Board of Health - October 18, 2019 Minutes
Regular Meeting: Friday, October 18, 2019
Present: Chelsey Matter, Christopher E. Anderson, MD, Chad Peterson, Lyn Telford, John Strand, Robin Nelson
Absent: Mike Thorstad
Others Present: Desi Fleming, Melissa Perala, Lori Sall, Suzanne Schaefer, Melissa Markegard, Preston and Brenton Nesemeier, Jan Eliassen, Larry Anenson, Heidi Lako-Adamson, Justin Bohrer
Chelsey Matter, Chair called the meeting to order.
Approve minutes from August 16, 2019: Robin Nelson made a motion to approve the minutes as presented, Lyn Telford seconded. All member voted to pass it unanimously and the motion was carried.
Justin Bohrer gave an accreditation update on PHAB process; we are 56 days away from deadline. Recently completed Performance Management Quality Improvement Plan, it was reviewed by management and staff. Workforce Development Plan is being worked on before the end of October. All Staff Survey and Core Competency Assessment have recently been completed. Things are looking good we will work on CHIP in January and February. Chelsey Matter asked about the DL meeting that was going to happen last time the Board met and Justin responded that the Detroit Lakes meeting was cancelled and then there was another meeting and it was cancelled. They are still working on getting together.
Larry Anenson discussed October being breast cancer awareness month. Female breast cancer represent 15.2% of all new cancer cases in the United States and 1 in 8 women will be diagnosed with breast cancer in their lifetime. Women’s Way is a program that helps with the financial burden of testing for breast and cervical cancers. This afternoon FCPH is holding a community event at 2:00 P.M. for breast cancer awareness. The Mayor of Fargo, as well as breast cancer survivors, will be there and everyone on the board and in the community is welcome to attend.
Melissa Perala reviewed the budget numbers. Not a lot to report regarding the revenues. There are two new grants and more family planning money. There will be a budget adjustment coming up because of the additional family planning money. End of September to end of March we will have $73,000 for supplies and marketing for underinsured and uninsured people. Public Health Network Opioid Response and ND Comprehensive Cancer Control are also new grants. The Opioid Response funds will help pay for Robyn Litke Sall’s salary. The comprehensive cancer and obesity control is to keep kids active. Nothing new on the expenses. We are at 71% right now and last year we were at 74% today so we are sitting a little better than last year. A lot of grant money has been coming in. Chad Peterson inquired about the Vet services expenditure line. Melissa responded that we could not budget for a lot of this money because it is donated. The building repair is a high cost at the shelter because it is an old building that needs constant care. The money for Tobacco is for media services so as soon as revenue comes in it will set off the expenses, the budget was not adjusted for that.
E-Cigs
Larry Anenson introduced the topic by stating that there is a great deal of information out of there but not all of it is accurate. In order to state some facts about E-Cigs he introduced Dr. Lako Adamson, Brenton Nesemeier, Melissa Markegard, and Preston Nesemeier.
Melissa Markegard Her presentation is one that is given to students and teachers in the area regarding the current vaping epidemic. There are flavors, they are easy to use and easy to get, the devices are designed in a way that make them easy to hide and the nicotine content makes them very hard to quit. Kids do not say E-cigs; the industry wants people to not use the word cig with vaping so people feel they are not connected. Kids say Vaps or Juuls, legally they are called ENDS (Electronic Nicotine Delivery Systems). That term is being used so all of them are covered under the laws that are being enacted. It is not harmless water vapor and it is not safer. It is not safe for adults or a minor. With these vape devices besides the dangers of nicotine and foreign substances in your lungs, it has to do with nano particles that are being inhaled into the lungs. The brain is still developing until women are 25 and men are 27. Changes how your brain is developing. Parents and friends will notice changes in the kids that are vaping. Nicotine affects your blood pressure. Kids came up with a term for the adverse effects calling it Nic Sick. What it really means is nicotine poisoning. It hurts them physically and mentally but because of the addictive qualities, they will continue to vape, which means they are addictive. There are very few restrictions on them and they have never been approved as a cessation aid. They are not allowed to advertise that anymore because it is not approved for that. There have been flavor bans in some states. The advertising is very youth orientated. There are some policies out there such as raise prices, flavor bans, purchase age up to 21, and raise taxes. When you look at the devices, they are designed to be hidden and blend in. An adult does not hide their vaping device. Things to look for when kids are using: increased headaches, nausea, mood swings, irritability, anxiety, impulsivity and an unexplained sweet fruity smell. Handout shows what some of the devices look like.
Dr. Lako Adamson She discussed vaping induced lung injuries. It is difficult because there is so much new information coming in. She is looking at information from the CDC and the New England Journal of Medicine. There have been 1,299 confirmed lung injury cases. This number is probably much higher because they find this diagnosis by exclusion (meaning they look for other causes and when they rule other things out they will attribute it to vaping even though some of the other “causes” are not responsible or responsible by themselves). Many of the current cases did use THC oils. When you vape it becomes superheated which creates nano particles that get deeper into the lungs and when it condenses it leaves oil residue in the lung. It is not just the THC that causes this. It is the nicotine and flavors that cause this. Some of it is black market items but it is also the regular products. Seventy percent of those that have been diagnosed are males and this injury has caused 26 deaths so far. The numbers could be greater. Not every state has been keeping track of this. When you are inhaling foreign substances into your lungs some of the symptoms will be coughing, shortness of breath, chest pains, nausea, vomiting, abdominal pain, diarrhea, fatigue, fever, weight loss, it will develop over a few days or weeks. You can have fatigue, fever and weight loss. We need more research into treatment and cessation. We need treatment because even if it is made illegal we need to know how to treat it. The CDC is recommending that no one vape, regardless of age.
Preston Nesemeier There was mobile vending machines for tobacco products so we created an ordinance so you cannot use mobile vending for tobacco products. State license is required to sell electronic cigarettes and there is a penalty for each offense if sold to minors in the works. The business will go on probation the first time, including a $500 administrative penalty. Every violation after includes the $500 administrative penalty and a suspension of license if during their probationary period. We do tobacco compliance checks with local law enforcement. Four times a year in Fargo, West Fargo and twice a year in Cass County. So far, no vape shop has failed. FDA has approved nicotine replacement therapy (patches, gum, lozenges, inhaler, nasal spray, Chantix, Wellbutrin NOT vaping). If someone is currently vaping, they should switch to FDA cessation products. We have Break Away from Nicotine (BAN), which is a comprehensive treatment program that offers counseling, free nicotine replacement therapy for up to one year, internal referral, and is beneficial for people experiencing behavioral health issues, in home nursing or transportation issues. Offered at FCPH for residents giving them free nicotine replacement therapy for up to one year. There is also NDQuits which is free cessation assistance to ND residents and offers free nicotine replacement therapy for up to 8 weeks up to twice a year and provides phone and email counseling.
Brenton Nesemeier Discuss vaping stats for North Dakota, smaller towns are not reporting but there is most likely cases there too. A 17 year old just died; they are the youngest patient to die from vaping. Alaska has not reported a case yet but all other states have. Now with the flu season some of the symptoms overlap so they may not be diagnosed correctly. The cases are reported by phone or online to the ND Department of Health. Cases are preliminary assigned a disposition based on the information received and by following guidelines. Field epidemiologists complete a chart review to determine the final disposition of the case. Chart review includes reviewing all the labs, hospitalization information, and discharge/intake notes. The test by exclusion and they follow up with the provider and definitely rule out any other disease and show that no antibiotics cured it.
Questions:
Robin Nelson wanted to Melissa to talk about the impact on youth and the discreet products. Melissa said these are a marketing piece to target kids. In addition, when you ask a smoker how many cigarettes you smoked today, they can answer that question so you can get an approximate of nicotine taken into the system. With vaping, there is no distinct beginning and end. They can puff all day long. They also share hits off friend’s devices. When she asked the question of one of her BAN people this middle school student said they vaped about every 15 minutes. The addiction is so high they keep taking hits. From January to September we have 64 minors caught vaping last year the total number for the entire year was 64. Now that school is back in session, those numbers are going to increase. Chad Peterson wanted Dr. Lako Adamson to quantify the number of unreported cases more. Dr. Lako Adamson said we could not tell how many are not being reported or coded correctly because there is no ICD 10 code for it as it is an exclusion diagnosis. We cannot quantify it. Chad Peterson wanted to know if this comes from people who are modifying their pods or just regular vaping (no CBD or THC). For nicotine, there is nothing to assure the measurement of the potency of nicotine in the pods is accurate. The FDA should regulate the level of nicotine as a federal issue. At this point we are not raising the age of purchasing we are looking to fine the businesses here that sell to minors. John Strand mentioned that 5,100 people are dying every hour from cigarettes. Lyn Telford said that we should have a ban on all tobacco products for anyone under the age of 21. Melissa Markegard stated that if flu was killing us like this we would be more upset but since its tobacco, we do not act as aggressively as we should to prevent and treat it. Majority of youth using cigarettes rate has dropped to 8% but unfortunately, youth vaping has gone from 20% to 33%. This is what is addicting our youth. Vaping one time can injury your lungs because of the smaller particles. The Board of Health endorses the FDA and CDC stance on vaping in that all individuals should refrain from vaping. Chad Peterson mentioned the Montana Meth Project that is supposed to scare youth into not using. Melissa Markegard responded that normally scare tactics do not work. We have the National Anti-Tobacco campaigns and the Truth Initiative but it is difficult to beat big tobacco. They own the vaping companies and are backed by billions of dollars. They send lobbyists to prevent anyone from going after their bottom line. Robin said that lawmakers should look at it again and would benefit from seeing Melissa’s full presentation. Lyn mentioned if they have to wait until 21 to drink why not tobacco. Public Health will work on a policy. Some Minnesota counties have raised the tobacco age to 21. Fargo is the biggest community and we set the example for the state so we should raise the age as well as do a flavor ban.
Public comments: None
Meeting Adjourned
Next Meeting: December 13, 2019