 This is S-288, another world ago in January, February. If you remember, there was a whole lot of concern about the steep rise in the use of flavored like e-cigarettes, otherwise known as vapes. In schools, they don't leave an odor. Kids can hide them in their hand, but there was a lot of health concern about their health impacts and a lot of concern about the chemicals that some of these high temperature. Delivery devices also burned and got inhaled, heavy metals, amongst other things. And this was health and welfare's bill. It got more extensive than I will say some of us on the committee were comfortable with. It reached into all flavored, including cigarettes, cigars, chewing tobacco. But we started with the vapes and that's where we are, but it's, you know, we've had other health issues on our mind and it kind of got taken off. But it had been my intention to bring this bill up like this was an S-bill. We had another week to get S-bills out by crossover. It had been my intent to bring this one up for discussion. So I thought we'd have Jen walk us through it. Jill Sudofgarin is here from the Vermont Medical Society. After that, I will leave it to the committee if we go any further with this. And I will tell you there is a lot of interest, both for the health advocates groups and for people selling these products. And it will take us some time in testimony. And this one has not been through the other body. So it's chances of crossover are slimmer than some. So with that, Jen, why don't you, can you put it up on the screen and walk us through it? Yes. Do you want to look at the actual, so there's a, the bill itself or the, the amendment that was passed out of the health and welfare committee, which is 21 pages. I also have a one page summary. I don't know which one you prefer. Okay. That'll get us out of here before dinner. All right. And when you have a moment, would you send me the summary so I could post it? Yes. Thank you. All right. So this is a summary of S-288 and act relating to banning flavored tobacco products and e-liquids. It starts off with some findings, including some about youth use of e-cigarettes and flavored e-cigarettes and the regulation of menthol cigarettes. So we can look at any of these in more detail if you want for the actual language. Section two amends seven VSA chapter 40, which is the chapter on tobacco products. It expands the definition of tobacco substitute so there's a little bit broader and can capture emerging products that might be designed a little differently. It adds a definition of what we called e-liquid, which is the substance that's used with an e-cigarette to produce a vapor or aerosol regardless of whether the substance contains nicotine. And then added that term added or replaced that terminology e-liquid with some other similar terms, but sometimes inconsistent terms throughout the tobacco statutes. The amendment eliminates the ban on and the penalty for possession of cigarettes, e-cigarettes and tobacco paraphernalia by people who are under 21 years of age. So it gets rid of the ban and the penalty for possession under 21. It keeps the ban and penalty for people under 21 purchasing attempting to purchase or using false identification to purchase or attempt to purchase these products or e-liquids. So it gets rid of the ban on possession, but it keeps the ban on purchase and penalty on purchase attempt to purchase and using false ID for purchase. It updates some statutes on contraband and seizure to include e-cigarettes, e-liquids and tobacco paraphernalia that are sold offered for sale or possessed for sale and violation of the internet sales ban and then a new flavor ban. So some of this is just updating some of the language to keep pace with other changes to the statutes and then adding the new flavor ban. And then it bans the retail sale, but not possession of flavored cigarettes, e-cigarettes and e-liquids. So it would only allow tobacco flavored products. This ban includes a ban on the sale, retail sale of menthol cigarettes. And the penalty is up to $100 for a first defense and $500 for a subsequent offense, the same as the penalty for sale to a minor. And that would be assessed on the owner, operator or manager of a retail establishment, not specifically on the clerk. Section three gives the judicial bureau jurisdiction over violations of the ban on the sale of flavored tobacco products and substitutes and cigarettes and all of those things. Section four just has a conforming change adding e-liquids to an exception to the default penalty provision. Section five adds e-liquids to the ban on the use of tobacco products and e-cigarettes on public school grounds. Section six makes a conforming change just correcting that e-liquid terminology from the different language that was used for the substance misuse prevention oversight and advisory council. Section seven makes some clarifying and conforming changes to the definition of other tobacco products for taxes on e-cigarettes. One of the things we did here was in section one in the tobacco statutes and in section seven in the tax statutes tried to harmonize the direct the definitions of tobacco products so that they were not there a little bit circular and an inconsistent. And then section. We have this right. I'm sorry. The finance has this because it has to do with tobacco taxes. It may. There's also the the penalty for the violation. That's judiciary. Oh, okay. I think we have it because maybe that is why you are a go tax. Okay. Well, it's just changing a definition, I think, but we can look more specifically at that. That's helpful. And then section eight directs the attorney general's office to report by December 1. This, that was the date we put in there back in January. So you may want to revisit that, but direct the attorney general's office to report by December 1. Regarding whether and to what extent Vermont could legally restrict advertising and regulate the labels for e-cigarettes and other vaping related products. And the act would take effect in a few days. So this is, if you decide to pursue this, you may also need to look at revisiting that effective date. We'll take that off acts on e-cigarettes, the liquid only, not the paraphernalia used to inhale it. And that bill was vetoed. I believe not this session, but the session before. And so right now this would include e-cigarettes in the tobacco tax. We'd have to look at that. I don't think that's the, well, let me look before I tell you that is or isn't the case. Maybe that is the case. Only John Bloomer knows why. But I know we taxed them and it got vetoed. Okay. I think we're, I thought we were making conforming. Changes. Yeah. Yeah. We're adding, we're adding them to the tobacco tax. Well, there aren't. So let me just share this bit of language. So this is the tobacco tax chapter. So section seven here is amending 32 BSA section. And this is the definition of other tobacco products. So it's, it's. So under existing law, we have already included, including any liquids, whether nicotine based or not. This would just replace that with E liquid. So it's the same concept, just using the different terminology. So, and otherwise there, there, the rest are just conforming. So we don't have any changes to correct some grammar. But I don't think there's a policy change in section seven. It's just some conforming revisions. That's why we had it, but. We will take a look. Okay. Senator Serajkin, you have a question. Nolan, can you give us some clarity first? Yes. Okay. I'm going to go back to my fiscal office. There is a fiscal note for this bill. And Graham and I wrote it in January. And there's a revenue impact. So I just put it up on the web page. Would you like to be co-host so you can share it? Well, Graham's here. So if you want to hear from it, I would recommend he lead on it, but why don't that's up to you, whether either if Graham's even ready to prepare to talk about it today or another day, I don't want. Okay. Graham, are you prepared to talk about the fiscal note? I can give you the fiscal note that we prepared back in February, although I'm looking through Jen's walkthrough and it's slightly different than what we prepared. The fiscal note that was prepared was for all, for banning all flavored tobacco products. So it looks like they're, this one included. Like flavored. Other tobacco products like cigars would be allowed in this and so. I'd have to look, I think you're looking right now just at, that you maybe looking at the tax definition, which is just in there for tax purposes. I mean, I mean, if the majority of the revenue lost here is on the ban of menthol cigarettes. So I could talk about the fiscal note and even if there is a small ban, even if the ban on cigars and other tobacco products is, is or is not in the bill, it's not going to move the revenue estimate that much. So if faith wants to pull it up, I can just overview it quickly for the committee. But essentially, that's all. Yeah. Let me just pull it up on my computer too. Are you waiting for me to pull it up faith or okay. Thank you. Coming. Sorry. My iPad and don't have it. So no one I've paired this fiscal note back in January. So, you can see in the bill summary that it is included, banning the sale of basically all flavored tobacco products, including flavored cigarettes of any kind, other tobacco based products, cigars, cigarettes, tobacco stuff and tobacco, but also what was going to ban any flavored electronic cigarettes. And so the fiscal impact on this was going to be a revenue loss. If you scroll a little bit down, that would be a loss of $5.45 million in fiscal 21. With $4.76 million to the general fund and then $690,000 to the education fund, because cigarettes and tobacco products do pay the sales and use tax. So the majority of that revenue, the 5.45 million dollars comes from the banning of flavored cigarettes. So about almost $4 million, $4.1 million of that 5.45 is mental cigarettes. And the remaining is e-cigarettes and other tobacco products. So I can follow up with any, I can answer any follow up questions. Big fiscal impact is mental cigarettes. That's correct. Yeah. Has anybody done any projected fiscal impact of the savings that might result from healthier outcomes? I think that, I think we addressed that in the fiscal know where we say it's really hard. I mean, it's a great question. And it's really hard to, essentially the answer is yes, it will have positive health outcomes. And no, we have no way of measuring how much that would, when, you know, when that would be or how to measure it, you know, if it's more long-term. So I mean, I'm sure that there are studies that have stuff, but there's no easy way to measure that, but I think. I'm sure for example, as you look back to the effect of the campaigns to reduce tobacco use, there is some measurable effect by reducing smoking. That may be a very long-term in nature. Yeah. I mean, it would be hard to take those studies and use it to study. I think it's one of those things where like, we should study it down the road and see what the impact would be if we do this, but I don't think there's any way for us to extrapolate those savings and be able to actually put a number on it. All we can say is yes, there'll be a positive health effect by reduction, any kind of reduction in tobacco use. Well, I guess if it doesn't, we could re-institute the use of flavored tobacco down the road. That too. We will be on to something else down the road. And there are lots of people who would like to testify on the potential impact of this on health. So right now, Nolan or Graham or Jen, have we got any questions for them? I just, just to clarify, I thought I saw at the bottom of the fiscal note that like 18 or 19% of the loss in revenue would come from the banning of menthol cigarettes. Was that correct or was it flipped? You have the stat, right? What it is is menthol cigarettes make up a significant portion of total cigarette sales. And in Vermont it's estimated that about 18% of total cigarette taxes come from the sale of menthol cigarettes. So if we banned everything but menthol, we'd be losing about 80% of that 5.45 million? No, so what another way of putting this is we collect roughly about $65, $70 million in cigarette taxes a year. Right. And about 18% of this, 18% of the total sales of cigarette taxes are menthol cigarettes. And so it's essentially a statistic that just said, that sort of highlights how the major revenue loss in this bill is from the sale of menthol cigarettes. So if you didn't do the menthol cigarettes as part of this bill, instead of a 5.45 million revenue loss, it would be closer to about 1.2, 1.3 million because the menthol cigarettes, our portion of this bill is about $4.1 million. I'll take your word for that, but how does, if it's only 18%, because we're not banning all cigarettes. All cigarettes. It's 18% of the cigarette sales, not of the revenue would be used. Got it. Got it. Okay. Sorry. Sorry if I didn't understand the question fully. We're still on having our teeth pulled. So was your, was your invitation madam chair to ask Jen a question as well? Yes. So I guess we would have additional witnesses on this. If we go forward with it, but what was the rationale as best you can tell the madam chair, you can answer this as well for changing the, the age of possession. We just went through raising the age of possession. And now your committee is, I guess eliminating, are you eliminating the possession age altogether or you're lowering it to 18. You're allowed to walk around with cigarettes without any penalty. I'll walk around. Jen. Yeah, I'm looking back at the language, but I believe it is the, that just the walk around the possession piece so that it would not. So it would eliminate the language. Right now the language says a person under 21 years of age shall not possess purchase or attempt to purchase. And it would get rid of the shall not possess part. That's my question. Do you know the thinking as to why the committee did that? I can try that. I think the idea was that we wanted to stop the sale. As we have, but we didn't want to get in, you know, we did this with possession of alcohol and you ended up getting a lot of kids in a lot of trouble. That wasn't really what we wanted to do. We wanted to stop. We wanted to go after the manufacturers, the sellers, but we didn't really want to start trying to criminalize. Teenagers. Did we have we done that for alcohol too? I don't know. I don't think so. I just, I just find it curious because we just did that. A year ago or two years ago that we lowered, we raised the age sales and possession. And I'm wondering why the rethinking of that at this point. I think when you hear from Jill from the medical society, she may be able to touch on that. Cause I think they were one of the groups that was in favor of eliminating the penalty on possession. Yes, definitely. This is Jill Satof-Garron from the Vermont medical society. And just saying that those possession laws that are going after youth have not been shown to be very enforced very well. Also, it just sets up a situation where you're not really going after the youth are the ones that are being targeted by the industry. They're being targeted by the sales. And so we do really want to go after the seller and the retailer, not the youth. So I think we were in your committee with some testimony on this as well. And I can send you that if you want, Senator Sorokin. I would like to see that. Sure. But one of the concerns with this bill was we had just raised the purchasing age to 21. It went in, I believe either last September or October. So it's been in effect for about a year. And when we were looking at this in January, one of the concerns was while they're not allowed to buy anything. So why are we banning adults knowing full well that you can go to, you know, you can drive over the border and buy whatever you want, which is the other issue that's out there. And we did ascertain that if Senator Westman's senior citizens club went to Montreal and purchased a couple of packs of menthol cigarettes for their neighbor that they were not criminally liable. But so you can still go to New Hampshire and do 21 and come back with them. Or if you're 18, you can go to New Hampshire or 16, whatever the age is there. Okay. Jill, why don't you? Sure. So Jill Satov-Garand for the record. Thank you for having me. I'm going to be talking about the health impacts, not the finance impacts. I'm also speaking on behalf of the Vermont Academy of Pediatricians, the Vermont Chapter, and the Vermont Academy of Family Physicians. And we support banning all flavored tobacco products, including the eliquids and the menthol products. And basically I'm going to keep my comments pretty brief. I did send faith some documents for you to take a look at. But I just want to say that during the COVID pandemic, we really weren't focused on this bill. And like Ann said, it seems like a million years ago that we were dealing with youth vaping epidemic. And we were dealing with looking every day and seeing the CDC saying there's, you know, so many youth going to the ER with these lung collapsing and respiratory issues related to bates. But I will say that it's extremely relevant right now. And even during the COVID pandemic and particularly because we've seen the youth behavioral risk survey data, which shows that among high school students in Vermont, the use of e-cigarettes and vapes has more than doubled from 12% in 2017 to 26% in 2019. So we still have a serious problem. We're also dealing with the fact that kids are about to go back to school. So they're going to go back to maybe their peer groups where they've used these products in the past. And then a study was just published August 11th, which I feel like is super relevant in the Journal of Adolescent Health. And it found that teenagers and young adults who vape were five times more likely to experience COVID symptoms. And so because they were experiencing these symptoms, they were able to be tested. And those that were tested that used e-cigarettes were five times more likely to be diagnosed with COVID. Now these are not the age group that really got COVID. But the fact that they were using vapes made them more susceptible to getting COVID. And then those teenagers and young adults who used both e-cigarettes and conventional cigarettes were 6.8% more likely to be diagnosed with COVID. So this is a serious issue. We know that flavors are what appeal to kids. I like Skittle flavored. We like Skittle flavored. If it's Skittle or gummy bear flavored, kids are going to want to buy it. And we know that 80% of our youth between the ages of 12 and 17 years old started with a flavored product. So they start with a flavored product and then nearly 90% of adult smokers, the ones that become adult smokers started before the age of 18. So you're really just developing, the industry is developing their adult user who is going to keep their industry alive. The problem is that these flavored products that are out right now, they are in a super high potency of nicotine. So we don't even know what the health impacts of this is going to be. We know that one pod, one of the jewel pods equals one pack of cigarettes. And we also know that flavors, although the FDA did approve flavors to be used in food, they were not to be inhaled. So the byproducts of heating these e-liquids and what happens on our lungs are not understood. So we don't really understand what's going to happen with the high potency. And we don't really understand what's going to happen when these irritants get into our lungs except that we know that the kids are more susceptible to these vaping problems which are sending them to the hospital and they're more susceptible to COVID. We also know that the reward centers of the adolescent brain are particularly vulnerable to nicotine and to that addictive priming of the brain. So I would say ideally none of the tobacco products would be exempted, especially menthol because it's been specifically targeted and marketed to low income populations and the black American communities. But our members do support moving this bill because we really think that it's important to stop the initiation of youth users. And there's a lot of data on the information that I sent faith. So hopefully you'll get a chance to review that. But I'm open to any questions. Okay. Any questions for Jill? Senator Pearson. Thank you, ma'am, Chair. I'm curious, Jill, do we have any data to figure out whether tobacco 21 is working in Vermont? That's a good question. I mean, I do know that those numbers were, that I just cited were 2019 numbers. And like Ann was saying that the tobacco 21 just went into effect September of 2019. So I think that the data is not in on that quite well. Quite yet, but I can reach out to the department of health and see if we have any more information on that. And we also at the same time, basically almost double the cost of vapes and e-cigarettes and all that, right? Do we have any data on the impact there? We have data just in terms of there being, you know, people have done some switching and so that's what we're worried about a little bit in terms of if the menthol is still out there that kids could switch to regular combustibles. So. But it's illegal for them to buy. Yes, it is illegal. Yes. And then there was one other point I wanted to make because Senator Brock was asking about just in terms of if we've quantified cost and we've quantified savings in terms of our prevention interventions. And I will say that annually we spent $348 million in healthcare costs related to tobacco use. So when you put that up against the impact of this legislation, I think it, I think that the healthcare costs are more meaningful. And I also just wanted to say that the 3450 of 50% of Bermaners have four chronic diseases and that's related to three behaviors and the first one being tobacco use. And that chronic disease costs money as well. So one little piece, if I was reminded in addition to Vermont's increase of the smoking age to 21 that actually nationally there is now a federal age 21 for sale of tobacco products. So to the extent that's helpful. It was passed in December of 2019. Right. Passed and signed. Okay. There's also a federal ban on flavors, but I gather it's got some mixed reviews as to how it's being enforced or interpreted, but we can check that out if anyone would like. Okay. Yes, the very short version of that is that there's three types of flavored East cigarettes. There's the pods. There's the ones that come as a already filled electronic cigarette and then there's the open tank ones. And it's only the pods that are restricted under the federal law. The filled ones and the open tank ones are not, although there's some potential regulatory enforcement. That could happen in the future. So I'm a little unclear. Jill, as to what you were saying about menthol. It sounded to me like you were. About to say that they're an important part of this bill, but you would like to see the bill move forward. Even if that. Wasn't part of it. And I think I got an email from. One of the tobacco control lobbyists saying that, but can you state what your. Position is about this bill going forward with or without. Mental coverage and. Who again, I mean, I know you said you represented the. The pediatric groups and stuff like that, but I didn't understand who your main client was. Well, I am the policy and communications manager for the Vermont medical society. And we also represent the American Academy of Pediatrics, Vermont chapter and the Vermont family of physicians. Okay. So it's made up of 2400. Physician and physician assistants across the state of Vermont. And we would like to see this bill move forward with all tobacco products because we don't want to see the switching. And we've seen that in other occasions. And there's actually in the, the information that I send, there is. Data that shows that youth do switch. But we also feel like. The incremental step of moving this forward of a flavored ban will stop the initiation. Or reduce the initiation from youth because we know that that. If 80% of our. Teenagers and young adults are getting. Hooked by the, the flavor. They start with a flavored product. Then by banning that flavored product, you're going to. At least reduce. The initiation. And so we do think it's an important step. That being said, again, ideally, everything would be included. All. So flavored. Does not include mental. It does. I'm saying. I'm still confused what your position is on mental then. We would like mental to be included. We would like mental to be included. Right. But would you not want the bill to go forward? If it doesn't include mental. Right now I'm saying that I would want the bill to move forward. If mental. If mental. If mental is taken out. Our members still feel like this would be an incremental step that we would support moving the bill forward. We would like to see it included, if possible. Right. Okay. Senator McDonald. There were some testimony about studies taken place since we last discussed this back in the late spring in the spring. Having to do with COVID. Could you. Can I send it suggests that vapors were more likely to contract COVID or they were. Vapors were more likely to test positive. For COVID. They were more likely to contract it. Even in the age category that they were in. So are they. Okay. And. If they contract it, then they're more likely to pass it along. Just by logic. Yes, but they also were suffering from it as well because of their, their lungs were. Already compromised. And so it made them more likely five times more likely. Okay. Well, our, our. The rationale, which finally banned the smoking of cigarettes and restaurants and public places. Was it. Based on that it was a stupid thing to do. It was that the, those that. It was at the second hand smoke. Affected people who weren't smoking in those same locations. Exactly. So I maybe it would be a stretch for Dr. That. We banned the product to stop the more rapid spread of the COVID-19. That would only be a temporary. Solution to. A temporary. I hope the temporary. Thank you. I did send the study to faith as well. If you want to look at it. Okay. All right. And again, remember January instead of people dying of COVID, we had the whole rash and that came down to. Pre-filled with. Cannabis wasn't that where they, they, but we had a whole rash of teenagers. In the hospital was severely damaged lungs. We had a lot of people dying of COVID-19. We had a lot of people dying of COVID-19. When they were looking at this bill. We're down in another world and another whole. Long damaging. Viruses, but. Okay. Think about this. Let me know what you'd like to do. If you'd like to hear from other people, let me know. We actually did well on time. Despite all the technical difficulties. And thank you. Thank you folks for hanging in there. Thank you. Faith and Dilia. If you see her. For getting us all straightened out. And I'll see you tomorrow. Tomorrow we are doing broadband. Then ending live stream now.