Board of Commissioners asks Department of Health for recommendations on how to limit young people’s access to nicotine flavored products

August 19, 2022

After a detailed briefing on premature deaths and tobacco-related illnesses among residents, Multnomah County Chair Deborah Kafoury on Tuesday asked the Department of Health to come back with recommendations on how the county can reduce smoking. young people’s access to nicotine products.

Recommendations from the Department of Health – including restrictions on flavored products that appeal to young people and can set them up for lifelong addictions – will be presented in September. President Kafoury has created a online form for those wishing to comment on any proposed flavor restrictions.

She recognized the difficulty of reducing the use of nicotine products, both for users and for companies. “But at some point,” she said, “we have to say enough.”

“And especially after two years of a deadly respiratory virus that’s exacerbated by smoking – I’m ready to say, ‘Enough is enough.'”

In a key part of Tuesday’s briefing, Multnomah County Health Officer Dr. Jennifer Vines told the Board of Commissioners that tobacco and COVID-19 have a “serious interaction,” explaining that hospitalized smokers with COVID-19 were linked to higher risks of complications. And the dead.

The data of the American Heart Association published in July 2022 found that those who smoked were 45% more likely to die and 39% more likely to be treated by a ventilator.

The American Lung Association dubbed COVID-19 and tobacco as “creating a crisis within a crisis.”

Attracting the next generation of tobacco users

The main concern with flavored nicotine and tobacco products stems from the high number of preventable deaths and health problems – including cancers and heart risks – associated with their use. In Multnomah County, these are the two leading causes of death.

Vines said young people were particularly prone to using nicotine and flavored tobacco products, mostly in the form of e-cigarettes or vapes – calling them nicotine addiction starters.

“Almost all use flavored products,” Dr. Vines said.

She said there was a clear reason for this. Dr. Vines introduced a number of flavored tobacco products, such as vapes and cigars, all offering appealing flavors similar to candy: gummy bears, chocolate and vanilla, banana ice cream, pineapple and rainbow Skittles. sky.

“Hard to tell the difference, isn’t it? said Dr. Vines, as she held a vape pen with colorful packaging – a flavored tobacco product.

The The Oregon health authority reported that in 2017, 57% of Oregon 8th graders who used tobacco or vaped sought out flavored products, with that share jumping to 65% among 11th graders who used tobacco or vaped. This compares to only 21% of adults using flavored tobacco or nicotine products.

This candy tobacco flavor has a historical precursor: menthol.

Dr. Vines explained how the menthol flavor can mask the irritating sensation of inhaling cigarette smoke and give smokers a less harsh feeling. Menthol was also invented for adults at one time as an alternative to cigarettes.

“Like you’re breathing fresh air through your menthol cigarettes, which we know isn’t true,” she said.

Tobacco flavor is strategic, Dr. Vines said. A flavoring agent like menthol can make smokers inhale more deeply, not feel the irritation – and therefore have a harder time quitting.

Dr. Vines said 99.6% of retailers surveyed in Multnomah County sell at least one type of flavored tobacco product, such as menthol cigarettes, e-cigarettes, cigarillos or smokeless tobacco.

The low prices of these flavored tobacco products also make them attractive and easily accessible to young people. In Multnomah County, 67% of retailers that sold cigarillos or little cigars advertised them for less than a dollar. And even for products that cost more than a dollar, 73% of retailers offered price discounts or promotions.

“When it’s cheap, tastes good and is widely available, kids will use it,” Dr. Vines said.

Marketing efforts saturate black and LGBTQ+ communities

Dr. Vines spoke about long-standing disparities in the use of nicotine and tobacco. The African-American community, as well as the LGBTQ+ community, have traditionally been targeted by the tobacco industry.

Tobacco industry marketing tactics target black neighborhoods, which often have 10 times more tobacco ads. This saturated advertising has led more young people and adults from these communities to use these products. According to tobacco controlBlack smokers consume menthol at a higher rate – 85% – than smokers of any other race.

LGBTQ+ youth use cigars, e-cigarettes or vaping products at higher rates than other youth. Dr. Vines reported that among high school students who report smoking e-cigarettes, 30% identify as bisexual, 27% as lesbian/gay, and 23% as heterosexual.

Multnomah County first to limit youth access and allow retailers

Multnomah County has consistently led efforts to address the health effects of tobacco and nicotine use.

In September 2019, the Multnomah County Public Health Advisory Board recommended to the Board of Health, consisting of the Board of Commissioners, to consider a ban on flavored tobacco and nicotine. This was based on an epidemic of vaping-related lung disease and a steady increase in teen vaping rates. This effort came just before Multnomah County was faced with COVID-19 and focused its immediate public health resources on fighting the pandemic.

Dr. Vines has long pushed for Multnomah County to do more, recounting recent policy changes made in an effort to make tobacco products less accessible to youth and young adults. In April 2017, Multnomah County Public Health urged the council to raise the legal age for the purchase of tobacco to 21 in April, and shortly thereafter, Governor Kate Brown signed SB 754 into lawraising the legal purchase age to 21.

In October 2015, the Racial and Ethnic Approaches to Community Health (REACH) Program and the Coalition of Communities for Action on Health, Innovation and Environmental Health (ACHIEVE)identified flavored tobacco as a major contributor to health disparities, specifically affecting black and African American communities.

Commissioner Sharon Meieranwho is also a practicing emergency physician, said it was an issue “near and dear” to his heart.

“I see these impacts in the ER with my patients,” she said.

Commissioner Susheela Jayapal said the health effects of tobacco and flavored products are clear, but also said she wanted to ensure the impact of the regulations “does not land on already vulnerable communities”.

“We know that many vaping nicotine products are candy flavors that are appealing and used by many young people,” said Curator Jessica Vega Pedersonwho said she looked forward to continuing to learn about other health effects of tobacco and nicotine products in September.