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Session 2 COUGH Cessation Student Advocates Training

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CYAN and Project UNIFORM

on 23 May 2017

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Transcript of Session 2 COUGH Cessation Student Advocates Training

COUGH
Tobacco Cessation Student Advocates
An online training series
for college students who are interested in helping
tobacco users quit.
SESSION 2
Overview
Nicotine
Overview of Tobacco Products
Nicotine
The harmful addictive substance found in all tobacco products.

It's an addictive drug that causes immediate effects on the body:

Travels through the body in the bloodstream, reaching the brain in 7-15 seconds.
Boosts the brain's "reward center" causing a pleasant feeling.
Adrenaline is then released, which increases heart rate and blood pressure, causes rapid shallow breathing, which can damage the heart, arteries, and lungs over time. This increases the chance of heart attack, stroke, and chronic lung disease.
Tobacco & Nicotine Products
In some cases nicotine is beneficial.
When used correctly, such as in an FDA approved medicine for tobacco cessation it can help a person break nicotine dependence.
Sometimes Nicotine
is "Good"
But sometimes nicotine keeps people addicted...
The products we watch...
Smoked Products
Other Products
Aerosol Products
Smokeless Products
Cigarettes
Menthol
Cigars
Little Cigars
& Cigarillos
Hookah
Chew/Dip/ Snuff
Snus
Dissolvables
Stealth Vaping
Hookah Pens
Accessories
Refills
Nicogel
Cigafizz
Nicotine Water
Verve Discs
Tju Gum
Zonnic Gum
Roll Your Own
Hookah
Steam Stones
Tobacco leaf wrapped in paper and smoked through an acetate filter.
At least 600 ingredients in cigarettes.
More than 7,000 chemicals when burned.
At least 69 of these ingredients cause cancer.

Why so many ingredients?
Nicotine Delivery
Flavor
The 2009 Family Smoking Prevention and Tobacco Control Act includes a ban on flavored cigarettes, including mint flavor. Menthol, however, is exempt from this regulation.

Menthol is not just a flavoring additive.
Menthol is used to attract and retain young smokers.
Menthol cigarettes are heavily marketed to young people, African Americans, and women.
Among cigarette smokers, menthol cigarettes have been found to be used at a higher rate in young people than older adults.
A tightly wrapped bundle of dried and fermented tobacco. Wrapped in tobacco leaves or in brown tobacco-based paper.

Lower in price than cigarettes.

A 2013 study found ever-cigar use in young adults to be 37.9%.
of this group 21.5% had only used little cigars or cigarillos. 32.3% had only used little cigars, and 46.2% had used both.
Little Cigar: Similar to a cigar, but comparable in size, shape, and appearance to cigarettes. Looks like a brown cigarette.

Cigarillo: A short, narrow cigar. Smaller than a full size cigar, but larger than a little cigar.

Flavors can mask the harshness of tobacco, which makes the product more appealing to youth.
Advertising of flavored tobacco products has been targeted toward youth.
More than 2/5 of middle and high school smokers report using flavored cigars or cigarettes.
Hookah: A waterpipe used for smoking tobacco (shisha)

Hookah use is a fast growing trend in tobacco use among young people.

Hookah smoke is just as dangerous as cigarette smoke.
Hookah is addictive, just like cigarettes.
Hookah contains nicotine, and can increase stress in the body.

An average hookah smoking session of 45 to 60 minutes is the same as chain smoking 15 cigarettes
Carbon monoxide poisoning is a serious concern
Hookah smoke contains heavy metals such as lead, chromium, and nickel.

5 times more cancer causing agents
100 times more tar
11 times more carbon monoxide
4 times more nicotine
Compared to cigarettes...
Heat-treated porous materials soaked in fluid (usually glycerin) and heated in hookahs where tobacco would normally be placed to create a smoke-like aerosol, or vapor.

Virtually nothing is known about potential health risks from steam stones in hookah
Heated with charcoal which means the user inhales charcoal smoke, containing carbon monoxide and carcinogenic polyaromatic hydrocarbons.
Additive-Free
Loose tobacco is rolled by hand or machine into individual cigarettes.

May be perceived by users as less harmful to health than factory-made cigarettes - this idea is not supported by scientific tests.

Younger, financially stressed smokers are disproportionately using RYO products. A lower annual income, being male, being younger, having a higher level of nicotine addiction are all factors that are associated with RYO use.

RYO products circumvent tobacco laws and regulations:
The tobacco, paper, or both may contain flavors.
It is less expensive to produce RYO cigarettes than to purchase factory made cigarettes.


Smokers may view "natural" cigarettes as healthier or more ecologically friendly. This is a key selling point of this brand.

Additive-free cigarettes deliver nicotine, carbon monoxide, and (presumably) other toxic components of tobacco smoke in equal or greater amounts than conventional cigarettes.
Reports show that the smoke from these products contains considerable quantities of carcinogenic compounds.
The production and consumption of all cigarettes are devastating to the environment.
Cigarette butts are the single most littered item on US roadways and waterways, and they are toxic to humans and animals.
The environmental consequences of tobacco use include deforestation, fires, and solid, liquid, and airborne waste produced by the manufacturing process and released into the environment.
Chewing tobacco is used by putting a wad of tobacco inside the cheek. Usually a person will spit the saliva and tobacco juices that accumulate in the mouth.

Snuff is a finely ground or shredded tobacco that is either sniffed through the nose or placed between the cheek and gum.

Smokeless tobacco users who dip or chew 8-10 times per day may be exposed to the same amount of nicotine as persons who smoke 30-40 cigarettes per day. That's about 1.5-2 packs.
Smokeless products are addictive and their use has been linked to oral cancer, oropharangeal cancer, heart disease, and pancreatic cancer, as well as heart disease as well as other conditions.
Flavor may play a role in the initiation and maintenance of tobacco use. Mint or wintergreen is a popular choice of new smokeless tobacco users.
Snus is finely ground tobacco (snuff) packaged in a small teabag-like pouch.
Contains cancer causing chemicals, and is known to cause mouth, larynx, stomach, and pancreatic cancer. Some evidence suggests that young male users of this product are at increased risk of heart attack.
In 2013 Camel Snus made it's pouches 70% bigger!
Dissolvable tobacco products are finely milled tobacco held together with food-grade binders and made in different shapes.
Concerns include:
The potential for poisoning in children.
Adverse complications resulting from prolonged exposure to tobacco in the mouth.
Other health problems usually resulting from tobacco.
Currently only available in select test-market cities. As of July 2013, RJR announced it's plans to scale back marketing of this product.
E-Cigarettes
Electronic cigarettes, or Electronic Nicotine Delivery Systems (ENDS) vaporize a solution, usually containing nicotine and other ingredients into a aerosol that is inhaled by the user:
Propolyne glycol or vegetable glycerin (humectant)
Flavor (fruit, candy, tobacco, coffee, bacon, etc.)
Nicotine

All major tobacco companies also are in the e-cigarette business.
FDA has proposed regulation for e-cigarettes, but has not yet regulated the products.
NOT APPROVED FOR CESSATION USE
Electronic Cigarettes are made to look like common household products.
Novelty
Circumvent indoor-air laws restricting the use of e-cigarettes
E-cigarettes that are flavored to taste like hookah.


E Liquid or E Juice
Mixture of nicotine, flavor, and propolyne glycol or vegetable glycerin.
Used to refill e-cigarettes.
Also available in a thicker solid.
Concerns
Nicotine overdose from absorption through skin or accidental ingestion.
Erroneous labeling.
Mechanical Mods and Rebuildables

Drip Tips
Tanks and Clearomizers
RJ Reynolds developed a smoking cessation gum.
Sold in test markets in Iowa and Nebraska.

Concerns:
A cessation product from a tobacco company represents a potential conflict of interest.
Other efforts by the tobacco industry which appear to promote cessation have been found to undermine public health.



A nicotine gum from Altria, Denmark.
Not currently for sale in the U.S.
From NuMark (an Altria company).
Small plastic chips.
Meant to be chewed on until nicotine is extracted, then discarded.
Currently only sold in Virginia.
Nicotine-infused water.
Not legally for sale.
May still be found for sale.
Nicotine Candy.
Sold in gas stations/ convenience stores.
Discovered for sale in California during a retail data collection project in 2013.

Nicotine Hand Gel.
Sold in the UK and online.
Session 2 Done
Review
In this session we talked about nicotine and introduced the tobacco products that we currently monitor.
Next Session
Session 3 will provide an overview of understanding nicotine dependence including addiction, the health effects of tobacco use, and what happens when a person quits tobacco.
Evaluation
To get credit for this session, follow the link to the brief evaluation.


Pixotine
Toothpick soaked in nicotine solution.
Marketed as an alternative to smoking.
Sold online beginning Spring of 2014.

Concern:
Accidental ingestion/poisoning.
Circumventing tobacco-free laws.
Prolonging addiction.

Heat Stick
The Marlboro HeatStick is being released in Japan and Italy in late 2014, with further expansion expected in 2015.

Short cigarette-like sticks are heated to a minimum of 660 degrees Fahrenheit to vaporize tobacco leaves.
Energy Dip
Energy Dip, such as Revved Up, is chewing tobacco with caffeine and other energy supplements added.
Developed by 2 Marines
Concept: pairing of smokeless tobacco and energy drinks
“This is really for our fellow military members and the guys with the long, hard shifts: the firefighters, or for somebody who’s on patrol overseas. I want them walking around alert, not tired."

"The whole idea behind the product was that we developed it for the military. We’re not really interested in branching out. We’re focused on this, and this is our forte. The smokeless business is on the rise. It’s good timing.”
-RevvedUP Website
Evaluation
: http://www.surveymonkey.com/s/CCSA-Assessment-2

Evaluation
: http://www.surveymonkey.com/s/CCSA-Assessment-2
FDA Regulation Update
Proposed regulation would:
Prohibit sale to minors.
Require registration with the FDA/ disclose ingredients.
Prohibit direct and implied claims of reduced risk.
Prevent distribution of free samples.
Require health warnings.
Prohibit sale of e-cigarettes in vending machines unless machines are in adult-only facilities.

Proposed regulation would not:
Limit where e-cigarettes could be used.
Restrict flavorings or additives in the products.
Restrict type and location of e-cigarette advertising and marketing.
Restrict where e-cigarettes can be sold aside from vending machines.
Website:
http://www.fda.gov/newsevents/publichealthfocus/ucm172906.htm
Cigarettes are the only product on this list currently regulated by the FDA.
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