Tobacco Awareness Articles: A Menu of Options for Employee Newsletters and Communications from Mecklenburg County Health Department – January 2015

New Tobacco Regulations for Mecklenburg County in 2015

Soon there will be more public places in Mecklenburg County that are smoke-free or tobacco-free. A county-wide wellness initiative will provide the public and employees who work for the County, City or Towns protection from secondhand smoke, support for quitting tobacco, and will role model a tobacco-free norm for kids. The Mecklenburg County Board of Commissioners passed two regulations or “laws” in October 2014 that will become effective March 18, 2015. March 18 is also “Kick Butts Day” – a day for youth to stand up and speak out against the harms of tobacco.

The first regulation is a Board of Health Rule for smoke-free government grounds which means all government buildings, vehicles and property in the county, city of Charlotte and the towns of Cornelius, Davidson, Huntersville, Matthews, Mint Hill and Pineville will be smoke-free. No smoking will be allowed anywhere on the property. Smoke-free is defined as banning all lit smoking products such as cigarettes, cigars, pipes, hookahs and cigarillos.

The second regulation is a County Ordinance for tobacco-free parks. This means that all parks, greenways and property owned by the Mecklenburg County park system will become tobacco-free. Two areas exempted from the parks ordinance (will not be tobacco-free) include golf courses owned by the county, as well as some of the regional parks. For more detail, click here. There are more than 210 parks and rec facilitates and over 240 miles of trails and greenways in Mecklenburg County, and most will be tobacco-free. Some of these exempted regional parks will be tobacco-free during special events with large gatherings of people. Tobacco-free is defined as banning the use of all smoking products, as well as smokeless products (chew, dip, snuff) and electronic cigarettes or vapor products.

Enforcement will focus on signs and public education. This approach has been successful in other communities. For more information, visit Tobacco Free Mecklenburg or call 980-314-9064.

Why is Tobacco a Problem in our Community?Although a lot has changed in the past 20 years with who and where people smoke in North Carolina, tobacco remains the leading preventable cause of death and illness in our state. Mecklenburg County’s Community Health Assessment shows that chronic disease (i.e. heart disease, cancer, stroke, respiratory disease, diabetes etc.) is one of the top health problems in our community. Of all the risk factors leading to these chronic diseases, tobacco is the strongest. If tobacco use decreased, many of these diseases would be prevented. It’s no surprise as cigarette smoke contains over 7,000 chemicals with 70 known to cause cancer. Cigarette smoke not only hurts the smoker but bystanders as well. Other tobacco products (cigars, pipes, smokeless tobacco) carry many of the same risks; in fact there is no safe tobacco product. The 2014 Surgeon General’s Report on the Health Consequences of Smoking estimates that smoking kills close to half a million Americans a year and costs more than $289 billion a year in direct medical care and economic loss. To put this into perspective, more than 10 times as many U.S. Citizens have died prematurely from cigarette

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smoking than have died in all the wars fought by the U.S. in its history. In North Carolina, smoking kills about 12,200 adults over 35 each year, and costs $5.96 Billion in medical care and lost productivity. The good news is that we know what works to reduce tobacco use, such as smoke-free polices that protect from secondhand smoke and help smokers to quit. For more information, visit www.tobaccofreemeck.org

Tips and Resources for Quitting Tobacco

Everyone knows that smoking and using other tobacco products is not good for you, but quitting is hard! On average it takes 5 to 7 tries to quit for good. Each attempt is practice toward becoming tobacco-free for life. Studies show that cigarettes are more addictive than heroin, and the first three weeks after you quit can be the most difficult. The key is to stick with it, to line up support and to seek out help. The QuitlineNC (1-800-Quit-Now or www.quitlinenc.com) is a great free resource to connect you with trained tobacco quit coaches, 24-hours day, 7 days a week. Evidence shows that combining at least 4 telephonic or face-to-face counseling sessions with one or more of the FDA-approved medications for quitting will more than double your chances for success.Within 20 minutes after you smoke that last cigarette, your body begins a series of changes that continue for years. 20 minutes after quitting, your heart rate drops. 12 hours after quitting, carbon monoxide levels in your blood drops to normal. Two weeks to three months after quitting, your heart attack risk begins to drop. Your lung function begins

to improve. One to nine months after quitting, your coughing and shortness of breath decrease. One year after quitting, your added risk of coronary heart disease is half that of a smoker's. Five years after quitting, your stroke risk is reduced to that of a nonsmoker's five to 15 years after quitting. Ten years after quitting, your lung cancer death rate is about half that of a smoker's. Your risk of cancers of

the mouth, throat, esophagus, bladder, kidney and pancreas decreases. Fifteen years after quitting, your risk of coronary heart disease is back to that of a nonsmoker's.

The good news is that close to 70% of NC smokers tried to quit last year. If you are seeking advice on how to help a friend or co-worker quit, see these tips at QuitlineNC. If you have employer-based health insurance, find out what your health plan offers for quit support. To view a Mecklenburg County Quit Guide, click here or visit the Tobacco Free Mecklenburg webpage.

Is Quitting Smoking on Your Calendar for 2015?(From the Centers for Disease Control and Prevention)

Every January 1, people all over the world make New Year's resolutions. If you're one of the nearly 7 out of 10 current U.S. smokers who want to quit, why not get started today?

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Smoking is still the number one cause of preventable death and disease in the United States. Quitting now can cut your risk for diseases caused by smoking and leave you feeling stronger and healthier.

Develop a Quit Plan - Planning ahead is a major part of successfully quitting smoking. Smokefree.gov offers details on how to create an effective quit plan , including: Picking a quit date. Starting the New Year smoke free is a great idea. Letting loved ones know you're quitting so they can support you. Listing your reasons to quit smoking. See the "Smoking and Diabetes" ad featuring Bill—another former

smoker who participated in the Tips campaign—for advice on finding your reasons to quit. Identifying triggers that make you want to smoke so you can avoid them, especially during the early days. Having places you can turn to for immediate help, including the free resources listed below.

Use Free, Effective Resources - There are many free resources for people trying to quit smoking: 1-800-QUIT-NOW (1-800-784-8669) or 1-855-DÉJELO-YA (1-855-335-3569) (for Spanish speakers). This free

quitline offers a lot of resources, including free quit coaching, a free quit plan, free educational materials, and referrals to other resources where you live. See NC Quitline .

Smokefree TXT . This free 24/7 program sends encouragement, advice, and tips to help smokers quit smoking and stay quit. To get started, just text QUIT to 47848, answer a few questions, and you'll start receiving messages.

Online Help . This Tips From Former Smokers Web page provides additional helpful online quit resources, including links to:

Smokefree Women ; Smokefree Teen; Smokefree Español Smokefree Apps , The free QuitSTART app, developed with teens in mind, can help track cravings and moods,

monitor progress, and identify smoking triggers.

Find a Medication That Is Right for You - Because cigarettes contain nicotine, a powerfully addicting chemical, your body may feel uncomfortable until it adjusts. This is known as withdrawal, and there are medications that can help lessen this feeling and the urge to smoke. Studies show that smokers who use medicine to help control cravings, along with coaching from a quitline, in a group, or from a counselor, are much more likely to succeed than those who go it alone. Talk to your doctor, pharmacist, or other health care provider before using any medications if you: Are pregnant or nursing Have a serious medical condition Are currently using other medications Are younger than 18 years of age

Many options are available if you are considering using medications to help you quit smoking. The most common quit smoking medications are nicotine replacement therapies (NRTs), which give your body a little of the nicotine that it craves without the harmful chemicals found in burning cigarettes. Examples of Food and Drug Administration (FDA)-approved NRTs that you can buy over the counter include: Nicotine patches Nicotine gum Nicotine lozengesNRTs that require a prescription include nicotine inhalers and nasal spray; your doctor can also prescribe medication that does not contain nicotine (such as bupropion or varenicline) to help you quit smoking completely.

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As the start of a New Year approaches, isn't now the perfect time to quit smoking? You can start 2015 as a healthier you by developing a quit plan, using free resources, and finding a smoking medication that is right for you. Even if you don't smoke yourself, you can use this article to help a friend or family member become smoke free in 2015! To learn more about tobacco prevention in Mecklenburg County, visit Tobacco Free Mecklenburg webpage or call 980-314-9064.

Electronic Cigarettes – what are they and are they safe?

Electronic-cigarettes heat and vaporize a liquid that contains nicotine. These “vaping” devices, also called electronic nicotine delivery devices, are metal or plastic tubes that contain a cartridge filled with a liquid that turns into steam or aerosol when heated by a battery. In addition to nicotine, the liquid has other chemicals such as propylene glycol, glycerol, and may contain a variety of metals and possible carcinogens. Most e-cigs contain nicotine, although some claim to sell nicotine-free cartridges.

As of early 2014, there were 466 brands and 7,764 unique flavors of e-cig products. (American Heart Association report, 2014). These flavors are often candy or fruity-like and range from bubble gun, to apple, strawberry, caramel, popcorn, chocolate and so on. There are now 3 generations of e-cigs with the first ones looking like cigarettes while the newer ones, often called “tanks,” are larger and refillable. Some people believe e-cigarettes may help people who smoke lower nicotine cravings while they are trying to quit. But no research yet has supported the claim that e-cigarettes actually help people quit smoking. There is also the possibility that e-cigarettes could increase the nicotine addiction and thus interfere with quitting.

Vaping products are unregulated at this time, pending possible FDA regulation in the near future. The secondhand “vape” or aerosol is not just clean air and water – it contains nicotine and studies are finding other metals and particles. There is a concern about the health impact of deep lung inhalation of these metals and particles.

The N.C. legislature, in the 2013 youth access law, considers e-cigs a “tobacco product” because the nicotine is derived from tobacco. Therefore, tobacco-free policies and regulations in NC prohibit the use of e-cigarettes. This can be confusing with smoke-free laws, as technically “smoke-free” does not include “vape”. However, many communities and business are starting to add e-cigarettes to smoke-free polices. One great concern is the rise in e-cig use among NC youth. From 2011 to 2013, e-cig use increased 352% among NC high school teens (2013 NC Youth Tobacco Survey).

Is the e-cigarette safer than a cigarettes? Science is still answering that question with long-term studies, however, “safer than a cigarette” does not mean it is safe product.

Secondhand Smoke

Secondhand smoke includes smoke from a burning tobacco product such as a cigarette, cigar, or pipe, and smoke that has been breathed out by the person or people smoking. When a person smokes

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near you, you breathe in their secondhand smoke (SHS). It contains more than 7,000 chemicals, including hundreds that are toxic and about 70 that can cause cancer. In 2006, the U.S. Surgeon General’s office released a report that states “there is NO safe level of exposure to secondhand smoke”. Breathing even a little amount of SHS can be dangerous and immediately impact health.

Exposure to secondhand smoke can cause: Cancer Heart Disease (breathing in SHS for even a sort time can have immediate harmful effects on the heart) Breathing problems (i.e. wheezing, cough, phlegm and breathlessness) Asthma (can cause asthma in young children and act as a trigger for asthma for all ages) Sudden infant death syndrome and other problems in infants and children (i.e. ear infections, asthma,

respiratory infections, slower lung growth).

Separating smokers from non-smokers, cleaning the air and ventilating buildings cannot eliminate secondhand smoke. Smoke-free polices and laws are the best way to provide protection from dangerous secondhand smoke. Mecklenburg County will enact a Board of Health Rule for smoke-free government grounds in the county, city and towns in March 2015. This health initiative will provide protection to employees and the public from the dangers of secondhand smoke. For more information, go to www.tobaccofreeemcek.org

Smokeless Tobacco – Not Safer than Cigarettes

Smokeless tobacco is also known as chewing tobacco, spit or spitting tobacco, dip, chew, snuff, or snus. Most people chew or suck (dip) the tobacco in their mouth and spit out the tobacco juices that build up. “Spitless” smokeless tobacco is now available. Nicotine in the tobacco is absorbed through the lining of the mouth. Smokeless tobacco typically contains 28 cancer-causing agents.

Although flavorings (besides menthol) are not allowed in cigarettes, the tobacco industry offers sweeteners and flavorings in smokeless tobacco. It can taste more like candy with flavors such as vanilla, mint, and fruit, which makes it more appealing to young people. While the available evidence shows that smokeless tobacco may be less dangerous than cigarettes, long-term use of chewing tobacco and other smokeless tobacco products can cause serious health problems. There is no safe level of tobacco use.

Following are some of the harmful health effects of smokeless tobacco: Mouth, tongue, cheek, gum, and throat cancer Cancer in the esophagus (the swallowing tube that goes from your mouth to your stomach) Stomach cancer, Pancreatic cancer Increaseed risk of heart disease, heart attacks, and stroke Addiction to nicotine (which can lead to smoking) Leukoplakia (white patches in the mouth that can become cancer) Receding gums (gums slowly shrink from around the teeth) and gum disease (gingivitis) Bone loss around the roots of the teeth Abrasion (scratching and wearing down) of teeth Cavities and tooth decay Tooth loss, stained and discolored teeth Bad breath

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For help to stop using smokeless tobacco, you can call the NC Quitline at 1-800-Quitnow or 1 800-784-8669. For information about tobacco-free efforts in Mecklenburg County, visit www.tobacoofreemeck.org. Source: Mayo Clinic and the American Cancer Society

Nicotine Addiction

The design and contents of tobacco products make them more attractive and addictive than ever before. Ever wonder about nicotine addiction? Like cocaine, heroin, and marijuana, nicotine increases levels of a neurotransmitter called dopamine. Dopamine is released normally when you experience something pleasurable like good food or your favorite activity. When a person uses tobacco products, the release of dopamine causes similar effects. This effect wears off quickly, causing people who smoke to get the urge to light up again for more of that good feeling, which can lead to addiction. Studies suggest that other chemicals in tobacco smoke, such as acetaldehyde, may enhance the effects of nicotine on the brain.

When taken in the form of smokeless tobacco, nicotine is absorbed through the mouth tissues directly into the blood, where it goes to the brain. Even after the tobacco is removed from the mouth, nicotine continues to be absorbed into the bloodstream. Also, the nicotine stays in the blood longer for users of smokeless tobacco than for smokers.

Each cigarette contains about 10 milligrams of nicotine. A person inhales only some of the smoke from a cigarette, and not all of each puff is absorbed in the lungs. Therefore, a person gets about 1 to 2 milligrams of the drug from each cigarette. Studies of widely used brands of smokeless tobacco showed that the amount of nicotine per gram of tobacco ranged from 4.4 to 25.0 milligrams. Holding an average-size dip in your mouth for 30 minutes gives you as much nicotine as smoking 3 cigarettes. A 2-can-a-week snuff dipper gets as much nicotine as a person who smokes 1½ packs a day. Whether a person smokes tobacco products or uses smokeless tobacco, the amount of nicotine absorbed in the body is enough to make someone addicted. When this happens, the person compulsively seeks out the tobacco even though he or she understands the harm it causes.

Treatments (such as nicotine patches, gum or lozenges or prescription drugs such as Chantix or Bupropion) can help people who use tobacco products manage these symptoms and improve the likelihood of successfully quitting. Most people (nearly 70%) who smoke want to quit. Quitting can be very hard, that’s why it is better to never start at all. For help quitting tobacco use, call QuitlineNC at 1-800-Quit-Now (1-800-784-8669). For more information about efforts to reduce tobacco use in Mecklenburg County, go to www.tobaccofreemeck.org Source: National Institute on Drug Abuse

Smoking and Diabetes

The 2014 Surgeon General’s Report has found that smoking is a cause of type 2 diabetes, also

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known as adult-onset diabetes. Smokers have a greater risk of developing type 2 diabetes than nonsmokers and this risk increases with the number of cigarettes smoked per day. How does smoking cause diabetes? Smoking increases inflammation in the body. Inflammation occurs when chemicals in smoke injure cells, causing swelling and interfering with cell function. Smoking also causes oxidative stress, a condition that occurs when chemicals from smoke combine with oxygen. This damages cells. Evidence shows that both inflammation and oxidative stress are related to an increased risk for diabetes.

Studies have also confirmed that people who have diabetes and smoke have more complications. Exposure to nicotine can make insulin less effective. Smokers with diabetes are more likely to have serious health problems than those who do not smoke (i.e. heart and kidney disease, poor blood flow to feet and legs, eye disease and nerve pain.) For help quitting smoking, call QuitlineNC at 1-800-Quit-Now or 1-800-784-8669.

Smoking and Cancer

One out of every three cancer deaths in the U.S. is linked to smoking. The 2014 Surgeon General’s Report on the Consequences of Smoking reports that scientific evidence now shows that smoking causes 13 different types of cancer. This list includes the following cancers: Lung, trachea and bronchus; Oropharynx (mouth); Larynx (throat); Esophagus; Leukemia; Stomach; Liver; Pancreas; Kidney and Ureter; Cervix; Bladder and Colorectal. Two new cancers added to this list as being caused by smoking are Liver and Colorectal cancer. Lung cancer is now the nation’s most common cancer in both men and women. Smoking causes almost 9 out of every 10 lung cancers.

Even though smoking rates have gone down , the risk for lung cancer has increased over the past 50 years. The Surgeon Generals’ Report finds that changes in how cigarettes are designed and what they contain have increasedthe risk of cancer in smokers. Additional cancers are associated with smoking include breast cancer and prostate cancer.

Cigarette smoke contains 7,000 chemicals, with 70 of them known to cause cancer. Each puff from a cigarettes delivers a mixture of chemicals to the lungs where they are absorbed into the bloodstream and carried to every cell in the body. Many of these chemicals damage DNA which controls how cells reproduce and can cause cells to mutate and grow uncontrollably, starting the path to cancer. For help quitting smoking, call QuitlineNC at 1-800-Quit-Now or 1-800-784-8669.

Smoking and Heart Disease

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Smoking is a major cause of heart disease and causes one in three deaths from heart disease, according to the 2014 Surgeon General’s Report on the Consequences of Smoking. Heart disease kills more than 800,000 people a year in the US. More than 16 million Americans have heart disease and almost 8 million have suffered a heart attack and 7 million have had a stroke. The risk of heart disease increases with the number of cigarettes smoked per day and how many years a person smokes. Exposure to secondhand smoke also causes heart disease in nonsmokers, More than 33,000 nonsmokers die every year in the US from heart disease caused by exposure to someone else’s tobacco smoke.

How does smoking cause heart disease? Chemicals in cigarettes smoke cause the cells that line the blood vessels to become swollen and inflamed. This can narrow the blood vessels and can lead to many problems: atherosclerosis (hardening of the arteries); heart attack; stroke, blood circulation problems; and aortic aneurysm (enlarged arteries). These are all very serious conditions that can result in disability or death.

Some forms of smokeless tobacco increase your heart rate and blood pressure (due to the nicotine). Long-term use of smokeless tobacco may increase your risk of dying of certain types of heart disease and stroke. (Mayo Clinic). The best thing tobacco users can do for their heart health is to quit tobacco for good. Within a year of quitting, the risk of heart attack drops dramatically. Within five years of quitting, smokers lower their risk of stroke to about that of a person who has never smoked. Smoking damages the heart and blood vessels very quickly but the damage is repaired for most smokers who stop smoking. For help quitting smoking, call QuitlineNC at 1-800-Quit-Now or 1-800-784-8669.

Youth Tobacco Use

Every day in the United States, more than 3,200 kids under age 18 smoke their first cigarette, and 700 kids become daily cigarette smokers. Many of these kids will become addicted before they are old enough to understand the risks and will ultimately die too young of tobacco-related diseases. In fact, 90% of adult tobacco users start before the age of 18. A concerning trend is highlighted in the 2013 NC Youth Tobacco Survey. Although youth smoking rates are at an all-time low (15.5%), the use of other tobacco products among teens is rising. There was a 352% increase in the use of e-cigarettes among N.C. high school teens from 2011 to 2013. Unfortunately, this can result in nicotine addiction. The community must take steps that keeps kids from starting to use tobacco. Tobacco-free environments de-normalize tobacco use and make it more the exception than the norm. Youth do what they see. It is this social change that can make a difference in reducing the number of kids experimenting with tobacco.

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Mecklenburg County’s parks system will become tobacco-free as of March 18, 2015. This means that no tobacco use (smoking, smokeless tobacco or electronic cigarettes) will be allowed anywhere on park property. Parks are a family and kid-friendly place that promote clean living and healthy lifestyles. For more information about this health initiative, go to www.tobaccofreemeck.org.

Celebrating Smoke-Free Restaurants/Bars in N.C.

January 2, 2015 will mark the five-year anniversary of smoke-free restaurants and bars in North Carolina. This state-wide health initiative to protect the public and hospitality workers from the dangers of secondhand smoke has been a huge success.

“The smoke-free law has made big changes in our state’s health, while growing more popular and having no impact on overall sales or employment,” said Dr. Marcus Plescia, Mecklenburg County Health Director, “In fact, the state has issued an infographic on the law showing the top five benefits the law has had in the state.”

The top five things that Smoke-Free Restaurants and Bars Law has done for NC:

Air quality improved by 89% in restaurants and bars. Average weekly Emergency Room visits due to heart attack decreased

by 21% and visits due to risk of asthma decreased by 7%. Growing support for smoke-free laws influenced many other business

that adopted smoke-free polices for their worksites. Studies showed no negative impact on restaurant/bar income or

employment due to the law. Social norms changed. Now people cannot imagine going to

restaurants/bars that allow smoking.

Go out and celebrate NC smoke-free restaurants in 2015!For more information, visit www.smokefree.nc.gov

Additional Resources:For a list of fact sheets from the 2014 Surgeon General’s Report go to: http://www.surgeongeneral.gov/initiatives/tobacco/ Infographics highlighting facts from the 2014 Surgeon General’s Report can be found at NC Tobacco Prevention and Control Branch.

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Tobacco Free Mecklenburg: http://charmeck.org/mecklenburg/county/HealthDepartment/CommunityHealthServices/TobaccoUse/Pages/TobaccoFreeMeck.aspx

For more information or questions about content and resources, call Kim Bayha, Tobacco Prevention Coordinator at 980.314.9064 or email kimberly.bayha@mecklenburgcountync.gov

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