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Voices: Missoula physicians support banning sale of flavored tobacco to protect kids

It’s time to end the flavor trap and stop Big Tobacco from targeting Missoula kids with flavored e-cigarettes, cigarillos, hookah, chew and other products.

As Missoula physicians who treat local children, we believe the industry already has had too much lead-time in enticing youth with its deadly products and creating a new generation of users. We need to act now.

After hearing the call for action from dozens of community members, our local hospital boards and local health professionals, we are excited that the Missoula City Council has introduced an ordinance to restrict the sale of all flavored tobacco products in our community. This action should be supported by all who care about Missoula kids and their healthy future.

We are shocked by the statistics that show frequent use of e-cigarettes by Montana youth increased by 263 percent between 2017 and 2019. Sweet-flavored, high-nicotine products such as JUUL fueled this astronomical increase, eroding decades of progress in reducing underage use of tobacco.

The use of sweet flavors—menthol, cherry, bubblegum, root beer float, strawberry and more—to entice kids into addiction is nothing new. Studies from the mid 1990s unveiled a “graduation strategy” used by the tobacco industry to entice young users into addiction and the use of stronger products over time. Kids who start using tobacco before age 18 are more likely to become lifelong users.

The flavor trap strategy is reflected in quotes from tobacco executives dating back to the 1970s and 80s. Consider this statement from Lorillard Tobacco: “The base of our business is the high school student.” Or this one from U.S. Tobacco: “Cherry Skoal is for somebody who likes the taste of candy, if you know what I’m saying.”

Today, we have not just Cherry Skoal but also cotton candy-flavored vape and Banana Smash Swisher Sweet cigarillos and many more flavored products besides.

Among youth, 70 percent who use e-cigarettes and 74 percent who smoke cigars say flavors are the main reason why they use these products. Also worth noting is that, in Montana, only 5 percent of adults use e-cigarettes, compared to 30 percent of youth. It’s clear who the industry is targeting, and that its strategy is working.

But flavors restrictions work, too. Studies show that these public health protections can help stop kids from trying and using tobacco and nicotine products that lead to addiction. A study in the Journal of Adolescent Health shows that the 2009 ban on flavored conventional cigarettes contributed to a 43 percent reduction in youth smoking.

A restriction on all products and all flavors—including menthol, which is used to target children as well as people of color, low-income users and LGBTQ community—will save us from playing whack-a-mole as the industry comes up with new products and devices designed to skirt the rules.

Additionally, restricting the sale of these products in all locations is the most equitable and effective protective approach. If flavored products are allowed for sale anywhere in a community, kids will still obtain them from older social sources. The idea that youth could still get flavored products outside the city or online shouldn’t prevent Missoula from taking this action to protect its kids. Restricting the sale of flavored tobacco products within the city will reduce youth tobacco use.

Under Missoula’s ordinance, unflavored tobacco flavored products would still be available for sale.

Acting now also is vital due to the COVID-19 pandemic. Recent research from Stanford University shows that kids who vape are five to seven times more likely to develop COVID than kids who don’t vape. We also know that kids share e-cigarettes and other products, increasing the risk for possible infection as they return to school.

Let’s put a stop to the flavor trap here in Missoula. Nationwide, nearly 300 cities have restricted the sale of flavored tobacco and e-cigarette products. We should do just as much to keep our kids safe, especially at a time when healthy lungs are so important.

Paul Smith, D.O., Pediatric Pulmonologist; Kathy Rogers, M.D., Pediatrician; Lauren Wilson, M.D., FAAP, Pediatrician; Jean Hsieh, M.D., M.S., Pulmonlogy and Critical Care Physician; Rob Stenger, M.D., M.P.H., Family Physician and Program Director, Family Medicine Residency of Western Montana