“We act when we need to act based on the health of the community,” said Public Health Director Jessica Guernsey.
After much deliberation and rejecting an amendment to exempt flavored hookah, the Board of County Commissioners unanimously approved the first reading of the proposed ordinance to ban the sale of flavored tobacco and nicotine products in Multnomah County.
The board will continue to accept public comment online until a final reading and vote on the ordinance on Dec. 15.
The Thursday, Dec. 1 action came four months after Chair Deborah Kafoury directed the County Health Department to develop a policy proposal to reduce youth access to flavored tobacco and nicotine products in order to curb their detrimental impacts on health and mortality.
“For as long as I have served on this board, and for many years before me, community advocates have asked Multnomah County to do something about the leading cause of preventative death: tobacco and nicotine use,” said Chair Kafoury. “And today, finally, we have the opportunity to take action and end the sale of flavored tobacco products in Multnomah County. “
But moving forward required the Board to balance the health of residents with business, cultural practices and community norms.
Public Health Director Jessica Guernsey detailed more than a decade of community engagement aimed at educating the public about the health risks of nicotine and tobacco use, which is the leading cause of preventable death in Multnomah County.
She highlighted the Action Communities for Health, Innovation and Environmental Health (ACHIEVE) Coalition, describing the group as “the front end of elevating this particular issue as a priority since 2009.” Guernsey also mentioned the efforts of myriad other groups, including the Multnomah County Public Health Advisory Board, Providence Rebels for a Cause, Oregon Partners for Tobacco Prevention, African and Immigrant Refugee Coalition and Flavors Hook Oregon Kids.
The Health Department's activities around limiting the use of tobacco and nicotine stretch back to 2012., starting with a briefing to the Board about youth access to tobacco, followed by public hearings. In 2014, then-Deputy Health Officer Dr. Jennifer Vines alerted the Board about the use and access to tobacco and e-cigarettes in Multnomah County.
In 2015, the County launched a campaign that focused on hookah, flavored tobacco and social smoking. That same year, the Board passed an ordinance that prohibited minors from buying and using inhalant delivery systems like e-cigarettes, vape pens and e-hookahs, among others products, and restricted their use in any indoor area that is smoke-free under the Oregon Indoor Clean Air Act.
And in September 2019, the Multnomah County Public Health Advisory Board recommended that the Board of County Commissioners, acting as the Board of Health, consider a flavored tobacco and nicotine ban. The Health Department originally hoped to bring the flavor ban forward soon after, but was delayed by COVID-19 pandemic that started in early 2020.
In preparing the ordinance, the Health Department conducted an online survey, collecting more than 1,000 responses, 50.2% of which said they were current users of tobacco or vape products, and 35% who did not use.
Out of all respondents, 63.4% opposed the ordinance and 35.9% supported. But at a public hearing Monday evening, the testimony, while split on the issue, tilted toward support for the ban, with more than a dozen public health and healthcare providers urging the Board to act quickly and allow no exemptions.
“This has been a long time coming,” said Public Health Officer Vines, who stressed the importance of passing this ban.
Dr. Vines said the Public Health’s three main goals were to:
- Decrease the use of youth using this product.
- Address racial health disparities.
- Address a driver of health in Multnomah County.
“Tobacco and nicotine are one of the upstream drivers of poor health and underlying conditions in our county,” she said.
According to Dr. Vines, the ordinance, which will be enforced through the existing Tobacco Retail Licensing Program:
- Defines a flavored tobacco product.
- Bans the sale of flavored tobacco and nicotine products.
- Removes outdated language regarding minimum legal sales age and enforcement.
- Becomes effective on Jan. 1, 2024.
Ending the sale of flavored nicotine and tobacco “is among one of the best practices in particular to address our primary goal” of keeping young people from tobacco use, said Dr. Vines.
She also addressed several misunderstandings that were repeated at the public hearing that was held on Monday, Nov. 28, including questions about why the County needs this ordinance if the purchasing age for tobacco is 21 and the Tobacco Retail Licensing program is in effect.
Vines explained that minors are still able to access the products. Sting operations conducted by the County found that one in five businesses — and sometimes as many as one in three — sold products to youth under 21 years of age.
Concerning questions about whether an adult heavy smoker is better off using a vape or e-cigarettes, Dr. Vines said there are other FDA-regulated products that actually help people know how much nicotine they’re taking in and eventually quit if that is their desire.
Stegmann proposes exemption for three hookah lounges
Commissioner Lori Stegmann proposed amending the current ordinance to exempt three local hookah lounges. She said that after listening to hours of testimony, reviewing comments and even visiting a hookah lounge, she felt the lounges create a unique safe cultural space for people of Middle Eastern and North African descent. The proposed exemption would only apply to existing hookah lounges that were already licensed and not to new hookah businesses.
“I’m concerned that the ordinance, as currently written, will impact the entirety of the revenue stream for the three existing licensed hookah lounges, which will ultimately force them to shut down,” she said.
Commissioner Sharon Meieran said she also found it compelling and difficult that the ordinance would impact a cultural gathering space for people who may not have an equivalent.
“I thought long and hard about this,” she said. “What it comes down to for me is they are selling a product that is so incredibly damaging. One hour of hookah use is the equivalent of smoking up to 400 to 500 cigarettes.”
Meieran said that as a doctor, she was trained to perform risk-benefit analyses and that to her, the “benefits for community gathering and the individual owners are outweighed by the degree of harm caused.”
Commissioner Jessica Vega Pederson noted that her office had also heard from people of Middle Eastern and Northern African heritage who urged her to ban flavored products. She said her decision to vote against the amendment took into account that hookah lounges would still be able to sell unflavored hookah, shisha and food and beverages.
Both Vega Pederson and Meieran said they wanted to find ways to support those small businesses through such a transition.
The amendment failed 4-1.
“My analysis really starts and ends with the public health impact,” said Commissioner Susheela Jayapal, reflecting on the importance of the passing of the ordinance, particularly for young people in the community.
She also thanked the staff for their years of work and community engagement.
“What it shows is that this ordinance is not a stand-alone or a sudden policy proposal,” she said. “It’s the latest piece of a long-standing, carefully considered and layered approach to addressing one of the more pressing public health issues that we face.”
Commissioner Vega Pederson thanked the hundreds of people who gave input, participated in the survey and gave testimony during public hearings.
“I believe it’s an important step to protect our community and prevent our young people from lifelong addiction to nicotine,” she said.
“Our goal is to prohibit the sale of flavored tobacco products that will result in a reduction of youth consumption and addiction, and this ordinance will achieve that,” said Commissioner Stegmann.
Noting that Multnomah County works often to improve its residents’ health, safety and stability by affecting conditions and factors upstream, Chair Kafoury said that, in this case, “there is no mystery about the source that feeds our community’s growing rate of tobacco addiction. And that’s where we have to intervene. This is an area in which we can make a difference, a life saving difference, through public policy.
The online survey about the proposed ordinance remains open through Wednesday, Dec. 14.
