 Today we are shifting gears entirely and going to start talking about e-cigarettes and whether we want to do something more in the state about that. And the chair thought it would be appropriate to sort of understand the landscape. And for that purpose we have invited the Commissioner of Health to come and talk to us about what we know about electronic cigarettes. Super. Any questions ahead? Oh, can you do it now? Okay. Thank you. I'll do my editorial comments in the beginning. So I'm Commissioner of Health, Dr. Levine. The talk is labeled electronic vaping systems and public health crisis. Oh excuse me for a minute. Commissioner, this is your first one to hear this year. Perhaps we should first ask you. That's fine with me too. All right, so we'll go around and take a look. Logan McColl from Love Love, representing Illinois and Brisbane. Mary Beth Redmond, representing assets of the town outside of the village. Carl Rosenquist, representing the town of Georgia. Jessica Bernstead, representing Shelburne and St. George. And me. Sandy Haas, representing Rochester, Bethel, Stockbridge and Pittsfield. Robert DeFawn, representing Arizona. Teresa Loog, and I represent Waterbury, Bolton, Huntington, and Beale's Court. Dan Noyes, Wilkett, Hyde Park, Johnson, and Belvingere. James Gregor, chair of the Wage and Wage Street. Kelly Payell, London, Maryland. Thank you. That was a test. So you may hear other terms used besides electronic vaping systems. A newer term that's fondly been erased by some is ENDS, electronic nicotine delivery systems. It's all about vaping, and it truly is a public health crisis. The advertisement for the talk was this was science, and it will be science, but not intimidating science, but important science. The other thing is that I've delivered similar talks now quite a few times around the state, because it turns out school systems are very eager to hear about this, because they are absolutely terrified, petrified, frustrated, and pretty much just really concerned about what has been labeled, as you see, the true academics in their systems. So, when we talk about academics in public health, we're usually talking about a small number of cases. So, if there were a few cases of Ebola or Zika in the state of Vermont, that would be an epidemic. CDC says there was a 680% increase in six-year period in teen youths. We don't see those kinds of numbers before. That's like astounding. Now, we have made incredible progress in decreasing smoking rates, both in adults and in youth. So, right now in 2017, numbers have leveled off at about 9% for youth before their now-term combustible cigarettes, because they must be differentiated from these new reforms. But you'll see that the rate in electronic vaping systems is 12%. To give you an astounding statistic, 75% increase in just a one-year period, according to the National Youth Tobacco Survey, which was quoted by the FDA Commissioner Gottlieb, when he suddenly became very, very concerned about it. The things that are really of major concern with the Juul epidemic, and Juul is a brand name, but it's now a part of the lexicon because people are Juuling. So, it's kind of like Kleenex is one type of tissue, but everybody says give me the Kleenex. So, Juuling is sort of taking over the industry, but there are competitors that are doing okay as well. And that is the form of these electronic nicotine delivery systems that middle and high school students are using. And that form is fairly non-obtrusive. It's not like you may have seen pictures of these, you know, elaborate devices that deliver nicotine electronically. But the Juul device, which I'll pass around because I'm sure not every one of you has seen it, is cool. And if you were in the high school years, you would say, this is a cool thing. So, this looks like the thing you stick in your computer, and it is because that's where you're charging this up. This is the power you get. This is the flavor pod, quite small and concise, and you just sort of insert that and smoke through here. The one I'm passing around is Creme Brulee. You'll find that the flavors are quite authentic. I've only brought this one flavor today in this one design, but you could see how in a technology era, especially down in recent growing up, they would find this quite cool. Even more importantly, it can stay attached to their computer and be in their backpack, which is at their feet. And they can sort of look for something in their backpack and take a quick hit. And what they know how to do is to make it not appear that they're smoking. Go, there are many videos on the internet that show very cool ways to make smoke rings and designs and what have you, and that's part of your lore. When you're in school, that's not so cool because they've got taken away from you pretty quick. So they can actually smoke it without releasing any visible smoke. So, the cool aspect of it, the flavors, and then the nicotine addiction part of the three major conservative areas. I'm giving you a list of what I'm going to show you, about why these things are dangerous and why I'm so concerned about them. I won't read you every item on this slide because there's going to be an individual slide for each one of them. But we're going to go through all the things that the adult public should be concerned about. And I think as a state, and probably nation, we should all be concerned about as well. So starting with the prevalence of tobacco products and these vapid systems. In the past year, one survey, one quarter of high school students say that they have used an anti-tobacco product. That doesn't necessarily mean this device got an anti-tobacco product. And indeed, from 2015 to 2017, there was a reduction in use of tobacco products from 25% to 19%. One third of the youth said that they tried to quit, but found these to be highly addictive. We, in our Youth Risk Behavior Survey, look at either ever use, meaning they've tried it some time, but this is current use, which is usually looked at as a 20 or 30 day amount of use. So in the most recent Youth Risk Behavior Survey in 2017, there was an increase in ever use from 30 to 34%, and a decrease in current use from 15 to 12%. One of the most important aspects of an addicting substance and its uptake in the population is do people consider it to be harmful or safe to use? A lot of people drink and coffee around the table. Most people think caffeine is not a big deal, and they don't really look at that as a harmful substance. If there was an injectable opioid like heroin, most people would say, I don't think that's potentially good for me. So nicotine has achieved a different kind of sort of notoriety in the human. So when you look at cigarettes, the combustible cigarettes, are used are not like having their head in the sand. They know that these are dangerous. They know they could get cancer and heart disease and smoking. So they say, 68% of them say, this is a powerful thing. I'm always going to start doing this every day. However, when you look at e-cigarettes and look at 12th graders nationally, because we didn't ask this on the last YRBS survey, because this epidemic has happened so quickly that the questions just weren't in place. They say nationally, regular cigarettes 75%, 76% are harmful. E-cigarettes, 38%, 39% are harmful. And then looking at a separate independent data source, though reliable, fewer than 50%, two years later, said they thought they were smart. So there's a certain problem here with people, especially youth, thinking that these substances are not as harmful as traditional cigarettes. And in fact, unfortunately in our Youth Risk Behavior Survey, we also find that when we ask them questions about alcohol and cannabis, they view those as not especially harmful as well. Yes? A question about that. So originally vaping versus juuling was really to help people give up smoking because they could reduce the amount of nicotine over time. And so my brother did that. My kids saw that and that we all rejoiced in that as a family because he was finally quitting. And then I caught my youngest having one of these in his backpack and I asked him about it and his immediate response was, well mom, it's not smoking. I'm not hurting my lungs. And I wasn't sure, you know, so is it steaming or is it smoking? Is it the same sort of, I'm going to talk about the nicotine now. I'm just talking about the... What's in the very private separate slide, for example. Oh, okay. But the short answer is much of it is a great unknown. However, we don't believe the carcinogenic effect is the same. But we don't absolutely know because it hasn't gone on long. Because even getting cancer from smoking cigarettes doesn't happen in two, three, five years. It happens in decades. So we don't actually know. But the perception of harm is usually something that we can correlate with being a good deterrent. And if there's a low perception of harm, that usually correlates with higher uptake. I mentioned earlier the power of flavors. If you did take a whiff of this, I assume you felt it was pretty authentic for creme brulee. Well, it turns out creme brulee and all of the fruity flavors are the ones that the kids are really picking up on the most. And I've seen this number, which I have trouble believing, of 7,000 flavors. Now that's not one company producing a lot of, you know, of all the competitors. But they don't talk about flavors in terms of tens or hundreds. They talk about them in terms of thousands. So this is pretty dramatic. And youth, obviously, have a high uptake because they appreciate the flavors. The flavor itself is not addicting. It's the fact that the pleasure of the flavor is addicting. A pleasure? Yes. Who made new factories these? Well, this is the jewel company. So it's invested in a subsidiary of any tobacco company or anything like that? Several of these companies are part of tobacco companies now because they recognize this is a great company. They think about it, yes, yeah. But not all. Oh, okay. Some of the big ones, more recently, I don't know, it's been like the last month, got purchased by large tobacco companies. Because they're, they see the truck. That's right. And this is kind of a competitor, but it's also kind of a portfolio of addicting nicotine substances. The African-American population traditionally has favored mint and menthol, more so than fruit, and those are also probably playing with these in this group. And this does recapitulate the dark history from cigarette because the tobacco industry, as everyone kind of says now that we're talking about marijuana most of the time, that the tobacco industry wrote the playbook about how to get a population addicted to something that gives them pleasure and keep them buying it forever and ever and ever. And usually we talk about sort of the 80-20 formula where you addicted 20% of the population and that counts for 80% of your sales. Everyone else is more casual in this. If we look at the way you get into smoking these in the first place, 80% of youth say that they appreciated the flavor. That was sort of the thing that they used first, that Dr. Ngo-Wen. And there's a very dark history in flavored cigarettes, as well, combustible cigarettes, so that this is just following suit with this. The physician had on now, nicotine addiction is really a major concern. I think nicotine has not received the notoriety it should receive over time because cigarettes have been around so long and everybody's concerned about lung cancer, not necessarily what is the nicotine doing. And the only time the nicotine comes up is when somebody genuinely wants to quit and then we try to offer them all kinds of nicotine replacement that would be something like hell. But if you look at what nicotine does to a brain, it does a lot in terms of development of a young brain, learning potential of that brain, whether it be more long term or whether it be the day that they're in school flooding their brain with nicotine. So it affects their overall learning and attention and can affect behavior because like any addicting substance you get cranky when you don't have it. And there are stories of how youth even become combative, when their devices are taken away. I just made a presentation to Recovery Coach Network which was mostly for opioids because we brought in the topic to all substances and talked about Juuling there and while I was talking about it the representative from the office of the attorney general was there who was very appreciative that we were doing this and within days he got an email that he sent to me from a parent of a 17 year old describing a 17 year old who'd been using these for two years and basically every waking moment was using them. At night he was trying to stay awake because he knew the parents would take it away if he wasn't away and he was actually becoming abrasive with them because of the fact that if he didn't have this he couldn't feed his addictions. Very concerning. And we know that the younger the brain the easier the addiction process occurs and the fun nature of the changes in the brain. I don't like to usually scare audiences saying this is the gateway drug but it actually has been regarded by many in the scientific community as sort of a primer for the brain so once you've got addicted to nicotine it does prime you in a way that it's easier to get addicted to other substances. When we interview people in the public spoke system who are on treatment for opioid addiction and look at their natural history they began prescription opioids in their late teens and then perhaps heroin in their early 20s but pretty uniformly they began with cigarettes not these because that was 10 years ago now but regular cigarettes and nicotine in their early teens moved on to alcohol and cannabis in their mid teens and then to opioids. The other impressive fact is that if you talk to adults who are constant smokers 95% of us say they began before age 21 so again that impact on the youth brain is so important to aging away and we talk about the developing brain from teenage years all the way to 25 because the young adult brain actually is still developing at the age of 25 and the pregnant and recently delivered population are also really of concern to us because obviously of the impacts on fetus while we're pregnant and on the new child being in the environment with some of the smokers being considered developing. Not only do you think these are not harmful but impressively they don't understand that there's nicotine in them sometimes. So again they're being attracted to the coolness of the technology and the flavor they may or may not know there's nicotine but up to 40% of them in survey say they didn't know there was nicotine and I didn't tell you this when I did my little demo so this has about 200 hits that you can get out of it this flavor part. That's equivalent to a pack of cigarettes so if you think about how quickly you can do 200 hits of these that will probably kids who share these and they're not going to do this all in one sitting but over time they can probably do that a lot quicker than a pack of cigarettes. So the potency of the nicotine in here is very high. Again sort of akin to the THC of today versus the THC people who were in college in the 70s, 80s, 90s is very very different. So nicotine being such an addictive substance it's now at a level that could predict the addiction even more. We've had people present at our health department who I'll just say this one thing at the health department we had a sort of international summit on these devices and we had two high school kids there who were very very powerful and testable to everybody in the room but a constant story is people who graduate high school and are going to even do a job into college and are still using these in setting if I had only known this was addicting I might not have done this because I can't get off of that and we're finding in the clinical world that you can't get off of these as easily with things we use for smoking cessation compared to regular cigarettes. I just from an economics standpoint what does one of those little pods compare to a pack of cigarettes compared to a pack of cigarettes? I believe it's two packs of cigarettes to one pack which is a price differential so it's cheaper too and you get a lot out of this one That's why I was referring as you said it's a one to pack of cigarettes So the nicotine is equivalent but the price is actually even better cheaper and I think you can get one of these for $25 to $35 a part that you don't have to change so in kids pool resources before that maybe I'm going to put this in a chair Can you change? Can you keep the base and just add the... Just keep putting whatever flavor you want You can use for CBD That's coming up on the slide too So you can be very innovative say the least So these harms about that we don't know so well Clearly there's vapors so this could affect your hair waste People talk about volatile organic compounds in the way that we talk about you know, PFAS and water that being volatile organic compounds in the sense as well and we don't know so much about what are all the organic compounds that are coming into your circulation through your lungs We don't know the impact of what's in all of your flavors because you're not just so chewing gum you're actually inhaling this and it's getting in the bloodstream Studies have shown that there are contaminants but we don't know what the contaminants might do there are metallic fragments we don't know what they do when they get into the deeper part of your lung and in addition to these volatile organic compounds people use the word ultrafine particles because obviously it's dissolved in the liquid so they're verifying particles and there's a history through modern medicine of lots of ultrafine particles that aren't good for people's lungs like silicon and people in vines and things like that so we don't know enough about lung health yet because it hasn't been going on long enough Potential downstream impacts might have to do with the fact that there's now clear documentation that even though you may have started using these because you didn't want to smoke cigarettes you end up going to the smoking cigarette route through this pathway and then of course they have all the risks of regular cigarettes like lung cancer and heart disease and anything else and this most recent literature and this is now literally within the last month has to do with what are we going to do with the generation of people who are now adults who are actually addicted to these because we really don't know as I alluded to before treating them for this addiction isn't the same as treating somebody who is just a combustible cigarette smoker a lot of these therapies have not been shown to work in this particular realm How do you get these? Kind of the same way they get regular cigarettes it's exactly the same and unfortunately I hate to be the some alarm raiser here the same way they get prescription open it's through the diversion route whether they've been borrowed, sealed or given these by a youth who is of age to purchase them somehow they got them and it's usually through a peer network however they can be very creative on the internet as well one thing that FDA commission got was quite a gas to learn when he was researching this was that the age verification software or whatever we call it on the internet is not foolproof and you know how to get around that in some cases people have demonstrated you just click that you're over 18 and that's acceptable that didn't ask you to ask you for any other way to verify that it's truly your age so whether you're buying it from a retailer or diverting it or getting it through the internet is not a real hard task to get I don't want to call out in a negative way retailers in Vermont because actually we found that they are really really cooperative and helpful whether it be alcohol, regular cigarettes or these but certainly legislation that proposed making it even more restrictive to buy these would obviously be useful but I don't want you to think that a lot of retail community is responsible for this epidemic coming in a nice way doing the job it's supposed to do as part of the liquor control and the control legislation and then as was just stated a few minutes ago co-edition so you can put whatever you want in these parts and you know CBD oil I love that actually because that implies there's no THC in it but there's also fluids that will have THC and in states that have legalized marijuana and have an active tax regulating system they can actually vape marijuana they don't have to smoke it there are plenty of roots you can get it in and the playbook of the tobacco industry would actually imply that it would be a good thing for industry to have liquids that would co-edit people so not only are they getting addicted to nicotine but addicted to THC at the same time and I told you about the age what you rule with we talked about the price point two ponds is one pack yes, so one pack so the way you look at it it's cheaper we're not the math committee and then there's the lack of regulatory framework so I told you about the internet age verification loopholes online purchases really are not restricted there's no real regulatory framework that's built around what these flavors are what's in these pods testing the products for safety we did a lot of good work and youth actually helped us with our counter balance campaign to get rid of flavors and cigarettes but it's not the same problem and the marketing strategies for the companies have not been limited though they've been called out in the public press by the FDA and others now the FDA unfortunately has come up with a bunch of things they thought would be useful but none of them have really happened and they all take time and I would think states can probably accomplish them along quicker than the FDA will but we're really really gratified to see that surge in interest is going to do something at some point in time to make it less easy to access the inferior youth and my last slide is just this graph that shows the incredible improvement we've seen over time both in adult and youth rates of use of tobacco products and as one of my early slides showed you unfortunately even though the youth rate 217 is not on there but it's down to 9% the youth rate of use of these is 12% so we hate to see lines that are starting to go in the wrong direction crisscrossing because we have made so much progress in our population plenty of progress left to make but still and it's especially concerning if these do leave some element to pick up regular cigarettes because that will impact that graph as well so those are the sort of prepared things I have to say I'm more than willing to answer any questions or talk about something that you've wanted me to talk about that I didn't mention I'm just curious in terms of other states are there other states that we can look to that are forward thinking in terms of how to deal with this crisis my sense is this is so fast from coming so recent that I can't tell you a lot about what other states have done often we have models but I think we would be an early adopter a diffusion of innovation curve or at least an innovator maybe it's not like this has picked up much anywhere else I think that's good in Vermont and preempt the next presentation but there's already a lot of good things we did with regular old must-have cigarettes wrote the legislation in a way that applied to any of these nicotine-free system products so we're ahead of the game in that regard in terms of social aspects where it could swell I appreciate that question if you can ask the Legislature for that and I won't be here tomorrow because I'm going from out of state to a national council on state legislatures meaning around how does it be around the terminal child's health with those sort of that group of people who were there so I can ask why are they here as well Topper, did you have your hand up? So did I see a hand over here Yeah it was in terms of here and down to ask the question I was going to ask If you had your wish what would be the four things that would be at top on your list that you think we should do we could do to slow us down In your role as a I want to remind members of the committee that the commissioner of health works for the governor so we have to we have to make sure that we give him the opportunity to respond from what does science or what does literature or what does past practice as opposed to what would he like to do Very happy Thank you for that I was still so we have another version of this graph that is very messy to look at because it looks at the Vermont preventive health framework and looks at interventions you can do and have problems like smoking from the individual level through the family level through the community level through the organizational level all the way to the policy and if you look at these major drop-offs and rates many of them, if not most are accompanied by legislation that either impacted how easy is it to smoke in our society or how expensive is it to smoke in our society so those kinds of interventions from the policy standpoint had the biggest bang for the buck if I just sat with you as my patient in the exam room and said smoking is not a good idea you've increased your risk of heart disease and lung cancer that gives a 1% pay 1 out of 100 people might actually quit because I said that now over time, maybe more than one would but that should take us decades to finally get to that point whereas if I drop the price I mean to increase the price tremendously or impede your ability in society to smoke readily that would have a very much significant impact so those kind of interventions were very very powerful and it turns out that though I did allude to the fact we did a lot of good in our laws previously you could actually as we just talked buy these cheaper than regular cigarettes and they're not subject to some of the same penalties financially impacted regular cigarettes health intervention another public health intervention that I can't say is as proven though the CDC does support it very much is raising the age of smoking to 21 so it turns out that 18 year olds have peer groups certainly 15, 16, 17 year olds have peer groups but they all have something in common to get to and those who are now eligible to buy these are eligible to divert them just like regular cigarettes and that's the way kids have started smoking forever is it's accessible to and states that have raised the age to 21 the thought is that there's no peer group anymore that's eligible to buy because the 19 and 20 and 21 year olds are not in the high school or middle school environment anymore so it's less easy to have that diversion occur I will say that only six states thus far have dominated tobacco 21 law over 300 cities have many of them feel successful one of the most major cities in America though has actually reported no success in New York City the thought about New York City was that it's not a law that was the problem it was enforced so that's all I can say the CDC estimates that environments that do raise the age have a 10 to 12 percent decrease in the uptake of smoking as a result of that so those are sort of public health interventions that at least we know something about in literature that would be helpful the other thing that the FDA is thinking about which I'm certainly endorse is banning the sale of fruity flavored cigarettes or e-cigarettes and that certainly would eliminate one of the major attractants for middle and high school students those flavors unless in a more controversial way I didn't actually extend that to men to menfall which from a public health person standpoint reeks of lack of health equity because that doesn't give the African American population the same opportunity to be as healthy by not using these because they can still use the flavors of choice for that as history has shown and the other thing that the commissioner recommended was actually restricting where you could buy these so you couldn't go into just like your gas station convenience store it wouldn't be good enough to have a special place there but if you went to a special vaping store in that very restricted area and did all the age verification etc etc they felt that they knew that would be a good one for the African American so those are the kinds of things that we know about that good application to work any time for one more question do you know how long a charge how long would it be the base itself so they don't have to keep buying the base oh yeah right so they spent $30 and then two months later this is like your memory stick it keeps charging it's the gift it keeps giving you never need to replace it for that reason it probably does have a finite life span but I don't think it's short but you know the incentive to buy a new charge would be a new design because again this is to be attractive to youth even though the company says we never market it to youth so there's many ways what kind of people would want the latest version currently because it contains negativity it's illegal to buy a lesson if you're less than 80 there is a prohibition on it but it's easy to have other people buy it for you just like that and as I said on the internet it seems like you can be 15 and buy it and why now I had two sons and two younger sons wanted to stop smoking both of them did try it but they didn't stay with the baby and one I'm just I guess I was discussing money with them and why he was always out of money he just quit smoking one day he just stopped his brother can't believe it because he can't stop it and he knew the secret what made him able to just one day he said he wasn't going to spend $70 a week on smoking anymore I should say two quick things one is that these have been advocated to be ways to quit smoking but the literature actually has not come out definitive on that it's actually come out divergent where there's an equal amount of floor yet I'm just convinced this will help you get off the re-grab cigarettes and the second thing is that just to bring me back to the beginning of my presentation if you go to talk to any superintendent principal or teacher you will see the absolute torment that you're going through and if you ask the principal to open their top desk drawer you will see so many of these are just going back it's really a it's at the crisis level of the schools which is why the schools are inviting me because the students they have their own little session for but the parents and the community members are just like oh my god what have you created that's a real noise so Vermonters I think would be appreciative of us all paying attention to this actually thank you very much I think you've given us a great introduction in overview of the health aspects in terms of setting the stages or whatever informing us now we have legislative council bringing a friend with you I am not but I have an answer to this oh ok while you are getting in your seat there's a lot of new people in this room and this is still the beginning of the session so if people who are sitting around could please identify themselves and who their client is hi I'm Sherry Les Bronson I'm the board of the association and who is your client I'm Matt McVan with NMR and our term represents Reynolds which makes a paper Reynolds with me and I and we represent the big technology association I'm Rebecca Ryan with the American Mali Association Jennifer Kautso with the American Cancer Society Cancer Action Network I'm Keith Grasse I'm the assistant to the commissioner of practice I'm Keith Grasse I'm the assistant to the commissioner of practice I am the assistant to my mother's job Mr. Cooper and I'm a new co-worker of Je's and I'm just observing her welcome to legislative council what can any of you say transportation ok there's some new toys and power points and I'm just eating pretty much the best one Jayden Bookard being legislative council so I prepared for you an overview of our Vermont smoking laws have kind of given you both how we currently regulate tobacco and where people can smoke. Hopefully this will give you some basis to consider some legislation that is on your wall. So the first thing I wanted to show you is where fine our smoking laws are actually spread out in a couple of different places in our statutes that can make them hard to find. So one of them is in Title 7 in Chapter 40. Title 7 is largely on alcoholic beverages but there is a chapter on tobacco products. So that's where a lot of the stuff about who can buy, who can sell lives. And then in Title 18 there are two different chapters that both have some elements of smoking laws in them. One of them is Chapter 28 on occupational health. This has some a sub chapter on smoking in the workplace and then the other is Chapter 37 which is smoking in public places. Some of these work fairly well together in some places it's a little confusing how to read them together. So they make some efforts to clean that up before making some other changes. So first I wanted to give you some here's some definitions from Title 7 and they do get used in other places in the statutes as well. So the first is tobacco products. That's a term that's used a lot in the statutes and that's a lot of what you might traditionally think of as tobacco products. You've got cigarettes, little cigars, roll your own tobacco, snuff, cigars, new smokeless tobacco and any other product that's manufactured from, derived from or contains tobacco that is intended for human consumption by smoking, chewing or in any other manner. So can I ask a question? So does that mean the material that goes into the jewel or the electronic cigarettes are not considered? Do they fit into this? Right, no, this definition is really your kind of more traditional tobacco containing product. So we'll look in two more slides at what would be, what would constitute the electronic cigarettes and the flavor pods or nicotine pods that go into them. But no, this is why in some places, and this will come up when we look at the legislation today, we need to refer to things beyond just tobacco products to cover the whole landscape. So we have tobacco products and we have tobacco paraphernalia and this is any device used intended for use or designed for use in smoking, inhaling, ingesting or otherwise introducing tobacco products into the human body or for preparing tobacco for smoking, inhaling, ingesting or otherwise introducing it to the human body. This specifies that it includes devices for holding tobacco, rolling paper, wraps, cigarette, rolling machines, pipes, water pipes, carburetion devices and bombs and who goes. So we're still not quite into your e-cigarettes yet. That's going to be on the next slide. Really, I almost gave you a picture on here of one because you can find that on the internet, but Google it, isn't it? And then our third definition, and this is where we get into the e-cigarettes, is tobacco substitute. This is a term that was developed, if not in this committee, at least in part in this committee, a number of years ago. This describes products, and it specifically says including electronic cigarettes or other electronic or battery powered devices that contain and are designed to deliver nicotine or other substances into the body through the inhalation of vapor and that have not been approved by the U.S. Food and Drug Administration for tobacco cessation or other medical purposes. So if it's something that's FDA approved for tobacco cessation, that's not a tobacco substitute under here. We're talking about things like what Dr. LeMaine was showing you, that's a device that is designed to be used to inhale nicotine vapor into the body. Products that have been and specifies products that have been approved by the FDA for tobacco cessation or other medical purposes are not tobacco substitutes, not what we're talking about here. So these are our three categories then, and you'll see them come up a lot. We've got tobacco products, we've got tobacco paraphernalia, and we've got tobacco substitutes. Those make sense so far? Let's see how those come up. So we have some existing restrictions on the sale of tobacco products, tobacco substitutes, and paraphernalia. There is a prohibition on selling or providing tobacco products, tobacco substitutes, or tobacco paraphernalia to anyone under 18 years of age. There are also existing provisions on vending machines that sell tobacco products. So if you remember those old cigarette machines, those are banned and have been for a while. There is a provision that says tobacco products and substitutes can only be displayed or stored, and there are some exceptions, but the general rule is behind a sales counter or in another area inaccessible to the public. So it could be by the counter, it could be in the back room or in a locked container. Somebody has to ask for these. They can't just reach out and grab one of the register. That was something that this committee worked on a few years ago. There's also a prohibition on the sale or purchase of beades. I had to look that one up so you can see a very small print and made down at the bottom. Beades are small, thin, hand rolled cigarettes imported to the US primarily from India and other Southeast Asian countries. The statutes define them as a product containing tobacco that's wrapped in some leaves I'm not going to try to pronounce. But these are very specific products and those are just not allowed. You can't buy them, you can't purchase them in Vermont. And that provision has also been in place for a number of years. And there's a prohibition on selling cigarettes or little cigars individually or in packs of fewer than 20. Then we have possession or purchase by a minor. So a person who's under 18 years of age shall not possess can have purchase or attempt to purchase tobacco products, tobacco substitutes or tobacco paraphernalia. In addition, a person under 18 shall not misrepresent their age to purchase or attempt to purchase these products for items. A person who is under 18 years of age who possesses these items is subject to having them immediately confiscated and being subject to a $25 civil penalty. And if the person misrepresent their age by presenting false identification to purchase these items, they will be fined up to $50 or required to provide up to 10 hours of community service or them. So can't have them if you're under 18, you can't buy them, you can't buy them and you can't try to buy them. Okay. So that's regulating the behavior of the under 18 year olds themselves. It is also impermissible to sell or furnish tobacco products, tobacco substitutes or tobacco paraphernalia to a person who's under 18 years of age. If somebody does, they are subject to a civil penalty of not more than $100 for a first offense, not more than $500 for any subsequent offense. The law also requires the division of liquor control to conduct or contract out for compliance tests of tobacco licensees where they send in 16 and 17 year olds to try to purchase tobacco products, tobacco substitutes and tobacco paraphernalia. And the goal is to maintain at least 90% statewide compliance for buyers who are 16 or 17 years old. And there's a report on this that comes up periodically that I think goes to that as general assessment. But we may have changed that. And multiple violations, if somebody keeps selling to minors, then they can have a their tobacco license suspended for short periods of time. And there's different periods. There's different periods depending on how many violations there were and can be for a couple of weekdays or for weekend days that they're frequent violators. Yes, going back to the yes. So furnishing is a pretty wide definition. You can sell it, but you also can't give it, provide it to them or in any other way. This may be a question as much for James as for you. One sells one doesn't have to be 21 to sell, right? And you don't have to be 18 to sell cigarettes. You can be I believe it was it is 16 in our statutes. And there's Yeah, I didn't put that language. Okay, no, she's changing the top. What what happens if I violate one of these rules? And I get a $25, $100 fine. What happens if I say I'm not gonna knock on paper? They're enforceable through the Judicial Bureau. So the Judicial Branch handles the collection of those. I'm don't think I'm familiar enough with the actual process is there. To understand, I can certainly find out for you what the Judicial Bureau process is. But that's how it's enforced. It's enforced like a traffic ticket. This may be a silly question, but it's to that. Can you to go and make a team can be the same? In other words, could you put nicotine? Are they the same? Nicotine is is included in cigarettes. I may turn to the Commissioner and some of this. So the nicotine is the part that is consistent throughout cigarettes and electronic cigarettes. It's the tobacco that is present in the combustible cigarettes that is not in the electronic. Okay, so all of this that just says tobacco. So when it says tobacco products, we're talking about, you know, like the stuff that people dip. Right, stuff that goes in a pipe, regular cigarettes, yeah, the chew, all of that fits into the tobacco products category because there's tobacco involved. But the nicotine is is a consistent element. I think there are, or there may be some things that people can recall testimony in this committee in the past from vaping advocates that there are some non nicotine flavor pause. But that does not seem to be the majority of them. So in other words, if we just refer to something as containing nicotine, you may be leaving open a window that you don't intend to. We've an existing statute on internet sales that says and we'll be revisiting this one in a few minutes. It says it is illegal to cause cigarettes, rolling around tobacco, little cigars or snuff. So we're talking now just in the world of tobacco products ordered or purchased by mail or through a computer network, telephonic network or other electronic network to be shipped to anyone in Vermont other than a licensed wholesale dealer or retail dealer. So it's the only people who should be able to order online and have these things said to them are dealers, licensed wholesale dealers or retail dealers. It is also illegal to provide substantial assistance to someone in violating this prohibition. So I think that is so that you know, somebody is using the library's computer to order something the library was not knowingly involved in providing assistance to someone in violating this provision but something out helping another person out to order something, then they would be but violating this prohibition. Chapter and entries. Statute does not specify. There is so it allows the I just shouldn't say that I think the Attorney General's office is who enforces it. I don't know the extent of their enforcement. But there are criminal penalties and there are also civil penalties available from the Attorney General's office. Topper is your question on internet sale or all sale? Well, I know when the stores have been doing. Okay, sir. Okay. I'm just trying to think about the internet. Right. The internet piece refers to the Attorney General's office as opposed to the control or I guess it's now the Department of Go Lottery. They have people go right there that involved in the compliance checks. But internet sales is through law enforcement and the Attorney General's office. So my question was that that vision does not include the baking? No, but in about five minutes, you're going to hear from somebody who is proposing that it should. That's that's the that's age 26 that we're about to look at. And that's why I thought it would be helpful for you to see that our current law just refers to the tobacco products. The bill, we're going to look at what add in tobacco paraphernalia and the tobacco substitutes, which is that term we use for electronic cigarettes. Community thought process, the organization that today's testimony was one, why do we care? So the public health kinds of things and two, what's the current landscape in the policy world? And so do we need to do anything? That becomes policy decision and what is the proposal? So the representative tell when we finish this will be sharing what the proposal is. Right, so violations of this provision are punishable as follows. Knowing or intentional violation results in imprisonment for up to five years, a fine of up to $5,000 for both. The Attorney General can also impose a civil penalty as we have a criminal penalty and then also a civil penalty of up to $5,000 for each violation of violation is also considered an unfair and deceptive trade practice and violation of Vermont's Consumer Protection Act, which gives the Attorney General's office a lot more tools at their disposal to investigate and enforce. Just curious why we let each other and sound like tobacco substitute. And tobacco paraphernalia. Yeah. I looked at those who've been on the committee. Just, it wasn't an issue back then. I don't think this section has been amended in quite a while. So it may have predated the emergence of these products. Alright, so that was the type. Those were the title seven provisions relating to kind of the products themselves. And then we get into the sections on using these combustible tobacco products and your cigarettes and electronic cigarettes. So our first group of statutes relate to smoking in the workplace. Smoking cigarettes and using electronic cigarettes. It uses the terms that we use in the statute that the lighted tobacco products so lighted cigarette and using a tobacco substitute, which is the electronic cigarette that might be easier just to put it this way. So smoking cigarettes and using e-cigarettes is prohibited in any workplace and it gives a lot of information about what a workplace looks like workplace means an enclosed structure where employees perform services for an employer. That includes restaurants, bars and other establishments that serve food or drinks for both. Except for schools, it says workplace does not include areas commonly open to the public or any part of a structure that also serves as an employees or employers personal residence. Still working on understanding exactly what was intended. I've been talking to the health department about this. I was putting this together. I thought I don't know what that means does not include areas commonly open to the public. We do have another set of laws. We're going to look at next on smoking in public places. But I think it might make sense at some point to give a little clarity around how these all work together. For schools, workplace includes any enclosed location where instruction or other school sponsored functions occur. And for resorts, hotels and motels, the workplace includes hotel rooms and suites. Last few years, all hotel rooms in Vermont are now smoke free. That does not used to be the case. Used to be no smoking in the common areas, but you could smoke in homes that had been designated for smoking. Now there's no smoking in any of those. There are a couple of exceptions to the ban on smoking in the workplace. So there was an exception parked out for what are commonly referred to as vaping lounges, places that are established for the purpose of selling electronic cigarettes and flavor pods to customers and then allowing them a place to use those. If somebody working in a vaping lounge doesn't get to say you can't smoke in my workplace because that's the focus of that workplace. There's also an exception for the designated indoor smoking area at the Vermont Veterans Home. There is one place inside there where people are allowed to smoke and that has continued to be exempted from these restrictions. Enforcement of the smoking in the workplace provisions is by employee complaint to the Department of Health. And there is a prohibition on employers retaliating, taking adverse action against an employee for enforcing the ban. And there is a provision specifying that this law does not restrict municipal smoking ordinances that might go further. They have to be at least as protective of the rights of non-smokers as the state law, but municipalities can impose additional restrictions on top of these. So that's the smoking in the workplace case. And then we have smoking in public places. And this provision says that smoking cigarettes and using electronic cigarettes is prohibited in all enclosed indoor places of publicly access, public access and publicly owned buildings and offices. It defines a place of public access as any place of business, commerce, banking, financial service or other service-related activity, whether publicly or privately owned and whether it is for-profit or non-profit to which the general public has access or which the general public uses. And it gives some examples that are included buildings and offices, means of transportation and commentary or waiting rooms, arcades, restaurants, bars and cabarets, retail stores and grocery stores, libraries, theaters, concert halls, auditoriums and arenas, barbershops, hair salons, laundromats and shopping malls, museums, art galleries, sports and fitness facilities, planetariums and historical sites. Common areas of nursing homes and hospitals are common areas meaning where people that are open to the public, including lobbies, hallways, elevators, restaurants, restrooms and cafeterias and buildings or facilities owned or operated by a social, paternal or religious club. Jen, if I recall, when we use include is that limited by? That's a great question. Yes, so in fact we specify in statute in title one that including means, including but not limited to. But we don't have to save and not limited to every time it saves us some space in the green books but it is always a non-exhaustive list. So these are some examples but it is not the full landscape. Different ways of saying something that is supposed to be exhaustive like shall mean the following or something like that. Includes is illustrative but not exhaustive. Alright, smoking, additional provisions on smoking in public places. Smoking cigarettes and using e-cigarettes is also prohibited in all enclosed indoor places in lodging establishments such as resorts, hotels and motels including sleeping quarters and adjoining rooms rented to guests. So again a workplace where you can't smoke includes hotel rooms and this prohibition on smoking in public places also includes hotel rooms. So under both of these chapters you can't smoke in a hotel. Are e-cigarettes the same thing that we were just talking about? Yes, I mean yes. So e-cigarettes is how I'm describing the tobacco substitutes that we define and tobacco substitutes is actually the term that's used but yes, that includes I'm very attractive. Yes, the device you were showing us. Smoking cigarettes and using e-cigarettes is also prohibited in designated smoke-free areas of property or grounds owned by or at least to the state or to a municipality. It's prohibited in any other area within 25 feet of state-owned buildings and offices and I took a picture as you can see it on the right from downstairs outside the side door of the state house. That's why that sign says no smoking within 25 feet of this building. And it's prohibited on the grounds of any possible Who wanted it to zap? Sergeant Yes, Sergeant Arms Capital Police I think are the ones who are responsible for that. And if we see something, save something. Yes. There's cigarette butts right on the floor. Yes, people often do still stand right outside somebody who goes back and forth. And smoking cigarettes and using e-cigarettes is also prohibited on the grounds of any hospital or secure residential recovery facility owned or operated by the state. Including all enclosed places in the hospital or facility and the surrounding outdoor properties. So if you drive by the Ramatze Geiger Care Hospital in Berlin you will see people out on the sidewalk off the property smoking and the back is white. There are exceptions to the ban on smoking in public places that are two of them are the same as what you saw in the smoking in the workplace provision so there's an exception for the lounges and for the designated indoor smoking area and the Vermont Veterans Home. There's also an exception for areas not commonly open to the public of an owner operated business with no employees. Soul proprietorship and there's a part of the plate of the store or office that is not commonly open to the public that owner can smoke in that area. As long as that owner has no employees right this is soul proprietorship no employees. And finally the enforcement provisions for the smoking in public places laws a proprietor or employee who sees someone smoking or using an electronic cigarette must ask the person to stop. It's a shall. If the person persists the proprietor would ask the person to leave the premises. And again we have this provision saying that the state law does not restrict municipal smoking ordinances that go further than this in protecting the rates of non-smokers. An example that might be in a community that had a public park that's an open space but they decide to have an ordinance that there's no smoking in that park. They can define other spaces as smoke free as long as they are building on this and not giving more smoking access. Based on what you said about all these places you can't smoke or use lack of substitutes for all the children that are talking about that are doing this in school or breaking the law that would be subject to find or their parents. They could be subject under the prohibition on possessing their products. They're actually I understand. There is no monetary penalty associated with these prohibitions. So you're right that they are not allowed to smoke in school is also the teacher's workplace. They are not allowed to smoke in any enclosed location where instruction or other school sponsored functions occur but the enforcement is by employee complaint to the department. Thank you. Doesn't it seem like tobacco addresses tobacco use in general? It just says smoking cigarettes. It uses the official language. I was trying to make it more accessible but it does say possession of lighted tobacco products and use of tobacco substitutes is prohibited in these places. What does that also mean? The means of ingesting tobacco? No. It refers to lighted tobacco products. Exactly. In a daycare center where the original We do have provisions in our statutes on smoking or not smoking in child care facilities and licensed child care homes. They're slightly different depending on whether it's a center where there's no smoking on the premises or whether it's a licensed home where there's no smoking when there are children present. Yeah. I read this last time I'm not commonly open to the public so a person's house other than where the children are would not be open to the public but the added thing here of an owner-operated business with no employees what if there is an employee and they smoke in that house? So I would consider smoking in a child care facility I don't think falls under the smoking in public places provision it would fall under the specific provision on smoking in a child care facility. So whether it may be an area or maybe a public place if it's a child care center but a person's home is not a public place so but once you're talking about a child care whether it's a child care facility or a licensed child care home we do have a specific provision on smoking in those markets that might fall under smoking in a more public place? It could to the I mean I think the clearest one is the one that applies directly to that and I did not think to put that in here There's a special provision just for child care and Dan will hold that up My point is, I know about all of that but the way this is written it says if you have an employee in an area not commonly open to the public in an owner operated business the day care center is an owner operated business if they have any employee even though I know about the specific thing of day care centers do they fall under this? This is an exception so an exception to the ban on smoking in public places is for there is an exception for an owner operated business with no employees that has areas that are not commonly open to the public as part of that I think before we continue to back and forth it'd be best if you pull up the specific around sorry and as people are talking about laws related to tobacco that perhaps are not here I think we have something around smoking in cars with the obvious ones but I'm sorry I forget the age Needing a job Needing a job Needing a job Yeah so you cannot smoke in a car with a child present who is under the age of 8 which is the age of which you need to be under federal law in a car seat or booster seat Okay thank you and now we have a lot of you are pulling that up perhaps we should wait for the other questions Yeah so I think there were some provisions added to this last year when the legislature was working on provisions related to marijuana but there is Language Entitled 33 it says no person shall be permitted to use marijuana or cultivate it or use tobacco products or tobacco substitutes on the premises both indoor and outdoor of any licensed child care center or after school program at any time so that's the set so that's the center can't use them on the premises at any time and then no person is permitted to use marijuana tobacco products or tobacco substitutes on the premises both indoors and in any outdoor area designated for child care of a licensed or registered family child care home while children are present and in care and if use of marijuana or smoking of tobacco products or tobacco substitutes occurs on the premises during other times the family child care home must notify prospective families before they enroll their child in that family child care home that the child will be exposed to an environment in which marijuana, tobacco products or tobacco substitutes are used can't grow in marijuana and we are keeping this discussion on tobacco so Topper continue with your question around child care centers I don't know how I said does this apply to a day care center I don't see why it wouldn't because it's an area not commonly open to the public in an only operated business which is the day care center and if they have no employees there's an exception if they have an employee they don't they don't come under this exception is that correct? so I think arguably that is correct as far as what laws apply to a child care facility these specifically apply to a child care facility so given that these are specific to the child care facility and those are general for the general population these are the provisions that would prevail and they say you can't smoke the child care facility so the ones that are specific to the child care facility are the ones that would govern what can happen of child care facility I think that should be referenced yet so that people know it to me if they have an employee they're going to not get that exception they don't get any exception if you have kids here at a child care facility and they're kids there after the kids are out of here they can smoke I understand that I know it was this last year what I'm just saying and one is law and the other is a power point to share with us and to point out things that was loaded I was just a little curious I know this one's a little long way but on the same the last slide you just mentioned every law does not restrict municipal smoking ordinances and I was just curious what power the law grants municipalities to regulate I'm going to send you to my colleague because of the bill and rule and it's all complicated I'll do one so I won't doubt if you're interested I can talk to her I was curious so I was just wondering kind of off of a little bit of chapter 33 the rules that create the commissioner of the Department of Health can they regulate products or substances that they need harmful so could the commissioner say this is harmful and shouldn't be allowed I believe that is true I will look to you guys but they certainly do that with respect to for example illegal drugs they have kind of blanket authority to regulate things that are dangerous but I'm not sure I can try to pull up that do you want to hear from them we're phony friends yes hello everyone so again for the record livingston from the health department so we can look into the specifics of this we do have a regulated drug rule we work on with the Department of Public Safety and we try to update that over a couple of years so things like synthetic cannabinoids are on that list I believe that they need to be schedule one or otherwise illegal but I can check that for you and I believe that we explicitly give the commissioner of health the ability to do things by rule yes that's correct but we explicitly in that we whether tobacco tobacco substitute things might be another avenue we all we give commissioners across the board in many of our laws the ability to write rules right the rules are to supplement laws so they can't conflict with the statute and sometimes it's good to have statute I would think the commissioner one of them the first responsibility of the governor is to protect the people of the state of the month so I would think that through that responsibility the commissioner should have that power to protect the people of the state okay are there other are there other questions are there other questions or are you finished I can pull up if you want to look at the school or the more responsive to your smoking in school question public school grounds no person shall be permitted to use tobacco products or tobacco substitutes on public school grounds or at public school sponsored functions and school boards can adopt policies that include confiscation and appropriate rules to law enforcement that's Gen C there's a window sill I think we'll have a little chair shuffle here obviously okay I've represented Till introduced his bills and after that we'll take a break and then we'll have I think Gen will do very fun representative Till's bill Gen will come back and then Rebekah Ryan do you want to pull it up here do you want me to pull it up do you want me to pull it up here we have to give you a help so for the record you're still from Jericho I hear you talk about age 26 and I'm chair, members of the committee thank you for taking some testimony on this bill you know in December of 2018 the Surgeon General did something that is pretty unusual and has to be put out of advisory I try to say I'm talking about the whole range of different kinds of smoking use and what prompted him was a one year increase in utilization by high school students of 78% that got the headlines and also had a 47% increase on middle schools and he used the word this is an epidemic we need to do something we need to do something now and you know we've been fighting this tobacco battle for 50 years and we have been kind of winning but this has the potential to completely reverse all the games that we made that rate of increase it's really scary so why is it scary? because we know that how the teenage brains reacted to nicotine they did it earlier easier more easily than do adults at lower levels of nicotine and it's a more profound addiction we also know that kids who use electronic cigarettes are four times more likely to become tobacco combustible tobacco users they're also more likely to be users of other drugs from Arnavon Acid with the brain changes in those nicotine receptors and the perception of pleasure from substances and so this feeds into a whole lot of things that we're worried about so why would we target online sales currently you can't ship tobacco the kid can't go online and get tobacco shipped to their house but they can with the e-cigarettes and the paraphernalia with the e-cigarettes and right now the distribution is about a third of third people get their e-cigarettes at fake shops and third get them at convenience stores and third get them online with tobacco we know that the 18 to 20 year olds provide 90% of the tobacco to the younger teens it's not that high with e-cigarettes it's only about 50% and why is that it's because the other teens can go online in Vietnam how successful are they getting them online well one study out of North Carolina 93% of the time kids went on they were able to get e-cigarettes and another study out of Connecticut after they passed the law trying to prohibit this sort of thing it still was 86% they looked at how many of these online sites they're supposed to have age verification and back in 2015 a study showed there were three out of 120 sites that actually had useful age verification another one showed of the online vendors about 61% had a pop that says are you 18 or are you 21 and you just had a click that was it 35% had none no verification so 96% no verification real verification of age and I thought that was crazy but I tried a couple of sites over the weekend sure enough I went to three sites all three of them decided that's not control and that's why these things and having them shipped directly to them so the dramatic increase the downstream effects in terms of tobacco addiction and tobacco usage and subsequent health problems related to that and this ready availability on the real problem four other states have done this those states are Maine South Dakota Arkansas and Utah they have all said in no direction I certainly have gotten a fair amount of hate mail about this I'm pretty profane and it's from there are people who do think these are smoking cessation devices they're not the FDA has multiple cessation devices that they have approved they have offered to the aid cigarette companies the cessation device go through the process and be declared that and all we want to do is try to do that and the reason is that they're not cessation devices what happens in the majority of the times people become good users so they do use e-cigarettes they continue to use regular cigarettes so the numbers of success with just using e-cigarettes alone I mean it's not statistically different than placebo so I'm confused getting hate mail but now does this prohibit someone from buying e-cigarettes from James absolutely not so if you can still buy them still buy them my personal story about it one of the arguments some people say it's more expensive I mean it's like a market more general why make it a little more aggressive so anyway we weigh negative effects on what we do against the positive effects I think in the last year it's become increasingly clear that the positive effect of land use on on sales is much more important than the convenience of somebody who is using them for for trying to use them for smoking cessation 78% and in one year 70% increase in use by high schools 49% 47 for you identified four states who have prohibited internet sales in general for you do you happen to know when those laws went into effect it's all very recent so we don't have data at present to have that impact 2016 is the first do you have information as to the impact of reducing internet sales of cigarettes had on the use of cigarettes you know I haven't looked it up that was the key piece of the fight but I haven't looked up the numbers but you know internet sales are much more than they were 20 years ago are there questions right now that's coming up we'll start right now yes this is both a challenge for you so the text as I read it somebody generally being able to purchase the battery pack, the power supply of the baking product as that could technically be used for a non tobacco use as long as it falls under the tobacco substitutes definition which can hold itself easier to buy I mean in theory you kind of buy these just for including non-microbial in the same way but they're still labeled as what do you say they're still labeled as a tobacco part of tobacco part of one of those kind of that I mean there's lots of different kinds of battery packs you can buy that wouldn't be covered for this oh no no I do mean specifically related to the vaping products but you can buy vaping products that are specifically for non-tobacco substitutes to be used such as CBD or marijuana substitutes unless the language that you use here is specifically tobacco paraphernalia so I'm just curious how that might work I think you might say this the language of the veil is both tobacco substitutes and tobacco paraphernalia the tobacco substitutes are products including electronic cigarettes and other battery powered devices that contain and are designed to deliver nicotine or other substances into the body through the inhalation of vapor so if they're designed to deliver nicotine or other substances into the body through the inhalation of vapor which I think those you have to go to the store and buy another if you are choosing to go to the forest you would have to go to the store right so the fact is that they're designed to work a particular way or using it for other substances is immaterial to the definition James did you have a question No I was the same Did you have something to add? No we just said she said that there was no matter what you choose to use the forest in the beginning the back of this ended for the root so it makes you relevant but you personally I would like to thank you very much You have ten minutes before you have to be downstairs maybe if we could come back in ten minutes thank you very much Jen I think we need you in the speak otherwise we'll never get back for act Are you sure you don't want to sit next to mom make sure she does okay you can bring a chair over there you go can I take your picture perfect thank you all for your indulgence I wish I could see you I know you're always very welcoming so Jennifer Harvey legislative council again now I'm going to take you through the language of H26 I think is what I'm up here for again and I'll talk to you about his interest in the law and so this would add to that internet sales provision that we looked at earlier well it would actually add in two places so it would add tobacco substitutes liquids containing nicotine or otherwise intended for use with a tobacco substitute and paraphernalia it would prohibit anyone from engaging in the retail sale of those products unless that person is a licensed dealer or has purchased those items from a licensed tool sale dealer so that was an existing place where it seemed like some of our in-state sale pieces weren't consistent and then it would add in the internet sales piece that no person shall cause cigarettes, water or tobacco little cigars would add tobacco substitutes liquids containing nicotine or otherwise intended for use with a tobacco substitute or paraphernalia it would order a line or apply the phone to be shipped to anyone other than a licensed tool sale dealer or retail dealer in this state so it's making some of the provisions regarding sale of tobacco products consistent for electronic cigarettes, tobacco, paraphernalia and liquid nicotine and other flavoring of the pods that go with the these cigarettes and one page is really just the overview and the list is built to it can I ask a question that's not directly related to the language or related to the topic? go right ahead I don't remember if you covered this or not you might have covered it in your overview are these products these tobacco substituted products do you know if they are under the same ban on advertising as cigarettes and tobacco products? I don't know the answer to that I mean all of that advertising stuff is a federal level so I don't know the extent to which they I don't I just read an article that they are not I feel like you see ads for them you no longer see ads for cigarettes but that's anecdotal that's a federal law yes as opposed to a state law it is but that doesn't mean we couldn't make a state law well I think we may be preempted in some of it I have to look there is some potential issue with federal preemption there you showed me online all the ads that come through and who's online from these companies it just blew me away I want to look to our store expert you can't put tobacco for things on your door yeah I was looking to go sign outside if I want to but I have to get shot so can we try to do that and we've got the answer I think there was some talk about that I think there certainly can be first amendment issues for conducting commercial speech for lawful products yes we have a sign law yeah but that's sort of a time place and manner restriction yeah it's the content so this would be regulating content for more time we need a couple more information about I don't want to see any content remember you said the camel I know the TV stuff I thought that there were things around the counter and what you could have on the counter in terms of um tobacco the product itself but not the advertisements yeah you can't do anything that's um that's national okay this is where we have Marlboro B99 back which is closer to my store most of the time Carl just on the top of page 2 where it's an act relating to restricting retail and internet sales of electronic cigarettes I thought this was limited to internet sales but it talks about retail right so that's the prohibition in section 1 on engaging in the retail sale of these products unless the person is a licensed wholesaler or has purchased them or has purchased them from a licensed wholesaler I'm a licensed I'm a licensed retailer somebody at this is pretend I'm a shop assistant they want to sell cigarettes they can't do it until they get licensed right and this would say that nobody can engage in the retail sale of these products unless they're a licensed dealer or has purchased them from a licensed wholesaler or has purchased them from a licensed wholesaler so the licensed retailers so we're extending that now to internet sales I was looking at it we're extending that now to internet sales right so that would mean that a retailer couldn't purchase those products online and then sell them in Vermont either you can't even I can't go to another convenience store to buy cigarettes and sell them you have to buy them through a licensed wholesaler see you can't go to Costco you can but they're a licensed wholesaler oh okay we can go to the clutch they're closed too we go to Costco because Costco is a licensed wholesaler as opposed to just a store you can't go to the college you can get something to say I don't work this weekend I don't have customers around in the Indians can't sell not for reasonable you can buy us an opinion this is just often this bill but I'm just curious we're talking about how people do different things it seemed to me it was a popular thing I heard about anyway that people would go to the casino an Indian casino buy cigarettes and then apparently they don't have something to do with the taxes the government it's illegal to do that right people would then try to resell those cigarettes and that would be illegal what's that you can buy but I mean some people did sell us so it was illegal to do that in terms of the enforcement part of this of the monitoring part of this it was mentioned that the attorney general's office is responsible for that the internet sales piece so for the internet sales piece yes for the retailer piece I believe it is the department of the department but the enforcement department doesn't be the same as that yes these are fitting into the existing statues just adding the electronic cigarettes and related products to the current prohibitions that are regulated by the respective regulatory okay so do you see that someplace can you explain what that's yeah that's what I'm looking for what place is this I'm not saying it's a building no because I'm only amending a piece of it so this is internet sales um and then the attorney general may see so violation is comfortable as it follows in addition to anything else the attorney general the civil penalty the shipment or transport is a separate violation during narrow consecutive injunction state is in level 2 let us just say the attorney general will 2 and 3 so 2 and 3 2 says in addition to and in lieu of any other crime no remedy provided by law upon a determination that a person is violated the section the attorney general may impose a civil penalty an amount not to exceed $5,000 and in number 3 the attorney general may seek an injunction the attorney general's office also enforces the state's consumer protection act so that's in number 5 if anybody makes money on it that goes into the general fund and before we go to questions talk about this we'll continue on this Trevor what you've presented to us I think is a good learning which is when we have a bill that is amending an existing statute for instance it does not have the entire underlying statute so sometimes we have to go back to the which is what Jen is doing for us now going back to the underlying statutes to get the answers to our questions Teresa and then Carl one sorry were you not finished I just have one big question I've heard that and I think what we should do is get something from the attorney general saying on this new piece that's here that his office is going to monitor this because then talk about that it talks about what he'll do if somebody does something Jen would you flip up in that section on to the definition section so I'm just wondering if we do we need to have anything there because at the beginning they're defined for the whole chapter so in the definitions section and at the beginning of the chapter it has as used in this chapter and this is where we have definitions of tobacco products tobacco paraphernalia and tobacco substances so it's a little confusing to find again in certain terms and actually the terms that are being defined there they're pulling in the definitions from the tax statutes so something to perhaps look at is the consistency between this and the tax I mean a lot of the tax statutes refer back to chapter or to title 7 so I guess that's what was confusing me I was trying to figure out why there were additional definitions in the section that we're amenity or that we're discussing yeah I don't really the only thing I can think of is if maybe these were originally codified somewhere else I'm not really sure why somebody did it that way unless it was extremely inactive it wasn't really so I can't speak to them but we like consistency we love consistency so happy to make any changes you would like to achieve consistency call not specifically on this but as far as are we going to hear from the retailers association their position on this I just thought it would be useful to hear obviously a very compelling case has been made by the commissioner and this is trying to address portion of it so I'm not saying that I just think it would be appropriate that we have the retailers absolutely or some similar group yes and call thank you for bringing that up the next item on our agenda is community discussion community discussion around this in terms of various decisions to make or not make after Rebecca sorry after Rebecca so yes and having looked at this a little more I do want to answer your question I think the definitions are in here because while we use the terms cigarettes, spoilery or tobacco things like that in the definition of tobacco products the terms themselves are not actually defined there they're defined as far as what is a cigarette what is snuff and because subsection B is only calling out certain parts of what makes up tobacco products the cigarettes, spoilery or tobacco and snuff there are more examples in the tobacco products definition than just those it does make sense I think to have those terms defined so then that leads me back to my original question is whether we needed a definition here then those are being called out specifically for their use in this chapter because also when we have the definitions for the whole chapter they don't include an actual definition of cigarette even though so one possibility could be to move those definitions into the overall chapter definition which might make some sense as far as this bill all we're doing is chopping it into two and adding a jeep so everything else is still there so the definitions still exist the definitions that are in existing 70s, 8, 10, 10 are still there they're not going away so in terms of what we do or don't do can we not get into that discussion yes, no I'm confused as I guess I've not been I feel more confused than I did when I started my questions sorry I think one thing to note is that not all tobacco products are subject to that prohibition on internet sales so you can order cigars through the over the internet through the mail they can be shipped to people over month that's okay but cigarettes are not right so that is where I had come to in my head and I'm thinking like well why I don't know are there other questions around content not about what any shoulders shouldn't do but content on what the bill has introduced says okay thank you so much thank you so much thank you very much and Rebecca and Jen I think you need to share some of your hourly salary oh I do Jen we have two people on the side who can help yeah we're we're the building name sleeping on the job again I'm Rebecca Ryan I'm Rebecca Ryan from American Law Association thanks for your time today I'm going to be very brief I'm going to be presenting Compelling and Public Health impacts of electronic cigarettes this is my formal testimony and this I want to make is one we advocate and we know the most effective ways to reduce tobacco use is one comprehensive fully funded tobacco control program and part of that is enforcement two is clean indoor air laws and you heard from Jen and Dr. Levine we have very strong laws to protect people from secondhand smoke and secondhand emissions and then the third is high tobacco and there are eight states currently plus DC that actually have tax electronic cigarettes Vermont is not one of those so that's an opportunity you raise the pack price you raise the pack price by 10% equivalent for other tobacco products that's the most effective way to use those products and then we're also supporting the emerging best practice which is raising the age of school stuff these are all just statistics that Dr. Levine cited this morning I won't talk about those I have resources that we offer on our website you can click on any one of those links see more information but what I want to focus on is that last the last link it's a New York Times article from November 2018 it's called the price pool and the nicotine addiction and it's really chilling I would encourage you to take the time to read it but it's about a student that was actually from Massachusetts high school student who started dueling at the age of 16 he enrolled in UVN as an 18 year old and I just want to read a short clip from that article Matt said he drew a pleasing mentee moistness into his mouth so he clearly liked the flavor of the fuel then he held it kicked it to the back of his throat let it balloon into his lungs blinking in astonishment at the euphoric power punch of nicotine felt it that he would later refer to as the head rush now he's 19 years old he's no longer using but he said it was love at first puff as a student he said at UVM he used a pie which as you learn from Dr. Levine is about more and more every day and he reported that a girl in his dorm hall sold fuel pods from a stock she had bought from a guy who ordered arm loads on the internet so you know it's anecdotal but that's kind of describing what Dr. Levine said is happening around these cigarettes and then from the assistant principal from U32 she said that she knows of a parent who received a shipment of electronic cigarettes at home and I didn't order these but her son did with the help of an adult friend so they're buying them online whether they're whether the site is checking for age or not they're getting around that I know of a 12 year old that was caught with dual multiple times in the school she was expelled and now she's getting home in Franklin Grand file from one of our community partners she said the story she hears over and over again that kids are buying gift cards, easy gift cards cash cards and then ordering things on eBay and then Walmart so they're figuring out ways to get around it and then from a pulmonologist in Newport she said it's really easy buying a Walmart gift card and purchasing these online so those are just some of the stories that are happening around the state this is actually the this is the door Dr. Levine was talking about this morning the principal's door from the school in Franklin Grand file did you pass that award? yes I think those are the main points I wanted to make without duplicating it's sort of a long association we support this bill in an effort to make sure that electronic cigarettes are treated like other tobacco products in the state just extending this law makes sense it's the age 21 the other age is 18 increasing the age to 21 that's different bill people can't amend things Rebecca did you have data around what the impact is on teenagers for increase in the price through applying tax on this you said it reduced that was a deterrent but do you have any data about that? we can probably look to Minnesota it's how the electronic cigarette tax is on this I know that the proposals that have been introduced in this building are trying to tax electronic cigarette liquid the same as other tobacco products which would be 92% of wholesale this is similar it's 95% so I could look at that and see what that has done that would be the probably the best example thank you thank you thank you very much so for me the more agenda planning group in sort of trying to mix up both introduction so let's get working on bills we did not have kinds of bills on our wall and this was one and there seems to be several bills related to electronic cigarettes so my first question is do you want to are you willing and interested to pursue thank you to continue to pursue taking testimony on this bill yes well I was just suggesting we have a retailer's association of course you can do that for us but I'd like overall as a whole people I thought because I like the consumers in general I like that idea just there okay so I am very interested in pursuing the topic I guess I would like to see what the other are there other bills coming to our committee about this mirroring the tobacco tax is downstairs and in ways and ways okay and I think there are another bill in 18 to 21 that's all tobacco then that's all tobacco products including e-cigarettes and I know that has it been introduced in the house we have it okay and we have it okay so I mean those are okay so yeah okay okay so the answer is yes okay Topra has said one to hear from the AG the retailers consumers we have all sorts of people around the room who else would like to testify those of you who are representing clients who have an interest Maggie we may but I don't feel like I'm not going to say that I need to catch up with you first same same as Maggie go check if you have an interest if they have an interest and will be communicating with members of the legislature about this bill I will expect them to testify if they have no position fine but I mean that's what the committee process is all about we will make amendments absolutely pretty much the same I raised my hand okay okay same thing no I'm ready okay I thought you meant right now today no no no anyone here you have your two seconds I did submit written testimony today on behalf of the cancer society but I would be interested to know certainly it's an important topic the whole issue I mean this address is just a very narrow fairly important piece but I think the topic overall is extremely I know that Tina from the American Heart Association also submitted written testimony so maybe they thought this was going to be like since they saw a committee discussion they thought this was going to be like those of you who are new to this committee I don't we don't work that way we take testimony and people who have different opinions than maybe the vast majority of the committee I make them come in and testify because they put another view on it and they may in that shift our opinion and the only time in my recollection that we have done something the same day that we have introduced it was probably close to 20 years ago when the federal government did Medicaid Part B and it would have impacted under Governor Douglas and it negatively was impacting the prescription drug benefit for senior Vermonters and we started a bill and it went through the entire process to the senate to the governor's desk in a week it was a day maybe it was a day we passed it in a day and he signed it the next month it's going to snow until they have to move fast but that is the only time and that was this was trying to protect the group of individuals whose benefit was being taken away so we will put this on the agenda in the next couple of weeks depending on where we are in terms of things but we will begin to move forward on that tomorrow in the interest of bringing we are not coming back today because we have the governor's right budget address tomorrow when we get off the floor we are taking an introduction for our committee today yes okay and then in the afternoon I think there is a number of bill introductions and those will be what I call the speed dating which is in other words the concept of the the proposers will explain their bill and then we can come back as we start to get more bills we can't do all of them we will begin to have to make decisions as to where we put our energy on that so that is what will happen on Friday if we are interested in pursuing looking at this legislation I would love folks to maybe read the near time I mean to look more in depth I don't want to lose time I'm sorry I'm teaching at UVN tomorrow I'm turning the energy I guess you look at some of the links which Rebecca gave us and things like that other questions did this work good in terms of having the commissioner give a overview and next week he gets to come back for more of a what is the health department because actually the health department has a lot of varied things so we'll be taking so we'll be continuing that sort of what a state government within our committee will be taking up more testimony and duly keeps getting requests more testimony around age 57 and people can always submit their testimony their comments and we will post all letters that we get on our so the people can be can be heard and we're going to the movies next Friday awesome it's in room 11 but another issue sort of in terms of non-specific bill right now but another issue that we have spent a lot of time in this committee in the previous years that touches education healthcare and everything else is trauma or resiliency or adverse childhood experiences and there is a sort of an introduction or a film that's about half an hour that we're joining a boatload of committees in room 11 on Friday morning that's next Friday to make sure you have your badges because the people around here asking for badges I've lost my money what? you know I had it 15 minutes ago I think you can take it if you stand the door I know but I mean what are you doing? you have to be okay okay and so I will see you I apologize I will be in charge and Sandy's not there and Sandy's not there it will be time out we'll take care of it okay good yes I'm going to a hotel safe trip I'm going to National Council so legislators I'm learning that you've got maternal child health and adverse childhood events and things like that and your return date is when? at 10pm I thought you were taking a little time mom I tried to I know so I said I'm going to a hotel I'm going to New Orleans but I don't think I'm going to see anything in New Orleans I'm leaving at 6.20 tomorrow morning okay thank you all