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Sharon Cummins, Ph.D. Director of External Affairs California Smokers’ Sharon Cummins, Ph.D. Director of External Affairs California Smokers’

Sharon Cummins, Ph.D. Director of External Affairs California Smokers’ - PowerPoint Presentation

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Sharon Cummins, Ph.D. Director of External Affairs California Smokers’ - PPT Presentation

Sharon Cummins PhD Director of External Affairs California Smokers Helpline Assistant Professor Department of Family Medicine and Public Health University of California San Diego California WIC Association Annual Conference ID: 762514

cigarettes quit vaping smoking quit cigarettes smoking vaping california counseling smokers

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Sharon Cummins, Ph.D.Director of External AffairsCalifornia Smokers’ HelplineAssistant ProfessorDepartment of Family Medicine and Public HealthUniversity of California, San Diego California WIC Association Annual ConferenceApril 30, 2019 Pregnant Women and Parents of Young Children: Smoking, Vaping, and How to Help

I feel very confident answering clients’ questions about E-cigarettes/vapes.Strongly agreeAgreeDisagreeStrongly disagree

OutlineSmoking and VapingSecondhand exposure of childrenVapes and JUULs/SuorinQuitting Resources

Pregnancy Risk Assessment Monitoring System (PRAMS, CDC)Currently 40 states—not CA1,300-3,400 women/site annuallyYears 2000-2015Smoking behavior:3 months before pregnancyLast 3 months of pregnancyCurrently – postpartumAdded e-cigarettes/vapes in 2016

Harm of Smoking on Fetus and Pregnancy and Young ChildrenMiscarriage Ectopic pregnancy, placenta previa and abruption, pre-term labor Respiratory dysfunctionSIDS in babiesLearning disabilitiesMulready-Ward C and Sackoff J (2012) Matern Child Health J DOI 10.1007/s10995-012-1178-5

Small-for-gestational-age (SGA)Risk for having a baby in the smallest 5% to 10% of birth weights is as high as 2.5 times greater

Overall Smoking Prevalence (PRAMS)

2015 PRAMS8.8% women smoked during the last 3 months of pregnancyOf women who smoked 3 months before pregnancy 55% quit during pregnancy. Among women who quit smoking during pregnancy, 43% relapsed within 6 months after delivery.Still that means:55% quit rate57% stay quit for 6 monthsCompares well to having a medical crisis like a heart attack!

Who Smokes During Pregnancy and AfterVaries by state—social norm?AgeEthnicityIncomeEducation

Why Women Smoke/Vape During PregnancyReasons similar to that of the general populationNicotine addictionStress, anxiety, mood control, boredomSocial normMay not understand the harm of smoking or vapingMay not believe the claimsCrawford JT (2008) Clin.Obstet.Gynecol Jun 51(2):419-435Bailey BA et al., (2012) Matern.Child Health J. Feb 16(2):414-422

What about E-cigarettes & Vaping?

The percentage of adults who use e-cigarettes is closest….5%10%20%30%

Add adult use of e-cig image

E-cigarettes & Vaping Devices Ciga -likes Tanks Mods Pods

E-cigarettes & Vaping Open system vs closed systemOver 400 brands & over 15,000 flavors available1 Long-term health risks unknown Efficacy for smoking cessation not firmly establishedWill they help smokers quit or will they “re-normalize” smoking and impede cessation efforts? JUUL & Suorin increasingly popular among youth—current use for high school students is 11.7 in 2017, up from 1.5 in 2011. 1 Hsu, et. al, 2018 Truth Initiative: e-cigarettes: facts, stats and regulations

The most dangerous ingredient in e-cigarettes is the nicotine.Strongly agreeAgreeDisagreeStrongly disagree

https://youtu.be/A25HTqlVfPk

Nicotine and the Developing BrainPrefrontal cortex:Decision makingPersonality Moderating social behaviorContinues to develop until 25 years oldSpeed of action increases risk of addiction Create lots of receptors Tolerance? Rat studies

Unintended ConsequencesWhat if clients become unwilling to use FDA approved NRT?Credibility is important

Exposure to Secondhand SmokeSID, respiratory infections, ear infections, asthmaMarked decrease from 87.5% to 25.2% since 1988But still large disparitiesHighest among 3-11 years (38%)Blacks (50%)Those living in poverty (48%)

What is in the Vape Aerosol?NicotinePropylene glycol and glycerolFlavorings Metals—chromium, nickel, tinAcetone, formaldehydeUltrafine particles

How to HelpWhat is your role?Help dispel mythsEstablish policyHelp smokers or vapers to quit Prevent uptake of e-cigarettes Educate parents Educate yourself Start the conversation Provide resources

Telephone Quitlines in 1992 Statewide Quitline No Statewide Quitline AZ WY OR ID MT UT NV WA CA TX AR OK ND LA KS IA NE SD CO NM MO MN TN AL KY OH MS MI IN GA FL PA ME NY WV VA NC SC VT CT D.C. RI NJ MD DE NH MA IL WI AK HI Source: CDC Office on Smoking and Health

Motivate smokers to call Multiple Counseling Single Counseling Self-Help A Randomized Trial Months Follow-Up Evaluation 3 6 12 © California Smokers’ Helpline

Quit Attempts Source: Zhu et al. (1996), JCCP, 64 , 202-211 Self-Help 58.8 66.7 66.6 Treatment Group Quit in 3 Months % Single Counseling Multiple Counseling © California Smokers’ Helpline

Relapse Curves for 3 Groups Source: Zhu et al. (1996), JCCP, 64, 202-211 © California Smokers’ Helpline

Key ResultsIt is feasibleTelephone counseling works (efficacy)More counseling is better (dose-response relationship) Long-term intervention is not necessaryKeeps the cost low

The California Smokers’ Helpline provides nicotine patches to most smokers who want to quit. Strongly agreeAgreeDisagreeStrongly disagree

Besides Counseling?Self-help materialsFree nicotine patchesText programMobile apps (android and iphone)Chat

Vaping CessationThe California Smokers’ Helpline has a counseling protocol for vapers.Among youth, there is limited interest in quitting Uptake is more common at presentLearn as much as you can about vapingBe ready to listen Start the conversation (e.g., What do you like about vaping?) Be ready for questions Isn’t vaping safer than smoking? But vapes don’t have (much) nicotine?

Vaping Cessation (cont.)Lack of studies on vaping cessationSmoking cessation principles can applyMotivation PlanningSetting a quit dateKeep tryingUnique considerations Type of device Nicotine strength Patterns of use Quitting aids?

Helpline Approach to VapesWhen clients ask, counselors provide psychoeducation on what vapes are and how they function For clients who already use vapes, counselors determine type of device and amount of nicotine intake

Helpline Approach (cont.)Counselors discuss safety & efficacy issues:Long term health effects unknownCurrently not enough empirical evidence to recommend vapes as a way to quit smoking cigarettes Not FDA approved or included in the US Clinical Practice Guidelines However, counselors adhere to a quit attempts philosophy If clients make quit attempts using vapes, counselors will provide support and work with them toward the goal of becoming nicotine free

Vaping Cessation ResourcesStanford Medicine– Tobacco Prevention Toolkittobaccopreventiontoolkit.stanford.eduCDC infographic about vapes—good for clientshttps://www.cdc.gov/tobacco/infographics/youth/pdfs/e-cigarettes-usb-flash-508.pdf Hajek et al.(2019) RCT of e-cigs versus NRT, NEJMhttps://www.nejm.org/doi/full/10.1056/NEJMoa1808779?query=featured_home Truth Initiative® - Free text message program Text “QUIT” to 202-804-9884 E-cigarettes: facts, stats and regulations VapEnders – program being pilot tested for teens who vape www.vapenders.com California Youth Advocacy Network - educational materials www.cyanonline.org California Smokers’ Helpline – pilot protocol for callers 1-800-NO-BUTTS; www.nobutts.org

ResourcesCalifornia Smokers’ Helpline1-800-NO-BUTTS1-800-QUIT-NOWWebsite--www.nobutts.orgMaterialsEnroll in counselingWebinars—for continuing education credit

FIGURE 2 .  Percentage of nonsmokers aged 3–11 years* with evidence of secondhand smoke exposure (serum cotinine levels 0.05–10 ng/mL), by race and ethnicity † — National Health and Nutrition Examination Survey (NHANES), United States, 1988–2014 * Nonsmokers aged ≥4 years for NHANES III 1988–1994. †  Because of sample design, racial and Hispanic origin categories were limited to non-Hispanic whites, non-Hispanic blacks, and Mexican Americans across all survey cycles. Top

Thank you!Sharon CumminsSpeaker / Director of External Affairsscummins@ucsd.edu858.300.1046 Darci Miller Outreach / Marketing djm015@ucsd.edu858.300.1065 Office Please reach out to us if you have any questions.