Health Disparities and Substance Use among Youth

Transcript

00:00 --> 00:02Funding for Yale Cancer Answers is
00:02 --> 00:04provided by Smilow Cancer Hospital.
00:06 --> 00:08Welcome to Yale Cancer Answers
00:08 --> 00:10with Doctor Anees Chagpar.
00:10 --> 00:11Yale Cancer Answers features
00:11 --> 00:13the latest information on cancer
00:13 --> 00:15care by welcoming oncologists and
00:15 --> 00:17specialists who are on the forefront
00:17 --> 00:19of the battle to fight cancer.
00:19 --> 00:21This week it's a conversation about
00:21 --> 00:23tobacco and e-cigarrete use among
00:23 --> 00:25young people with Doctor Grace Kong.
00:25 --> 00:27Doctor Kong is an associate professor
00:27 --> 00:28in the Department of Psychiatry
00:28 --> 00:30at the Yale School of Medicine,
00:30 --> 00:33where Doctor Chagpar is a professor
00:33 --> 00:35of surgical oncology.
00:35 --> 00:37Grace, maybe we can start off by you
00:37 --> 00:39telling us a little bit more about
00:39 --> 00:41yourself and what it is that you do.
00:42 --> 00:44Sure. I'm associate professor in
00:44 --> 00:46the Department of Psychiatry at Yale,
00:46 --> 00:49and I have a PhD in clinical
00:49 --> 00:50psychology with specialization in
00:50 --> 00:52child and adolescent psychology.
00:52 --> 00:54And my research is focused on
00:54 --> 00:56preventing tobacco use among youth
00:56 --> 00:57through conducting research that
00:57 --> 00:59could inform policies and also
00:59 --> 01:01develop and disseminate prevention
01:01 --> 01:03and cessation interventions that
01:03 --> 01:05are relevant to youth.
01:07 --> 01:10So let's take a step back and really
01:10 --> 01:13talk about substance use and
01:13 --> 01:15tobacco in particular amongst youth.
01:15 --> 01:18You know, my perception is that
01:18 --> 01:22if we look at just tobacco use in general,
01:22 --> 01:23that rates are declining,
01:23 --> 01:26do we find that it's declining amongst
01:26 --> 01:29youth as well or are the youth still
01:29 --> 01:31engaging in tobacco use and other
01:31 --> 01:34substances as much as they used to?
01:35 --> 01:37Yeah, that's a great question.
01:37 --> 01:39When we were looking at
01:39 --> 01:40tobacco use trends among youth,
01:40 --> 01:42the trends are changing rapidly.
01:42 --> 01:43So when we think about tobacco,
01:43 --> 01:45we think about cigarettes and
01:45 --> 01:47cigarettes.
01:48 --> 01:51It is what causes cancer,
01:51 --> 01:53and they're the most used
01:53 --> 01:55tobacco product among adults.
01:55 --> 01:57But the cigarette smoking youth
01:57 --> 01:58rates have decreased tremendously
01:58 --> 02:00among youth and over the general
02:00 --> 02:02population in the last two decades.
02:02 --> 02:04So cigarettes are addictive and
02:04 --> 02:05deadly product that causes cancer.
02:05 --> 02:07But there are other tobacco products
02:07 --> 02:09that are emerging in the market which
02:09 --> 02:12are addictive and has serious health consequences,
02:14 --> 02:15and even unknown health consequences.
02:15 --> 02:19And when we talk about tobacco trends
02:19 --> 02:19in youth,
02:19 --> 02:22we have to talk about E-cigarettes.
02:22 --> 02:24These are electron nicotine electronic
02:24 --> 02:26nicotine product that contain
02:26 --> 02:27propylene glycol and vegetable
02:27 --> 02:29glycerin and it contains different
02:29 --> 02:31concentrations of nicotine and
02:31 --> 02:33thousands of different flavors.
02:33 --> 02:35And you could be customized
02:35 --> 02:37in many different ways.
02:37 --> 02:40So for example the level
02:40 --> 02:43of the vapor could be controlled.
02:43 --> 02:45So you could really have a large vapor
02:45 --> 02:47that people could use to do vape tricks
02:47 --> 02:50or as little vapor that cannot be seen
02:50 --> 02:52and so that people could be using
02:52 --> 02:54these devices discreetly in schools
02:54 --> 02:56and of concern, this
02:56 --> 02:59nicotine level increased over time.
02:59 --> 03:01An example is Juul.
03:01 --> 03:03Juul is an E-cigarrete brand that's
03:03 --> 03:05became extremely popular among youth
03:05 --> 03:07and these are shaped like a Flash Drive
03:07 --> 03:09and has nicotine salt which makes
03:09 --> 03:11nicotine a lot easier to inhale but
03:11 --> 03:13at the harsh effects and it comes
03:13 --> 03:14with diverse flavors and this
03:14 --> 03:17allowed very high levels of nicotine
03:17 --> 03:20to be in this e-cigarrete product.
03:20 --> 03:22So E-cigarettes currently are
03:22 --> 03:23the highest tobacco use
03:23 --> 03:25product used among US youth in
03:25 --> 03:27the past several years.
03:28 --> 03:31And so with that Grace,
03:31 --> 03:35do we find that our youth are
03:35 --> 03:39using more E-cigarettes and
03:39 --> 03:41you mentioned that it's addictive,
03:41 --> 03:43do we know the health consequences
03:43 --> 03:45of these E-cigarettes as well?
03:46 --> 03:49Yeah. So currently the long term health
03:49 --> 03:51effects of E cigarettes are
03:51 --> 03:54unknown and are being researched.
03:54 --> 03:55They're still fairly new.
03:55 --> 03:57It's been on the market
03:57 --> 03:59for the past decade or so.
03:59 --> 04:01So we don't really know the
04:01 --> 04:02long term health effects.
04:02 --> 04:04There are some studies showing
04:04 --> 04:07acute effect and we do hear
04:07 --> 04:09anecdotally from youth about some
04:10 --> 04:12other health issues that they're
04:12 --> 04:15having which includes breathing issues,
04:15 --> 04:16coughing, just chest pains.
04:16 --> 04:18So there's more work that needs
04:18 --> 04:19to be done to really understand
04:19 --> 04:21the effect of E cigarette use
04:21 --> 04:23and the long term health effects.
04:24 --> 04:26And if I understood you
04:26 --> 04:29correctly there still is a high
04:29 --> 04:31concentration of nicotine in these products.
04:31 --> 04:34And so when we think about regular
04:34 --> 04:36cigarettes, one of the perceptions
04:36 --> 04:40I think that we have is that
04:40 --> 04:42the nicotine is actually one of
04:42 --> 04:45the elements that causes the long
04:45 --> 04:47term effects of lung cancer.
04:47 --> 04:49And other cancers.
04:49 --> 04:55And so is it fair to hypothesize that
04:55 --> 04:59E cigarettes will have a similar
04:59 --> 05:02effect given the high
05:02 --> 05:05concentration of nicotine or is it more
05:05 --> 05:07about how that nicotine is delivered?
05:08 --> 05:09Yeah, I think it's both,
05:09 --> 05:12right, it's a level of concentration,
05:12 --> 05:14level of nicotine that's in the
05:14 --> 05:16product as well as the power in
05:16 --> 05:18which the nicotine gets delivered.
05:18 --> 05:23So it is true that over the years E
05:23 --> 05:25cigarette concentration has increased
05:25 --> 05:27tremendously in this e-cigarrete product.
05:27 --> 05:29So Juul is a good example of one
05:29 --> 05:32that came in the market around 2017
05:32 --> 05:36and that's created this
05:36 --> 05:39huge youth use in E cigarettes.
05:39 --> 05:43So after Juul became somewhat regulated,
05:43 --> 05:46te FDA now said that e-cigarrete
05:46 --> 05:48cartridges like Juul
05:48 --> 05:50can not come in appealing flavors
05:50 --> 05:52other than tobacco and menthol.
05:52 --> 05:54So this allowed room for other
05:54 --> 05:56products like disposable E cigarettes
05:56 --> 06:00which come in as equal to or even
06:00 --> 06:02higher nicotine level.
06:03 --> 06:05Nicotine is what makes
06:05 --> 06:07the products addictive and
06:07 --> 06:10what we see in youth in
06:10 --> 06:12Connecticut is that they're addicted.
06:12 --> 06:15So we have an intervention program
06:15 --> 06:18that we're delivering cognitive therapy
06:18 --> 06:19as well as incentives
06:19 --> 06:21to help youth to quit.
06:21 --> 06:23And what we see from these kids is
06:23 --> 06:25that they're really addicted to
06:25 --> 06:27nicotine and they're using E cigarettes
06:27 --> 06:29constantly and they need help to quit.
06:32 --> 06:33They are as addictive as cigarettes
06:33 --> 06:35and we're seeing youth who are
06:35 --> 06:37really addicted to these products
06:37 --> 06:38and we live in
06:38 --> 06:40a market free market where you
06:40 --> 06:41know it's not just E cigarettes,
06:41 --> 06:43there are cigarettes and other
06:43 --> 06:44combustible tobacco in the market.
06:44 --> 06:46So if they're addicted to E
06:46 --> 06:47cigarettes they also
06:47 --> 06:48could be using
06:48 --> 06:50the products which also increases
06:50 --> 06:52their health risk into getting
06:52 --> 06:54cancer in the future.
06:54 --> 06:57So one of the questions before
06:57 --> 06:59we get into smoking cessation and
06:59 --> 07:02trying to help kids who are
07:02 --> 07:05addicted to E cigarettes, quit.
07:05 --> 07:08One of the questions I always have
07:08 --> 07:11is why do people start to begin with?
07:11 --> 07:13I mean do we have a sense of that?
07:13 --> 07:16Is it the perception that
07:16 --> 07:20this is cool or
07:20 --> 07:24why do people start to begin with?
07:24 --> 07:27Yeah, tobacco use typically
07:27 --> 07:29starts in adolescence, right.
07:29 --> 07:31So we know that 90 some
07:31 --> 07:33percent of adult smokers start
07:33 --> 07:36smoking before 18 years old.
07:36 --> 07:39And in fact, 99% of adult smokers,
07:39 --> 07:41they start before they're 26.
07:41 --> 07:44So adolescent and young adult age is
07:44 --> 07:47when lot of these tobacco use begins.
07:47 --> 07:49So why do they start?
07:49 --> 07:52They start because it's cool.
07:52 --> 07:53They come in many different
07:53 --> 07:54appealing flavors.
07:54 --> 07:55Of course cigarettes are different.
07:55 --> 07:58It only comes in menthol and tobacco flavor.
07:58 --> 08:00Other appealing flavors are
08:00 --> 08:01disallowed in cigarettes.
08:01 --> 08:03But that doesn't mean that other
08:03 --> 08:04tobacco product doesn't, right?
08:04 --> 08:06So cheap cigars come in
08:06 --> 08:08multiple different appealing flavors
08:08 --> 08:11are sold in stores such
08:11 --> 08:13as gas stations, convenience stores.
08:13 --> 08:16E cigarettes again come in more than
08:16 --> 08:197000 flavors and are also marketed
08:19 --> 08:22differently. We live in
08:22 --> 08:24a connected digital media world,
08:24 --> 08:26right, where social media really dominates,
08:26 --> 08:30especially youth social interactions.
08:30 --> 08:32And that's also been sort of pushed
08:32 --> 08:34forward because of the COVID pandemic
08:34 --> 08:36where people are more online,
08:37 --> 08:41so these are marketed on social media.
08:41 --> 08:44They're portrayed as cool,
08:44 --> 08:46aspirational, fun products.
08:46 --> 08:49So these are problems.
08:49 --> 08:51That kind of drives young
08:51 --> 08:54people to start using the product.
08:54 --> 08:57And so are there any interventions before
08:57 --> 09:00we get to trying to get people to quit?
09:00 --> 09:03Are there any interventions out there
09:03 --> 09:05trying to get people not to start?
09:05 --> 09:08I mean it seems to me that primary
09:08 --> 09:09prevention would start there.
09:10 --> 09:12Yes. I think people now
09:12 --> 09:14recognize that for example,
09:14 --> 09:17e-cigarrete use is a problem in
09:17 --> 09:19America that has really
09:19 --> 09:21highlighted the need for prevention
09:21 --> 09:23and cessation interventions.
09:23 --> 09:25So currently a lot of effort is
09:25 --> 09:28made by the FDA to develop and
09:28 --> 09:29disseminate prevention campaigns.
09:29 --> 09:32For example, they have the ad campaign
09:32 --> 09:34called the Real Cost campaign,
09:34 --> 09:36which highlights themes that
09:36 --> 09:37could appeal to youth.
09:37 --> 09:40So for example, educating youth about
09:40 --> 09:42E cigarettes that they're just like
09:42 --> 09:44cigarettes that puts them at risk for
09:44 --> 09:45addiction and other health consequences.
09:45 --> 09:48And that also highlights that
09:48 --> 09:50E cigarettes contain other dangerous
09:50 --> 09:52chemicals such as acrolein that
09:52 --> 09:54causes irreversible lung damage,
09:54 --> 09:55formaldehyde which is a cancer
09:55 --> 09:57causing chemicals and so on.
09:57 --> 10:00And these campaigns are disseminated
10:00 --> 10:03on digital media platforms like
10:03 --> 10:05social media and other like Spotify,
10:05 --> 10:07Pandora and so on.
10:07 --> 10:09They also have campaign NOTE Confidence: 0.866642286
10:09 --> 10:11flyers and materials that
10:11 --> 10:12are distributed to schools because
10:12 --> 10:14we know that a lot of e-cigarrete
10:14 --> 10:16use happens in schools,
10:16 --> 10:17especially school bathrooms.
10:17 --> 10:20So they have flyers and that
10:20 --> 10:23they could post in these settings.
10:23 --> 10:25The National Cancer Institute also has
10:25 --> 10:28an initiative to help people to quit,
10:28 --> 10:31particularly teen.smokefree.gov
10:31 --> 10:34they have specific advice and skills
10:34 --> 10:38that youth could access to help them to quit.
10:38 --> 10:40Despite these programs out there,
10:40 --> 10:41you know, there's still a great need,
10:41 --> 10:43we get calls from schools all over
10:43 --> 10:45Connecticut saying that e
10:45 --> 10:46cigarette use is a problem in their
10:47 --> 10:48school and the punitive measures
10:48 --> 10:50that they have actually do not work.
10:50 --> 10:53So there's really a need to develop
10:53 --> 10:56and test interventions that appeal
10:56 --> 10:59to youth because one intervention
10:59 --> 11:00does not fit all.
11:01 --> 11:03And we want intervention that works, right.
11:03 --> 11:05So we need researchers to develop
11:05 --> 11:06intervention that appeals to
11:06 --> 11:07youth and that actually works.
11:08 --> 11:10The one preventative measure that
11:10 --> 11:14I wanted to ask you about before we
11:14 --> 11:16get into your intervention is taxation.
11:16 --> 11:21I mean, it seems to me that in regular
11:21 --> 11:24cigarette use that when people tried,
11:24 --> 11:27you know, education, they tried putting
11:27 --> 11:30gruesome pictures onto
11:30 --> 11:33cigarette packages, they tried
11:33 --> 11:37having some barriers to purchase.
11:37 --> 11:38You have to show your ID.
11:38 --> 11:41It's often behind a locked cabinet.
11:41 --> 11:44It seems to me, and you know this
11:44 --> 11:45literature better than I do,
11:46 --> 11:48that one of the things that had the
11:48 --> 11:51biggest impact was when there was such
11:51 --> 11:54significant taxation that the cost really
11:54 --> 11:57drove people to make the decision between
11:57 --> 12:00do I smoke or do I eat?
12:00 --> 12:04And that often was the kind
12:04 --> 12:07of extreme measure that got
12:07 --> 12:11people to choose not to smoke.
12:11 --> 12:12Have people tried that for
12:12 --> 12:14E cigarettes for the youth.
12:14 --> 12:17I mean it would seem to me that
12:17 --> 12:19adolescents have a smaller
12:19 --> 12:21pocketbook than adults,
12:23 --> 12:26And that's a good point.
12:26 --> 12:27I think that the pricing
12:27 --> 12:28would help, hike the price,
12:28 --> 12:31would help youth to stay away from
12:31 --> 12:31these cigarettes.
12:31 --> 12:34But it's also important to keep in
12:34 --> 12:36mind that youth or some youth are not
12:36 --> 12:38purchasing their own E cigarettes.
12:38 --> 12:40They're really borrowing from their friends,
12:40 --> 12:41getting it from their friends,
12:41 --> 12:43getting from their parents who think
12:43 --> 12:45these are safer product to use.
12:45 --> 12:48So other things to keep in mind is that
12:48 --> 12:51while E cigarettes might be more costly,
12:51 --> 12:52there are other really
12:52 --> 12:54cheap products out there.
12:54 --> 12:55For example,
12:55 --> 12:58cigarillos and little cigars are cheaper
12:58 --> 13:01than cigarettes and they're sold
13:01 --> 13:03widely in other places.
13:03 --> 13:04So yes,
13:04 --> 13:06I do think that increasing prices
13:06 --> 13:09is 1 strategy to help you stay
13:09 --> 13:10away from tobacco products.
13:10 --> 13:12But it has to be more comprehensive
13:12 --> 13:14and there has to be other
13:14 --> 13:15approaches
13:15 --> 13:17that will eventually keep youth
13:17 --> 13:20out of using these products.
13:20 --> 13:22We're going to talk a
13:22 --> 13:24lot more about the other strategies,
13:24 --> 13:26including the ones that you've been
13:26 --> 13:29working on and developing to help get
13:29 --> 13:31youth the help that they need to
13:31 --> 13:34quit smoking and avoid
13:34 --> 13:36E cigarettes altogether
13:36 --> 13:38after we take a short
13:38 --> 13:40break for a medical minute.
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13:57 --> 13:59resulting from cancer treatment.
13:59 --> 14:03Smilowcancerhospital.org.
14:03 --> 14:05The American Cancer Society
14:05 --> 14:07estimates that more than 65,000
14:07 --> 14:09Americans will be diagnosed with
14:09 --> 14:11head and neck cancer this year,
14:11 --> 14:15making up about 4% of all cancers diagnosed.
14:15 --> 14:16When detected early, however,
14:16 --> 14:19head and neck cancers are easily
14:19 --> 14:21treated and highly curable.
14:21 --> 14:23Clinical trials are currently
14:23 --> 14:25underway at federally designated
14:25 --> 14:26Comprehensive cancer centers such
14:26 --> 14:29as Yale Cancer Center and Smilow
14:29 --> 14:31Cancer Hospital to test innovative new
14:31 --> 14:33treatments for head and neck cancers.
14:33 --> 14:35Yale Cancer Center was recently
14:35 --> 14:37awarded grants from the National
14:37 --> 14:39Institutes of Health to fund the
14:39 --> 14:42Yale Head and neck Cancer Specialized
14:42 --> 14:44program of Research Excellence,
14:44 --> 14:45or SPORE,
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14:47 --> 14:49treatment of head and neck squamous cell
14:49 --> 14:52carcinoma due to resistance to immune,
14:52 --> 14:53DNA damaging,
14:53 --> 14:55and targeted therapy.
14:55 --> 14:57More information is available
14:57 --> 14:58at yalecancercenter.org.
14:58 --> 15:01You're listening to Connecticut public radio.
15:02 --> 15:04Welcome back to Yale Cancer Answers.
15:04 --> 15:06This is doctor Anees Chagpar and
15:06 --> 15:08I'm joined tonight by my guest,
15:08 --> 15:09Doctor Grace Kong.
15:09 --> 15:11We're talking about health disparities
15:11 --> 15:13and substance use amongst youth.
15:13 --> 15:15And before the break,
15:15 --> 15:18Grace was telling us about how tobacco use
15:18 --> 15:21amongst youth is really trending upwards,
15:21 --> 15:25but more so in the form of E cigarettes.
15:25 --> 15:28We talked a little bit about
15:28 --> 15:30measures that can be taken to stop
15:30 --> 15:33people from actually starting to smoke.
15:33 --> 15:33But Grace,
15:33 --> 15:36let's get into some of your work
15:36 --> 15:39looking at how we can help you
15:39 --> 15:41to quit smoking and quit
15:41 --> 15:43their use of E cigarettes.
15:43 --> 15:45Can you tell us more about your
15:45 --> 15:47work and what you've been finding?
15:47 --> 15:51Yes. So we have a study that's funded by the
15:51 --> 15:54American Heart Association to develop
15:54 --> 15:58interventions to help youth to quit and
15:58 --> 16:00this is a project that's been
16:00 --> 16:02led by Doctor Suchitra Krishnan-Sarin
16:02 --> 16:04who I've worked with for many years.
16:04 --> 16:07And and we initially started this
16:07 --> 16:09project with cigarette smoking youth
16:09 --> 16:11many years ago before
16:11 --> 16:12E cigarettes came on
16:12 --> 16:14the market and became popular.
16:14 --> 16:17And now we're extending this to E
16:17 --> 16:19cigarettes and what we're doing is
16:19 --> 16:21we're providing individualized cognitive
16:21 --> 16:23behavior therapy skills that teachers
16:23 --> 16:26use to deal with withdrawal symptoms
16:26 --> 16:28to avoid high risk situations that
16:28 --> 16:31puts them in risk for vaping
16:31 --> 16:33and individualized personal
16:33 --> 16:35plans and as well as skills to
16:35 --> 16:37help them manage their stress,
16:37 --> 16:39anger, or depression that may
16:39 --> 16:42put them at risk for vaping.
16:42 --> 16:46And we also incentivize them to stay
16:46 --> 16:49abstinent from vaping and so
16:49 --> 16:51that's the intervention that we're
16:51 --> 16:53currently conducting in Connecticut high
16:53 --> 16:55schools as well as to young adults.
16:56 --> 16:59And so tell us how that's been working.
16:59 --> 17:01I mean it seems to me that people would
17:01 --> 17:04need to be motivated to quit even to kind
17:04 --> 17:07of contemplate participating in the study.
17:07 --> 17:10Yeah. So it's interesting what we're seeing
17:10 --> 17:14now are youth who are motivated to quit.
17:14 --> 17:16I think several years have passed where
17:16 --> 17:18they thought it was cool, they're doing
17:18 --> 17:21it and now they're feeling some health
17:21 --> 17:22effects, immediate health effects and
17:22 --> 17:25so they want to make this positive
17:25 --> 17:27changes for themselves and for
17:27 --> 17:29them it's hard to find resources
17:29 --> 17:32to really help them to quit.
17:32 --> 17:34So we are in schools recruiting
17:34 --> 17:36participants who want to quit and
17:36 --> 17:37as well we're on social media
17:37 --> 17:39and we're finding that kids are
17:39 --> 17:41motivated to quit at this point.
17:41 --> 17:44Tell us more
17:44 --> 17:47about what you've been finding in
17:47 --> 17:50terms of the quit rates.
17:50 --> 17:52Are all youth able to quit and
17:52 --> 17:55are all youth able to access the
17:55 --> 17:57services that you're providing?
17:58 --> 18:00So we are conducting research right now,
18:00 --> 18:02so we do not know the quit rates.
18:02 --> 18:05However, just looking across the literature,
18:05 --> 18:07the quit rate is pretty low.
18:07 --> 18:09That's why there is a really strong need
18:09 --> 18:12to develop interventions to help
18:12 --> 18:14people quit and stay quit over time.
18:14 --> 18:16So we do not know the rates right now,
18:16 --> 18:18but if you're looking at the
18:18 --> 18:20cigarette smoking literature again,
18:20 --> 18:22I think you see a higher quit rate
18:22 --> 18:25when rewards are provided for quitting,
18:25 --> 18:26which is called contingency
18:26 --> 18:29management and that's in the upwards
18:29 --> 18:31of 30 to 40% quit rate.
18:31 --> 18:34But again, the challenge with this
18:34 --> 18:36is really maintaining motivation to
18:36 --> 18:38quit over a long period of time.
18:39 --> 18:43I mean, it seems to me that
18:43 --> 18:46incentivizing people to adopt good behaviors,
18:46 --> 18:48whether it's quitting smoking
18:48 --> 18:49or losing weight or doing
18:49 --> 18:51pretty much anything you want,
18:51 --> 18:54one of the issues that I always
18:54 --> 18:57think about is how sustainable is that?
18:57 --> 18:59I mean, if you're going to pay people to
18:59 --> 19:02quit the moment you stop paying them,
19:02 --> 19:04the incentive now is gone and it
19:04 --> 19:07would be easier to relapse and
19:07 --> 19:09so if you keep paying them well
19:09 --> 19:11that turns out not to be very
19:11 --> 19:13sustainable over the long run.
19:13 --> 19:16Right, and so I think combining
19:16 --> 19:18contingency management with other skills
19:18 --> 19:20like cognitive behavioral therapy,
19:20 --> 19:22so when people are saying that you
19:22 --> 19:24know they can't stand their withdrawal
19:24 --> 19:27symptoms or they don't know how to
19:27 --> 19:29deal with these high risk situations,
19:29 --> 19:32we are really teaching them skills to deal
19:32 --> 19:34with these situations that hopefully
19:34 --> 19:37they could learn and try again
19:37 --> 19:40in the future, because we know from
19:40 --> 19:41cigarette smoking literature that
19:41 --> 19:43many people quit several times before
19:43 --> 19:44they quit for good.
19:44 --> 19:46So just having this standard situation
19:46 --> 19:48where they're taught these lessons
19:48 --> 19:50will hopefully give them skills that they
19:50 --> 19:52could really use in the long run.
19:54 --> 19:57Can you talk a little bit about your
19:57 --> 20:01focus on marginalized youth and the
20:01 --> 20:03disproportionate levels of of tobacco
20:03 --> 20:05related cancers and other illnesses in
20:05 --> 20:08that population and what you're
20:08 --> 20:10trying to do to really target that
20:10 --> 20:13population to help them to quit?
20:13 --> 20:15Yes. So when you look at tobacco
20:15 --> 20:17use rates as an aggregate,
20:17 --> 20:19we see that marginalized youth such
20:19 --> 20:21as youth who are native Hawaiian,
20:21 --> 20:23Pacific Islander, or American Indians,
20:23 --> 20:25are more like to use
20:25 --> 20:26commercialized tobacco products.
20:26 --> 20:29We are also seeing exponentially higher
20:29 --> 20:32use rates across all different tobacco
20:32 --> 20:35products across LGBTQ population of youth.
20:35 --> 20:37And when you're also
20:37 --> 20:39looking at specific tobacco,
20:39 --> 20:42we see a different risk in
20:42 --> 20:44marginalized communities.
20:44 --> 20:44For example,
20:44 --> 20:47if you just look at tobacco use rate,
20:47 --> 20:49you see that black youth are
20:50 --> 20:52smoking less cigarettes and they're
20:52 --> 20:54using less tobacco products overall.
20:54 --> 20:56But if you break it down by tobacco product,
20:56 --> 20:59what you see is that black
20:59 --> 21:00youth are using cheap cigars,
21:00 --> 21:02little cigarillos, at a lot higher rates
21:04 --> 21:06and this is problematic.
21:06 --> 21:08Because cigars also cause cancer,
21:08 --> 21:09and if you again
21:09 --> 21:11break it down by
21:11 --> 21:12different tobacco products,
21:12 --> 21:14you do see this difference as in
21:14 --> 21:16marginalized groups which might
21:16 --> 21:18contribute to their
21:18 --> 21:21overall cancer rate in the future.
21:21 --> 21:24Another example is smokeless tobacco.
21:24 --> 21:26We also see that smokeless tobacco
21:26 --> 21:29tends to be used more by
21:29 --> 21:33rural youth, also males and athletes.
21:33 --> 21:36And this is problematic too because
21:36 --> 21:37you know smokeless tobacco has
21:37 --> 21:39been linked to oral cancer as well
21:39 --> 21:40as other cancer in the stomach
21:40 --> 21:42and so on because
21:42 --> 21:44they're digested.
21:45 --> 21:47And it seems to me that
21:47 --> 21:50as we think about different communities,
21:50 --> 21:52they'll each have their
21:52 --> 21:54own particular tastes and
21:54 --> 21:56preferences for tobacco products.
21:56 --> 21:59But when you think about the
21:59 --> 22:01LGBTQ community, for example,
22:01 --> 22:05who has a higher rate of tobacco use,
22:05 --> 22:09I wonder whether one strategy
22:09 --> 22:12to help reduce tobacco use,
22:12 --> 22:14particularly in that Community,
22:14 --> 22:17is to engage the LGBT community themselves.
22:17 --> 22:19I mean, when we think about
22:19 --> 22:20the AIDS epidemic,
22:20 --> 22:23the reason why we now have gotten
22:23 --> 22:26AIDS under control is in large
22:26 --> 22:28part a great credit to the
22:28 --> 22:32LGBTQ community who really rallied
22:32 --> 22:35together and were very proactive about
22:35 --> 22:38educating their own community members
22:38 --> 22:42and being proactive in terms of programs.
22:43 --> 22:45I wonder whether
22:45 --> 22:47some initiatives have been taken
22:47 --> 22:50to really engage that Community
22:50 --> 22:52in tobacco cessation as well.
22:55 --> 22:56With the tobacco control community,
22:56 --> 22:59I have seen a huge shift in the
22:59 --> 23:01focus in marginalized communities.
23:01 --> 23:04So there are a lot of studies that are
23:04 --> 23:06ongoing
23:06 --> 23:08focused on these populations.
23:08 --> 23:11So yes, getting people from the
23:11 --> 23:13community involved in the
23:13 --> 23:16conversation to advocate for tobacco
23:16 --> 23:18control policies to improve the health
23:18 --> 23:21is a really important key element.
23:21 --> 23:24I also want to talk a little about
23:24 --> 23:25social media because a lot of
23:25 --> 23:28the social norms are
23:28 --> 23:30reinforced through social media
23:30 --> 23:32and I think especially when we're
23:32 --> 23:34talking about targeting youth and
23:34 --> 23:37providing interventions towards youth,
23:37 --> 23:39having policies in place
23:39 --> 23:41to restrict targeted tobacco
23:41 --> 23:43promotion to these marginalized
23:43 --> 23:46groups of vulnerable groups is
23:46 --> 23:48also very important in the overall
23:48 --> 23:51climate to reduce tobacco use.
23:51 --> 23:53When we think
23:53 --> 23:55about social media though,
23:55 --> 23:56I think that there's two
23:56 --> 23:58prongs that one could take.
23:58 --> 24:02One is to restrict disinformation,
24:02 --> 24:06advertising of harmful products,
24:06 --> 24:09etcetera, but the other is
24:09 --> 24:11really to engage key influencers.
24:11 --> 24:15I mean, I'm thinking about why is it
24:15 --> 24:18that people think that smoking is cool?
24:18 --> 24:19Oftentimes, especially historically,
24:19 --> 24:22when we think about tobacco use,
24:22 --> 24:24it was because
24:24 --> 24:27there was the Marlboro man,
24:27 --> 24:30I can't even say that correctly anymore.
24:30 --> 24:33But the whole perception
24:33 --> 24:37of this being really cool through what
24:37 --> 24:39was then popularized media figures.
24:39 --> 24:43And so when we think about social media,
24:43 --> 24:47I wonder whether another tactic is to engage
24:47 --> 24:52key influencers in a positive quit campaign?
24:52 --> 24:55So instead of saying we're not going to
24:55 --> 24:58advertise E cigarettes on social media,
24:58 --> 24:59which is fine,
24:59 --> 25:02but may be perceived as a form of censorship.
25:02 --> 25:05Whether an equally or perhaps even
25:05 --> 25:08more powerful suggestion might
25:08 --> 25:10be to get key influencers,
25:10 --> 25:12you know the rap artists,
25:12 --> 25:15the movie stars,
25:15 --> 25:18the hip hop artists, et cetera,
25:18 --> 25:22to come out and to in a very forceful way,
25:22 --> 25:24say to their own constituents,
25:24 --> 25:26the people who look up to them
25:26 --> 25:27as role models,
25:27 --> 25:32smoking sucks and people should quit.
25:32 --> 25:34And I wonder whether that has
25:34 --> 25:37been contemplated as well in
25:37 --> 25:38the social media space.
25:39 --> 25:40Yeah, people are trying
25:40 --> 25:42to figure out how to best utilize
25:42 --> 25:45social media to disseminate this
25:45 --> 25:47prevention messages and I think you're
25:47 --> 25:49absolutely right, getting
25:49 --> 25:51influencers or celebrities
25:51 --> 25:54to relate these anti vaping messages
25:54 --> 25:56is going to be important because we
25:56 --> 25:59do know that when they talk about pro
25:59 --> 26:02tobacco use messaging that works.
26:02 --> 26:04So it makes sense to start looking
26:04 --> 26:07at social media as a way to utilize
26:07 --> 26:09some of these techniques that work
26:09 --> 26:11to promote these messages.
26:11 --> 26:12It has not been done yet.
26:12 --> 26:14And has not been done well.
26:14 --> 26:16So it's still in the very beginning
26:18 --> 26:20we're still asking these questions like
26:20 --> 26:22how can we use social media to better
26:22 --> 26:24promote healthy behaviors including
26:24 --> 26:26tobacco use, not using tobacco?
26:26 --> 26:29And getting back to some
26:29 --> 26:31of the disparities that you had mentioned,
26:31 --> 26:33you wonder as well,
26:33 --> 26:36I think I'd be really interested
26:36 --> 26:38in any research that's out there
26:38 --> 26:40in terms of differences in cancer
26:40 --> 26:42rates amongst different products.
26:42 --> 26:44So when you talk about
26:44 --> 26:47African American men for example,
26:47 --> 26:50youth using more of the
26:50 --> 26:52cigarellos, well,
26:52 --> 26:55does that have a higher rate
26:55 --> 26:59of cancer risk or a lower rate
26:59 --> 27:03or does the modality of
27:03 --> 27:06nicotine or tobacco consumption not
27:06 --> 27:09make a difference in terms of cancer
27:09 --> 27:11risk that any kind of
27:11 --> 27:13tobacco is still tobacco and it's
27:13 --> 27:16still going to increase your risk of
27:16 --> 27:19a dozen different kinds of cancers?
27:19 --> 27:22And I think that's an important
27:22 --> 27:24question because of the variety of
27:24 --> 27:26tobacco products that's out there,
27:26 --> 27:28because I think the question now
27:28 --> 27:30is which tobacco product is
27:30 --> 27:32most harmful and which is less harmful.
27:32 --> 27:34And that kind of research is still not done.
27:34 --> 27:37Even even asking about cigarillos and
27:37 --> 27:40cigar use is more of a recent thing.
27:40 --> 27:42You know, ten years ago people didn't
27:42 --> 27:44even ask people these questions.
27:44 --> 27:46So when you're looking to differentiate
27:46 --> 27:48which cigar products, for example,
27:48 --> 27:49have more health risk,
27:49 --> 27:51even that question is hard to ask.
27:51 --> 27:53It's hard to differentiate.
27:53 --> 27:55And also people are using multiple products.
27:55 --> 27:57So for example,
27:57 --> 28:00cigar smokers tend to smoke cigarettes.
28:00 --> 28:03So it's hard to also identify which
28:03 --> 28:05product has greater risk because
28:05 --> 28:07they're being used together.
28:07 --> 28:08So it's a great question,
28:08 --> 28:09an important question,
28:09 --> 28:11but hard to answer currently.
28:12 --> 28:14Doctor Grace Kong is an associate
28:14 --> 28:16professor in the Department of Psychiatry
28:16 --> 28:18at the Yale School of Medicine.
28:18 --> 28:20If you have questions,
28:20 --> 28:22the address is canceranswers@yale.edu,
28:22 --> 28:25and past editions of the program
28:25 --> 28:27are available in audio and written
28:27 --> 28:28form at yalecancercenter.org.
28:28 --> 28:30We hope you'll join us next week to
28:30 --> 28:32learn more about the fight against
28:32 --> 28:34cancer here on Connecticut Public Radio.
28:34 --> 28:36Funding for Yale Cancer Answers is
28:36 --> 28:38provided by Smilow Cancer Hospital.

Information

Health Disparities and Substance Use among Youth with guest Dr. Grace Kong December 4, 2022 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095