Reducing the Influence of Tobacco Marketing

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NEW SURVEY REVEALS LARGE PROPORTION OF COLUSA COUNTY YOUTH THINK IT WOULD BE EASY TO GET E-CIGARETTES

Just released findings from county-wide survey finds students susceptible to future tobacco use

FOR IMMEDIATE RELEASE

CONTACT:
Amanda Pitts
Email Amanda Pitts
530-458-0380

Colusa, CA – October 3, 2019 – New research shows that over 43% of students in Colusa County believe it would easy to obtain e-cigarettes. These findings are part of new research released today on student use of, knowledge of, and attitudes toward tobacco products, including cigarettes, e-cigarettes, smokeless tobacco, and marijuana.

Over 500 students from middle and high schools in Colusa County were surveyed as part of a public health campaign to address the current youth e-cigarette epidemic. Today, health advocates from Yuba, Sutter, and Colusa counties are holding a press event to release the results of this scientific survey, which is one of the most extensive tobacco-focused surveys conducted with students in the Tri-County area to this date.

"Overall, the findings show positivity that use of traditional cigarettes has decreased to historical lows among youth, but the risk for future tobacco use of non-traditional tobacco products remains high," said Amanda Pitts, Colusa County Public Health. "The thousands of flavored tobacco products on the market, along with the tech-inspired devices and predatory marketing by the tobacco industry fuel the rising popularity of e-cigarettes among adolescents. Most students in Colusa County that use tobacco products use flavored e-cigarettes and many non-users are at risk for future use."

The survey found the following for Colusa County:

  • Among Colusa County students who had never used tobacco, over one-third were susceptible to future use.
  • Nearly 20% of students had been offered a tobacco product in the past 30 days.
  • In Colusa County, almost 30% of middle and high school students have tried a tobacco product.

Over the last three months, lung injury outbreaks have occurred across the country, all associated with electronic cigarette use. Over 530 cases of lung injuries have been reported to the Centers for Disease Control. Seven deaths related to these illnesses have occurred, two of which happened in California. Two-thirds of cases are with patients 18 to 34 years old and 16% of cases are individuals under 18 years old.

In the midst of these outbreaks, the Trump Administration announced plans to ban flavored e-cigarettes to reverse the epidemic of youth e-cigarette use that is impacting communities across the country. Shortly after this announcement, California Governor Gavin Newsom signed an executive order to confront the youth vaping epidemic. In the 2018 U.S. Surgeon General’s Advisory on E-Cigarette Use Among Youth (PDF), states and local communities are encouraged to take action by implementing evidence-based strategies to reduce e-cigarette use among young people, such as restricting young peoples’ access to e-cigarettes in retail settings, licensing retailers, and implementing price policies.

"The widespread popularity of e-cigarettes is of particular concern and reflects the spike in use by teens and young adults" said Ted Mamoulelis, Health Program Specialist Supervisor for Colusa County Public Health. "We are also seeing cases of vaping-associated pulmonary injury in California, which should motivate our community to take the necessary steps to protect our counties young people from the risks of e-cigarettes."

Another goal of this survey was to examine the impact that secondhand smoke and secondhand aerosol has on youth in Colusa County.

This survey found that a large amount of students were exposed to secondhand e-cigarette vapor or secondhand smoke. There currently are no local smoke-free protections for children living in apartments. "Exposure to secondhand smoke and secondhand e-cigarette vapor continues to put at risk the health of non-smoking Colusa County residents, including youth, elderly, and other health-vulnerable populations" said Daisy Velasquez – Colusa County Public Health. "Children, especially, have limited choice to protect themselves from smoke and e-cigarette vapor. Building resilience starts with communities providing protections for their most vulnerable."

Additional survey findings for Colusa County:

  • Two in five students had been exposed to vapor from an e-cigarette or smoke from a traditional cigarette in a room or car within the last 30 days.
  • Over 30% of students were exposed to advertisements promoting electronic cigarettes.
  • Four out of five students who had visited a convenience store in the last 30 days were exposed to flavored tobacco advertisements.

The rising popularity of e-cigarettes among youth in Colusa County continues to be a matter of concern. Current e-cigarette use among middle and high school students in Colusa County is 6.6%, which accounts for the majority of all youth tobacco use (9.8%). While youth use of traditional cigarettes has decreased, the majority of youth that currently use do so because of their access and addiction to e-cigarettes.

Colusa County Public Health is committed to continuing to work with local health advocates and partners to provide accurate information and help make the healthy choice the easy choice for Californians.

For more information on youth tobacco use and e-cigarettes, please visit our Flavored Tobacco page.

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Printable version of press release available (PDF)

Data report for Colusa County Student Tobacco Survey (PDF)

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8/30/19 Statement from CDC Director Robert R. Redfield, M.D., and Acting FDA Commissioner Ned Sharpless, M.D., on federal and state collaboration to investigate respiratory illnesses reported after use of e-cigarette products

Media Statement (PDF)

For Immediate Release: Friday, August 30, 2019
Contact: Media Relations
(404) 639-3286

Both the U.S. Centers for Disease Control and Prevention and the U.S. Food and Drug Administration are working tirelessly to investigate the distressing incidents of severe respiratory disease associated with use of e-cigarette products. We were deeply saddened last week to learn of the death of an adult in Illinois who had been hospitalized with a severe respiratory illness following the use of an e-cigarette product. We are working closely with state and local health officials to investigate these incidents as quickly as possible, and we are committed to taking appropriate actions as a clearer picture of the facts emerges.

We’ve also made it a top priority to communicate with the public about our efforts. Today, we are providing several updates about efforts between CDC, FDA, and state health officials to investigate these incidents that have impacted both youth and adults across the country. First, we are updating the number of potential cases of respiratory illnesses reported after use of e-cigarette products. Additionally, we are sharing more details about the work CDC and FDA are undertaking as part of the investigation, including current status. We are also providing the public and our health partners across the country with information to help mitigate the risk of additional incidents and what health officials and clinicians can do to help us gather as much data as possible to better understand these illness and potential causes.

As of August 27, 2019, 215 possible cases have been reported from 25 states, and additional reports of pulmonary illness are under investigation. States are completing their own investigations and verifications of cases based on CDC’s recently released standardized case definition. While some cases in each of the states are similar and appear to be linked to e-cigarette product use, more information is needed to determine what is causing the respiratory illnesses. In many cases, patients reported a gradual start of symptoms, including breathing difficulty, shortness of breath, and/or chest pain before hospitalization. Some cases reported mild to moderate gastrointestinal illness including vomiting and diarrhea, or other symptoms such as fevers or fatigue. In many cases, patients have also acknowledged recent use of tetrahydrocannabinol (THC)-containing e-cigarette products while speaking to healthcare personnel or in follow-up interviews by health department staff.

Even though cases appear similar, it is not clear if these cases have a common cause or if they are different diseases with similar presentations, which is why our ongoing investigation is critical. CDC and the FDA are providing consultation to state health departments and working closely with them to gather information on any products or substances used. For example, our agencies are working to standardize information collection at the state level to help build a more comprehensive picture of these incidents. This includes investigating the brand and types of e-cigarette products, whether any of them are products that would fall within FDA’s regulatory authority, as well as where they were obtained.

CDC is helping involved states investigate whether the illnesses may be linked to specific devices, ingredients, or contaminants in the devices, or substances associated with e-cigarette product use, with assistance from FDA. Current assistance to states includes deploying CDC staff to Illinois and Wisconsin to assist their state health departments with the respective state investigations; releasing a Clinician Outreach and Communication Activity (COCA) Clinical Action Alert describing this investigation and asking providers to report possible cases to their state health departments; developing and distributing to involved states a standardized case definition, medical chart abstraction form, and case interview questionnaire with input from states who are running investigations; reviewing and providing feedback on data collection and health messaging tools for states; and facilitating information sharing between states with possible cases.

In addition to daily meetings between our federal agencies, as well as frequent communication with state health officials, the FDA has been and will continue to provide laboratory assistance. The FDA has received about 80 samples and continues to receive requests from states to send more samples for the FDA to analyze. The samples represent a variety of different types of products and substances – a number of which contained incomplete information about the product. The FDA is analyzing those samples for their contents, whether they contain nicotine, substances, such as THC or other cannabinoids, or other chemicals and ingredients. The results of that testing will be shared with the respective states to aid in their investigations and will help inform the federal response.

More information is needed to better understand whether there’s a relationship between any specific products or substances and the reported illnesses. At this time, there does not appear to be one product involved in all of the cases, although THC and cannabinoids use has been reported in many cases. At this time, the specific substances within the e-cigarette products that cause illness are not known and could involve a variety of substances. We continue to gather information about the names of the products used, where they were purchased, and how the products were used. That information is critical to help determine whether patterns emerge on which we can take additional action. While we continue to gather more information about these incidents and any specific products or substances involved, we also believe it’s important to provide the public with useful information to help protect themselves and their loved ones, as well as continue to notify health care professionals about the illnesses, what to watch for, and how to collect and report information on these cases. As part of that commitment, CDC today issued a Health Alert Network (HAN) Health Advisory. The advisory includes the recommendation that while this investigation is ongoing, if you are concerned about these specific health risks, consider refraining from the use of e-cigarette products.

Anyone who uses e-cigarette products should not buy these products off the street (e.g., e-cigarette products with THC or other cannabinoids) and should not modify e-cigarette products or add any substances to these products that are not intended by the manufacturer. Regardless of the ongoing investigation, e-cigarette products should not be used by youth, young adults, pregnant women, as well as adults who do not currently use tobacco products. If you use e-cigarette products, monitor yourself for symptoms (e.g., cough, shortness of breaths, chest pain) and promptly seek medical attention if you have concerns about your health. CDC and the FDA will continue to advise and alert the public as more information becomes available. Adult smokers who are attempting to quit should use evidence-based treatments, including counseling and FDA-approved medications. If you need help quitting tobacco products, including e-cigarettes, contact your doctor. If you are concerned about harmful effects from e-cigarette products, call your local poison control center at: 1-800-222-1222. We also continue to encourage the public to submit detailed reports of any unexpected tobacco- or e-cigarette-related health or product issues to the FDA via the online Safety Reporting Portalexternal icon.

As this investigation continues, our agencies remain committed to working as quickly as possible, in collaboration with our state and local public health partners and the clinical community, to find out as much as we can about these cases and potential causes and communicating with the public about these efforts to protect and promote the public health. Our ongoing oversight and educational efforts related to e-cigarettes is critical to our public health mission and, especially, to protecting youth from the dangers of nicotine addiction and tobacco-related disease and death.

3/13/19 Statement from FDA Commissioner Scott Gottlieb, M.D., on advancing new policies aimed at preventing youth access to, and appeal of, flavored tobacco products, including e-cigarettes and cigars

The FDA is proposing to end its current compliance policy as it applies to flavored electronic cigarettes and prioritize enforcement of such products offered for sale in ways that pose a greater risk for minors to access these products. The FDA also expects manufacturers of products that remain on the market under these new conditions to submit premarket applications to the agency by August of 2021. This application date is one year earlier than the FDA previously proposed.

Read the full statement online.

12/18/18 U.S. Surgeon General’s Advisory on E-Cigarette Use Among Youth

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On December 18th, The U.S. Surgeon General Jerome Adams issued an advisory on e-cigarette use among youth (PDF). The Surgeon General has officially declared e-cigarette use among youth an epidemic in the United States. In this advisory, he provides information for parents and teachers about their role in addressing this public health epidemic.

Read this advisory (PDF) for more information on the latest e-cigarette trends among youth and steps you can take to protect youth in Colusa County.

Parents, learn what to look out for!

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Learn what to look out for at FlavorsHookKids.org

Get involved in our work at Colusa County Partners for Health!

JUULs and Youth: A New Style of E-Cigarettes

A new e-cigarette product called the JUUL hit the market two years ago. After their first introduction, JUULs quickly became popular. JUULs currently make up 30% of total e-cigarette sales.1 Much like other e-cigarettes, the JUUL devices heat up a liquid cartridge to create a vapor. Each cartridge provides 200 puffs and contains a variety of different flavors.1 Each cartridge also contains 59 milligrams per milliliter of nicotine, which is equal to the amount of nicotine found in an entire package of cigarettes.1 One distinguishing factor of these e-cigarettes is their small size -- they can fit in the palm of your hand and they resemble a USB flash drive.

JUUL Vaporizer (Image Property of California Department of Public Health)

An additional difference between the JUUL and other nicotine-containing e-cigarettes is the way that nicotine from JUULs is absorbed into the body. The liquid in JUULpods is designed with a salt-based nicotine absorption method, which delivers nicotine to the body and brain in a way very similar to traditional cigarettes.1 These pods also come in flavors like mango, cool mint, fruit medley, and crème brulee, which can often be appealing to youth. Public health advocates are concerned that the appealing JUULpod flavors, in combination with the highly addictive salt-based nicotine, will get youth hooked on tobacco products.

These new JUUL products are being labeled as a smoking alternative, but it is important to remember that the long-term health effects of heating and inhaling the chemical components of the vapor are unknown.1 E-cigarettes are not an FDA-approved method of cessation. A list of FDA-approved cessation products can be found on their website or by clicking the link here.

Sources

  1. "Why Should I Be Worried About JUULs?" JUUL 101 | Tobacco Prevention Toolkit | Stanford Medicine, Stanford School of Medicine, med.stanford.edu/tobaccopreventiontoolkit/E-Cigs/ECigUnit6.html

Reducing the influence of tobacco marketing on youth

Youth use rates in Colusa County remain high above the rest of California. In Colusa County, almost 23% of youth are using tobacco products in some form.1 The state average is almost 10% lower at 13.8%.1 New and emerging products are contributing to the consistently high youth use rates. New products like electronic cigarettes and flavored tobacco products are heavily marketed toward youth and are creating the next generation of nicotine addicts.

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Flavored Tobacco Products

In the United States, cigarettes are prohibited from containing flavors other than menthol as part of the Family Smoking Prevention and Tobacco Control Act of 2009. The FDA recognized that flavored cigarettes were gateway products for many children and young adults to become regular smokers, so they prohibited them.2 However, other flavored tobacco products are still available such as flavored such as little cigars, e-cigarettes, and hookah. These products have skyrocketed in availability and consumption over the last few years. These flavored products can come in a wide range of youth appealing flavors including chocolate, berry, apple, Jolly Rancher, breakfast cereal, wintergreen, and peach.3

There is great concern that these new flavored tobacco products are being directly marketed toward youth in Colusa County to create the next generation of addicts.

Here’s why: 

  • 4 out of 5 kids who ever used tobacco products started with a flavored product. 4
  • Almost 23% of Colusa County youth are current tobacco users.
  • Nearly 86% of stores in Colusa County sell flavored tobacco products, which often have kid-appealing flavors such as grape, watermelon, gummy candies, and even breakfast cereals.
  • Flavorings help mask the naturally harsh taste of tobacco, which makes flavored tobacco products more appealing to youth and easier to initiate and continue use.3

Electronic Cigarettes

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Electronic cigarettes, also known as e-cigarettes, e-hookahs, hookah pens, vapes, vape pens, vape pipes, and mods, were first introduced to the United States in 2007. Since their introduction, they have skyrocketed in popularity, availability, and variety. E-cigarettes are battery-operated devices that heat a liquid solution until it changes chemical phases to become an aerosol, which is then inhaled.E-cigarettes are, by California law, considered tobacco products. E-cigarettes can contain nicotine, which is highly addictive and can harm adolescents during critical periods of brain growth and development.5

E-cigarettes have become popular among youth in recent years. The rate of youth e-cigarette use has surpassed the rate of traditional cigarette use.5 E-liquid comes in over 7,700 flavors that can be appealing to youth such as Fruit Loops and Cap’n Crunch. Studies have demonstrated that appealing flavors are one of the main reasons that students experiment with e-cigarettes.5 Youth are bombarded with e-cigarette advertising exposure in retail stores, on the Internet, in television or movies, and in newspaper or magazines.5

E-cigarettes are still a fairly new product and there have been no studies done on the long-term health consequences of using e-cigarettes. We do, however, already know several of the dangers.

Here are some of the known dangers of using e-cigarettes:

  • E-cigarette aerosol is not just a harmless water vapor.
    • E-cigarette aerosol contains at least 10 chemicals known to cause cancer, birth defects, or other reproductive harm.
  • Flavoring chemicals in e-cigarettes have been linked to severe and irreversible lung diseases.
    • Diacetyl is a chemical originally used in food flavorings. Diacetyl is now also used as a flavoring chemical in the manufacturing of e-cigarette juice.
    • A Harvard School of Public Health study found that diacetyl was present in 75% of flavored e-cigarette liquids and refill liquids tested.3
    • Diacetyl is associated with the development of the irreversible lung disease called bronchiolitis obliterans or "popcorn lung." Popcorn lung causes an irreversible loss of pulmonary function and damage to cell lining and airways.3 There is no treatment for this disease – the only cure is a lung transplant.
  • E-cigarette poisonings have increased among young children.
    • E-cigarette products can come in a variety of flavors and colors that can be enticing to young children.
      • Ingestion of liquid nicotine can cause nausea, vomiting, abnormal heart beat, and even death.3
      • E-liquid solutions can contain varying concentrations of nicotine, ranging from no nicotine to 100 mg per milliliter. A 10 mg dose of nicotine is lethal for a child.3 
  • E-cigarettes are NOT approved by the U.S. FDA to help people quit tobacco.
    • E-cigarette use is actually strongly associated with use of other tobacco products. Youth that use e-cigarettes are almost 4 times more likely to smoke traditional cigarettes than someone who never used an e-cigarette.6

Learn about the availability of flavored tobacco, e-cigarettes, and other tobacco related products in Colusa County at the Healthy Store for a Healthy Community Website.

Sources:

  1. California Student Tobacco Survey, 2016
  2. California Medical Association. Flavored and Mentholated Tobacco Products: Enticing a New Generation of Users. 2016.
  3. California Department of Public Health, California Tobacco Control Program. (2017). Flavored Tobacco Products Fact Sheet.
  4. Campaign for Tobacco-Free Kids, American Academy of Pediatrics, American Cancer Society Cancer Action Network, American Heart Association and American Lung Association. The Flavor Trap How Tobacco Compainies Are Luring Kids with Candy-Flavored E-Cigarettes and Cigars. 2017.
  5. U.S. Department of Health and Human Services. E-Cigarette Use Among Youth and Young Adults A Report of the Surgeon General Fact Sheet. 2016.
  6. Soneji, Samir, et al. "Association Between Initial Use of e-Cigarettes and Subsequent Cigarette Smoking Among Adolescents and Young Adults." JAMA Pediatrics, 2017, doi:10.1001/jamapediatrics.2017.1488.

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