WA House RSG - Committee Meeting
(September 17, 2024) - DOH YCCTPP Updates

2024-09-17 - WA House RSG - Committee Meeting - DOH YCCTPP Update - Takeaways
[ Event Details ]

DOH youth tobacco and cannabis prevention staff interpreted Healthy Youth Survey data, shared public health goals for the future, then responded to questions and concerns from legislators.

Here are some observations from the Tuesday September 17th Washington State House Regulated Substances and Gaming Committee (WA House RSG) Committee Meeting.

My top 4 takeaways:

  • Hannah Febach, Washington State Department of Health (DOH) Division of Prevention and Community Health Policy and Rules Manager, talked about the role her department played in communicating risks of tobacco and "high potency cannabis,” including educating retail staff, and mentioned the assistance of federal grants (audio - 4m, video - TVW, Presentation, Fact Sheet).
    • Formerly known as the Youth Marijuana Prevention and Education Program (YMPEP), the Youth Cannabis and Commercial Tobacco Prevention Program (YCCTPP) sponsored training on vapor product disposal in November 2023, followed by a training on cannabis education and safe storage led by University of Washington Addictions, Drug, and Alcohol Institute (UW ADAI) researcher Bia Carlini the following month.
    • Febach told lawmakers that Heidi Glesmann and Marie Gray co-managed the YCCTPP. She indicated they would cover “a brief overview of the department's role in cannabis and commercial tobacco prevention work and share some high level information about our programming,” as well as more details about the “2023 Healthy Youth Survey [HYS] related to youth tobacco and cannabis use. And finally, we'll share some insight into the department's goals looking forward in these important areas of public health work.”
    • Providing “some clarification on word choice in our presentation today, we talk about ‘commercial’ tobacco,” said Febach, in order to recognize “the difference between commercial tobacco and traditional tobacco, which has cultural, medicinal, and spiritual importance to several American Indian tribes. Any references we make to tobacco today, we're talking about commercial tobacco.”
    • Febach highlighted three reasons DOH officials undertook this work:
      • First, “that commercial tobacco remains the leading cause of preventable death in the United States.”
      • “The second is that use of nicotine and THC [tetrahydrocannabinol] can have a negative impact on developing brains, including areas that control attention, learning, mood, memory, and impulse control…we're still learning about some of the long term health effects of high potency THC.”
        • Researchers, public health officials, and cannabis sector interests planned to discuss cannabis health effects and policy at the Thursday September 19th symposium hosted by the UW ADAI regarding, “Cannabis, Schizophrenia, and Other Psychotic Disorders: Moving Away from Reefer Madness Toward Science.”
      • “And finally, emerging products like new vapor products and nicotine pouches are surging in popularity with youth. We really see it as our role at the department to ensure that parents, public health…workers, educators, and policymakers understand the risks associated with youth commercial tobacco and cannabis use, and have the confidence, skills, and tools to support the youth in their lives.”
    • Febach described how DOH work was “guided by the Revised Code of Washington and federal guidance for commercial tobacco,” and included coordinating “prevention and cessation efforts across the state, disseminating state and federal funds, serving as the CDC [US Centers for Disease Control and Prevention] grantee for the National and State Tobacco Control Program,” plus acting as “primary subject matter expert and resource for organizations, communities, and individuals in Washington.” For cannabis, their efforts included, “overseeing the cannabis use public health hotline, prevention and education, programming, media based education campaigns, outreach to priority populations, disseminating State funds to the Washington Poison Center for cannabis and vapor prevention, and implementing policy changes such as addressing the retail education needs for high THC cannabis, which stem from legislation passed last year.”
  • Commercial Tobacco Prevention Manager Heidi Glesmann and Community Partnership Manager Marie Gray offered their "cautious interpretation" of 2023 Healthy Youth Survey (HYS) responses around access, use, and “co-use” of tobacco and cannabis vapor products (audio - 8m, video - TVW).
    • Glesmann shared that a “unique” aspect of their programming was “more than half of our grantees and contractors are doing work that focuses on both cannabis and commercial tobacco prevention as well as tobacco cessation.” Her presentation showed how community partners were located around Washington, and she remarked when staff were “identifying priority topics, geographic areas of priority, or other programmatic decisions, we are using data as one of the tools to support this decision making,” including the biannual HYS responses.
    • Gray stated that the survey was useful for “identifying trends and patterns in adolescent…health behaviors, [as well as finding] areas of need to inform policy and practice, evaluate the impact of school and community prevention efforts, and lastly, provide data for grants and other funding sources.” Glesmann also sounded a note of caution, as “this survey went through some changes, and in tandem with the pandemic of COVID-19…there were some shifts and changes in data that were not present in previous years of this survey. This calls for cautious interpretation of the results over time for cannabis and tobacco. Specifically, we saw a drop of use by approximately 50% in 2021. That dropped rate has remained stable in 2023 and we are continuing to monitor this in the next iteration of the survey,” slated for 2025.
    • Considering the 2023 results around tobacco and cannabis, Gray said “the data presented primarily focuses on 10th graders, as that is our program benchmark,” where “cannabis and E-cigarettes are one of the top three highest reported substances or products used.” Moreover, “smokeless tobacco and nicotine had a large increase in reported usage, and that is due to a question modification: products like nicotine pouches, lozenges, gum, and toothpicks were added to the definition.”
    • According to Gray, cannabis responses reinforced a “disparity that exists in reported use, especially when you disaggregate the data by demographics like race, ethnicity, gender identity, sexual orientation, identified risk, and protective factors, grade average, and mental health status.” Among five populations making up the high end of cannabis use rates, she pointed out that “American Indian or Alaskan Native, and Black or African American 10th graders that report cannabis use [reported at] 1.5 times more than the state prevalence.” Glesmann added that average tobacco or e-cigarette use was also higher among these groups.
    • Focusing on cannabis and tobacco vapor items, Glesmann emphasized, “due to the prevalence of use…as well as the overlap between cannabis and commercial tobacco, [responses showed the] primary method of accessing those products, these vapor products, is through social sources.” Gray mentioned that cannabis and tobacco vapor products had significant overlap, so HYS “has a question to address this, and helps our program understand what youth are inhaling when they're using these vapor products.” Students were reporting using nicotine vapor items the most, “with THC second, and a combination third.” Respondents who were unsure were closely behind in the “co-use of substances.”
    • Glesmann concluded their briefing by sharing how flavored vapor products, though already prohibited in the regulated cannabis market, remained common and favored by youth. The majority of 10th graders “report using it with a flavored tobacco and or cannabis product,” she said, and of those two in three reported using flavored cannabis vapor products. Use of multiple substances was another top concern, Glesmann remarked, which “only reinforces for us our thought that prevention and education is an intersectional issue.”
    • The impression Glesmann and Gray had was that, “while use continues to decline, there is still a need for prevention and education to maintain that decline.”
  • Glesmann and Gray took a moment to mention the goals of YCCTPP along with new staff joining the program (audio - 2m,  video - TVW).
    • Considering required components in HB 2320, a law passed related to “high potency THC,” Gray said their implementation of the statute involved hiring a new staffer (“which is really exciting”), developing mandatory signage for stores, plus “the beginnings of development for the retail education course.”
    • Gray also acknowledged working with WSLCB counterparts “to work on the recently completed cannabis consumer survey that will help guide public education and other programmatic efforts.”
    • Glesmann referenced the fact sheet provided to the committee that named six focus areas for the program through 2027:
      • Inform Washingtonians about the effects of cannabis and commercial tobacco on overall wellness through education.
      • Foster collaboration and innovation statewide in youth cannabis and commercial tobacco use prevention.
      • Ensure sustainability of cannabis and commercial tobacco prevention programming.
      • Improve social determinants of health to reduce disparities and improve quality of life in Washington.
      • Utilize upstream prevention approaches by drawing from existing science-based frameworks to create policy, systems, and environmental change.
      • Leverage partnerships and resources to move towards universal barrier-free access to commercial tobacco dependence treatment.    
  • Two lawmakers had a series of questions related to adult substance use prevention, racial and ethnic disparities, rural populations, and eliminating underage use.
    • Co-Chair Shelley Kloba was curious how education targeting adult retail consumers would impact youth substance use. Gray responded that this requirement was given to them by legislation, allowing regulators to emphasize more secure storage of cannabis in the home, and “hopefully that trickles down to youth” to reinforce the educational campaigns aimed at them (audio - 1m, video - TVW).
    • Representative Melanie Morgan said she was struck by the presenters’ emphasis on higher rates of nicotine use among Native American and African American youth, believing that “I know how addictions get started: high stress, poverty, peer pressure, behavioral health.” She noticed they “threw in at the end of your presentation there about improving conditions…but I don't hear a plan on really, how to address these conditions as they could be the root cause of the addiction in the first way” (audio - 5m, video - TVW).
      • Febach felt DOH “truly relies on the work of our partners…in these efforts, things like community organizations and nonprofits that truly uplift those community driven solutions to address these types of disparities.” These partnerships were important since local organizations “know their communities best, and what types of prevention and support work that they need to move the needle on this,” she stated.
      • Glesmann offered more specifics, referring to the nine regional contractors for YCCTPP who each had “a network of sorts of groups or organizations or different agencies throughout their county, multi-county, or single county region,” and produced work plans informed by HYS data. She then noted that, statewide, “we additionally have priority population contractors…working in those regions. So for the American Indian/Alaskan Native community, it's the American Indian Health Commission of Washington State. And for the Black and African American community, it's the Center [for] Multicultural Health.” These groups got funding dedicated to cannabis and tobacco prevention, Glesmann explained, stating there were also “tailored media campaigns…for each of those demographic populations we have identified.” She stated that staff tried to find effective programs for communities with above average substance use, including through community grants, in an effort to “expand the prevention network that exists in Washington state.” Glesman welcomed new organizations or awareness efforts, indicating that the nine contractors were retained for “18 months, and they're heading into their year two starting in about 30 days.”
    • Morgan was also curious how the programs reached rural communities in Washington “making sure it's not just focused in urbanized areas on the west side of the mountains” (audio - 1m, video - TVW).
    • Kloba inquired about declining cannabis use seen in the 2021 and 2023 results. Acknowledging that the survey cohort was changed during the pandemic, she hoped it would be possible to “follow up with us and show…the breakdowns, the 12th, the 10th, the eighth graders, and show the use over time and how that has decreased. I think that would be helpful.” She was interested in clarification on what they considered “cannabis use,” asking for the panel to “refresh me on, on how you define current use” in HYS questions (audio - 3m, video - TVW).
      • Gray checked whether Kloba meant “the way that people are using cannabis, or the timeframes that are asked about?” Kloba responded, “they were defining ‘current use,’ and it was like, 8.8% of 10th graders were responding ‘yes’ to current use,” asking, “what does that mean?”
      • Glesmann answered that this was asking students about substance use within the last 30 days, regardless of mode of ingestion.
      • Kloba voiced gratitude, “I saw some breaking out of cannabis and delta-8[-THC and delta-]10, there was 2% use.” She pointed out that was “the type of stuff that is available online with no age gating, and that is extremely serious. It's not tested. It's got all kinds of garbage in there. And so thank you for making sure you're following up on that particular subset.”
      • Learn more about WSLCB enforcement around non-regulated cannabinoid products from a September 10th briefing to board members.
    • Morgan asked about tobacco and cannabis resources for adults “who would appreciate prevention as well.” She also raised the question of WSLCB staff who’d testified earlier, “what is the plan to eliminate the illegal use of these substances by adolescents?” She regarded the current program as being “after the fact that they've already…used, they've already become addicted,” requesting an explanation “what do we do up front in terms of barring adolescents from using for them, because it's illegal. And…how is this prevention that we're going to be looking at for adults?” (audio - 5m, video - TVW)
      • Glesmann suggested information on handling illegal use of cannabis was the domain of the Washington State Patrol (WSP), but that DOH did have resources geared towards adults that talked about health and abuse risks for cannabis as well as tobacco. She said a key audience for this message was supporting “individuals with behavioral health conditions.” While there were adult-specific cannabis prevention and cessation resources, much of their program “focuses on adults and influential adults. Part of the reason that cannabis is focused on…that 12 to 20 population is that's how it was written in the legislation for us.” Gray seconded this explanation of their resources and program focus on those under the legal age to consume cannabis.
    • WSLCB Director of Legislative Relations Marc Webster described how retail compliance checks—whereby Enforcement Officers sent those under 21 into a licensed premises to attempt to buy tobacco or cannabis products—ensure “cannabis licensees are not that vector in which product is getting into the hands of youth.” He also remarked that money from the State dedicated cannabis account “does go into some of the prevention activities that, that our partners at the Department of Health are talking about here.” He then mentioned, “the store is not the only way that this is getting into the hands of folks. So thinking about how you tackle something like internet sales is a much broader topic.”

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