Breaking News! Oakland City Council Votes For #FlavorBan

UPDATE on July 11th CAHC Blog Post: We're happy to report that, around midnight on July 18th, into the wee small hours of the morning on July 19th, the Oakland City Council voted in favor of prohibiting the sale of flavored tobacco.

The council session was packed with public speakers, including our very own Namiye Peoples and Robert Lee!

Thanks to our CAHC team members for showing up and speaking out, and thanks to our partners who work to combat Big Tobacco and fight for the health and well-being of our city and nation's most vulnerable populations.

In order to become a law, the ban will require a second approval vote in September, and would go into effect in 2018. The fight is not over, but we can do it together! 

CAHC Health Equity Statement

The California Adolescent Health Collaborative (CAHC) and our partners work with some of the most vulnerable youth: young people who live in very rural areas without public transportation or access to quality healthcare, foster children who have no family or even consistent school environment, homeless children and very low-income youth who don’t know where their next meal is coming from or where they will sleep the night, commercially exploited children who are treated as commodities, children (disproportionately of color) who have been accused of committing crimes and are incarcerated, young people who become parents before reaching adulthood. CAHC’s Director brings these youth into focus at the tables she sits at:

  • The California Partnership to End Domestic Violence’s Leadership Team Addressing Adolescent Relationship Abuse
  • The California Department of Public Health’s Office of Health Equity Advisory Committee
  • The California Convergence to Counter Childhood Adversities
  • The Justice for Young Families Board

CAHC advances equity in three ways: across demographics, across geography, and across sectors.

  1. Many people think of equity mostly in terms of demographics: people’s health is determined by where they live and grow up, the color of their skin, their employment and social status, who they love, and what’s in their wallets and bank accounts. These circumstances largely determine how social structures shape our health or illness. Biology also shapes our health, and age is one place where the two intersect. Most adolescents are at the peak of health physically, yet they are the most vulnerable to developing mental illness. This is in part due to rapid brain development, but is also impacted by the systems that young people exist within: schools, juvenile justice, foster care, media, healthcare, housing, etc. CAHC strives to address all of these social determinants of health and the inequities they engender as they intersect within California’s adolescent population. We do this by building young people’s capacity to investigate and propose solutions to problems plaguing the institutions they engage with. Some examples include:
    • CAHC and Faces for the Future are collaborating with Castlemont High School to collaboratively develop the first Community Health Equity Academy (CHEA) for high school students that we are aware of. CHEA students will not only be engaged as decision-makers in co-developing Academy structures, culture, and learning opportunities, but will also be trained and coached in Youth Participatory Action Research, enabling them to cooperate with industry partners in investigating and acting to improve community health issues, while preparing them for careers in health and adjacent sectors (all of which will benefit from their highly-developed understanding of social determinants of health). This project is funded by Atlantic Philanthropies and Oakland’s Measure N through the Oakland Unified School District.
    • We partnered with MISSSEY, an organization whose mission is their name: Motivating, Inspiring, Serving and Supporting Sexually Exploited Youth, to develop and pilot-test a youth-centered health curriculum that enables sexually exploited youth (SEY) to understand and advocate for their own health, that young clients named YEH (Youth, Empowerment, and Health): The More You Know. Our next step is to train youth service providers in organizations that serve SEY and rigorously test outcomes of the training. This project was funded by the Lalor Foundation, and we are currently seeking funding for the next phase
  2. One of the most powerful social determinants of health is place. Young people who grow up in disadvantaged urban neighborhoods experience myriad threats (and some protective factors) to their health and development, while young people who grow up in rural areas experience different health threats and protections. Such differences are highlighted in California’s Central Valley and Bay Area, two places which are rich centers of agriculture and technology respectively, but yet they are paragons of inequality with accompanying disease pockets in their most marginalized neighborhoods. CAHC connects such communities so that resources, including technology, research, finances, skilled people and lessons learned from experience can be transferred and utilized to improve community health and youth empowerment. We do this by designing and implementing whole programs with organizational partners and participants in both of these geographic areas. Some examples include:
    • CAHC facilitates Project PARTNER (Partnering with Adolescents to Ready The Newest Engaged Researchers) in two majority immigrant communities: Chinatown in central Oakland and Livingston, a majority Latino immigrant agricultural community. We’ve developed inter-generational advisory boards with capacity to research community health priorities, at which point they will present to each other and receive feedback. This builds personal connections across the geographic divide and allows people from very different, but physically close, cultures to share their strengths, skills and knowledge for mutual benefit. This project is funded by the Patient-Centered Outcomes Research Institute.
    • CAHC coordinates multiple partner organizations, in the Central Valley and the Bay Area, to develop economic opportunities and healthy relationships skills among youth who are students in traditional and continuation schools, youth involved with the juvenile justice system, foster youth, youth who are parents and young people who are homeless. With the Healthy Relationships and Economic Pathways (H-REP) program, we are actively developing skills such as website development among young people in communities that neighbor the Silicon Valley yet remain economically depressed. By pairing this with healthy relationships education, we reduce youth’s chances of being injured or developing diseases as a result of relationship abuse in adolescence or domestic violence in adulthood, while also increasing their chances of economic wellness, which is a strong determinant of health. This program is funded by the Office of Family Assistance of the Department of Health and Human Services.
  3. The work of disease prevention and health promotion is currently facilitated in three main domains: research, programs, and policy. While labor conducted within each of these domains is dependent upon that done in the other two, few people or organizations conduct their business across these three domains. Research is the purview of people with terminal degrees, by design those people with privilege to access such higher education. Similarly, policy is made by people with social power. CAHC works across those boundaries by training young people in research and advocacy, and incorporating them into program development and decision-making. We do this by partnering with young community members, service providers, and practitioners in our research studies, and building capacity for advocacy among our research team. Some examples include:
    • With the support and guidance of Advisory Committee members from universities, nonprofits, and public agencies, CAHC partners with a local nonprofit to design and implement a study of the social and structural facilitators of and barriers to breastfeeding among diverse adolescent mothers. Young mothers joined the research team, making decisions, collecting and analyzing data alongside academic and community researchers. This project is funded by the California Breast Cancer Research Program of the University of California Office of the President (UCOP).
    • Our study called META-Oak (the Marketing of E-cigarettes Toward Adolescents in Oakland) includes youth journalists as co-researchers on the team and built the foundation for our advocacy for a cutting-edge city policy to ban flavored and menthol tobacco products. This project is funded by the Tobacco Related Disease Research Program of UCOP and the Tobacco Control Policy Leadership Institute.

To assist in achieving health equity for America’s 42 million plus adolescents, HHS could:

  1. Collaborate with the state level Offices of Health Equity (OHE), such as the relatively new OHE of the California Department of Public Health, to understand and coordinate the work that they are doing and the strategies that work. Ensure that adolescents are considered as an essential population of people with particular needs and extreme vulnerabilities, along with people of color, sexual minorities, people with disabilities, etc.
  2. Continue to fund our H-REP program. Continue funding initiatives similar to Looking Beneath the Surface, an initiative of the Administration on Children and Families, but with particular focus on CSEC (commercially sexually exploited children) given that this population requires specific and particular programming.
  3. Fund community-based participatory research (or YPAR) without mandating a specific health issue be addressed. This would allow for lay researchers and community members to develop partnerships with scientific researchers, developing common language and groundwork in the process of identifying a priority health risk or disease or social determinant of health they have decided together to address. CBCRP of the UCOP has done great work in this area and would be a good funder to work with to learn how to do it well.
  4. Connect with the American Public Health Association’s Anti-Racism Collaborative, led by Camara Jones, to explore how HHS can specifically support progress toward health equity for all races and ethnicities.
  5. Explore jointly developing an RFP with the National Institutes of Justice or a similar organization that specifically addresses the need for multiple stakeholders to improve the ability of the juvenile justice system to protect the health of its youth, via both public health programming and better connecting medical care to community providers. This could be done by requiring use of a collective impact or similar strategy to facilitate structured, measurable collaboration.
  6. Expand funding opportunities that come from the Office of Adolescent Health so that mental health is prioritized equally with physical and sexual health. Currently, the majority of its funding activities seem to be focused on sexual health.
  7. Develop opportunities to connect youth in rural and urban areas.
  8. Work with Opportunity Youth United to discuss how HHS/ OASH can support the recommendations to increase opportunity and decrease poverty for the 5.6 million young adults who are disconnected from school and work, the “opportunity youth.”
  9. Convene other private and public funders to learn from each other and align strategies so that resources are leveraged and targeted to where they can have the most impact. Many funders are moving toward funding core operating support as it allows organizations to be nimble and responsive in their pursuit of their mission. Funding organizations to contribute to health equity in this way could be very effective.

CAHC Supports the Oakland Children – Smoking Prevention Ordinance

The California Adolescent Health Collaborative (CAHC) would like to express our support for the Oakland Children - Smoking Prevention Ordinance to prohibit the sale of flavored tobacco products in Oakland, including menthol, and to prohibit tobacco discounts and coupons. Since 1994, CAHC has been working across sectors to improve the health of California’s adolescents and the capacity of our systems to support adolescent health. Our strategy is to connect research and practice so that young people develop the knowledge, skills, and resources they need to transition successfully into adulthood. We partner with schools, school districts, public health departments, youth empowerment and employment organizations, juvenile justice systems, healthcare providers, youth leaders, and scientific researchers in service of our mission. We exist because adolescents are different, science proves this and we all know it. It’s time that our policy reflects this knowledge as we strive to better care for our youth on the cusp of adulthood. This means not allowing tobacco companies to lure youth into toxic nicotine addiction with appealing flavors and marketing. 

Smoking is the leading preventable cause of death in the United States, and if smoking continues at current rates, 5.6 million young people under the age of 18 will die of a smoking-related disease. Cancer is the leading cause of death in Alameda County (24.5% of all deaths), and 19% of Oakland youth have been diagnosed with asthma, compared to 15% statewide. Youth smoking prevention is important, as 90% of all people who smoke start smoking by age 18 and 99% start by age 26.  Research shows that 81% of youth tobacco users ages 12-17 initiated with a flavored product, and 80% used a flavored tobacco product in the past month. While youth smoking has declined over the past decade, use of non-cigarette tobacco products has increased. In the Oakland Unified School District (OUSD), 78% of 11th grade smokers reported starting smoking between ages 11 and 17. E-cigarette use tripled among U.S. high school youth from 2013 (4%) to 2014 (13%), and reached 22% among OUSD 11th graders.

CAHC and our partners at the Center for Tobacco Control Research and Education at the University of California, San Francisco were so alarmed at the raising rates of e-cigarette use that we have been co-leading a study with youth journalists, to better understand the Marketing and promotion of E-cigarettes Toward Adolescents in Oakland (META-Oak Study). We are in the process of reporting our findings, but through our photovoice process we have found that flavors, colors, and price points are essential components not only of the way that tobacco and e-cigarette products are marketed in Oakland, but also of the way that youth themselves perceive and learn about such carcinogenic vices. In the process of investigating our research question, our youth co-researchers have become avid anti-tobacco advocates. Given that we don’t have the opportunity to intensively train all of Oakland’s youth, this ban is the next best thing we can do to protect them from predatory big tobacco.

CAHC is dedicated to health equity. Given the evidence that flavors and menthol tobacco products are disproportionately marketed toward and used by adolescents and communities of color, we believe that a citywide universal ban can bring us closer to a health equitable city. CAHC and our partners work with some of the most vulnerable youth: foster children, homeless children, commercially exploited children, children who have been accused of committing crimes and are incarcerated. In our experience, too many children are left behind. Let’s prioritize health equity starting early, and give our youth a fighting chance.

Few programs or organizations have the ability to positively impact as many children as do law-makers. We hope that Oakland will lead the way for the nation in emphasizing the importance of our children’s health by banning flavored tobacco products including menthol.

CAHC Supports SB 328 - You Should Too!

Attention all people who care about teens! Please contact your CA State Legislators to support SB328! Find your rep using this link: http://findyourrep.legislature.ca.gov/

Or, if you are in or near Sacramento or willing to travel, come express your support at the Committee hearing on July 12th! Contact alison.chopel@phi.org if you are interested and need more info.

 

The California Adolescent Health Collaborative (CAHC) strongly supports SB 328 (Portantino), which will require California school districts to start their middle and high school days no earlier than 8:30 a.m.

Since 1994, CAHC has been working across sectors to improve the health of California’s adolescents and the capacity of our systems to support adolescent health. Our strategy is to connect research and practice so that young people develop the knowledge, skills, and resources they need to transition successfully into adulthood. We partner with schools, school districts, public health departments, youth empowerment and employment organizations, juvenile justice systems, healthcare providers, youth leaders, and scientific researchers in service of our mission. We exist because adolescents are different, science proves this and we all know it. It’s time that our policy reflects this knowledge as we strive to better care for our youth on the cusp of adulthood.  

Given the established connections between widespread health problems (including obesity-related diseases, unintentional injury such as motor vehicle accidents, and intentional injury such as suicide), and insufficient sleep, the returns on the proposed policy to start schools later and allow California’s young people the opportunity to protect their health could be even greater than we anticipate. Changing school start times is vital given the physiological changes that adolescents undergo. Adolescents need at least as much sleep as children, and their changing circadian rhythms make it extremely difficult to sleep earlier, even when required to wake earlier. Myriad risks of inadequate sleep to health and cognition include increased ADHD symptoms, suggesting that improved adolescent sleep could result in marked educational improvements.

Furthermore, as violence to self and others is linked to mental illness, this policy could improve public safety. While adolescents as a group, in comparison to other age groups, are at the peak of physical health, they are disproportionately impacted by poor mental health and especially vulnerable to developing new mental illness. There are things we can do to protect our youth from these risks- and one of them includes encouraging and protecting healthy sleep. Given the lack of fit between adolescents’ biological needs and their societal requirements— some secondary schools start as early as 7 a.m.- mandating later school start times is a reasonable way to do this. We have a responsibility to our children to act on the science.

CAHC is dedicated to health equity. Given the evidence that sleep is an inequitably distributed health input (men, black people, and less affluent people get less sleep than their counterparts), we believe that addressing it among youth in a universal way via a statewide school policy can bring us closer to a health equitable society. CAHC and our partners work with some of the most vulnerable youth: young people who live in very rural areas without public transportation or access to quality healthcare, foster children who have no family or even consistent school environment, homeless children and very low-income youth who don’t know where their next meal is coming from or where they will sleep the night, commercially exploited children who are treated as commodities, children (disproportionately of color) who have been accused of committing crimes and are incarcerated. In our experience, too many children are left behind. Let’s prioritize health equity starting early, and give our youth a fighting chance.

Few programs or organizations have the ability to positively impact as many children as do state law-makers. We hope that California legislators will lead the way for the nation in emphasizing the importance of our children’s health by mandating that schools respond to science which unequivocally draws the link between school start times, sleep, and disease and injury prevention.

For more information, check out this SB 328 Fact Sheet!

Why Teens Are Smoking Less, In Their Own Words

California Adolescent Health Collaborative’s META Oakland: E-Cigarette Marketing research program was featured by California Healthline in an article written Kellen Browning on July 5, 2017. Read the article here or on the California Healthline website. This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

When Maya Terrell saw the anti-smoking television commercial, she knew she would never try a cigarette.

It featured an ex-smoker with a hole in her throat where her larynx used to be.

“I was like, ‘Never!’” recalled Terrell, 18. “I was scared.”

Besides, she said, smoking is just plain gross.

“My friends don’t smoke cigarettes,” said Terrell, of Sacramento, Calif. “It’s nasty.”

Terrell is emblematic of a generation of teenagers who appear more knowledgeable about the risks of tobacco — and are smoking fewer cigarettes than ever before.

When researchers first started consistently tracking teen cigarette use in 1999, 29 percent of high schoolers reported smoking a cigarette in the past 30 days. That’s compared with 8 percent in 2016, according to data released this month by the Centers for Disease Control and Prevention.

Reported use of e-cigarettes, known as vaping, also fell for the first time since e-cigarette tracking began in 2011, dropping from 16 percent in 2015 to about 11 percent in 2016. However, non-Hispanic white students remained more likely to use e-cigarettes than their Hispanic or non-Hispanic black peers.

At the same time, other research suggests kids’ marijuana use is up — a possible sign of shifting tastes and habits.

Cigarette smoking is known to increase the risk of cancer, heart disease, stroke, lung diseases and diabetes. Tobacco use is “the leading cause of preventable disease and death” in the U.S., according to the CDC.

Many smokers in past generations ignored warnings about tobacco risks amid heavy advertising by tobacco companies. Today’s teens are more aware of the perils, and seem unsurprised by the CDC’s recent findings.

“I’ve had family members have a lot of consequences because of smoking,” explained Juliet Brisson, 15, while shopping at a Sacramento mall. “Older people used to smoke a lot, and they get effects as they get older. [Teens] are probably seeing that happen and are realizing they shouldn’t.”

Brisson’s friend Angelina Campos said that observing what happens to those who smoke, as well as anti-smoking campaigns, can influence her generation.

“People see the campaigns, they’re seeing the consequences, they’re seeing others die from tobacco usage,” said Campos, 17.

California has long led the nation in restricting access to tobacco and continues to make it harder and more expensive to use. The San Francisco Board of Supervisors recently approved a city-wide ban on the sale of flavored tobacco products, including menthol cigarettes. California raised the minimum legal agefor purchasing tobacco from 18 to 21 in 2016, and voters also increased the state tax on tobacco products by $2 per pack by approving Proposition 56 last year.

Such measures help decrease teen smoking rates, said Dr. Alison Chopel, the director of the Public Health Institute’s California Adolescent Health Collaborative.

“California is kind of leading the nation in terms of declining rates of cigarette smoking. I think part of that has been the tax, and … the age availability definitely makes a difference,” Chopel said. “Any way that you can restrict access is definitely going to be helpful.”

Chopel heads a project called Marketing E-Cigarettes Toward Adolescents Oakland (META Oakland), which employs youth researchers and journalists to study how e-cigarettes are advertised. They’ve since branched out to monitor trends with other tobacco products.

META Oakland found that flavors of e-cigarettes and other products, such as “Mango Tango” and “Watermelon Wave” entice teens. Chopel said that despite the encouraging recent data, anti-smoking advocates need to “remain vigilant” to counteract tobacco companies’ advertising.

Flavored e-cigarette and tobacco products are heavily marketed to minorities. The CDC found that menthol cigarette promotions in particular have been “targeted heavily toward African Americans through culturally tailored advertising images and messages.” Nearly 9 in 10 African-Americans who smoke prefer menthol cigarettes, the CDC says.

FROM ORIGINAL ARTICLE: MAYA TERRELL, RIGHT, WALKS WITH LAMARR MORRIS IN SACRAMENTO’S ARDEN FAIR MALL ON JUNE 19. (KELLEN BROWNING/CALIFORNIA HEALTHLINE)

FROM ORIGINAL ARTICLE: MAYA TERRELL, RIGHT, WALKS WITH LAMARR MORRIS IN SACRAMENTO’S ARDEN FAIR MALL ON JUNE 19. (KELLEN BROWNING/CALIFORNIA HEALTHLINE)

E-cigarettes are probably a healthier choice — but not an ideal alternative. They contain nicotine, and the CDC says they can lead to addiction, harm brain development and encourage use of other tobacco products.

A recent study found that e-cigarette and traditional cigarette smokers tested similarly for levels of nicotine, but e-cigarette smokers showed “substantially reduced levels of measured carcinogens and toxins” than cigarette smokers.

Mac Carroll, a 14-year-old Sacramento student, sees classmates smoke e-cigarettes at school. He suggested teenagers might be influenced to vape because it’s trendy.

“If everyone’s doing it, you kind of just want to do it yourself, you know?” Carroll said.

But Andy Knox, a 16-year-old Davis, Calif., resident, thinks the recent decline in teen vaping shows that e-cigarettes are past their peak popularity.

Vaping is “generally widely culturally viewed as pretty much ridiculous,” Knox said.

Many of the teens interviewed said the waning interest in cigarettes is closely linked with the increase in popularity of marijuana.

“Generally, if you talk to people at school, they know all the things that tobacco causes, like cancer, and they don’t see marijuana as dangerous as that,” he said. “Also, the effect that it has on you is more pleasurable with marijuana than with tobacco.”

Though some teens may believe that smoking marijuana isn’t as dangerous as cigarette smoking, it may cause addiction, lung damage, impaired driving and brain development problems, according to the CDC.

California voted last year to legalize recreational use of marijuana for those 21 and older starting in 2018. Knox thinks the outcome has influenced teenagers’ behaviors as well.

“People are probably having the instinct with marijuana that, ‘Well, it’s going to be legal in a few years, so you might as well start,’” Knox said.