108: Tackling E-Cigarettes and Flavored Tobacco Products

ROBERT JOHNSON:
This is Public Health Review Morning Edition for Monday, January 31st, 2022. I'm Robert Johnson. 
Now, today's news from the Association of State and Territorial Health Officials. 

Like so many other public health concerns, tobacco use increased among smokers during the pandemic. Tobacco products like e-cigarettes are part of the problem. 
The work to limit access to flavored vaping products, especially among younger people, is on ASTHO's top 10 list of policy issues to watch in 2022. It's also the topic of our morning conversation with Jan Malcolm, commissioner of the Minnesota Department of Health. 
What has been the impact of the pandemic on youth tobacco use in the country? 
JAN MALCOLM: 
Well, I think several things. First of all, certainly we know that smoking can make youth, just like adults, more vulnerable to serious illness from a coronavirus infection. So, there's certainly the direct impact on health risk. 
And certainly it's reasonable to think that kids who've been previously using may have continued to use due to all the stresses of the past year and a half, where they may have started using tobacco products out of stress and isolation and all the terrible effects we know the pandemic has had on kids in general. 
And I think for us in public health, it's also certainly—the pandemic has been sort of all-consuming and it's taken us away from some of the work that is so critical that we get back to, on issues very much like youth tobacco use, which is still a huge public health problem in our state and everywhere else. 
JOHNSON: 
That's right—and we're still thinking about ways to reduce youth access to e-cigarettes and flavored tobacco products. 
Where do you see the most potential for progress on that front this year? 
MALCOLM: 
Yeah, I think flavor restrictions are one really big opportunity, and we know that a number of states have passed state-level policies banning of the sale of flavored commercial tobacco products. Many other states, including ours, are considering that. We had a bill introduced in 2021 that we hope makes progress this year. And the good news is we've had a lot of action at the local level. A lot of local jurisdictions have passed flavor bans, including menthol. So, with that kind of momentum locally, we're hopeful that we can get that state-level flavor restriction done. 
Menthol is a particular concern, including from a health equity perspective. We know that menthol makes it easier to start and harder to quit for many people. And we know that the Black—African American Black youth use menthol products at a far higher rate than the general youth population, and same is true for adults. So, menthol is a particular focus as well from a health equity perspective. 
Then, of course, there's increasing prices—that continues to be a strategy that we want to keep going back to. Some of our local jurisdictions have passed ordinances, for instance, prohibiting the use of coupons or price discounts—another strategies. 
And, of course, at the state level, removing and preventing preemption—local jurisdictions are often are in the lead on these issues, and we want to do everything we can to protect their ability to do that. 
And then, of course, state laws or policies if we can go get those done, are our first prize. We were able to pass Tobacco 21 language here in Minnesota. And so, I would urge folks to keep an eye on that as a tool if that's not yet been done in your state. It's powerful tool that we have benefited from being able to pass here. 
JOHNSON:
Any effort to reduce access is often met with pushback by the industry. Is that the biggest threat again? And, if so, how do you see those efforts playing out in 2022? 
MALCOLM: 
I think it's wise to know that these efforts can be derailed; or even progress, once you made it, doesn't necessarily stay unless you keep defending it. We know that the tobacco industry is not backing down. Their influence at the state level and the local level continues to be strong. And we know that we have to be very vigilant. 
And a concern I think—again, kind of back to the pandemic—is just the degree to which our resources have been so significantly devoted to that. And we need to be able to free up some resources to do that advocacy work, working with local partners, and working at the state level to protect the gains we've made and make some more. 
JOHNSON: 
Are there any specific strategies you think might help ensure progress when it comes to regulating youth access to these products? 
MALCOLM: 
Yeah, I think so. 
In our state, we've got a pretty good tradition of community engagement—getting youth particularly involved and raising up their voices and having them be a real part of the advocacy corps to speak really passionately about their own experience. And certainly e-cigarettes is a whole thing—you know, the vaping crisis, the lung disease from that, but also the how quickly kids can get addicted using e-cigarette products. And having them tell their stories to local city councils or the state legislature is far more powerful than me doing it. 
So I think just, again, protecting local control is so very important in fighting preemption and doing what we can.
JOHNSON: 
Find out more about the work underway to limit access to flavored e-cigarette products in a new ASTHO policy brief, available now using the link in the show notes.

February is Black History month. ASTHO CEO Mike Fraser is thinking about the contributions Black Americans have made to advance the cause of public health, as well as those accomplishments still to come. 
MICHAEL FRASER:
I really focus on the future. What I'm most excited about are some of the things we're doing at ASTHO that, obviously, tie into Black History Month, but are more about the future: things like our Diverse Executives Leading in Public Health program; things like how we're going to help states implement our Racism As a Public Health issue statement; opportunities to cultivate and grow new Black leaders in public health, many of whom are in health departments, many of whom are folks that we're just thrilled to work with and want to support throughout their professional careers. 
So, that's where I get my energy and excitement about Black History Month. I love to learn, obviously, and reflect, but also to think about the future.
JOHNSON: 
Fraser joins Gail Christopher, executive director of the National Collaborative for Health Equity, for a Q&A focused on racial equity and the connections with public health. 
The article was posted a year ago, but it remains a useful resource on the topic, so we're bringing it back. Find a link in the show notes. 

Finally this morning, ASTHO is hosting part two of a webinars series about the assault on public health leadership. The event is set for February 9th at 4:00 pm Eastern time. Attendees will learn how to balance self-care and personal safety with their leadership duties and staff responsibilities. 
Register using the link in the show notes. 

That'll do it for today's report. 

Be sure to join us again tomorrow morning for more ASTHO news and information. 
I'm Robert Johnson. You're listening to Public Health Review Morning Edition. Have a great day.