Health Policy News Special Edition: E-cigarettes

Dear Friends,
The e-cigarette epidemic has grown exponentially over the past few years and continues to present challenges to communities and public health officials. Calls to the Washington Poison Center have nearly doubled every single year since 2010 when the first e-cigarette 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 fledgling industry, while the industry innovates 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 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. 
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. Recent researchhas 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 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 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 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. 
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 CountyKing County,Pierce CountyClark 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.
The American Academy of Pediatrics just yesterday issued this statement: "The AAP now strongly recommends the minimum age to purchase tobacco products, including e-cigarettes, should be increased to age 21 nationwide."
"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 and dangerous to their long-term health."
It seems to me, we may not know everything there is to know about e-cigarettes, but we know enough to adopt policies to protect children and adolescents.


Connect To These Resources:

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

NEAR@Home Toolkit

How are social services professionals using NEAR (Neuroscience, Epigenetics, Adverse Childhood Experiences, and Resilience) science and knowledge? Home visiting and mental health professionals, along with other experts have come together to create, review and test a new toolkit designed as a training manual with guided processes to safely and effectively talk about the trauma of Adverse Childhood Experiences.

The NEAR@Home toolkit, designed over a three plus year period by federal Health Resources and Services Administration Region X (Alaska, Idaho, Oregon and Washington), Quen Zorrah (Thrive WA), Laura Porter, and others, is a "guided process to talk about trauma and resilience in Home Visiting".  

Download the NEAR@Home toolkit from the Thrive WA website here

Healthy Living Collaborative - 2015 Strategies

The Healthy Living Collaborative (HLC) is constantly focusing on upstream solutions that support community-based initiatives to improve health and wellness. The HLC is committed to strengthening families, neighborhoods, and systems in order to ensure health equity. HLC brings together partners from all sectors, combining resources and ideas, to improve the lives of everyone.

Click on the link to the Healthy Living Collaborative's 2015 Strategy document to see what the policy priorities are for this year. 

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Healthy Living Collaborative 2015 Strategies

Webinar: Adversity, Resilience and the Role of Health Systems in Prevention

The Learning Institute's Laura Porter participated in a recent webinar for the National Association of State Mental Health Program Directors (NASMHPD) on Adverse Childhood Experiences (ACEs) and the role of health systems in building resilience:

Adversity, Resilience and the Role of Health Systems in Prevention

Adversity in childhood, particularly in the absence of protective factors, can have profound developmental consequences. If not addressed, childhood adversity can initiate a “cascade” of risk factors, often leading to behavior problems, school failure, substance abuse and other negative outcomes. Health care personnel are in a unique position to identify and intervene early in this process. By educating families, strengthening protective factors, and working with children to build resilience, health care workers can help to prevent the onset of problems later in childhood or adolescence. 

This webinar provides a brief overview of adversity, resilience, and implications for prevention of substance abuse and other negative outcomes. It also describes effective prevention approaches in a variety of healthcare settings, including pediatric hospitals, emergency departments, school health clinics, and home visiting programs. Particular attention is paid to a dual-generation approach and to building partnerships for prevention. 

Click here to view the recorded webinar. 


Special Edition Health Policy News You Can Use, June 3rd 2015

Since the Washington State Legislature concluded their first special session without action on a 2015‐2017 operating budget, capital budget or transportation revenue package they are now in a second 30 day special session.   On May 28th, the final day of the first 30‐day special session, Senate Republicans released their latest operating budget. The Senate Republicans' budget proposal increases spending on higher education, state parks, drought relief and wages for caregivers in assisted living facilities. It adds $66 million to pay for collectively bargained state employee pay raises,  contingent on a new bill requiring contract negotiations to be open to the public. The Senate Ways and Means Committee voted their Republican budget bill out of committee on Thursday. See this link for the budget details.  For more special session and budget info, click on the link for the full Health Policy News You Can Use

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Health Policy News You Can Use_ Special Edition June 3, 2015.pdf

Community Context for Academic Achievement; A Report on Community Factors that Predict Resilience & Prevention in Nine Randomly Selected Communities in Washington

January 20, 2015

Executive Summary

The context for optimal human development includes healthy families, flourishing communities, and the events and systems that shape these. Community capacity is found to be significantly correlated with positive trends in the rates of child safety and school completion (Laverack, 2006; Hall, 2012). Community capacity is described as the empowerment of communities to come together, share responsibility for alleviating crises, improve services, and build healthy environments for families and children (Chatskin, 1999).
This study provides information about the community context for child and family life in Washington, including the degree to which systems of the community operate effectively as a whole to improve outcomes. Using information from Key Informants in nine Washington communities, we consider processes that communities use to develop a sense of belonging and shared identity, come together in celebration or problem solving, reflect on past efforts, agree upon and collaboratively generate solutions, and weave a stronger social fabric as a part of considering community capacity development. Key Informant interviews and community capacity scoring of those interviews are designed to provide insight into the community contextual environment and the capacities of that environment.
Qualitative data from key informants in nine randomly selected Washington communities are considered in this report. Processes and tools used for analysis of the interviews and rating of community capacities are consistent with those used in over a decade of systematic observations of community capacity in Washington State. This includes both capacity index scores (Longhi & Porter, 2009), and correlations between interview content and descriptions of characteristics of five distinct phases of community capacity building (Flaspohler et al., 2012).
Forty-seven interviews with Key Informants in nine Washington communities, reveal common themes, as well as, significant community variation in practices that help communities to flourish. Since the instruments to assess community capacity have been consistently used from 1998 through this 2014-15 interview process, community capacity trends over time are also considered. The names of persons interviewed and the names of the communities where interviews were conducted are not used in this report in order to preserve confidentiality and optimize reporting of most promising and most challenging community capacity building stories.

Connect To These Resources:

Community Context Report_1-20-15_final to Dr Blodgett.pdf

Health Policy News - Final 2015 Regular Session Edition

Dear Friends,

With operating budget negotiations stalled, the legislature adjourned Sine Die on Friday. This was two days earlier than Sunday April 26th the scheduled 105th day of the regular legislative session. Governor Inslee will call the legislature back into special session on Wednesday, April 29th. Budget negotiators have been invited to meet with Governor Inslee on Monday, April 27th in advance of the start of special session.  

More in the full version of this final, regular edition of Health Policy News You Can Use!

Thanks for joining us this 2015 Legislative Session!

- Your Healthy Policy News Team (Erin, Julie, Whitney and Friends) 

Connect To These Resources:

Health Policy News You Can Use_ Final 2015 Regular Session Edition.pdf
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