Susan Montgomery has seen firsthand the impact of addiction during her 22 years working at Multnomah County. She was hired on as a temporary addictions counselor in 1996.
Working in the field of addictions and recovery can be tough, but Montgomery found reasons to stay with it. “I was attracted to both the challenge...and the amazing accomplishments of people in recovery,” she said.
Last year Montgomery transitioned away from direct clinical service, and joined the Tobacco Control and Prevention Program as an inspector for Tobacco Retail Licensing(link is external), an effort that launched in 2016 when the County board voted to require every tobacco retailer to obtain an annual license.
Now she travels throughout Multnomah County ensuring tobacco retailers comply with the law.
There are many differences between the worlds of addiction recovery and tobacco regulation. But Montgomery tries to focus on where they meet.
“These two worlds are not separate,” she said. “I’m struck by the intensity of the number of retailers and customers using tobacco products, and we know what that is doing to their health.”
According to a 2015 Oregon Health Authority prevention and education report(link is external), cigarette smoking is the leading preventable cause of death in the state and nation. It causes asthma and lung, liver, and colorectal cancer.
Montgomery keeps these major public health consequences in mind during her inspections; to protect the health of children and adolescents, and to promote a tobacco and nicotine-free environment.
“Raising the legal sales age from 18 to 21 is a wonderful public health initiative,” she said.
A new law that went into effect Jan. 1, 2018 (commonly referred to as Tobacco 21) set the purchase age of tobacco at 21. That is why, in addition to assisting retailers, the Tobacco Control and Prevention Program conducts Minimum Legal Sales Age inspections to prevent vendors from illegally selling tobacco to youth.
“Many of our licensed tobacco retailers don’t want youth to have access to these products,” said Kari McFarlan, the Tobacco Control team supervisor. “They understand, and may even have experience with the consequences of smoking related illness.”
On a typical day, Montgomery might come into the office to consult with colleagues about some intricate detail of tobacco regulation. Then she’ll return phone calls, send emails, and update databases, before she hits the road to visit retailers.
Montgomery said she finds the retail environment is vast and diverse; no two stores are the same. From drive-through shops to mom-and-pop stores, to national franchises, if they sell tobacco or nicotine products, they will get a visit from Montgomery. As part of the retail licensing program, more than 700 retailers and their employees have access to education, training, and support from the County’s tobacco prevention staff.
Montgomery tries to visit 60 retailers each month. Once in a store, she will greet the store manager, staff, or owner. In small shops, those are often one and the same. Then Montgomery looks for proof of compliance to state and local tobacco laws. This includes ensuring that required signage is visible, that tobacco products are being kept behind a counter, and that nicotine e-liquids are properly packaged and labeled.
Montgomery has a lot of ground to cover during her inspections. She asks to see each establishment’s license, ensures the license and the state’s minimum-sales-age statute are posted, and makes sure products are in their original packaging with the proper health warning.
“I want to make sure retailers are not selling loosies,” she said, using a slang term for individual cigarettes sold apart from the original pack.
Specialty stores have also opened to respond to the vaping boom. Montgomery makes sure these retailers are also following the state’s packaging and labeling rules.
The Centers for Disease Control and Prevention released a study(link is external) in 2014 warning of an increased number of calls to poison centers because of e-cigarette liquids. About half those calls involved young children under age 5.
“A kid that can’t read the word strawberry flavored (e-liquid) might mistake a cartoon strawberry on a package for what it’s meant to represent,” Montgomery said, “like the kind of thing you might see on a kids’ cereal box.”
Poisoning related to e-cigarettes and e-liquids can occur in three ways: by ingestion, inhalation or absorption through the skin or eyes. The most common adverse health effects are vomiting, nausea and eye irritation.
Geographically speaking, Montgomery has a large area to inspect. Most of Multnomah County’s retailers are in Portland, but she also visits shops in Gresham, and smaller towns, and country stores on the county’s rural edges. “There are different style cultures in these stores,” she said. “And there’s such a wide range of retail environments that sell tobacco product under our program’s regulation.”
While Montgomery balances different kinds of inspections, her annual compliance inspections will bring her to every tobacco retailer, every year. This means retailers will get to know Montgomery, as she works to establish a partnership to keep more young people healthy and nicotine-free.
After 22 years with Multnomah County, Montgomery still thinks this work makes a difference, especially focusing on repairing the health disparities within low-income communities and communities of color.
“This work matters in part because there is a lot of unfairness going on out there,” she said.
Big tobacco corporations target vulnerable people with tobacco and vape advertisements. And Montgomery said she’s proud to work with an agency that cares about targeting efforts to serve the most vulnerable.
“I really do believe this work matters,” she said.