The Evolution of State Quit Tobacco Services:
Adaptation or Stagnation
ARE YOU READY?
Kathi Wilson
Tobacco Cessation Coordinator
Wyoming Department of Health
Mental Health and Substance Abuse
Services Division
kathi.wilson@health.wyo.gov
I want it noted that the following presentation is strictly based
on my experience supervising the Wyoming Tobacco
Cessation Service, plus research that I have found on line and
by talking with others who are the “experts” in the field of
tobacco cessation.
This presentation is to prompt discussion about tobacco
cessation services and how our quitlines/web-based services
need to adapt and grow with the ever changing
tobacco/nicotine products and the consumers using them.
Kathi Wilson
In the beginning…..
In 1992 California was the first state quitline in the US, “California Smoker’s Helpline”
Seventeen years later we have 1-800-QUIT-NOW coverage in all 50 states.
Since tobacco cessation first began scientific research has
continually uncovered data about the health effects of using
tobacco.
Combine this with new tobacco and nicotine products that
are continually introduced to the consumer market, the
emergence of dual or multi users, and possibly one day a
consumer that is strongly addicted to nicotine who has never
used a tobacco product = confusion…..
hat does this mean for state quitlines/webbased services or state tobacco cessation
services?
 As Quitlines/counselors/ educators are we
researching how new products can influence
our participants success rate within our
programs?
Potential Adverse Effects Of Nicotine
Nicotine Intoxication
Low Birth weight
Stroke
Sudden Death
Fetal Neurotoxicity
Esophageal Reflux
Delayed Wound Healing
Hypertension
Peptic Ulcer Disease
Symptoms of nicotine poisoning:
•Abdominal cramps
•Agitation
•Restlessness or excitement
•Muscular twitching
•Rapid breathing
•Breathing stops
•Burning sensation in mouth
•Fainting
•Heartbeat-pounding
Coma
Confusion
Convulsions
Depression
Difficulty breathing
Drooling
Headache
High Blood Pressure
Vomiting and weakness.
http://health.nytimes.com/health/guides/poison/nicotine/overview.html
Nicotine is such a poisonous substance
that one drop of pure nicotine
would kill a grown person. It is so
poisonous that it can be
used as a pesticide on plants.
http://www.adapp.org/Documents/nicotine and Tobacco...
If you dip, 2.0 mg. - 3.5 mg of nicotine per dip enters your bloodstream,
twice the dose delivered by a standard 1mg cigarette.
Users who consume 8 to 10 dips or chews per day (one-third-1/2 of a can of
snuff or 1.3 - 1.2 of a pouch per day) receive a NICOTINE DOSE equal to
that taken by a heavy cigarette smoker (30-40 cigarettes daily).
A recent report indicates that users who went through two cans of snuff per
week had a saliva nicotine level equal that of people smoking two packs of
cigarettes per day.
http://www.trytostop.org/quitting-smoking/products.html
These are only some of the new products that can be found…..
Camel Snus: RJ Reynolds Tobacco Co., available in three
flavors, attractive cans (cell phone shaped), sold cold for
“freshness”, 8 mg of nicotine in each pouch and does not
have to be spit out.
Camel Sticks/Orbs/Strips: "It's meeting the
needs of smokers," says Rob Dunham, of R.J.
Reynolds, maker of Orb and Camel cigarettes.
With lozenge-like Orb, he says there's no smoke,
no spit, no litter.”
Made from finely ground flavored
tobacco, the products melt in the
mouth within 3 to 30 minutes. Camel
dissolvables are said to deliver
about 0.6 to 3.1 mg of nicotine each.
Marlboro Snus: Use “flavor strip technology”
and dried tobacco. 6.33 mg up to 7.61 mg of
nicotine with four flavors to choose from.
Revved Up: Developed by two
Marines, Revved Up is a
smokeless tobacco infused
with energy elements, similar
to Red Bull. Developed to
combat fatigue in troops,
patented and sold by Southern
Smokeless Tobacco.
E-Cigarette:
The Food and Drug Administration released an analysis of 19
varieties of electronic cigarettes that said half contained nitrosamines (the same
carcinogen found in real cigarettes) and many contained diethylene glycol, the
poisonous ingredient in antifreeze. Some that claimed to have no nicotine were found
to have low levels of the drug. The devices are available in more than 4,000 retail
outlets nationwide, as well as on many Web sites, with a starting cost of $40 to $70.
Over the past year, sales have grown from about $10 million to $100 million,
according to the Electronic Cigarette Association, the industry’s trade group. They
also come in a variety of flavors, including chocolate, mint and apple, which make
them appealing to children and adolescents.
By THOMAS H. MAUGH II LOS ANGELES TIMES Aug. 19, 2009, 1:18PM
Nico-Water: "Nicotine water runs a serious potential of both
being hazardous and serving as a first step into addiction with
children," says Matthew Myers, president of the Campaign for
Tobacco-Free Kids. 4 mg of nicotine per bottle.
Nicoshot: Developed by a German Company, three
cans of Nicoshot is comparable to an entire pack of
conventional cigarettes. (3 cans = 1 pack of cigarettes)
Larry Wald, the owner of the Cathode
Ray Club, came up with the homemade
brew as he searched for ways to help
Nicotini: smokers cope with the new smoke-free
atmosphere Florida voters ordered last
fall. Soak tobacco leaves in vodka
overnight, deaden the juice's harshness
by adding a couple other liquors and
voila: the nicotini of Las Olas.
xamples:
8-10 dips /day = ½ can = 40 mg nicotine = 2 packs of cigarettes (average)
1 can = 80 mg nicotine = 4 packs of cigarettes (average)
Example One:
Example Two:
If a person uses ½ can of tobacco/day (40 mg) of nicotine
PLUS
Camel stick (3.1mg) X 3/day = (9.3 mg) of nicotine
TOTAL: 49.3 mg of nicotine per day (average)
Smokes one pack of cigarettes/day = (20 mg) of nicotine
PLUS
Marlboro Snus (6.33) X 2 pouches/day = (12.66 mg) of nicotine
TOTAL: 32.66 mg of nicotine per day (average)
s Quitlines, if we do not gather
the correct or enough information
about ALL of the products people are
using, we could be setting them up for
relapse, nicotine toxicity and
improper use of cessation
medications. Plus, we loose an
opportunity to educate about these
“other” products and nicotine
addiction.
hat does this mean for state quitlines/webbased services?
 Are we excluding certain tobacco
users from our programs by the
images/wording we use?
(Are messages clear?)
“Smoke Free”
vs. “Tobacco Free”
In recent years we have recognized the
need to replace the word “Smoke Free”
with the word “Tobacco Free”, to cover all
other forms of tobacco use……
In light of all the new laws that
have passed prohibiting
smoking in public areas,
increased tobacco taxes and
new products available at the
consumer market………the new
catch phrase may now need to
be…….
“Nicotine Free”
“Nicotine Free”
nicotine and tobacco products
“Tobacco Free”
Accommodate for smokeless tobacco
and other forms
“SMOKE FREE”
Smoking and secondhand smoke
This sign is still appropriate, but does not
cover the use of all tobacco products.
Would prefer it to say…”No Tobacco”.
Logo may now be outdated ? How do we
account for pouches or the cell phone shaped
cans??
hat does this mean for state quitlines/webbased services?
 As we provide these services are we
matching the growth and knowledge of the
tobacco companies, or are we still stagnant/out
dated in our approach?
Recognizing state budget cuts and the
challenges these restrictions impose on our quit
services, we can and need to be creative to
accommodate the needs of all of our
tobacco/nicotine users.
Wyoming has been taking a hard look at our
services over the past months. We are interested
to learn how other states are dealing with all
these new challenges in the quest for the most
comprehensive and effective quit tobacco
program.
In our efforts to adapt from Smoke Free to
Tobacco Free in our scope of services, how or
should we now move in the direction of Nicotine
Free?
Throughout this presentation we
have hinted about how messaging
and promotion needs to fit the
target population.
“Tobacco is Tobacco”….”Nicotine
is Nicotine”, no matter the
package.
So where is the universal “No Safe
Tobacco icon?”
Is this not the true message we
want everyone to know?
Adaptation or Stagnation
How are YOUR quitline/web based cessation services
dealing with these new tobacco and nicotine products?
How are you accommodating a consumer that is different
from those of the past?
How do we address new tobacco and nicotine products
when talking about a quit attempt?
Thank you