Oregon Tobacco Facts

Targeting

Adding menthol flavoring to cigarettes is a common industry practice to make cigarettes seems less harsh. For decades, the tobacco industry worked to create a product preference for menthol cigarettes among minority populations (13, 14). For example, the industry linked menthol cigarettes to themes of African American empowerment and identity, targeting retail stores and neighborhoods and media, music and magazines(14). Studies show that neighborhoods with higher proportions of African American residents have greater numbers of tobacco advertisements, a larger presence of menthol cigarette advertising and lower prices for menthol cigarettes (13). Unfortunately, people who use menthol cigarettes also have less success in quitting and could be at greater risk of lung cancer (13, 14).

• African American people and American Indian Alaska Natives smoke at higher rates than white people in Oregon (Figure 6.1).
• 51% of African American Oregonians who smoke use menthol cigarettes compared to only 16% of white, non-Latino cigarette smokers (Table 6.4).

The tobacco industry has also targeted people with mental illnesses and addictions. They provided cigarettes to psychiatric facilities, sponsored research to show that nicotine alleviates negative mood and blocked smoke-free property policies in mental health and substance use treatment settings (13). People with mental illnesses live 25 fewer years, on average, than the general population, largely because of tobacco-related health conditions (13).

• Among people who report experiencing poor mental health approximately one in four (24%) smoke while only about one in seven (12%) of people who report not experiencing poor mental health smoke (Table 6.1). 

Policy Protection and Access to Care

As policies that help people quit or prevent youth from starting tobacco use have expanded, communities with higher incomes have benefited more and decreased tobacco use more rapidly relative to communities with lower incomes. For example, while smoke-free homes and housing policies have expanded, people who rent are still more often exposed to secondhand smoke (Table 6.6). In turn, secondhand smoke exposure can cause health problems even among people who don't use tobacco and can make it harder to quit for people who are addicted to quit.

• About one in three Oregonians with a household income of less than $20,000 a year smoke. In comparison, about one in 10 Oregonians with a household income of more than $50,000 a year smoke (Table 6.1).
• In addition, 22% of people who rent are exposed to secondhand smoke compared to only 15% of people who own their home (Table 6.6). 

While 65% of people in Oregon who smoke express that they want to quit (Table 4.6), many do not have access to the environments, medication or counseling that are critical to sustaining a successful quit attempt. Smoking cessation support such as receiving advice to quit from a health professional, counseling through phone or internet-based services and medications like Nicotine Replacement Therapy (NRT) are all effective at helping people quit and stay quit, especially when used in combination.

While access to cessation support has expanded throughout Oregon, disparities in access to and use of these resources still exist.

• People who are ethnic or racial minorities are more likely to report experiencing discrimination when interacting with doctors or the health care system (13) and thus may be hesitant to seek out counseling or medications that could assist with quitting.
• People who are ethnic or racial minorities or those who are low income are less likely to receive advice to quit from a health care provider, including counseling on how to use cessation medications like NRT (13,16).
• Oregonians who have no health insurance are offered recommendations and support from health care providers on how to quit tobacco at a much lower rate (42%) than people who have insurance through the Oregon Health Plan (55%) (Figure 6.2)

The persistence of this inequity in the health care system is likely due to many factors including physician bias, lack of resources or a focus on treating other conditions perceived as more urgent.

Communities Leading Change 

The commercial tobacco industry has harmed tribes and Native communities in Oregon for decades by stealing cultural imagery and misrepresenting sacred traditions to sell commercial tobacco products (17, 18).

• 27% of American Indian and Alaska Native adults smoke cigarettes while only 17% of white, non-Latino adults smoke cigarettes (Figure 6.1)

Investing in culturally specific practices and services is a way to improve access to treatment and counter industry targeting. For example, native-led organizations and Oregon's nine federally recognized tribes are using their tribal culture to treat commercial tobacco use and fight tobacco industry tactics through the Native Quitline. This service was created in partnership with these tribal communities to offer culturally specific help to American Indian and Alaska Native peoples to quit commercial tobacco. It is one way that Native peoples in Oregon can quit commercial tobacco using Indigenous values, supported by a quit coach trained to work with Native peoples.

Table 6.1: Percentage of adult cigarette smoking, by select demographic groups, Oregon

Table 6.2: Percentage of adult cigarette smoking, by sexual orientation, Oregon, 2016-2019

Figure 6.1 Percentage of adult cigarette smoking by race and ethnicity, Oregon, 2016-2019  

Table 6.3 Percentage of adult tobacco use⁽¹⁾ among Oregon Health Plan members, by race and ethnicity, Oregon, 2016-2019

Table 6.4. Percentage of adult menthol cigarette use among cigarette smokers, by race, Oregon, 2016-2019

Table 6.5. Percentage of menthol cigarette use among cigarette smokers, by age group, Oregon

Table 6.6: Percentage of adult exposure to any secondhand smoke indoors in a typical week, by demographic groups, Oregon, 2018

Section 7: Retail tobacco environment and marketing

The tobacco industry spends more than one million per hour promoting its products in the United States. (19) The tobacco industry spends more than $100 million on marketing every year in Oregon (Figure 7.1). Almost 80% of the tobacco industry's total marketing expenditures for cigarettes and smokeless tobacco products (20) and 61% for e-cigarette products (4) are is in the retail environment including convenience stores, pharmacies and grocery stores.

In 2021, the average cost of a pack of cigarettes in Oregon was approximately $6.82 (Table 7.1). However, the price of a pack is often less than that to the buyer, because the tobacco industry provides discounts to offset the price. To offer these discounts to consumers, retailers must follow tobacco company requirements on product placement and advertising in their stores. This increases exposure to promotional advertising and product displays (21). Approximately three out of every five tobacco retailers advertise sales, discounts or other price promotions on tobacco products (Table 7.2).

Appeal to Kids

Tobacco products are often marketed to appeal to kids. They often have candy-like packaging, come in sweet flavors and are advertised or placed in areas where youth are likely to see them (Table 7.3). Three of four youth reported seeing tobacco product ads at a store within the last month, and almost half visited a convenience store in the past week (Table 7.4).

Among stores that sell tobacco in Oregon:

• Nearly one in five display toys, candy or gum within 12 inches of tobacco products (Table 7.2).
• More thank one in five place advertisements for tobacco products within three feet of the floor (Table 7.2).
• Over nine in 10 stores sell flavored tobacco (Table 7.2)., which makes them appealing to young people (22).

Youth Access to Tobacco

In 2018, Oregon made it illegal to sell tobacco to people under the age of 21. Prior to 2018, it was illegal to sell to those under 18.

• Among tobacco retailers inspected in 2019, over 15% illegally sold tobacco to underage Oregonians.
• Small cigars/cigarillos and e-cigarettes are illegally sold to underage youth more frequently than cigarettes (Figure 7.3).
• Retail sales to underage Oregonians was highest in tobacco shops, followed by small markets and mini marts that also sold gas (Table 7.8).

Figure 7.1 Annual tobacco industry marketing expenditures and Oregon Tobacco Prevention and Education Program funding (in millions of dollars), Oregon, 1998–2019 

Table 7.1 Average cigarette pack price in Oregon, Washington and California (1), 1990-2023

Figure 7.2 Average cigarette pack price in Oregon, Washington and California(1), 1990-2023

Table 7.2 Percentage of Oregon retailers with tobacco product marketing, 2018

Table 7.3 Percentage and number of Oregon retailers with tobacco product marketing by county, 2018

Table 7.4 Percentage of youths exposed to tobacco advertising, Oregon, 2019

Source: Oregon Healthy Teens. Unpublished data. 

Table 7.5 Percentage of sources of tobacco products and ease of access among youth, Oregon, 2020

Table 7.6: Percentage of purchase locations for vaping products and cigarettes among adults, Oregon, 2021

Figure 7.3 Rate of tobacco sales to underage people by product type, Oregon, 2017-2020 

Table 7.7 Rate of tobacco sales to underage people by Oregon county, 2017-2020(1)

Table 7.8 Rate and number of tobacco sales to underage people by store type, Oregon, 2017-2020(1)

Citations

1.  Federal Trade Commission. Federal Trade Commission cigarette report for 2020. Issued 2021. Available at https://www.ftc.gov/system/files/documents/reports/federal-trade-commission-cigarette-report-2020-smokeless-tobacco-report-2020/p114508fy20cigarettereport.pdf. Accessed 2022 August 12.
   
2.  Federal Trade Commission. Federal Trade Commission smokeless tobacco report for 2020. Issued 2021. Available at https://www.ftc.gov/system/files/documents/reports/federal-trade-commission-cigarette-report-2020-smokeless-tobacco-report-2020/p114508fy20smokelesstobacco.pdf. Accessed 2021 August 12.
3.  CounterTobacco.org. Spending at the point of sale: Federal Trade Commission Reports. Available at: https://countertobacco.org/the-war-in-the-store/#ftcreports. Accessed 2022 July 10.
   
4. Federal Trade Commission. Federal Trade Commision E-Cigarette Report for 2015-2018. Issued 2022. Available at https://www.ftc.gov/system/files/ftc_gov/pdf/E-Cigarette-Report-2015-2018.pdf. Accessed 2022 March 30.
   
5. U.S. Department of Health and Human Service Public Health Service Office of the Surgeon General. The health consequences of smoking—50 years of progress: A report of the surgeon general, 2014. Available at https://www.surgeongeneral.gov/library/reports/50-years-of-progress/full-report.pdf. Accessed 2016 Oct 21.
6. Oregon Health Authority. Public Health Division. Oregon Health Promotion and Chronic Disease Prevention section. Oregon Behavioral Risk Factor Surveillance System. Unpublished data.
7. U.S. Department of Health and Human Services. Preventing tobacco use among youth and young adults: A report of the Surgeon General, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2012. 
   
8. Health and Human Services (HHS). Preventing tobacco use among youth and young adults: A report of the surgeon general, 2012. Available at http://www.surgeongeneral.gov/library/ reports/preventing-youth-tobacco-use/full-report.pdf. Accessed 2016 Oct 21. See also, Hegmann KT, et al. The effect of age at smoking initiation on lung cancer risk. Epidemiology 4(5):444-48, September 1993; Lando HA, et al. Age of initiation, smoking patterns, and risk in a population of working adults. Preventive Medicine 29(6 Pt 1):590–98, December 1999.
   
9. U.S. Department of Health and Human Services, Preventing tobacco use among young people: A report of the surgeon general, 1994.
10. Centers for Disease Control and Prevention. (2012). Preventing tobacco use among youth and adults: a report of the surgeon general. Page 2. Available at: http://www.cdc.gov/tobacco/data_statistics/sgr/2012/consumer_booklet/pdfs/consumer.pdf.
    
11. Burrows, D. (1984). Strategic research report: Young adult smokers-startegies and opportunities. Legacy Tobacco Docuemnts Library. RJ Reynods. Bates No: 508783540. Available at: http://legacy.library.ucsf.edu/tid/swx83d00/pdf.
    
12. Myers ML. New study finds over 40 percent of youth smokers use flavored little cigars or cigarettes, shows need for FDA to regulate all tobacco products. Campaign for Tobacco-Free Kids. Oct. 22, 2013.
13. Achieving Health Equity in Tobacco Control. December 2015. Available at: https://truthinitiative.org/sites/default/files/media/files/2019/03/Achieving%20Health%20Equity%20in%20Tabacco%20Control%20-%20Version%201.pdf.
    
14. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion. https://www.cdc.gov/tobacco/basic_information/tobacco_industry/menthol-cigarettes/index.html.
    
15. Discrimination in America: Summary Report. (2018) National Public Radio, the Robert Wood Johnson Foundation, and Harvard T.H. Chan School of Public Health. Available at https://www.rwjf.org/content/dam/farm/reports/surveys_and_polls/2018/rwjf443620.
    
16. Tan, A., Young-Wolff, K. C., Carter-Harris, L., Salloum, R. G., & Banerjee, S. C. (2018). Disparities in the Receipt of Tobacco Treatment Counseling within the US Context of the Affordable Care Act and Meaningful Use Implementation. Nicotine & tobacco research: official journal of the Society for Research on Nicotine and Tobacco, 20(12), 1474–1480. https://doi.org/10.1093/ntr/ntx233.
    
17. Centers for Disease Control and Prevention (CDC). American Indians/Alaska Natives and Tobacco Use. Available at https://www.cdc.gov/tobacco/disparities/american-indians/index.htm. Accessed 2020 July 10.
    
18. American Cancer Society, Cancer Action Network. (n.d.) Manipulating a sacred tradition: an investigation of commercial tobacco marketing & sales strategies on the Navajo nation and other native tribes. Available at: http://action.fightcancer.org/site/DocServer/Industry_Influence-_Indi- an_Lands-_Indian_Gaming.pdf ?docID=8902.
    
19. Tobacco Free Kids. Broken promises to our children, a state-by-state look at the 1998 state tobacco settlement 16 years later. December 2014. Available at: http://www.tobaccofreekids.org/content/what_we_do/state_local_issues/settlement/FY2015/2014_12_11_brokenpromises_report.pdf. Accessed 2016 Oct 21.
    
20. CounterTobacco.org. Spending at the point of sale: Federal Trade Commission Reports. Available at: https://countertobacco.org/the-war-in-the-store/#ftcreports. Accessed 2020 July 10.
21. Feighery EC, Ribisl KM, Clark PI, Haladjian HH. How tobacco companies ensure prime placement of their advertising and products in stores: interviews with retailers about tobacco company incentive programmes. Tobacco Control 2003; 12:184–188.
    
22. Kostygina G, Glantz SA, Ling PM. Tobacco industry use of flavours to recruit new users of little cigars and cigarillos. Tob Control. 2016;25(1):66–74.