Supporting Youth to be Tobacco Free Trish Hill, Interior Health Andrea Winckers, BC Cancer Agency

Slide 1

Supporting Youth to be Tobacco Free

Trish Hill, Interior HealthAndrea Winckers, BC Cancer Agency

2Learning Outcomes

At the end of the session, participants will have an increased understanding of: The latest evidence on youth and tobacco use Cessation medications and ways to support successful quitting Tobacco industry marketing tactics o youth Environmental damage and social justice issuesAnd will have greater confidence in: Addressing tobacco with youth/young adults who smoke Using interactive tools to educate and motivate youth to take action on tobaccoTobacco Facts Tobacco kills 6000 people a year in B.C. including about 110 non-smokers

Kills of long term users when used exactly as intended by the manufacturer

Causes twice as many deaths as vehicle crashes, alcohol, suicide, homicide, and HIV combined4 4,000 + chemicals in cigarette smoke, more than 50 are cancer-causing

Reduces immunity and interferes with wound healing, even among younger users

Tobacco Facts 5Youth and Tobacco ProductsNicotine is one of the most addictive substances knownYouth often underestimate their dependence Tobacco dependence is associated with addiction to other substancesTreatment of other addictions is more successful if tobacco is included 6Recovery is more successful when tobacco dependence is addressed at the same time as other addictions (ref. MH paper)Many people assume that teens smoke in huge numbers, but in fact youth age 15-19 have the lowest smoking rate of all age categories in Canada except for those age 65+.Despite these comparatively low prevalence rates, tobacco use continues to be a serious health issue for youth, particularly since 85% of current smokers started using tobacco before the age of 18.One major concern is that youth often underestimate their nicotine dependence. In one well-known study, 5% of young smokers predicted that they would still be using tobacco in five years. Five years later, 80% of them were still smoking. In one well-known study, 5% of young smokers predicted that they would still be using tobacco in five years. Five years later, 80% of them were still smoking.

Support YouthYouth are increasingly asking for help to quit but are not well supported Young people are subjected to multi-million dollar marketing campaigns by tobacco companies85% of current smokers started before age 18

7Unassisted quit rates for youth are substantially higher than for adults (40% vs. 3% at 12 months)Youth smoking patterns are less established, and they tend to smoke fewer cigarettes. They may also live in supportive environments.

Source for slide = AJPH Vol. 99 No. 3 March 2009Use example of promotions in bars and pubs.

Youth have tried to quit in past year63% of 15-17 yr olds69% of 18-19 yr olds62% of 20-24 yrs olds45 % of 25+

Trishs paper =Smoking rates among youth in Canada have steadily declined since the Youth Smoking Survey began in the mid-1990s, dropping from 24% in 1994 to 11.4% in 2006/07. Many people assume that teens smoke in huge numbers, but in fact youth age 15-19 have the lowest smoking rate of all age categories in Canada except for those age 65+. According to the 2006/07 Youth Smoking Survey, 82% of Canadians in grades 5-9 have never tried even a puff of a cigarette. In BC, 14% of 15-19 year olds are current smokers (daily and occasional). The average age that current smokers had their first whole cigarette in BC is 14 years old.

Tobacco Use in BCRates in Interior region are higher than the provincial average (15%), at 17% (106,500 smokers)

837,000 annual deaths in CanadaAlmost a quarter of all deaths in Canada are caused by tobacco2008 BC Stats CHESS Omnibus Survey dataHutchinson, Richardson & Bottorff, 2008Aboriginal people, those with low income/education and people with Mental Health/Addictions issues have significantly higher tobacco use rates. In fact, one study found that almost 50% of tobacco consumed in the US was by those with mental illnesses.Youth Tobacco Use in BCBC youth smoking rates are lower than the national average11% for BC youth aged 15-19 (BC Stats 2008)31% for aboriginal youth (BC Stats 2008)Higher prevalence among those with lower socio-economic levels, mental health and addictions issues92008 BC Stats CHESS Omnibus Survey dataYouth age 15-19 - lowest smoking rate of all age categories As with adults, Aboriginal youth, and those with low education income, and/or those with mental health and/or addictions issues are more burdened by tobacco use than the general population.Youth FeedbackEver Thought of Quitting VideoSupport at school West Kootenay Youth Forum FeedbackNot being supported Give out gum gum therapyRefer to Freedom QuestIncentives not nec. WorksTeachers put stress on studentsSupport for stressMore contact with youth workers - busy

1010 Whats HappeningNic attacks in classSmoking is going up with youth older kids smoking7 yr old younger and younger (7-11)Chew is cheaper- not seeing it at school - more in sportsMost youth are smoking

Why do Youth smoke?Dont want to be alonePeer pressureFlappin coolFamily normalizedEveryone is doing itStress of life-tried to quit stressful situation, started againOral fixationBeing part of a groupTry the different flavours appealAddiction - like video games-easiest thing to findNot IDBooters fee $21 a packFamily purchases smokes

What have you seen working for your peers?Supports seem to be for adults7 quitters:Switched to potGum TridentCigarette aversionFinding something to do instead, e.g. videogamesQuitting buddySponsorScared negative experienceEnvironment friendsFacebook may look @ itNicotine Inhalers? AlternativesExpensive NRTs subsidies?-no informationTM support quitting buddy

What is it like now that you cant smoke on school grounds?Makes kids want to smoke moreNot being enforced schools have given up Crowe has 2 smoke pitsRebelling not coming back to classTMS down by the basketball hoop

What could schools do to help youth stop smoking/chewing?Not being supported Give out gum gum therapyRefer to Freedom QuestIncentives not nec. worksTeachers put stress on studentsSupport for stressMore contact with youth workers - busy

Gross Vid 1

http://www.youtube.com/watch?v=5qYh2tosxos

11Debrief

Taking the cool out of KOOLForms of TobaccoCigarettes, pipes or cigarsSmokeless tobacco (chew or snuff)Newer alternatives:Paan (betel nut and candy)Dissolvable tobacco productsElectronic cigarettes

12Describe Paan, dissolvable and electronic cigarettesThe CigaretteHundreds of additives are used to:Increase uptake of nicotine to the brain (ammonia)Keep the cigarette from going outMask the taste (sugars, cocoa, other flavourings)Make smoke more tolerable to the lungs (bronchodilators)

Combustion (CO) and chemicals from soil, fertilizers and pesticides

13Cigarettes are the most widely-consumed form of tobacco in the world.Canada manufactured 58 billion cigarettes in 1995, Tobacco Atlas, WHO 2002.Ammonia free-bases the nicotine in cigarettes. The nicotine reaches the brain in 7-10 secondsSidestream smoke is more toxic because it burns at a lower temperature than mainstream smokeCO is a poisonous gas that binds to the haemoglobin more easily than oxygen does Tobacco Additives: cigarette engineering and nicotine addiction. ASH, Imperial Cancer Research Fund. 14th July1999

How to Build a Poison BoxThe cost of the poison box could be up to $40 depending on if you have some of these items already. For children's safety, we emptied all the containers we purchased, washed them and re-filled with water. Some items we added food colouring to (ie: blue for the windex, pink for the nail polish remover, etc...). Items that have safety seals we did not empty however we inspect the seal before each use to ensure safety.We created large address labelsand put the chemical and a description on it and attached it to the container. We also put tape over the label to keep it clean and to stop it from getting ripped off. Poison Box Items:Small Plastic Red Gas Can - Benzene - "Found in pesticides & gasoline" Windex Bottle - Ammonia - "Helps you absorb more nicotine (which helps keep you addicted)" (Make sure the bottle you use lists ammonia on the bottle label)Glass/Plastic Jar with fake Frog & water - Formaldehyde - "It causes cancer and can damage your lungs, skin and digestive system. Its used to preserve dead bodies"Bag/Jar of Flour - Arsenic - "Deadly poison that makes your lips burn and your breath turn bad. Found in rat poison" Bottle of Nail Polish Remover - Acetone - "Active ingredient of nail polish remover" Lighter - Butane - "Highly flammable, also found in gasoline" "D" size Battery - Cadmium - "It causes damage to the liver, kidneys and brain and stays in the body for years" Piece of metal pipe - Carbon Monoxide - "Replaces oxygen in the blood stream" Container of turpentine - Turpentine - "Very toxic. Most commonly used as a paint stripper" Small container of anti-freeze - Propylene Glycol - "Keeps tobacco from drying out. Also helps deliver nicotine to the brain."Taper Candle Stearic Acid Used to coat cigarette paperGlass/Plastic Jar filled with 3 cups of molassass Tar This tar represents the approximate amount of tar a smoker puts into their lungs each year when smoking one package of cigarettes a day.

CigarillosNew legislation regulates flavourings, packaging and size but loopholes are appearing Packaged to look like lip gloss and markers.

14There are three pic.s that will come up (individually) upon mouse click.Smokeless TobaccoSnuff (3.6 mg of nicotine after 30 min)Chew tobacco (4.5 mg after 30 min)Snus (new in Canada)

Cigarettes: 1 mg nicotine

15Smokeless is not HarmlessOral cancer LeukoplakiaPeriodontal disease and dental cavities

Oral Cancer: survival rate of 62% at five years

Leukoplakia: white plaques or patches on mucosal membrane

Black, hairy tongue:Caused by defective desquamation of filiform papillaeHypertrophy of papillaeLoss of blood clots occurs 4 times more frequently in smokersDelayed wound healing do to reduction in peripheral blood supply

16Target ConsumersAthletes

Male

Youth

Smokers

17Interesting that Skoal is trying to advertise to a young rugged sports type and making it seem like it is a hard core product.Did you know that there is a Skoal forum on the internet where dippers can talk; young teens talking to older hard core dippers.

One participant writes Name: just started; Theres nothing wrong with pouches. I dip both pouches and long cut. The pouches are great at work because I can get rid of it fast if I need to.

Another participant called Senior Dipper writes; pouches have their place but nothing beats loose dip.

Yet another called redman 22, just started; says pouches are good some times but you need to do at least 5 of them to get a rush ; long cut beats pouches by so much.Gross Vid 2

http://www.youtube.com/watch?v=1MF4sCvkAAA&NR=1

Psychological EffectsMore likely to have depressionMore likely to have other addictionsMore severely dependentOften lack effective alternative coping skills

19An addiction is a pathological relationship with a mood altering activity with life damaging consequences. It is a biopsychosocial disorder where the brains reward system is dysfunctional, can affect most organ systems, social/family consequences and brehavioural deterioration/consequences.Youth who cant comfort themselves are more at risk for smoking.

Depression and Smoking

20The 5 most Effective Interventions:

Increase price Reduce tobacco promotionsCreate smoke-free public placesCounter-advertisingCessation supports for tobacco users*21Based on 40+ years of research and hundreds of research studies.Support and RespectTobacco addiction should be considered a chronic condition which requires ongoing support and repeated interventionTobacco users should be treated with respect, dignity and sensitivity when they are offered tobacco interventionTobacco users have the right to decide whether, when, and how they will stop using22Positive InfluencesMentoring by successful youth quittersCreate trust by using a non-judgemental, supportive approachRecommendations by peers to quitPerception that their tobacco use is hurting someone else (e.g. exposing a younger sibling to second-hand smoke, modeling tobacco use to younger students)

2323ZahraSource: CTI e-learning youth module

Youth tend to trust not for profit organizations - http://www.youthtobaccocessation.org/Uploads/PDF/NCTOH_10_07_EvidencedBasedTreatments_Curry.pdf

Brief Interventions are EffectiveMinimal interventions lasting less than three minutes increase overall quit rates teachable momentSmoking cessation interventions delivered by multiple types of service providers markedly increase cessation ratesStopping is a process which may take several attempts brief Interventions support this processThere are many opportunities to support youth to be smoke-freehttp://www.youtube.com/watch?v=oAoUeIDQsoo

24The 3 As of Tobacco Cessation:Ask Advise Assist

253 As : Ask Advise Assist

1. Have you used tobacco in the past month?

2. Are you interested in reducing or stopping your tobacco use?

3. Referral to Quitnow or arrange a follow-up call or appointment with client

Designed for use by non-healthcare professionalsCoaches the practitioner how to communicate effectively to help with the difficult process of changing behavior and overcoming addiction

TEAMTobacco Education & Action Module 26New website tobbaccoed.orgTailored InterventionsGoal setting, development of coping skills and self efficacy, cognitive reframing, problem solving, positive reinforcement Developing a Quit Plan - TEAM27Social/cognitive-behavioral approaches are promising

Expert Panel Review, McDonald et al., 2003Stop Smoking MedicationsNRT: patches, gum, lozenges, inhaler Bupropion (Zyban)Varenicline (Champix)

Insufficient evidence that they are effective for general youth population, yet effective in adult populations to increase odds of quitting

Advise heavily addicted youth to discuss medications with their physician or pharmacist

28Seven first-line medications approved for use in Canada:

Lozenges great for chew users, Inhalers great for hand/mouth NRT: patches, gum, lozenges, inhaler x 1.5-2 Bupropion (Zyban) x2Varenicline (Champix) x3All work better when combined with social/cognitive supports like individual or group counselling.MotivationSocial injusticeEnvironmental devastationMarketing to youth

Formerly emphasis was on the dangers of tobaccoTraditional use of tobacco: a positive model for aboriginal and non-aboriginal youth29Historically, Health Education was used to increase youth awareness of the dangers of tobacco, in the hope that it would motivate them to be smoke free. The focus was on smokers being bad or stupid and working on individual choice of youth to stay away.

Ill tell you why I like the cigarette business. It costs a penny to make. Sell it for a dollar. Its addictive. And theres fantastic brand loyalty.

30

http://www.youtube.com/watch?v=JndtG8Y7yfw

A Global EpidemicTobacco is grown in over 120 countries on more than 4 million hectares of the worlds agricultural land

Tobacco companies use exploited labour

Child labour is very inexpensive

3232http://www.cancer.org/downloads/AA/TobaccoAtlas13.pdfwww.earthisland.org/.../Girl_picking.jpg

Globally, tobacco production has almost doubled since the 1960sIf this trend continues as projected to 2010, more than 85% of the worlds tobacco will be grown in developing countries

In developing countries, increasing demand and favourable policies have resulted in a 3-fold increase in production, while production has declined by more than 50% in developed countries

Environmental ImpactsPesticide and fertilizer runoff from fields Massive deforestation associated with tobacco curing

Workers suffer:Pesticide poisoning Green tobacco sicknessLung damage

3333http://www.cancer.org/downloads/AA/TobaccoAtlas13.pdf

2004

Lung damage from tobacco and field dust

Environmental ImpactsWorldwide, an estimated 3/4 of a billion kilograms of cigarette butts are disposed of every year They deposit nicotine, heavy metals, plastic fibers, benzene and other carcinogens into our environmentCigarette butts can take up to 15 years to break down34Cigarette butts comprise 1/4 of the items tossed onto U.S. streets. Smokers see butts as a natural kind of trash. But they are not biodegradable

34ScenariosYou are a youth worker. Tyler (16) is in your office talking about an incident where he lost his temper. During the discussion he lets you know that hes really trying hard to quit smoking and its turned him into a bit of a jerk.

2. You are a family friend. Christy is an 18 year-old whos just found out that shes two months pregnant. At a backyard BBQ, you notice that shes on her 4th cigarette of the evening. She sits down beside you and starts to talk about her pregnancy. 35

36The Motor Vehicle Act now prohibits smoking in cars when children under 16 are present

Traditions

Please respect traditional use of tobacco37Brief overview of the traditional use of tobacco vs. commercial mis-use.Kyms Aboriginal Resources CD.Social EcosystemPublic PolicyCommunity( resources, norms)Organizational(social, economic, political) institutions)Interpersonal(family, friends, social networks)Individual (knowledge, attitudes, skills, genetics)Research states:That fear-based just-say-no approaches to drug education do not work, and they never have. To date, traditional drug education programs have failed to have any significant influence on student behaviours. Similarly, zero-tolerance drug policies have failed to solve student drug issues (instead they isolate the students who need connection with peers and caring adults the most). Centre for Addictions Research of BCResearch StatesCreating healthy physical and social environments for learning that builds connections. Benefits both academic and social development. Reduce engagement in high risk behaviours.Developing health literacy understanding skills and confidence needed to survive and thrive in world where substance use is common. Asset focused approach seeks to build on supporting personal capacity. 40 Developmental Assets.Cognizant of risk what factors about the environment contribute to risk? Important to know how to address risk and compensate for it.Interactive ActivityBullring Activity Each string represents an asset and a risk your school currently has in regards to tobacco use.

Multiple uses: triggers, supports, personal assets etcWhole School ApproachInvolves 3 interconnected areas for action that address students needs for: a healthy environment to learn and grow; healthy relationships and connections with peers, teachers and other school staff, and exposure to learning environments that help gain the knowledge and skills required to maximize their health and wellbeing. (Dan Reist)Areas for Action: Utilizing the 4 Pillars framework: Policy; Parnership & Sevices; Social & Physical Environment; Teaching & LearningUtilizing the 4 Pillars Framework:

Brainstorm for each pillar what your school could do to address tobacco use.

How does your school function to promote wellbeing?

How does your school address building personal capacity?43Offer programs:At youth centers and workplaces In winter, notspring/summer Before school, during lunch or during work,not after schoolUse a variety of cessation tools and formats

ResourcesQuitNow:1-877-455-2233 www.quitnow.caClick on Resources for Health Professionalshttp://www.becomeanex.org/www.bccancer.bc.ca/PPI/Prevention/tobaccowww.interiorhealth.ca >choose health> tobacco reductionwww.otru.org Training Online Course Tobacco and Public Health: from Theory to Practice.http://www.healthyheart.bc.ca/clinicalprevention44More Links Global social justice issues: http://www.globalissues.org/article/533/tobacco http://www.eclt.org/ http://www.who.int/tobacco/resources/publications/rights_child/en/ http://www.corpwatch.org/article.php?id=14947 Environmental Impacts: http://www.nsra-adnf.ca/cms/file/pdf/factsheet.pdf http://www.ash.org.uk/files/documents/ASH_127.pdf http://www.who.int/tobacco/en/atlas16.pdf

Tobacco Free YouthChart12674

General Population

Sheet1General PopulationSmokers26Non-Smokers743rd Qtr1.44th Qtr1.2To resize chart data range, drag lower right corner of range.

Chart14456

Depressed Population

Sheet1Depressed PopulationNon-Smokers44Smokers563rd Qtr1.44th Qtr1.2To resize chart data range, drag lower right corner of range.