National Native Network Technical Assistance Webinar

1. National Native NetworkTechnical Assistance Webinar

2. E-cigarettes and the Community • Presented by: • SohabArif, MPH • Health Educator • California Rural Indian Health Board (CRIHB) • Master of Public Health, Public Health, UC Davis School of Medicine, 2016 • Bachelor of Science, Biochemistry and Molecular Cellular Biology, UC Davis, 2016

3. E-cigarettes and the community • Sohab has a bachelor’s in biochemistry, a master of public health and extensive experience in biochemical as well as public health research and teaching. During graduate school, he was appointed as a smoke and tobacco ambassador to properly implement the smoke and tobacco free policy. Currently he is the health education specialist at California Indian Health Board, Inc. focusing on smoke and tobacco related issues in Indian Country. Other than clinical research experience with cancer, he is also on the executive committee for the California Dialogue on Cancer (CDOC).

4. Faculty Disclosure Statement • As a provider accredited by ACCME, ANCC, and ACPE, the IHS Clinical Support Center must ensure balance, independence, objectivity, and scientific rigor in its educational activities. Course directors/coordinators, planning committee members, faculty, reviewers and all others who are in a position to control the content of this educational activity are required to disclose all relevant financial relationships with any commercial interest related to the subject matter of the educational activity. Safeguards against commercial bias have been put in place. Faculty will also disclose any off-label and/or investigational use of pharmaceuticals or instruments discussed in their presentation. All those who are in a position to control the content of this educational activity have completed the disclosure process and have indicated that they do not have any significant financial relationships or affiliations with any manufacturers or commercial products to disclose.

5. Faculty Disclosure Statement • Funding for this webinar was made possible by the Centers for Disease Control and Prevention DP13-1314 Consortium of National Networks to Impact Populations Experiencing Tobacco-Related and Cancer Health Disparities grant. Webinar contents do not necessarily represent the official views of the Centers for Disease Control and Prevention. • No commercial interest support was used to fund this activity.

6. Accreditation The Indian Health Service (IHS) Clinical Support Center is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The IHS Clinical Support Center designates this live activity for 1 hour of AMA PRA Category 1 Credit™ for each hour of participation. Physicians should claim only the credit commensurate with the extent of their participation in the activity. . The Indian Health Service Clinical Support Center is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. This activity is designated 1.0 contact hour for nurses.

7. CE Evaluation and Certificate • Continuing Education guidelines require that the attendance of all who participate be properly documented. • To obtain a certificate of continuing education, you must be registered for the course, participate in the webinar in its entirety and submit a completed post-webinar survey. • The post-webinar survey will be emailed to you after the completion of the course. • Certificates will be mailed to participants within four weeks by the Indian Health Service Clinical Support Center.

8. Learning Objectives/Outcomes By the end of this webinar, participants will be able to: • Differentiate between traditional and commercial tobacco/e-cigarettes. • Identify FDA approved cessation resources from other products on the market. • Explain and communicate the harms of e-cigarettes to their patients.

9. E-Cigarettes and the Community Sohab Arif, MPH Health Education Specialist ll Research and Public Health Department

10. Overview During today’s webinar we will discuss: Traditional vs Commercial Tobacco Harms of electronic cigarettes FDA approved cessation resources

11. Traditional TobaccoStories • Many Indigenous nations have traditional stories of how tobacco was introduced to their communities • Many stories emphasize the sacredness of the plant and its powers to both heal if used properly and to harm if used improperly! • Some researchers say that the original tobacco was discovered about 18,000 years ago

12. Traditional TobaccoUse • Used by Medicine People for both healing and blessings • Used to smudge • Given as a gift when welcoming guests to the community and as an offering to those requested to pray or share their wisdom

13. “Tobacco can both give life and take life. It is a very powerful, potent, and magical being whose properties can cause great harm when abused. The flip side….is that tobacco can also provide great healing when not abused.” -Tharon P. Weighill Sr. (Chumash)

14. Used as a prayer or an offering to a healer, elder, or other person as a sign of respect or thanks • Smoked in a pipe for ceremonial purposes • Medicinal tobacco was often used as a painkiller • Scarcely contains actual tobacco • Premeditated and conscious addition of chemicals that lead to addiction • Deliberate targeting of specific consumer groups Traditional Commercial

15. Which Tradition Do You Want to Pass on? OR

16. Super Bowl Ad https://www.youtube.com/watch?v=QR5D-IJ6S2k

17. What is an e-cigarette

18. Types of E-Cigarettes

20. Federal Regulations • On May 10, 2016, the U.S. Food & Drug Administration (FDA) published a final rule to begin regulating e-cigarettes, cigars, pipe tobacco, hookah, and all other tobacco products. The Tobacco Control Legal Consortium and other public health organizations had been pressing the FDA to take this step for nearly seven years, recognizing it as an important foundation for protecting public health from the enormous toll of illness and death caused by tobacco use.

21. Legislation 2016 • In 2016, FDA finalized a rule extending our regulatory authority to cover all tobacco products, including vaporizers, vape pens, hookah pens, electronic cigarettes (E-Cigarettes), e-pipes, and all other ENDS. FDA now regulates the manufacture, import, packaging, labeling, advertising, promotion, sale, and distribution of ENDS. This includes components and parts of ENDS* but excludes accessories.

22. California Regulations • Just passed law that considers e-cigarettes as tobacco products and subject to California Tobacco Regulations • Must be 21 to purchase beginning June 9, 2016 • Regulation in every state and county can be different

23. Strengths of the Industry

24. What is the impact?

25. Re-Normalizing Smoking Behavior

26. Traditional Youth Targeting

27. Advertising

30. Billboards

31. Targeting the Plugged In Generation

32. It’s Own Language VAPE- The act of using an e-cigarette MOD- Modifications to an e-cigarette THROAT HIT- The sensation of a “bite” at the back of the throat when vapor hits it DRY HIT- No vapor on the drag JUICE- the liquid nicotine in the tank of the e-cig 710- Marijuana wax or oil that can be vaporized with e-cigs.

33. Use of Influencers

34. Social Media Memes

35. YouTube

36. Google

37. Internet Pop-Ups

38. Social Media

39. Can easily be used for drug use

41. Teens who use e-cigarettes are 3 times more likely to try cigarettes in a year Source: Wills, Knight, Sargent, Gibbons, Pagano, and Williams. (2016). Longitudinal Study of Electronic Cigarette Use and onset of cigarette smoking among high school students in Hawaii.

43. Diacetyl Diacetyl has been linked to popcorn lung (bronchiolitis obliterans) and other respiratory diseases. It was found in 47 of 51 e-cigarette flavorings tested. (Source: Allen et al. 2015. Flavoring Chemical in E-Cigarettes. Harvard School of Public Health)

44. Explosive

47. Vapor Safety Vapor is not just “harmless” water. Vapor contains diacetyl, propylene glycol, nicotine, and heavy metals. Various studies also suggest possible known carcinogens (Scientific American 2014) Short term exposure shows negative impact on lung function. (Grana, Benowitz, Glantz, 2014)

48. Cessation • E-Cigarettes are not FDA approved cessation devices. • Most studies show dual use of e-cigarettes and conventional cigarettesfor adults and youth. • Smokers that use e-cigarettes 1/3 less likely to quit than smokers that don’t use e-cigarettes. (Grana, Benowitz, Glantz 2014)

49. 7 FDA APPROVED TOBACCO CESSATION MEDICATIONS • First-line prescription and OTC NRT* medications: • Nicotine nasal spray (prescription) • Nicotine inhaler (prescription) • Nicotine patch (OTC) • Nicotine gum (OTC) • Nicotine lozenge (OTC) • Other first-line medications: • Bupropion SR (Wellbutrin SR, Zyban) • Varenicline(Chantix) 1-800-LUNGUSA

50. Over the Counter