For the first time in three years, the Coalition for Tobacco-Free Hawai‘i (CTFH) was able to convene their annual stakeholder meeting in person at the Ko’olau Ballrooms in Kaneohe this past November. The all-day event brought together close to 100 people, including tobacco prevention and cessation professionals, current and former lawmakers, local activists, organizers, researchers, and speakers to build community and strategize about “tobacco’s evolving landscape,” the theme for the gathering. The annual stakeholders meeting is also the venue for our Alakai Awards where CTFH recognizes and honors the dedication and hard work of individuals and organizations working in tobacco prevention and control.
In 2019, the last time the CTFH stakeholders meeting was held in person, a youth vaping epidemic declared in 2018 was growing and the EVALI (e-cigarette and vaping associated lung injury) outbreak was causing hundreds of hospitalizations and deaths, a daily feature on news media. By March of 2020, the Centers for Disease Control had completely shifted their focus from tracking the EVALI outbreak to responding to the growing COVID-19 pandemic, and many people started to transition daily life from commuting to and from the workplace and school to working and learning remotely from home.
A lot has changed in the two years it took to get people back to work and school in person. To kickstart the day, a keynote presentation on the evolving tobacco landscape was provided by Kevin Ramirez, HIPHI’s YEPP (Youth ESD Prevention Project) coordinator. E-cigarettes and vaping products entered the U.S market in 2007, but the first investigative report of the industry conducted by the Federal Trade Commission would not be published until 2022. A brief summary of the report’s findings opened the keynote address, as Ramirez recapped that over the last several years “total e-cigarette sales have grown from millions to billions, pod-based system sales have grown from millions to billions, tobacco flavored product sales have dropped by 50%, and non-tobacco flavored product sales have grown 300%. Average nicotine strength in e-cigarette products has doubled, spending on advertising and promotion has doubled, and spending on social media influencers and brand ambassadors has grown from the low hundred thousands to over half a million.”
Ramirez highlighted some of the vape industries’ newest innovations, including new technology to increase the use of “water-based” vaping, the introduction of mesh coil technology for disposables, and several vaping companies’ attempts at being more “environmentally friendly” with the introduction of biodegradable vaping devices. Many of these new tactics were touted as making the use of e-cigarettes safer without compromising flavor, a throwback to the tobacco industries’ pretense of making their combustible products safer with the introduction of cigarette filters and “low tar” and “light” cigarette options. His presentation closed by spotlighting new products from tobacco companies like nicotine pouches, and new startup companies selling personal diffusers that put vitamins, minerals, and other compounds like caffeine and melatonin into vapes targeting and rapidly gaining popularity with youth and young adults. It’s clear that some of these vape companies are evolving past tobacco and nicotine, but copying the tobacco playbook by making claims that using these products are somehow healthy, safe, and provide some sort of benefit to one’s personal wellness.
Joelle Lester, the Director of Commercial Tobacco Control Programs with the Public Health Law Center, delivered a keynote address that focused on the “endgame,” a time in our foreseeable future when tobacco products are no longer being sold and consumed. The tobacco epidemic over the last ten years is estimated to have caused over 480,000 deaths annually in the U.S., aided in large part by tobacco industry expenditures of $8 billion dollars annually in marketing costs and $31 million in federal lobbying costs to weaken public health and tobacco control policies. Lester detailed how ending the tobacco epidemic is a social justice issue requiring comprehensive regulation and legislation to eliminate the health disparities brought on by incremental policy approaches. Stressing the importance of taking action on the local level, she cited several examples such as Beverly Hills and Manhattan Beach in California where local ordinances were recently passed prohibiting the sale of all tobacco products in their jurisdictions.
Unfortunately for our efforts here in Hawai‘i, local organizing can no longer impact tobacco product sales and marketing at the county level due to preemption language that was inserted into a 2018 bill. Since then, all efforts to regulate the sale and marketing of tobacco products in Hawai‘i can only happen at the state level. CTFH has been steadily working to repeal or sunset that preemption language, another hot topic addressed at the gathering.
During the lunch break, Hawai‘i Community Foundation Program Officer Tricia Mabellos invited representatives from Hawai‘i Health & Harm Reduction Center and Hāmākua-Kohala Health to share their ongoing work in youth vaping prevention and adult tobacco cessation work across the state. The highlights included over 3,600 students reached via vaping prevention education, and over 7,600 adult participants attending tobacco cessation programs with 43% of those participants successfully quitting tobacco. A large part of a comprehensive approach to tobacco control with the endgame in mind is more investment in youth prevention efforts and expansion of culturally accessible adult cessation programs, both components strongly supported by CTFH.
Before the second half of the day’s breakout sessions began, the Alakai Award winners were recognized. The Outstanding Advocate Award winner was Laverne Moore, a special education teacher at McKinley High School and a teacher lobbyist for the Hawai‘i State Teachers Association. Over the years, Laverne has worked to keep our keiki healthy and safe and has advocated for legislation to end the youth vaping epidemic in Hawaiʻi. Her testimony during the last legislative session was powerful for lawmakers to hear as she explained academic impacts of using e-cigarettes.
The Outstanding Service Provider in Tobacco Control Individual Award winner was Dr. Hannah Preston-Pita, a licensed clinical psychologist, certified substance abuse counselor, and CEO of the Big Island Substance Abuse Council (BISAC). Dr. Preston-Pita worked to make BISAC a smoke-free campus, helping their clients and staff to quit smoking and reduce exposure to secondhand smoke. She has spoken to many different stakeholders about their efforts and has served as a role model for other treatment centers.
Lāna‘i Community Health Center’s E Hanu Lanai tobacco cessation program won the Outstanding Service Provider in Tobacco Control Organization Award. The program consists of an integrated team of medical, behavioral health, and community health workers, whose overall goal is to assist patients with quitting all forms of tobacco and to educate our youth and community on tobacco prevention. Their team has also developed social media campaigns focused on the harmful effects of vaping on youth, educating parents on current ESD and flavors targeting youth, tobacco education and the importance of cessation on health and the environment, and encouraging community to engage in smoke-free activities.
The Outstanding Community Partner Award winners were Shani “Kai” Carvalho, Jennifer Valera, and Kristin Mills. Kai Carvalho and Jennifer Valera have been a dynamic duo working with Hāmākua-Kohala health for the last ten years and combine their professional skills with their dedication to provide support to youth in North and East Hawai‘i, serving as mentors to Hawaiʻi Island Youth Council members. They also conduct youth electronic smoking device (ESD) prevention education for public and private schools on the island. Kristin Mills is a Public Health Educator at the Maui District Health Office and is passionate about teaching resilience and coping skills, vaping prevention, and mental wellness. Kristin focuses on programs that not only have an impact on public health but that are sustainable to teach, believing in planting small seeds of wellness. Kristin has helped to step in to provide leadership on tobacco prevention efforts in Maui County.
The Outstanding Media Champion Award winner was Dr. Kathy Kozack, host of ‘The Body Show’ on Hawai‘i Public Radio for the past 12 years. Dr. Kozak has been very supportive of the CTFH Youth Council’s work to end the sale of flavored tobacco products and has featured Youth Council members on her radio program.
The ‘A‘a Award is given to an individual who has made an outstanding personal contribution to the efforts of CTFH. This year’s ‘A‘a award winner was Theresa Ng, a graduating senior at the University of Hawai‘i at Mānoa and an active member of the CTFH Youth Council since 2020.
The Kanalu Award is given to an individual who is new to tobacco control and who has made an outstanding contribution to tobacco control efforts. This year’s Kanalu Award winner was Jendrik Paul, the founder of the Marshallese Community Organization of Hawai‘i. Jendrik was a participant in the CTFH inaugural community of practice cohort focused on tobacco and equity. Through this experience Jendrik was able to attend the African American Tobacco Control Leadership Council’s 3rd National Menthol Conference in Washington DC and has committed to educating his community about the harms of tobacco.
The Hokule‘a Award is presented to a steward of the tobacco control movement who has made significant contributions to decrease the burden of tobacco in Hawai‘i. The winner of this year’s Hokule‘a Award was Rosalyn “Roz” Baker, a former Senator and Chair of the Senate Health Committee. Roz has been a tireless advocate for the regulation of tobacco in a multitude of ways throughout our state. From raising taxes, to stopping the sale of tobacco products to those under 21, to Hawaii’s clean indoor air laws, Roz has introduced and ardently fought for many bills to get through both legislative chambers, including those that would better regulate the sale of the never-ending wave of new nicotine delivery methods enticing our children to start using nicotine at younger and younger ages.
The final Alakai Award was the Ekaha Award, given to a tireless advocate for tobacco prevention and control who can weather many storms while inspiring others. The winner of the Ekaha Award was Lila Johnson, currently the tobacco prevention and control section supervisor for Hawai‘i State Department of Health, where she has worked for the past 28 years. “Like the ‘ēkaha fern, Lila’s energy continues to inspire and she leaves a thriving environment for all wherever she goes,” stated Jessica Yamauchi, CEO of Hawai‘i Public Health Institute, when presenting the final Alakai award for Lila.
Following the Alakai Award winners portion of the day, attendees then headed to one of three concurrent breakout sessions. Breakout One focused on “Local Research and Data Innovation” with panelists Dr. Yi Zuo, Professor of Mechanical Engineering at the John A. Burns School of Medicine; Dr. Scott Okamoto, Professor and Research Faculty at Hawai‘i Pacific University; and Kathleen Corpuz, a community member representing Pilipino Underrepresented Scholars Organization. Breakout Two focused on “Health Impacts of Vaping and Youth Cessation” with panelists Dr. Bryan Mih, Associate Clinical Professor at the John A. Burns School of Medicine; Pedro Haro, Executive Director of American Lung Association of Hawai‘i; and Reiko Ayabe, Diversion Program Coordinator for Hale Opio Kaua‘i. Breakout Three focused on “The Tobacco Industry’s Targeted Marketing in Hawai‘i” presented by Kevin Ramirez, Youth ESD Prevention Coordinator for HIPHI.
After the breakout sessions ended, attendees gathered in the main ballroom for another keynote address, this one focusing on preemption and why it is incredibly important to organize to repeal it. The national context on preemption was highlighted by Mark Meaney, Deputy Director of Commercial Tobacco Control Law and Policy at the Public Health Law Center. Peggy Mierzwa, Policy and Advocacy Director for HIPHI, then took the stage to provide the local context on preemption and outline a strategy to repeal it here in Hawai‘i.
To close out the day, our final panel was the “Call To Action Closing Panel” featuring four panelists: Rosalyn “Roz” Baker, former State Senator; Reid Kuba, a middle school principal; Kinohi Bridges, current CTFH Youth Council member; and Cory Chun, newly elected Hawai‘i State Representative for District 35. The closing panelists each spoke about how to move forward in the different aspects of our work and at different levels from the State Legislature, to the schools, and more broadly in our wider community. Increasing grassroots support for our legislative bills seeking comprehensive regulations around e-cigarettes was one of the top priorities, along with repealing preemption so that local counties can take action rather than waiting for everything to happen at the state level.
Our sincere thanks go out to speakers, attendees, and all who contributed to this resounding success. Overall, the event was informative and inspiring, and being able to convene in person made the day even more rejuvenating for us all to continue to do this work with the dedication, commitment, and passion it requires.
