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Heart American Heart Associa t 33mo�ny Q (I y02,
Association. i, - , nil Y."An ordinance amending Chapter 14 o the Hawaii County Code 1983
2016 Edition,As Amended), by adding a new article relating to the
prohibition of flavored tobacco products"
December 5, 2023
Chairman of the Board
Brandt Farias The American Heart Association supports Bill 102, "An ordinance amending Chapter
14 of the Hawaii County Code 1983 2016 Edition,As Amended, by adding a new
President article relating to the prohibition of flavored tobacco products."
Zia Khan,MD
Board Members Flavors, including candy, mint, menthol, and fruit flavors, play a major role in
Greg Christian tobacco products' appeal to youth,and can make it more difficult for adult users to
Jason Fujita quit their nicotine addiction by masking the harshness of tobacco.Youth are initially
Michael Lui,MD attracted to these products by their flavors and then many move on to regular use
Ben Morgan Matthew Reeves,D.o.,MBA and nicotine addiction.To ensure we don,t lose a new generation of kids to nicotine,
Ben Salazar we must remove all flavored tobacco products from the market.Youth will gravitate
Michael Tanoue,M.D. toward any flavors left on the market, even if some are removed.
David Underriner
Tobacco industry representatives may attempt to carve out exemptions for
products it claims aren't attractive to youths, such as premium cigars or hookah. No
tobacco product is safe.Allowing exemptions to flavored tobacco restrictions only
opens the door for the industry to introduce new products designed to circumvent
Serving Hawaii since 1948 the law and continue to target under-age users, and to make it more difficult to
Our Mission: enforce the law.This industry has proven adept at using this tactic in other
"To be a relentless force for a world communities and states where exemptions were allowed.
of longer,
healthier lives." Tobacco use among our keiki is being driven by kid-friendly flavored e-cigarettes.
There are misconceptions about the safety of e-cigarettes. Since they are not
combustible,e-cigarettes are often touted as a safer alternative and potential
For more information on the AHA's tobacco cessation tool. Increasing evidence suggests the contrary-that e-cigarette
educational or research programs, (including vaping) products cause significant harmful effects. No flavored tobacco
visit www.heart.org or contact your product has been approved by the FDA for use as a tobacco cessation product,
nearest AHA office. despite misstatements made by the tobacco industry.
In addition to nicotine, many e-cigarette and vaping products may also contain
flavoring additives, propylene glycol and glycerol and metals. Research shows that
each of these ingredients can harm the heart and lung systems in both animal and in
` vitro studies. E-cigarette and vaping products with flavoring additives are associated
with respiratory diseases,chronic cough,shortness of breath, airway obstruction,
asthma,and chronic bronchitis. Further, e-cigarette and vaping product use is
associated with other substance use and abuse, including alcohol and cannabis.
E-cigarettes and traditional tobacco products contain addictive nicotine and toxic
chemicals that may have adverse effects on their cardiovascular system and their
overall health.These products can cause a wide array of severe, adverse health
effects that include nicotine poisoning, and harm to the neurologic,cardiovascular,
respiratory and gastrointestinal systems. Increasing evidence suggests e-cigarettes
Hawaii Division 1707 Richards Street,Ste.615 I Honolulu I HI 196813 Comm. N ( 1) ii�
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have significant acute injurious effects on the airway epithelium, increased
pulmonary inflammation,and respiratory immune suppression.They can cause an
increase in blood pressure, heart rate,flow of blood to the heart and a narrowing of
the arteries(vessels that carry blood). Nicotine may also contribute to the hardening
of the arterial walls, which in turn, may lead to a heart attack. Some e-cigarettes and
newer tobacco products deliver more nicotine than traditional cigarettes.
People experiencing nicotine addiction may feel increased levels of irritability,
anxiety and depression that can only be relieved by taking another hit of nicotine.
These symptoms are reported in Hawaii's youth by our teachers who find their
students who use e-cigarettes to be increasingly uncontrollable, abusive,and
disruptive in their classrooms when denied their ability to leave the classroom for a
"hit."
The current FDA tobacco flavor policy falls short of what is necessary to address
youth tobacco use,state and local governments need to move forward to address
loopholes. Under the FDA's guidance,thousands of e-cigarette flavors will remain
on the market since the policy exempts menthol e-cigarettes and allows fruit, candy,
and mint flavored liquid nicotine used in refillable open tank systems or in
disposable e-cigarettes to stay on the market. In addition, other flavored tobacco
products such as menthol cigarettes and flavored smokeless tobacco and cigars are
still allowed to be sold.The FDA has also shown to be ineffective at enforcing its
existing restrictions on flavored tobacco products. Local authority and enforcement
need to be exercised to address this health emergency.
We also recommend that Bill 102 ensure penalties are levied on the owner/operator
of the tobacco retail location instead of clerks and other non-management
employees. Research shows that compliance is most effective when penalties for
failing to follow tobacco laws are levied on the owner/operator rather than non-
management employees. In addition, non-management employees are often low-
wage earners who are unable to afford financial penalties.
We respectfully encourage Hawaii Councilmembers to provide their community the
same protections that the states of California, Massachusetts, New Jersey, New
York,and Rhode Island,along with 360 other counties and communities'governing
bodies nationwide have provided to their constituents by restricting the sale of
flavored tobacco products—including menthol.
Respectfully submitted,
Donald B.Weisman
Government Relations/Communications and Marketing Director
2IPage