see what the evidence shows but as of now the evidence is quite clear i don't agree with the need to delay the regulations from what would have been august two thousand and eighteen to twenty twenty two that evidence is pretty strong that this question is also to dr rector say you said that jewel is one of the more highly concentrated in terms of nicotine content  of all the vapors on the market is there a difference in the health risks and also the benefits to using so the more nicotine you consume the more likely you are to become addicted to the product it's just an addictive drug so if something has a lot of nicotine in it you're going to become addicted more quickly more strongly in terms of a smoking cessation device is that what you mean like there's some benefits of there being nicotine in it to replace the nicotine you get from cigarette smoking the the products that are on the market that have been approved by the food and drug administration that have gone through a rigorous testing and f d a approval have nicotine in them that's like the nicotine patch and gone and and those sorts of things they don't have anywhere near as much nicotine as they've been products have and that's kind of on purpose you don't want to perpetuate the addiction you kind of want to give enough to ease the person off their nicotine addiction and slowly reduce the need for does that answer your question there are some that do not have nicotine there are very few but they do have flavors and the flavors are chemicals it's not like you're actually eating strawberries you know it's their chemical flavors so there's always some level of toxic  people in a stall if i didn't mean that to be funny but i mean if a teacher is in using the bathroom themselves and there's five or six people in the stall they have a pretty good idea that something else is going on and you do get used to seeing groups of people in going in and out of the bathrooms i mean i think all of our schools our communities and whether it's beating bullying or anything else when the embers of the community see something that's going on that's hurting someone remembers a committee will step forward to stop it so why i don't need a teacher in every room we have a community that cares about each other and when they see someone who is harming themselves and the community in general the oh the fact is it's really hard to catch students bating in the bathrooms in the hallways in our locker rooms behind the theater out in the parking lot these are just places that we've heard they ping occurs but it's really really hard and just like our fellow panelists said you know we rely actually on the community and our peers to be able  to identify risk behavior so that we can address it in a response that's responsible and respectful way i just want to add one expert thing with this whole catching high school student so my son is a sophomore at north end and high school unfortunately north hundred high school has decided to be somewhat of a police state in this matter because they take it very seriously and every bathroom in the entire high school that has no vay been with warnings the teachers are now taking rotation during the day to go in and out of the bathrooms constantly they're locking half of the bathrooms during the day so that they're restricting access so it's because my son comes home and tells me dad it's like out of control that sort of the presence of the teachers and they're just trying to so this is kind of where it's gotten you know  north end of high school is the way they're trying to sort of deal with the baby an issue because it's it was out of control over the last several years in the bathrooms but there are that's their approach to it but i'm i think you make a very good point i just this is a little counter intuitive but i kind of reference that before with cigarette smoking probably the strongest effect was from regulation making it virtually impossible to smoke indoors making it illegal in most places are raising taxes so that they're not affordable anymore so with all the you know pressure we put on parents and kids to kind of know the facts and stop it and all that that's effective but more effective this kind of making it against the social norms and turning it into something that's not considered cool and ok so when they stop the cigarette advertising starts having it be ubiquitous that's really what did it so that's why i am a strong proponent of the regulations and i think it makes a big difference and it's you know the evidence shows kids you say if i'm wrong but just telling kids that something's bad for them is actually not that effective despite the fact that i did that to if it's important for people to know the facts but what you say what you're going to do is you might affect the kids who are not at such high risk but kids who are at high risk of doing these  things this is more of an observation kids deal with peer pressure they don't we and a lot of kids are doing it and making it sound like it's cool i think a lot of it starts at the home and parenting and making it not be cool are allowed so kids feel like oh hey look i got this and yeah my mom knows about it but it's not harmful or it just it just becomes something that as parents who do try to be involved makes it harder for us with our kids to have friends where there's not that much restriction in the household so just an observation thank you very much that's important there's a lot of kids that we saw from the survey that are not doing it and there's a lot of kids like this group here who are doing very positive things in the community to stak i mean this question applies to more on a school by school basis but what are the repercussions if students outside of school are say on social media or something like that so i can start  o basically i would meet with the student and talk to the parents but there isn't much we can do for students who are doing outside of our school grounds but at least the awareness is there and then also offering them follow up or mandating follow up meetings with our counseling program and its story to be similar i mean i think certainly with what's going on we're looking at our handbook knowing that it would be doing something illegal and how you take very seriously you know i think we i think college counseling codes that over fifty percent of colleges will actually check their candidates on social media so we actually think of your social media footprint as a reflection of who we are as as a community every case is unique every case is individual and every case actually starts with a conversation with their class dean the dean of students and and then it goes from there when we have a situation that's social media that we think parents need to know about that you know there's a phone call just to  bring it to their attention to date i haven't had anyone have a policy issue because of something on social media they've all been having been called at school or outside you you thank you so much for having this program i just feel like this is really important is educating our community and students and parents and everything i did a ton of research on all this so i feel really excited to finally have it out here but one of the things i really liked is  what they said about educating and not being so police i do think the importance is to really educate our kids educate parents in our community to know what is it about so i was in hopewell high school recently and every back to me just had what is it what  you and i really appreciated that that information was there every time a kid went to a stall they closed the door it was really front of them so i think we could start by educating and not really you know punishing more and more students take responsibility for getting the information out weevil levy and i work with robbie when a corps with the eighth graders who are now creating a workshop for seventh grade health classes and they've they've worked really hard they've created a skit they have their statistics they have discussion questions at the high school level health teachers have sent me you know projects that kids have done for their for their health program and so kids are starting to be aware and to have some voice thank you i just i just want to add one thing along those lines on a positive note which i mentioned earlier if you look at the national statistics there's some hope that people are getting the message the rates have gone down slightly from previous years so it really kind of peaked in two thousand fifteen and there seems to be some minor decline so the message with all the research that's been coming out i think is getting out there hopefully and the four high schools represented here we thank you for coming out and being part of this you have any questions you can always reach a sykora household we have to get the answers for you if you want programs actually jackie shriver who does a coffee and conversation  program in your home she'll come in and you can have a host program in your home of parents of your friends and she'll do a private program for you at in your home so contact our house and or jackie she's sitting right over there thank you very much for co