Dr. Allison Myers:
The place to start with this problem, at the risk of repeating or at the risk of preaching, is that combustible tobacco is the leading cause of death and disability on the planet, right. So not simply in Oregon, not just Portland, not just rural Oregon, not just the United States, but it’s a planetary problem that combustible tobacco is making people sick. The tobacco industry spends about $9 billion a year on marketing, broadly, any kind of marketing. Ninety percent or so of that $9 billion is focused in the retail setting.

The first thing you’ll notice is that there’s what’s called a powerwall display behind the register. Lots of folks want that space for their product. The tobacco industry pays a lot of money to get that space, and that’s the first piece of evidence that we know that the tobacco industry has essentially taken over the retail setting. Young people, children, who shop in retail stores where there are a lot of tobacco products and advertisements and price discounts are much more likely to start smoking than children who are not exposed to tobacco products and advertisements and price discounts.

Following behind that and depending on store type, you’ve got the food industry and the alcohol industry, for example, and then sugar-sweetened beverages also competing for space. So as your average consumer, and I think folks who I would like to be thinking about public health, I think it’s safe to say… these are industries that are selling products. Yes, they are.

And then underneath that, there’s a whole other level of to what degree are these companies manipulating consumers? Another way of thinking about it is that there are young people who have no ability to make a good choice. There’s no such thing as a healthy choice in the environment where they’re growing up, right. If you think about kids and their walk to school, some of them will walk a mile through leafy green pastures. Others will walk a mile in front of tobacco and liquor stores with displays, advertisements, et cetera and that continual exposure is something that we all need to be concerned about because what opportunity does that young person have to be healthy when they’re constantly seeing tobacco and alcohol advertisements every day repeatedly.

The retail environment is one manifestation of place that we can change as a community, right. We get to decide how much and what types of tobacco products can be sold in the store. We get to decide what kinds of food products, whether they’re beverages or vegetables or staple foods, whole grains. We get to decide what exactly it is that we want to have available in our stores.

And then also, as a community, we can think critically about the nature of our neighborhood as one that either promotes or detracts from health. Do we have safe spaces for physical activity? Is our community inviting? And so suddenly we’ve got power and we’ve got choice and it’s a time more than ever, I would say, in the United States when local communities can and should come together to make decisions about what we want our future to look like. We can decide for tobacco, also for food, also for alcohol. There are lots of options for communities to think about how they want to shape their experience, their lived experience.

Bob Brewer, MD, MSPH:
I think a lot of people have the misperception that most people who binge drink or drink to excess in general have serious drinking problems are alcoholics or alcohol dependent are some of the common words that have been used to describe this in the past. Addicted to alcohol. And in fact that’s not true. About nine out of 10 people who report binge drinking or who drink excessively in general do not meet the diagnostic criteria for alcohol dependence or what’s sometimes been referred to as alcoholism. Well, excessive drinking includes binge drinking, which is basically drinking to the point of acute intoxication, and we would define that as having five or more drinks on an occasion for a man, an occasion being within a short period of time or four or more drinks on an occasion for a woman. And then heavy drinking, which is defined as 15 or more drinks per week for a man or eight or more drinks per week for a woman. And then any alcohol consumption by pregnant women or youth under age 21 we would consider that to be excessive.

Now binge drinking is by far the most common pattern of excessive drinking. And that’s engaged in both by adults and by youth. So under age 21. And we consider that to be the most deadly, costly and expensive pattern of excessive alcohol consumption in the United States. The other mythology around binge drinking is that a lot of people think that it’s just a problem with young people, particularly college students or perhaps high school students, when in fact it really is a significant problem across the lifespan. And we actually see higher rates of binge drinking among adults 35 to 44 than we do among high school students. And also I think a lot of people mistakenly believe that binge drinking is really only a problem if you get behind the wheel of a car, that as long as you’re not drinking and driving, you’re probably okay.

When in fact that’s not the case. You can still get into fights with people. You can still engage in risky sexual behavior and you can still pickle your liver binge drinking at home, even if you’re not behind the wheel of a car. So there are a lot of problems related to binge drinking that go beyond just impaired driving. The economic cost of excessive drinking overall is just under a quarter of a trillion dollars per year based on our most recent estimates for 2010. And if you take that cost and you divide it by the total number of drinks that are sold and consumed, it comes out to about $2.05 per drink. And binge drinking is responsible for about three quarters of those costs. That includes lost productivity, criminal justice expenses, and health care expenditures as well. Alcohol taxes in general run around $0.05 per drink on average across all beverage types. That would be beer, wine, and liquor. There is quite a substantial difference between the average tax per drink and the economic costs, as we would estimate it per drink.

Steven Fiala:
Okay. And, here we go.

Steven Fiala:
Thanks everyone for joining our very first Data Within Reach webinar. This webinar is going to focus on flavored tobacco use among Oregon adults and youth. My name is Steven Fiala and I am one of the research analysts focused on tobacco within the Health Promotion and Chronic Disease Prevention section of the Oregon Public Health division. Let’s get started.

Steven Fiala:
First, we’re going to go over our time together. We’re going to start by describing the purpose and format of the webinar series. Then we’ll get into the data, so describing youth and adult use of flavored tobacco. That’s going to take about the first 15 minutes of the 30 minute webinar time, maybe a little bit more because for this very first webinar we’re going to describe the purpose and format so that’ll take up a little bit of time. Ideally we would have about 15 minutes left at the very end for any questions you all have about what we go through. and we’re hoping that this maybe even will spark some discussion among you all.

Steven Fiala:
Some logistics, I’m going to take this opportunity to remind everyone to mute their phones. If you haven’t done so, go ahead and press that button right now. Then we’re also asking people to hold all their questions until the end of the data sharing portion of the presentation. Again, we’re hoping to have 10 to 15 minutes for your questions and discussion, so hold those to the end. You can also in, Go To Webinar, type your questions into that sidebar. We’ll start by reviewing some of those questions and answering those when we get to that point in the webinar.

Steven Fiala:
To briefly discuss the purpose of the webinars series, this is meant to provide a venue for a timely sharing of the data that we collect on a variety of topics, including tobacco use. We also want to provide an opportunity for people interested in health promotion and chronic disease prevention to ask questions about some of the data we’re sharing, and again, to hopefully have a discussion. In sum, the webinars are intended to provide you with short, bite-size chunks of information and again, hopefully spark some discussion and interest in the topic.

Steven Fiala:
We also wanted to point out that the plan for these webinars, this webinar series, is to provide additional data to compliment the content in the Health Within Reach blog that comes out. That Health Within Reach blog topic for the month of October came out last Friday, it was on flavored tobacco to coincide with Halloween. This Data Within Reach webinar will also focus on flavored tobacco and again, complement some of the information that was in that blog post.

Steven Fiala:
Before we get into the specific data points, we want to briefly mention where all these data are going to come from. We’re going to review data collected from eighth graders and 11th graders in Oregon as well as Oregon adults. Data on eighth and 11th grade tobacco use, they are collected through our Oregon Healthy Teen survey, or OHT, which is a pen and paper and web-based survey administered every odd year in Oregon to eighth graders and 11th graders in their schools. Our adult data are collected through the Oregon Behavioral Risk Factor Surveillance System, or BRFSS, which we might use for short, and that is a telephone-based survey of adults in Oregon and that’s administered every year. The data that we’re going to review today are 2015 Oregon Healthy Teens data for our eighth and 11th graders, and then 2014 adult data from the Oregon BRFSS.

Steven Fiala:
Really briefly, before we get into the data points, to provide just a little bit of context we wanted to point out that as of 2009, except for menthol, flavors are not allowed in cigarettes. This means that flavored cigarettes like Twista Lime and Kauai Kolada are no longer allowed. However, non-cigarette tobacco products which include little cigars and cigarillos, smokeless tobacco, hookah, and electronic cigarettes, they’re all still allowed to have flavors, so the tobacco industry can flavor those products.

Steven Fiala:
Really quickly, just to look at the variety of flavors offered in little cigars and cigarillos, here’s some Swisher Sweets flavors like peach and strawberry. Here are some hookah flavors like blueberry pancake, cotton candy. And then here are a few flavors of electronic cigarette liquid nicotine, including gummy bears and Skittles and Mountain Dew. That was just to provide a little bit of context. Cigarettes can’t be flavored except for menthol, and non-cigarette tobacco products can be flavored.

Steven Fiala:
Now the moment you have all been waiting for. The data. Let’s dive right in. First we’re going to look at a graph showing current use of cigarettes and those non-cigarette tobacco products we looked at among the Oregon youth, young adults, which we’re defining as people between the ages of 18 and 24, and then adults over the age of 24. Those are our age groups we’re going to look at today. We’re going to look at cigarette smoking as well as non-cigarette tobacco use. Again, non-cigarette tobacco use includes use of any of those products we talked about like little cigars and cigarillos, smokeless tobacco, hookah, and electronic cigarettes.

Steven Fiala:
First we’re going to start with our eighth graders cigarette smoking prevalence. In 2015 we saw that 4% of eighth graders reported current cigarette smoking. Moving on to 11th graders. See that 9% of 11th graders reported current cigarette smoking in 2015. Moving on to young adults, we see that 16% of young adults between the ages of 18 and 24 reported current cigarette smoking. And then our last age group of adults over the age of 24, about 16% as well.

Steven Fiala:
Here are our current cigarette smoking prevalences for youth, young adults, and adults. You can see that over time as people age, the cigarette smoking prevalence increases from age group to age group. From young adulthood to adulthood it appears to be a maintenance of cigarette smoking, going from 16% to about 16%.

Steven Fiala:
Now we’re going to move on looking at non-cigarette tobacco use. We’ll start with eighth graders. For eighth graders we see that 11% reported current use of a non-cigarette tobacco product, or about one in 10. You can see that it is more than double the cigarette smoking prevalence among that group. For 11th graders, 23% reported non-cigarette tobacco use, so nearly one in four 11th graders, and also more than double the cigarette smoking prevalence.

Steven Fiala:
Then moving on to young adults between the ages of 18 and 24, reporting non-cigarette tobacco use is about 32%, so about one in three. Similar to cigarettes smoking we’re seeing this consistent increase in non-cigarette tobacco use as people age. Then when you look at adults over the age of 24, so getting out of that young adult period, it drops pretty dramatically down to 11%.

Steven Fiala:
Overall we’re seeing here that non-cigarette tobacco use prevalence for eighth graders, 11th graders, and young adults is about double that of the cigarette smoking prevalence. So the orange bars are higher than the blue bars. And then we see that as we get into adults over the age of 24 that the cigarette smoking prevalence is higher and that non-cigarette tobacco product use decreases pretty rapidly.

Steven Fiala:
Now that we’ve looked at use of cigarettes and non-cigarette tobacco products which, as we mentioned, cigarettes can’t be flavored except for menthol and non-cigarette tobacco products can be flavored, we’re going to now review newly collected data on a question on our surveys that specifically asks about past flavored tobacco use.

Steven Fiala:
This is past 30 day use of flavored tobacco, which we define as current use, among current tobacco users in Oregon. In the previous graph we were looking at the entire population of eighth graders, 11th graders, young adults, and adults. For this one, we’re looking specifically at that group of tobacco users. For eighth graders, 11th graders, young adults, and then adults over the age of 24, it’s those who have indicated using a tobacco product recently, so it’s that tobacco product … tobacco user group.

Steven Fiala:
We’ll start with eighth graders first. We see here that 64% of eighth grade tobacco users report using flavored tobacco in the past 30 days. That is pretty high. Then when we look at 11th graders, that increases. We see that among 11th grade tobacco users, 71% report current use of flavored tobacco. Then when we look at our young adults, among young adult tobacco users, about 59% report using flavored tobacco.

Steven Fiala:
I don’t know if we want to get into the technical details but some of you will appreciate this, for the eighth and 11th graders, the question is past 30 day use of flavor. When we look at young adult and adult, the question actually asks in the past year, so those time frames are different. What that means though is that the young adult estimate and the adult estimate is actually a more conservative estimate because they’re reporting on their entire previous year’s use, whereas youth are reporting past 30 days. Just wanted to point that out.

Steven Fiala:
Then when we look at adults over the age of 24 we see that among those tobacco users, about 9% reported flavored tobacco use in the last year.

Steven Fiala:
The message really, here, is that flavored tobacco use is higher among our Oregon youth, eighth and 11th graders. It’s still fairly high among that young adult age group, between 18 and 24, but then when we look at tobacco users who are over the age of 24 we really see that that use of flavored products decreases really drastically. And then just to point out the contrast, we see that among that tobacco using group that flavored tobacco use is nearly eight times higher among 11th graders compared to those adults 25 and older. I’ll let that slide sink in for a moment.

Steven Fiala:
Those were our bite-size chunks of data. The takeaways that we want people to remember is that non-cigarette tobacco products like little cigars, cigarillos, chewing tobacco, hookah, and electronic cigarettes can be flavored, while cigarettes cannot, except for menthol. And then we saw from that first bar graph where we looked at cigarettes versus non-cigarette tobacco use, that non-cigarette tobacco use prevalence was about twice that of cigarette smoking prevalence for youth and young adults. Then in that last bar graph that we just looked at, we saw that flavored tobacco use is quite a bit higher among youth and young adults compared to adults that are over the age of 24. Those are takeaways that we want people to walk away with.

Steven Fiala:
Now we are going to open up the lines for any questions about what we just looked at or to have a conversation among those on the call. Feel free to unmute yourselves and we are going to scroll through the questions on here.

Steven Fiala:
The first question is, are we going to have access to these slides on HPCDP Connection?

Steven Fiala:
That is something I should have mentioned at the start of this, is that we are recording this right now. We plan to record all of these webinars and then archive them on the Health Within Reach blog page so that you can access these. If you attended them or if you’re unable to attend any of the webinars, you can go to that Health Within Reach blog page and watch them.

Steven Fiala:
Are e-cig numbers included in the non-cigarette tobacco use data?

Steven Fiala:
Yes, that’s an excellent question. For that first graph when we split up cigarettes and non-cigarette tobacco use, we were including electronic cigarettes in that non-cigarette tobacco use category. That included little cigars and cigarillos, large cigars, hookah tobacco, electronic cigarettes, and chewing tobacco.

Steven Fiala:
Those were the only two questions that we had typed in here. We want to open it up to you all. Do you have any questions about the data you saw? Or if you want to have a conversation about any of it with your peers that are on the phone, feel free.

Steven Fiala:
I’m not hearing anyone that wants to talk about this any further. Again, we’re hoping that this will become a webinar series.

Steven Fiala:
Before anyone jumps off while I babble, I want to also say that when I stop this webinar, you’re going to get an evaluation survey that’s going to pop up on your computer. We would really appreciate it if you would fill that out because it’s going to help us with continuous quality improvement of these webinars. Then I think in addition to popping up on your screen, if you don’t have time for that, I think it’s also going to send you an email. Which either way you want to fill it out, it doesn’t matter to us, but we’d really appreciate your input.

Steven Fiala:
Hey.

Speaker 1:
Is there any indication after youth start using the flavor tobacco and they get older, older youth like 19, 24, do they continue to have higher rates of smoking as they become adults, older adults? In other words, is there a second group of people that are really using this flavor to keep them really addicted on maybe regular cigarettes after they stop using the flavor? Kind of like menthol, menthol keeps people more addicted and harder to quit. Does that make sense?

Steven Fiala:
No, your question does make sense. I don’t know that I can be specific to say that those that are-

Speaker 1:
The slide you have up now, you have 32% using that flavored. When they get older, are they going to continue maybe working on regular cigarettes or is there any indication of that they’ll stay more addicted?

Steven Fiala:
Yeah, so it’s not longitudinal, it’s just cross-sectional point in time. But that was kind of the food for thought of this slide is showing that, yes, from eighth to 11th young adults, that there is this increase in use of non-cigarette tobacco products that we know are able to be flavored. They also, some of their products tend to be cheaper, and so both of those things do appeal to youth and contribute to use.

Steven Fiala:
Then we do see this really dramatic decline when we head into adults over the age of 24, whereas we see a consistent prevalence of cigarette smoking. That is kind of the thought behind a slide like this, but obviously using this kind of cross-sectional data we can’t infer any kind of-

Speaker 1:
Sure, I understand. Just wondered if there are any studies from other states or places that have done this with a longer period of time?

Steven Fiala:
Yeah, that’s a really good question and we could look into that.

Speaker 1:
Thank you.

Steven Fiala:
Thank you.

Steven Fiala:
If there aren’t any other questions we’ll just thank you for your time and attending. Again, please fill out that webinar evaluation and… Oh, that’s a good point. There’s another person in the room. Surprise. They’re saying that you can also email us with any questions that you have and we’ll get back to you, and then just look forward to the next Health Within Reach blog post and associated Data Within Reach webinar. Again, thank you for your time. This will be archived, again, on the Health Within Reach blog page.

Steven Fiala:
We’re going now.

Meghan McCausland:
Okay, welcome everyone to the Data Within Reach webinar. This webinar is hosted by the Health Promotion and Chronic Disease Prevention section of the Public Health Division at the Oregon Health Authority. My name is Meghan McCausland and I’m a research analyst in the Health Promotion and Chronic Disease Prevention section. Today, I’m joined by my colleague, health promotions strategist, Sarah Wylie. As we get started today, I’d like to remind everyone of a few webinar courtesies. Please mute your microphone when you’re not speaking. This helps reduce the amount of line feedback and background noise and it helps everyone hear others when they’re speaking. If you choose to share, please say your name and where you’re from before asking your question or providing your feedback and comments. This helps everyone follow along in the conversation and know who’s speaking. This webinar will be recorded and it will be posted to the Health Within Reach blog following today’s event.

Meghan McCausland:
I might also ask that you hold your questions until the end of the data sharing portion of today’s webinar. There will be about 10 to 15 minutes in the end for questions and discussions. However, you are welcome to send any questions using the chat function of the webinar at any point throughout the presentation. And we’ll check the chat box for questions as we kick off the questions and discussions’ portion.

Meghan McCausland:
Today’s Data Within Reach webinar titled Tobacco Cessation Programs and Interventions in Oregon. For our 30 minutes together today, we will review tobacco use in Oregon, present data on Quit Line performance and discuss the resources, outreach and media campaigns for tobacco cessation. I hope that most of you came upon this webinar via the Health Within Reach blog. As part of the Health Within Reach blog, we occasionally hold a Data Within Reach webinar, and these webinars are meant to provide additional data that compliment the topic addressed in the Health Within Reach blog posts. Future Health Within Reach blog posts and associated Data Within Reach webinars will cover topics related to health behavior and chronic diseases. So I encourage you to sign up for future posts’ notifications, and to share the blog with your colleagues or other interested partners.

Meghan McCausland:
The purpose of this webinar series is to provide a venue for timely sharing of data that we collect on a variety of topics. We also want to provide an opportunity for people interested in health promotion and chronic disease prevention to ask questions and have a discussion about these data.

Meghan McCausland:
I’d like to take a minute to describe our three main data sources for this webinar. One way we collect data is by the behavioral risk factor surveillance system, which is a yearly phone survey given to Oregon adults covering topics such as health disease, risk factors, tobacco and alcohol use, and chronic diseases. We also reference data from the National Centers for Disease Control and Prevention, as well as data from our tobacco Quit Line, which I’ll describe later on here.

Meghan McCausland:
Let’s start by taking a look at tobacco use in Oregon. As of 2017, 26% of Oregon adults were current tobacco users. Tobacco use includes cigarettes, little cigars, large cigars, hookah, e-cigarettes, and smokeless tobacco such as chew or snus. Additionally, in 2017, 17% of Oregon adults were current cigarette smokers. Cigarette smoking prevalence estimates stayed relatively consistent in Oregon over the past five years between 16% and 17%.

Meghan McCausland:
What does smoking cessation mean? Surprisingly, when it comes to research, there are several different definitions. For example, some studies and surveys regarding smoking cessation identify those who have quit as those who’ve stopped smoking for three months, but some say six months or a year or more. However, it’s not really that simple. Despite Mark Twain’s tongue-in-cheek quote, research shows that it’s very difficult to quit smoking or using tobacco, and to stay smoke and tobacco-use free. It takes people several serious tries on average about six to 10 attempts, and some things that can make it difficult to quit are withdrawal symptoms like stress, irritability, cravings and weight gain. Targeted tobacco advertising can also make it difficult to quit. However, research also shows it’s possible with the help of family and friends with health care professionals or community support, as well as evidence-based cessation tools. And today, there are more former than current smokers.

Meghan McCausland:
Who wants to quit smoking? Our latest 2017 data show that three out of five adults in Oregon who smoke do want to quit. That means 60% of adults cigarette smokers in 2017 wanted to quit smoking, and additionally just over half attempted to quit within that year. This is similar to the national statistics. CDC data from 2015 show that 68% of cigarette smokers in the United States said that they wanted to quit, and 55% did attempt to quit within that year.

Meghan McCausland:
This table shows a breakdown of smoking prevalence and cessation efforts by race and ethnicity. This data can be useful for identifying potential at-risk populations and to help target cessation efforts. The smoking prevalence varies between race and ethnicity, the highest prevalence being American Indian, Alaskan native, and African-American.

Meghan McCausland:
I’d like you to draw your attention to the third row here. We see that the quit attempts among the populations remain relatively similar. And the last row regarding the Oregon tobacco Quit Line, Oregon adults were asked whether or not they had heard about the Quit Line. And again, there are some variations among the populations. Here, 72% of American Indian, Alaskan natives reported hearing about the Oregon Tobacco Quit Line while only 47% of Asians reported hearing about it. So to put this into context, the overall percent for Oregon adults who have heard about the Quit Line is 62%. These data indicate who’s receiving the message about the Quit Line resources.

Meghan McCausland:
What is the Oregon Tobacco Quit Line? It’s one tool available to help people quit using tobacco products. The program is free and both telephone and web based offering opportunities to use the technology of choice. The services are provided in both English and Spanish. Also, participants will have access to a Quit Coach 24/7, and these coaches will point tobacco users towards the resources and help them build a quit plan, providing a personalized quick guide to guide them through the program. Participants can also receive information on current evidence-based quit aides such as nicotine patches, gum or medications. These are available to some of the participants as well. And finally, providers can refer patients directly to these services.

Meghan McCausland:
Let’s look at some Quit Line data. We receive these monthly reports from our Quit Line contractor who administers the program. These reports provide us with snapshots of performance and utilization. And so when we review Quit Line data reports, we see that of those who enrolled in Quit Line program between July 2017 and June 2018, 82% enrolled via the phone service and 18% enrolled via the web.

Meghan McCausland:
So now let’s look at the breakdown by age. This chart illustrates the age group distribution of those who reach out to the Quit Line by a method of contact, so either phone or web. Our reports show that the largest age groups contacting the Quit Line are between 31 and 60, and this chart shows the method of contact within the various age groups. So note the difference between access methods across the age groups. The younger populations are more often accessing the services via the web, however, that switches in the 51 to 60 age bracket, and the phone becomes the more common method of access. And with those over 71 using the web less than 5% of the time.

Meghan McCausland:
Let’s look at the distribution by gender and method of contact. On the left side, you see that those self identified as female contacted the Quit Line more often than men. The chart shows the percent of self identified males and females who reached out to the Quit Line using either the web or the phone. And here we see something interesting that women reached out to the Quit Line more often. However, data show that women have a lower prevalence of use. For example, our 2017 data show that among cigarette smokers, 44.5% are female, whereas 55.5% of the smokers are male. So though men have a higher prevalence of use, they were accessing the Quit Line services less, and additionally men were more likely to use the phone than women.

Meghan McCausland:
This pie chart shows the breakdown for insurance coverage type among Quit Line participants between July 2017 to December of 2018. Notice the high percent of participants are Medicaid members are 38%, and Medicare members are the second highest, 34%.

Meghan McCausland:
Let’s look at some utilization numbers. The data here show the total number of calls and web contacts to the Quit Line over time from the calendar year 2014 to 2018. Notice in 2015, it’s quite a bit higher than the other years and this is due to an extensive media campaign in 2015 to promote the Quit Line and to help direct more people to the services. And therefore we saw this large influx of calls and web contacts. However, there has not been a campaign since early September 2017. Later, Sarah will discuss current efforts to promote tobacco cessation.

Meghan McCausland:
Let’s look at how people are accessing the services and how the word gets out. Upon registration, people are asked where they heard about the Quit Line and participants identified three main categories. 25% said that they heard about the Quit Line from a provider. 19% said that they heard about the Quit Line from TV or from a commercial, and 12% said that they heard about the Quit Line from a family or friend. These data show that health care providers can actually have a large impact on guiding smokers and tobacco users to the Quit Line services.

Meghan McCausland:
Reviewing the monthly reports and compiling the data can help us understand the demographics of Quit Line participants. Can help us identify populations who might benefit from additional tobacco cessation outreach, and it can help us understand how the program is functioning in Oregon.

Meghan McCausland:
It’s also important to keep in mind that quitting tobacco use is very difficult and it may take people several tries, and research shows that having support is key to success. The Quit Line is just one tool available to help people quit. Nicotine replacement therapies are also evidence-based cessation tools, and medications can double a person’s chances of quitting. Medical providers have the unique opportunity to help monitor and manage these cessation efforts. Tobacco users who are trying to quit may also find support through social groups, through family and friends, or mental health counselors. In addition, Oregon Medicaid covers tobacco cessation services such as counseling and cessation medication. So with that I’m going to pass it over to Sarah Wylie to discuss some of the health promotion and campaign strategies in Oregon.

Sarah Wylie:
Great. Thank you, Meghan. As Meghan discussed, there are studies showing that two effective strategies can really help people to quit smoking. The first of those is media advertising. And as Meghan showed in an earlier graph, there’s a pretty significant difference between the years when the Oregon Health Authority has been able to run big cessation campaigns and the years when we didn’t have the funding to run that level of media. Another very effective way to help people quit smoking is to hear from their health care provider. In a few minutes, I’ll talk about how we’re pairing these two strategies together to hopefully help more people in Oregon quit smoking this year.

Sarah Wylie:
The Oregon Health Authority has a smokefree Oregon brand and we have a cessation arm of that brand and the messages that we run for cessation on Smokefree Oregon, try to encourage tobacco users to quit and also encourage them to reach out to the Quit Line or their health care provider to make sure they get the help that they need. We know that help helps and that people who have counseling and medication to support their quit attempt are double their chances of having a successful quit. So on December 31st, we kicked-off our most recent Smokefree Oregon cessation campaign and we’re able to continue that campaign through the end of May 2019. At the moment, we have two primary campaign audiences. The first of those campaign audiences is people who use tobacco. And within that audience, we are especially trying to reach people who are being targeted by the tobacco industry and who smoke at higher rates than the general population.

Sarah Wylie:
We’re also trying to reach groups that are disproportionately affected by tobacco use, which could include having a family member or a close friend who uses tobacco. The groups of people that we’re especially trying to reach with this campaign include members of the Oregon Health Plan. We know that 29% of Oregon Health Plan members smoke compared with 17% of the general population. We also know that people with lower incomes are more likely to smoke, especially those earning less than $15,000 per year. And so our campaign is also trying to reach people who fall into that group as well. Other demographic groups that we know smoke at higher rates or are at risk of establishing lifelong addiction include communities of color, especially African American and Native American, Alaska native populations, young people aged 18 to 24, people who identify as lesbian, gay, bisexual, transgender, queer, current or former members of the Armed Forces, and then people with less than a high school education.

Sarah Wylie:
And so through the magical world of media targeting, we’re able to provide digital ads that reach each of these groups pretty specifically, and this allows us to make very strategic use of limited campaign dollars. The ad that we’re running right now is primarily on digital media, although we do also have some billboards that are up in Oregon’s higher population centers and we’re looking forward to seeing the data come back into the Quit Line on whether those outreach efforts were effective. A second audience that we have for this particular campaign, there’s a little bit new for us, so here at health promotion and client disease prevention, we do a lot of work with health systems to help them improve their workflows related to tobacco cessation, make sure that they are covering tobacco cessation benefits if they’re an insurance plan, and ensure that through each of the touch points that providers or an insurance company has with a patient, that they’re making sure that folks know the options that are available to them to try and quit.

Sarah Wylie:
But we haven’t used mass media to reach out to health care providers directly. And so that’s one of the things that we’re doing with this campaign. What we’re trying to do is create a magic moment between a health care provider and somebody who was trying to quit tobacco, where part of the mass media campaign is increase the tobacco users desire to quit and the awareness of the health care provider is also increased that the person who uses tobacco wants to hear from them. And so we’re trying to create that conversation between the two audiences to make a successful cessation attempt a little bit more likely.

Sarah Wylie:
So here of the few of the ads that we’re currently running to reach people who smoke. These are up right now on digital media. And then there’s similar messages that are up on billboards in neighborhoods with a higher percentage of our target groups. There are messages running in both English and Spanish. So the ads for people who smoke are pretty explicit. These ads were developed several years ago and they were part of that very successful 2015 campaign. They use direct messages about the health benefits of quitting smoking and as few as 12 hours after quitting and then up to five years. The radio ads that we have in English and Spanish right now are also featuring similar content.

Sarah Wylie:
And then we have this set of ads which are designed to reach health care providers. These ads were originally developed by the New York State Department of Health, which found that through research that providers wanted direct information about what they could do. They found that even though doctors really liked to have autonomy to govern their own practice and to treat their patients as they see fit, when they see ads or they see advice, they’re not looking to click on a link to go visit another training or another website. They would like the ad to tell them exactly what to do.

Sarah Wylie:
So if you look at these ads, they are quite directive for health care providers. They say this smoking is an addiction. You can treat it with medication and counseling and that you as a health care provider using medications and counseling can double your patient’s success rate. Since these ads were effective in New York, which has done quite a bit of outreach to their Medicaid population and also to their health systems, we decided to borrow them with their permission and to rebrand them for smokefree Oregon. And we’re looking forward again to seeing the results of these ads having filled them in Oregon for the first time. So now I’m going to pass it back to Meghan who will talk about our main takeaways from this webinar.

Meghan McCausland:
Great. Thanks Sarah. So here are a few key points that I’d like to reiterate. Many Oregonians who smoke or use tobacco products do actually want to quit. The Oregon tobacco Quit Line is one tool to help people quit and there they discuss their current campaign efforts to help promote tobacco cessation and there are going on right now. It’s also important to make sure that those who want to quit have access to the resources and they have support for success. Notice at the bottom there, smokefreeoregon.com is Oregon Health Authority’s site offering resources on cessation services if you need a little bit more information. Well, thanks so much for tuning in to today’s Data Within Reach webinar on tobacco cessation in Oregon. You’re welcome to send any remaining questions to Sarah or me. Our contact information is there at the bottom of the screen. On behalf of the Health Promotion and Chronic Disease Prevention section of the Oregon Public Health division, thanks so much for joining us today.

Vicky Buelow:
Hello everyone and welcome to the second Data Within Reach webinar. This webinar will focus on sugary drink consumption among Oregon youth. My name is Vicky Buelow and I am one of the research analysts focused on diabetes, physical activity, nutrition, and obesity within the Health Promotion and Chronic Disease Prevention section of The Oregon Public Health Division. Before we get started, I’d like to go over some logistics. First, I’d like to remind everybody to mute their phones. Please be sure that your phone is on mute and not on hold. Second, this webinar is currently being recorded and will be posted to the Health Within Reach blog for later viewing. And finally, after the end of this presentation, a short evaluation survey should pop up on your screen. If you don’t have time to fill it out immediately after the presentation, it will also be emailed to you about one hour after the presentation ends. We would greatly appreciate everyone filling it out so we continue to improve on the kind of webinar series in the future.

Vicky Buelow:
So for our 30 minutes together today, we will start with a brief description of the purpose and format of this webinar series. Then we will describe youth sugary drink consumption with Oregon specific data selected by the Oregon Public Health Division, and then provide an opportunity for questions and discussion. The data presentation portion of this webinar will be about 15 minutes and then we will have 15 minutes for questions and discussion. If you have any questions during the presentation, please type them into the webinar sidebar. We will start with answering these questions at the end of the webinar. We will do our best to get through all of those questions and we’ll get back to people on questions that we are able to answer during our time here today.

Vicky Buelow:
So I hope that most of you came upon this webinar via the Help Within Reach blog. For each new post on the Help Within Reach blog, there will be an accompanying Data Within Reach webinar. The Data Within Reach webinar will occur two to three weeks after the blog post. These webinars are meant to provide additional data that compliment the topic addressed in the Health Within Reach blog post. In addition to obesity and sugary drink consumption, future Health Within Reach blog posts and associated Data Within Reach webinars will cover topics like diabetes, heart disease, cancer, and other health behaviors and chronic disease related topics.

Vicky Buelow:
The purpose of this webinar series is to provide a venue for timely sharing of data that we collect in a variety of topics, including consumption of sugary drinks. We also want to provide an opportunity for people interested in health promotion and chronic disease prevention to ask questions and have a discussion about these data. In sum, these webinars are an attempt to provide bite-sized chunks of new data and hopefully start some discussion.

Vicky Buelow:
Before we dive into the data, I also want to provide some definitions and a little bit of background on the of sugary drinks. When we talk about soda for this presentation, we are referring to regular, non-diet soda. Regular soda contains calories from added sugars such as high fructose corn syrup or cane sugar. When we talk about other types of sugary drinks, we are also referring to the regular non-diet versions. Other types of sugary drinks include fruit-flavored beverages such as Kool Aid, Sunny Delight, or Snapple; sports drinks such as Gatorade or Powerade; flavored milk that is sweetened with chocolate or strawberry flavors; energy drinks such as Red Bull, Rockstar, or Monster; and sweetened coffee or tea beverages such as a Starbucks Frappaccino or an Arizona Iced Tea.

Vicky Buelow:
So why does Public Health care about soda and other sugary drinks? Sodas and other sugary drinks are the largest source of added sugar and extra calories in the American diet. Nearly half of the added sugar in the average American diet gets consumed in the form of sodas and other sugary drinks.

Vicky Buelow:
The average 12 ounce serving of soda contains about 140 calories of over 10 tablespoons of sugar with little to no other nutrient value. Sodas and other sugary drinks are a public health concern because they contribute to obesity, diabetes, cardiovascular diseases, and poor oral health. We also know that the intake of added sugar is particularly high among children and adolescents. Research has shown that teens get about 13% of their daily calories from soda and other sugary drinks, which brings us to our data about sugary drink consumption among Oregon youth.

Vicky Buelow:
So first I’m going to briefly describe our sources of data you’re about to see. The data in this presentation was collected through the Oregon Healthy Teen survey, or OHT, which is a pen and paper or a web-based survey administered every odd year to 8th and 11th graders in their schools. This presentation will focus on 8th graders specifically. I will also show some data from the Oregon School Health Profile Survey, which is administered every even year in secondary schools. The School Health Profile Survey is made up of two pen and paper surveys. One is completed by school principals and the other is completed by a health education teacher. We’re going to review our most current years of available data, which includes 2013 or 2015 data from the Oregon Healthy Teens and 2014 data for the School Health Profile Surveys.

Vicky Buelow:
Since the last Health Within Reach blog post was about how the places where we live, work, and play are connected to our health, I will first start with soda availability in urban schools. Schools are a critical community institution that serve as a daily learning place for almost all children in Oregon. Back in 2004, soda was available for purchase in nearly all of Oregon’s schools. In response to concerns about childhood obesity, Oregon passed a law in 2007 that set healthy standards for food and drink sold in Oregon schools. Under this law, regular non-diet sodas could no longer be sold in schools. By 2010, soda was reported to be sold only in one in five schools in Oregon, and that trend has continued today. This law helped drive weekly soda purchases at school down from 34% in 2003 to 11% in 2013. So in 2003, over one in three Oregon 8th graders purchased soda at school at least once per week. But by 2013, that number was down to about one in 10.

Vicky Buelow:
During that same time period, daily soda consumption among Oregon 8th graders also declined. The percent of Oregon 8th graders who consume soda at least once per day has declined 65%, from 34% in 2003 to 10% and 2015. Today about one in 10 Oregon 8th graders consumes soda at least once a day on average. And that’s great news. However, with the decline in soda consumption, other types of sugary drinks are being introduced and marketed to youth. And many of these beverages, such as sports drinks, to fruit flavored beverages and sweetened teas, are still available in our schools.

Vicky Buelow:
And our data show that youth are consuming these drinks just as much as soda. Today, among Oregon 8th graders, 10% consume fruit-flavored beverages, flavored milk, and sweetened coffee on a daily basis. About 9% consume sports drinks, and about 4% drink energy drinks at least once per day on average. Overall, about one in six Oregon 8th graders drink at least one soda or one other sugary drink per day on average. So there are your brief snippets of data on sugary drink consumption among youth in Oregon. That should be the takeaways from this webinar. First being that soda consumption among Oregon youth has declined. Second, while soda is largely unavailable in schools today, other types of sugary drinks are available, and our data show that youth consume other types of sugary drinks as often as soda.

Vicky Buelow:
Now I’ll take a look at any questions that came through the sidebar on the webinar. Do we have any questions? Okay, I don’t see any questions that came in through the sidebar, so I’m going to turn it over to Heather Gramp who will present some questions for discussion. Feel free to unmute your phones now you can participate in the discussion. We will have the next 15 minutes or so for questions and conversations about these data.

Heather Gramp:
Okay. Hi everybody. This is Heather Gramp. I’m a policy specialist in the Health Promotion and Chronic Disease Prevention section. And this discussion today is really meant to be a back and forth. We have some questions and some answers, but we know we have a great audience on the line here and many of you have expertise and some thoughts about this topic and where we might go from here in Oregon. So please be an answerer as well as a questioner if you would like. So to set the stage, to recap. We focused on some of the data in schools because these are really a critical community institution that is a daily learning place for almost all children in Oregon, and as Vicky indicated, sugary drinks are the largest contributor of sugar and excess calories in our diet. And so far we’ve had this law in 2007 that did roll back the availability of sugary drinks and so now we’re kind of looking at what impact that might have had and what else are some things we should think about.

Heather Gramp:
So one question that I’m going to put out there, and I hope a brave soul will chime in and kick off the discussion with an answer, beginnings of an answer, would be just wondering how our participants on the phone think that the school nutrition environment affects kids’ health. How important is it? How important is it that we adjust it compared to other settings? Just generally, how do you think that school effects kids health in terms of nutrition?

Jennifer Young:
Hi, this is Jennifer Young.

Heather Gramp:
Hi Jennifer.

Jennifer Young:
Hi. So I actually was just reviewing some of the [inaudible].

Vicky Buelow:
Thanks Jennifer. And yes, we did get a question about that actually through the webinars. So the question is, the number of soda available from schools is still far from zero, so are kids reporting they can purchase sodas in school? Is this an enforcement issue or is there some loophole? And the answer to that question is yes, our data is based on self-report. So there could be some education issues, there could be some issues about identifying what type of beverage people are thinking of when they hear the word soda. So it is an issue with self-report and enforcement.

Heather Gramp:
Yeah, and this is Heather. And to just add to that. The law as it was passed didn’t necessarily have enforcement tools on the ground at every school, though we know, far and away, most schools are in compliance. We may found some that are not. And what’s not covered by the laws, we know our youth still have access to purchasing sugary beverages on their own because we still have a lot of open campuses in Oregon for our schools. And we also still have marketing that is allowed in schools. And just a piece of info to share is some federal rules will be released soon, we hope, under the Healthy, Hunger Free Kids Act of 2010 requiring schools to have full wellness policies, which I know a lot of people on the phone are probably familiar with and working on.

Heather Gramp:
And we’re aiming to see those wellness policies, we anticipate that, like the Oregon law, they will really require some minimum nutrition standards for all those competitive foods that are sold in the schools. But they may also be adopting some specific practices around pricing and availability and marketing. And marketing is an area that a coalition tried to address, I know, last legislative session passed Bills 3363 to put some restrictions on marketing of sugary beverages and other foods in schools, and that did not move forward. So I’m wondering if, back to the original question about what else people, or actually that’s the second question. What other changes in the school environment can we be making to maybe continue to decrease sugary drink consumption among young people? Kind of threw out a few examples of where some gaps might be. So what should we be doing to address those?

Vicky Buelow:
Any ideas?

Heather Gramp:
And we know you all have probably more experience than those of us that are here working directly with schools in your communities. And I know you have some ideas about gaps and what might be ways to address those in that school efficient environment.

Jill:
Hello. This is Jill [inaudible].

Heather Gramp:
Hi Jill.

Jill:
[inaudible].

Heather Gramp:
Yes, thanks for bringing that up Jill. And that reminds me, for the folks on the phone, I want to point you to a resource that our reception here have put together last year called, it’s a website, I’m going to read it out. Oregonpanlaws.org. And it’s Oregon P-A-N for physical activity and nutrition. So oregonpanlaws.org. And if you go there, you can click on different settings and if you are particularly interested in schools, you can look at both federal and state laws that are in place so you’re familiar with some of these specifics and some of the caveats of what is and what isn’t covered.

Heather Gramp:
Because as Jill so rightly pointed out, our summary there of this 2007 Oregon law, as well as point out a couple things, and one of them is that the standards do not apply when parents or adults are significant members of an audience for a school event, like a theater performance or sporting event. And that is a gap. Another thing just to point out is that local school districts may adopt stricter standards than the Oregon law. And so that is an opportunity I would point out there that the way that law was written did not preempt local districts from doing more. Anyone else have some ideas about other changes in the school environment that might help continue this decrease in sugar beverage consumption?

Jennifer Young:
This is Jennifer Young with [inaudible].

Heather Gramp:
Yeah, I’m glad you brought that up Jennifer. On the positive side, at the same time that this law set the standards for meals, snacks, and beverages sold outside of those federal breakfast and lunch programs. On the promoting healthy food side, 2007 was also the year that the Oregon Farm to School program was established to get more fresh fruits and vegetables in Oregon schools. And as Jennifer, as you pointed out as well, I know there’ve been a number of projects in districts around the state to get access to functional drinking fountains and water and allow students to carry water bottles and just some simple institutional policy changes like that have brought access to water into the mix, which is certainly a better alternative than a sugary beverage.

Heather Gramp:
Well, any other comments about the school environment and sugary beverages? Any closely related topics that people want to bring up, either as a comment, observation or something you’re working on, a success you want to share, or a question to the group?

Heather Gramp:
All right. I’m glad that people were able to hear the latest greatest data from us, so you’re up to date with that. Again, the oregonpanlaws.org is somewhat of a companion piece to this webinar in that you can get an overview of a lot of the applicable laws related to nutrition in the school setting, federal and state laws. And continuing, we hope you continue to follow the Help Within Reach blog, and when the recording of this comes out, please feel free to pass that onto colleagues who you think this information would be valuable for if they missed it. And also we encourage you to take the evaluation survey that you’ll be getting shortly.

Vicky Buelow:
Thank you very much.