Public institutions are offices and other entities that constitute local, state, and federal governments. These organizations are funded by tax dollars and operate in the service of the citizens that pay those taxes. The federal government has tried to pass comprehensive healthcare reform in the past from President Roosevelt. It had been not easy due to the complexity, magnitude, and economic concerns in the health care system. The processes by which public policies are created are dynamic, fluid, and loosely connected (4).
Once Congress passes a law, it must be interpreted based on federal rules by the relevant federal agencies. Before a rule can be enacted, a proposed rule must be posted for a period of public comment and written responses made to each comment. A rule is finalized once it goes through the chain of the executive branch of government and a formal process that requires public posting and a formal response to every comment.
During the Presidency of Barack Obama in 2008 Congress passed the Family Smoking Prevention and Tobacco Control Act (TCA), which specifically designate authority for the regulation of tobacco products to the FDA on the premise that adults had the freedom to choose to use tobacco products but minors should not be exposed to an addictive substance. Intense action must be taken to prevent e-cigarettes from addicting a generation of children to nicotine. The manufacturers of e-cigarettes must submit the evidence to FDA if they argue that it helps to quit smoking. It is necessary to ban flavors that put down another generation at risk of nicotine addiction (3).
The following are the current laws in Arizona regarding tobacco/ vaping products (3). It is a petty offense in Arizona to sell, give or furnish tobacco or vapor products to a minor (anyone under the age of 18). Cottonwood and Douglas have passed a Tobacco 21 law, making the legal age to purchase tobacco 21. It is a petty offense for a minor to buy or have in his possession or knowingly accept or receive a tobacco or vapor product from any person. Arizona defines a “vapor product” separately from tobacco as “a noncombustible tobacco-derived product containing nicotine that employs a mechanical heating element, battery or circuit, regardless of shape or size that can be used to heat a liquid nicotine solution contained in cartridges. Vapor product does not include any product that is regulated by the United States Food and drug administration under chapter V of the federal food, drug, and cosmetic act.” The state-wide smoking prohibitions of A.R.S. § 36-601.01 (Smoke-free Arizona) do not apply to vapor products. The following municipalities have ordinances that prohibit vaping where smoking is not permitted (some exclude bars and restaurants): Tempe, Coconino County, and Flagstaff (1).
The Federal law that was passed on December 20, 2019, prohibits sales of all tobacco and vapor products to anyone under the age of 21 years old. FDA stated law became effective on that date. States may choose to continue with current age law at the risk of losing federal funding. Federal law prohibits the sale of closed system devices (pods, cartridges) containing e-liquid in flavors other than tobacco or menthol. Vapor products are not subject to any of the tobacco luxury taxes outlined in A.R.S. title 42, chapter 3(1).
Arizona Attorney General’s office said that reducing youth access to tobacco has been a priority but that it is still reviewing the new law to determine how it will affect the state. Arizona was one of 31 states where the legal age to buy tobacco was 18. However the cities of Tucson, Flagstaff, Goodyear, Douglas, and Cottonwood had raised the age to 21, according to the Campaign for Tobacco-Free Kids (5).
References
1) Arizona laws and taxes. Retrieved from http://www.casaa.org/find-my-state-info/arizona/
2) Arizona revised statutes. Retrieved from https://www.azleg.gov/arsDetail/?title=42
3) H.R. 1256 (111th): Family Smoking Prevention and Tobacco Control Act. Retrieved from https://www.govtrack.us/congress/bills/111/hr1256
4) Kingdon, J. W. (2011). Agendas, Alternatives, and Public Policies, Update Edition (2nd ed.). London: Longman Publishing Group
5) The toll of tobacco in Arizona. Retrieved from https://www.tobaccofreekids.org/problem/toll-us/arizona
6) Tempe vape shop owner reacts to federal ban on certain e-Cigarette products. Retrieved from https://www.fox10phoenix.com/news/tempe-vape-shop-owner-reacts-to-federal-ban-on-certain-ecigarette-products
Annie's Blog 
Hey Annie, Thank you for the informative blog, which led me to more reading on the topic of Adverse Childhood Experience (ACE). The National Institute for Health Care Management states (NIHCM) “one in three children have experienced at least one ACE and 14% experienced two or more. The most common ACEs were having a parent/guardian divorced or separated; living with someone with an alcohol or drug problem; and having a parent/guardian who has served time in jail” (NIHCM, 2019.) I was shocked to read these facts, though it was nice to know I would not be without tools when in practice. The NIHCM article went on to state that protective factors can help mitigate these ACE’s or stressors. Protective factors may include a nurturing and attachment environment, the parent’s resilience, social connections, concrete support from parents and social/emotional support from parents (Child Welfare Information Gateway, 2020.) Cultivating these protective factors could prove difficult in diverse clinical situations.
I found this Podcast (see references below) from the Child Welfare Information Gateway website. In these two podcasts, they discussed strengthening their protective factors through therapy and being aware of different coping mechanisms. I am continuing to work with children at my clinical site and now I am aware of more resources for the children and the parents. Thank you
References
Child Welfare Information Gateway. (2020, March). Protective Capacities and Protective Factors: Common Ground for Protecting Children and Strengthening Families. Retrieved March 6, 2020, from https://www.childwelfare.gov/topics/preventing/promoting/protectfactors/
Child Welfare Information Gateway. (2020, March). Retrieved from strengthening their protective factors. https://www.childwelfare.gov/more-tools-resources/podcast/episode-9/
National Institute for Health Care Management. (2019, November). How Adverse Childhood Experiences Impact Health. Retrieved March 6, 2020, from https://www.nihcm.org/categories/how-adverse-childhood-experiences-impact-health
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Medical and health entities in the public sector most definitely influence policies related to the issue of teen vaping. In previous years, leading medical institutions like the Surgeon General, lacked empirical data to build a case against e-cigarette use.1 This did not stop them from advising against the use of e-cigarettes, but concrete examples of the dangers were difficult to come by. Now that these products have been on the market for about a decade, the body of evidence has grown to clearly illustrate the dangers. Not only are there the inherent risks associated with nicotine, but a condition known as E-cigarette or Vaping Associated Lung Injury (EVALI) has emerged. While the exact etiology of EVALI is not well understood, there appears to be an association with the use of Vitamin E acetate and/or THC products while vaping.2 Data on this and other conditions associated with vaping provides firm ground for public sector entities to more aggressively pursue legislative action prohibiting the distribution of e-cigarette products.
References
1. Adams, J. (n.d.). Surgeon’s general advisory on e-cigarette use among youth. https://e-cigarettes.surgeongeneral.gov/documents/surgeon-generals-advisory-on-e-cigarette-use-among-youth-2018.pdf
2. Centers for Disease Control and Prevention. (2020, February 25). Outbreak of lung injury associated with the use of e-cigarette, or vaping, products. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html
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Thank you for the blog post, vaping appears to be radically increasing, especially amongst adolescents in the United States. According to Miech et al. (2019), 12th graders increased their vaping habits from 11% in 2017 to 20.9% in 2018. Food and Drug Administration (FDA) states that in 2019 5 million middle school and high schoolers are using electronic nicotine delivery systems (ENDS). The Food and Drug Administration and the Centers for Disease Control and Prevention (CDC) are concerned about associated respiratory illnesses with vaping use (FDA, 2020). According to the Food and Drug Administration (2020), a 2014 survey reported 81% of youth e-cigarette users stating the availability of fruit and mint flavors as the main reason for use. More policies need to be put in place to ensure we don’t end up with a large part of our young population addicted to nicotine products.
References:
Food and Drug Administration. (2020, February 14). Vaporizers, E-Cigarettes, and other ENDS. Retrieved March 8, 2020, from https://www.fda.gov/tobacco-products/products-ingredients-components/vaporizers-e-cigarettes-and-other-electronic-nicotine-delivery-systems-ends
Miech, R., Johnston, L., O’Malley, P. M., Bachman, J. G., & Patrick, M. E. (2019). Adolescent Vaping and nicotine use in 2017–2018—US national estimates. New England Journal of Medicine, 380(2), 192-193.
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Hi Annie,
Thank you for your informative post on vaping and the state and federal laws that regarding minor use and distribution. While researching Governor Ducey’s stance on raising the age to 21 for nicotine products, I came across an excellent website that the American Heart Association has put together. It’s the “Quit Lying” campaign and the information contained encourages teens to advocate to congress and their local leaders. There is lots of useful information, including resources for educators. I think I will print out some of the activities and use them as a nursing group topic on the adolescent unit.
SAMHSA reports that e-cigarettes were the most commonly used nicotine product among children in high school and middle school, with 11.7% and 3.3% respectively, for the year 2017. This is astounding. I do hope that Governor Ducey reflects and changes his mind on raising the age to 21 at the state level.
McCance-Katz, E.F. (2017) Urgent and emerging issues in prevention: Marijuana, kratum, e cigarettes. Substance Abuse and Mental Health Services Administration
Retrieved from
Click to access samhsas_15th_annual_prevention_day_afternoon_plenary_recording.pdf
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Hello Annie,
What a compelling blog you have there! I really enjoy reading your blog post this week regarding public sectors and their influences on vaping in teenagers. Few months ago, I attended a Health Equity conference and Mayor Coral Evans was there to present some recent accomplishments of Flagstaff. One of the accomplishments was that The Flagstaff Council approved a Tobacco 21 ordinance in July, 2019. I was very pleased to hear that. And thank you to your post I have learned that Tucson, Goodyear, Douglas, and Cottonwood have also raised the smoking age to 21. I think this will help reduce youth access to tobacco. Vaping is very dangerous and manufactures are not required by FDA to list all ingredients in their products (Neilson, 2019). Scientists have found acetals in the e-liquids, but little is known about the effects they have when inhaled (Neilson, 2019). However, many teens were hospitalized with severe damaged lungs due to vaping (Neilson, 2019). Scientists need to conduct more study to fully understand the consequences of acetal inhalation. As of right now, e-cigarettes should be banned.
References
Neilson, S. (2019). Irritating compounds can show up in “Vape Juice.” Retrieved from https://www.npr.org/sections/health-shots/2019/07/30/746238009/irritating-compounds-discovered-in-vape-juice
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