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September - November 2021

ARMC Tobacco Cessation Department

Holiday 2021 Issue

Currently, the Tobacco Cessation Department at Anaheim Regional Medical Center (ARMC) serves over 3,700 people who want to quit smoking each year. On average, this means the department helps 10 people quit smoking every single day. With a staff of 11 and services offered in English, Spanish, Vietnamese, Korean, and Farsi, the Tobacco Cessation Department has come a long way since 2003, when it was first established at ARMC.

“The best Christmas gift is to realize how much you already have”

— Unknown

In September - November, we helped 920 people quit smoking!

NEW-LUNG has helped people who want to quit smoking and vaping. Below is the number of people who have received NEW-LUNG services this quarter.

September

Patients 212

Adults 62

Youth 57

October

Patients 205

Adults 23

Youth 53

November

Patients 225

Adults 10

Youth 47

TOTAL 920

If you know anyone who is ready to quit smoking, call 1-866-639-5864. Free services in English, Spanish, Vietnamese, Korean, and Farsi.

SEE WHAT’S INSIDE

03 CHANTIX RECALL UPDATE

04 COUNTING YOUR BLESSINGS

05 FDA DELAYS MAKING DECISIONS ON JUUL

06 SANTA’S 5-MIN CRACING BUSTER

07 A.C.T. MODEL AND FLOWCHART

08 CROSSWORD PUZZLE

09 HOLIDAY GIFT FROM NEW-LUNG

2021 Voluntary Chantix Recall Update

On September 15, 2021, the University of Wisconsin Center for Tobacco Research and Intervention issued an update regarding Nitrosamine Contaminants found in Chantix which can increase the risk of cancer when exposed.

What We Know:

Pfizer identified Chantix tablets containing 150-470ng (155-474) of nitrosamine per tablet.
The July 2021 Pfizer voluntary recall applied to all Chantix tablets distributed nationwide to wholesalers and distributers between June 2019 and June 2021.
In August 2021, the Food and Drug Administration (FDA) approved Chantix products by Pharmaceuticals that contained nitrosamine levels of 3ng/per 1mg tablet (3ppm).

Things To Note:

Pfizer has argued that given episodic use indication for Chantix (a 12-week treatment regimen), daily use is not an appropriate risk standard given most individuals only take Chantix for 3-6 months.
Testing for nitrosamine levels is still ongoing. It is unclear if there are any long-term risks to users.
It is unclear if nitrosamine impurities are a result of storage, packaging, manufacturing, or the chemical structure of specific medications.
It is unclear whether the FDA plans to issue any additional guidance to patients and healthcare providers regarding the use of non-Pfizer Chantix products.
No guidance has been provided by the FDA or National Institutes of Health (NIH)regarding the research use of Chantix given the nitrosamine impurities.

Citation:

UW Center for Tobacco Research and Intervention. (2021, September 15). 2021 Varenicline Update regarding Nitrosamine Contaminants.

Count Your Blessings

FDA Delays Making a Decision on Juul and Other E-Cigarettes

The Food and Drug Administration (FDA) faced the task of reviewing applicants for over 6.5 million new tobacco products, many of which were already on the market. The court-ordered deadline to review applications for these tobacco products was September 9, 2021.

On September 9, 2021, the FDA announced that it has denied additional flavored e-cigarette applications and has taken action on about 93% (6 million) of the total timely submitted applications. The FDA stated they have made significant progress working to understand these products and the Marketing Denial Orders (MDO) for more than 946,000 flavored e-cigarette products. However, most applications lacked sufficient evidence that they have a benefit to adult smokers. The FDA’s case noted that flavored e-cigarette products are extremely popular among youth, with over 80% of e-cigarette users being between the ages of 12 through 17 years old.

The FDA states they will continue to work on the remaining applications that were submitted by the courts on September 9, 2021, many of which are in the final stages of review. The burden falls on the applicants to provide evidence to demonstrate that permitting the marketing of their products meets the applicable statutory standard. All new tobacco products without the statutory required premarket authorization are marketed unlawfully and subject to enforcement action at the FDA’s discretion.

You can find statements on today’s actions by the FDA from several of the plaintiffs that brought on today’s court-ordered deadline below:

Citation:

Easton, J. (2018, January 1). Quitting Cigarettes: One of the Toughest New Year’s Resolutions. Quitting Cigarettes: One of he Toughest New Year’s Resolutions - UChicago Medicine. https://www.uchicagomedicine.org/forefront/health-and-wellness-articles/quitting-smoking-is-one-of-the-toughest-resolutions

Santa’s 5-Minute Holiday Craving Busters

American Academy of Pediatrics A.C.T. Model and Flow Chart

Click here for a printable flow chart that illustrates the A.C.T. Model

Click here to access a PDF version of “Youth Tobacco Cessation: Considerations for Clinicians”

Tobacco use by adolescents and young adults is a health concern that can lead to nicotine dependence. Adolescents and young adults are vulnerable to nicotine dependence because their brains are still developing. Behavioral and pharmacological supports exist to help youth quit successfully. More specifically, it is the Pediatric Health Clinicians who play a critical role in a family’s life. Clinicians are trusted to educate youth about health harms, encourage quitting, and provide cessation support.

Tips to Successfully Implement the A.C.T. Model:

ASK the right questions
- Begin asking tobacco-related questions at age 11, and screen during every clinical visit.
- Use language youth will understand.
- Ask open-ended questions.
- Be honest and begin the conversation confidentially without a parent present.
COUNSEL youth to quit their tobacco or vape use
- Be clear. Explain that nicotine can hurt their brain as it develops. Ensure youth understand that stopping tobacco is an important way to prevent short- and long-term health problems.
- Be personalized. Explain that quitting tobacco may benefit youth’s other interests such as athletic performance and or saving money.
- Explain the benefits. Explain that quitting helps avoid things like exposure to toxic chemicals and metals, bad breath, stained teeth, or prematurely wrinkled skin.
TREAT youth by providing appropriate behavioral support and prescribing pharmacologic support when indicated
- Assess youth’s level of nicotine dependence.
- Link all youth who use tobacco or vapes with behavioral cessation support.
- Consider pharmacologic cessation support for youth who are moderate to overly dependent on nicotine.
- Follow-up with youth after their quit date to assess progress, offer additional support, and make treatment adjustments as needed.