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Home My WebLink AboutCOM 0593.025 2022-2024 PI PCI 5p 1 RILL 10Z ♦r' ; ', '-T i4,'.A. ,, JOSH GREEN,M.D. f ti _4, t KENNETH S.FINK,MD,MGA,MPH GOVERNOR OF HAWAII # DIRECTOR OF HEALTH KE KIA'AINAO KAMOKU'AINA'OHAWAI'I `ni L lip ,{° KA LUNA HO'OKELE STATE OF HAWAII DEPARTMENT OF HEALTH KA`OIHANA OLAKINO P.O.Box 3378 Honolulu,HI 96801-3378 doh.tesamony@doh.hawaii.gov Testimony in SUPPORT of Bill 102 AN ORDINANCE AMENDING CHAPTER 14 OF THE HAWAII COUNTY CODE 1983 (2016 EDITION,AS AMENDED),BY ADDING A NEW ARTICLE RELATINC> TO THE PROHIBITION OF FLAVORED TOBACCO PRODUCTS COUNCILMEMBER SUSAN"SUE"L.K. LEE LOY, CHAIR cx-�i POLICY COMMITTEE ON HEALTH, SAFETY, AND WELL-BEING - , Hearing Date: December 5, 2023 Room Number: Hawai`i County ° 37> Building& .� Videoconference 1 Fiscal Implications: The fiscal impact of a ban on flavored tobacco products in Hawai`i County 2 would result in reductions in the State's tax revenues while at the same time leading to 3 reductions in chronic diseases and health care spending, including Medicaid spending in the 4 state. • 5 Department Testimony: The Department of Health(DOH) supports Bill 102 as both a health 6 equity and social justice issue to protect the next generation in Hawai'i County from lifelong 7 addiction to tobacco use. Bill 102 prohibits the sale of flavored tobacco products and nicotine 8 products (including menthol),prohibits the mislabeling as nicotine-free any e-liquid products 9 containing nicotine, and establishes penalties for violations. 10 The absence of protective policies to act as a preventive buffer between the promotion of 11 enticing electronic smoking devices (ESDs), also known as e-cigarettes, and youth, contributed 12 to the ongoing rise in frequent use and unrestricted access to nicotine. It is estimated that 29.8% 13 of high schoolers and 17.3%of middle schoolers in Hawai`i County reported current use of Comm. N•. Sqb. c Ref. To: a i l'7 Ref. Date 4-EC ® 5 I Bill 102 Page 2 of 4 1 ESDs.I°2 The unrestricted promotion of e-cigarettes has addicted a new generation of young 2 people to nicotine, increased exposure to harmful substances and likelihood for smoking 3 cigarettes in the future.3 U.S. retail sales data showed that sales of the highest levels of nicotine 4 grew from 5%of total e-cigarette sales in 2017 to 81% in 2022.4 These data raise serious public 5 . health and safety concerns because of the long-term effects of nicotine on youth brain 6 development.5 Nicotine is associated with reduced impulse control, mood disorders, disrupting 7 memory, learning, and sleep, according to a report of the U.S. Surgeon General.6 8 Comprehensive evidence-based prevention policies are needed that restrict the sale of flavored 9 tobacco products. 10 Alluring flavored tobacco products continue to drive the youth vaping epidemic. Nearly 11 85%of U.S. youth who currently use e-cigarettes use flavors.? The most popular flavors 12 continue to be fruit, followed by candy/dessert/sweets, mint, and menthol.8 Among users of 13 cartridge or pod-based e-cigarettes, over half reported using either fruit(58.4%) or menthol 14 (53.9%), followed by candy/desserts/sweets (30.3%) and mint(27.6%).9 15 Menthol flavors are too often exempted from tobacco control policies.10 Menthol is an 16 organic compound that has cooling, analgesic, and irritative properties,which can change the • 1 Hawaii IBIS-Query Result—Hawaii Youth Risk Behavior Survey(YRBS)Data—Electronic vapor product—Current use,High Schools,County- level.(2017-2021).Retrieved August 23,2023,from https://hhdw.org/report/query/result/orbs/VaporCurr/VaporCurr HS CNTY.html z Hawaii IBIS-Query Result—Hawaii Youth Risk Behavior Survey(YRBS)Data—Electronic vapor product—Current use,Middle Schools,County- level.(2017-2021).Retrieved August 23,2023,from https://hhdw.org/report/query/result/orbs/VaporCurr/VaporCurr MS CNTY.html 3 US Department of Health and Human Services.E-cigarette Use Among Youth and Young Adults:A Report of the Surgeon General.pdf icon [PDF—8.47MB].Atlanta,GA:US Department of Health and Human Services,CDC;2016.Accessed July 27,2018. 4 Ali,F.R.M.,Seaman,E.L.,Crane,E.,Schillo,B.,&King,B.A.(2023).Trends in US E-cigarette Sales and Prices by Nicotine Strength,Overall and by Product and Flavor Type,2017-2022.Nicotine&Tobacco Research,25(5),1052-1056.https://doi.org/10.1093/ntr/ntac284 6 The Effects of Nicotine on The Adolescent Brain—Vaping Side Effects.Get the Facts Here.-Tobacco Free CA.(n.d.).Retrieved January 28,2021, from https://tobaccofreeca.com/e-cigarettes/the-effects-of-nicotine-on-the-adolescent-brain/ 6 U.S.Department of Health and Human Services.E-Cigarette Use Among Youth and Young Adults.A Report of the Surgeon General.Atlanata, GA:US DHHS,Centers for Disease Control and Prevention,National Center for Chronic Disease Prevention and Health Promotion,Office on Smoking and Health,2016. 2 Cooper,M.(2022).Notes from the Field:E-cigarette Use Among Middle and High School Students—United States,2022.MMWR.Morbidity and Mortality Weekly Report,71.https://doi.org/10.15585/mmwr.mm7140a3 8 Cooper,M.(2022).Notes from the Field:E-cigarette Use Among Middle and High School Students—United States,2022.MMWR.Morbidity and Mortality Weekly Report,71.https://doi.org/10.15585/mmwr.mm7140a3 9 Cooper,M.(2022).Notes from the Field:E-cigarette Use Among Middle and High School Students—United States,2022.MMWR.Morbidity and Mortality Weekly Report,71.https://doi.org/10.15585/mmwr.mm7140a3 10 The importance of strong local flavored tobacco policies.(n.d.).Truth Initiative.Retrieved February 1,2021,from https://truthinitiative.ordresearch-resources/emerging-tobacco-products/study-highlights-importance-strong-local-flavored Bill 102 Page 3 of 4 • 1 way the brain registers the sensations of taste and pain and when in cigarettes can make harmful 2 chemicals more easily absorbed in the body. 11,12 Menthol also facilitates absorption by masking 3 the harshness of, and making it easier to inhale, cigarette smoke. The availability of menthol 4 cigarettes likely increases experimentation and progression to regular smoking and the 5 availability of menthol increases the likelihood of addiction for youth smokers.13'14 Exempting 6 menthol perpetuates social injustice as menthol flavoring has been used by the tobacco industry 7 to appeal to youth, racial minorities, and marginalized populations. The tobacco industry has 8 targeted minority groups such as the lesbian, gay, bisexual and transgender(LGBT) community, 9 Asian Americans,Pacific Islanders,Native Hawaiians, and African Americans.15,16,17 Menthol 10 use is also high among those with behavioral health conditions and those who are 11 socioeconomically disadvantaged.18'19 12 Higher proportions of youth e-cigarette use in Hawai`i counties call for more urgent 13 action on the local level. The proportion of high school (29.8%) and middle school (17.3%) 14 youth in Hawai`i County who currently use e-cigarettes is alarming.20,21 The DOH supports Bill 15 102 as a measure to protect the next generation from lifelong addiction to tobacco use by 1145 U.S.Department of Health and Human Services.The Health Consequences of Smoking-50 Years of Progress:A Report of the Surgeon General.U.S.Department of Health and Human Services,Centers for Disease Control and Prevention,National Center for Chronic Disease Prevention and Health Promotion,Office on Smoking and Health,2014. 12 U.S.Department of Health and Human Services.Tobacco Use Among U.S.Racial/Ethnic Minority Groups—African Americans,American Indians and Alaska Natives,Asian Americans and Pacific Islanders,and Hispanics:A Report of the Surgeon General.U.S.Department of Health and Human Services,Centers for Disease Control and Prevention,Office on Smoking and Health,1998 13 8 U.S.Food and Drug Administration,Tobacco Products Scientific Advisory Committee.Menthol Cigarettes and Public Health:Review of the Scientific Evidence and Recommendations.March 23,2011.Available at: https://wayba ck.arch iveit.org/7993/20170405201731/htt os://www.fda.gov/down I oa d s/Adviso rvCo m m ittees/Comm ittees M eeti ngM ate ria Is/T obacco Products Scientific Advisory Committee/UCM269697.pdf 14 U.S.Food and Drug Administration.Preliminary Scientific Evaluation of the Possible Public Health Effects of Menthol Versus Nonmenthol Cigarettes.2013.Available at:http://ourl.fdlp.gov/GPO/gpo39032 'Washington,H.(2002).Burning Love:Big Tobacco Takes Aim at LGBT Youths I AJPH/Vol.92 Issue 7.American Journal of Public Health. https://ai ph.aphapublications.org/doi/ful l/10.2105/AJ PH.92.7.1086 16 Muggli,M.E.,Pollay,R.W.,Lew,R.,&Joseph,A.M.(2002).Targeting of Asian Americans and Pacific Islanders by the tobacco industry: Results from the Minnesota Tobacco Document Depository.Tobacco Control,11(3),201-209.https://doi.org/10.1136/tc.11.3.201 17 Primack,B.A.,Bost,J.E.,Land,S.R.,&Fine,M.J.(2007).Volume of Tobacco Advertising in African American Markets:Systematic Review and Meta-Analysis.Public Health Reports,122(5),607-615. 18 National Survey on Drug Use and health,2018 19 National Survey on Drug Use and health,2018 20 Hawaii IBIS-Query Result—Howai'i Youth Risk Behavior Survey(YRBS)Data—Electronic vapor product—Current use,High Schools,County- level.(2017-2021).Retrieved August 23,2023,from https://hhdw.org/report/query/result/orbs/VaporCurr/VaporCurr HS CNTY.html 21 Hawai'i IBIS-Query Result—Hawai'i Youth Risk Behavior Survey(YRBS)Data—Electronic vapor product—Current use,Middle Schools, County-level.(2017-2021).Retrieved August 23,2023,from https://hhdw.org/report/query/result/orbs/VaporCurr/VaporCurr MS CNTY.html Bill 102 Page 4 of 4 1 prohibiting the sales, distribution, and mislabeling of all flavored tobacco and nicotine products 2 in Hawai`i County. 3 Thank you for the opportunity to testify. 4 • Offered Amendments: None.