144 hours 17 minutes 34 seconds

144 hours 17 minutes 33 seconds

144 hours 17 minutes 32 seconds

144 hours 17 minutes 31 seconds

Rob Crane, MD Professor - ClinicalOhio State UniversityDepartment of Family Medicine

Nicotine and Tobacco to Age 21

State Legislative Conference

Rob Crane, MD Professor - ClinicalOhio State UniversityDepartment of Family Medicine

Nicotine and Tobacco to Age 21Review What You May Already KnowTobacco most deadlyNicotine most addictiveEffect on kids brains & behaviorEvidence that T21 works & whyNew DataEarly nicotine causes mental health issuesE-cig & hookah use exploding with teensUpdate on Politics and the LawA hole in the law - enforcementBest practice in insuring compliance

State Legislative Conference

Columbus City CouncilNovember 22, 2016Rob Crane, MDOSU Department of Family MedicinePreventing Tobacco Addiction Foundation (PTAF.org)

Nicotine and Tobacco to Age 21Why?Why Now?Why Columbus?Why Does It Work?What?

The worst failure of American PublicHealth of the last hundred years.Responsible forone in fiveof all deathsin the U.S.An powerful gateway to substance abuse and mental illness.NICOTINE AND TOBACCO

Primary Smoking

All of WW II

AutoCrashesAll of VietnamWarGun ViolenceDrug Overdose

Second-handSmoke

Primary & SecondhandSmoke Kills More Than Half A Million Americans AnnuallySmoking and Mortality - Beyond Established Causes. BD Carter, et al. NEJM 2015 372:631-640

Primary Smoking

All ofWWII

AutoCrashesAll of VietnamWarGun ViolenceDrug Overdose

Second-hand Smoke

Myocardial InfarctionStrokeLung CancerEmphysemaAortic Dissection Asthma PrematurityPlacental AbruptionStillbirthS.I.D.S.MiscarriageAcute LeukemiaKidney CancerCervical CancerLip/Tongue/Mouth CancerBreast CancerBladder CancerEsophageal CancerAlzheimersChronic Bronchitis

DeathSufferingPainLossDispairBereavementHospiceICUDisabilityDepressionFuneralEmergency RoomSurgeryChemoRadiation

Reproductive Outcomes

Female infertilityLow sperm count, motility, functionReduced erectile function

MiscarriageEctopic PregnancyPlacental Abruption/AccretionPlacental Previa

Low birth weight PrematurityStillbirth

SIDSPoor Lung DevelopmentBehavior ChangesSmoking in pregnancy doubles infant mortality

United State Surgeon GeneralCenters for Disease ControlDepartment of Health and Human Services5.6 Million

InhalerPatchCigaretteGumSprayMinutes

Venous Nicotine Levels: Various Delivery Systems

InhalerPatchCigaretteGumSprayMinutes

Venous Nicotine Levels: Various Delivery SystemsArterial Nicotine Level From Smoking(Freebase Nicotine) not to precise scale

Berridge, MASmoking Produces RapidRise of [11c]Nicotinein the Human BrainPsychopharmacology 2010

One Cigarette - 10 Puffs

12 cigarettes per day - 120 spikes of nicotine per day - 44,000 spikes per year

Adolescent smokers First illicit drug a gateway

3X more alcohol use8X more marijuana use 22X more cocaine use

Higher dropout ratesMore likely to experience teen pregnancyMore violence, more incarceration

The earlier a kid starts,the heavier a smoker as an adult.Early Nicotine Use Changes Brains

Early Nicotine Use In Susceptible IndividualsAlcoholismSubstance AbuseSchizophreniaBipolar DiseaseDepression/AnxietyAttention Deficit HyperactivityDebilitating Mental Illness

BidirectionalReinforcementNot Just Self MedicatingNicotine Destabilizes Affect

Kutlu, et al. Nicotine and Psychiatric Illness. Int Rev Neurobiology. 2015

Kandel, KandelMolecular Basis For Nicotine as a Gateway DrugNEJM 2014

What percent of US 11th gradestudents use nicotine/tobacco(30 day prevalence)?(YRBS) 201525%E-cig and vaping17%.

Selling E-Cigs The Old Fashioned Way

Methadone offers heroin users a less harmful addiction,with fewer antisocial effects. E-cigarettes may function similarly for nicotine addicted adults.But should our kidsbe aggressively marketed and soldthis form of methadone?Methadone

Needham, Massachusetts 2004 Health Board Acts Grandfathering 2005-2008

High School Smoking - Two Age Limits

1820 year olds purchase only 2%of cigarettes sold, but are 90% of the supply of addictive tobacco to younger kids.

Lester Hartman, MDJonathan Winickoff, MD

Published March 12, 2015

4.2 Million Years of Lives Saved in Kids Currently Alive Today

25% Drop in Youth Initiation

12% Drop in Overall Smoking

12% Drop in Prematurity

16% Drop in SIDS

In the last three years over 200 cities in 14 states have raised their minimum sales age to 21.Hawaii and California are the first Tobacco states, both started with grassroots Covers 60 million people

CDC Polln = 420075% Support70% of Smokers

95% of all smokers began smoking before age 21

Enforcement Is Critical

Designate a specific enforcement agencyIdentify a funding source for enforcementRequire a specific number of compliance checksStrongly consider a specific tobacco retail licenseProvide for citizen complaintsRequire appropriate signage and retailer educationEnforcement Is Critical

Enforcement Is Critical Designate a specific enforcement agency - HEALTHIdentify a funding source for enforcement - TRLRequire a specific number of compliance checks - 2/YR

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