INCORPORATING ADVOCACY INTO PUBLIC HEALTH

PROGRAMMINGTHE NO SMOKING - NO VAPING - IT’S THE LAW!

CAMPAIGN IN NJ

Public Health Associations’ Collaborative Effort PHACE

May 19, 2016

• Early adoption (2006) of the Smoke Free Air Act, prohibiting smoking in enclosed indoor spaces

Hugh victory for NJ Comprehensive Tobacco Control Program – Prevention, Treatment (Quit Centers, Quitnet,

Quitline, REBEL) NJ Breathes- advocacy group - diverse statewide stakeholders Advocacy training of program educational, outreach and service delivery

• 2010 - amendment banning the use of electronic smoking devices - "e-cigarettes" in indoor public places and workplaces and the sale to people 19 years and younger

• NJ also early adopter of increase in tobacco tax

TOBACCO CONTROL HISTORICAL BACKGROUND A “RICHES TO RAGS” TALE

HISTORICAL BACKGROUND • Early adoption of clean indoor air law -false sense of problem solved?

• Funding has been steadily declining –

• 30 million 0 last in the nation

• Tobacco control program eliminated NJ Breathes membership dwindled Smoking declines leveled off – currently 17.3

• Funding currently from CDC –• training of health care professionals (ASK, ADVISE and REFER)• clean outdoor air policy smoke free multi unit housing• point of sale tobacco free worksites • NJ Quitline promotion

FUNDING CHANGES = PROGRAMMATIC CHANGES

• With the transition to primarily CDC supported funding, and the need to do more with less came a shift in focus:

Primary prevention

Environmental policy change

Population health

The three Cs- collaboration/collective impact/coalitions

Disparate populations

NEW FUNDING FOCUS

• Public health programs required to look beyond the one on one client relationship

Promote policy change

Municipality level policy change

Impact systems on a broader scale

Understand cultural differences

Work smarter – collaboration and partnerships – including legislative arena

ESTABLISHING PRIORITIES

• Funding reductions required prioritizing dollars – counties with highest prevalence

• Southern Counties

Higher rate of unemployment Higher rate of poverty Decreased access to health care information, screening and services Higher rate of morbidity due to chronic disease

• Funding -cessation in health care settings ASK, ADVISE and REFER Promotion of the NJ Quitline using multi media Youth campaign ENDS campaign

Cou

2011 2015 2016

Atlantic 23% 20% 19%

Bergen 15% 14% 12%

Burlington 18% 15% 14%

Camden 20% 19% 15%

Cape May 22% 21% 17%

Cumberland 25% 24% 19%

Essex 17% 15% 17%

Gloucester 21% 19% 15%Hudson 20% 16% 15%

Hunterdon 15% 13% 12%

Mercer 15% 13% 16%

Middlesex 15% 12% 12%

Monmouth 17% 16% 14%

Morris 14% 13% 13%

Ocean 20% 17% 17%

Passaic 17% 17% 16%

Salem 24% 25% 19%

Somerset 12% 9% 11%

Sussex 20% 18% 15%

Union 17% 15% 15%

Warren 22% 19% 15%

% of NJ adult smokersby county‐ county health rankings2011, 2015, 2016

ENDS- NEW GENERATION OF TOBACCO ADDICTION• Cigarette smoking among teens has declined, ENDS use has tripled from

2013-2014

• ENDS – electronic nicotine deliver systems “e-cigarettes” battery-operated devices generally contain cartridges filled with nicotine, flavorings, chemicals Nicotine and other chemicals heated into a vapor

• In 2012/13

76.8% of adults who were past 30 day e-cigarettes users were also current cigarette smokers (dual users)

• Opportunity for public health and legislative advocates to join forces and revitalize tobacco control in NJ

THE EVOLUTION OF ENDS

It’s not just a habit…it’s a phenomena

Medium Sized E-Cigs, Vape Pens (VP), Personal Vaporizers (PV)

Mods

VAPING – WHAT’S ALL THE FUSS?

• The vapor NOT just water - aerosols can contain heavy metals, ultrafine particulate and cancer causing agents

• Nicotine is highly addictive Toxic to developing fetuses Impairs fetal brain and lung development

• Flavoring -GRAS (generally recognized as safe) for use in foods NOT inhalation effects of many of these inhaled flavorings largely unknown lung inflammation and disease (ie: popcorn lung)

CDC Office of Smoking and Health: July 2015

VAPING…

• Adolescent brain -still developing nicotine can disrupt the formation of brain circuits that control

attention, learning and susceptibility to addiction

• The flavorings appeal and are very dangerous to children Poisoning through ingestion of liquid nicotine, absorption through the skin

and inhalation Calls to poison control centers have increased from 1 per month in 2010

to 215 in 2014 More than half of children 5 and under

NEW TOYS…OLD TACTICS

• ENDS traditionally been an unregulated industry Nicotine concentration, other contents Often made overseas Falsely marketed as nicotine free

• ENDS marketing tactics similar to tobacco(tripling from 2011-2013) Full of false claims Promote ENDS use places that prohibit cigarette smoking proven to have increased use by youth including candy flavored productsthemes of rebellion, glamoursex celebrity endorsements sports and music sponsorships

E-CIGARETTE ADVERTISING

• Not subject to traditional tobacco advertising bans• 69% of high school students exposed to ads

THEN THERE’S THE FACT THAT YOUR E-CIGARETTE MIGHT BLOW UP!!!!

ENDS ON THE RISE IN ADULTS

ENDS ESPECIALLY ON THE RISE AMONGST TEENS

A WORD ABOUT HOOKAH• Water pipe used to smoke tobacco through cooled water

• Water does not filter cancer-causing toxins from the smoke

• Hookah smoke contains higher levels of arsenic, lead, nickel, tar and carbon monoxide than a cigarette

• A 45-60 minute session can equal nearly 100 cigarettes

• Hookah is as addictive as smoking traditional cigarettes 1 in 5 boys and 1 in 6 girls in high school have used hookah. By college age, nearly 40% of students have smoked hookah

• NJ’s smoke-free air act also bans indoor smoking indoor workplaces, including restaurants and food stores,Including hookah

ADVOCACY HAPPENING AT LOCAL LEVELS

• Most are unaware of the 2010 ban on electronic smoking devices in indoor public places and workplaces

• Some NJ municipalities have begun advocacy efforts to address the growing concern about ENDS, by: Banning the use of e-cigarettes in city owned parks, playgrounds, and outdoor

recreation areas

Increasing the age of sale of ENDS from 19-21

Increasing the license fee for vape shops

STATEWIDE ADVOCACY PARTNERSHIP ESSENTIAL

• ENDS has the potential to re-establish tobacco control funding in NJ

• Public health professionals can help legislators to better understand- and put a “face” on the issue – work together to educate youth, the public, the decision makers

• Statewide youth campaign – present the facts – educate and advocate tobaccofreenj.com/ENDS to order signs, posters, and table top tents (all local health departments)

• Targets public places, worksites and youth• Social media campaign- DontGetVapedIn working on 4NJTeens website• Ad series Blogger, Jimmy Fallon• Buzzfeed • Community Outreach program

SMOKEFREE TEEN

DontGetVapedIn – NJ specific URL

SMOKEFREETXT

• Free texting smoking cessation• Program for young adults to try and quit smoking• Text QUIT to 47848 • Smokefree.Gov/smokefreetx

• Telephone based counseling for any NJ resident 16 years or older • No parental consent needed to register for program• 18 years or older qualify for free nicotine patches • 1-866-657-8677 (NJ STOPS)

• Other NJ tobacco control resources:• www.njquitline.org• www.tobaccofreenj.com• www.facebook.com/njquitline• www.momsquit.com• www.njpn.org

CONTACT INFORMATION

Merle J. Weitz, MSWDirector of Public Health ProgramsSouthern NJ Perinatal Cooperative/Family Health Initiatives856.675.5322mweitz@snjpc.org

Thank you!