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
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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.