So you think you know tobacco?

Pete Dehnel, MD Stefan Pomrenke, MD Medical Director Family Physician Physician Advocacy Network Westside Community Health Services

Physician Advocacy Network

www.panmn.org

Outline

1. Health Risks of Cigarettes

2. Health Risks of E-cigarettes, Smokeless Tobacco, and Hookah

3. Common Myths

4. Your Stories

Health Risks of Cigarettes

Source: Clearway Minnesota

Source: CDC, 2014

Source: Smoke Free 60+

Disparities

Minnesotan Adults Minnesotan Youth

Source: MDH, 2014; MDH, 2016.

Source: QUITPLAN®

Source: Ellis, 2014

Source: Polito, 2005

Source: CDC, 2016

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.

Source: Israel Cancer Association, 2014

Health Risks of E-cigarettes, Smokeless Tobacco, and Hookah

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.

Source: San Francisco Tobacco Free Project, 2015

• 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

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.

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.

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

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.

Source: Minnesota Department of Health , 2015.

Child Nicotine Poisonings

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

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

Source: Stand AZ, 2016

Source: www.thetruth.com

Common Myths

“Smoking is normal.”

Source: Awkward Family Photos

[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.

“I can afford to smoke.”

Source: QUITPLAN®

“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

“Commercial tobacco is the same as sacred tobacco.”

Source: Aboriginal Tobacco Program

“E-cigarettes are not a tobacco product.”

Source: Tobacco 235

Source: Southington Steps Coalition, 2016

“E-cig vapor is just water vapor.”

“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

“Menthols taste better so they aren’t as harmful.”

Source: Tobacco Free CA, 2016

“The water in hookahs filters out toxic chemicals.”

Source: CDC, 2015

Your Stories

Questions?

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

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

Centers for Disease Control and Prevention (2014). 2014 Surgeon General's Report: The Health Consequences of Smoking—50 Years of Progress. Retrieved from https://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/index.htm.

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.

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/