Tobacco and Nicotine Products. "The Times They are A'Changing" FOMA, 2019 NOVA SOUTHEASTERN UNIVERSITY AHEC Dr. Nevin Zablotsky

Transcription

1 Tobacco and Nicotine Products "The Times They are A'Changing" FOMA, 2019 NOVA SOUTHEASTERN UNIVERSITY AHEC Dr. Nevin Zablotsky 1

2 Cigarette Usage in U.S.A 1955 Ages Percentage % % % % % All ages 52.6% H.Wentzel.W,Green,D National Clearinghouse for Smoking (60,62,64)

3 Cigarette Usage in U.S.A 2018 Ages Percentage % % % >65 8.8% Total: 15.1% C.D.C

4 Florida Tobacco Fast Facts 2,701,900 Adult Smokers 16.1% Tobacco Free Kids November 2018

5 Florida Tobacco Costs $8.64 billion dollars annual costs directly related to smoking $8.32 billion dollars lost in productivity

6 Tobacco History First Cultivated B.C in Peruvian/Ecuadorian Andes

7 Tobacco Total of 64 species of tobacco plant Two used by man Nicotiana rustica Nicotiana tabacum

8 Tobacco Nicotiana rustica Strong and harsh 20x more nicotine than tabacum Eastern Europe and Asia Used by S. American shamans

9 Tobacco Nicotiana tabacum Milder Multiple varieties Used in most cigarettes

10 History continued Tobacco shamans doctor-priests Use tobacco in religious rites and as medical treatment

11 Tobacco continued Usage Also used as mild analgesic and antiseptic Treated toothaches by wrapping leaves around tooth Leaves or juice applied to wounds

12 History continued Jean Nicot, 1559 French Ambassador to Portugal, distributes tobacco seeds throughout Europe Agrees with Dr. Monardes and extols its ability to cure cancer, bad breath, toothaches, migraines, kidney stones, dandruff, tapeworms Nicotine, the addictive drug in tobacco named in his honor

13 James Buck Duke 1889 Age 33 of North Carolina forms American Tobacco Company

14 Cigarette Production Skilled hand roller produced 200 cigarettes in one hour

15 We Can Now produce 20,000 Cigarettes a Minute

16 Click to edit Master text styles 25

17 Tobacco and Nicotine Products

18

19 Cigarettes It takes 5 seconds for a hit to reach the brain

20 Chemicals In Cigarette Smoke 7,000 chemicals, 80 Carcinogens Benzene Formaldehyde Strychnine Polonium 210

21 Tobacco Fast Facts: WHO billion people smoke cigarettes in the world

22 Prevalence C.D.C 2018 U.S Cigarette Adult Smoking Rates 37.8 million people 18 years or older 15.5% 16 million Americans live with a smoking-related illness 34

23 35

24 36

25 37

26 Cigars - Prevalence In 2017, 12.3 million people aged 12 or over smoked cigars in the U.S 9% of high school boys used cigars 6.3% of high school girls used cigars 1.5% middle school students

27 Cigars All cigar smokers, whether they inhale or not are exposed to smoke and its toxic and cancer-causing chemicals affecting Lips Tongue Throat National Cancer Institute

28 Smokeless Tobacco It takes 3-5 minutes for a hit to reach the brain

29 Smokeless Tobacco 3,000 Chemicals of which 28 are known carcinogens Arsenic Cyanide Polonium 210 (Nuclear Waste)

30 Snuff Tobacco Finely ground moist firecured tobacco Comes in pouch or can Tuck pouch or shreds between cheek and gums Buffered to alkaline ph that is easily absorbed

31 Smokeless Tobacco Comes in several forms Snuff or Snus Chewing(Dip,Pinch,Rub) Orbs, Sticks, Strips

32 SNUS Swedish word for snuff Scandanavian Snus is steampasteurized moist powdered tobacco Less nitrosamines Small bit placed in upper lip Not spit out

33 Chewing Tobacco Loose leaf Twist Plug

34 Smokeless Tobacco Dip or chewing 8 to 10 times per day equals the nicotine of smoking 30 to 40 cigarettes a day.

35 Smokeless Tobacco Camel Orbs Camel Sticks Camel Strips mg nicotine

36 Electronic Nicotine Delivery Systems

37 E-Cigarettes

38 E-Cigarettes First developed in China in 2003 by Hon Lik, Chinese pharmacist In response to losing his father to lung cancer Look for safer way to get nicotine

39 What Are They? Battery-powered nicotine delivery systems that produce heated aerosol instead of smoke 59

40 61

41 Usage Slow steady draw to fill mouth and hold for 3-5 seconds Inhale in lungs and exhale through nose and mouth Will feel hit in about 30 seconds After 3-7 draws take a short break

42 The Hype Are E-Cigarettes Safer To Use Than Cigarettes?

43 The Hype Are E-cigarettes Effective Smoking Cessation Aids?

44 So They Promote Them

45

46

47

48 72

49 N.Y Times: April 14, 2014 Major producers targeting young people Giving away free samples at music events and sporting events Running advertisements on radio and television on youth oriented programs 73

50

51 CDC / E-Cigarette and Vaping It is estimated that 10.8 million adults in the U.S are vaping

52 Noncigarette Tobacco Products and Future Use of Cigarettes in Youth JAMA 1/2/18 Use of e-cigarette,hookah,non-cigarette combustible tobacco, or smokeless tobacco Youth using any of these producets are more likely to use cigarettes one year later Using more than one of these products even more likely to use cigarettes

53 Flavoring Chemicals in E- Cigarettes 7,000 e-cig flavorings presently on the market Harmful chemicals now being detected Diacetyl 2,3-Pentanedione Acetoin 83

54 84

55 E-Cigs F.D.A has analyzed samples Some contain propylene glycol Nitrosamines Toxic chemicals Carcinogens Tobacco

56 86

57 Death of First Child From Liquid Nicotine McClatchy Washington Bureau January 13,2015 BY LINDSAY WISE The 1-year-old boy died in Fort Plain, NY, on December 9 after ingesting liquid nicotine. Local police said the death appeared to be a accident. Child s death revives call for federal government to regulate liquid nicotine for e-cigarettes 88

58 Int J Environ Res Public Health Jan; 15(1): 75. "At present, the research on E- cigarettes is fragmentary and incomplete, and there has been no systematic review of its safety "

59 Feb. 6th 2019 American Stroke Association International Stroke Conference Survey finds compared to non-users E-cigarette users had a 71 percent higher risk of stroke 59 percent higher risk of heart attack 40 percent higher risk of heart disease.

60 E-Cigs No Scientific Proof Yet of Their Safety

61 Are E -Cigarettes a Real Tobacco Cessation Aid? 95

62 Dual Use A 2018 report from the National Academies of Sciences, Engineering, and Medicine showed Among adults in, 58.8 percent of e- cigarette users also smoked cigarettes. Among young adults in, 40 percent of e- cigarette users also smoked cigarettes 96

63 American Lung Association 2019 The FDA has not found any e-cigarette to be safe and effective in helping smokers quit. If smokers are ready to quit smoking for good, they should call QUITNOW or talk with their doctor about finding the best way to quit using proven methods and FDA-approved treatments and counseling.

64 2019 NEJM: E-Cigarettes Vs. Traditional NRT as Effective Cessation Aids A year long, randomized trial in England with 885 subjects used either e-cigarettes or traditional nicotine replacement therapies. Both groups also participated in at least four weekly counseling sessions They noted that 80 percent of the study participants who had quit by using e-cigarettes were still vaping at one year, while only 9 percent of the NRT group was still using nicotine products.

65 Positive Cessation Aid? Both groups also participated in at least four weekly counseling sessions, an element regarded as critical for success. They noted that 80 percent of the study participants who had quit by using e- cigarettes were still vaping at one year, while only 9 percent of the NRT group was still using nicotine products.

66 Big Tobacco Enters the Scene

67 E-Cigarette Finances Blu Ecigs founded in 2009 Blu Ecigs sold to Lorillard in 2012 for $135 million dollars Becomes first big tobacco company to enter the e- cigarette market

68 E-Cigarette Finances R.J Reynolds buys Lorillard in 2015 for $29.5 billion dollars includes Blucigs, Kool, Winston, Salem and Maverick brands

69 JUUL JUUL's hardware is made in Shenzhen, China The JUUL pods are made in the United States Highly concenterated nicotine vaporizer User inserts flavored pod into stick

70 Nicotine/Nicotinic Salts

71 Nicotine First isolated in 1828 in Heidelberg Clear liquid, poisonous alkaloid Natural insecticide Found in tobacco,also in tomatoes, potatoes, eggplants in insignificant concentrations

72 Nicotine Nicotine naturally occurs in tobacco as a base In 1960s Phillip Morris scientists added ammonia and created unprotonated (Freebased) nicotine Making it more basic and lipid soluble and easier for it to be absorbed into the lungs

73 Nicotine Cigarettes and most e-liquids use freebase nicotine Freebase nicotine easily passes through the blood brain barrier Inhaling freebase nicotine is harsh to the mouth and throat

74

75 Side Effects of Nicotine

76 So What are JUULs?

77 JUUL 2007 Adam Bowen and James Monsees found Ploom Labs They create the PAX vaporizer and introduce JUUL e-cigs in 2015 at PAX Labs and spin off in 2017 to JUUL Labs

78 Nicotine In 2007 JUUL labs mixes freebase nicotine with benzoic acid creating nicotinic salt in a biologically accepted liquid 112

79 JUUL/Nicotinic Salts This combination can be absorbed readily and is inhaled smoothly Delivers 2x concentration of nicotine as other e-cigs Speed of "hit" mimics cigarettes

80 JUUL - Highly Addictive 114 Campaign for Tobacco-Free Kids

81 JUUL/ CNN Feb.7th 2019 BMJ Journal Tobacco Control: Dr. Robert Jackler Stanford Research In 2015 the majority of companies had 1%-2% nicotine concentration JUUL released it 5% nicotine pods In 2019 competing brands reach into the 5% to 7% range of nicotine concentration "This makes it potently addictive to nicotine-naive teenagers" 115

82 JUUL In September of 2018 JUULs has a 72% market share of the e- cigarett market

83 JUUL USA Today Oct New vaping has "gone viral" on middle and high school, college campuses Flavors like creme brulee, mango and fruit medley

84 JUUL Can fill with THC Can be mistaken for a USB stick Can be charged in computer

85 E-Cigarettes and Vaping September 2018 JUUL labs valued at $15 billion dollars December 2018 Altria purchases a 35% stake in JUUL labs for $12.8 billion dollars JUUL's value equals $38 billion dollars

86 Nobody is quite sure what to do with those wanting to quit, as this is all so new, said Ira Sachnoff, president of Peer Resource Training and Consulting in San Francisco

87 E-Cigarette and Vaping

88 E-cigarette and Vaping

89 Heat Not Burn Products

90 History of Heat-Not-Burn Products All of These Products Attempt to Simulate Smoking Cigarettes

91 History of Heat-Not-Burn Products These systems use heated tobacco not burning tobacco Constituents are heated to 350 degrees fahrenheit and aerosolized Device then removed and smoked like a real cigarette

92 History of Heat-Not-Burn Products Iqos Glo Ifuse Ploom

93 Iqos Iqos marketed by Philip Morris International PMI has spent $3 billion dollars developing these types of products

94 Iqos 1994 launched in Japan and Italy 2016 available in 20 countries As of March, million devices sold in Japan Demand has outstripped supply

95 January 25th, 2018 FDA advisory panel said PMI should not be able to claim IQOS is safer than smoking PMI still awaiting FDA final decision

96 Please Don't Forget About the Impact of Cigarettes 136

97 7 million people in the world die from tobacco related illness per year Every 6 sec. someone dies in the world from tobacco-related use

98 One Billion People Will Die in This Century From Tobacco Use

99 Tobacco is the single greatest cause of disease in the U.S and is responsible for 480,000 deaths annually Centers for Disease Control and Prevention

100 16 Million Americans Live With a Smoking-related Illness

101 Florida Tobacco Mortality Rates 32,300 deaths directly related to smoking per year 2,960 deaths from 2 nd hand smoke per year Tobacco Free Kids 2018

102 You Can Make A Difference A brief 3 minute conversation with a health care provider followed by a referral to cessation services can more than double the chances of quitting. Ask every patient about their tobacco use Advise patients of the benefits of quitting Refer to tobacco cessation services Source: Treating Tobacco Use and Dependence Clinical Practice Guideline, 2008 Update USDHHS Public Health Service

103 Where can you refer patients? Local Group Cessation Programs offered FREE in every county in Florida Group Quit programs offered through your local AHEC and Tobacco Free Florida , ahectobacco.com Free NRT Patches, Gum, Lozenges Groups facilitated by Tobacco Treatment Specialists Statewide: Tobacco Free Florida s Phone Quit (over the phone counseling) and Web Quit (online cessation program)