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Updated: 5 hours 14 min ago

Election Canvassers Want Latinos to Know Voting Is Good for Their Health

November 07, 2022

HUNTINGTON PARK, Calif. — Jonathan Flores spent a sunny Saturday in late October knocking on the doors of registered voters in this predominantly Latino working-class town in southeastern Los Angeles County. Most people weren’t home or didn’t come to the door. Some of those who did expressed strong opinions about Joe Biden and Donald Trump and took an interest in abortion rights and clean-air initiatives on the California ballot for the Nov. 8 election. One young man gave Flores the brush-off, saying he doubted his vote would be counted.

Like the other canvassers sent out that day by AltaMed Health Services Corp., a large chain of community clinics, Flores sported a black baseball cap and a T-shirt emblazoned with “My Vote. My Health.” Underneath, it read the same in Spanish, “Mi Voto. Mi Salud.” His mission was to urge residents to cast their ballots, even if they had never voted, so they could be fairly represented in city hall, Sacramento, and beyond.

“I feel like I’ve seen communities — people who look like me, like my parents — struggle through so much,” said Flores, 31, whose mother and father were born in Mexico and now live in the Central Valley. “So reaching out to them at the core of those issues is basically what got me doing this.”

Health care institutions across the United States have mounted get-out-the-vote efforts in recent years, inspired by a growing belief that voting improves the health of individuals and communities. The American Medical Association has endorsed that idea. AltaMed, with an active civic engagement department, has targeted more than a quarter-million registered voters in Los Angeles and Orange counties this election, most of them in Latino communities. It has offered early voting at a dozen clinics and plans to send canvassers out right up until Election Day.

“Our problems are often triggered — or exacerbated — by factors in our daily lives, whether it’s the air we breathe, where we live, the food we eat,” said Aliya Bhatia, executive director of Vot-ER, a nonprofit organization that works with 700 hospitals and clinics around the U.S., including AltaMed, to encourage patients and staff members to vote. “Vot-ER’s work helps patients be part of a process of going upstream to shape those policies that impact our health.”

Getting out the vote can be challenging in Latino communities despite their potential as an electoral force. The Latino population has quadrupled in the last four decades and now constitutes 19% of the U.S. population. In California, Latinos account for over 39% of the population, exceeding the share of non-Hispanic whites and making them the state’s largest ethnic or racial group.

However, voter participation among Latinos continues to trail other groups. Their turnout in the 2020 election was more than 14 percentage points below that of the state’s eligible voter population, according to data from the Center for Inclusive Democracy at the University of Southern California’s Sol Price School of Public Policy.

Researchers and Latino advocacy groups cite various factors that inhibit Latino voting, including feelings of cultural and linguistic marginalization, a mistrust of government, a disproportionately high poverty rate, and a younger-than-average population. Another key factor, they said, is a lack of outreach by political campaigns and other election organizations.

In a recent poll by the Latino Community Foundation, 71% of California Latino residents said they had not been contacted by a political party, campaign, or other organization this year.

“It makes a difference in whether they are actually going to turn out to vote,” said Mindy Romero, director of the Center for Inclusive Democracy.

In neighboring Los Angeles, mayoral candidate Rick Caruso, a billionaire developer, has made a strong effort to court Latinos, which could play a decisive role in his race to lead a city where they account for nearly half the population. After trailing by a double-digit margin early on, Caruso has pulled even with his opponent, U.S. Rep. Karen Bass, according to a recent poll published by the Southern California News Group.

Notably, 43.7% of Latino voters said they would back Caruso, compared with 29.4% for Bass.

“He is meeting us where we are, at our businesses, where we shop, where we eat. He is telling us he sees us and he hears us,” said Nilza Serrano, president of the Avance Democratic Club, a Latino organization in L.A. County that has drawn scrutiny over its endorsement of Caruso. “I think our community is fed up and a little exhausted from not being heard.”

In Huntington Park, where 97% of residents are Hispanic or Latino, predominantly of Mexican origin, the upcoming election wasn’t top of mind for some residents.

Maria Robles, 28, who was born here to Mexican immigrants, got confused when asked about her party affiliation. “I don’t know. Is it the Democrats?” she asked, speaking through her front screen door. Robles said she voted for Biden in the last election but regrets it now and, if she could do it over, would vote for Trump instead.

Surveys show that health care is a leading concern among Latinos, although it’s eclipsed by worries about inflation and the economy. Latinos are more likely than other residents to be uninsured. Nationally, they have high rates of diabetes and obesity. And their communities have been hit hard by covid-19.

But political campaigns repeatedly fail to link the health care concerns of Latinos to voting, Romero said.

One example is the Inflation Reduction Act, which, among many other things, caps the monthly cost of insulin for Medicare beneficiaries at $35. Democrats wanted the insulin cap to apply to privately insured people as well, but that provision was blocked by Republicans in the Senate, denying the benefit to millions.

“Yet very few Democrats are talking about it on the campaign trail,” said Rodrigo Dominguez-Villegas, director of research at UCLA’s Latino Policy and Politics Institute. “I mean, the ad pretty much writes itself: ‘We tried to pass this for everybody, but Republicans opposed this specific policy that was going to benefit your uncle, your grandma, your father, your cousin.’”

The environment is another significant concern. Residents of Huntington Park and neighboring cities, almost all with overwhelming Latino majorities, have lived for decades with air and soil pollution from the heavy industry nearby and the traffic along Interstate 710, a freeway corridor choked with diesel-powered trucks transporting cargo from the nation’s two busiest ports.

Bryan Martinez, a Huntington Park resident, grew animated when he learned about Proposition 30, a state measure that would impose an additional 1.75% tax on personal incomes above $2 million to subsidize zero-emission vehicle purchases, electric charging stations, and wildfire prevention programs.

“That’s something I’m really interested in,” said Martinez, 32. “It’s staggering how much pollution comes over here with the winds. I have a lot of friends who are asthmatic.”

Californians are also being asked to vote on an initiative, Proposition 1, that would cement the right to an abortion in the state’s constitution — a response to the U.S. Supreme Court decision that overturned Roe v. Wade. Numerous polls show Latinos strongly support abortion rights, including the Latino Community Foundation survey, in which 61% of Latinos in California favored Proposition 1.

Margarita Gallegos, a Huntington Park resident who was born in Mexico and immigrated to the United States nearly 50 years ago, expressed strong support for abortion rights.

“There are people who have been abused and don’t want to have the baby,” Gallegos, 68, said in Spanish. “Women should have the right to choose for themselves and should also be able to take what they need to take so they don’t become pregnant.”

Speaking to Flores and two of his AltaMed colleagues from her front porch, Gallegos said that it was important for people to vote and that she would definitely cast her ballot.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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California: propuesta de prohibición del tabaco aromatizado le abre paso a la pipa de agua

November 03, 2022

LOS ÁNGELES – En 2019, los propietarios de negocios locales comenzaron a reunirse regularmente en el salón de pipas de agua (narguiles) de Arnie Abramyan, en las afueras de Los Ángeles, para luchar contra una propuesta estatal para prohibir la venta de tabaco aromatizado.

Desde el barrio de Tujunga, con una fuerte presencia de armenios, a los pies de las montañas de San Gabriel, Abramyan y otros propietarios de tiendas y cafés de narguiles comenzaron a correr la voz de que la prohibición, impulsada por una creciente epidemia de uso de cigarrillos electrónicos entre los adolescentes, podría dejarlos fuera del negocio y hacer desaparecer un preciado ritual social que muchos sienten como parte de su herencia.

“Íbamos a ser un daño colateral”, dijo Abramyan, ahora presidente de la National Hookah Community Association.

A medida que su movimiento crecía, los propietarios de los negocios contrataron a un cabildero y viajaron a Sacramento para reunirse con legisladores. Publicaron videos en YouTube sobre “la historia y la tradición centenaria” de fumar estas pipas de agua tan populares en Medio Oriente.

Su trabajo dio frutos: en agosto de 2020 los legisladores estatales aprobaron la prohibición de la venta de tabaco aromatizado, incluidos los cigarrillos mentolados, pero eximieron a los puros premium, el tabaco de pipa suelto y el “producto de tabaco de shisha aromatizado” utilizado en las pipas de agua.

Nunca entró en vigencia. Las grandes tabacaleras lanzaron rápidamente una campaña de referéndum y reunieron suficientes firmas para llevar el tema a las urnas. Este mes, los californianos decidirán, a través de la Propuesta 31, si mantienen o bloquean la ley, que haría ilegal la venta de cigarrillos, cigarrillos electrónicos y otros productos de tabaco aromatizados en comercios. También se prohibiría la venta de chicles o gomas de mascar que contengan nicotina y no estén aprobados por la FDA.

Si la ley se mantiene —los últimos sondeos indican que la mayoría de los votantes la apoyan—, California se convertiría en el segundo estado en eliminar de las tiendas los vaporizadores de sabores y los cigarrillos mentolados, que han contribuido a atrapar a millones de fumadores negros y latinos desde que las compañías tabacaleras empezaron a comercializarlos en los barrios urbanos hace medio siglo.

La cuestión de por qué California ha concedido una excepción a los fumadores de narguiles mientras prohíbe los cigarrillos mentolados, la elección del 85% de los fumadores afroamericanos, ha generado un debate sobre qué productos del tabaco —si es que hay alguno— merecen protección.

Hasta hace poco, los esfuerzos por prohibir los mentolados habían fracasado ante las agresivas tácticas de las tabacaleras, que han evitado pérdidas multimillonarias equiparando dichas prohibiciones con el racismo y la guerra contra las drogas.

Los grupos antitabaco advierten que esta estrategia se ha convertido en un modelo para evitar la interferencia del gobierno. Denuncian que la exención del narguile es el último ejemplo de cómo las empresas utilizan con éxito las políticas de identidad para seguir beneficiándose de un producto mortal.

“El narguile ha recibido un pase sin ninguna razón científica”, dijo Carol McGruder, cofundadora del African American Tobacco Control Leadership Council. McGruder, que lleva años librando una guerra contra las empresas tabacaleras por apuntar “de manera depredadora” a las comunidades negras con los cigarrillos mentolados, dijo que fumar narguile se ha puesto cada vez más de moda entre los jóvenes negros.

Muchos jóvenes creen erróneamente que fumar narguile es menos perjudicial que otras formas de fumar, pero los expertos afirman que el tabaco que se absorve a través de las pipas de agua es tan adictivo como el de los cigarrillos y contiene alquitrán, nicotina y metales pesados similares que provocan cáncer.

“Sacan una hermosa pipa de agua antigua y dicen que la pipa de agua tiene que ver con la familia y la comunidad”, dijo McGruder. “Pero todo es cuestión de dinero”.

Las propias grandes tabacaleras están atacando la exención del narguile, al decir que demuestra que la ley discrimina a los fumadores negros y latinos al prohibir los sabores mentolados, mientras que da “un trato especial a los ricos”, como argumenta una campaña publicitaria pagada por la industria.

“La Propuesta 31 aumentará la delincuencia y ampliará los mercados ilegales, recortará los ingresos para servicios básicos y podría volverse en contra de las mismas comunidades que sus los que la proponen dicen querer ayudar”, dijo Beth Miller, vocera de la campaña “No a la Propuesta 31”.

Más de 360 municipios, agrupados principalmente en California y Massachusetts, han restringido la venta de productos de tabaco aromatizados, incluidas las cápsulas de cigarrillos electrónicos de sabores que atraen a los niños —fresa, chocolatada y ponche rosa— que, según las autoridades sanitarias, han servido de puerta de entrada al consumo de tabaco entre los adolescentes.

Aproximadamente la mitad de las ordenanzas restringen el mentol, mientras que menos de 20, casi todas ellas en California, exime el tabaco para narguile y los bares de narguiles.

En 2021, el 80% de los estudiantes de secundaria y casi el 75% de los estudiantes de secundaria que habían usado un producto de tabaco en los 30 días anteriores informaron que usaban tabaco con sabor, según los Centros para el Control y la Prevención de Enfermedades (CDC). En 2019 y 2020, un brote de una dolencia pulmonar relacionada con el vaping, conocido como EVALI, mató a 68 personas.

La epidemia de vaping ha dado a los activistas antitabaco una oportunidad para ejercer presión contra los cigarrillos mentolados. Inventados en la década de 1920, su sabor fresco y a menta ayudó a los nuevos fumadores a adoptarlos más fácilmente que los cigarrillos sin sabor, y la industria los comercializó como una opción más saludable.

En los años 60, las tabacaleras apuntaron a la comunidad negra, repartiendo muestras gratuitas a jóvenes “comunicadores” de moda en barberías y bares. Los cigarrillos mentolados representan más de un tercio de los $80,000 millones del mercado estadounidense de cigarrillos.

Reynolds American, el mayor fabricante de cigarrillos con mentol del país, incluido Newport, batalla contra la prohibición de los mentolados dando dinero a la Red de Acción Nacional del reverendo Al Sharpton y a otros grupos de derechos civiles.

Cuando el Concejo de la Ciudad de Nueva York propuso una prohibición de los cigarrillos mentolados en 2019, Sharpton citó el caso de Eric Garner, un hombre negro que murió bajo custodia policial en 2014 después de que lo detuvieran por vender supuestamente cigarrillos sueltos y sin impuestos en la calle.

Pero el éxito de estos esfuerzos ha tenido un precio devastador, dicen expertos en salud pública. Los hombres afroamericanos tienen la mayor tasa de nuevos casos de cáncer de pulmón en Estados Unidos, según los CDC.

A principios de este año, la FDA anunció un plan para prohibir la venta de cigarrillos con sabor a mentol, una medida largamente esperada por las autoridades sanitarias y algunos líderes negros, incluso mientras se preparaban para una prolongada batalla legal con la industria del tabaco que podría retrasar la prohibición durante varios años.

Los activistas antitabaco se han centrado en el mentol durante años, dijo Valerie Yerger, profesora asociada de política sanitaria en la Universidad de California-San Francisco. “Nadie se centró en el narguile”, agregó.

Pero el uso de la pipa de agua entre los jóvenes ha aumentado en las últimas décadas.

En las contiendas de narguile que se celebran en Estados Unidos y Europa, los concursantes compiten por construir la pipa de agua más elaborada, a menudo con una banda sonora de hip-hop. Las pipas de agua elaboradas, con sus onduladas bocanadas de humo, suelen aparecer de forma destacada en los videos de rap.

“Es otra forma que ha encontrado la industria para mantener a nuestros jóvenes adictos a estos productos”, afirma Yerger.

Los proveedores de narguile argumentan que las prohibiciones generales ponen en peligro a los propietarios de pequeños negocios, muchos de ellos inmigrantes, y amenazan con borrar un “rico patrimonio cultural” al prohibir de hecho las pipas de narguile, que suelen formar parte de las reuniones y celebraciones de árabes, armenios, persas y otros originarios de Medio Oriente. Rechazan la afirmación de que su lucha es solo por dinero.

“Los salones de narguile son un distintivo de la comunidad”, afirma Rima Khoury, consejera general de Fumari, una empresa de tabaco para narguile con sede en San Diego.

Para Abramyan, fumar un narguile era un ritual adulto después de la cena que sus padres, de origen iraní, trajeron consigo cuando emigraron a Estados Unidos en la década de 1980. Las ornamentadas pipas de agua suelen tener varios metros de altura y tardan al menos 20 minutos en prepararse.

“Esto no es algo que los niños fumen en los baños de la escuela”, dijo. “No queremos que nuestros hijos fumen, pero ¿por qué no va a poder mi abuelo fumar su narguile en su patio?”.

Los grupos de estudio de la Biblia y la sección local del Rotary Club se reúnen regularmente en su salón de narguile de Tujunga, Garden on Foothill, que cuenta con quioscos al aire libre para familias y grupos. “Para los musulmanes que no beben alcohol o los que no quieren ir a clubes de striptease, este es un espacio seguro”, afirma.

Munchies Mart, la tienda que maneja a pocas cuadras vende pipas de narguile hechas a mano y tabaco de sabores como limonada de fresa, naranja pop y agua fresca, muy lejos del tabaco empapado de manzana que, recuerda, su abuela persa mezclaba en su cocina.

Utilizar las prácticas culturales para argumentar las exenciones de las políticas públicas no es nada nuevo, dijo Arnab Mukherjea, profesor asociado de salud pública en la Universidad Estatal de California-East Bay.

Pero dijo que las comunidades suelen sufrir cuando los intereses corporativos “utilizan la identidad cultural para comercializar un producto de consumo masivo”.

“Vas a cualquier ciudad universitaria”, dijo, “y los bares de narguile están llenos no de musulmanes practicantes, sino de chicos en edad universitaria que van allí a socializar, consumiendo sabores en goma de mascar y algodón de azúcar”.

Esta historia fue producida por KHN, que publica California Healthline, un servicio editorialmente independiente de la California Health Care Foundation.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Colorado Voters to Decide Whether All Schoolkids Get a Free Lunch

November 03, 2022

During most of the pandemic, in every public school cafeteria throughout the country, every kid could get a free lunch, not just those from the poorest homes. Everyone.

The program that fed 50.6 million U.S. students expired in September, but some states are figuring out ways to extend it. California and Maine have both passed legislation to fund universal free lunch.

In Colorado, a coalition of parents, teachers, and anti-hunger advocates are pushing to make permanent universal free school lunches, and lawmakers in the Democratic-controlled legislature put it on the ballot.

GlendaRika Garcia, a bilingual food assistance navigator for Hunger Free Colorado, strongly backs the idea.

“I think that the kids being able to eat for free at school is really important, for all families, all kids,” said Garcia, a widow and a single mom of four boys.

Two of them, Alonzo and Pedro, tossed a football around in front of their apartment building, as Garcia explained the Healthy School Meals for All proposal on the ballot.

“Kids can’t learn if they don’t have good nutrition,” said Garcia, whose job entails signing up people for benefits and making sure they’re eligible.

The measure, known as Proposition FF, would use state funds to offer free meals for all public school students. It would also fund pay increases for school cafeteria workers, helping schools deal with staff shortages, and would incentivize schools to buy Colorado-grown food. That has some families, workers, and farmers cheering.

But critics point to a steep price tag for a new government program, which raises $100 million annually from a tax on households that make $300,000 or more a year.

School-aged members of a family of four making less than about $51,000 a year are eligible for free lunch. But supporters of the measure say that right now more than 60,000 Colorado kids can’t afford school meals yet aren’t eligible.

Garcia sees the proposal as a game changer, an equalizer. Depending on her job, Garcia at times qualified for her sons to get free lunches and at times didn’t, a blow to her budget.

Another issue, Garcia said, is that some kids bully others for getting a free lunch. It happened to her as a child when she also qualified for free lunch, and it happened to one of her sons.

“They know that people can identify if they can’t afford it. It hurts my heart,” she said.

Her son Alonzo said that at his high school some kids avoid the lunchroom rather than admit they qualify for free lunch.

“I think that they get embarrassed because they can’t afford it,” he said.

Many Colorado districts reported a clear uptick during the pandemic of kids eating lunches provided for free at school.

“We were feeding kids that we have never fed before, and it was good to see them coming up, and not just buying junk food,” said Andrea Cisneros, the kitchen manager at West Woods Elementary School in Arvada.

Many students arrive at school without food, said Dan Sharp, the school nutrition director in Mesa County Valley School District 51 in Grand Junction.

The district saw a 40% year-over-year increase in meals served during the pandemic, said Sharp.

“I really believe there’s more households here and students that could qualify but don’t, due to the stigma that goes with applying for free and reduced meals,” he said.

Proponents said they did several food insecurity surveys throughout the pandemic and, according to a recent survey, 44% of respondents with kids at home reported struggling to have access to nutritious food.

Low-income students will keep receiving free meals through federal funding, whether the proposal passes or not. There’s no organized opposition to the measure, but it does have critics.

“Nobody wants to be evil enough to say it, but this is a really stupid idea,” said Jon Caldara, president of the Independence Institute, a libertarian think tank. “Most kids in Colorado do not need this. And in fact, those who do, already have this.”

The group’s voter’s guide recommends a no vote.

“This proposal is, ‘Hey, let’s get the rich guys to buy our kids’ lunch,’” he said. “This is another expansion of state bureaucracy that is just not necessary.”

The governor told Colorado Public Radio’s Colorado Matters he hasn’t made his mind up about how he’ll vote on it.

“I don’t have an objection to the funding mechanism, but at the same time I sort of ask myself, ‘If we had this, would it be better just to be able to pay teachers better, reduce class size?’” said Gov. Jared Polis, a Democrat. “Or is the best use of it lunches for upper-middle-income families?”

He added that the measure “doesn’t affect the state finances one way or the other because it’s effectively revenue-neutral with the mechanism.”

His Republican opponent seemed to lean toward supporting Proposition FF in her interview on the show.

“I haven’t had a chance to look at it, but I do want to make sure that every child has access to healthy food and lunches, so I’m certainly open to it,” said Heidi Ganahl.

The Common Sense Institute, a nonpartisan free-market think tank, analyzed the measure and raised several concerns, with modeling that showed it could be underfunded or raise more money than is needed.

“There needs to be some good oversight on the program so that costs are managed well, and also that they don’t develop a huge surplus,” said Steven Byers, the group’s senior economist.

Despite concerns about cost, universal free school lunch appears popular throughout the nation.

California allocated $650 million from its state budget to fund and support its universal free school meals program for the 2022-23 school year. Maine’s program was estimated by lawmakers to cost around $34 million a year.

Washington, Minnesota, Wisconsin, Ohio, Pennsylvania, New York, Massachusetts, and North Carolina introduced bills similar to the one on the Colorado ballot, most of them during the current legislative session. All of them are still in committee and have yet to go up for a vote.

A report published in June 2022 by the Urban Institute, a nonpartisan think tank focused on social and economic research, found that 76% of adults living with children enrolled in public school and 67% of adults not living with children enrolled in public school supported permanent free school meals.

This story is part of a partnership that includes Colorado Public RadioNPR, and KHN.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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California’s Proposed Flavored Tobacco Ban Gives Hookah a Pass

November 03, 2022

LOS ANGELES — In 2019, local business owners began gathering regularly at Arnie Abramyan’s hookah lounge on the outskirts of Los Angeles to fight a proposed statewide prohibition on the sale of flavored tobacco.

From the heavily Armenian neighborhood of Tujunga in the foothills of the San Gabriel Mountains, Abramyan and other hookah shop and cafe owners began spreading the word that the ban, prompted by a burgeoning epidemic of e-cigarette use among teens, could put them out of business and extinguish a beloved social ritual that many feel is part of their heritage.

“We were going to be collateral damage,” said Abramyan, now president of the National Hookah Community Association.

As their movement grew, the business owners hired a lobbyist and traveled to Sacramento to meet with lawmakers. They posted YouTube videos on “the history and centuries-old tradition” of smoking the water pipes popular in the Middle East. Their work paid off: State lawmakers passed the ban in August 2020, which outlawed the sale of flavored tobacco, including menthol cigarettes — but exempted premium cigars, loose pipe tobacco, and the “flavored shisha tobacco product” used in hookah pipes.

It never went into effect. Big Tobacco quickly launched a referendum drive and gathered enough signatures to bring the issue to voters. This month, Californians will decide — via Proposition 31 — whether to uphold or block the law, which would make it illegal for brick-and-mortar retailers to sell flavored cigarettes, e-cigarettes, and other flavored tobacco products. Sales of gums or gummies that contain nicotine and are not approved by the FDA would also be prohibited.

If the law is upheld — recent polling indicates that a majority of likely voters support it — California would become the second state to rid stores of both flavored vapes and menthol cigarettes, which have helped hook millions of Black and Latino smokers since tobacco companies began marketing them in inner-city neighborhoods half a century ago.

The question of why California has granted hookah smokers an exception while banning menthol cigarettes, the choice of 85% of African American smokers, has sparked a debate about which tobacco products — if any — merit protection. Until recently, efforts to outlaw menthols had failed in the face of aggressive tactics by tobacco companies, which have staved off billions in losses by equating such bans with racism and the war on drugs.

Anti-tobacco groups warn that this strategy has become a model for fending off government interference. They decry the hookah exemption as the latest example of business successfully using identity politics to keep profiting from a deadly product.

“Hookah has been given a pass for no scientific reason,” said Carol McGruder, co-founder of the African American Tobacco Control Leadership Council. McGruder, who has spent years waging war against tobacco companies for their “predatory targeting” of Black communities with menthol cigarettes, said hookah smoking has become increasingly trendy among Black youths.

Many young people mistakenly believe that hookah smoking is less harmful than other forms of smoking, but experts say tobacco smoked through water pipes is just as addictive as cigarette tobacco and contains similar cancer-causing tar, nicotine, and heavy metals.

“They bring out a beautiful antique hookah pipe and they say that hookah is all about family and community,” McGruder said. “But it’s all about money.”

Big Tobacco itself is assailing the hookah exemption, saying it proves that the law discriminates against Black and Latino smokers by banning menthol flavors, while giving “special treatment to the rich,” as an ad campaign paid for by the industry argues.

“Prop. 31 will increase crime and expand illegal markets, cut revenue for critical services and could backfire on the very communities its proponents say they want to help,” said Beth Miller, a spokesperson for the “No on Prop 31” campaign.

More than 360 municipalities, clustered primarily in California and Massachusetts, have restricted the sale of flavored tobacco products, including e-cigarette pods in kid-friendly flavors — strawberry, chocolate milk, and pink punch — which health officials say have provided a gateway to teenage smoking. Roughly half of the ordinances restrict menthol, while fewer than 20 — nearly all of them in California — exempt hookah tobacco and/or hookah bars.

In 2021, 80% of high school students and nearly 75% of middle school students who had used a tobacco product in the previous 30 days reported using flavored tobacco, the Centers for Disease Control and Prevention reported. In 2019 and 2020, an outbreak of vaping-related lung disease, known as EVALI, killed 68 people.

The vaping epidemic has given anti-smoking activists an opening to lobby against menthol cigarettes. Invented in the 1920s, their cool, minty flavor helped new smokers adjust to them more easily than non-flavored cigarettes, and the industry marketed them as a healthier option. In the 1960s, tobacco companies turned to the Black community, handing out free samples to hip, young “communicators” in barbershops and bars. Menthol cigarettes account for more than a third of the $80 billion U.S. cigarette market.

Reynolds American, the country’s largest maker of menthol cigarettes, including Newport, has battled menthol bans by giving money to the Rev. Al Sharpton’s National Action Network and other civil rights groups. When the New York City Council proposed a menthol cigarette ban in 2019, Sharpton cited the case of Eric Garner, a Black man who died in police custody in 2014 after he was stopped for allegedly selling single, untaxed cigarettes on the street.

But the success of these efforts came at a devastating price, public health experts say. African American men have the highest rate of new lung cancer cases in America, according to the CDC.

Earlier this year, the FDA announced a plan to ban sales of menthol-flavored cigarettes, a long-awaited move hailed by health officials and some Black leaders, even as they braced themselves for a protracted legal battle with the tobacco industry that could delay the ban for several years.

For years, anti-smoking activists have been focused on menthol, said Valerie Yerger, an associate professor of health policy at the University of California-San Francisco. “Nobody was focused on hookah,” she said.

But water-pipe use among young people has been on the rise in recent decades.

At Hookah battles across the United States and Europe, contestants compete to build the most elaborate water pipe, often to a hip-hop soundtrack. Elaborate water pipes, with their billowing puffs of smoke, are often prominently featured in rap videos.

“It’s just another way the industry has found to keep our young people addicted to these products,” Yerger said.

Hookah purveyors argue that blanket prohibitions endanger small-business owners, many of them immigrants, and threaten to erase a “rich cultural heritage” by effectively outlawing hookah pipes, which are often part of gatherings and celebrations for Arabs, Armenians, Persians, and others hailing from the Middle East. They reject the claim that their fight is only about money.

“Hookah lounges are a hallmark of community,” said Rima Khoury, general counsel for Fumari, a San Diego-based hookah tobacco company.

For Abramyan, smoking a hookah was an after-dinner, adult ritual his Iranian-born parents brought with them when they immigrated to America in the 1980s. The ornate water pipes are often several feet tall and take at least 20 minutes to set up.

“This is not something kids are smoking in the bathrooms at school,” he said. “We don’t want our kids to smoke, but why shouldn’t my grandpa be able to smoke his hookah in his backyard?”

Bible study groups and the local Rotary Club chapter regularly meet at his Tujunga hookah lounge, Garden on Foothill, which features outdoor gazebos for families and groups. “For Muslims who don’t drink alcohol, or people who don’t like to go to strip clubs, this is a safe space,” he said.

The shop he runs a few blocks away, Munchies Mart, sells handmade hookah pipes and tobacco in flavors such as Strawberry Lemonade, Orange Pop, and Agua Fresca, a far cry from the apple-soaked tobacco he remembers his Persian grandmother mixing in her kitchen.

Using cultural practices to argue for public policy exemptions is nothing new, said Arnab Mukherjea, an associate professor of public health at California State University-East Bay.

But he said that communities often suffer when corporate interests “use cultural identity to market a product for mass consumption.”

“You go to any college town,” he said, “and the hookah bars are filled not with practicing Muslims, but with college-age kids who are going there to socialize, consuming flavors in bubble gum and cotton candy.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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