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Individual Steps to Critical Media Awareness

Take ads seriously. Think about how they are selling to you. Consciously choose to accept or reject. 2. Discuss with friends -- analyze ads together. Be vocal about ads that are violent toward women. 3. Exercise your consumer power. Write letters to editors. Vote at the cash register by not buying.

Tobacco's Toll

14% men and 11 % women (2018). Half of children regularly exposed to SHS • Shortens life 10-14 years. Half of smokers die from smoking. Over $240 BILLION is spent each year to treat smoking-related diseases. Worldwide over 6 million deaths per year (CDC). Will be 8 million by 2030.

Campus Efforts

26.4% of women sexually assaulted in college (2019). Campus Sexual Violence Elimination Act (part of VAWA) • to enact campus policies for education, reporting, discipline and support California: • Affirmative Consent Standard - to evaluate cases • High School Education Curricula

Is violence a public health issue?

3 women die every day in U.S. at hands of their partner or ex. ¨ 40% of mass killings begin with the killer targeting partner, wife, ex ¨ 1 in 6 women, 1 in 19 men stalked ¨ 1 in 5 women, 1 in 16 men sexually assaulted while in college. ¤ 95% of student assaults go unreported (ACLU)

Sexual assault

66-75% of sexual assaults are done by someone known to the woman ¨ 70% of all sexual assaults are planned ¨ Only 36% of rapes and 20% of attempted rapes are reported to police

African Americans

85% of African American smokers use menthol • Promotions in "Focus Communities" (poor, urban, African American) • Themes of African American urban experience, clubs, music, Hip Hop culture

Pen Pal Vape Pen

A vape pen that writes • Usually comes with replaceable ink kits and a rechargeable battery that is compatible with USB chargers

The Leo Knudson Family Fund - Helping Cancer Patients during the COVID-19 pandemic (29 families)-Small Grants

Alleviated food insecurity • Helped to pay funeral costs • Housing/rent avoiding evictions • Provided stipends for monthly expenses while patient in chemotherapy • Supported a widow with young children • Supported a caregiver • Support for a fruit vendor

Care for Caregivers Program Support

Food for health care workers PPE equipment to LAC+USC and community members Care packets for health care workers Tutoring for children of health care workers (130 children)

Edutainment: At the intersection of education and entertainment

Based on Communication and Behavioral Change theories, this framework helps explain how change can be achieved through "raising social consciousness and by educating the public via a custom-tailored piece of entertainment that is capable of producing behavior change. " Miguel Sabido (1969)

Health Disparities

CVD accounts for one-third of the disparity in years of life lost between African American and White populations • Stroke - twice as high among African Americans • Heart disease deaths - one third higher, and earlier among African Americans and AI/AN • Diabetes higher among African Americans, Hispanics, AI/AN, contributing to heart disease.

Second Generation: E-Cigarettes with Prefilled/Refillable Cartridge

Can be used multiple times and is rechargeable • E-liquids can include nicotine, cannabis, flavorings, solvents (propylene glycol and vegetable glycerin), or other substances • Includes a cartridge that can be refilled/replaced or the device comes prefilled • Are not modifiable • Cartridges and battery pens are usually bought separately • Can have between 200 to 500 puffs

Tamale Lesson

Our study challenged the underlying assumption that the traditional recitation of facts is the optimal way to convey health-related information. • Why did Pinocchio's nose grow? (TR01) • What was the name of your third-grade teacher and one significant fact she taught you? • Tested Narrative versus Non-Narrative Narrative versus Non Narrative - Tamale Lesson vs It's Time Had a Pap Test/Made an Appointment) at 6 Months Follow-Up Transportation Identification Emotion

Intimate partner violence (IPV)

Pattern of purposeful coercive behaviors that may include: ¨ inflicted physical injury, ¨ psychological abuse, ¨ sexual assault, ¨ progressive social isolation, ¨ stalking, ¨ deprivation, ¨ intimidation, ¨ threats ¨ By someone involved in an intimate or dating relationship ¨ Aimed at establishing control of one partner over the other.

Environmental Cues

Environmental cues are signals around a person that inform them what is happening and how to respond. Help focus on a required or preferred action. Environmental cues help shape behavior. Environmental cues mean that the instructions to do something come from the environment rather than from an individual What is an example of a natural cue? A tree for example (The Jacaranda tree) A natural cue is one in the natural environment that the observer can see, hear, touch, feel, smell, experience

Violence Against Women Act

Establish Office of Violence Against Women, Dept of Justice, Hotline. ¤ Helps states enforce protection across state and tribal borders ¤ Funds training & education of court personnel ¤ Reauthorizes STOP (Services, Training, Officers, & Prosecutors) Domestic Violence, expands it to dating violence ¤ Funds improvements to databases dealing with stalking, dating violence, sexual assault, and domestic violence. ¤ Funds programs to protect women including college women and women with disabilities, against rape and violence ¤ 2013: Extended to same sex couples, undocumented immigrants, jurisdiction of tribal courts. 2019: Transgender. ¤ Developing model intervention programs ¤ Protocols to protect women in prisons & juvenile detention ¤ Streamlined laws such as civil court protections

Virtual Reality/Animation (in the works)

Examining Vaccine Hesitancy - Using lessons learned for COVID vaccinations • Making end of life more meaningful- taking care of the whole person • LAC+USC County Hospital (+ Viterbi) • USC Institute for Creative Technology • USC Office of Research Advancement • Collaboration Fund • USC SensoriMotor Assessment and Rehabilitation Training in Virtual Reality Center • USC SMART-VR Center studies and develops virtual technologies for healthcare. • Led by Sook-Lei Liew, James Finley, Albert Rizzo, Judy Pa, Marientina Gotsis and Glenn Fox Engage Young people through Virtual Reality and Animation Experiences (LAC+USC) • Family Reunions Project (immigrant families)- returning home via VR • Improve quality of Life of Cancer Patients • Rendever (Seniors check off bucket list)

Effective Partnerships between Health Care Providers and DV Programs

Examples of effective models including: (1) trained clinical staff with referral relationships with local domestic violence programs; (2) co-location of domestic violence advocates in clinic settings for immediate response; (3) hospital-based domestic violence staff; (4) integration of domestic violence responses in the patient-centered medical home; and (5) home-visiting services

Es Tiempo

Exploit the blooming of a stunningly beautiful Jacaranda tree's annual bloom as an environmental cue to come in for screening (if have not been screened) and/or get vaccinated against HPV. Es Tiempo outdoor campaign images • Bus benches Billboards Lamp posts Es Tiempo

VAWA Doesn't Cover

Female Genital Excision (half million at risk) (may be found in U.S. among East Africa refugees) ¨ Only limited efforts to stop sex trafficking. ¨ Forced child marriages. ¨ Under fire by NRA: stopping gun sales to men convicted of violence toward women

Other Possible Risk Factors for African Americans

Fewer physicians, researchers • Disparities in clinical encounters, screenings, referrals • Stresses related to poverty and systemic racism: - John Henryism: high prolonged effort under stress. - Sojourner Syndrome: stay strong, constantly. - Stress Process Model/ Geronimus' Weathering Hypothesis: early stress & deterioration.

Cancer Community partnerships to reach at risk populations to fight COVID-19 - Via Small grants

Funded community partners to directly engage in innovative COVID education Community partners working together on cancer and COVID-19: • The Men's Cancer Network (AA) • Celebrate Life Ministry (AA) • Haus of Volta (NHW women) • The Colon Club (AYA) • Hep B Free (API) • Camarena Health (H/L Agricultural Workers) • IDEPSCA (H/L Jornaleros/Day laborers • Weingart YMCA

Survivors of one form of violence are more likely to be victims of another

Girls who are sexually abused are more likely to: suffer physical violence and sexual re-victimization engage in self-harming behavior be a victim of intimate partner violence later in life q Youth who have been physically abused by a dating partner are also more likely to have: suffered or witnessed abuse been a victim of sexual q Women and girls involved in gangs: often experience physical, emotional and sexual abuse by other gang members are more likely to have been abused as children

High Blood Pressure Treatment Among African Americans - Not Working Well

Have HBP: 48% White, 56% Black adults • Treated: 60% White & Black adults • Uncontrolled: 52% White, 61% Black • Doctors not adequately treating African Americans. • Mortality (due to HBP): 15% White males, 50% Black males; 15% White females, 41% Black females • AA's may have higher genetic risk and risk factors of obesity, smoking, salt, sedentary lifestyle, stress.

Third Generation Continued: Sub-Ohm Tank

Have low resistance coils, allowing users to create a large cloud (aerosol) with a strong delivery (hit) of nicotine and other substances

Cardiovascular Disease - CVD

Heart and blood vessel disease or "Heart Disease" - Heart Attacks: coronary heart disease - Stroke: cerebrovascular disease (major strokes or TIA's) - Atherosclerosis - ongoing disease Almost one in five people in U.S. has some form of heart disease • Leading cause of death in U.S. Coronary Artery Disease - Atherosclerosis One kind of heart disease - the most common • First sign may be a heart attack • Plaque builds up in arteries, narrowing and hardening them • Reduces blood flow and weakens heart Heart Disease Can Lead to Heart Attacks One-third of all premature deaths • One in six deaths overall in U.S. • Higher in women than men. • AI/AN and African Americans bear largest burden. At earlier ages. • 7 out of 10 have high blood pressure at time of first attack. Heart Attacks - Different for Women Symptoms in women can be vague - sweating, chest pressure, jaw pain, etc. • Push your doctor, push yourself to check. • Learn hands-only CPR to save a life. Stroke Blood flow to the brain is interrupted by a blocked or a burst blood vessel. Fast onset. • Major - hemorrhagic • Minor - transient ischemic attack or mini-stroke (85% of strokes) • Primary cause of long-lasting disability in U.S. • Declining in the US mainly due to better control of hypertension & smoking. (8 out of 10 have HBP) Most of the major risk factors for cardiovascular diseases are "modifiable" Smoking/commercial tobacco use • Diet • Physical inactivity • Obesity • Uncontrolled hypertension • Uncontrolled diabetes • High cholesterol

Tobacco Use

Heart attack risk 2 to 4 times higher among smokers. • Stroke 2 times higher. • One-fifth of heart disease deaths due to tobacco. • African Americans start smoking at a later age; have more difficulty quitting, and greater morbidity & mortality due to tobacco. • Marketing aimed at African Americans.

Messaging - HPV - examining vaccination hesitancy - Addressing misinformation

Messaging: Vaccinate both Boys + young men and Girls + young women if we are Going to make a difference

CVD Risk Factors: Modifiable vs. Non-modifiable

Modifiable • Hypertension • Diabetes • High Cholesterol • Smoking • Low Physical Activity • Stress Non-modifiable • Race • Genes/family history • Gender • Age • Environment of Systemic Racism

Popular Education - Accelerating translation from discovery to delivery by engaging communities in participatory processes

It takes approximately eight years for scientific discoveries to reach communities. • Need to accelerate the process of translation from the bench side to the bedside to community public health interventions and influence various level. • We need to optimize engagement and communication in a bidirectional manner.

How common in same-sex and bi-sexual relationships

Lifetime Prevalence: ¨ 44% lesbian women, 61% bisexual women, 35% heterosexual women. ¨ 26% gay men, 37% bisexual men, 29% heterosexual men. Less often reported to police and taken less seriously by police. Additional psychological abuse: include threats to "out" victimized individual to his/her social support system; or to keep person isolated

Effective Strategies to eliminate disparities

Listen to the community Create a CAB or CAAB Actively and continuously engaging community partners Responding to community needs by incorporating feedback into program planning Developing educational products that are culturally and language specific and resonate with the community of focus Developing transdisciplinary teams Employing and deploying community health workers (promotores de salud) Negotiating a common agenda Shared learning

Visionary: The Tobacco End Game

Lower nicotine levels gradually to zero. 2. Redesign: Raise pH to make taste & smoke unappealing. 3. Annual license to smoke. 4. Raise legal smoking age each year. 5. Require Rx to buy. 6. Set prices to reduce profit margins each year.

risk factors

Major CVD Risk Factor: High Blood Pressure (HBP) Reading over 120/80 • One in three adults (29%) - Half of those have it under control - No symptoms • Higher as you get older, or if African American • Fair level of awareness: 54-66% • Effects: heart disease, stroke, kidney disease • Medication, weight loss, stop smoking, reduce salt, reduce alcohol, exercise more Risk Factor: Sodium Average actual consumption: 3,500 mg/daily, RDA is 2300 mg and RDA for high risk adult is 1500 mg Risk Factor: Diabetes Causes a breakdown in the vascular system • Contributes to heart disease, kidney disease and blindness • African Americans are about 2x's as likely to develop Type II diabetes as non-Hispanic Whites. • Diagnosed in adults (2022): - 7.4% Whites - 10.4% Filipinos / 5.6% Chinese - 11.8% Latinos - 12.1% African Americans - 14.5% American Indians and Alaska Natives Risk Factor: High Blood Cholesterol Plaque build up. • 2 in 5 adults have high cholesterol - (≥ 200 mg/dL) • African Americans: - 10.5% women, 9.2% men • About 1/3 of adults have never been checked • Risk factors • Lifestyle: reduce saturated and trans fats, lose weight, exercise more, stop smoking, reduce alcohol. • If that doesn't work: statins. Risk Factor: Sedentary Lifestyle Doubles the CVD Risk • Over 1 in 4 adults report no leisure physical activity (may do so at work or elsewhere) • Sedentary Lifestyle = less than 30 minutes brisk aerobic-type exercise or work at least 3 x week • Moderate levels (30 minutes daily, at least 5 x week) - confer benefits. Less than 1 in 4 adults do so. • No leisure time activity - more common among African Americans Protective Factor: The Heart Healthy Diet Controlled portion sizes. • Healthy Plate. • Avoid unhealthy fats. • Reduce sodium. • Healthiest: the DASH Diet

IPV Factors: Relationship

Marital conflict ¨ Drug and alcohol use ¨ Marital instability (divorce, separation) ¨ Dominance and control of relationship by one partner over the other ¨ Economic stress ¨ Unhealthy family relationships and interactions

Prevalence: Sexual Assault

One in 6 women and 1 in 59 men experience rape at some point; one-third experience PTSD ¨ 20 to 25% of college women experienced attempted or completed rape. 5% in past year. ¨ 12.5% women, 5.8% men sexually coerced at some point ¨ 1 in 12 women and 1 in 45 men stalked in their lifetime. ¨ 1 in 6 women are incest survivors ¨ Numbers are probably underestimates

How common?

One in every four women - in her lifetime. ¨ Females who are 20-24 years of age are at the greatest risk of nonfatal intimate partner violence. ¨ 1 in 4 teens report some sort of abuse from a dating partner each year. ¨ 2-4 times greater for women with disabilities. ¨ Most cases of domestic violence are never reported to the police.

First Generation Products: Disposable E-cigarettes

Only a one-time use Cannot be recharged or refilled Sometimes called "cigalikes" Typically contains ~200 puffs

Policies at San Francisco Board of Supervisors 1988-present

Retail environment: single cigarette sales, vending machines, self-service displays, pharmacies, licensing, density, tobacco 21, flavors/menthol, e-cigarette sales Protection from secondhand smoke: restaurants, bars, workplaces, playgrounds, transit stops, entryways, taxis, bingo, public housing, parks

Types of Violence - Physical Threats

Physical violence: intentional use of physical force with potential to cause death, disability, injury, or harm, withhold medical care, forcing drugs, imprisonment ¨ Sexual violence: ¤ Use of physical force to compel person to sexual act ¤ Sex act with individual unable to understand, decline participation, communicate unwillingness ¨ Threats of physical or sexual violence: words, weapons, stalking, gestures used to communicate intent to cause death, disability, injury, or harm for oneself or someone close

Popular culture can cultivate and reinforce violence as acceptable

Popular media images promote: ¨ Unhealthy lifestyles ¨ Impossible thinness ¨ Over-sexualization of young girls ¨ Racism ¨ Ageism ¨ Homophobia ¨ Subjugation ¨ Violence

Types of Violence- Other threats

Psychological/emotional violence: acts, threats of acts, coercive acts to inflict trauma. ¨ Economic violence: Forcing financial dependence, withholding access to monies, forbidding work or school ¨ Stalking: willful, repeated, malicious following of someone or harassing with intent to instill fear; often digital

Major CVD Risk Factor: High Blood Pressure (HBP)

Reading over 120/80 • One in three adults (29%) - Half of those have it under control - No symptoms • Higher as you get older, or if African American • Fair level of awareness: 54-66% • Effects: heart disease, stroke, kidney disease • Medication, weight loss, stop smoking, reduce salt, reduce alcohol, exercise more

IPV Factors: Institutions

Religion: Clergy and counselors may be trained to "save" marriages at all costs ¨ Legal system: ¤ Police officers may treat it as domestic dispute, dissuade women from filing charges ¤ Prosecutors may be reluctant to prosecute. ¤ Judges may levy a fine rather than a jail sentence. ¤ Restraining order may not prevent abuser from repeat assaults. ¨

U.S. Public Health Action Plan - Examples

Research on modifiable risk factors • Support for state surveillance efforts: - BRFSS - YRBSS • Policies & food labels - Remove trans fats in foods • Tobacco taxes and laws • Support for intervention research • Modification of school lunch programs

Sexual Assault Terms

Sexual Harassment: verbal, non-verbal, psychological conduct that is unwanted and sexual in nature ¨ Sexual Assault: any unwanted sexual contact from pinching to penetration or murder ¨ Acquaintance Rape: sexual assault to someone by someone they know ¨ Date Rape: sexual assault of someone by someone they had agreed to see socially Marital Rape: sexual assault of woman by her husband; sex is used to humiliate, hurt, dominate wife, and even threaten life

U.S. Action Plan to Prevent Heart Disease and Stroke - The Five Essential Components

Taking Action: Science, Knowledge for Prevention & Treatment 2. Strengthening Capacity & Organization: Public Health Agencies and Partnerships 3. Evaluating Impact: Monitoring the Burden, Measuring Progress, and Communicating Urgency 4. Advancing Policy: Defining the Issues and Finding the Needed Solutions 5. Engaging in Regional and Global Partnerships: Multiplying Resources and Capitalizing on Shared Experience

Retail Sales Promotions

The main place tobacco is marketed & promoted. • $7.8 billion in 2017 for cigarette marketing. • 78% at point of sale. • Discounts, coupons, shelving systems, displays, price discounts to high volume stores, slotting fees.

How is the data measured?

•Surveillance (Complete vs. sampling). •Specifically designed studies for COVID data capture (e.g. case-control). •Studies of convenience (originally designed to address a different scientific question, but adapted for COVID) •Electronic Health Care (HER) records. • •For each type of study, think of biases that might exist for that type of data, or how it might be missing data or have some uncertainty in the estimation: •For example, for EHR data, who has access to that specific health care system, who enters the health care system and why?

Proposition 31 - Uphold ban on flavored tobacco products

This prop is to overturn a 2020 law that prohibits the sale of some flavored tobacco products. • A "yes" vote upholds the current law • A "no" vote would strike down the law and allow the sale of flavored tobacco products. • In 2020, Governor Newsom signed a law to ban flavored tobacco products. • Law is not in effect yet. • At least 60 cities and counties across California have already banned the sale of some flavored tobacco products and menthol cigarettes.

Key Challenges

Tobacco use is the leading preventable cause of death in the United States. More than 16 million Americans are living with a disease caused by smoking. Smoking causes cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis. Smoking is a known cause of erectile dysfunction in males.

African American Diets

Traditional: May be high salt, fried, sweetened. • Non-Traditional: - More fast foods compared to other groups; prepackaged meals & foods (high in saturated/trans fats and salt) - Inexpensive/processed meat (high in fat, salt; low in healthy fats) - Low in fruits & vegetables - Soda • Black men eat fewer fruits and vegetables than any other population • Urban midlife Black women (Daroszweksi, 2004): 90% planned to avoid high fat foods; 70% consumed diets >30% fats

One section of law protects immigrant women

Violence Against Women Act (2000) ¤ Title V: Battered Immigrant Women Protection Act of 2000 changes immigrant law so abusive spouses cannot use the law to keep women from reporting abuse for fear of losing visas. Some types of visas to protect immigrant women or permit them to visit family.

Does the tobacco industry use their own products?

When David Goerlitz, a former Winston ad model, asked an RJR rep why the company's executives don't use their own products, the response was: "We do not smoke the (expletive], we just sell it. We reserve the right to smoke for the young, the poor, the blacks and the stupid."

Its not just a woman's issue

When we call rape a woman's issue, we move it away from a problem of the dominant culture to a problem that just affects women. • Instead of asking why Mary was beaten or why she stays, we need to ask John Why? • Jackson Katz, "Violence Against Women—It's a men's issue" TED Talk

Narrative Storytelling & Culturally specific in language Educational Videos

tay Connected Los Angeles: Where Art Meets Public Health to Combat the COVID Pandemic among Latinos in Los Angeles Stay Connected L.A. SPECIFIC AIMS • Develop, Test and Deploy a community-based participatory COVID-19 educational intervention for Latino populations in L.A. County where 'art meets public health'. • Assess and Promote Health Safety behaviors: vaccination, wearing masks, physical distancing, handwashing • Evaluate knowledge, social connection, & mental well-being Why are Hispanics/Latinos less likely to get the vaccine? Thought didn't qualify for vaccine Didn't want to give out personal information Concerned over Immigration status Vaccine cost Lack of health insurance Vaccine safety issues Vaccine effectiveness issues Lack of trust of government sources Misinformation on vaccine Overwhelming amount and sources of information Many are still issues today Campaign Element Resources Management and Referrals Approach • 10 Promotores de Salud trained • 66 clients followed for 8 weeks • Provided resources, exercises, made referrals Common themes: • Helped with masks, coping, quarantine • Education about COVID-19, boosters, *mental health was key issue • Information, guidance, & referrals for mental health, Medicare, housing, food insecurity PROGRESS: Survey -Design, methods & participants Compared to the Community sample, the CVN Client sample had: • MORE women, people of Mexican/Chicano identity, and people born outside of the U.S. • Less education, household income, and health care coverage placing them at higher risk Survey results • most were tested • ¼ were positive • Community sample took more risks in the past month vs. CVN ClientsGeneral health poorer among CVN clients. Mental health poorer in Community sample Most of the Community sample (81%) saw the campaign vs. 1 in 3 (33%) CVN clients Exposure to the campaign was via: • 56% billboards • 43% posters • 35% website • 35% social media • 14-20% bus benches, murals, lamp posts Liked: motivates people to get vaccinated • teaches the importance of vaccination • focus on keeping the family safe & healthy • images, colors, Spanish, essential workers Stay Connected Los Angeles Vaccination rates were higher in our samples vs. LA County Hispanic/Latino population's Vaccination rate (1+ dose) • 95% of Community sample • 87% of CVN Clients sample • vs. 65% of Latinx population in LA County Campaign exposure was associated greater vaccination among CVN Clients Percent of12+ vaccinatedwith 1+ dose during active period of Stay Connected L.A.

By Population- Rates of Women Raped in Their Lifetime

¤ By Race/Ethnicity ¤ White - 18% ¤ Hispanic/Latino - 14% ¤ Asian/Pacific Island - 7% ¤ American Indian - 34% ¤ African American - 22% ¨ Women with disabilities have highest rates of sexual violence and interpersonal violence ¨ Women in poverty: 3 times greater rate of domestic violence compared to women not in poverty

Who is involved in IPV?

¨ Current or former partner or spouse ¨ A parent against a child ¨ Caretakers or partners against elders, mentally disabled, physically disabled ¨ Between siblings ¨ 2/3rds of assaults against women are by someone they know

Why do women stay?

¨ Poverty ¨ Pressure by friends, family, co-workers to stay ¨ Familiarity ¨ Love of partner and difficulty giving up hope ¨ Fear of losing or harming children ¨ Intimidation, physical & economic

ecigs Not Safe!

• Can contain nicotine salts, more potent than in box mods or cigarettes, with amounts unregulated. • Can contain vapor that is harmful, with flavors and nicotine. • Can lead to cigarette use. • Tobacco industry moving away from combustibles?

Community Coalitions

• Grassroots organizing to pass institutional policies, like no tobacco sales on the property. • City and county policies to ban flavors. • Local efforts lead to state legislation like SB793 - banning sales of flavors, menthol.

Menthol & Mint: Helps the Poison Go Down

• It makes smoking more palatable, less harsh • Harmful as an Additive: • Teen starter product; • Greater potential for addiction; • Harder to quit; • Potential for relapse; • Vehicle for predatory marketing to vulnerable populations.

Federal FDA Regulation: Family Smoking Prevention & Tobacco Control Act

• No free samples, • Limits self-service sales, brand sponsorship of events, etc. • Banned flavored cigarettes except for menthol • Removed labels "light" & "mild" • Bans sale of "loosies" except flavored cigars • Now: approval of vape products

State: The California Anti-Tobacco Program

• Prop 99 Tobacco Tax, 1988 • Prop 56 Tob Tax, 2016 • Health Departments, Schools, Community-Based Grants and Statewide Grants • Statewide Media Campaign & Counter Marketing • Data Analysis and Evaluation: Over $1 Billion Spent in 20 Years • One of Lowest Smoking Rates in Nation

Propositions

• Proposition 1 - Guarantee Abortion Rights in State Constitution. • Proposition 26 - Legalizing Sports Betting at Tribal Casinos. • Proposition 27 - Allow Online Sports Betting • Proposition 29 - Impose New Rules on Dialysis Clinics

Third Generation: Tanks or Mods

• Rechargeable vaping product designed for multiple use • Are modifiable ("mods") which allows consumers to customize the substances in the device • Have tanks or pods that are continuously refilled

Food Insecurity- YMCA Distribution Program - Small Grant

• Servicing 1300 families each week • Over four million pounds of food distributed •People still hungry - unemployed - challenged by reduction in number of drivers •Expanded from areas surrounding HSC to 22 neighborhoods Expanded to other programs via local churches and Boys and Girls Club

State Policy: Tobacco Taxation

• Tax increases are the single most effective intervention to reduce tobacco consumption (demand for tobacco) • 10% price increase è • Consumption drops

Fourth Generation: Pod Mods

• Vaping product with "pod" cartridge that also contains a modifiable system ("mod") • Has a variety of shapes and sizes • Common brands include Juul and Suorin • Are refillable with compatible prefilled pod cartridges that contain nicotine, THC, and CBD with or without flavorings