Health Policy News You Can Use - E-cig Special Edition.pdf

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Calls to the. Washington Poison Center have nearly doubled every single year since 2010 when the .... campaigns to comba
Dear Friends, The e-cigarette epidemic has grown exponentially over the past few years and continues to present challenges to communities

Follow Julie Peterson, Senior Director of Policy @healthygenjulie

and public health officials. Calls to the Washington Poison Center have nearly doubled every single year since 2010 when the first ecigarette poisonings were reported in this state. E-cigarettes are not subject to federal regulations, nor are the liquids used in them. The FDA is currently considering rules to regulate the

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product at an astonishing speed, while research has shown the liquids contain a wide variance in nicotine content. Consumers who wish to use the devices for cessation may actually be using higher levels of nicotine then if they were smoking combustible cigarettes. In the last 2 years, the Washington State Legislature has considered various policy options to deal with e-cigarettes without the passage of final legislation. The policy options on the table have included: taxation, retailer licensing, child-safe packaging, restricting the age of sale to those age 18+, requiring disclosure

Today's Health Policy News is also brought to you by Healthy Gen Fellow and MPA candidate, Rachel Beck. Thank you Rachel!

of nicotine content and toxic or carcinogenic chemicals in the liquids, prohibiting internet sales, etc. Meanwhile, local health departments are considering policy regulations through board of health ordinances, or are leading community conversations about the devices. However, the infancy of the health impact research complicates policy discussions. Background E-cigarettes, or vape pens, are increasingly popular products that deliver nicotine and other harmful ingredients to users and bystanders, yet no federal regulation of these products currently exist. The American Public Health Association has recommended that states and municipalities enact laws prohibiting the use of e-cigarettes in enclosed public areas and places of employment due to their potential as a source of pollutants.

Secretary of Health John Wiesman was a panel presenter for the October 20th, CDC Public Health Grand Rounds, Ecigarettes: An Emerging Public Health Challenge

Recent research has suggested that contrary to some opinions, e-cigarettes may not be effective tobacco cessation aids and may even inhibit the ability to quit. In 2014 and 2015, 33 Attorneys General submitted letters urging the FDA to require warning labels and childproof packaging, as well as restricting advertising, prohibiting flavoring, and other restrictions. Although the FDA is considering warning label and childproof packaging regulations, there is still no way to verify ingredients or safety claims made by manufacturers. Impacts on Children & Youth The 2014 Healthy Youth Survey found that one in five high school seniors in Washington reported e-cigarette use, almost triple the amount reported in 2012. This dramatic increase indicates the growing social acceptance of e-cigarettes among teens, which threatens to undermine decades of anti-tobacco education and advocacy. This is worrisome for many reasons, including because

More research & policy implications: E-Cigarettes: Evidence and Policy Options in WA State Public health researchers at the University of Washington Summary of Vapor Product Research Snohomish Health District The E-Cig Quandary Special Report by Harvard T.H. Chan School of Public

nicotine is particularly harmful to brain development in children and adolescent smokers are more likely to continue into adulthood. There is also early evidence that teens who vape are more likely to take up traditional combustible cigarettes. Manufacturers of e-cigarettes are not subject to the same advertising rules as the tobacco industry and therefore can market their products using celebrity endorsements or cartoon characters that appeal to children. Vaping products are also available in candy-like flavors that are attractive to younger users. E-liquid, the nicotine-containing component, presents a poisoning threat to children via ingestion, inhalation, and skin contact. Exposure to even tiny amounts of e-liquid can cause vomiting, seizures, and death. A CDC study

Health Youth Substance Use Prevention - Ecigarettes and Vapor Drug Delivery Devices Policy Brief, Office of the Governor Jay Inslee Can E-Cig Regulation Protect the Public's Health? The Forum from Harvard T.H. Chan School of Public Health

found that the number of calls to poison centers related to e-cigarettes had increased from one per month in September 2010 to 215 per month in February 2014. More than half of these calls concerned children under the age of 5. In 2015, the Washington Poison Center has reported 58 e-cigarette poisoning exposures, including 40 pediatric cases. Eighty-five percent of these exposures concerned children between the ages

Poisoning threat by the numbers: Calls to WA Poison Center:

of 1 and 3. The use of e-cigarettes to consume marijuana and synthetic drugs is also a growing public health concern. A recent study of high school students in Connecticut found high rates of vaporizing marijuana. Because vaping can be almost completely odorless, users are able to smoke marijuana in public places without detection. Marijuana use on school property is of particular concern for this reason. E-cigarettes can also be used to vaporize highly dangerous drugs such as synthetic marijuana.

2009 - 0 2010 - 2 2011 - 19 2012 - 18 2013 - 73 2014 - 182 2015 (YTD) - 58 % of calls related to Pediatric

Regulatory Context Only e-cigarettes that are marketed for

exposures:

therapeutic purposes are currently regulated by

2013 - 68%

the Federal Drug Administration (FDA). The FDA

2014 - 73%

has issued a proposed rule to extend the agency's tobacco regulating authority to cover

2015 - 69%

additional products including electronic cigarettes and others. This would bring ecigarettes and like vaping devices under the same requirements of currently regulated tobacco products, including reporting product and ingredient listings; requiring health warnings; only making direct and implied claims of reduced risk if the FDA confirms scientific evidence in support of the claim; ban the distribution of free samples; and establish minimum age and identification restrictions. Still this would not halt online sales, ban vaping in public areas, or ban marketing of flavors appealing to youth and children. And until FDA rulemaking, which takes time based on the findings of longitudinal studies, States and Municipalities are left to come up with their own regulations . E-cigarettes pose unique regulatory challenges to state and local authorities. In Washington, it is illegal to sell e-cigarettes or other vaping products to minors under the age of 18. However, because vaping products can be purchased online sales are difficult to monitor. Grant County, King County, Pierce County, Clark County, and the city of Pasco currently have ordinances in effect prohibiting the use of e-cigarettes in all areas where smoking is prohibited. Clark, King, and Pierce Counties also prohibit free sampling of vaping products. Grant County prohibits possession of any vaping product or device by anyone under the age of 18. King, Pierce, and Snohomish counties are currently considering new or revised e-cigarette ordinances.

Some Local Public Health Jurisdictions have launched public health awareness campaigns to combat misinformation about e-cigs and vaping, including, TacomaPierce County Public Health - Think Again, Pierce County and California's public health department Still Blowing Smoke An informative article from Vox on recent pushback towards researchers and public health agencies from vaping advocates: "How Big Vaping is misinforming the public about ecigarettes" The efforts of the Spokane Regional Health District in issuing a health

The American Academy of Pediatrics just

warning and a call to

yesterday issued this statement: "The AAP now

action as more teens

strongly recommends the minimum age to

turn to electronic

purchase tobacco products, including e-

cigarettes was

cigarettes, should be increased to age 21

highlighted in the

nationwide."

news.

"Tobacco use continues to be a major health threat to children, adolescents and adults," said Karen M. Wilson, MD, MPH, FAAP, chair of the AAP Section on Tobacco Control and section head of Pediatric Hospital Medicine at Children's Hospital Colorado. "The developing brains of children and teens are particularly vulnerable to nicotine, which is why the growing popularity of e-cigarettes among adolescents is so alarming

News from the LA Times on Vaping shops wariness of FDA regulation: "Vaping shops say

and dangerous to their long-term health."

FDA regulation could

It seems to me, we may not know everything

business"

there is to know about e-cigarettes, but we know enough to adopt policies to protect children and adolescents. Warmly, Julie @healthygenjulie [email protected]

put them out of

This Health Equity Impact Assessment (HEIA) examines the potential racial, social, environmental, and economic health equity effects of a potential tobacco retail licensing policy on Multnomah County

22nd Annual WSPHA Conference: Partnerships & Innovation - A Public Health Imperative

L-R: Brynn Brady, Ceiba Consulting, Erin Dziedzic, Dziedzic

communities.

Public Affairs, Brad Banks, WSALPHO, Drew Bouton, Department of Health. Not pictured: Dr. Alexander Garrard, WA Poison Center

A big thank you to the panelists at the WSPHA 2015 Conference Workshop - Journey of a Bill: Partnerships in Policy Work on the journey of House Bill 1645 "Concerning youth substance use prevention associated with tobacco and drug delivery e-cigarettes and vapor products", and the concerted leadership and cross-sector collaboration necessary for the ongoing progression of the bill throughout session. There are often many challenges & barriers to passing effective public health policies, strong cross-sector partnerships and leadership, and evidence-based research & communications strategies are crucial to the ongoing work of public health and prevention advocates in Washington state. A big thank you to all who worked on the bill and all who participated on the panel!

Healthy Gen Fellows We at Healthy Gen are lucky to have each year a cohort of amazingly bright graduate school student Fellows who contribute to our work. Today's Health Policy News comes to you due to the research and writing of current Healthy Gen Fellow and second-year MPA candidate at the Evans School of Public Policy & Governance at the University of Washington, Rachel Beck. Rachel's background is in global health and her current academic research focuses on the intersection of health and the built environment. She grew up in the Seattle area and is passionate about promoting the health of all Washingtonians. At Healthy Gen Rachel is currently working on different health policy and

Get to know our Executive Director Melanie Gillespie and check out her new blog, Convergence Emergence And while you're at it, take a look at the most recent news and happenings from Healthy Gen with our new e-blast, HOPE Happens

community health projects on topics such as community health benefit policies. Thank you Rachel!

If you are or know of a Seattle-area graduate student who is interested in public health or health policy and wants to know more about the Healthy Gen Fellows program, please send a note to [email protected]

Stay Connected Foundation for Healthy Generations 419 3rd Ave West, Seattle, WA 98119 206-824-2907