Here’s to 20 years of tobacco prevention success—but Oregon’s fight isn’t over yet

Oregonians, we have reasons to celebrate.

First, an anniversary: It’s been 20 years since Oregon voters approved Measure 44, which raised the price of tobacco and dedicated a portion of sales revenue to preventing kids and young people from starting to smoke and to helping smokers quit.

Second, our achievements over the past two decades:

  • Teen smoking rates have dropped dramatically.

    Governor Kate Brown and Karen Girard celebrate 20 years of tobacco prevention in Oregon

  • Tobacco users who want to quit (and nearly two out of three do) continue to have the help and resources they need to succeed.
  • Oregonians are buying half the number of cigarettes they were buying back then.
  • And the Indoor Clean Air Act, which expanded in 2009, has made the air cleaner in nearly every workplace and public space in Oregon, from public schools to hospitals, from parks to restaurants and bars.

This spring, Gov. Kate Brown traveled to several Oregon cities to celebrate the communities, citizens and students whose ongoing efforts are protecting kids and saving lives from tobacco.

Karen is joined by Lillian Shirley, State Public Health Director, and other Oregon Health Authority staff to commemorate 20 years of tobacco prevention at the State Capitol ceremonial room

As Brown recognized Cottage Grove’s Youth Advisory Council at a public celebration, she said, “Knowing that Oregon’s next generation is so passionately engaged and supportive of these important public health issues gives me confidence that this great work will continue to set new goals and rewrite the narrative on tobacco in Oregon.”

Yet these accomplishments are tempered by a sad fact: Tobacco still kills. It remains the No. 1 preventable cause of death and disease in our state. Every year, more than 7,000 Oregon fathers, mothers, daughters and sons die from tobacco-related causes. A few years ago, that number included 69-year-old Bob Main of Bend.

Karen Girard with her father, Bob Main

My dad.

My dad was a high school teacher and outdoorsman who spent 22 years managing public water resources in Central Oregon. He smoked cigarettes from age 15 until about age 40. Then he did what he was supposed to do: He quit.

Thirty years later, when he was nearly 70, my dad was diagnosed with lung cancer common to tobacco users. Even 30 smokefree years were not enough to undo tobacco’s damage.

I had already decided, long before my dad got sick, that I wanted to work in public health. But Oregon’s statewide movement to reduce tobacco’s toll—on the Oregonians who die from using it, and the people who loved them and still miss them—is a personal fight, too.

What will it take to win? Foremost, we can keep working to protect kids and future generations by:

  • Raising the price of tobacco. When the price goes up, fewer kids use it.
  • Restricting the sale of flavored tobacco products and other youth-targeted marketing tactics in retail stores. Flavors mask tobacco’s harsh taste, making it easier to use and easier to become addicted.
  • Protecting Oregon’s Indoor Clean Air Act (ICAA). Protecting access to clean indoor air means saying no to new exemptions to this law, one of the strongest in the country.

Two decades ago, with Measure 44, Oregonians committed to a sustained investment in addressing the tremendous threat that tobacco poses to the health of our people and our state. Our successes so far should inspire us to further reduce tobacco’s devastating impact. They should also motivate us to address similar threats to our collective health, like the widespread availability of cheap sugary drinks—a key factor contributing to chronic diseases including obesity, heart disease and diabetes that affect hundreds of thousands of Oregonians every year.

Oregon Health Authority’s Health Promotion and Chronic Disease Prevention staff shows a timeline of 20 years of tobacco prevention in Oregon

So, let’s take a moment to celebrate.

Then let’s get to work.

Curious about a chronic disease topic you’d like to see covered here? Interested in writing a guest blog? Keep the conversation going by leaving a comment below. 

Candy-flavored Tobacco is a Trick, not a Treat—and It’s for Sale in Your Neighborhood

Every day, tobacco companies market their addictive products to Oregon kids and teens by making them look, smell and taste like candy. Tobacco companies are so adept at this targeted trickery, many adults don’t even notice it.

For all of us who care about Oregon and the ways that our communities help, or harm, our health, it’s time to take a closer look. Candy-Jars-IMG_2081_Cropped

  • A wide array of tobacco products, easily accessible to kids and teens today, are packaged and flavored to be nearly indistinguishable from candy.
  • These flavored little cigars, cigarillos and hookah tobacco are dressed up in shiny, brightly-colored wrappers and tins.
  • They are sweetened with the same chemicals used to flavor popular kids’ products like LifeSavers™ and Kool-Aid™.
  • Despite fruity and kid-friendly names like grape, chocolate, “vivid vanilla” and “cherry crush,” these products contain nicotine and are as dangerous and addictive as cigarettes.

Tobacco companies say they add sweet and fruity flavors to tobacco because grownups like sweet stuff, too. Yet new numbers show that Oregon kids are far more likely than adults to use flavored tobacco.

In contrast, about 15 percent of adult tobacco users in Oregon use flavored tobacco products according to the most recent Behavioral Risk Factor Surveillance System survey. Among youth tobacco users, more than half (60%) of 8th graders and more than two-thirds (68%) of 11th graders used flavored tobacco, according to the 2015 Oregon Healthy Teens survey.

Clearly, tobacco companies’ targeted marketing to young people is working. Their tactics are on display in the gas stations, convenience stores and other retailers where most tobacco is sold in Oregon. Young people visit these stores often: More than half of 8th graders (58%) and 11th graders (57%) in Oregon shop in a convenience store at least once a week.

Over the past few years, public health workers and community members in every Oregon county coordinated visits to stores that sell tobacco and documented that nearly all of them—nine in ten—sell flavored tobacco products (when menthol cigarettes are included, that percentage climbs to 98 percent).


Tobacco companies claim these flavored tobacco products, such as cotton candy flavored cigarillos, aren’t meant for kids, who can’t legally buy them. Yet the data clearly show that the majority of kids who use tobacco products are using flavored tobacco products. Because the candy and fruit flavors attract kids—and because they mask the natural harsh taste of tobacco—they make it easier for kids to experiment with tobacco, and easier for kids to become addicted.

In the case of menthol-flavored tobacco products, that minty flavor also has a soothing effect on the lungs that reduces the irritation and discomfort associated with smoking—similar to the way a mentholated cough drop soothes a sore, scratchy throat.

An Oregon retailer sells flavored little cigars next to candy.

An Oregon retailer sells flavored little cigars next to candy.

Fortunately, a growing number of Oregon kids won’t be fooled by the tobacco companies’ candy-flavored tactics. Students in Hood River High School’s Health Media Club and the Rebels of Portland’s Madison High School are educating their siblings and peers about how tobacco companies target young people, and about the dangers of tobacco. These teens set an empowering example for the rest of us for how to push back against tobacco companies’ influence and harmful effects on all Oregonians.

We can join them by noticing what’s for sale in our communities, talking with the young people in our lives about what we find, and sharing photos on social media to #whatsforsale.

We can connect with the Oregon Tobacco Prevention and Education Program (TPEP) coordinators in our individual counties and tribes to meet others who care about these issues and are working to make our communities healthier.

We can help young Oregonians avoid a lifetime of addiction and build a healthier state—by refusing to fall for the sweet tricks of the tobacco companies.


Curious about a chronic disease topic you’d like to see covered here? Interested in writing a guest blog? Keep the conversation going by leaving a comment below.


­Oregon’s New E-cigarette Law: More Fresh Air, Less Youth Access to Nicotine

Oregon Governor Kate Brown recently signed a new law that means inhalant delivery systems, including e-cigarettes, can no longer be used in any indoor area that is already smokefree under the Oregon Indoor Clean Air Act (ICAA), as of January 1, 2016.

The new law also helps keep nicotine out of the hands of kids by not allowing the sale of inhalant delivery systems to minors—an important step at a time when youth use of e-cigarettes is climbing dramatically in Oregon and nationally.

Use of e-cigarettes mimics conventional cigarette smoking, and e-cigarettes also contain the same addictive ingredient, nicotine. Instead of smoke from burning tobacco, e-cigarette users inhale aerosol consisting of nicotine, flavor additives and other chemicals. When users inhale from the end of an e-cigarette, a battery-operated device heats a liquid solution (e-liquid or e-juice) into an aerosol. (See image below.)


You may be surprised at how many teens are using e-cigarettes compared to just a few years ago. Oregon saw a 150 percent increase in e-cigarette use among high school-age kids from 2011 to 2013. Nationally, e-cigarette use among high school students tripled from 2013 to 2014—from 4.5% to 13.4%, according to a recent report from the U.S. Centers for Disease Control and Prevention. We expect to see a similar increase in Oregon when new numbers are reported this fall.

These rising rates are troubling because, while the risks posed by e-cigarettes are still being studied and are not fully understood, we know that smokeless does not mean harmless. Preliminary testing of e-cigarettes has identified chemicals known to cause cancer and birth defects in first and secondhand e-cigarette aerosol, including the carcinogens formaldehyde and acetaldehyde.

We also know that e-cigarettes increasingly are serving as starter products for kids and teens to other tobacco products and, potentially, a lifetime of nicotine dependence. A national survey found that youth who had tried e-cigarettes were nearly twice as likely to say they would try a conventional cigarette.

In Oregon, our Oregon Healthy Teens Survey revealed that one in five 11th-graders, and one in three 8th-graders, who are currently using e-cigarettes have never tried conventional cigarettes—and therefore are being introduced to nicotine through e-cigarettes.

Not allowing the sale of e-cigarettes to kids and teens is an important step toward reducing youth access, but it’s only the first step. Tobacco products and e-cigarettes continue to appeal to young people, despite laws that prevent their sale to minors. Tobacco products and e-cigarettes are attractive to youth because of pricing strategies that lower the cost; targeted marketing; and kid-friendly fruit and candy flavors such as grape, “cherry crush” and chocolate.

Oregon’s new law, in addition to protecting kids and teens, benefits all Oregonians by addressing concerns about the contents of e-cigarette aerosol. Despite manufacturers’ claims that their products are safe, there is evidence that the aerosols produced by e-cigarettes contain carcinogens and other toxic chemicals.

By expanding Oregon’s Smokefree Workplace Law to include e-cigarettes and other inhalant delivery systems, the law protects our right to breathe fresh air that is free of these potential toxins. Oregon is now one of eight states in the country to include e-cigarettes in its Smokefree Workplace Law.

As an Oregonian, I hope you’re as proud as I am that our Legislature has taken this step to preserve our fresh air and to help prevent our young people from becoming addicted to nicotine and tobacco products.

Curious about a chronic disease topic you’d like to see covered here? Interested in writing a guest blog? Keep the conversation going by leaving a comment below.

Welcome to Health Within Reach: Talking about Place Matters

Anyone involved in public health in Oregon is familiar with the idea that “place matters,” shorthand for how the social conditions in which we live affect our health. These conditions are key to reducing the physical and financial toll of chronic disease on our state. Public health isn’t alone in this conversation—far from it. Oregonians representing a wide range of professions and passions have long known how place matters to people’s lives and well-being. Recently I’m hearing this civic conversation growing louder and helping to shape our places in ways that prioritize health.

These wide-ranging voices were the animating force of our most recent Place Matters Oregon (PMO) conference in Portland. The 500-plus attendees and speakers went far beyond the folks you might expect at a public heath gathering, to include land use planners, teachers, affordable housing advocates, transportation officials, community activists, state legislators, a library director and conservationists.

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