so you think you know tobacco? don’t get stumped by a...
TRANSCRIPT
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So you think you know tobacco?
Pete Dehnel, MD Stefan Pomrenke, MD Medical Director Family Physician Physician Advocacy Network Westside Community Health Services
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Physician Advocacy Network
www.panmn.org
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Outline
1. Health Risks of Cigarettes
2. Health Risks of E-cigarettes, Smokeless Tobacco, and Hookah
3. Common Myths
4. Your Stories
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Health Risks of Cigarettes
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Source: Clearway Minnesota
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Source: CDC, 2014
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Source: Smoke Free 60+
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Disparities
Minnesotan Adults Minnesotan Youth
Source: MDH, 2014; MDH, 2016.
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Source: QUITPLAN®
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Source: Ellis, 2014
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Source: Polito, 2005
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Source: CDC, 2016
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More than 33,000 nonsmokers die each your from coronary heart disease linked to second hand smoke
Source: CDC, 2014; Chilean Corporation Against Cancer, 2008.
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Source: Israel Cancer Association, 2014
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Health Risks of E-cigarettes, Smokeless Tobacco, and Hookah
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Health and Nicotine
E-cigarettes have a lot of unknowns, however; as a medical community we scientifically know the effects of nicotine, which is the main ingredient in e-cigarettes, flavored products, smokeless tobacco, and hookah.
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Source: San Francisco Tobacco Free Project, 2015
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• Youth e-cigarette use is now more than double cigarette use
• Half of e-cig users report dual use
• Conventional cigarette use fell by nearly one third since 2013 • 12.2% of 11th graders smoked
in 2013 • 7.5% of 9th graders smoked
in 2013
Figure 1. Youth Tobacco Use in Minnesota
Minnesota Student Survey
Source: Minnesota Department of Health, 2016
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Nicotine Comparisons
• We cannot compare the amount of nicotine in cigarettes and e-cigarettes because e-cigarettes don’t deliver a systemic dose; 1 cigarette contains 10 to 15 mg delivering a systemic dose of approximately 1 mg.
• Nicotine content per puff using the same e-cigarette device may vary by as much as 40%.
Source: Schroeder & Hoffman, 2014; Hildick-Smith et al, 2015.
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Sciencepics, n.d. (Used with permission)
Increases risk for heart
disease
Increases blood pressure
Damages vascular tissue
Those with diabetes can
experience
Insulin resistance
High blood sugar/
Higher hgb A1c levels
Highly addictive
Pharmacologic Effects of Nicotine
Source: Cleveland Clinic Heart and Vascular Team, 2014; Bajaj, 2012.
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Evidence shows that fetal exposure to nicotine can have
negative long-term effects, including impaired fetal
brain and lung development.
Source: Minnesota Department of Health, 2015.
Nicotine & Fetal Health
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Liquid Nicotine Dangers
1/8 of a teaspoon is enough to poison children under 5
years old.
Ingestion
Skin contact
Eye contact
Source: Minnesota Department of Health , 2015.
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Source: Minnesota Department of Health , 2015.
Child Nicotine Poisonings
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Source: American Association of Poison Control Centers, 2015.
20
374
Number of cases
Jan 2011 Jan 2015 American Association of Poison Control Centers
National Nicotine Poisonings
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Nicotine Poisoning
• Vomiting is the most common symptom
• Symptoms occur within 15 mins – 1 hour and may last 1-2 hours after a mild exposure
• Other symptoms: Nausea, tremor, rapid heart rate and breathing, high blood pressure and increased alertness.
• Skin/eye exposure can lead to irritation and redness and inflammation of conjunctiva
Source: Centers for Disease Control and Prevention, 2014
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Source: Stand AZ, 2016
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Source: www.thetruth.com
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Common Myths
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“Smoking is normal.”
Source: Awkward Family Photos
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[CATEGORY NAME]
[CATEGORY NAME]
Want to quit
Don’t want to quit
Want to quit
All Minnesotan Adults American Indian Adults
Desire to Quit Smoking
Source: MDH, 2014; Minnesota American Indian Communities, 2013.
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“I can afford to smoke.”
Source: QUITPLAN®
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“Switching to American Spirits is better for your health.”
Source: Glamour Magazine, 2013
64% of American Spirit smokers inaccurately believe their brand is less harmful than others
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“Commercial tobacco is the same as sacred tobacco.”
Source: Aboriginal Tobacco Program
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“E-cigarettes are not a tobacco product.”
Source: Tobacco 235
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Source: Southington Steps Coalition, 2016
“E-cig vapor is just water vapor.”
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“E-cigarettes help you quit.”
Nicotine Gum No prescription
Nicotine lozenge No prescription
Nicotine patch No prescription
Nicotine nasal spray Prescription Required
Nicotine inhaler Prescription Required
Bupropion SR tablets Prescription Required
Varenicline tablets Prescription Required
Source: American Academy of Family Physicians, 2014
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“Menthols taste better so they aren’t as harmful.”
Source: Tobacco Free CA, 2016
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“The water in hookahs filters out toxic chemicals.”
Source: CDC, 2015
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Your Stories
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Questions?
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Physician Advocacy Network
A project of Twin Cities Medical Society
1300 Godward Street NE, Suite 2000
Minneapolis, MN 55413
612.362.3706
www.panmn.org
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References Aboriginal Tobacco Program. Know the Difference. Retrieved from http://www.tobaccowise.com/resources/know_the_difference/
Awkward Family Photos. Retrieved from http://awkwardfamilyphotos.com/2014/01/08/thank-you-smoking/
American Academy of Family Physicians (2015). Pharmacologic Product Guide. Retrieved from: http://www.aafp.org/dam/AAFP/documents/patient_care/tobacco/pharmacologic-guide.pdf.
American Association of Poison Control Centers. (2016, January 31).Electronic Cigarettes and Liquid Nicotine Data.
American Cancer Society (2015). Health Risks of Smokeless Tobacco. Retrieved from: http://www.cancer.org/cancer/cancercauses/tobaccocancer/smokeless-tobacco
Bajaj. (2012). Nicotine and Insulin Resistance: When the Smoke Clears. Retrieved from American Diabetes Association database.
Burhansstipanov, L. (2009). Native American Tobacco Education Fact Sheets: Ceremonial Use. National Native Network. Retrieved from http://natamcancer.org/nnacc_dwnlds/SHEETS/02-18-07_Tob-ceremony_04-12-09.pdf.
Center for Disease Control (2014). CDC National Health Report Highlights. Retrieved from: https://www.cdc.gov/healthreport/publications/compendium.pdf
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Centers for Disease Control and Prevention (2014). Nicotine: Systemic Agent. Retrieved from http://www.cdc.gov/niosh/ershdb/emergencyresponsecard_29750028.html
Centers for Disease Control and Prevention (2015). Current Cigarette Smoking Among Adults in the United States. Retrieved from https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/.
Centers for Disease Control and Prevention (2015). Retrieved from https://twitter.com/CDCTobaccoFree
Centers for Disease Control and Prevention. (2016). Tobacco Use and Pregnancy. Retrieved from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/tobaccousepregnancy/
Chilean Corporation Against Cancer. (2008). Retrieved from https://adsoftheworld.com/media/print/conac_brown
Clearway Minnesota. Still A Problem. Retrieved from http://www.co.goodhue.mn.us/ImageRepository/Document?documentID=7820
Cleveland Clinic Heart and Vascular Team. (2014).E-Cigarettes: Tobacco-Free, But Your Heart May Still Be at Risk. Retrieved from Cleveland Clinic Database.
Dale, L (2014). What is thirdhand smoke, and why is it a concern? Retrieved from http://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/third-hand-smoke/faq-20057791.
Ellis, J. (2014). Retried from http://jerushaellis.ca/illustrations/nicotine-addiction-and-your-brain/.
Food and Drug Administration (2016). FDA's New Regulations for E-Cigarettes, Cigars, and All Other Tobacco Products. Retrieved from http://www.fda.gov/TobaccoProducts/Labeling/RulesRegulationsGuidance/ucm394909.htm.
GASP of Air Colorado. Harmful chemicals in Electronic Cigarettes. Retrieved from http://www.gaspforair.org/gasp/gedc/pdf/E-CigSmoke.pdf.
Goriounova, N et al (2012). Short- and Long-Term Consequences of Nicotine Exposure during Adolescence for Prefrontal Cortex Neuronal Network Function. Cold Spring Harbor Perspectives in Medicine 2(12). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3543069/.
Hartmann-Boyce, J. et al (2016). Can electronic cigarettes help people stop smoking, and are they safe to use for this purpose? Cochrane Library. Retrieved from http://www.cochrane.org/CD010216/TOBACCO_can-electronic-cigarettes-help-people-stop-smoking-and-are-they-safe-use-purpose.
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References Hildick-Smith, Pesko, Shearer, Hughes, Chang, Loughlin, & Ipp. (2015). A Practitioner’s Guide to Electronic Cigarettes in the Adolescent Population. Journal of Adolescent Health.
Iffland, I., Muller, R., Groneberg, D, & Gerber, A (2016). High particulate matter emission from additive-free Natural American Spirit cigarettes. SpringerPlus. DOI: 10.1186/s40064-016-3635-x.
Israel Cancer Association. (2014). Third hand smoking. Retrieved from https://adsoftheworld.com/media/print/israel_cancer_association_third_hand_smoking
Minnesota American Indian Communities (2013). Tribal Tobacco Use Project Survey Report 2013. Retrieved from https://www.minnpost.com/sites/default/files/attachments/TTUPrpt.pdf.
Minnesota Department of Health (2014). Tobacco Prevention and Control: Data and Reports. Retrieved from http://www.health.state.mn.us/tobaccodata
Minnesota Department of Health (2014). Tobacco-Related Health Disparities. Retrieved from http://www.health.state.mn.us/divs/hpcd/tpc/topics/disparities_docs/Tobacco-RelatedHealthDisparities.pdf
Minnesota Department of Health. (2015). Health Advisory: Nicotine Risks for Children and Adolescents. Retrieved from http://www.health.state.mn.us/divs/hpcd/tpc/topics/nicotine.html
Minnesota Department of Health. (2016). Minnesota Student Survey. Retrieved from: http://www.health.state.mn.us/divs/chs/mss/
Natural American Spirit (2015). Retrieved from https://www.truthinadvertising.org/natural-american-spirit/
Pearson, J. et al. (2016). Misperceptions of harm among Natural American Spirit smokers: results from wave 1 of the Population Assessment of Tobacco and Health (PATH) study (2013–2014). Tobacco Control. Doi:10.1136/tobaccocontrol-2016-053265.
Polito, J. R. “I couldn’t quit for money”. Retrieved from http://whyquit.com/Youth/Messages/Kathryn.html
Quit Plan. Cost of Smoking. Retrieved from https://www.quitplan.com/thinking-about-quitting/why-to-quit/cost-of-smoking.html?cpd=3&cpp=7.50&calculate=Calculate
Quit Plan. Stop Smoking, Start Repairing. Retrieved from https://www.quitplan.com/request-materials.html
San Francisco Tobacco Free Project. Electronic Cigarettes. Retrieved from http://sanfranciscotobaccofreeproject.org/electronic-cigarettes/
Schroeder, M. & Hoffman, A. (2014, February 11). Electronic cigarettes and nicotine clinical pharmacology. Tobacco Control, 23(2). Retrieved from Tobacco Control Database. Ecigarettes.
Smith, S. (2015). American Spirit Sued In Class-Action Lawsuit Over Deceptive Marketing Of Their 'Natural' Cigarettes. Medical Daily. Retrieved from http://www.medicaldaily.com/american-spirit-sued-class-action-lawsuit-over-deceptive-marketing-their-natural-355858.
Smoke Free 60+. Quit for My Health. Retrieved from https://60plus.smokefree.gov/quit/health
Southington Steps Coalition. (2016). Retrieved from http://www.southingtonsteps.org/article/2016/06/03/steps-youth-council-asks-do-you-know-what-chemicals-are-your-e-cigs
Stand AZ (2016). Toolkit. Retrieved from http://www.standaz.com/toolkit/
The Truth. Hookah. Retrieved from: https://www.thetruth.com/
Tobacco Free CA. Resources. Retrieved from http://tobaccofreeca.com/resources/
Tobacco 235. Retrieved from https://tobacco235.wordpress.com/