Michigan’s LGBT Community Results of a First Ever Tobacco Use Assessment Study including Electronic

– [Instructor] Welcome and
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email us at etwebcast. – [Elaine] And welcome to today’s webinar, Michigan’s LGBT Community: Results of a First Ever
Tobacco Use Assessment Study, including Electronic Devices. My name is Elaine Lyon. I’m a public health consultant with the Tobacco Control Program at the Michigan Department
of Health and Human Services. And joining me here in the
studio is Carolyn Chaudhary. She is a public health consultant also with the Tobacco Control Program and she is an evaluator who
has done a great deal of work regarding the analysis of this survey that we’re going to hear about today. We’d like to take this
opportunity to welcome you and thank you for your time joining us. You’re probably aware that
tobacco use is the single
most preventable cause of disease, disability
and death in the U.S., and it continues to be
higher among individuals with low income and education, the uninsured, and among some racial, ethnic and cultural minority groups,
such as the lesbian, gay, bisexual, and transgender community. The most recent data on
Michigan’s adult smoking rates is from the year 2017. Here, you can see that while
the state average is 19.3%, Michigan’s LGBT community
and other communities suffer from much higher rates. In this case, the adult LGBT community smokes at a rate of 41.4%, more than twice the state average. So, while the presentation today focuses on the survey itself, it is helpful to understand
why tobacco use is so high in the lesbian, gay, bisexual,
and transgender communities. So, how did tobacco use
become such a big part of the LGBT community? Is the industry a friend or foe? Stigma, stress, lack of
support, and discrimination have plagued this community for years. Like many experiencing life crises, people reach for substances that they hope will dull the pain and help them cope. Enter the tobacco industry. One of the primary reasons
tobacco use is so high in the LGBT population is the
targeting of this community by the tobacco industry. Tobacco companies have
often marketed themselves as friends of various communities by offering to sponsor events
and give money to LGBT causes. Let’s briefly take a moment to look at some of the examples of this. It’s well known that the tobacco industry utilizes multiple strategies and channels to influence people and try
to engage them in tobacco use. Through its marketing,
the industry focuses on specific populations and manipulates cultural and societal beliefs, expectations, and needs of
different groups of people to influence behavior and to
increase the social acceptance of tobacco use among various populations. In addition, the industry capitalizes on opportunities for sponsorship,
uses other marketing tools, and develops relationships with lawmakers to insinuate itself into communities and to portray Big Tobacco as a friend to issues of importance or
concern to a given community. It’s important to know,
especially in light of the survey that we’ll be discussing today and its focus on electronic
nicotine devices, direct advertising on TV and radio is still allowed for these products, but it has been prohibited
from other forms of tobacco, such as cigarettes, for several years. And then we have all the tobacco imagery, including the use of
young models and colors, which is a very appealing marketing tactic to a lot of communities,
including the LGBT population. Like other groups, the LGBTQ community gets special attention
from the tobacco industry. This 2001 ad circulated in Europe and is obviously looking to
appeal to the transgender set. The line in Spanish says,
“Share your happiness.” Project SCUM, otherwise known as Subculture Urban Marketing,
was a plan proposed in 1995 by R. J. Reynolds Tobacco Company to sell cigarettes to members of the alternative lifestyle
areas of San Francisco, in particular, the large
number of gay people in The Castro and homeless
people in the Tenderloin. Here, these ads are obviously intended for the gay and lesbian audience. Tobacco companies have long
targeted certain populations and have posed as allies, as we mentioned, by sponsoring events and
donating to organizations represented by the very
communities they target with their addictive products. Certain brands, such as the ones
here appeal to the community using both imagery and words familiar to this group of people. Note the wording on the snus ad in the lower right-hand corner
which uses the term “pride,” a term often used in the community, as well as the word “freedom” used in the American Spirit
ad in the upper right. Let’s talk a little bit about
how the survey came to be. The survey was administered in two ways, online through a SurveyMonkey link and a pen-and-paper version. Several agencies sent
people into neighborhoods to collect data, and all
did some data collection at their Pride events held
in the summer of 2018. You can see here the
agencies who participated, and we want to publicly thank them for the time that they took
to get some of these results: LGBT Detroit, OutFront
Kalamazoo, Affirmations, Perceptions, and the Grand
Rapids PRIDE Center. LGBT data has always been heard to collect, and survey instruments have
not always been LGBT-friendly and culturally sensitive. So, to have these agencies doing outreach collecting data was key. They are known and trusted
in their communities. Please note: We recognize
we don’t have all categories listed on the survey for
identifying sexual orientation and gender identity. However, we did ask for input
from members of the community and did our best to include categories we thought would be helpful. – [Carolyn] Okay, so
I want to take a moment to say “Good morning” again. I’m going to take the
remainder of this webinar today to really go through these
results that we analyzed. So first, again, we want to say “Thank you!” to these agencies that did participate. Knowing that willingness to have people actually do these surveys, as Elaine mentioned, it’s
really great that we had trusted members of the community to push forward this survey. So, really quick, I want to just to reiterate what the objective of the survey was. So, the purpose of this
study was to determine the e-cigarette usage rate
among the LGBT community here in Michigan and what their
behavior and beliefs were, and then to also get the demographic and socio-economic factors, as well, because this is very
important for us to collect. So, as Elaine had mentioned,
adult participants and clients who were a part of these agencies completed these surveys
anonymously. The sample was for ages 18 and
older of different racial and ethnic backgrounds,
which I will also mention within our results. The survey itself
was about 24 questions, so I’m not going to go through
each question specifically. What we decided to do today was to really hone in on the most important
questions that we did receive feedback from. Here, you can see the
results of e-cigarette use within gender identity. So, first, let’s make sure that we have our definitions correct. Many of us do know these definitions, but I just want to clarify again so that we are all on the same page. So, gender identity is
defined as the deeply held internal sense of self
as masculine, feminine, or a blend of both or neither, or it could also be something else. Gender identity can correspond to, or differ from, the sex assigned at birth. So, when deciding which categories to include for gender identity, we had a lot of input from the community members. We had several conference
calls with these agencies to figure out which gender identities would be correct to use for this survey. So, for this question,
we decided on “cis female,” “cis male,” “non-binary,”
“trans female,” “trans male,” and we also had a line to put “other” in. A cis female is a person
whose female gender identity aligns with their sex of female at birth. Cis male is a person
whose male gender identity aligns with their sex of male at birth. Non-binary is identity of
someone whose gender identity is not exclusively masculine or feminine. Trans female is
someone who’s male at birth, but identifies as female and trans male is someone
who’s female at birth, but then it identifies as male. So, here, as the results show, we can see e-cigarette
users within the population that we surveyed. The highest
rates of use of e-cigarettes was with the trans female
and trans male populations here in Michigan. So both a little bit higher than 27%. Then, the next highest
rate was non-binary at 21.4%, cis male at 20.4, and
then cis female at 13.1%. You can notice all the
way on the right-hand side that we have 14.3% of users saying that they identified as “other.” We had a very, we had a wide variety
of write-ins for this and in the future, when
we do do this survey again, or any other surveys, we are
going to look a little bit deeper about what the common, the common written answer was, and then we’ll probably also go back and talk with members
within the communities to see if we should broaden our
options for gender identity. So, as Elaine said, we understand
that we did not include every term that is
available. But, we thought that this was going to
represent our population that we were serving. So now, with sexual orientation of users who use e-cigarettes at the moment, as Elaine had mentioned, as well, we had asked for input
from the community members to see which options we
should list for this question. So, “sexual orientation” refers
to whom we are physically, emotionally and, or
romantically attracted to. So, for here, we have our, the options were “lesbian,” “gay,”
“bisexual,” “straight,” and “other.” As we can see, that “other” bar is very high, and I’ll get to that
in a moment. But, again, just to clarify on some terminology, “lesbian” refers to a woman who’s primarily attracted to women. “Gay” refers to a man who’s
primarily attracted to men. And “bisexual” is an individual who’s attracted to people of their own and of
opposite gender, as well. So here, within the results of this data, we had across the board, a very kind of similar percentage here, with “bisexual” and “other” being the highest with a little bit over 21%. Then with our lesbian community
here in Michigan at 19.2%, and then among our gay
population in Michigan at 16.4%. And then, also noting
that since these surveys were given during Pride events, we know that we have a lot of individuals who are allies to the community. So, we know an “ally” is typically a person who supports and advocates
for the LGBTQ+ community, and we know that they can
be allies for other members that identify differently than themselves. So, we found it to be important to include that population, as well. As we can see here, 6.3%
of those who are straight — or we should say “allies” —
who attended these events were also e-cigarette users, as well. So now, to come back to
that other bar, at 21.8%. While going through the
data and really looking through that raw data of
what people were inputting, we had a wide variety of write-ins. We also had a few individuals
who decided not to select, so that’s why they selected “other.” We had a few individuals who said that they weren’t comfortable
answering this question. So, that could also feed
into why the “other” question for gender identity — that maybe someone may have also selected
“other,” because even though we did say that this survey was anonymous and that no one would be able to connect that individual with these survey results, we do know that having that willingness to disclose your sexual
orientation or gender identity is something that could
also be very personal, and people not also
wanting to disclose that or to be included, or wanting
to have that as data collection. Even though these people
were out at these events and participating in these events, some people may not have wanted to really put that down on
paper or on that SurveyMonkey. We did have, as Elaine mentioned that, some were done on SurveyMonkey, as well. So that “other” bar, we know is
very high, and in the future, for gender identity, we are going to make sure that we try to include more categories so that we can have a better understanding of who we really are surveying. And just a reminder, as well, if there are any questions
throughout this webinar, note that on your screen, there
is that little chat bubble where you can input your questions. So, please feel free to put
that down in the chat box as we go. [Note: This is an archived version
of this webinar, so this option will no longer work.] And so now, the next slide that
I wanted to take a moment, too, and really speak with
everyone here today about is age group. So, e-cigarette use with an age group is something that is very
important for us to know this data, because we want to know who’s
actually using these devices. As you can see here, for age use, the 18 to 24 years of age
and 35 to 44 years of age are the two highest age groups
that are using e-cigarettes. So, at almost 25%, we have
users of 18 to 24 years old, and then at 25.9% — so almost 26% — we have users who are
using these e-cigarettes from ages 35 to 44. Then, at 13.3%, we have users who are aged 45 and up, and then at 10.9%, we have users of ages 25 to 34 years of age. So, age is always something
that’s really important, especially with these devices. We know that a lot of the companies in the industry that are putting out these products, we know that they are geared more towards our youth and younger adults, so this survey does show
that the majority of users lie between those ages of 18 to 44. As Elaine had mentioned before, the tobacco industry were target marketing, and the influence on the LGBT community, and this just shows, as well,
that age is another factor of that targeted marketing. We know that these devices, that there are like hundreds
of devices that are out there, and we know that it’s our young adults that are kind of getting
lured into using these, and it shows that even
within the LGBT community, that shows just the same, as well. So, the next data that we
collected was on education level. So these again, are the
current users of e-cigarettes during this survey. We have here that the
highest number of people who are e-cigarette users correlating with their education
level, 23.7% of individuals said that they were high school graduates. Then, we had 18.9% of participants who said that they had less than a
high school education level. And then, users who are, again, currently using, 15.6% had some college or above. So, again, we wanted to
include this education level because we know that this is also another very important factor
for socioeconomic status. And we know that this is good
data that we need to collect to then show those characteristics of who are using these
products and tobacco. So, again, with the other
factor of socioeconomic status that we calculated other
than education level was household income. So, that annual gross income — again, another very important characteristic that we wanted to capture. Here, we can see that
the largest percentage of e-cigarette users showed at 35.5% that they fell under that
category of $20,000 to $34,999 of that income per year. Then, the other income
levels are about the same. We have less than $20,000 at almost 20%. Then, we kind of go up again
to $35,000 to almost about $50,000, which people said they were at 13.1%. Then, we go up another
category ($50,000 to $74,000) and that’s at 18.6%. And then users who make
more than $75,000 per year was at 19.6%. So, we found it kind of interesting that a
lot of the other categories were very similar. However,
we did see that large boost of almost like a double from
that category of individuals who lie within that $20,000 to $35,000 annual gross income. So, again, this data was really
important for us to collect as we know that surveying
the LGBT community is one that we don’t
always have an opportunity to collect data on, so this
is why we wanted to show this slide to you as well. So, this next slide is
very, very important. This was one of the questions
that we were very interested in seeing the results come back for. So, this slide, again, like this survey, was with tobacco use and e-cigarette use. So, this slide shows
current e-cigarette users and smoking status. So, that means e-cigarette
use and cigarettes or other tobacco-like forms, as well. So, this data here is
very important, again, and we can see that people who are currently using e-cigarettes and currently cigarette
smokers is at 38.6%, the highest percentage rate
out of the survey participants. So, this means that
individuals from the community are dual users, which is
a very big health concern that we have. Many individuals have mentioned that they are using these e-cigarettes to try to quit using cigarettes. However, we do see that if
you are indeed trying to quit in a lot of these
e-cigarettes advertisements and thelike, these industries
are trying to say, “Oh yes.” Like these e-cigarettes are good for smoking cessation, and
use this and make the switch, and you’ll quit using that
regular tobacco or cigarettes. But the FDA does not see e-cigarettes as a form of quit tobacco
or cessation product, and they shouldn’t be advertised as such. However, we are still
seeing those advertisements and marketing out there
for “make the switch, you’ll be able to quit using cigarettes.” However, we see that still,
people using e-cigarettes and cigarettes at the same time is the highest percentage
that we’re seeing here within the community. So, again, we can see that
maybe using these e-cigarettes are not actually helping
people really quit, or they’re staying longer
with using cigarettes. Another two points that
we got out of the survey that were very shocking for
us after I did the analysis was that we had former smokers who came back to using a
different form of tobacco. So, we had people who had
quit smoking cigarettes and they started using these
e-cigarettes again. 31.7% of our population that we surveyed said that they had quit smoking and
now are using e-cigarettes. So, that just shows kind of that pull that
these products have to people. They’re very sleek, and they’re
really easy to carry around. These products get around
our Smokefree Air Laws. So, this could be another
reason why maybe former smokers are coming back to it. And these devices have very
high levels of nicotine. So, unfortunately, these people
who have had successful quits and have been tobacco-free for some time are now coming back to
just a different form and getting hooked on
nicotine, just a different way. So, that was at 31.7% of our participants who said that they came
back to a form of tobacco. Another percentage that was
kind of shocking to us, too, was at 29.7% — almost 30% — of
people who were taking the survey said that they were “never smokers.” They had never used
cigarettes, They had never used any form of tobacco. However, now, they are e-cigarette users. So, almost 30% of users
are now hooked on nicotine. So, this just shows that these
products are not just popular with individuals who have used
different forms of tobacco, like cigarettes or any
other kind of tobacco. But, we now see that these
products are very popular with people who have never
used any form of tobacco, which was very startling for us to see, and we found it very important
to share with you today. So, these numbers here — very interesting. We can see the trend of that
dual use, as I had mentioned, and then just seeing people
come back or initiate the use of e-cigarettes. So, another really important
question that we had was, “Was your aim of using e-cigarettes to actually help you quit smoking?” As I have just mentioned, a lot
of these e-cigarette products are advertised as a cessation product. So, it wasn’t too surprising
to see that about 44.6% of individuals were saying that they wanted to use e-cigarettes as a form of quitting smoking. And as we know there
have been many success stories, as I had mentioned, of people
using these products to quit. But then, what’s really important, too, with this is that once individuals would quit using cigarettes, then they would also quit
using e-cigarettes, as well. So, seeing that people
wanted to quit smoking and have that interest of
quitting using cigarettes, it’s very important that we see that 44.6% of people want to quit smoking, and they think that
using these e-cigarettes is a way to do that. So, that’s another really
good form of information that we collected. So, now we
know that we have a high number of individuals who want to quit smoking. So, that makes us think about, “Okay. So, how else can we get there to help in giving more options to quit?” But, then, we had almost 40% — so 39.6% — of these e-cigarette users whose aim of using was not to quit. So, this was also an
interesting kind of data point that we got, because then
that also would show that either individuals
who are smoking cigarettes that they just wanted to
continue using cigarettes or other forms of tobacco and then, also, use
e-cigarettes at the same time. So, we know that we have
this set of the population who are either not ready to quit using cigarettes, or they just wanted to use the
e-cigarettes in dual use. So, another data point
that I wanted to mention was that 13.9%. So, what we’ve collected
from that data there was that we showed that
either people were, they were not sure, they
don’t know why they started using the e-cigarettes. So, was that aim of using it yes, no, they didn’t fall in the category. Or it could have been that someone was not an e-cigarette user
who had taken this survey, and they said that this
was not applicable to them, that this question was not
appropriate for them to answer. Or it could have been possibly that someone just didn’t
want to answer this question. So, that’s kind of the mindset that we have is when we were analyzing this data and we get to that
option where we see other or not applicable. As an evaluator, I always
want to think, “Okay. Well, what is this answer? Why are people clicking this?” So, sometimes, you will find
the answer, sometimes you won’t. But, it is important, too,
so I wanted to show you that number, as well. But, a takeaway from this
slide — the biggest takeaway —
00:29:56,820 –>00:30:01,260
is that we have people who want to quit: 44.6%. So, I can’t stress that enough — that we have people who
are in the community that want to quit. So, that just shows us that
we need to have more options. What are those other options out there to help people within the
LGBTQ+ community to quit? So, this next slide is really
important for us, as well. This was a multiple
kind of formatted question, where we said, “Mark all that apply to you.” And so, this was on goals or reasons for using an e-cigarette. So, this is just a few of the options that were here, and these were the highest
percentages of those options. So, the highest percentage
is that they’re still using e-cigarettes having successfully quit regular cigarettes at 77%. So, this also shows that we had those former smokers
that are now coming back to using these products. So, that’s a very high percentage. So, we’re seeing people
still using these products after successfully quitting
regular cigarettes. And again, I wanted to also just mention that people could also
select all that apply. So, that’s why these numbers
don’t add up to 100%. So, just making sure
that we know that people were able to mark all that applied. So, the next highest goal or reason for using an e-cigarette was the, “Would you recommend a
cigarettes as a good way to quit regular cigarette smoking?” So, people were clicking “yes,”
that they would use this as a way to quit regular cigarette smoking, which then just ties into
that other percentage of still using e-cigarettes. And then it was also asked that “Would you use an e-cigarette
to help quit cigarette smoking?” And 44.6% of those had said “yes,” which would correlate
back to that percentage of people saying that they
were actually wanting to use e-cigarettes as a way of quitting. And then 24.5% of people said that they were successful
in quitting smoking using those e-cigarettes. So, this was kind of some of
those like beliefs and goals and reasons surrounding e-cigarettes. So, these were each like individual kind of questions there that people could select all that apply. So what’s really important here is that almost all of these questions are talking about some
form of quitting smoking or quitting using tobacco, and we’re seeing that all the participants in the survey are saying that they’re using e-cigarettes or they would recommend using e-cigarettes as a good way to quit cigarette smoking, or that they’re still using
it, or they are successful, which is great, and we always encourage support of quitting tobacco. However, if they continue
to use those e-cigarettes, after the fact is when it’s
going to become concerning, as well. So, just something here
to show goals and reasons of people wanting to use e-cigarettes. So now, I wanted to take a moment and go through the beliefs
surrounding e-cigarettes. So, with beliefs around these, participants were also
instructed to mark all that apply, and as you can see,
we have a lot of people who have marked probably multiple times or maybe people who just maybe
didn’t want to take the time to really go through this, since we did say that it was kind of a lengthy survey. As Elaine had mentioned,
we did have feedback from the community before,
and when we were trying to figure out what the most
important questions were for their survey, we decided to keep in this belief surrounding the e-cigarettes. So, we noticed here that the highest belief that was clicked — with 262 times — was that e-cigarettes have a gateway effect for non-smokers and children to start smoking regular cigarettes. So, people believe that e-cigarette use will actually be that gateway for children and other smokers, as
well, which is something that we have seen and researched. There’s been articles out that show that people who use e-cigarettes, especially youth and young adults, would probably transition into
cigarettes later on in life. This is a very important point, because we also saw that
high number of “never smokers” — almost 30% — remembering never using tobacco, but they’re using e-cigarettes. So, our question is, “Will these people who have used e-cigarettes in this survey, will they maybe transition into regular cigarettes later on, as well?” Then, we have two other percentages of people who clicked that were the second and third highest. So, their belief that they are safer than other tobacco products,
such as regular cigarettes. That was 211 participants, so about 35.3% of people had clicked in, thinking that e-cigarettes
were actually safer than regular cigarettes. So, this is another common myth that we see when we talk about e-cigarettes — that people think they’re safer, people think that they are less harmful. So, this is another really important piece that we need to educate
out in the community — that they are not safer,
that safe doesn’t… like “safer” does not equal “safe.” So, just again, very important to stress that this is what we’re
seeing, is that people think that it is safer than using cigarettes,
and this is probably why a lot of individuals are, in
turn, using these products. The next one is that
they increase the chance of quitting smoking. So, another belief here,
with 32.2% of individuals, is they’re thinking that if
they use this product, then it’ll help them quit smoking. As I’ve mentioned before, these products all
contain nicotine, as well. So, sometimes, it’s
really hard to gauge how much nicotine people
are actually receiving with these products. So again, if we do want to quit smoking, there are other alternatives, there are other ways to
quit smoking. Again, we need to maybe look a little deeper about what those other options are so that we give those options to clients and community members and people that we’re trying to educate, and have awareness out there about e-cigarettes — that there are other options. Let’s look those through before someone wants to try
to think about e-cigarettes. Another belief that we
had that was very popular was that by using e-cigarettes, you will smoke fewer cigarettes, and your health risks will go down. So, that was 26.6% of
responses from the survey, is that people truly believed
that using these products, your health risk will go down. There are health risks
that are very similar with cigarettes and e-cigarettes. E-cigarettes’ health risks, we’ve had a lot of reports into the FDA that show lung problems,
like pneumonia, asthma, cardiovascular issues. We’re seeing contact dermatitis, like skin and oral mucosal lesions. We’re seeing a lot of people
using e-cigarettes who are experiencing seizures, and there are a few different health risks that are not associated
with just using cigarettes. So, combined together, we can imagine what
those health risks are. So, it’s also very
important for us to know that we need to educate
about those health risks. That it’s not safer. That we have a lot of those heavy metals that are included within
these products that you’re not getting with cigarettes. And then another belief that we had was that nicotine is just
an additive substance, that it does not pose
any other health risks. So, this was at 16.6% —
about 99 participants clicked that nicotine is just an additive. So, we know from research and studying with cigarettes that nicotine is harmful to the brain development. We’ve seen in the survey earlier that the majority of
these e-cigarette users are actually young adults, and we know that brains
do not fully develop until about age 25 or 26.
And if we’re dual users, and that also means that
our young adults are having maybe double
amounts of nicotine that they’re using with these products. So, it is very important, again, for us to inform our
community that nicotine is not just an additive substance, and that it is very
dangerous to the health. So, back to some of the reasons
why e-cigarettes were used. We kind of have, across the board, maybe our first four options there are very similar percentage-wise. We also told people to
click all that could apply. So, it’s not surprising that
we see that the flavors and being less harmful were at the highest percentage for reasons why people used e-cigarettes. So, flavorings is very
big with these products. There are thousands upon
thousands of flavors that can be used with
these e-cigarette devices. So, not too surprising that
we saw flavorings as a high. Less harmful again from
some of the other questions that we’re building up to this reasoning for using e-cigarettes. We saw that people said
that they were less harmful. So, people thinking that, “Oh. It
could just be flavored water that they’re using in these products.” That it is just a vapor;
it’s not dangerous. However, we have research
and studies showing that it’s actually an
aerosol and not a vapor. So, again, educating
people that it is harmful to use these products. And then another higher percentage that we got for people
wanting to use e-cigarettes and reason for using was that
they can use these products where cigarettes are prohibited. So, this just meaning that
e-cigarettes right now are not covered under
our Smokefree Air Law here in Michigan. So, that means that people
can use these devices like back out in bars, at the clubs. They can use them in restaurants. You can use them in any public place. So, this is another big draw
for using these products. And we know that socializing and being out in your
community is very important. Within the LGBTQ+ community, socializing and being with
members in your community is really important. So, if we have this other poll that brings people back together
again with e-cigarettes, this just shows us that our users are wanting to use these products because they can use them, again, where cigarettes are prohibited. 39.6% — again, almost
40% — of individuals said that quit smoking
cigarettes was their reason. And we saw that with the
beliefs and attitudes towards these products — that it’s great that people want to quit smoking. It’s amazing that we have
such a high number of people who want to quit. However,
they’re also using e-cigarettes which could
lead to that dual usage as we saw the percentages before, as well. And then the two other reasons for use that were a little bit lower
than these upper options were that family and friends
and then it costs less. So, the cost was something
that pulls people in. Devices itself usually are one-time cost, anywhere from like $20 to $30. And then getting the
refillable pods or cartridges and filling the e-juices, it
may seem like it’s less costly to do that or people will share
using these products, as well. So yes, maybe it is a
little bit less costly, and people will want to use these more. Family and friends, we think
that that’s also something really important to share at 26.7%. This could be influence. This could be maybe people saying, “Hey,!I’ve
tried this. You try it, too.” Or it could be family or friends that want current smokers to quit smoking and they say, “Hey! Maybe
you should use this. I’ve heard that if you
switch to these products, you’ll be able to quit using cigarettes.” So, just something really important here that across the board, we
have a lot of reasonings for why people are using these products. So, back to the flavor, because flavor was something
that was a very big reason for why people
were using these products. Flavor is just such a significant reason. At 72.3%, we see that people
preferred using fruity flavors. This was not shocking to me when I was going through these results, because having these fruity flavors is something that’s really appealing to our youth and young adults, and to all users, actually,
because it’s something new, it’s something exciting. These fruity flavors — it
kind of masks how harsh the effects of inhaling this aerosol, and it kind of gives you that smooth feel in your throat, and in your lungs. So these fruity flavors,
there’s thousands of flavors that are out there, as
I’d mentioned before. The flavors are endless. There’s so many different combinations that are out there. But, 72.3%
of people have been saying that the fruity flavors
is what their draw is. Then, at 22.8%, we see
that menthol is a flavor that is really important to users. And we know from past
events with tobacco industry — that menthol was a flavor
that was used to market and be advertised to certain populations. So, we know that menthol is a flavor and it’s another big pull, because that menthol kind
of gives that cooling effect for users. And there are a lot of
other flavors out there. We decided to try to do
the vanilla, chocolate, coffee flavor to see how many people were interested in that flavor, and we saw that 18.8% were wanting to use that flavor. The regular flavor at 8.9% —
I want to clarify that regular for these e-cigarette companies means kind of like a tobacco flavor. So, that would kind of
be like, for instance, there’s like a tobacco Virginia Slims. So, that’s just like a, I don’t
want to call it traditional, but just like a regular
cigarette kind of flavor. But again, 72.3% is a
huge, huge, huge, huge preferred flavor. So, that’s really important as to why, when we’re talking about these flavors, when we talk about how to control the advertising and the
regulation of all of this, it’s really important for
when we think of flavor bands, this could be a way to
curb users to want to use. Because without those fruity flavors, without all of these
flavors that are available, maybe people won’t be so drawn to it. So then, thinking about
quitting tobacco methods, which is really important,
because we’ve seen in the survey that there were a large amount of people who wanted to quit tobacco. So, we wanted to see what are your methods, like have you used or enrolled in any of the following
methods for quitting tobacco? And something that was
very high was that we saw that 33.7% of people
who have tried to quit or are quit have quit on their own. And then, we have that 22.8% of people have never tried any of the below options. So, they’ve never tried the
over-the-counter medications. They’ve never tried medications
prescribed by the doctor. They haven’t tried those
quit or stop smoking classes. They’ve never used the quitline. They don’t use any other
type of counseling, either. So, that 22.8% — we need
to try to figure out what would work for them
if they want to quit, what can we do to help them quit? Or, also, we can see here that maybe that “none” is people who
who don’t want to quit. So, we have a mix of people in that 22.8% of either not having that
right quitting method that would work for them, or
they just don’t want to quit. And then, also, coming back to that quitting on their own — which could be the cold turkey
or any other kind of methods — we know that that is not the most sought-after method of quitting. We know that doing that cold turkey is not the preferred way to quit. So, we’ve seen that 10.9% of people have tried using a prescription
medication by their doctor, 5.9% have tried
any type of counseling, 5% have tried using
over-the-counter medications, and then 3% of users have used
stop-smoking classes and the quitline. So, another thing, really quick,
that I wanted to just mention is again, we need to try to figure out within the LGBT community, what methods do we think would work the best? If these methods are not
working, we need to try to come up with some more creative ways to engage the communities who want to quit using tobacco and e-cigarettes. So, here are some great LGBT
tobacco-related resources talking about quitting tobacco that we wanted to provide for
you all today who are here, participating on this
webinar with us today. So, we do have the
Michigan Tobacco Quitline. Again, you can either
call the 1-800-QUIT-NOW, or you can use the website
and do a text program or chat that way. This Free Life has quit
resources and information specifically for LGBTQ+ community. The CDC also has some great resources, and then the LGBT Health Link
also has some great sources there, as well. The Truth Initiative has
fact sheets, data and reports, and then also the National
LGBT Health Education Center, the Fenway Health, has
online training, publications, fact sheets, reports — another
great, great resource. – [Elaine] So, let’s work together to solve the tobacco problem. It is a winnable battle. The tobacco industry continues to spend about $8.5 billion on marketing annually — that’s more than $23
million a day — nationwide, while only about $459
million is spent each year on tobacco prevention
programming in the U.S. So, it is easy to feel outnumbered. But, we do feel the fight against tobacco is a winnable battle, and
that working together, we can make an impact on tobacco use rates and reduce the number
of new youth smokers, and the health disparities that
exist related to tobacco use, as well as secondhand smoke exposure. So, we invite you to join us. There are a number of things that the Tobacco Control
Program can offer you as we work together. We do facilitate meetings
of statewide partners. We can work with you on
tobacco-free pride events. We offer a lot of tobacco
related education. We have language around model policies that could help you
pass tobacco-free parks or beaches policies, for example. So, we are here, we are available, and we are willing to work with you to help solve this problem. – [Carolyn] So, we’re going to
take a short break right now at this time. If there are any questions
that you would like to address and have us answer, please
put it into that chat box, and we’re going to give a few minutes just so you can go ahead and
input some of your questions. (mellow music) (mellow music) – [Elaine] Okay, we’re back. Thank you so much for those of
you who submitted questions. One of the questions that came in is can’t the FDA do anything
about JUUL/e-cigarette false advertising? So, the Federal Trade
Commission is really the entity that regulates advertising. The Food and Drug Administration — the FDA — does have the authority
to regulate the marketing and manufacturing of e-cigarettes, and that came into
being as of August 2016. So, an example of that
would be if a manufacturer wants to put its product on the market, they need to submit an application to the Food and Drug Administration and get their approval, so to speak, to actually put that
product on the market. It would include things
like what ingredients are in the product and that kind of thing. So, although the FDA does
have a significant role in regulating e-cigarettes, it’s not the false advertising piece that’s something that is
within their authority, so to speak. That would come from the
Federal Trade Commission. – [Carolyn] And then
something, too, is that, so the FDA has made a removal
of most of those products, so for a lot of, especially with JUUL, they had to remove a lot
of the flavored products that they had. So, at the moment, flavors
that are available for users are mint, menthol,
like a tobacco flavor, and then a few other flavors are still available that are out there. So, unfortunately, mint and
menthol are still categorized as flavors, and like we’ve even
seen during the survey today in the results, about
22% favor to menthol. So, even though there are, there has been cut back on flavoring, I mean there used to
be thousands of flavors and now, they’ve limited
them down to just a few. But, it is important to
know that they have kept that mint, menthol tobacco,
and like a few other flavors, like a fruit medley and a cucumber, which are obviously still flavors. But, at least, they have
tried to narrow down, specifically with JUUL,
those flavor options. So, we did have another question about if the slides will be available. Yes, they will, and please
look for I believe there may be a downloadable option there to see those slides, and
you can download those. Also, if there are any
questions or follow-ups, please contact us over at MDHHS, and we will be more than willing
to answer any questions that you may have about
what we’ve reviewed today during the webinar. And then the other question was, “Are there any planned interventions after we’ve seen these
results of the survey?” – [Elaine] And yes. Well, for one thing, of course, we’re going to be distributing this survey to a number of partners across the state, and this is also
something that we will use in talking about disparately
affected communities as we go forward, as a section if you will, with partners across the state. I did attend a couple of
Pride events this past summer, and that is also in the plans — to continue to be present at Pride events. For example, I was at the Grand
Rapids Pride event this year, and we estimate we talked to about 900 to a thousand people that day about the tobacco industry marketing that goes on to their community. We talked about a number of
resources to help people quit. So, we’ll, of course, continue to do that, whether it’s at a Pride event, or anywhere for that matter, that we
are attending health fairs or presentations, that sort of thing. We do have a couple of agencies with whom we’re currently working, although I don’t know the extent of some of the work that’s going on. I do know that we are working closely with a couple of organizations
who serve the LGBTQ community and so, although I can’t
elaborate too much at this moment because I don’t happen to be involved, I can tell you that there is
work that is still going on. I believe that is all the
questions that we have for today. You can see our phone number listed here, and for whatever reason, we did not put our email addresses on here, so we apologize for that. This is Elaine Lyon speaking, if you wish to reach out to me, my email is [email protected] – [Carolyn] And for my
contact information, Carolyn Chaudhary, my email is
[email protected] And we thank you for taking
time this morning, first thing, to join us for the webinar, and we hope that you have
all learned a little bit more about the survey that we’ve done and now, have a little bit of an idea of how to take some
action in the community. Thank you.