Editor’s note: This is the fourth installment of “Healthy in Humboldt,” an ongoing monthly series profiling health challenges in Humboldt County and what’s being done to overcome them.
While Humboldt County is more often recognized for cannabis, its tobacco and nicotine habits are also topping most counties in the state and have been holding steady or even rising in the last half decade, according to the most recent state data.
The state data released this year shows an average of 20 percent of Humboldt County adults smoked cigarettes between 2012-2015, up from 17.7 percent in 2009, with high school students’ tobacco use also in the same range in 2016.
But California legislators and voters have worked to implement stricter regulations and deterrents in the years since, including raising the tobacco and nicotine use and purchasing age to 21 and increasing the tax by $2 in 2017.
Even with his store being next door to Arcata’s bar row, Arcata Liquors owner Jeff Nagan said he’s seen about a 17 percent drop in cigarette sales since the state upped the age requirement and taxes last year.
Similar trends have been observed throughout the state.
Another factor is the rise of e-cigarettes and nicotine vaporizers, which the state’s data did not include.
“I think it’s just a sign of the times,” Nagan said Friday morning. “I’ve witnessed a lot of trends. It’s a trend. Smoking is becoming passé. I’m fine with it because something else will pop up.”
The higher taxes have nearly doubled the funding for the county’s Tobacco-Free Humboldt program, according to county officials, which it plans to use to expand its outreach and programs by this summer.
“That includes both efforts to prevent tobacco uptake in the first place, especially among young people, and then to improve access to services to help people quit,” county Department of Health and Human Services health education specialist Jay McCubbrey said.
The rise of nicotine vaporizers and e-cigarettes within the past decade has also prompted inquiries into whether it really is a safer alternative to traditional tobacco and whether it is promoting nicotine use to youth. California now regulates liquid nicotine and e-cigarette products just like traditional tobacco, including the taxes and age increases, which STIL owner Jason Whitcomb of Eureka said he supports.
Along with a vast array of glass art and pipes, Whitcomb’s store on Broadway sells various liquid nicotine products — known as vape juice — and vaporizer pens.
Some have called for even stricter regulations on the products, such as banning flavored nicotine vapor that they are argue make the product more enticing to people at a young age.
Whitcomb said there are health risks that come with using the product, but said that these products are less damaging than traditional tobacco products like cigarettes or dip.
SMOKING BY THE NUMBERS
Tobacco use in California has been declining since the state efforts to crackdown on tobacco use in 1989, with a little more than 13 percent of adults in California using it in 2015 down from more than 20 percent in 1996, according to the data.
Between 2013-2015, Humboldt County the fourth highest prevalence of adult cigarette smokers of all 58 counties at about 20 percent with several other rural counties near or above that number.
McCubbrey said the data is more accurate in more densely populated counties, with the data for counties like Humboldt being based on estimates.
He said most people take 7-9 attempts of quitting before they quit tobacco for good.
“You become dependent not only on the [nicotine], but you also integrate smoking into your daily routine,” he said. “Both of these things need to be addressed to help someone successfully quit.
It’s a challenge because most people never develop a plan on how they’re going to successfully quit.”
The consequences of not quitting can be deadly.
Cigarette smoking causes more than 480,000 deaths each year in the U.S., with 10 times as many U.S. citizens dying prematurely from cigarette smoking than have died in all the wars fought by the U.S., according to the U.S. Centers for Disease Control and Prevention.
It is also the most common cause of lung cancer, with Humboldt County having a higher than average lung cancer death rate than the state between 2013 and 2015, according to the most recent state data.
The state’s death rate was about 32 deaths per 100,000 people compared to Humboldt County’s 43 deaths per 100,000.
According to the U.S. Centers for Disease Control and Prevention, rural areas are more impacted by tobacco use than urban or metropolitan areas because of socioeconomic factors, culture, policies and lack of proper health care.
The American Lung Association’s 2017 State of Tobacco Control report gave Humboldt County local governments average to failing grades based on their regulations promoting smoke-free air, smoke-free housing and reducing tobacco sales. The county and all seven of its cities received zero points for reducing tobacco sales, but Arcata, Blue Lake, Eureka and Fortuna received A grades for its regulations on tobacco smoking.
RISE OF VAPING
STIL employee Justin Noel, 32, said he now has several half marathons under his belt, but used to be a heavy smoker after starting when he was 18.
Noel said he’s now tobacco free and attributes that to him switching to a vaporized nicotine.
“I couldn’t imagine smoking a cigarette right now,” Noel said.
Whitcomb said that while anecdotes aren’t evidence, a number of customers who come to his store say they have quit smoking cigarettes or using traditional tobacco after switching to vaping, especially because they can regulate the concentration of nicotine they ingest.
But McCubbrey is skeptical and said the studies have not shown that connection despite it being one of the most rapidly researched products on the market. He also said that the control of nicotine levels can also go the other way, with people using higher doses of nicotine and making them more likely to become addicted.
“When they first came out, the industry promoted their use as a way to quit smoking regular cigarettes,” McCubbrey said. “A lot of people still think that that’s true, but e-cigarettes have never been tested in a clinical setting as to their effectiveness as a quit smoking aid and they cannot be recommended.”
A review of scientific studies on vaporized nicotine and e-cigarettes by the National Academies of Sciences, Engineering, and Medicine found that evidence supports these products might help adults stop smoking traditional cigarettes, but might also cause youth who use them to use traditional cigarettes.
The review also found e-cigarettes have lower levels of toxicants than normal tobacco, but that the long-term effects on human health and mortality “are not yet clear.”
Whitcomb said further research into the health effects of liquid nicotine and traditional tobacco needs to move forward.
“We need to find out what the problems are so that if we are going to make a comparison in order to reduce our harm, we have the facts,” he said. “It seems right now that good, honest information is difficult to come by.”
Even with the state raising the tobacco and nicotine purchasing age to 21, McCubbrey argues that the variety of flavors of liquid nicotine make them more attractive to younger users.
He said most smokers start when they are younger, with the new e-cigarettes replacing clove cigarettes or menthols that kids used to use.
Several recent news reports have specifically called out the JUUL vaporizer pen — which has a small, inconspicuous rectangular design — as becoming more popular among teen users.
One of Eureka High School’s two assistant principals Rob Standish said that the number of times they have found students using tobacco hasn’t changed in the last few years, and that there have been a handful of students that have been caught with vape pens.
“The vast majority of students know that that’s not something that belongs on campus,” Standish said.
Standish said more students are caught with marijuana than tobacco.
Tobacco possession can result in suspension, but students may also attend the Boys & Girls Club teen court and substance abuse brief intervention program, which Standish said has been successful in helping students with addiction.
Standish said he believes that e-cigarettes and flavored nicotine seem targeted to youth because of their flavors, the fact that they’re electronic and don’t require a lighter.
Whitcomb disagrees that the products are marketed toward children, saying that adults can still enjoy the various flavors they did as children and demonstrate so because they’re buying the products.
Noel said that teens are able to easily order liquid nicotine and vaporizers online, but said websites have been becoming more strict in recent years.
Whitcomb said that while there needs to be restraint on part of the government to restrict personal liberties, he said that the goal of harm reduction with regulation is something that he strongly supports.
“Because children are at a time in their life when they are most susceptible to developing lifelong negative behaviors,” he said. “And while 18-21 is definitely not a child anymore, we still recognize that its an important time in people’s lives to avoid some of the riskiest behaviors that we choose.”
With cigarette sales down, Nagan said he may consider selling e-cigarettes and vape juice at Arcata Liquors. As a cigarette smoker himself, Nagan said he understands the health risks and is fine with state and local governments working to promote reduction in tobacco use, even if it does affect his business.
He said he and other businesses on the plaza took a similar hit when Arcata banned smoking on the plaza.
“You just have to diversify a bit and start selling artesian water,” Nagan said, half-joking.
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