Crow Wing Energized officials gave an eye-opening presentation to the county board about tobacco use in the county and electronic cigarette use by Brainerd High School students.

In January, the Crow Wing Energized Tobacco Coalition was formed by the grassroots group to address the rise in tobacco use in the county. Coalition representatives sat down with the county board of commissioners at the Tuesday, Aug. 20, committee of the whole meeting.

“Based on the survey results right here, we put together a coalition of health care professionals, law enforcement, city officials, the schools and community leaders,” said County Community Services Division Manager and Crow Wing Energized Co-chair Kara Griffin.

According to the Minnesota Department of Health, 1 in 5 deaths in the county are due to tobacco use and more than $60 million is spent annually on treating tobacco-related disease and illness within the county.

“I just find it amazing how we’re working on tobacco -- to get people to quit smoking, but yet it’s legal -- and now all these kids are doing the vaping thing, and they say that’s worse. … It just doesn’t make any sense to me,” Commissioner Paul Koering said. “It’s just kind of insane.”

Crow Wing Energized

Crow Wing Energized is focused on reducing the harm of commercial tobacco through increasing “community knowledge and awareness of the dangers of tobacco use, available resources, and through policy, systems and environmental change.”

“Based on our 2017 survey, we noted that we had an increase by 6% in people that are using tobacco, and tobacco would include the vaping, the e-cigs, chewing tobacco, chewables … and less than half were attempting to quit, which was also a decrease from 2013,” Griffin said.

Crow Wing Energized’s mission is “to improve the health and wellness of county residents by engaging formal and informal community leaders, so the healthy choice becomes the easy choice.”

“And they (tobacco industry) also have done a really nice job of targeting those that are most vulnerable, so our lowest-income population,” Griffin said of the 44% of cigarette-smoking adults in the county in 2017 that made less than $20,000 a year.

An electronic cigarette, or e-cigarette or e-cig -- sometimes also known as a “vaping device” -- is a battery-operated device that typically heats a flavored nicotine solution into a vapor, which is then inhaled.

“I think people starting vaping or using e-cigs thinking that was a healthier alternative, and especially with our youth population, and now we know the negative impacts,” Griffin said.

A new study by Minnesota researchers found positive effects from a comprehensive statewide tobacco control program, including more than 4,000 lives saved and over $5 billion in saved health care and productivity costs.

Conducted by HealthPartners Institute and ClearWay Minnesota, the research validates two decades’ worth of smoking prevention and cessation efforts at a time when funding for such efforts will soon run out.

“The tobacco industry is clearly targeting the youth with their flavors. What adult wants to smoke cotton candy? … And we know that youth brains are not as developed, and we’re introducing these chemicals as well as it’s highly addictive factors,” Griffin said.

E-cigarettes

Among retailers assessed in the county, 9 in 10 sold flavored tobacco and 2 in 3 sold menthol tobacco, according to the Minnesota Department of Health.

“They market to a group, and then people get hooked on it and then we spend tax dollars to try to get them unhooked off of it,” Koering said.

The devices have shrunk in size over the years and may resemble a lighter, an iPod or a USB flash drive, for example, depending upon the manufacturer, making the e-cigs portable, concealable or often mistaken for other things than a vaping device.

“That one looks like a small cellphone,” Koering said at the information-only meeting where Jessica Williams, a member of the Crow Wing Energized Tobacco Coalition, brought examples.

According to the Centers for Disease Control and Prevention, e-cigarette aerosol can contain harmful substances, including heavy metals, cancer-causing chemicals, and flavorings such as diacetyl that can cause permanent lung damage, Williams told commissioners.

“If we can’t have lead in paint, why are they allowing lead in these products? … I would see more kids utilizing this product with lead in it than going along a house and chewing on the siding to get lead in their lungs,” Commissioner Steve Barrows asked.

Williams replied, “Part of it is regulation hasn’t kept up.”

The rate of cigarette smoking among 18- to 24-year-olds has been cut nearly in half, from 15.3% in 2014 to a new low of 8.5% in 2018, but e-cigarette use by this group nearly doubled during that same time, according to the 2018 Minnesota Adult Tobacco Survey of statewide data.

“And then you also saw an increase in the percentage of people who were using these products that have never smoked or been previous smokers,” Williams said.

In 2018, 44% of e-cigarette users reported they have never smoked cigarettes; this is up significantly from 2014, according to the 2018 Minnesota Adult Tobacco Survey, and among young adults, 72.6% of e-cigarette users never smoked, compared to 30.4% in 2014.

“Initially, the idea of coming up with these devices has been if you take away the actual combustion of cigarettes, it would be less harmful than smoking a combustible cigarette, but there’s still a significant amount of harm with the different heavy metals and other chemicals,” Williams said.

She said use of nicotine salts by some e-cigarette manufacturers can provide a higher, quicker release of nicotine into the body than other manufactured e-cigs. This more closely simulates the experience of smoking a combustible cigarette and can also make them more addictive.

Tobacco coalition

Conventional cigarettes remain the most commonly used tobacco product among Minnesota adults, according to the Minnesota Department of Health and ClearWay survey, and the percentage of adults who smoke cigarettes has dropped to 13.8%, down from 14.4% in 2014.

“One of the webinars I was part of, just to become educated, talked about an hour at a hookah party, which I didn’t know what a hookah party was, but an hour being at the hookah party was the equivalent of smoking 200 cigarettes in that short amount of time,” Griffin said of vaping.

Crow Wing Energized is led and funded by Crow Wing County, Essentia Health and the Statewide Health Improvement Partnership.

Crow Wing Energized created a student survey with help from the Minnesota Department of Health this past spring to provide insight into tobacco usage and mental illness among high school-aged students.

“So just imagine being a teacher in the school system and having kids with these items,” Griffin told the commissioners about the pocket-friendly e-cigarettes.

Williams said, “With the smaller sizes of these devices, it’s also easier for you to hide them, or their parents might not be aware what they are exactly.”

Of the almost 600 students surveyed from Brainerd High School and Brainerd Learning Center, almost 2 in 5 have tried cigarettes or e-cigarettes; almost 1 in 10 have smoked cigarettes in the past 30 days; and 1 in 5 students have used e-cigarettes in the past 30 days.

“It can give you a buzz. It takes about seven seconds for the nicotine to go through your lungs and into the brain, and so that’s part of why nicotine is addictive because you are getting an adrenal release and all those other chemicals going on in your brain associated with addiction,” Williams said.

And as with all tobacco products, nicotine can also pose a significant risk to pregnant women and result in low birth weights and interfere with brain development, according to Williams.

“So we know this is bad. We’ve heard of ‘dry counties,’ down in the South … what if the county board says no more vaping in Crow Wing County? Can we do that?” Koering asked.

According to ClearWay Minnesota, there are 40 cities and counties that have raised the tobacco age to 21 as of July, including Bemidji in Beltrami County.

Almost 95% of tobacco users start before 21, according to the U.S Department of Health and Human Services. Although e-cigarettes are not an evidence-based approach to quitting, 37.9% of smokers reported using them in their last quit attempt, according to the state survey.

“It takes about 7 to 10 quit attempts for somebody to actually quit nicotine,” Williams said.

ClearWay Minnesota, a nonprofit organization created by Minnesota’s tobacco settlement, provides nearly 70 percent of total funding for cessation and prevention efforts around the state, but the organization is set to sunset in 2022.

What is Crow Wing Energized doing?

  • Promote smoke-free environments.

  • Promote cessation resources.

  • Establishing a tobacco coalition of community members.

  • Public and youth education campaigns.