 All right. Good morning. It is February 24th. And this is the Senate Health and Welfare Committee. This morning we're going to be looking at two bills. We'll be looking at S24, the Flavors Bill as we call it, and then later on we'll be looking at the flexibility bill with audio only. So this morning we're going to begin with our Commissioner of Health, Dr. Mark Levine and Commissioner, I can't thank you enough for taking time out of your day to be here with us and to testify on S24. Thank you. You can introduce yourself for the record and I think you know members of the committee. So we'll just go from there. Thank you. Sure. So this is Commissioner Mark Levine, Department of Health. And this committee and I have a long history. And an equally long and successful history with tobacco containing products and our youth, particularly. I don't need to recount past successful endeavors. We've embraced and the alignment that the committee's had with much that goes on in public health. Many of my comments will be pretty familiar to you. Having seen some aspects of the bill already that you've been drafting. And sometimes they will have been considered by you already. Others may be more novel. But what I'll discuss in the next few minutes will be nicotine, but minimally because I think we're on the same page with nicotine. Vermont usage patterns of these tobacco and vaping products. The other harms that flavors can have. The strategies used by the tobacco industry. Issues surrounding men fall in particular. And it's linked to racial injustice. Vermont programming on flavors. And what has been done and not done at the federal level. Or by other states. So everybody knows that nicotine is a major ingredient in nearly all of the flavored tobacco and e-cigarette products. We've talked in the past about how an important substance it is with regards to addictive nature, especially in developing adolescent brains. The toxicity it can have, the impact on brain development. Specifically cognition, memory, attention, learning and behaviors. The FDA acknowledges the association between first use of a flavored tobacco product and current tobacco product use. And how this poses a potential public health risk. If you do studies of which multiple have been done, surveying youth and young adults, they will site flavors as a major reason for their use of the e-cigarette products. As well as things like hookah, cigars, menthol cigarettes, smokeless tobacco. Everyone here has probably heard of PACE. Since we're all here in Vermont, but just to review that's the policy and communication evaluation is what the acronym stands for. What it really does is it explores youth substance use behaviors. It's going through this year, starting a year or two ago. And really tries to understand the impact of state tobacco and other policies. As well as public health communication campaigns on youth behavior. If we look at waves one through three in 2019. And looking at youth and young adults 12 to 25 years of age. 27% of past 30 day smokers used menthol or mint flavored cigarettes. And 56% of past 30 day vapors used menthol or mint electronic vaping products. 10% of Vermont high school youth who vape reported that the primary reason that they used e-cigarette products is because they're available in many flavors. That data comes from our youth risk behavior survey. If we look at middle school youth, one in seven primarily use them because they are available in many flavors. From the 2018 tobacco retail audit, we know that flavors are accessible to youth in Vermont. 86% of tobacco retailers sold at least one kind of flavored tobacco product in 2018. And 40% of stores sold flavored e-cigarettes. 75% offered flavored cigarrillos or cigars. I think for my next set of comments, I'll talk a little bit about flavors in general. I think when we think about flavors, we don't always think about organic chemistry class. But flavors are chemicals and chemicals, as we know, depending on what they are and how much we use of them can cause bodily harm in some way. We have a campaign called Unhyped, which is a vaping prevention campaign for youth. It educates them and young adults on the dangers posed by flavors. Some of the things we talk about are the toxicity to cells from vanilla type flavoring in the vapes. Other risks in e-liquid flavors including cinnamon, strawberry, almond, and caramel. The California Department of Public Health issued a report on inhaled food flavorings in e-cigarettes incited concerns about inflammatory response from chemicals such as dye ketones. Stanford researchers have studied how e-cigarette flavorings damage human blood vessel cells, even without nicotine being present. And their findings included cinnamon and menthol flavors being particularly harmful. It goes without saying that flavors are there for a reason. And one of the more nefarious reasons is to attract and retain customers of these products. And it's well known that whether it's an e-cigarette, whether it's a regular combustible cigarette, whether it's pipe tobacco, a little cigar. This is a strategy used by industry to not only attract but retain users of these products. And clearly menthol is among thousands of flavors available, but it's well known to make quitting more difficult among youth, adults, and people of color. So I'd like to spend a little time on menthol since I know this is a big focus of your legislation. And there's good reason for it. Looking just at CDC guidance and programming and research, there's been a fairly long history of menthol being marketed as healthier, being advertised more prominently in low income neighborhoods in black communities, tailored and brand specific for youth and adults. It's made up 36% of all cigarette sales in 2018. It has a significant link to what I would term the overall rubric and concept of racial injustice. A 2019 meta-analysis found that among black Americans, menthol smokers have 12% lower odds of smoking cessation compared to nonce menthol smokers. I believe many of you may have seen Dr. Phil Gardner when he was here, or at least read some of what he's written. He testified in our committee last week, yes. Yes, well, very recently you heard him. Clearly, if you heard what he said, being an expert on menthol use in black communities and its impacts, he feels that restricting menthol and other flavors is a true health equity issue. It feels that in respect to flavor restrictions, if menthol is not included, it's racist. The tobacco industry does have a long history of targeting African Americans with menthol cigarette advertising. The Truth Initiative has documented this in a document called Read Between the Lies. Black youth are specifically at risk due to targeted promotions and price discounting. More than 90% of blacks who smoke report using menthol cigarettes. As a result, black Americans have higher death rates from tobacco-related causes or more likely to be exposed to second-hand smoke. And statistically, more than 39,000 black Americans die from tobacco-related cancers each year. Very recent from our, I think he still has a job, but I'll call him current or most recent surgeon general, Jerome Adams. He put out the report in 2020 on smoking cessation from the surgeon general's office. And that specifically addresses the lower likelihood of smoking cessation among African American menthol smokers. And it concludes, quote, use of menthol cigarettes has been shown to contribute to tobacco cessation-related disparities in the United States. What have we been doing in Vermont? Well, as you all know, we have a tobacco control program. And for the last six years, it's been educating on the dangers posed by flavored tobacco products through a campaign called the counterbalance campaign. This communicates with parents and concerned adults about the availability and advertising of tobacco products with enticing flavors and a variety of e-cigarette devices, including disposables. More than 30 tobacco prevention grantees and OVX youth advisors have been engaging youth and educating on the harms of flavors. Counterbalance seems to have had a pretty significant and positive effect on youth perceptions and thinking. A youth from Danville expresses the same concern that I have, and I'll just quote from this youth. I'm more concerned about flavored tobacco products because tobacco is one of the most harmful items. It can cause lung cancer, which kills many people each year. And quote, if we look at the state of lung cancer report 2020 produced by the American Lung Association, if we look at Vermont's rate of new lung cancers, it has not decreased in the past five years. What's been done at the federal level and other states? Well, in 2020, we know that the FDA did remove some flavored e-cigarettes from sale. They specifically did not remove menthol and mint. After this removal of the other flavors, sales of menthol and mint flavored e-cigarettes increased 105%. Needless to say, this did not really result in the desired impact in protecting our youth. A study, Tobacco Control is what it's called highlights the failings of partial flavor restrictions to protect young people from the risks of e-cigarettes, and highlights the concern of how youth and adults switch flavors based on product availability. The partial restriction enacted by FDA led to an increase of 1000% in the use of disposed e-cigarettes, going from 2.4% to 26.5% among high school current e-cigarette users, and a 4% increase from 3% to 15%, 400% increase among middle school. The CDC documented these findings in the 9, 18, 2020 morbidity and mortality weekly report, and it cites menthol e-cigarette use among nearly one half of flavored pre-filled pod or cartridge users, and one quarter of flavored disposable product users. This report refers to the advantage of comprehensive implementation of evidence-based strategies at all levels, national, state, local, to prevent and reduce youth tobacco product use, which ideally would be done in coordination with comprehensive FDA regulation. As you know, we've been waiting some time for this and have not seen it, and what we did see was only partial. What have other states done? I'm aware that Massachusetts and California have passed comprehensive menthol flavor restrictions. Around the country, 125 local jurisdictions have done so as well. There are some states in New England that are at least actively deliberating on this issue and addressing flavor tobacco restrictions as a health equity issue, but I'm not aware of any legislation to this time, specifically in Maine and Connecticut. But it would be fair to say, you know, in a conclusion that restricting the sale of menthol and flavored tobacco products is a recognized strategy to reduce both the initiation in youth of tobacco use and the continuation or retention by the marketplace of youth use of tobacco, and as a way to address health equity, which of course is in sync with the state health improvement plan, which has its foundational principles on health equity. And it's obvious looking at statistics that we can always do more to prevent tobacco associated cancers, heart disease, strokes, and all the tobacco related disparities we see in Vermont. A few other issues I'll just raise just to not just to pike curiosity but to put them on the table because you need to hear the complete picture. Every time in public health we talk about something that's really good for people. There are not always 100% of the public in the fan category. I refer to this as concerns about the nanny state. Now we have successfully navigated the nanny state in Vermont previously, as you know, we had wonderful tobacco and vaping legislation last year and a little bit more than last year and over the last several years. And people recognize the importance it was to protect our youth from the kinds of outcomes they might have without these legislations, but nonetheless, one can only tell people so much what they can and can't do so one has to choose wisely in those endeavors because a complete nanny state would never be endorsed by anyone. And there's another issue that always comes up in Vermont, which of course is cross border issues. If you ban something in one state but the state's pretty small and it has many other places on its borders. How do you address the fact that you may not have impacted behavior much at all because people have access to what you've banned. We're not aware of some of the states on our borders, even contemplating this kind of legislation. There's also an issue, I'll call it consistency across substances. We all know what has happened in Vermont with regard to the use of cannabis and the opportunity for people to do recreational cannabis. And there is also flavor considerations when you come to the edible forms of cannabis containing products that could have an equal impact on youth brains. And is it wise or, you know, is it inconsistent to do it on one substance and not another. We don't even go into alcohol which has plenty of other flavors, and which has not ever been a problem that's gone away in Vermont. Will there be national policy, whether that be the FDA, who's a little preoccupied now, like all of us with other issues. We have a new administration, we have new players and many of these agencies that have to do with health. So will there be something on a more national level that would help the states because it wouldn't have to be this random process. And then finally, we should always think about health care reform should always think about population health being a major component or building block of our all payer model. And the benefits this could have in that arena, because with my last conclusion comment I made previously, we still have to worry about tobacco related cancer tobacco related heart disease tobacco related stroke, you name it. Those are all big issues that require not just what you're entertaining but you know huge lifts in our society in the public health realm. And the impact of a package of those on population health would obviously do a lot to advance health care reform in Vermont as well as to make sure that we are keeping our eyes on all of the balls. And trying to not just reduce costs by somehow making health care cheaper, but reduce costs because people won't need to access the same health care, because they're coming to it in a healthier place. So I will stop there. Thank you. You gave us a flavor for a lot of different areas. And we appreciate it. I have two questions and then we'll, we'll just take a couple of questions and then move on because we have a lot of folks waiting to testify. My first question is some, well, I'll ask them in reverse order. We've heard that during the pandemic and as kids have been isolated home. We've seen an increase in youth use of these products and do you have is that part of the youth risk behavior survey or do we have that this Department of Health have that data. We are not going to have that data for some time, unfortunately. And the pandemic has thrown a lot of this off, off sync, if you will. But you can rest assured that all layers of our society have been doing things while they're in a stay home posture at increased levels that could be harmful to them. Yes, thank you. Then the other question I have is that I consistently hear from those who market vaping products e-cigarette products that, oh, they're these are so much safer than tobacco products. From your comments on flavors, I, I guess I automatically question that assertion, but maybe you could help us understand it. Yeah, I mean, I've, I've never been a proponent that these are safer in some way. And the main culprit is the one I spent the least bit of time on today but started out with which is nicotine. So, again, they are nicotine delivery devices. And I don't care if it's a combustible cigarette or if it's an electronic vaping device, or what have you. If you're delivering nicotine and you have the ability to deliver nicotine in an even more concentrated pattern that is not good for the developing brain, period. So I would, I would stand on that alone. Not to mention, I mentioned flavors and the chemicals and flavors, but there are lots, lots of chemicals in the devices and the delivery systems as well. So I think overall, I'm not sure the thesis that it's safer would, would really play out as well. Maybe safer in terms of lung cancer. But I'd rather, you know, not try to equate lung cancer 30 years later, versus a brain that's being impacted in the teenage years, and then what's the potential in life for that person based on the fact that their brain has already been impacted. Thank you. Senator Taranzini has a question and then Senator Hardy. Thank you, Senator Lyonson. Good to see you, Dr. Levine. I had a question but I'm going to at this time I'm going to hold off on it. I want to, I want to articulate my question a little bit better before I ask it so thank you. Senator Hardy and then Senator Cummings. Okay. Thank you madam chair and thank you Dr. Levine for being here with us during your busy schedule. I wanted to ask you or pick apart a little bit more your comments about the quote unquote nanny state, which, by the way, I hope we can find a different term for that that one rubs me the wrong way for a lot of reasons but you said basically I heard you say we have to sort of pick our battles, you know, in terms of what we focus on in at the broader public health level and we've seen you do that over and over again during the pandemic. Usually with really great results. So I'm wondering if we're talking about in the context of tobacco about picking our battles. Is this a battle. And I just want to get your clear answer on this is this a battle we should be picking that the flavors and specifically the mental battle for both youth and adults. You make the clear argument for youth. I didn't hear you focus as much on adults. That was a sticking point for us last year when this bill came up. And so I just like to get your clear answer to that. Sure. So for the youth it's the initiation issue. And for the adults and the youth it's the retention issue and the inability to quit issue, which are clearly correlated together. So the health equity issues are really, really important. I guess when you, you know, when I talk about the nanny states often equated or I caught it's a dichotomy the nanny state and the savvy state. So the savvy state, you know, is sort of picking its battles wisely and the public through education is endorsing behaviors and getting there eventually versus the nanny state where you kind of like we're done waiting. You can't do this anymore. Period. So it is very, very challenging. The reality is, my comments about consistency, you know, you open up doors every time you, you go through one. And so if, if, if you're going to go through door number one for flavors in this arena, do you then open up all these other doors which then follow suit. Like, if you're in the public, you feel oppressed in a sense, because of the fact that so many victims have come down. And is there a point where education alone can suffice and trying to influence behavior through education, as opposed to making the, the choice, the default choice, the healthy choice. So that's one of the principles of public health that we struggle with because we always want the default choice, the healthy choice to be the default choice. And if you can't buy flavors well, you've taken care of that pretty easily. But on the other hand, could you continue with the kinds of educational campaigns we've already started with, and get success that way it will take longer. But more people come along with you and be less resentful, be feeling like they have some freedom of choice in their lives that you haven't imposed upon them. This is really, really challenging. And there's not a really good answer to be honest. I think if we in public health make everything dependent on strict policies and guiding people's lives in ways that they don't have that freedom of choice, we will lose in the end too. So we have to be wise and make these choices in a way that's informed and really works in our advantage. My, my preference on this one to be honest is this should be an FDA thing that's national. We shouldn't have to go state by state and sort of chip away at this, if you will. And I don't know what this new administration or anything, you know, if that's going to be a game changer or not, you know, we've seen so many things dramatically change just in the last month. But they're not addressing, you know, real specific things like this at this point in time. And the FDA probably doesn't even have time to right now. But the bottom line is that would be the preferred way. It would take care of the border state issues it would take care of a lot of things, and it would send a clear message to the populations of color in this country that people actually care about them. And they've actually been thoughtful about these issues in that context. It's so easy for Vermont to stand out on all of these things and be the, you know, the pioneer and the leader and what have you, but probably in the big picture, we really do need to have this on a federal level. Dr. Levine, just because you've mentioned that the importance of education and obviously we've made huge progress with the tobacco settlement funds that we've had. And so I've been able to educate people and saw a dramatic downturn in the use of the tobacco products. But recently we've seen an increase in escalation. And so and my question is, does the health department have sufficient resources to do adequately cover all of the education and prevention programs necessary to sort of push back on the increased use that we're seeing. Yeah, so I'm going to give a yes and no answer, because we can always do more with more, but at the same time, even during the pandemic, none of this programming has been shut down by any means, it continues to proceed on. You, you, your committee knows even better about the substance misuse and prevention council that you helped create and worked with the governor very closely on and that council of course now has the tobacco component under its province. So we're paying attention to this pretty continuously. And I think that's a very positive thing. I would never say no to more money but I wouldn't say that money for education is going to, you know, an essential need this moment that you know, everything's been cut and we need something new because that's not true. We still have a lot going on. You're on mute. Thank you for being a good citizen, Senator Cummings and then Senator Hooker, and we're only taking questions from members of the committee. Dr. Levine, thank you. I think I was on this committee last year and part of the discussion with the larger Senate on the issues around this and I think you put your finger on it. I don't talk about youth, but we banned the sale of any tobacco vaping product of any sort to youth. Two years ago, maybe three years ago now, and I'm assuming we don't have the data on whether or not that worked. I don't think it did, but that's that's been a concern we, you can't sell it to kids. The counterweighting balances we've got some seriously addicted people. Example that came up or all the folks outside the AA meeting, lighting up. We've got the dual addiction. And then there's a lot of talk about while kids will just move down, you know, to whatever's left on the table so we're going to leave it on the table. I just filled out my absentee ballot was asked to vote and whether or not Montpelier should allow the retail sale of cannabis. Cannabis is on the table, in large part because banning it didn't work. It's better to control it. And so with this bill has no real money or program to help the ladies I know who take out their oxygen to light up and then put the oxygen to back in. Is this really making progress, unless we have a real kind of cessation, or, you know, are we going to get into judging by my emails, which I've been trying to answer. We're getting a lot of pushback on why am I going to have to continue to wear a mask and be limited if I'm and get a vaccination, if I'm healthy. Is that give and take I think we're struggling with I have never smoked I don't have a. None of my kids smoke I don't have a dog in this game I just am trying to find the right way to go. And you're illustrating the whack-a-mole game to the FDA restricted all these fruity flavors and things of that sort, and the magnitude of the increase in men and men fall was just phenomenal. So it probably didn't reduce users of these devices it just shunted them to a different flavor of the device, which is unfortunate. I know what you're coming from and you know, coming from a pandemic where we've been pretty prescription prescriptive for the population. And as you point out there are people who are like, Why do you mean I have to wear a mask, you know, and that kind of thing and we've been using emergency orders makes it even more challenging if you then come out with more orders to tell the population what they can't or have to do. But at the same time, we can't forget about all these other public health problems just because we've been going through a pandemic. So I know I know what you're talking about. I wish I have more statistics to give you on the youth behaviors through the pandemic, and through their time being much more remote and learning than any of us wanted them to be. We can only presume nothing has gotten substantially better. I'm not I don't want to comment on worse without statistics and without data. And as you point out, there are ways for youth to obtain things even if we wrote legislation that said you can't buy it. You can't get it on the internet. What have you. I'm hoping that the increase in age to 21 did eliminate a lot because it used to be that 18 year olds could still supply early teenagers very nicely and we're still in their sort of peer network, whereas 21 year olds, little less so, and a lot more disconnect between middle and high school youth. So. Dr. Levine, I think we should move to Senator Hooker for one last question because time is moving along and I'm sorry to interrupt but no no problem. And we are going to hear from from some young people who may comment on accessibility for the for the kids below 21. Yeah, good. Thank you. Senator Hooker. Thank you, Dr. Levine. This I just wanted to bring to mind another aspect of this we've talked about education we've talked about banning. We haven't really talked about marketing and I think that that really has a lot to do with the number of people who number of kids, especially who are attracted to these products and and I think I mean, this is just to put this out there so that we can perhaps discuss this at another time but I remember the Joe camel debate and what that did for smoking smoking in youth. And then the other aspect of course is taxing the products for every penny on the taxes. There's a direct correlation between that and the number of kids who don't start smoking. Thanks for pointing that out. That's been especially effective. The other part, just to recap the counterbalance campaign and other such efforts, at least at the youth level, allow the youth to call out the marketing and refute what it's trying to do, or at least reveal what it's trying to do somewhat surreptitiously at times. So they are directly confronting that and trying to influence their peers as they do that, which is a particularly effective and healthy way to go about this problem. Committee other questions. Senator Teranzini, have you formulated your words. I must admit, Senator Lines, my internet connection this morning has been tough. So I, I think that my question was dressed but did any of my colleagues ask about flavored alcohol and how that correlates if we, you know, if we think about banning flavored tacos is, is flavored alcohol on the horizon. You know, is that the next thing we tackle to try to, you know, the flavor of octaves and the wine coolers and things like that when I guess my question. I see both sides of the spill I really do and I have kids and you know nothing is more important than the health of our youth but I just asked myself like, like Senator Cummings said we, we didn't, we couldn't tackle the marijuana. We didn't tackle the usage so then we made it, you know, now it's okay to use and we're trying to regulate it and then I think my stuff we passed this and the next biennium are we going to look at flavored vodka's and wine coolers and that stuff so that's sort of my mindset and I'd love to hear any feedback you have on that document. So, as Senator lines is well aware. I do take my testimony seriously and I, I try to come prepared and I try to present you with the data and the public health angle. But I also feel it's important for me to be provocative when that's when, when the opportunity presents and just put things on the table that people need to think about not that I have an opinion and opinion on every one of those things I think issues that people should be thinking and you've just raised one that I became provocative with during this presentation, whether it's alcohol whether it's a cannabis edible product or what have you Yes, again, we know what human beings behavior is like there's plenty of research into behavior and challenges and changing behavior challenges in how behavioral marketing really becomes a big deal. The whole field of behavioral economics for that matter. And so, I'm not going to answer the question about, you know, the flavored vodka's and wine coolers and what have you, except to say that they exist for a reason. And many people in our society are responsible and can have enjoyment from those and no harm caused. But obviously what we're looking at today is there are pretty large swaths of our population that actually don't actually just enjoy and not be harmed but can actually find that as an initiation pathway that they didn't plan on otherwise, or a retention pathway that doesn't allow them to extricate themselves from a challenging situation. So I do think it needs to be considered across all aspects of products and human behavior. And perhaps thinking more broadly than just the flavored tobacco and vaping products. Thank you and thanks for your comments. The, I guess a question that we're trying to get at now is the, the huge increase in the number of flavors and the marketing that's taking place and the attraction for youths that we've seen in our committee and it's really difficult for any of us to regulate first rates in terms of advertising, but we can certainly look at the health outcomes and impacts for these products and knowing how addictive nicotine is. And then finally, I guess my concern when we raise the issue of flavors and alcohol or in cannabis is that those two products are regulated in a highly in a completely different way from tobacco tobacco is out more or less on the free market and cannabis now is being even even Senator Cummings voted about cannabis regulation the other day and alcohol is sold only in, you know, high test alcohol sold only in state stores so there are there are significant differences that arise and we try to equate those two I think it sounds jazzy but I had I couldn't resist commenting I'm sorry, Commissioner. Okay good. All right. Someday we'll sit down and have a cup of coffee over this I think we all deserve that at some point. Again, thank you so much for taking time out of your day and the and the important work that you've been doing for us on the pandemic we greatly appreciate your insight into both the pros and the cons of working on this issue. It's always a challenge for us we're interested in saving the $348 million a year expenditures that we see on tobacco health care costs and we're very interested in improving health outcomes for our youth and our adults so that's that's the motivation. And it is a public health issue as you have well pointed out so. Okay. Thank you for allowing me the opportunity to present this morning. Well you've done it. You've done a great job as usual and we greatly appreciate it. Good to see you all again. Yes. Good. Thank you and take care. So we're going to turn to Aaron Seagrist is here from the Vermont retail and Grocers Association. Are you there she is. Thank you. Good morning. I'm well how are you. Terrific. So, I think you prepared about five or 10 minutes of testimony is that what we're looking at. Hopefully less than 10 minutes I want to take too much of your time. And did we have something from you on our webpage. I haven't sent it yet but I will send it as soon as I am finished speaking. Yes. Terrific. Thank you and just send it to Nellie. It helps us then we can listen while you're speaking. Great. Yeah. I think you know everyone on the committee. But I'll introduce Senator Hooker from Rutland County. Yes. Senator Taranzini from Rutland County. Senator Cummings from Washington County. And Senator Hardy from Addison County. Hello. There you go. Thank you for having me today. For the record, I am Aaron Seagrist president of the Vermont retail and Grocers Association. We represent over 400, sorry, 750 members across the state. Our membership is inclusive of a variety of business types and models including general retail. So like your clothing stores and your country stores. Grocery stores, convenience stores, distributors, food producers and also business service providers. The retail industry in the state of Vermont employs over 65,000 Vermonters and we collected about $6.5 billion in 2019 in state tax revenues. So I'm only speaking on the financial impacts of S24. We do not have a position or we have not touched on the health impacts or anything of like again just financial impacts. So VRGA does not support the passage of S24, the bill that would ban flavored tobacco products and e-liquids do specifically to the financial impact. This legislation would have on the retail landscape in Vermont as well as on the state's revenues. A poll of my members returned a broad impact based on the size of retailer based on current sales. Small retailers reported that they would see anywhere from 35 to $45,000 of loss in revenue from these sales alone. The Massachusetts border reported closer to 50 and $55,000 in loss and a Vermont based convenience store with about 12 to 15 locations has reported that this would be a loss of more than $500,000. The Vermont based convenience store that I just touched on reported that historically they give more than $250,000 a year to charities around Vermont. In 2020 while they were unable to match that amount they continue to support cancer research and other community product projects by gifting just over 150,000. They also provide health benefits for their employees. Last year they incurred a nine and a half percent increase in premiums, and they've seen double digit increases in premiums in 2020. As well they've paid hazard pay on top of hourly wages well above minimum wage throughout the pandemic. So, due to the pandemic all stores, all store upgrades they had had several upgrades to their various locations around the state, they have been put on hold since 2020. Then multi million would have been multi million dollar investments that would have been reinvested into the community and provided more jobs and benefits to Vermonters. So, because of it should this bill pass their concern is that those projects would be pushed off further, and as well they would be reconsidering additional benefits or a reduction in healthcare benefits provided to their employees due to financial loss. A local convenience and redemption center in Washington County reported to me last night that this ban would reduce revenues by $40,000 alone, and that does not include ancillary purchases that customers make while stopping in the store. If this ban goes through, he would be forced to reduce his staff. Currently he has a 20 person staff, and he anticipates that this, this ban would require a reduction by at least three employees. If products have been so again it's not really our place to judge people with addiction, these products are approved and regulated by the FDA and consumers will have access to these products outside of Vermont. Well customers want convenient access to these legal products they will go the extra mile to get them should they be banned in Vermont. Further consumers will make purchases of additional products outside of Vermont as well. And we will no longer be talking about just the New Hampshire border impact, but we'll also be talking about the New York border impact, as well as once the Vermont US border or sorry the Canada US border reopens that will serve as a factor as well. I do want to share that I do feel it's a bit disingenuous to assume that by banning these products people will quit. Recent reports on the financial impacts of Massachusetts recent ban shows that sales have surged in Vermont and New Hampshire. Senator Cummings has touched on earlier today as well as in recent hearings, prohibition of alcohol and cannabis has failed to keep these products out of the hands of underage consumers. And if these bands haven't worked any in anything else why are we thinking that banning flavored tobacco within the political borders of Vermont will do the same. Let's quickly on tobacco compliance tests. As you know the Department of liquor and lottery each year conducts to tobacco compliance tests. And in 2018 the overall percentage of these licensees who did not sell tobacco to minors which means they passed their compliance checks was 91.9% In 2018 that compliance increased to 92.38% retailers do not want to be selling to underage consumers for various reasons. Specifically, morally, we did not oppose the ban or the increase in in age from 18 to 21. Additionally, if retailers sell to an underage consumer, they, they already suffer financial impacts. Retailers and the Department of liquor and lottery continue to work closely and improving trainings and access to those trainings to ensure that compliance continues. Additionally, should to us 24 pass out of committee. We passed the piece where what is it as seven VSA subsection 1005 I believe it is. We believe it should be should remain as written in statute. We believe there are tobacco compliance tests have shown that retailers are improving their compliance rates, and past testimony has requested that this section be removed and stated that retailers were the reason for the epidemic we have in Vermont. Again, it's disingenuous to blame retailers for the underage access to tobacco products as well. Eliminating the penalty for possession of tobacco products or prevent paraphernalia is it is the wrong decision and further signals that there is knowledge that a ban on these products will not reduce usage. If the ultimate goal is to reduce smoking those in possession of these products should be held responsible as well. And we oppose passage of us 24 based on the financial impact to businesses, further reductions in workforce and the fiscal impact to state revenues. And that's all I have prepared today. I'm happy to take questions. Thank you, Aaron. That was very comprehensive so just to be clear, you think that the penalties for possession should be left in statute. Yes. Okay, and I because I know there's also another bill that the possession use and purchase possession and use and possession which is also an economic development. So I don't know what you're thinking is on that but we're not taking testimony on that in here we have enough to do but okay thank you and you will get us, we will get us your written testimony. So we have send this as soon as soon as we're done. Okay, terrific. Senator Hardy. I'm chair and thank you Aaron for your testimony. I just have a question. I know that some of your members have voluntarily chosen to stop selling tobacco products in their stores. They've done so for a number of reasons but I'm wondering if your organization has done any work on the impact of those decisions within your membership and whether or not they have seen the benefits that I think they have wanted which actually are increased sales in their areas, safer stores, cleaner stores and a lot of things that that come along with selling tobacco products so I'm wondering if you've done any analysis, or if you know how many of your members have voluntarily chosen to cease sale of these products. That's a good question. I will share we have, we have not surveyed our members about that. But it is certainly a question to ask. We have heard, especially since increasing the smoking age from 18 to 21. We've heard from several members that they have eliminated it because the the break ins or the state for safety reasons, they just decided it was best. We have seen an increase in break ins or theft so that's certainly something that we could pull our members on and certainly circle back with you once we have a response. Yeah, I think that would be interesting because I know that a number of retailers have have chosen to do it for the safety reasons being number one but for other reasons as well moral reasons ethical reasons. And I think that financial impact may actually be less than than you think because more people will want to shop there because they feel it's more kid friendly place. I have a question I have or just a comment, you know, you mentioned the increasing cost of health care insurance for a lot of your members and, you know, we see that across every sector and this committee is extremely aware of that. I think, you know, one of the things that we've just heard testimony on from the commissioner and others is that over the long term this will actually decrease health insurance costs because fewer people will be addicted to to tobacco so I just wanted to put that out there for you to consider in your analysis of the health insurance costs because overall if we have a healthier population or health insurance costs will hopefully be reduced so just factor that in in your analysis. And in terms of the possession. You know I understand that you don't want retailers to be on the hook for things to obviously that's your job that's who you represent. But you also said that you were sympathetic to people who are addicted to alcohol to tobacco. And I think one of the main things for the possession language is to not blame people for their addiction and not criminalize addiction so I just hope that you can take that into consideration and your comments about that section in the future. So, thank you. Okay, I think some of this is going to have to wait until we have committee discussion but your points are well taken. Senator Cummings had a question and then I think Senator Hooker may have had a question. I just wanted to clarify with Aaron, are you saying that when we banned the sale of anything to minors that there was an increase in break ins, or that the availability of tobacco in a store is is in some way linked to break ins. I don't have exact data anecdotally, we have seen that once the age limit was increased, more of our members were reporting break ins or thefts. And one member who called us literally a month after the increase and said, I've had three break ins. One last night wasn't was the worst we've ever seen. I'm, I'm eliminating all of my tobacco. And it's break ins to acquire tobacco. So, I suppose logically you could extrapolate that if we banned it to everybody. Yeah, there may be there's a black market there may be seriously addicted people. There's absolutely a black market and and we will, we anticipate and have seen in other states that when these bands happen the black market has has increased and and we can anticipate where we expect that that will will continue to increase if should these products be banned. And these so called trunk slimmers are are walking into actual retailers and saying I can sell you these products for less, if you would like to buy them from me. Okay. Thank you, Senator Hooker, do you have a question. Okay. All right. Aaron, thank you so much. It's good to see you and see you. Thanks. Thanks for coming in to testify. It's always very helpful. All right. And I did actually want to clarify one thing not not from it's not your testimony but the question about what other states are doing and I do know that New York State has banned E flavored e cigarettes. So we're not completely without folks on the on around our borders who have done nothing. Okay. So I think I would like to move on. I'm going to move on to Richard Mariana's a first. And then I'm going to go to Graham Campbell because he has a he has a time limit and so Richard welcome and do we have testimony from you on our web page. I submitted testimony yesterday and I appreciate your time. Terrific. Okay. And so, again, we're looking for about you just a few minutes of testimony and then we'll have a few minutes for questions. So for the record, and we'll look forward to your testimony. Great for the record my name is Richard Mariano some 27 year law enforcement veteran who retired from the Bureau of Alcohol Tobacco and Firearms as the assistant director. Currently I'm a professor at Georgetown University here in Washington DC, and I'm a member of the International Association and chiefs of police and the police executive research for transparency and also various times employed by Reynolds American, the tobacco company to do research and a look at their product being used for illegal and illicit means. I'm not a smoker never had been a smoker but I'm in opposition to bill as 24. What I wanted to start out with is a brief presentation on prohibition that has not worked and is currently not working as we've tried to prohibit flavors and increase taxes around the eastern seaboard around the United States. Right now, a prohibition on a flavored product is a prohibition on an adult product. That is very, very difficult because right now you can't go into a store as a young adult or somebody under 16 to buy something like this. So by putting a prohibition into this, we're going to increase the amount of young adults are going to look for and try to find it. So the $13 million a year criminal market in Virginia, excuse me, Virginia Vermont's I apologize that if you ban this product, you tend, you will tend to lose $13 million of revenue that's currently taking place right now, and that doesn't include what is happening in Massachusetts where a large criminal population is now exploiting the various states rounded or coming to the various states to buy product or criminals coming in. Some of the things I wanted to talk about is what some of what it funds is prohibition and flavor bands fund criminal activity. It's known it's a fact. I appreciate you asking questions and some of the panel members before how it also destroys the quality of life in some neighborhoods. And it also creates a situation where if you put a ban in and a prohibition, it's very, very hard for police, especially nowadays, whether trying to do more with less to have to now take on the position of the enforcement of the sale of a flavored product. I mean, many of us will agree right now with the diminishing resources and what law enforcement has to take on. We want them to concentrate on serving and protecting rather than enforcing some senseless bands. What I want to say that is, maybe we'll talk about a public health strategy. And I want to talk, you know, concentrate also on a public safety strategy because my opinion and the, the opinion of the law enforcement people I work with on anything whether it's guns narcotics, in order to have a healthy community community, you need a safe community and public safety needs it must be part of your public health strategy. And then some questions raised about the illegal or flavored products where they come in from. I can tell you right now that currently Chinese organized crime is well invested in the products such as Jerry Berry and Captain crunch and the appeal to the younger population that are being trafficked and brought into this country. So a prohibition is only going to slow it down and it's not going to put an end to it. I give you some examples right now. There was just recently in the last three months there's been 500,000 illegal vape products and vape liquids seized by law enforcement coming into the United States directly targeting the youth from their marketing campaigns. And what I talk about marketing campaigns is how they package it and put it together. What I ask you is members of the committee you did a great job in your analysis of the legalization of marijuana to try to root out crime. If we go to the flavor ban here, you're going to create crime, and you can create crime in areas such as organized crime. You're going to excuse me, organized crime, street thugs, terrorist organizations, people of that group that have been involved in this in their currently track, trafficking tobacco products along the eastern seaboard. And I want to give you an opportunity to ask questions, please. Thank you. This is a different perspective and we appreciate it. Questions committee for Richard. I have a quick question. When you work for the ATF. What was your area that you focused on? I started as a special agent organized crime and I worked my way up to the assistant director where I was the number three responsible for 4800 employees. Excellent. Thank you. All right. Any other questions. Okay, thank you very much. I think your time. Yeah well no thank you we appreciate your being here and certainly you have the experience that's why I asked the last question. I think it's a great experience that lends itself to credible testimony and we appreciate it very much. Feel free to contact me if you have any other questions available on my testimony and I'll be glad to help you, or if we could do any research to assist in this matter. One of the questions that you raise is something that under underlies a lot of the concerns and that is why we currently have a regulatory system for both alcohol and cannabis in this state it's a highly regulated industries and so if we're going to make that comparison then perhaps we need to have a similarly regulated industry for tobacco. That's a whole different bill and a whole different perspective and I don't know how many states are even considered something like that. Agreed. Yeah. All right. Thank you very much committee and have a great afternoon. You too. Thank you. Graham Campbell is here he does have a fiscal note and he's on a schedule. So Graham, you are now sharing screen and you could put that fiscal note up so we can see it with probably an opportune time after listening to Aaron Segrist. Sure. Can the committee see my see the fiscal note. Yes we can. Yeah, perfect. So my name is Graham Campbell I work for the Joint Fiscal Office and for it's good to see some some Senate finance people here and some former center finance people I work with you a lot. I work on mostly tax policy for the Joint Fiscal Office, and then as such taxation and cigarettes and tobacco sort of falls under my, my policy area within the Joint Fiscal Office, although I did work with no one lying while on this fiscal note. This is our official fiscal estimate for S24 which is an act relating to banning flavored tobacco products and I will try to keep my testimony brief because I imagine that might be some questions but largely I would say for the committee members who were here last year this is the sort of basic underlying assumptions that were in the fiscal note last year are pretty much the same as they are this year. I was not able to find significant literature that would change the assumptions in the underlying analysis, but what has changed is the revenue estimate for tobacco products in general which have been revised about $8 million higher in fiscal year 22 and they were in the 2020 forecast on which is what the previous estimate for a ban on flavored tobacco would be and I want to highlight there that the increase was about $4 million on general cigarettes and then another $3 million of the estimate for e-cigarettes was basically doubled from January 2020 to January 2021 and that's just based upon the actual tax data that we are seeing from the tax we collect on e-cigarettes. To get to the punchline here, table one shows the revenue impacts and fiscal year 22 we think the total revenue impact will be about $5.64 million in revenue reductions across the general fund and education fund. The general fund will be from the taxes on tobacco and the education fund is the sales taxes on these products. Fiscal year 23 it jumps up to $6.69 million that's primarily because of fiscal 22 the bill takes effect in September and so with that full fiscal year. So in the first fiscal year you not only start later but whenever you introduce a ban like this the impact is always delayed by a month for any type of tax. You see a sort of smaller number of fiscal 22 and then for fiscal 23 you're looking at the full impact and then it declines down to $6.47 million and that's basically mirroring the slow decline in cigarette and tobacco tax revenues that the consensus forecast shows over time. So, like last year the majority of this revenue reduction is from menthol cigarettes. I'm just going to quickly pull up my table here so of the roughly 5.64 million dollars in fiscal 22, but 3.9 of it is coming from just cigarettes. So, because, you know, non flavored cigarettes are basically just means menthol cigarettes. That's essentially the impact of menthol cigarettes being banned in Vermont. We estimate that about 18.8% of cigarette sales in Vermont were menthol cigarettes that's lower than the national average, and that's that largely mirrors the racial or the demographic makeup of the month. And American smokers tend to smoke menthol at a higher rate, but because our population don't have as many African Americans in Vermont and some other states that is that sort of shows up in our relatively low menthol cigarette usage rate compared to other states. I made the noise here that these revenue estimates are higher than they were in S288 last year, which is roughly the same bill and that's because of the higher revenue estimates that came out in the January 2021 forecast. I want to emphasize that within these estimates, there's quite a bit of uncertainty because the revenue loss here directly tied to the extent to which people quit using tobacco products altogether or moving straight into the into the black market. And based upon surveys that we look at, depending on the type of tobacco you're talking between 30 and 65% of all users would quit altogether. And for you tobacco users, the evidence with about 60 to 75% would quit altogether or move into the black market, but I want to emphasize that even a relatively small change to these numbers whatever the assumption is can really change the revenue estimate. For instance, if you make the assumption that right now I think we have about 30, I assume about 35% of adults will quit smoking or join the early the market altogether into the black market on cigarettes. I would assume that that quit rate jumps to 45% and you lose about an extra million dollars. So it doesn't take much here to make the revenue estimates go up or down depending on those quit rates so you know I'm sort of, I guess covering myself in advance that if this bill were to receive resigned by the governor and the revenue estimates were much lower much higher it would be because of those quick rates. So the final point I want to add is, you know, the sort of long term health impacts and the potential savings to Vermont are, you know, undeniable those are not something that we estimated in this fiscal note. Mainly because they're just just difficult and they're somewhat indirect with lots of other factors being brought into play here so I guess with that I can take any questions on the note. That's very helpful and comprehensive as it was last year I have two questions. And you probably can take the fiscal note down because we have it on our, we also have it on our iPads. So Graham, as, as we're looking at this. You indicated that there's an increase in use in 20 fiscal year 2022. As compared with the past when previous analysis is done. It's, and we've heard from folks that the pandemic has caused an increase in use of some of these products. Is there any prediction on your, on your side of things that the useful drop after the pandemic. And I'm not going to make that prediction I'm looking at the, I'm looking at the revenue forecast. Yes, I know of the of cigarettes tobacco products and vaping products. On the cigarette side, it looks like the consensus forecast is building a sort of one time what I call one time bump up. And it's not just the numbers, you know, saying fiscal 20 it was a small number of bombs out and then it goes back to that small number it sort of goes up, and then slowly comes back down again. So there is that in the cigarette, what I would highlight here in the vaping side. You know, one of the biggest fiscal message that made in my career has been on the vaping cigarettes estimates. We estimated that was going to raise around a million dollars back when it was passed and it's on track to raise about $6 million in revenue which is significantly higher than any other state in terms after you adjust for population and usage so there is something inherent to I guess Vermont, they usage that is putting its revenue collection much higher than what we saw in any other state. So that is a number that received a big step up, and it is not projected to come back down, according to the consensus forecast of anything it's growing slightly from about $6.2 million in fiscal 21 to about 6.5 and fiscal year 23 so that is I explained a good chunk of the jump in cigarette and tobacco tax revenues, but we've seen fiscal year 22. Okay, thank you. My other question is probably one that would take a great deal more investigation on your part in terms of the health care costs and the health care impacts and maybe Nolan probably as well. The, to reach out for example to those in the state who do cardiovascular surgery or care where we've heard that pulmonary and cardiac deaths have been increased or and treatment has been increased as a result of tobacco use. But so, how much, if we were to ask you for an analysis of health care costs, how long would it take for us to get some sort of preliminary or even more concrete data. That's not something typically our office does overall the next morning I can bring that back that question back to Nolan. And yeah, it would be an interesting thought you know I'm not something we're going to ask for at the right at this stage we have heard from some of the advocates, specific numbers that have been sorted out from time to time but it would be great to know how that sugars off. Yeah, I can follow up with no one on that to see if there's any. Yeah, if you look at some of the studies I don't think we would as our office put together sort of offsetting numbers this revenue impact me. Any sort of revenue losses associated with cigarette and tobacco is always kind of a difficult thing and such that if you lose a lot more money then that means you're achieving your policy goal of. Oh yeah. So, to the extent this number is actually less than someone might think it is and, you know, you could easily respond by saying well, you know that means that not many people are putting smoking which is not the ultimate goal here so, you know, again, quite a lot of uncertainty in this assessment that this is based upon the literature we have available and again, I would not write off those potential health benefits and indirect benefits and fiscal benefits, because I mean no one I both really those are there, but that's just not the type of analysis that we have an offset direct revenue impacts with and it's not just in this. In this setting and you know I good examples economic development we almost never offset any fiscal cost related to an economic development expenditure tax incentive with potential revenue benefits so just a source standard not just our office also but also within the whole fiscal scoring field with your state governments and the federally. Thank you. Quick question for Graham committee. All right. Thank you very much. Thank you. Thank you for the update on this and I know you've spent a lot of time researching it initially and it's, we appreciate it. It's been a while ago, we can see that so. All right, we're, we'll keep moving along. And we have with us. Shane, Lynn, I skipped over you I do apologize for that. Some of the folks we were listening to had timing issues, and we appreciate your indulgence. So, why don't you introduce yourself and give us your testimony. Super thank you for inviting me here today appreciate it my name Shane Lynn. I'm the executive director of Champlain Valley dispensary medical marijuana dispensary up here in Burlington. I'm also the director of Vermont canvas trades Association which is the coalition of the medical marijuana dispensaries here in Vermont. I did submit testimony so there is written testimony you may have it in front of you. And I'll just kind of walk through what we've outlined. Over 20% of our registered patients utilize some form of a product, excuse me, some form of a product for their symptom relief. Our cartridges include either cannabis derived or botanically sourced terpenes as the active ingredients and flavor components. So we try to keep our products all natural when it comes to big or eliquid formulas. The image of our patients are cannabis naive it's their first time actually probably utilizing cannabis, and they might have a really strong reaction to the flavor. And so, being able to, you know, provide a flavor to the cannabis the normal kind of cannabis product without a flavor is very harsh. And so the flavor does benefit them when they want to utilize in elation, especially in elation of cannabis versus smoking and flower, the big product is a good alternative. You know, basically we use mild flavorings that also mask the aroma of cannabis. That's also a concern for a patient when it comes to privacy when utilizing cannabis for symptom relief. I'd also point out that other medications out there do use flavorings for medications so it's not unusual for people to have medications that have been flavored. And lastly, I think that one of the larger points are with the recent elicit vaping tests, the best way to ensure patient safety here in Vermont is by allowing the medical program to offer devices and liquid formulations which have been tested. There by displacing the counterfeit cartridges out there and the demand on the elicit cannabis market. We really support the intent of S24 but we'd like to ensure S24 will not ban the e-liquids that patients use for their medications. Because medical marijuana has not been approved by the FDA, it would be included in the definition of other substances slash tobacco substitute. The term tobacco substitute appears throughout S24. I'd like to propose an amendment to the definition of a tobacco substance to exclude medical marijuana from being considered other substances. Our amendment is the addition of the last sentence in bold and underlined in the testimony that I've submitted. And I'll just read that very quickly. The substances used in this section shall not include substances sold by dispensary registered under 18 BSA chapter 86 or seven BSA chapter 35 to registered patients and registered caregivers as those terms are defined in those chapters. And that kind of concludes my testimony be happy to take questions regarding, you know, the use of big pens in the medical marijuana program. And I know you've been working with patients and helping treat them with utilizing medical marijuana. The, the initial bill for that went through this committee and I was part of that discussion. Yep. So, thanks for your testimony. Senator Hardy has a question. Thank you madam chair and thank you, Mr Lynn chain, whatever. I'm wondering. So I'm looking at the language on at home here, and is this specific to medical marijuana so you're, you're just wanting this smaller carve out not a broader carve out for all cannabis vaping products is that correct. That's correct. Yes, just for the medical program as is right now. You know, and as I highlighted, you know, we have a 20 to 25% almost a quarter of our patients are utilizing big products right now. So, and some of those are lightly flavored is what your testimony. So what we do with the extraction process is where we, you know, we grow the plants and then we extract the terpenes from the plant so we're literally taking the aroma the flavor off of the plant we then add that back into the vape product as the flavoring so we're not using artificial flavors there so we're trying to stay natural in our approach to the products without that flavoring the oil from the plant is really harsh, you know, and most people probably would not enjoy inhaling it so this is a means to back to that you know mild flavor to it to not creating resistance to using the product. But again it's just in the narrow, not the broader. Okay, that was what I wanted to get there again. Thank you. Other questions. Senator Cummings. You're muted Senator. Would this bill van cannabis vaping. It wouldn't not medical marijuana but is marijuana considered a tobacco product. No, it's not. You know, and still, you know, still cannabis is not recognized by the FDA still so you know there's a lot of gray area here it's still federally legal. You know, so. Okay, yeah. But so our youth could vape cannabis, but not tobacco is that I've not I'm just throwing that out as an open question if we do this. So, what do we need I think to get answered. Well, Jen just popped up. Well, well, I was just going to say we'll ask Jen and there's a lot of prescient. Jennifer Kirby Legislative Council so I don't think anything about what Mr. Lin is is proposing affects the separate cannabis statutes that I think have the same 20 age 21 restriction I do think we have to look. But more carefully at how to frame the language if you wanted to pursue this kind of exception because it would take it. These products when when used by or sold to a registered patient from registered dispensary out of the definition of tobacco substitute across our statutes including things like the ban on using them on school grounds ban on using them and cars with children. So I think we would have to look at narrowing it a bit so that the application is clear, but as to the broader question about use use by youth it doesn't change the underlying cannabis statutes. I'm trying to remember but I think that when we passed. One of our bills. We banned. marijuana vape flavored vape marijuana products. So we have to check that. Yeah. All right. Any other questions for Shane. Senator Hooker. You. And thank you Shane. Just a, I'm curious to know how many flavors you have like when we're talking about flavored tobaccos there are hundreds and hundreds of them. I think we probably have three to four different flavors right now. So it's, it's limited. Thanks. Okay. Any other questions. Thank you for your and for the language I think it's important. Thank you madam chair thanks everybody for the time speaking and I'm available for follow up and if there are additional questions so have a good day. Thank you. You too. Take care. Okay. We have. Some folks with us. We did hear from Maria Davies previously but in a very crunched piece of time and so Maria. I'd like to welcome you back and understand that just a few minutes of testimony to upgrade or for to remind us of your concerns from the last time you were here. As a parent and then because we do want to hear again from Zoe pickle a short bit and then we have Moses for the first time so we want to leave sufficient time for Moses. I'd like to leave at least 12 or 15 minutes for Moses so we'll take five to seven minutes from Maria and Zoe so thank you and we do have your testimony online. Thank you. Thank you everyone. I'm not going to read my testimony. You have it in front of me. I've just been really actively listening. Thank you for letting me be in this space. I'm Maria Davies. I'm a still parent. And I am the parent of two kids middle schooler and high schooler. I'll give you briefly my story and my rude introduction into vaping because I wasn't privy to a lot of the vaping devices that were out there until my kids alerted me to this. They were on the school bus. They smelled the vape. They saw the vape kids were vaping on the school bus school bus contains middle schoolers high schoolers kindergartners. And so they're all mixed in. And my daughter alerted me to it. My son says he's seen it before. He didn't think it was a big deal. He's been offered vaping devices several times. He's always declined it. My daughter who's a middle schooler has also been offered vaping devices. So this alerted me and concerned me. I went to the principals and I said, do you see this? Are you seeing what's happening? And they said, yes, we do. And they said, we're confiscating it. Mrs. Davies. Don't worry. And then I thought, well, what are you doing with the devices? I'm not telling them in the landfill. Are you because I know they're not supposed to be in the landfill. But anyway, that's another story. And so they're confiscating it. They weren't penalizing the kids. They were just taking them away. But these kids were getting gift cards for their birthdays for Christmas for anything. And buying these devices online. So it just started getting really crazy. And I just thought, I wonder if parents are aware of this. So I started talking to a lot of different parents. Parents would come to me because of my connections with health and moral value. I'm stirring committee member there. Because I decided to start getting educated on these devices and what it meant and what was happening. So I can then educate my kids and my friends and my kids friends on what was happening. And together we form a parent group. You know, to talk about this, to bring a presenter in to say, these are the vaping devices. This is how it started. And this is what they look like now. Parents were just taken back. The kids knew exactly what they look like, how many flavors there were, what it, you know, how you charge the thing on your computer. And they could easily be concealed. So we showed them all of this. And I couldn't believe how much parents didn't know. And I went to kids new. So then we've got another presenter in another parent series to talk about what this does to their brain. And it's a long story, but we really try to educate both parents and the youth on what it is that they're doing so they could make healthier choices. For me, that was critical because I wanted the kids to know that they have options that they don't have to do this, but they're constantly being targeted by these tobacco companies. They put these vaping devices near areas where kids go, they flock to, you know, to get a cookie or a sweet or something. And there they are right there. And so that angers me because there isn't any real, you know, rain in on this, the marketing is just crazy. And so these kids, yes, they'll go out of their way to get these devices, but it doesn't mean that we have to stop curbing this marketing and curbing the use of these devices. You know, so we need help. This bill will help us. And I hear, you know, testimony from the other people saying their revenue, their revenue is going to go down. It's linked to crime. It's linked to this. But it's, it's at a cost of our kids health. These kids are really getting hoped, and they're getting incredibly, you know, sick with these devices. And nobody's caring about it. And our parents are not being educated. So I say, let's put some money in education to better educate the parents. COVID has exacerbated this issue because kids are in isolation. So I'm asking you with this bill to please help me, you know, house it because it's important to me, it's important to the parents that I speak to on a daily basis and the kids that come out and saying, I need to quit. We're telling the principles. I need to quit. And I don't know how to. I need it. I need to fix. We need to get out of the classroom to get a fix. This is crazy. And so we need help. We need some type of help when it comes to this. And I don't care about their bottom line that the tobacco companies bottom line. I care about my kids health, and those kids are getting hooked, who are going to different counselors trying to figure out how to get themselves on hook. So I'm here to ask you to please pass this bill because I'm not interested in the bottom line. I'm interested in my kids health. All right, thank you. We've got a couple of questions. I'm going to ask a question and then I'm going to turn right to Senator Cummings before you answer it. And maybe you can add it into an answer at some point. The question is simply that do you believe that the educational programs that you've offered to kids and parents have those educational programs and your mind been effective at deterring the use of these products. And I'll just scoot right over to Senator Cummings with her question. I wanted to ask, we banned the sale, both in stores and online the revenue sales aren't coming from youth we banned the sale two years ago. So where are your kids getting these things. So the kids are actually very savvy. They're getting them from older kids. Maybe they're siblings. I live in Stowe. It's very well known for a very party town. And unfortunately, people here turn a blind eye to that type of thing. And they will offer a kid a vape. I don't know why I don't know, you know what the reasoning behind it is. And so they'll also buy them vapes for their birthday. Unfortunately, I don't think parents are very aware as to what they're actually giving their kids. The reason why to, you know, to your other question, Jenny is that I, I think education is key. These parents were able to understand it was pre COVID so we actually met at the cafeteria at school, and put out a lunch and everything, and explain to the kids and the parents what this means. I couldn't believe that that was out there. And the more we did these parents series, the more parents came and got more educated and asked more questions and asked for more series or more, you know, ideas on different types of series like mental health and development and things like that. So I think that it took off really well pre COVID. Now that we're in COVID, we haven't been able to meet. I still get parents on the quiet path and still asking me, Hey, when are we doing these again so I'm putting a zoom parent cafe together for these parents so they can tell me what they're seeing and what they're hearing. So I think education is helping. Okay, so it, rather than extending bans to adults, we might do better with working on cessation for the kids that are hooked, and educating, because not if adults are buying these things for kids. This isn't going to stop that. Well, no, because we're banning it for adults too. Right. All right, I think I bought I want I really think that we should have to move on I apologize again but I think your points are extremely well taken and the work that you're doing and so sounds amazing. Please don't stop. Please don't stop with that and we appreciate your comments on the bill as well. Zoe, we're going to turn to you. And I'm going to ask you if you would mind if we put Moses a step ahead of you. No, go right ahead. Thank you. Thank you. Thank you. Thank you for introducing yourself for the record. Great. Thank you so much, Zoe. Thank you for making that little adjustment. I appreciate it. My name is Moses shine delaying. I am a student who graduated from Bells Free Academy Fairfax in 2017. And in the years since then I've found myself being pulled into a lot of these discussions and being a youth voice for things like drug prevention substance use and just wellness practices at the middle school. And one of the things I've been able to be involved in since graduating was I was the the youth, a youth co coordinator for a summer youth leadership and prevention program called Franklin County Teen Institute, where we have high school students that are sent from all five counties in Franklin County. So just as a refresher, that's Bells Free Academy Fairfax, that's Bells Free Academy, St. Albans, that's Mrs. Boyd Valley Union, that's richford and Inesburg high schools. And since then we've expanded to some kind of external ambassador positions. So we're having people from Burton, we're having people from this is a we're growing our community and through my role in that. I'm going to interact with a lot of high school students from a lot of different environments from Vermont and teachers. A year and a half ago, I was in DC for it's the community anti drug coalitions of America Convention in Washington, another big youth leadership forum, and one of our youth, who is attending from Mrs Boyd Valley Union shared this very powerful and empathetic about, it's a student in math class, she's working and she sees her friend who's going through nicotine withdrawals, because they need to go to the bathroom and the point being that their addiction, the influence that tobacco is playing on their lives is now taken away from their educational experience. And that's that's physical growth. And I'm here to just, I'm, I want to be able to really paint the picture for what young people are thinking about this isn't, I'm not, I don't necessarily have a, well I do have a pretty strong opinion about this but I want to be able to present this a view to you guys so you guys can make the informed decision rather than making this be something that I'm trying to do myself. With the, I like the tobacco 21 rule. I've done some projects on that in the last year or so, through UVM, being able to raise that smoking age from 18 to 21 did do a lot to term to limit access, but in terms of allure for kids and young people, the flavor is always going to be something that's incentivizing and who would taste good and I have friends who I'm living with right now, who are college age students and you know I see I saw them in June being like alright this is going to be the last this is going to be our last e-cigarette, blah blah blah and then like two weeks later they got another one. It's now, so this is June 2020, 2020, 2021 they're still at it and so and I'm seeing people continue to be hooked. I do think tobacco 21 did do a lot in terms of limiting access because like Maria had said I've also heard that in Inesburg I went to Bellsbury Academy Fairfax my school bus had we had kindergarteners on it we had and middle schoolers on it we had we had everybody you know I graduated with 75 students in my class we're a small condensed community and everybody sees everybody. At the time we were seeing the 18 year olds who were at the time able to able to go buy these products and then flip them on the buses so they're thinking about I just need to make some money, and they're not thinking about oh I'm selling a potentially hazardous tobacco product to you know middle schoolers adolescents and I think a lot about like through Teen Institute I've learned that the brain is still developing until 2728 and it's even higher for men. You know, so I think if if someone wanted to make the sacrifice at 21. There's still so much that we don't know about how these substances are going to affect developing mind and there's the flavors are targeting kids. I don't want to equate this too much to dab cartridges or concentrated cannabis things but you see the same marketing there. I'm seeing cannabis cartridges with like it's cartoons from Nickelodeon that I remember growing up and it's like Cosmo and Wanda on the side of the packaging they're bright it's the Skittles flavor it's the end but I know other people have made this argument for me and I only have a certain amount of time so I'm trying to keep moving. You're okay. I think in the short term college people my age I think about so I attend UVM UVM is not just from Otter students we have a lot of students who majority of students who are coming from out of state and are using flavored tobacco things because that's something that their normal state has normalized. So, if you tell 20 year old UVM student that Vermont is going to ban flavored e cigarettes, they're going to be bummed in the short term, but I also understand that we have to look at this in a larger perspective there's the with with menthol the idea of we're seeing all these racial injustices in terms of marketing and being able to use this opportunity to take menthol off the table can be an extension of a larger effort that we're seeing in terms of equity because you know I've I watched documentary last night called black lives black lungs about the different ways like we're having 80% of black smokers were specifically using menthol cigarettes and how that percentage of black smokers using specifically mental products has risen over the years it used to be equal with it with white white smokers were using the same rate is black and then five years past and the percentage of black smokers that were using menthol tripled and then a couple years past again it tripled again and now we're seeing that I I had previously thought that it was 80% of black smokers were smoking menthol cigarettes but we heard Mr. Levine earlier say that it's now above 90% tobacco is the leading killer in black deaths are the leading cause of black deaths in America right now with I think it's 45,000 to 49,000 a year of people are dying of this and that is a I can make the assumption that that's a direct correlation to the explicit targeting that we're seeing the I know that you guys are more familiar than I am but I'm in terms of targeting these people and okay so I'm saying a lot but if I'm if I'm painting my my personal opinion. I want to remember that story of the MVU student who is going through withdrawals. The tobacco 21 law is going to make an effect in terms of accessibility. But there's still more to do and in terms of if we're thinking on behalf of the entirety of the state is another thing that we can do to reduce that percentage of the possibility of young youth being initiated into these kind of products. Removing all flavors will only further deter the efforts of big tobacco trying to attempt to marketing product products to children. And again remembering that we're having brains that are still developing the information that Katka is sharing is still new because I couldn't I can tell you honestly I'm 21 I'd never seen a jewel before 2018. The whole process of an E cartridge cigarette thing we're still learning so much about and I like to err on the side of caution. And in terms of a, the financial argument, I believe that this this shouldn't be a money conversation this should be a public health conversation. This should be an equity conversation. There should be a racial justice conversation. This should be a humanity conversation. In terms of being able to make money. You know the market's going to do what it does and evolve like things do people forget about products as time passes and you know we think a lot about people being dependent on the product that they're first initiated with so for my generation or for the generation before me it was the combustible cigarettes, and there's the people who are still going to smoke the combustible cigarettes as we go. But for me, you know this this window of E cigarettes being a thing has only been like three four years, and I like the idea of being able to catch it earlier. The fact that Massachusetts is already passed legislation pertaining to this kind of stuff is again another green light for me in terms of we should be trying to match this effort, because it gives us the opportunity to kind of leverage our reputation as a state to a role model this kind of equity, empathy to other states, the people around us and to our federal government in time. So even though we might not be on pace, or we might we might not be matching the other states around us by making this statement we are influencing. They could be having this conversation six months from now and looking to for us for reference. I've said a lot, and I've rambled a lot, but I'd like to thank you for your time. You've covered a huge amount of ground Moses and thank you for that. Senator Cummings has a question Senator Hardy has a question, and then we're going to move on to Zoe and thank you for being here and for the good work that you're doing. Absolutely I'm happy to be of service. I've been told that we need to do this for racial equity because black people are more likely to smoke menthols than other people. The question is why I'm a woman, women have been targeted. I'm an antique dealer I can show you old Chesterfield ads where women are specifically targeted there's Virginia slims and you've come a long way baby. But I haven't heard that women are more likely to smoke or use menthol, except we do have a much higher percentage of pregnant women that smoke. But what I'm trying to figure out is this totally advertising, or does it have something to do with life experience or stress, or, you know, what is the best way to get at the issue. Yeah, I think there's I think there's definitely a lot of moving pieces in terms of this kind of like what could go into the effects of why are black people using more mental. I think about historically what the tobacco industry used to be. I, and I again, I don't know all the facts around this because I'm 21. I grew up in Kentucky, I probably and failed enough. You know, listen, listen, I do not want to interrupt this conversation I think the question that you've asked Senator Cummings is a question that perhaps we should review Dr. Gardner's testimony because it was so very much targeted toward marketing and the marketing piece has extremely key. I'm very sensitive to our time right now I think hold your question and that is something that perhaps you might want to reach out to Dr Levine about or folks in the health department. But I would I would also add very quickly that. And a lot of this is information I've kind of inhaled over the last few days but you're you're seeing tobacco, tobacco lobbyists. There are things like scholarships for the NAACP and they're kind of like, they're being able to kind of leverage the fact that they have this money that they can use to help in the short term, people who don't have that kind of level of money, and it gives them a bargaining chip on the table like with we saw the FDA, when Obama passed a legislation that made it illegal to add added additives into tobacco other than menthol menthol was left on the table because of tobacco lobbyists able to kind of influence that. But that again that is not a wheelhouse I am super confident and and I'm sure the first time efficiency, someone else can give you better than it. So I'm going to go on target with the FDA piece that is that has been documented. Senator Hardy. Thank you madam chair and thank you Moses for your testimony and all the work that you've been doing over the last few years in this area. It's very impressive. I asked for you to clarify and maybe underscore a point that I heard you make and, and, and this is a sort of what you've heard us ask various questions about this because two years ago which was actually my first year in the Senate, we passed tobacco 21, which, you know eliminated the sale of tobacco products, all across the board for anybody under the age of 21 so what I what I heard from you I think was that you think that has been effective that it is reduced the use of tobacco among people under 21, but that, because flavors are so alluring, and, you know, bringing people into the potential of using tobacco products. It hasn't been enough is. Yes, I would I would say my in the college setting the tobacco 21 rule that the idea of social source social social source awareness or social social source social source awareness. When you're in a high school setting is a lot less high schoolers that know 21 year olds, then if you're in a college setting, like 18 year olds are going to know 21 year old so college people have to sacrifice a little bit less because it's not for them to, if they wanted to bypass the whole there's 21 things, they can do that. And we're still getting the prevention efforts we want with middle schoolers and with high schoolers. Yes, there's another important piece about people coming from out of state and bringing these products into state, but I again I think that that's a good discussion from you guys to have rather than myself. That is a good place to move on. Thank you very much Moses it's great. Yes, and I'm happy to make myself available in the future. We dance a little bit about, you know what concentrated cannabis things I am also well versed in that I think there's an important legislation we should make about hemp and CBD production. Okay, well we're not going there today. Thank you for your time and I wish you luck and informed. Thank you. I want to give Zoe some time and we'll probably go past the 11 o'clock hour for this but Zoe. Just within a few minutes if you don't mind. You've heard a lot of the testimony but you've also been involved I think locally on some of the work so why don't you introduce yourself for the record and then give us your testimony. Thank you. I'm Zoe Piquel. I'm a youth advocate and I'm also a national youth ambassador for Vermont with the campaign for tobacco free kids. So for many years the tobacco industry has been focusing on youth with products to ensure it is longtime addicted customers and things haven't changed with the cigarette so it's still the same tactics industry documents and actions highlight their desire to get you hooked. And so Levin and RJ Reynolds sales representative asked the company which young people they were targeting. This was his response. They got lips we want them and from the Laurel our tobacco company. The base of our business is the high school students and I got these quotes from the 84 movement their website. In my first two years of high school I've just seen some of the impact of flavors and vaping I remember sitting in class and hearing countless conversations about vapes discussions over which flavors are the best if the classmate was willing to sell any dual pods and which device delivered the best head rush. And one thing that sticks out to me the most is hearing a classmate say I can't get out of bed until I take a hit I just can't get going without it. The classmate refers to the act of using the vape. And it's concerning that the amount of students in Vermont who report vaping daily has doubled. This is addiction. And so these products have become part of the youth culture flavors and all. And by passing this legislation you have the ability to remove these products from youth culture before they become too ingrained to remove. And one dual pod is equivalent to a pack of cigarettes. So these products are very addictive and they're very hard to stop, especially with flavors. Whether or not to start using tobacco products is certainly a choice that many face, especially when they're young and peer pressure and the need to fit in is high. So using the flavor tobacco products lessens the pressure to start, and a whole lot less youth will choose tobacco when it doesn't have the cool factor provided by flavors and menthol that are just begging kids to try them. Right now there are over 15,000 tobacco flavors on the market, and every single one of those flavors makes it easier to use the tobacco products because it masks the flavors of tobacco and all the other chemicals found in the devices. So make sure you get rid of all flavor tobacco products and don't just take the incremental step and not address mental. Getting her to some flavors will only will not stop the current vapors and tobacco users from using tobacco, nor will it prevent new youth from using tobacco in the first place. It's like when your favorite to crime show is no longer airing you can't watch it anymore. It's, you're not going to stop watching to crime shows you're just going to move on to the next one because it has the same idea behind it. It's the same exact thing with flavors. If you take away some flavors, the kids are still going to want the flavors they still like the flavors. They're just going to move on to the next flavor because it's still flavor it's still making it easier for them to use the tobacco products. We need to protect youth from the tobacco industry because it's been aggressive and focusing on them. And by them I mean youth jewels purchase ads on youth focused websites such as Cartoon Network Nickelodeon 17 magazine. They also rejected an ad proposal that would have laid a clear foundation for an adult centered marketing campaign, and their marketing techniques really dual to identity self image sex appeal and romance. And it's not even just dual. Most cigarette companies have used scholarships and almost but some of the cigarette companies have used scholarships sponsored events appealing flavors and social media to promote products to the to youth. And they've counted on kids to help market their products as well and it's worked. There's been user generated content that includes memes of kids movie characters holding vapes and other memes about jewel and other products have circled social media. Sorry, I forgot to share my screen when I first started. So, these are some at user generated content and ads if you don't mind turning your attention to the screen up here in the top row in the middle you have Elmo telling kids in order to be cool they need to vape. And you also have some of the memes that I was just describing with Buzz Lightyear saying when you're buzzing hard holding a vape and also Patrick describing how sophomores look their jewel when it's almost out of juice which refers to the liquid in it. So here on the bottom in the bottom left, there are easier ads I can be seen as youth marketing on the entire bottom row, but on the bottom left is a advertisement directly from jewel featuring a young woman holding her vape looking very appealing to youth. And the bottom middle is the ad proposal that I just briefly touched on that was rejected. And then here on the bottom right you have an ad from puff bar with which is a disposable cigarette that comes in many different flavors. And the ad all go over quickly. So they are saying that stay sane with puff bar the solo break they know that you'll love it because it's a perfect escape from back to back zoom calls, parental texts and WFH stress which is working from home stress. And so who would you say that is geared towards geared towards for me, I would say that is directly geared towards youth because they are the ones doing back to back zoom calls for school and other projects. They're getting parental texts, and they might not necessarily have working from home stress depending on their job. So I know I'm working from home right now but not everybody has the same occupation I do. So that is it could be seen as geared towards adult but that's less than half of the ad. So this bill can protect the future and present generations from these addictive products. As I said before, to effectively lessen the number of youth who choose to use products, all flavors need to go. If any flavors are still on the market, that's going to be what you'll find youth using. So you won't have to look too far back for an example. In 2018 when Jewel removed 3d flavors from stores following public pressure, the left mint and mental remaining mental sales jumped from 51% to 64%. And so given all these photos, I understand why Jewel and other vape companies have been so successful in getting youth to make the choice to vape. Youth are exposed to toxic addictive cancer causing devices and they have the choice in front of them to use them or not. So these flavors definitely make it a whole lot easier for them to use them. As a youth who resents the targeting of my generation by the industry and advocate who cares about the health of my peers and a sister who wants to protect her younger brothers, I firmly believe that the only way to end the youth vaping epidemic is by ending what is enticing youth to start with the availability of flavored tobacco products in all forms. And when your decision, I would encourage you to ask yourself what the reasons would be for keeping flavors on the market, whether it be revenue, or anything of the sort. And then consider how that outweighs to the future of our youth. As a youth, I would say that we deserve more than a lifetime of addiction. Zoe, thank you. That was very clear and comprehensive. A lot of information. One quick question for Zoe. Does anyone have a question at this point. Zoe thank you and I know that we'll stay connected and we appreciate the time that you've given to us, both today and last week. I think it was last week, all the time flies. Thank you. All right committee. This has been this has been a long haul on this one topic and we're moving into the next topic of audio only and we have folks here representing different interests. And I'm going to suggest and I mean seriously two minutes of a quick break, and then we'll come back and we'll begin to address. We'll begin to address and thank you Moses. Audio only the flexibility bill so Nellie you can put this.