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MEETING PACKET JUNE 2014 C1'rY OF SALEM, A�sSACHUSETTS BOARD OF HFALTH 120 WASHINGTON STREET,41" FwO PublicHealthR Prevent.Promote.Protect. TEL. (978) 741-1800 FAX(978)745-0343 KIMBERLEY DRISCOLL 1tqmdin@salem-com J_\Iuty x,\MDIN,16/1i 1-'l IS,CI 10,C11-VS NMAYOR NOTICE OF MEETING You are hereby notified that the Salem Board of Health will hold its regularly scheduled meeting Tuesday June 10, 2014 at 7.00 PM City Hall Annex 120 Washington St.3 rd Floor Room 312 MEETING AGENDA 1. Call to order 2. Approval of Minutes 3. Chairperson Communications c-n 4. Public Health Announcements/Reports/Updates > a. Health Agent r-n -0 b. PHN Report r c. Administrative d. Council Liaison 5. Tobacco 21 G. Miscellaneous 7. Adjournment Larry Ramdin Health Agent cc: Mayor Kimberley Driscoll, Board of Health, City Councilors Next regularly scheduled meeting is July 8, 2014 at 7pm at City Hall Annex, 120 Washington Street Room 312. Know your rights under the open meeting law MGL chapter 30A ss. 18-25 and City Ordinance section 2-2028 through 2-2033 This notice posted on "Official Bulletin Board" , 1-1— City Hall, Salem, Mass. on- yv,_ at �' �-[ &L in accordance with MGL Chap. 30A, Sections 18-26. CITY OF SALEM BOARD OF HEALTH MEETING MINUTES May 13, 2014 DRAFT MEMBERS PRESENT: Dr. Barbara Poremba, Chair, Dr. Shama Alam Dr. Danielle Ledoux & Gayle Sullivan OTHERS PRESENT: Larry Ramdin Health Agent, Council Liaison Beth Gerard & Suzanne Doty, Public Health Nurse, Councilor Furey MEMBERS EXCUSED: Martin Fair TOPIC DISCUSSION/ACTION 1. Call to Order 7:00pm 2. Minutes of Last Meeting Dr. Alam motioned to approve minutes, Gayle Sullivan 2nd. (April 8, 2014) Approved unanimously 3. Chairperson Announcements No updates 4. Monthly Reports-Updates A. B. Health Agent Approved. Copy available in BOH office. Report *Larry spoke to the owner of Red Lion and he will be carrying individual ash trays- City is looking to purchase and give away individual ashtrays as well. *The appeal for the injunction for Salem Grill Z Chicken was denied - we will have a month to respond. B. Public Health Approved. Copy available in BOH office. Nurse's Report *A small amount of PPD is available for contacts. *The one measles case is only a contact to a case. DPH is following up with all contacts. C. Administrative Approved. Copy available in BOH office. Report *Money from the DIG Grant will be used to pay our part-time inspectors for the rest of the fiscal year. D. City Council * Although the Board reduction has not been brought up at a Liaison Updates council meeting yet, Councilor Siegel is working on reduction to the Board. Siegel is for 5 members—Councilor Turiel is for any number. Councilor Gerard notified the Board about Martin not asking to be reappointed. City Ordinance states that he needs to notify the Mayor before 128 days of leaving the Board. *There is a trash concern on Balcomb Street, possible abandoned property. Sanitarian Elizabeth Gagakis was there and is in the process of resolving the matter. *The potential marijuana dispensary site is located in Ward 6 is being reviewed by the City Council. 5.-New Business4 x 'y A. Tobacco 21 Presented by Dr. Lester Hartman Others present, Director of NSCATACP Joyce Redford, Inspector Peter King &MA Municipal Association Atty. DJ Wilson Dr. Hartman went over the handouts given to the Board members. These handouts will be available in the Health Department office. Subject discussed were: 1. Comprehensive Policy 19 cities/towns in MA have adopted into their regulations, no purchase of tobacco products until the age of 21 Tobacco is the most preventable cause of death. Studies have shown that the brain is the most vulnerable before it fully develops. Full development of the frontal lobe does not occur until the age 25. Also 80%of people who start smoking at 18 and under will become addicted to tobacco for a longer period of their life time while only 19%of people who start smoking at the age of 20 or older will become addicted. The market has seen a morphing of tobacco/nicotine delivery devices that are geared towards a younger generation, such as flavored cigarillos and chewing tobacco. Also electronic nicotine delivery devices that are on the market today claim to be healthier but are not approved by the FDA. 2. Military Restriction argument 33.6%of troops in active duty are addicted to tobacco. Cancer rates are doubled among Veterans. 3. Retail Argument • Retail establishments have claimed they will lose business if the purchase age is raised to 21 years old. In the cities and towns were the age was raised, across the country, no significant loss of business was reported. 4. Why 21? Many high school seniors are 18 yr and 4-8%of high school students are 19 years old. This provides easy access to tobacco to the under-aged. Increasing age to 21 yr will decrease access to tobacco by younger students. The younger you start smoking the more likely you will become addicted. Discussion about presentation: Dr. Ledoux asked if the age of 18 is based on science. Dr. Hartman replied that it is the legal definition but 18 is not science based. Dr. Ledoux and Dr. Alam questioned, do we have enough information to push this forward. Dr. Hartman replied, one example is there was a 50% drop in smoking in Nedham after the age limit was raised to 21. A Metro west study was also done in 17 different communities. Atty. DJ Wilson also replied, this is not a state wide policy yet. The state's attorney general has to approve this policy as well. An example of a town increasing the age over time in Arlington. . Arlington has taken a"step up" approach to increasing the age, meaning they will increase the legal age one year, every year until they reach 21. Brookline has also raised the age to 19 and will be going up to 21. Newburyport has gone to 19 &Melrose is now 21. Others include Holbrook, Cambridge, Concord, Lexington and Stodeharn NYC will be increasing the age to 21 this month. Dr. Hartman, Joyce Redford and DJ Wilson are in agreement with a 2-3 month education for retailers of tobacco and nicotine products. Joyce Redford has spoken with the North Shore Cape Ann Preparedness Coalition and there is interest in other cities/towns in our coalition. Although this regulation change would not be funded by the DPH to do compliance checks they will be needed for ages 18-21. Compliance checks will need to be funded by each city and town that changes their regulation in this way. Councilor Gerard asked if Dr. Hartman knew the youth smoking rate. And does the BRFFS have this information?This could be helpful for the Boards raising the age to purchase to 21. Dr. Hartman replied the Youth Risk Behavior Services should have this information; also www.makesmokinghistory.org will have the information on adult statistics. Atty. Wilson and J. Redford asked to speak to the Board about improving other tobacco/nicotine policies since there has been new products folding the market since they last updated the Sale of Tobacco/Nicotine Regulation. *Four packs of cigars/cigarillos have hit the market in MA that are being marked as $0.99. Joyce suggested to the Board that they update the language to include four packs to be sold for$5. *Atty. Wilson said we will start seeing MA cities and towns banning flavored tobacco/nicotine due to a Providence RI ordinance being upheld by the federal courts; MA is in the same federal court district. Councilor Furey spoke and is in full support of the Board decision on this subject. Dr. Poremba will add this as an agenda item to discuss at the next meeting. More information is needed and will be available for next month's meeting. Larry will start looking for base line data for youth smoking in Salem for the Board for next month's meeting. This is about children and creating a smoke-free generation. 6. Health Agent Evaluation Motion to go to executive session Dr. Alam. Dr. Ledoux 2 nd Approved unanimously 7. MEETING ADJOURNED: 11:09 pm Respectfully submitted, 1plerk eather Lyons-Paul of the Board Next regularly scheduled meeting is June 10, 2014 at 7pm At City Hall Annex, 120 Washington Street,Room 311 Salem. Health Agent report June 2014 Announcements • A draft ordinance to adopt new Zoning rules to permit Backyard farming has been submitted to City Council. The City Administration was advised that the Board of Health will consider Backyard Farming regulations in September at the earliest. • Delilah Castro Sanitarian is out on Workmen's Comp as a consequence of an injury she sustained while conducting an inspection. • Captain Thomas Griffin of the Salem Police Department has been appointed Chief of the Peabody Police Department. Community Outreach • Suzanne Doty RN Public Health Nurse, is staffing a table at the Farmers market, providing blood pressures and information on public health topics • Larry Ramdin participated in' Campus Conflagration a tabletop exercise that simulated a fire at Salem State University. Public Health Highlights • Rodent and trash calls to the Department are increasing. • Larry Ramdin attended a planning meeting that discussed the planned Splash pad at Mary Jane Lee Park • An advisory walk through was done with the owners of a proposed Bakery on Derby Street. • The Department of Public Health held a conference call to discuss the 2104 Arbovirus season, there are no changes from last year. The testing of traps has begun and to date there are no concerns for Salem. Results are reported on Friday. Meetings and Trainings • David Greenbaum attended the North Shore REACT meeting, MSPCA gave a presentation on how to handle the pets of seniors when the senior is hospitalized or unable to care for the pet. • David Greenbaum attended the Salem REACT meeting, discussion and updates of current cases were conducted. I Inspections Item Monthly Total YTD 2013 Total Certificate of Fitness 47 275 577 Inspection Certificate of Fitness 3 14 29 reinspection Food Inspection 18 178 377 Food Re-inspections 4 104 227 Retail Food 2 22 55 ' Inspections Retail Food 0 7 27 reinspection General Nuisance 1 9 9 Inspections Food— 0 1 2 Administrative Hearings Housing Inspections 36 123 233 Housing re- 1 28 40 inspections Rodent Complaints 1 8 39 IF Court Hearings 0 2 10 Trash Inspections 10 72 146 Orders served by 0 2 2 Constable Tanning Inspections 0 1 1 Body Art 0 1 1 Swimming pools 9 23 30 Bathing Beach 27 27 102 Inspection/testing Lead Determination 0 1 4 Septic Abandonment 0 1 0 Septic System Plan 0 0 1 Review Soil Evaluation 0 0 1 Percolation tests 0 0 1 Total 159 899 1914 i Health Dept. Clerical Report FY 2014 Burial Permits Permits Plan Reviews Certificate of Copies / Fines Revenue Permit Fees $25 Fitness $50 July-13 $750.00 $2,085.00 $0.00 $2,400.00 $1,100.00 $6,335.00 'Food Service Est. <25seats s140 August $675.00 $655.00 $0.00 $1,900.00 $0.00 $3,230.00 25-99 seats $280 >99 seats $420 September $425.00 $640.00 $0.00 $1,450.00 $0.00 $2,515.00 Retail Food <l000sq' $70 October $900.00 $925.00 $0.00 $1,775.00 $1,200.00 $4,800.00 1000-10,000 $28o >1o,000 $420 November $600.00 $815.00 $180.00 $2,300.00 $1,100.00 $4,995.00 Temp.Food 13days s3oo December $300.00 $34,605.00 $0.00 $1,025.00 $0.00 $35,930.00 4-7days shoo >7days s January-14 Example of>7 day temp food permit. $750.00 $24,167.00 $0.00 $300.00 $0.00 $25,217.00 14(da s)divided b 7=2 x$600=$1200 February $950.00 $2,770.00 $540.00 $1,700.00 $425.00 $6,385.00 Frozen Desserts $25 March $1,375.00 $2,110.00 $450.00 $2,700.00 $1,207.00 $7,842.00 Mobile Food $210 April $1,150.00 $2,900.00 $0.00 $1,700.00 $0.00 $5,750.00 1 Plan Reviews New s18o May $1,125.00 $2,980.00 $180.00 $2,350.00 $0.00 $6,635.00 i Remodel sgo June Catering $25 per event/s2oo catering kitchen Body Art Est. $315 Total $9,000.00 $74,652.00 $1,350.00 $19,600.00 $5,032.00 $109,634.00 Body Art Practitioner 135 Review Plans s18o Fiscal Year Budget 2014 Suntan Est. $140 Rec.Day Camp $10 Salary Starting Ending Expenses Ext.Paint Removal s35 Full Time $341,259.00 $54,518.27 Starting Ending Transport Off.Subst. s1o5 Part Time $19,997.00 $2,319.63 $18,850.00 $2,793.46 Tobacco Vendors $135 Overtime $2,000.00 $566.55 Swimming Pools Seasonal $140 Balance $363,256.00 $57,404.45 Health Clinic Revolving Account Annual$210 Nonprofit$40 $14,178.28 Title V Review s18o Well Application si8o i • Disposal works s225/ Memo Date: June 13,2013 To: Larry Ramdin,Health Agent CITY OF From: Joyce Redford,Director BOARD OF HEALTH RE: Salem Tobacco Compliance Checks On May 15tn&19th,2014,the North Shore/Cape Ann Tobacco Alcohol Policy Program conducted follow-up tobacco compliance checks in the City of Salem. In addition to Joyce Redford,Director and Peter King,Inspector,three under aged youth participated in these checks. Fourteeni(14)establishments were checked and one(1)sale occurred;however there were two(2)violations issued. One for the sale to a minor the second for pricing of the cigar product,the Black&Mild was sold for$2.00. Violations occurred in the following establishments: . Establishment: Address: Offense: Fine: Kwik Shop of Salem io Jefferson Ave ist $100.00 Enclosed you will find a copy of the violation notices that were issued to each establishment at the time of the compliance check Should you have any questions regarding these checks please do not hesitate to contact me at 781-586-6821 4D CITY OF MASSACHUSETTS S ALEM, BOARD OF HEALTH t,t PublicHedth 120 W ASHINGTON STREET,4 FLOOR Prevent.Promote.Protect. TEL. (978)741-1800 FAx(978)745-0343 KIMBERLEY DRISCOLL lramdinnsaleni.coin , L:1RRY R,IMDIN,RS RL?F{S,CI-IO,(;1 [S MAYOR HIl.:u xi-1 AcFINT August 25,2014 Kwik Shop of Salem 10 Jefferson Avenue Salem, MA 01970 Dear Owner: On Thursday May 15,2014 at 5:11pm personnel from the North Shore/Cape AnnTobacco Alcohol Policy Program conducted a compliance check to determine if your permitted establishment would sell a tobacco product to a minor. A 17 year-old male purchased tobacco from a clerk in your store and pricing of cigar product sold was$2.00. Documentation is now on file at the Board of Health regarding that sale. Kwik Shop of Salem is in violation of Section III(A)of the Salem Board of Health Regulation Affecting the Sales of tobacco to a minor and pricing of cigars no less than$2.50. According to section D.Tobacco and Nicotine Delivery Product Sales to Minors Prohibited ;the sale of cigarettes,chewing tobacco,snuff, or any tobacco in any of its forms to any person under the age of eighteen shall be punished by a fine of ($100.00 Hundred Dollar fine)for the first offense. Also according to section F. Cigar sales regulated; any retail establishment that''sells or distributes any cigar under$2.50 shall be punished by a fine of ($100.00 Hundred Dollar fine)for the first offense • FOLLOWING THE THIRD(3RD)OFFENSE,THE BOARD MAY CONSIDER POSSIBLE REVOCATION OR SUSPENSION OF THE PERMIT. The North Shore Tobacco Control Program and the Salem Board of Health have worked with you and your employees to demonstrate methods to ensure compliance with this regulation. Therefore,you are ordered to pay a fine of$200.00 for the violations stated above. A check or money order payable to the City of Salem must be at the Board of Health office, 120 Washington Street,4ch floor,within ten days of receipt of this notice. Should you be aggrieved by this Order,you have the right to request a hearing before the Board of Health. A request for such a hearing must be received in writing in this office of the Board of Health within seven (7)days of receipt of this Order. At said hearing,you will be given the opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. You may be represented by an attorney. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection or investigation reports,orders, and other documentary information in the possession of this Board,and that any adverse party has the right to be present at the hearing. If you have any questions regarding this notification please call me at 978-741-1800. Sincerely yours, 0- , Larry Ramdin Health Agent LR/hlp CERTIFIED MAIL: 70121640 0002 3313 0577 cc: North Shore/Cape Ann Tobacco Alcohol Policy Program Barbara Poremba, Board of Health Chairperson and Members M�TCP m: Tobacco Compliance Check Form 2011-2012 Section 1: Establishment Survey Participants KWIK SHOP OF SALEM Name: � ID of Purchaser: 10 JEFFERSON AV Age: ❑15 ❑ 16 ❑ 17 Address:— Sex:❑Male ❑Female Salem Name of Adult Supervisor I � I City: Time of Check: am❑pm Date of Check: Type of Establishment: [3 Chain ❑ Independent ❑ Not Known Day of the Week: ❑Mon ❑Tues❑Wed ❑ Thurs ❑ Fri ❑ Sat ❑ Sun Style of Establishment(Check Only One): ❑ Convenience Store ❑ Groce Store 113 Bar ❑ Department Store ❑ Liquor Store Private Club(VFW,Le 'on,etc.) ❑ Gas Station Only [3Pharmacy/Drng Store Restaurant ❑ Gas�_Mart ❑ Other(bowling alley,golf club etc. Tobacconist Section 2: Sec • Was Compliance Check completed?Ye No If Yes please continue on to the next question,if No please skip this section and go to section 3. How was tobacco marketed? Al Over-the-counter:youth asks the clerk for the product. ❑ From a vending machine with a lockout device. ❑ Other Describe: Was the Purchaser asked for ID? YeAk No Was this an ID-based check? Yes❑No Was the Purchaser asked his/her a e? Yes❑No Sex of Clerk: Male ❑ Female Approximate age of clerk:❑Teen ❑Young Adult Adult ❑ Older Adult Type of tobacco asked for: ❑ Cigarettes Brand of cigarett asked for: [I Marlboro, ❑Ne ort ❑ Other: ❑ Chew/Dip ❑ Cigars Other B d' Was the sale made? Yes kNo ❑ " d le product cost: $ as a receipt given?Yes❑No❑ If `Yes how much di p Purchaser made payment using: ❑$1 bills ❑ $5 bill(s)❑ $5 bill and$1 bills/or change $10 bills) ❑ $20 bill ❑ change Section 3: If the youth did not enter the premises or did not attempt to purchase tobacco products please indicate why: ❑ Out of Business ❑ Temp.long term closure ❑ In operation,closed at time t of visit ❑ Drive thrn only Unsafe to access ❑ Tobacco out of stock ❑ Does not sell tobacco ❑ Unlocatable ❑ ❑ Pemnt Sus ended ❑ Inaccessible by youth ❑ Wholesale only/cartons ❑ Presence of police Private club personal [3achine broken Youth ins ector knows sal erson Other F� 4 'Don't sell'but tobacco residence seen m store/has permit °" z '3t' 4 ' +S Violation Notice Cit ownC1 { ' { - Board of Health POW&Health Prevent. Promote. Protect. This notice is to inform you that your establishment violated the Board of Health Sale of Tobacco Products &Nicotine Delivery Products and/or Environmental Tobacco Smoke(ETS)Regulation. Name of es ta ishin Address 1 Date 6f violation - 'Time of violation . Minor's age/gender Minor's ID# (Ordinance,Secti e 1 (Act Constituting Vio ation) �- icxcry Narrative information: Vx, �cc tl� 2� . under the pains and p nalties of perj ,that the above report is true to the best of my knowledge ndeli f A\A Inspe or nature) (Print name) ME I acknowledge I received this Violation Notice o41so �, 20 g at M a d I am being given a carbon copy of this noticeknowledge that I have been informed that the Peabody Board of th will provide additional,follow-up information tq this violation notice. s a �-s t t •e � 3 ner anager/Clerk(Signature) (Print name) iF '�ta�S A eF G e, • If vendor refuses this Notice or if the inspector feels unsafe in delivering it,an explanation must r written on a note attached hereto.Mailing of this Notice is thus required. i � p } Contact the North Shore/Cape Ann Tobacco Alcohol Policy Program at 781-586-6821 with questions k Establishment-white NSTCP-yellow Board of Health-pink CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH „� PablicHealth 120 W ASHINGTON STREET,4 FLOOR Prevent Promote.Protect. TEL. (978)741-1800 F.-�x(978)745-0343 KIMBERLEY DRISCOLL lxamdin(aasalem.com La2Rl'R,\MDIN,RS Rf.?F{S,C110,CI, I S MAYOR HI_,AL:n I AGI-1N'1' August 25, 2014 Kwik Shop of Salem 10 Jefferson Avenue Salem, MA 01970 Dear Owner: On Thursday May 15,2014 at 5:11pm personnel from the North Shore/Cape AnnTobacco Alcohol Policy Program conducted a compliance check to determine if your permitted establishment would sell a tobacco product to a minor. A 17 year-old male purchased tobacco from a clerk in your store and pricing of cigar product sold was$2.00. Documentation is now on file at the Board of Health regarding that sale. Kwik Shop of Salem is in violation of Section III (A)of the Salem Board of Health Regulation Affecting the Sales of tobacco to a minor and pricing of cigars no less than$2.50. According to section D. Tobacco and Nicotine Delivery Product Sales to Minors Prohibited ;the sale of cigarettes,chewing tobacco, snuff, or any tobacco in any of its forms to any person under the age of eighteen shall be punished by a fine of ($100.00 Hundred Dollar fine)for the first offense. Also according to section F. Cigar sales regulated; any retail establishment that sells or distributes any cigar under$2.50 shall be punished by a fine of ($100.00 Hundred Dollar fine)for the first offense • FOLLOWING THE THIRD(3RD)OFFENSE,THE BOARD MAY CONSIDER POSSIBLE REVOCATION OR SUSPENSION OF THE PERMIT. The North Shore Tobacco Control Program and the Salem Board of Health have worked with you and your employees to demonstrate methods to ensure compliance with this regulation. Therefore,you are ordered to pay a fine of$200.00 for the violations stated above. A check or money order payable to the City of Salem must be at the Board of Health office, 120 Washington Street,4th floor,within ten days of receipt of this notice. Should you be aggrieved by this Order,you have the right to request a hearing before the Board of Health. A request for such a hearing must be received in writing in this office of the Board of Health within seven (7)days of receipt of this Order. At said hearing,you will be given the opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. You may be represented by an attorney. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection or investigation reports,orders, and other documentary information in the possession of this Board, and that any adverse party has the right to be present at the hearing. If you have any questions regarding this notification please call me at 978-741-1800. Sincerely yours, 0- �s� . —t Larry Ramdin Health Agent LR/hlp CERTIFIED MAIL: 7012 1640 0002 3313 0577 cc: North Shore/Cape Ann Tobacco Alcohol Policy Program Barbara Poremba, Board of Health Chairperson and Members 70''B ACCO21 "HEALTHY TOWNS, HEALTHY KIDS." TM rT2D1 IT'S SIMPLE MATH: Raising the minimum tobacco sales age to 21 will dramatically reduce tobacco use. 2%of tobacco sales produces 90%of new smokers. Cigarette sales to those under 21 account for only 2.12%of total sales. But, because 90%of smokers start before the age of 21,these are the very sales that produce 9 out of every 10 new smokers. This means that the impact on store owners will be minimal and will only affect a very small percentage of their tobacco sales in the short term.' Raising the minimum tobacco sales age to 21 can reduce smoking rates to single digits. Only 10%of smokers start at the age of 21 or older.2 If the current smoking rate is about 20%,3 then by simple math, if someone reaches the age of 21 as a non-smoker,that individual has only a 2%chance of becoming a smoker(.1 X.2 = .02=2%). In New York City and other places where the smoking rate is down to 15%,a young person would only have a 1.5%chance of becoming a smoker(.1 X.15= .015=1.5%)at the age of 21 or above. This strategy is already working. �In 2005, Needham, Massachusetts voted to raise the minimum tobacco sales age to 21. In 2006, before full enforcement,the town had a youth smoking rate of 13%compared with 15%in the surrounding communities. By 2010,the youth smoking rate in Needham was down to 6.7%while the surrounding communities'rate only decreased to 12.4%.The percent decline in youth smoking in Needham was nearly triple that of its neighbors 4 90% of people who purchase for distribution to minors are between the ages of 18 and 20. Since most students do not reach twenty-one years of age while still enrolled in high school,increasing the legal age of sale would greatly reduce the number of students who could purchase tobacco products. By decreasing the number of eligible buyers in high school,this action will help reduce youth smoking by decreasing the access of students to tobacco products. A similar strategy was highly successful in addressing alcohol sales. A national age 21 law for alcohol sales resulted in reduced alcohol consumption among youth,decreased alcohol dependence,and has led to dramatic reductions in drunk driving fatalities.6'' At the time, some critics of the policy argued that because 18 year-olds can vote and enlist in the military,they should be allowed to be sold alcohol. Despite these arguments,the increase in the minimum sales age for alcoholic beverages has saved tens of thousands of lives of young drivers,their passengers,and others on the road.8 'Winickoff JP,Hartman L,Chen ML,Gottlieb M,Nabi-Burza E,DiFranza JR,Minimal Retail Impact of Raising Tobacco Sales Age to 21.American Journal of Public Health.2014.In Press. fihis is a conservative estimate.Centers for Disease Control and Prevention.National Center for Health Statistics.National Health Interview Survey,2008.Analysis by the American Lung Association,Research and Program Services Division using SPSS software. 'CDC.Morbidity and Mortality Weekly Report."Current Cigarette Smoking.Among Adults—United States,2011"November 9,2012.61(44);889-894. "Analysis of 2011 Youth Risk Behavior Surveillance System(YRBSS)data by Jonathan P.Winickoff,MD,MPH,Associate Professor of Pediatrics,Harvard Medical School. ,Difranza JR,Wellman RJ,Mermelstein R,et al.The natural history and diagnosis of nicotine addiction.Current Reviews in Pediatrics.2011;7(2):88-96. Zgenaar AC.Minimum drinking age and alcohol availability to youth:Issues and research needs.In:Hilton ME,Bloss G,eds.Economics and the Prevention of Alcohol-Related Problems.National Institute on Alcohol Abuse and Alcoholism(NIAAA)Research Monograph No.25,NIH Pub.No.93-3513.Bethesda,MD:NIAAA;1993:175-200. 'NHTSA's National Center for Statistics and Analysis,March 2005."Calculating Lives Saved Due to Minimum Drinking Age Laws:'Washington,DC,U.S.,DOT. 'DeJong W,Blanchette J."Case Closed:Research Evidence on the Positive Public Health Impact of the Age 21 Minimum Legal Drinking Age in the United States."J.Stud.Alcohol Drugs,Supplement 17,108-115,2014. rT 2 1 THE VULNERABLE TEEN/YOUNG ADULT BRAIN Nearly 90%of smokers started smoking by age 20.' Scientific study of the brain is increasingly showing a distinct gap between when we are physiologically mature and neurobiologically mature? In fact,there could be as much as a 4-7 year difference. During this period the brain continues to be highly vulnerable? The minimum age of military service does not equal readiness to enlist in a lifetime of smoking. THE SCIENCE OF BRAIN WIRING From neuroscience experiments,we know that the frontal lobe-the seat of human judgment-is not fully wired until age 25.3 This is why some describe the period from 18-25 years as emerging into adulthood.2 During this critical period,the brain remains especially vulnerable to tobacco addiction 4 Delaying the age of initiation of nicotine significantly prevents a lifetime of addiction. 99%of lifetime smokers started smoking before the age of 25? Tobacco affects the development of the brain in areas of addiction during this vulnerable period.',' The tobacco industry knew all of this as early as 1982: "If a man has never smoked by age 18,the odds are three-to-one he never will.By age 21,the odds are twenty-to-one."-RjReynolds, 19826 Brain health is public health 0 SAMHSA.Calculated based on the data in the 2011 National Survey on Drug Use and Health. The Surgeon General Report.2012."Preventing Youth Tobacco Use."http://www.surgeongeneral.gov/library/reports/preventing-youth-tobacco-use/factsheet.htmi. 'Crews et al,Adolescent Cortical Development:A Critical Period of vulnerability for addiction;Pharmacol Biochem Beh,2007,pages 189-199. 4 Morales et al,Cigarette Exposure,Dependence&Craving are Related to Insula Thickness in Young Adult Smokers;Nature/Neuropsychopharmacology,2014,pages 1-7 'U.S.Department of Health and Human Services."The Health Consequences of Smoking—50 Years of Progress:A Report of the Surgeon General:'Atlanta,GA: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. RJ Reynolds.Estimated Change in Industry Trend Following Federal Excise Tax Increase.;1982.Available at: http://legacy.library.ucsf.edu/tid/tib23dO0;jsessionid=211 D4CCFODBD25F9DC2C9BB025239484.tobaccoO3. L -r T 1 RESPONSES TO CONVENIENCE STORE OWNERS' CONCERNS Big tobacco (RJR and Philip Morris USA) have been working through the retailers. The arguments you may hear. We will go out ofbuslnem When Needham increased the sales age to 21 in 2005 not a single convenience store went out of business. Restaurant and bar owners had the same fear when smoking was banned,and this did not happen.' Tobacco sales to 18-20 year olds are only 2%of retail tobacco sales' CVS and Target have decided to stop selling all tobacco products,leaving more tobacco business for convenience stores. We make our profits from the anditary purchases(milk and bmacO when people come in to buy d&mMm 98%of tobacco sales and all associated ancillary purchases will be unaffected.' 18-20 year olds will have more money for other in-store purchases. They will juggo to otter towns and we will lose business Lower smoking rates are better for business. A city or town that creates fewer smokers will have higher socioeconomic status,better health status, better jobs, and better quality of life for all residents.' Research has shown a minimal retail impact of raising the sales age to 21.' In fact,since 2005 in Needham,there is no evidence for youth traveling to other towns to purchase tobacco. Each town that goes to 21 increases the likelihood that the surrounding towns will also to go to 21. Small decreases in youth access to retail tobacco are strongly associated with lower tobacco use. The key point is that youth will quit or use less tobacco,and those who don't smoke are less likely to start.',' We want this to go to thestat)e leg►slature in mokelta level nlaaft field. The banning of tobacco in bars and restaurants was won on the local level first before it went to the state. This is a ploy by the Tobacco Industry. When Utah's Senator Reid was asked whyTobacco21 didn't pass at the state level, he explained it to us in three words:"The Tobacco Lobby." • Hahn,EJ,"Smokefree Legislation:A Review of Health and Economic Outcomes Research,"American Journal of Preventive Medicine 39(6S1):S66-S76,2010. 'Winickoff JP,Hartman L,Chen ML,Gottlieb M,Nabi-Burza E,DiFranza JR.Minimal Retail Impact of Raising Tobacco Sales Age to 21.American Journal of Public Health.2014.In Press.3' 'U.S. Years of Progress:A Report of the Surgeon General'Atlanta,GA:U.S.Department of SDepartment of Health and Human Services. Health Consequences of Smoking—50 ea g p g P Up Q Health and Human Services,Centers for Disease Control and Prevention,National Center for Chronic Disease Prevention and Health Promotion,Office on Smoking and I lealth,2014. ,Scully M,Mcarthy M,Zacher M,Warne C,Wakefield M,WhiteV.Density of tobacco retail outlets near schools and smoking behavior among secondary school students.Aust New Zealand J Pub Health.2013;37(6):574-78. 'Henriksen L,Feighery EC,Schleicher NC,Cowling DW,Kline RS,Fortmann SIR Is adolescent smoking related to the density and proximity of tobacco outlets and retail cigarette advertising near schools?Prev Med.2008 Aug;47(2):210-4. Tr21 THE MILITARYAGE RESTRICTION ARGUMENT What you can't do until you are 21 years or older: Buy alcohol During the Vietnam era,29 states lowered the alcohol purchase age to 18 and highway death rates made a significant climb. Raising the sales age back to 21 caused the death rate to drop significantly.' Casino gambling Get a'license to carry' gun permit. Rent a car (must be age 25 - crash rates don't drop significantly until then) Rent a hotel room in some hotels. The argument: If you can go to war and bear arms at 18 you should have the right to smoke. Response:The minimum age of military service does not equal readiness to enlist in a lifetime of smoking. IN FACT: The U.S.Army Surgeon General says soldiers who smoke are less combat ready and take longer to heal 2 The U.S. Military is taking steps to ban all tobacco sales on military bases. Easy access to cigarettes has led to a 33.6%smoking rate among active duty military.2 Years of studies, including a comprehensive study on 9.3 million military beneficiaries, have revealed lung cancer mortality rates are double among Veterans 3 Veterans who served to protect our freedom but contracted emphysema from addiction to the discounted cigarettes in the military have lost their freedom 4 DeJong et Blanchette:Case Closed:Research Evidence on the Positive Public health Impact of Age 21 MLDA in the US,Journal of Studies On Alcohol and Drugs/Supplement No17.2014 pg 108-11 S 'http://www.army.mil/standto/archive/issue.php?issue=2012-11-20 3 A Study of Cancer in the Military Beneficiary Population,Guarantor:Raymond Shelton Crawford III,MD MBA,Contributors:Raymond Shelton Crawford III,MD MBA;Julian Wu,MD MPH;Dae Park, MD;Galen Lane Barbour,MD;Military Medicine,Vol.172,October 2007 'http://www.iom.ed u/—/media/Files/Report%20Files/2009/Mil ita rySmoki ngCessation/Combating%20Tobacco%2OM it itary%20for%20web.pdf . T 2 1 NOTES Contact Us i Jonathan P.Winickoff, MD, MPH Lester Hartman, MD, MPH jwinickoff@mgh.harvard.edu lester.hartman@childrens.harvard.edu T21 Version 2.0 v� rCIAMPAI'67 T6bAQD-FR1INCREASING THE MINIMUM LEGAL SALE AGE FOR TOBACCO PRODUCTS TO 21 "Raising the legal minimum age for cigarette purchaser to 21 could gut our key young adult market(17-20) where we sell about 25 billion cigarettes and enjoy a 70 percent market share."' —Philip Morris report, January 21, 1986 Tobacco use remains the leading cause of preventable death in the United States, killing 480,000 people each year.2 It is known to cause cancer, heart disease and respiratory diseases, among other health disorders, and costs the U.S. at least$130 billion in health care expenditures each year.3 700 kids under the age of 18 become regular, daily smokers each day;and almost one-third will eventually die from it., If current trends continue, 5.6 million of today's youth will die prematurely from a smoking-related illness.5 In addition to high tobacco taxes, comprehensive smoke-free laws and comprehensive tobacco prevention and cessation programs, increasing the minimum legal sale age(MLSA)for tobacco products to 21 has emerged as another policy strategy to reduce youth tobacco use and help users quit. The concept of increasing the MLSA is not new, however. In 2005, Needham, Massachusetts became the first city to implement a MLSA of 21.6 New York City became the first major city in the U.S. to raise its MLSA to 21 in November 2013.7 Hawaii County, Hawaii also raised its MLSA to 21 that same month.8 In addition to these locations,four states have MLSAs that prohibit the sale of tobacco products to individuals under the age of 19: Alabama, Alaska, New Jersey and Utah.9 In New York, Nassau County, Onondaga County and Suffolk County require individuals to be at least 19 years of age to purchase tobacco.10 Several communities in Massachusetts, including Belmont, Brookline and Watertown,also have a MLSA of 19.11 Because it is a relatively new strategy,direct research on increasing the MLSA to 21 is somewhat limited; but the data that are available provide strong reason to believe that it will contribute to reductions in youth tobacco use. Central to the MLSA strategy are the facts that many smokers transition to regular,daily use between the ages of 18 and 21; many young adult smokers serve as a social source of tobacco products for youth; and tobacco companies have long viewed young adults ages 18 to 21 as a target market group. Most Adult Smokers Start Smoking Before Age 21 National data show that 95 percent of adult smokers begin smoking before they turn 21, and a substantial number of smokers start even younger—more than 80 percent of adult smokers first try smoking before age 18.12 While nearly half of adult smokers become regular, daily smokers before age 18, more than 13 three-quarters become regular,daily smokers before they turn 21.14 This means the 18 to 21 age range is a time when many smokers transition to regular use of cigarettes.14 According to one national survey, 18- 20 year olds are twice as likely as 16-17 year olds to be current smokers(31.6%vs. 15.4%, respectively).15 Tobacco companies have admitted in their own internal documents that, if they don't capture new users by the age of 21, it is very unlikely that they ever will. In 1982,one RJ Reynolds researcher stated: `If a man has never smoked by age 18, the odds are three-to-one he never will. By age 21, the odds are twenty-to-one. 46 Delaying the age when young people first experiment or begin using tobacco can reduce the risk that they transition to regular or daily tobacco use and increase their chances of successfully quitting, if they do become regular users.t7 Adolescents are particularly vulnerable to the addictive effects of nicotine,and the U.S. Surgeon General has stated that"the potential long-term cognitive effects of exposure to nicotine in this age group are of great concern."18 Because adolescence and young adulthood are critical periods of growth and 1400 1 Street NW• Suite 1200 • Washington, DC 20005 Phone(202)296-5469 - Fax(202)296-5427 • www.tobaccofreekids.org Increasing MLSA for Tobacco to 21/2 development,exposure to nicotine may have lasting, adverse consequences on brain development. As reported by the U.S. Surgeon General, "This earlier age of onset of smoking marks the beginning of the exposure to the many harmful components of smoking. This is during an age range when growth is not complete and susceptibility to the damaging effects of tobacco smoke may be enhanced. In addition, an earlier age of initiation extends the potential duration of smoking throughout the lifespan. For the major chronic diseases caused by smoking, the epidemiologic evidence indicates that risk rises progressively with increasing duration of smoking;indeed, for lung cancer, the risk rises more steeply with duration of smoking than with number of cigarettes smoked per day."19 Adding to the concern is the fact that young people can often feel dependent earlier than adults.20 Though there is considerable variation in the amount of time young people report it takes to become addicted to using tobacco, key symptoms of dependence—withdrawal and tolerance—can be apparent after just minimal exposure to nicotine.21 According to the 2014 Report of the Surgeon General, "the addiction caused by the nicotine in tobacco smoke is critical in the transition of smokers from experimentation to sustained smoking and, subsequently, in the maintenance of smoking for the majority of smokers who want to qwt. „22 As a result of nicotine addiction, about three out of four teen smokers end up smoking into adulthood, even if they intend to quit after a few years.23 As noted above, smoking-related health problems are influenced by both the duration(years)and intensity(amount)of use. Unfortunately, individuals who start smoking at younger ages are more likely to smoke as adults, and they also are among the heaviest users.2 In addition to longer-term health risks such as cancer and heart disease,young people who smoke are at risk for more immediate health harms, like increased blood pressure, asthma and reduced lung growth.zs Nationally, 18.1 percent of high school students and 17.3 percent of young adults ages 18 to 24 currently smoke. According to one national survey, 31.6 percent of 18 to 20 year olds currently smoke.2 Older Adolescents and Young Adults are a Source of Cigarettes for Youth According to the 2013 Monitoring the Future Survey, 71 percent of 1 ofngrade students and 50 percent of 8th grade students say it is easy to get cigarettes.28 This perception that getting cigarettes is easy exists despite the fact that fewer retailers are selling tobacco to underage youth than ever before. In FFY2012 (the most recent year for which data are available), the national retailer violation rate was 9.1 percent— the second lowest in the history of the Synar program.29 This suggests that youth are obtaining cigarettes from sources other than direct store purchases. Research shows that youth smokers identify social sources, such as friends and classmates, as a common source of cigarettes. Although older and more established youth smokers are more likely to attempt to purchase their cigarettes directly than kids who smoke less frequently or are only "experimenting,"they are also major suppliers for kids who do not purchase their own cigarettes but instead rely on getting them from others. 0 And with more 18-and 19-year olds in high school now than in previous rears,younger adolescents have daily contact with students who can legally purchase tobacco for them. 1 A 2005 study based on the California Tobacco Survey found that 82 percent of adolescent ever smokers obtained their cigarettes from others, most of whom were friends. A substantial percentage (40.9%)of the people buying or giving the cigarettes were of legal age(18 years or older)to purchase them,with most (31.3%)being between 18 and 20 years of age. 16-to 17-year-olds were more likely to get their cigarettes from 18-to 20-year olds than were younger adolescents.32 Another study found that smokers aged 18 and 19 years were most likely to have been asked to provide tobacco to a minor,followed by smokers aged 20 to 24 years and nonsmokers aged 18 and 19 years, respectively.33 0 Data from the National Surveyon Drug Use and Health NSDUH show that pearl two-thirds 63.3/o of 9 ( ) Y ( ) 12-to 17-year olds who had smoked in the last month had given money to others to buy cigarettes for L r n Increasing MLSA for Tobacco to 21/3 them. One-third (30.5%)had purchased cigarettes from a friend,family member or someone at school. In addition, six out of ten(62%)had"bummed"cigarettes from others.' Raising the MLSA would reduce the likelihood that a high school student will be able to legally purchase tobacco products for other students and underage friends. Tobacco Companies Target Young Adults Ages 18 to 21 Tobacco industry advertising and promotional activities cause outh and young adults to start smoking, and nicotine addiction keeps people smoking past those ages. a Tobacco companies heavily target young adults ages 18 to 21 through a variety of marketing activities—such as music and sporting events, bar promotions, college marketing programs, college scholarships and parties—because they know it is a critical time period for solidifying tobacco addiction.36 It is also a time when the industry tries to deter cessation and recapture recent quitters.37 Tobacco companies realize that the transition into regular smoking that occurs during young adulthood is accompanied by an increase in consumption, partly because the stresses of life transitions during that time—going to college, leaving home, starting a new job,joining the military, etc.—invite the use of cigarettes for the effects of nicotine. Statements obtained from the tobacco industry's internal documents emphasize the importance of increasing consumption within this target market in order to maintain a profitable business: "...eighteen to twenty-four year olds will be "[c]ritical to long term brand vitality as consumption increases with age.'s9 "...(t]he number one priority for 1990 is to obtain younger adult smoker trial and grow younger adult smoker share of market.i40 "To stabilize RJR's share of total smokers, it must raise share among 18-20 from 13.8% to 40%...ASAP.i41 "Our aggressive Plan calls for gains of about 5.5 share points of smokers 18-20 per year, 1990-93(about 120,000 smokers per year).Achieving this goal would produce an incremental cash contribution of only about$442MM during the Plan period(excluding promotion response in other age groups and other side benefits). However, if we hold these YAS[young adult smokers]for the market average of 7 years, they would be worth over$2.1 billion in aggregate incremental profit. I certainly agree with you that this payout should be worth a decent sized investment."[emphasis in originalf In 2006, after reviewing the evidence against the tobacco companies in a civil racketeering case brought forth by the U.S. Department of Justice, U.S. District Court Judge Gladys Kessler made this conclusion about the industry's marketing practices: "From the 1950s to the Present, Different Defendants, at Different Times and Using Different Methods, Have Intentionally Marketed to Young People Under the Age of Twenty-one in Order to Recruit 'Replacement Smokers'to Ensure the Economic Future of the Tobacco Industry.'43 And in 2014, the U.S. Surgeon General eliminated all doubt regarding the industry's role in perpetuating our nation's tobacco epidemic. He stated: "...the root cause of the smoking epidemic is also evident:the tobacco industry aggressively markets and promotes lethal and addictive products, and continues to recruit youth and young adults as new consumers of these products.' Benefits of Raising the MLSA to 21 • Though a higher MLSA will not eliminate underage tobacco use, it would offer several benefits that could help reduce youth tobacco use and increase the likelihood that youth will grow up to be tobacco-free: Increasing MLSA for Tobacco to 21/4 • Delaying the age when young people first begin using tobacco would reduce the risk that they will transition to regular or daily tobacco use and increase their chances of quitting, if they become regular users.4 • Raising the MLSA to 21 would increase the age gap between adolescents initiating tobacco use and those who can legally provide them with tobacco products by helping to keep tobacco out of schools.46 • Younger adolescents would also have a harder time passing themselves off as 21-year-olds than they would 18-year-olds,which could reduce underage sales.47 • In addition, a MLSA of 21 may simplify identification checks for retailers, since many state drivers' licenses indicate that a driver is under the age of 21 (e.g. license format, color or photo placement).48 Campaign for Tobacco-Free Kids,February 5,2014/Lorna Schmidt Philip Morris,"Discussion Draft Sociopolitical Strategy,"January 21,1986,Bates Number 2043440040/0049, http://Ieqacy.library.ucsf.edu/tid/gba84eOO. 2 U.S.Department of Health and Human Services. The Health Consequences ofSmoking:50 Years of Progress.A Report of the Surgeon General.Atlanta,GA: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. 3 H HS. The Health Consequences of Smoking:50 Years of Progress.A Report of the Surgeon General.,2014. 4 Substance Abuse and Mental Health Services Administration(SAMHDA),HHS,Results from the 2012 National Survey on Drug Use and Health,NSDUH:Summary of National Findings,2013. 5 HHS. The Health Consequences of Smoking:50 Years of Progress.A Report of the Surgeon General.2014. 8 Needham Public Health Department,Application for Permit to Sell Tobacco and Tobacco Products, http://www.needhamma.gov/DocumentCenter/HomeNiew/4162. Caruso,DB,"Tobacco-Buying Age in NYC To Be Raised To 21 With New Legislation,"Hufngton Post,November 19,2013, http:l/www.h uffi ngto n post.com12013111119/tobacco-ag e-n yc_n-4301551.htm I. 8 PR Newswire,"Hawaii County Council Increases Age of Sale for Tobacco Products to 21—Bold Step Will Reduce Smoking and Save Lives," November 20,2013,http://www.i)rnewswire.com/news-releases/hawaii-county-council-increases-aqe-of-sale-for-tobacco-products-to-21---bold- step-will-reduce-s moking-and-save-lives-232736641.html. 9 American Lung Association,State Legislated Actions on Tobacco Issues(SLATI),http://www.lungusa2.org/slati/ 11 Nassau County Administrative Code,December 31,2010, http://www.nassaucountyny.govlwebsitelGenericServices/docs/NassauCountyAdminCode_Dec20lO.pdf.Onondaga Local Law Filing,January 12,2009,http://www.nysac.om/legislative-action/documents/ProhibitingSaleof robaccoProductsforAnyoneUnderl9Onondaga.pdf.Suffolk County Code,January 3,2005,http://ecode360.com/14948475. 11 Bartalini,A,"Belmont raising age to purchase tobacco to 19 come August," Wicked Local Belmont,July 24,2012, http:llwww.wickedlocal.com/belmont/news/x9l 5675698/Belmont-raising-aqe-to-purchase:tobacco-to-19-come-August#axzz2RxRlOnYh. Applebaum,T.,"Vote ups Brookline smoking age to 19," Wicked Local Brookline,May 30,2012, http://www.wickedlocal.com/brookline/news/x639965119/Vote-ups-Brookline-smoking-age-to-19#axzz2RxRlOnYh.Watertown Board of Health, "New Board of Health Regulation increases purchase age of tobacco and nicotine products from 18 to 19 and older,"n.d., http://www.ci.watertown.ma.us/DocumentCenter/HometView/5188. 12 Calculated based on data in the National Survey on Drug Use and Health,2011,http://www.icpsr.umich.edu/icpsrweb/SAMHDAI. 13 Calculated based on data in the National Survey on Drug Use and Health,2011,http:l/www.icpsr.umich.edu/icpsrweb/SAMHDAI. 14 Calculated based on data in the National Survey on Drug Use and Health,2011,http://www.icpsr.umich.edu/icpsrweb/SAMHDAI.See also: Hammond,D,"Smoking behaviour among young adults:beyond youth prevention," Tobacco Control,14:181—185,2005.Lantz,PM,"Smoking on the rise among young adults:implications for research and policy," Tobacco Control,l2(Suppl I):i60—i70,2003. 15 Substance Abuse&Mental Health Services Administration,U.S.Dept.of Health&Human Services,2011 National Survey on Drug Use and Health,Summary of National Findings,2012,http://www.samhsa.gov/data/NSDUH/2kl 1 Res ults/NSDUH results 2011.htm#4.1. 16 RJ Reynolds,"Estimated Change in Industry Trend Following Federal Excise Tax Increase,"September 10,1982,Bates Number 513318387/8390,http://legacy.library.ucsf.edu/tid/tib23d00;isessionid=21lD4CCFODBD25F9DC2C9BB025239484.tobacoo03. 17 See,e.g.,Khuder,SA,et al.,"Age at Smoking Onset and its Effect on Smoking Cessation,"Addictive Behavior24(5):673-7,September- October 1999;D'Avanzo,B,et al.,"Age at Starting Smoking and Number of Cigarettes Smoked,"Annals of Epidemiology4(6):455-59, November 1994;Chen,J&Millar,WJ,"Age of Smoking Initiation:Implications for Quitting,"Health Reports 9(4):39-46,Spring 1998;Everett, SA,et al.,"Initiation of Cigarette Smoking and Subsequent Smoking Behavior Among U.S.High School Students,"Preventive Medicine 29(5):327-33,November 1999;Breslau,N&Peterson,EL,"Smoking cessation in young adults:Age at initiation of cigarette smoking and other suspected influences,"American Journal ofPublic Health 86(2):214-20,February 1996. 18 HHS. The Health Consequences of Smoking:50 Years of Progress.A Report of the Surgeon General,2014. 19 U.S.Department of Health and Human Services.Preventing Tobacco UseAmong Youth and YoungAdu#s: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,2012. r Increasing MLSA for Tobacco to 21/5 20 HHS. The Health Consequences of Smoking:50 Years of Progress.A Report of the Surgeon General.,2014.HHS,Preventing Tobacco Use Among Youth and Young Adults:A Report of the Surgeon General,2012;U.S.Department of Health and Human Services(USDHSS),How Tobacco Smoke Causes Disease:The Biology and Behavioral Basis for Smoking-Attributable Disease: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,2010. 21 H HS.How Tobacco Smoke Causes Disease:The Biology and Beha vioral Basis for Smoking-Attributable Disease:A Report of the Surgeon General,2010. 22 H HS. The Health Consequences of Smoking:50 Years of Progress.A Report of the Surgeon General,2014. 23 HHS.Preventing Tobacco Use Among Youth and Young Adults:A Report of the Surgeon General,2012. 24 USDHSS,Preventing Tobacco Use Among Young People: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,1994. 25 HSS.Preventing Tobacco Use Among Young People:A Report of the Surgeon General,1994.See also Campaign for Tobacco-Free Kids fad sheet,"Health Harms from Smoking and Other Tobacco Use,"http://www.tobaccofreekids.org/research/factsheets/pdf/0194.pdf. 28 CDC,Youth Risk Behavior Surveillance,United States,2011,"MMWR61(No.4),June 8,2012;2011 National Youth Tobacco Survey MMWR61(No.31),August 10,2012.CDC,"Current Cigarette Smoking Among Adults-United States,2005-2012,"MMWR,63(02):29-34, January 17,2014,http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6302a2.htm?s cid=mm6302a2 w. 27 Substance Abuse&Mental Health Services Administration,U.S.Dept.of Health&Human Services,2071 National Survey on Drug Use and Health,Summary of National Findings,2012 http://www.samhsa.gov/datalNSDUH/2kl1Results/NSDUHresults2011.htm#4.1. 28 Johnston,LID,et al.,Mondoringthe Futurestudy,2013,http://www.monitorincithefuture.org//Dressreleases/13cigpr complete.odf. 29 Substance Abuse and Mental Health Services Administration,FFY2012 Annual Synar Reports:Tobacco Sales to Youth, http://www.samhsa.gov/prevention/docs/2012-An n ual-Synar-Report.pdf. 30 Robinson,LA,et al."Changes in Adolescents'Sources of Cigarettes,"Journal ofAdolescent Health,39:861-867,2006.White,MM,et al. "Facilitating Adolescent Smoking:Who Provides the Cigarettes?"American Journal of Health Promotion,19(5):355-360,May/June 2005. DiFranza,JR,et al."Sources of tobacco for youths in communities with strong enforcement of youth access laws." Tobacco Control,10:323- 328,2001.Substance Abuse&Mental Health Services Administration,U.S.Dept of Health&Human Services,2003 National Survey on Drug Use and Health,September 9,2004,http://oas.samhsa.gov/NHSDA/2k3NSDUH/2k3results.htm#ch4.CDC,"Youth Risk Behavior Surveillance -United States,1999,CDC Surveillance Summaries,"MMWR49(SS-5),July 9,2000,http://www2.odc.-gov/mmwr/mmwr ss.html. 31 National Center for Education Statistics,"Enrollment Trends by Age(Indicator 1-2012)," The Condition of Education,2012, http://nces.ed.gov/programs/coe/pdf/coe ope.odf.U.S.Census Bureau,Current Population Survey,Data on School Enrollment, http://www.census.gov/hhes/school/data/ci)s/index.html.Ahmad,S,"Closing the youth access gap:The projected health benefits and costs savings of a national policy to raise the legal smoking age to 21 in the United States,"Health Policy,75:74-84,2005.White,MM,et al. "Facilitating Adolescent Smoking:Who Provides the Cigarettes?"American Journal ofHealth Promotion,19(5):355-360,May/June 2005. 32 White,MM,et al."Facilitating Adolescent Smoking:Who Provides the Cigarettes?"American Journal ofHealth Promotion,19(5):355-360, May/June 2005. 33 Ribisl,KM,et al.,"Which Adults Do Underaged Youth Ask for Cigarettes?"American Journal ofPublic Health,89(10):1561-1564. 34 Substance Abuse&Mental Health Services Administration,U.S.Dept of Health&Human Services,2003 National Survey on Drug Use and Health,September 9,2004,htti)://oas.samhsa.gov/NHSDA/2k3NSDUH/2k3results.htm#ch4 http://www.oas.samhsa.gov/nhsda.htm#NHSDAinfo.(Note:While there have been more recent NSDUH surveys,no questions on youth access have been asked since 2003.) 35 H HS. The Health Consequences of Smoking:50 Years of Progress.A Report of the Surgeon General,2014. 38 Ling,PM,et al.,"Why and How the Tobacco Industry Sells Cigarettes to Young Adults:Evidence From Industry Documents,"American Journal of Public Health,92(6):908-916,June 2002.Sepe,ES,et al.,"Smooth Moves:Bar and Nightclub Tobacco Promotions That Target Young Adults,"American Journal of Public Health,92(3):414-419,March 2002.Ernster,VL,"Advertising and promotion of smokeless tobacco products,"NCI Monograph,8:87-94,1989.Griffith,D.,"Tobacco pitch to college students:Free samples of smokeless products are offered near campuses,"Sacramento Bee,May 25,2004,http://www.calstate.edu/pa/clips2004/may/25may/tobacco2.shtml. 37 Ling,PM,et al.,"Tobacco Industry Research on Smoking Cessation:Recapturing Young Adults and Other Recent Quitters,"Journal of General internal Medicine,19:419-426,2004. 38 Ling,PM,et al.,"Why and How the Tobacco Industry Sells Cigarettes to Young Adults:Evidence From Industry Documents,"American Journal ofPublic Health,92(6):908-916,June 2002. 39 U.S.V.Philip Morris USA,Inc.,et al.,No.99-CV-02496GK(U.S.Dist.Ct.,D.C.),Final Opinion,p.978,August 17,2006, http://www.tobaccofreekids.orq/contenVwhat_we dolindustry watch/doi/FinalOpin ion.pdf. 40 RJ Reynolds,"1990 Strategic Plan,"1990,Bates Number 513869196/9303,http://legacy.library.ucsf.edu/tid/vvn13d00. 41 RJ Reynolds,"Strategic Overview of YAS,"February 16,1989,Bates Number 506788947/8989,http:l/legacy.library.ucsf.edu/tid/rrg44d00. 42 U.S.V.Philip Morris USA,Inc.,et al.,No.99-CV-02496GK(U.S.Dist.Ct.,D.C.),Final Opinion,p.978,August 17,2006, http://www.tobaccofreekids.org/contenYwhat we do/industry watch/doi/FinalOpinion.odf. 43 U.S.V.Philip Morris USA,Inc.,et al.,No.99-CV-02496GK(U.S.Dist.Ct.,D.C.),Final Opinion,p.972,August 17,2006, http://www.tobaccofreekids.oLq/contenYwhat we do/industry watchldoi/Final0yinion.pdf. 44 H HS. The Health Consequences of Smoking:50 Years of Progress.A Report of the Surgeon General, 2014. 45 See,e.g.,Khuder,SA,et al.,"Age at Smoking Onset and its Effect on Smoking Cessation,"Addictive Behavior24(5):673-7,September- October 1999;D'Avanzo,B,et al.,"Age at Starting Smoking and Number of Cigarettes Smoked,"Annals of Epidemiology4(6):455-59, November 1994;Chen,J&Millar,WJ,"Age of Smoking Initiation:Implications for Quitting,"Health Reports 9(4):39-46,Spring 1998;Everett, I Increasing MLSA for Tobacco to 21/6 SA,et al.,"Initiation of Cigarette Smoking and Subsequent Smoking Behavior Among U.S.High School Students,"Preventive Medicine 29(5):327-33,November 1999;Breslau,N&Peterson,EL,"Smoking cessation in young adults:Age at initiation of cigarette smoking and other suspected influences,"American Journalof Public Health 86(2):214-20,February 1996. ^s White,MM,et al."Facilitating Adolescent Smoking:Who Provides the Cigarettes?"American Journal ofHealth Promotion,19(5):355—360, May/June 2005.Ahmad,S,"Closing the youth access gap:The projected health benefits and cost savings of a national policy to raise the legal smoking age to 21 in the United States,"Health Policy,75:74—84,2005. 47 White,MM,et al."Facilitating Adolescent Smoking:Who Provides the Cigarettes?"American Journal ofHealth Promotion,19(5):355—360, May/June 2005. 48 Tobacco Control Legal Consortium,'Raising the Minimum Legal Sale Age for Tobacco and Related Products,"December 2013, htto://www.oublichealthlawcenter.org/sites/defaulYfiles/resources/tcic-gu ide-minimumlegal-saleage-2013.pdf. Ralph Tobacco 21 Protecting youth by raising the minimum sale age for tobacco products from 18 to 21 years old Tobacco Use—Especially Among Young People—is a Critical Public Health Problem • Although tobacco use has decreased, tobacco is still a leading cause of preventable, premature death in the United States and New York City, killing thousands of New Yorkers each year.1,2 • 20,000 public high school students currently smoke in NYC.3 • Almost 100,000 young adults between the ages of 18-24 currently smoke in NYC.4 • About 80% of NYC smokers started before the age of 21.5 • The transition from experimental to regular smoking typically occurs around age 20.6 • Use of electronic cigarettes, which contain the highly addictive drug nicotine, more than doubled among U.S. high school students between 2011 and 2012 from 4.7% to 10%.7 Raising the Minimum Sale Age Reduces Access to Tobacco Products in Stores • In NYC, 25% of public high school students under 18 who smoke reported purchasing cigarettes in stores.e • Currently, teenagers who look older than 16 years old are significantly more likely to succeed in a purchase attempt than those who look younger? • The NYS driver license clearly indicates "Under 21", making it easier for retailers to identify youth at that age threshold. Raising the Minimum Age Reduces Access to Social Means of Purchasing Tobacco Products • Friends are a common source of tobacco among underage youth.10,11 • Between 1997 and 2011, the proportion of public high school students buying their own cigarettes from stores dropped, while the percentage who obtain cigarettes from someone else increased from 40%to 52%.12 • 90% of people purchasing cigarettes for minors were between 18 and 20.13 • High schools students are less likely to come into contact with 21 year olds than 18 year olds in their social circles, reducing opportunities to access tobacco from current legal buyers.14 Raising the Minimum Age Will Save Lives • After the minimum sale age was increased from 16 to 18 in England, there was a 30%decline in smoking among youth ages 16-17;15 younger students ages 11-15 were also less likely to be regular smokers afterwards than before the law.16 • By one estimate, raising the minimum age would decrease smoking prevalence by 67%for 14-17 year olds and 55%for 18-20 year olds.17 Smoking prevalence for those over 21 would decline slowly over time as these youth age, ultimately falling 30%.18 Public Support and Precedent • Needham, MA raised the tobacco sale age to 21 in 2005.19 Between 2006 and 2012, high school students in Needham who reported smoking in the past month declined over 50%.20 • Neighboring states and counties have raised the tobacco sale age to 19, including New Jersey in 200521, Nassau County in 200622, Onondaga County in 200923 and Suffolk County in 2005.24 • Two-thirds of New Yorkers favor raising the minimum age for sale of cigarettes from 18 to 21,with 69% of non-smokers and 60% of smokers supporting this policy.25 •Heaf h 'New York City Department of Health and Mental Hygiene. Preventing Non-Communicable Disease and Injuries:Innovative Solutions from New York City.New York:New York City Department of Health and Mental Hygiene,2011. 2 Danaei G,Ding EL,Mozaffarian D,Taylor B,Rehm J,Murray CJ,et al.The preventable causes of death in the United States: comparative risk assessment of dietary,lifestyle,and metabolic risk factors.PLoS Med 2009;6(4):e1000058. 3 Youth Risk Behavior Survey New York City Department of Health and Mental Hygiene,2011. 4 Community Health Survey.New York City Department of Health and Mental Hygiene.2011 'New York City Community Health Survey 2004-2007.Internal analysis of data 6 Hammond D.(2005). Smoking behavior among young adults:Beyond youth prevention.Tob C014:181-185. 7 Centers for Disease Control and Prevention.Notes from the Field:Electronic Cigarette Use Among Middle and High School Students —United States,2011-2012.Morbidity and Mortality Weekly Report 2013;62(35):729-30. 8 New York City Youth Risk Behavior Survey 2011. Internal analysis of data. 9 DiFranza JR,Savageau JA,Aisquith BF.Youth access to tobacco:the effects of age,gender,vending machine locks,and"it's the law"programs.American Journal of Public Health 1996:86(2):221-4. 10 DiFranza J,and Coleman M(2001).Sources of tobacco for youths in communities with strong enforcement of youth access laws. Tob Ctrl 200 1;10:323-328. 11 Robinson,L.et al.(2006). Changes in adolescents' sources of cigarettes.JAdolesc Health 39:861-867. 12 New York City Department of Health and Mental Hygiene.Epiquiery:NYC Interactive Health Data System-New York City Youth Risk Behavior Survey 1997-2011.April 19,2013.http://nyc.gov/health/epiquery 13 DiFranza J,and Coleman M(2001).Sources of tobacco for youths in communities with strong enforcement of youth access laws. Tob Ctr12001;10:323-328. 14 Ahmad,S.(2005).Closing the youth access gap:The projected health benefits and cost savings of a national policy to raise the legal smoking age to 21 in the United States.Health Policy 75:74-84. 15 Fidler JA,West R.Changes in smoking prevalence in 16-17-year-old versus older adults following a rise in legal age of sale: findings from an English population study.Addiction 2010;105(11):1984-8. 16 NEllett C,Lee JT,Gibbons DC,Glantz SA.Increasing the age for the legal purchase of tobacco in England:impacts on socio- economic disparities in youth smoking.Thorax 2011;66(10):862-865. 17 Ahmad,S.(2005).Closing the youth access gap:The projected health benefits and cost savings of a national policy to raise the legal smoking age to 21 in the United States.Health Policy 75:74-84. 18 Ahmad, S.(2005).Closing the youth access gap:The projected health benefits and cost savings of a national policy to raise the legal smoking age to 21 in the United States.Health Policy 75:74-84. 19 http://www.needhamma.pov/documentcenter/view/4162 20 http://www.wnyc.org/articles/wnyc-news/2013/apr/23/nyc-looks-boston-suburb-idea-cigarette-sales/ 21 http://www.nileg.state.ni.us/2004/Bilis/PL05/384 .PDF 22 http•//wwA,nassaucountyny aov/website/GenericServices/docs/NlassauCountyAdminCode Dec2010,pdf 23 http://www.n sac.or2/1eilistative:action/documents/ProhibitiniaSaleofrobaccoProductsforAnyoneUnder19Onondaea.pdf 24 http://ecode360.com/14948475 2s NYC DOHMH Tobacco Behavior and Public Opinion Survey,2012. • it Municipal Tobacco Control Technical Assistance Program Donald J.Wilson,Director c/o Massachusetts Municipal Association (617)426-7272 One Winthrop Square FAX(617)695-1314 Boston,Massachusetts 02110 djwilson@mma.org LOCAL POLICIES ON INCREASING THE MINIMUM AGE RE: TOBACCO NEW EFFECTIVE POLICY MUNICIPALITY AGE DATE TYPE POPULATION 1. Needham 21 4/1/2005 health regulation 28,886 2. Brookline 19 6/1/2013 bylaw: AG-approved 58,732 3. Belmont 19 8/1/2012 health regulation 24,729 4. Watertown 19 12/1/2012 health regulation 31,915 5. Westwood 19 4/1/2013 health regulation 14,618 6. Sharon 21 5/19/2013 health regulation 17,612 7. Walpole 19 5/21/2013 health regulation 24,070 8. Arlington 21 7/1/2015 health regulation 42,844 9. Canton 21 1/1/2014 health regulation 21,561 10. Ashland 21 1/1/2014 health regulation 16,593 11. Sudbury 19 1/1/2014 health regulation 17,659 12. Dedham 21 1/1/2014 health regulation 24,729 13. Dover 21 1/4/2014 health regulation 5,589 14. Wellesley 21 6/1/2014 health regulation 27,982 15. Scituate 21 5/1/2014 health regulation 18,133 16. Hudson 21 7/1/2014 health regulation 19,063 17. Norwood 21 7/1/2014 health regulation 28,602 18. Winchester 21 7/1/2014 health regulation 21,374 19. Wakefield 21 7/1/2014 health regulation 24,932 20. Reading 21 7/1/2014 health regulation 24,747 21. NEWBURYPORT 19 7/1/2014 health regulation 17,416 22. Westford 21 6/1/2014 health regulation 21,951 23. MELROSE 21 7/1/2014 health regulation 26,983 24. Brimfield 21 TBD health regulation 3,609 25. Sherborn 21 TBD health regulation 4,119 Cities in Capital Letters POPULATION TO 19: 189,139 (7) POPULATION TO 21: 379,282 (18) POPULATION TOTAL: 564,302 NATIONAL POLICY WITH AGE 19: AK, AL, UT,NJ and 3 counties in New York State NATIONAL POLICY WITH AGE 21: New York City(effective date -mid-May 2014); Big Island in Hawaii 5/13/14 A Technical Assistance Project for cities and towns funded through a Massachusetts Department of Public Health grant to the Massachusetts Municipal Association. L • On Oct 28, 2013, at 5.13 PM, "Victoria Grimshaw" <vgrimsha health.nyc.gov<maiIto:vgrimsha ohealth.nyc.gov>> wrote: Dear Lester and Jonathan, I wanted to touch base with you on the status of NYC's tobacco control bills. As you may have read in the NY Times, our Product Display bill has been set aside until we better understand how e-cigarettes should be dealt with. The good news is the other two bills (Tobacco 21 and Sensible Tobacco Enforcement, which includes strong trafficking laws, a discount ban, a price floor for cigarettes and little cigars, and cigar packaging requirements) will be voted on this week. On Wednesday, October 30, the bills will come before City Council for a vote, and we feel optimistic about their chances of passing. These two laws will make an enormous impact on tobacco control in NYC, and that is thanks, in no small part, to your expertise and support. Your work, particularly on the issue of moving the sales age to 21, made an overwhelming case for the need for these laws in our city. It is a contribution that will benefit our city for many years to come. We are so grateful for your support and look forward to continuing to work together. • The NYT article is here: http://mobile.nytimes.com/2013/10/28/nyregion/ci y-drops-bid-to-ban-display-of- ciaarettes.htm I Thanks again, Victoria Grimshaw, MPH Senior Policy Analyst Bureau of Chronic Disease Prevention and Tobacco Control Gotham Center 42-09 28th Street, 10th Fl. CN-46 Long Island City, NY 11101-4132 347-396-4561 varimsha&health.nyc.gov<mai Ito:vgrimsha ohealth.nyc.aov> The information in this e-mail is intended only for the person to whom it is addressed. If you believe this e-mail was sent to you in error and the e-mail contains patient information, please contact the Partners Compliance HelpLine at ht :/-www.partners,org/complianceline . If the e-mail was sent to you in error but does not contain patient information, please contact the sender and properly idispose of the e-mail. I It has come to my attention that Salem's Board of Public Health is considering a proposal to raise the age of persons allowed to purchase functional glass art and/or vaporizers from 18 to 21 in the City of Salem. I am writing this letter to inform you not only is this motion discriminatory to Medical Cannabis Patients the Ages of 18, 19, and 20, it will also have unintended consequences to the patients of Essex County that will be using the new dispensary set to open in January of 2015. I believe the department needs to be considerate to the businesses that contribute to our city and serve over 15,000 patients in Essex County according to the Massachusetts Department of Public Health's estimate that 2%of the Commonwealth's population are medical cannabis patients. Patients ages 18, 19, and 20 with debilitating conditions such as intractable pain, epilepsy, multiple sclerosis, cancer, nausea from chemotherapy treatments and other chronic conditions will have to find another method to purchase medical devices other than using the services at the dispensary that we have sought to have open since the passing of the medical cannabis act in 2012. The Massachusetts Department of Public Health also requires by law that the dispensaries in Massachusetts must offer patients Vaporization Devices to purchase from which Salem, MA is not exempt from abiding. Please reconsider lumping medical instruments such as functional glass and vaporization devices into this ordinance as it has many unintended consequences. Cancer does not discriminate, why should we? Sincerely, Nichole Snow Dawson Nichole Snow Dawson Cell: 781.248.5792 3 L Salem Board of Health 978-741-1800 work 978-745-0343 fax • From: Beth Gerard [mai Ito:bethgerard.ward6Cagmail.com] Sent: Thursday, July 31, 2014 11:46 AM To: Niki Smokes Cc: Heather Lyons Subject: Re: Department of Public Health - Motion to raise the Age to purchase Medical Devices and Functional Glass Art Hi Nichole, Thank you very much for your letter. I am cc'ing Heather Lyons-Paul, the Clerk of the Board, so your letter may be read into the record if you are not able to make the next Board of Health meeting on August 7th at 7pm on the 3rd floor of 120 Washington Street. You bring up great points that that Board will review and will be incorporated into the discussion. My other questions that I think would be helpful to the Board would be: 1. What percentage of medical marijuana patients in Essex County use smoking products to administer their •medications? 2. What are the conditions that would trigger a prescription for smokeable medical marijuana rather than edibles and what percentage of medical marijuana patients have those conditions? 2. How many medical marijuana patients are there in Essex County that are under the age of 21? 3. What do medical marijuana patients who are under the age of 18 do if they are prescribed a smoking form of medical marijuana rather than edibles? How do they get access to their medication? I look forward to hearing from you and hope you can attend the meeting next Thursday. Beth Ward 6 Councillor Beth Gerard 49 Larchmont Road 978-219-7249 On Thu, Jul 31, 2014 at 11:08 AM, Niki Smokes <nikismokes@gmail.com>wrote: TO: Ward 6 Councillor and Department of Public Health Liaison Dear Beth Gerard, My name is Nichole Snow Dawson. I am a resident of Salem, MA and a Patient Advocate with Massachusetts •Patients Advocacy Alliance. I work for the acceptance of Medical Cannabis and Medical Cannabis Patients in Massachusetts. 2 To: Larry Ramdin, City of Salem Health Agent Salem Board of Health Chair,Dr. Barbara Poremba and Members: Dr. Shama Alam,Martin Fair,Dr. Danielle Ledoux, Gayle Sullivan From: Patrick and Patricia Scanlan,42 Dearborn St., Salem,MA Date: May 15,2014 We are aware that the Board of Health and other departments are preparing guidelines addressing the keeping of chickens in the City of Salem, and this item may be on the board agenda June 10, 2014 or a future meeting. Although we plan to attend the meeting on this topic to express our opposition to keeping of poultry or fowl in the city,we would like to convey our feelings in writing., Last fall,within days of new owners moving into the home next to ours on Dearborn Street, and prior to meeting these new neighbors, we noticed that a chicken coop had been erected to house several chickens close to our lot line in view of a rear bedroom window. After we expressed our displeasure to them,they relocated the chickens in • At that time when inquiring with city departments, we learned that there were no protections for homeowners encountering neighbors with chickens throughout the city. We were stunned that backyard chickens were becoming an accepted part of life in Salem with no enforcement of regulations for abutters or those with health and nuisance concerns. Because of our experience we are pleased that this issue is now being formally addressed and appreciate the efforts put forth by the Health, Planning and Zoning Boards in proposing regulations for those desiring chickens in their yards. We still maintain our strong opposition to backyard chickens in Salem where residents generally live in very close proximity to one another. It does not make common sense that neighborhoods in Salem, with limited yard space,would be allowed to have chickens. Chickens,poultry and foul present health issues such as odor,noise, and attraction of rodents,hawks and other dangerous wildlife. Whether the justification is that poultry are considered"pets"or"sources of food", we believe they belong on larger lots in farm districts. We enjoy seeing chickens on farms and appreciate them in an appropriate environment, but we feel maintaining chickens in an urban setting is inappropriate. Patrick Scanlan is a lifelong resident of Salem, and during our thirty-year marriage we have both lived in Salem. Twenty-two years ago we purchased our first and only home at 42 Dearborn Street. We take pride in our property and consider it one of the nicest areas of the city. We certainly would have been deterred from investing in a home here if we were aware chickens could be allowed for any purpose abutting our property. At the very least we would have considered this as an adverse impact in negotiating the purchase price. We believe approving chickens in backyards is not in the best interests of current and future homeowners and presents more problems to the complexities of ensuring health and quality of life in the City of Salem. Thank you for your consideration of our comments. Sincerely, �� -� Patrick Scanlan Patricia Scanlan 1 Municipal Tobacco Control Technical Assistance Program Donald J.Wilson,Director c/o Massachusetts Municipal Association (617)426-7272 One Winthrop Square FAX(617)695-1314 Boston,Massachusetts 02110 djwilson@mma.org I Iwwwlw� Iwwwwwlww� i LOCAL POLICIES ON INCREASING TIME MINIMUM AGE FOR TOBACCO SALES i a MUNICIPALITIES AND EFFECTIVE DATES WITH MLSA OF 21 1. Arlington 7/1/15 14. Newton 9/22/14 2. Ashland 1/1114 15. Norwood 7/1/14 3. Braintree 10/1/14 16. Reading 7/1/14 4, Brimfield 9/1/14 17, Scituate 5/1/14 5. Brookline AG OK needed 18. Sharon 5/19/I3 6. Canton 1/1/14 19. Sherborn TBD 7. Dedham 1/l/14 20. Stoneham 6/1/14 8. Dover 1/4/14 21, Wakefield 7/1114 9. Foxboro 8/1/14 22. Wellesley 6/1/14 10. Hudson 7/l/14 23. Westford 6/1/14 11. Malden 7/10/I4 24. Westwood 9/1/13 12, Melrose 7/1/14 25. Winchester 7/1/14 1 13. Needham 4/1/05 26. Yarmouth 7/l/14 1 MUNICIPALITIES AND EFFECTIVE DATES WITH MLSA OF 19 1. Belmont 8/1/12 4. Walpole 5/21/13 2. Newburyport 7/l/14 S. Watertown 12/1112 3. Sudbury 1/1/14 NOTES: Cities are in bold. All are health regulations except Brookline(town bylaw)and Newton(city ordinance). Arlington is raising their MLSA to 21 in a three-year, step-up process. POPULATION TO 19: 115,789(5) (1.8%of state's 6,547,629 residents) POPULATION TO 21: 695,067(26) (10.6% of state's 6,547,629 residents) POPULATION TOTAL: 810,856 NATIONAL POLICY WITH AGE 19: AK,AL,UT,NJ and 3 counties in New York State NATIONAL POLICY WITH AGE 21: NYC(eff. date—5/18/14);Big Island(HI) 7/8/l4 I4.1 .wwwlwl�wwwll�lww�^� U w II.wI11W A Technical Assistance Project for cities and towns funded through a Massachusetts Department of Public Health grant to the Massachusetts Municipal Association. Municipal Tobacco Control Technical Assistance Program Donald J. Wilson,Director c/o Massachusetts Municipal Association (617)426-7272 One Winthrop Square FAX(617)695-1314 Boston,Massachusetts 02110 djwilson(amma.org MUNICIPALITIES WITH MINIMUM PRI IlyG FOR CIGARS 1. Abington 21. Edgartown 41. Norwood 2. Acton 22. Falmouth 42. Orange** 3. Adams 23. Fitchburgs" 43, Oxford 4. Amherst 24. Franklin 44. Peabody 5. Arlington 25. Gill 45. Rochester 6. Ashland 26. Greenfield 46. Rockport 7. Athol 27. Hatfield 47, Salem 8. Bedford 28. Hubbardston** 48. Saugus 9. Beverly** 29, Hudson* 49. Scituate 10. Billerica 30. Lowell* 50. Seekonk 11, Bolton** 31. Malden 51. South Hadley 12. Boston 32. Marion 52, Sudbury 13. Braintree 33. Medford 53. Sunderland* 14. Brewster 34. Middleton 54. Townsend 15. Chelsea 35. Millbury 55. Westport j 16. Cohasset* 36. Montague 56.W.Boylston 17. Buckland 37. Needham 57. Westford** 18. Dedham 38, Newburyport 58. Whately - 19. Deerfield* 39. Newton*": 59. Westwood j 20. Easthampton 40. Northampton* 60. Yarmouth** I 29A% of state's population lives in lasted municipalities.(1,924,0%of 6,547,629 residents) NOTES: i (1) Cities in capital letters. First to enact: Boston on February 2,2012. (2) No asterisk: These municipalities require that single cigars be sold1or at least$250;two- packs for at least$5.00;three-packs for at least$7.50 and 4-packs,or larger,at market rate(no minimum). One asterisk(*): These municipalities require the same pricing policy above but four-packs(or larger packs)must be sold for at least$5.00 at retail. Two asterisks(**): These municipalities require single cigars be sold for at least$2.50 and that all multi-packs be sold for at least$5.00 at retail. (3) Definition: Cigar: Any roll of tobacco that is wrapped in leaf tobacco or in any substance containing tobacco with or without a tip or mouthpiece not otherwise defined as a cigarette under Massachusetts General Law,Ch.64C,Section 1,Paragraph 1. 7/8/14 A Technical Assistance Project for cities and towns funded through aMass.DPH grant to the MMA. _-- The NEW ENGLAND JOURNAL of MEDICINE Is It Time for a Tobacco-free Military? Elizabeth A. Smith, Ph.D., Sara A.jahnke, Ph.D.,Walker S.C. Poston, Ph.D., Larry N.Williams, D.D.S., Christopher K. Haddock, Ph.D., Steven A. Schroeder, M.D., and Ruth E. Malone, R.N., Ph.D. ecretary of the Navy Ray Mabus recently all- personnel must abide by regula- pounced that he wanted to end tobacco sales on tions in order to maintain disci- pline, fitness, and morale. Pro- all Navy installations. Secretary of Defense Chuck hibiting tobacco use would be Hagel, citing both financial costs and tobacco's entirely consistent with other re- quirements regarding weight, fit- harmful effects on readiness, many military personnel still use ness, and cardiovascular health. added that military tobacco poli- tobacco, and its use remains ac- Military personnel are some- cy in general should be reviewed, cepted, accommodated, and pro- times said to need tobacco for including the possibility of end- moted in the armed forces. Why? stress relief; however, tobacco ing tobacco sales and establishing One reason is that tobacco use users in the military report high- smoke-free military installations. for military personnel is still too er levels of stress than do nonus- Currently, a Department of De- frequently characterized as a right, ers,3 so perhaps the stress being fense review of the tobacco issue a necessity, or a benefit.Achieving relieved actually derives from nic- is under way, 5 years after the a tobacco-free military requires otine withdrawal. Most military Institute of Medicine called for a rethinking these perceptions and personnel are not tobacco users, tobacco-free military.1 unmasking the forces perpetuat and smoking prevalence is sub- Military personnel are required ing them. stantially lower among officers to pass fitness tests,undergo pe- The belief that members of the than in the civilian population riodic drug tests,and meet weight armed forces have a right to use —a fact that undermines the n- and body-composition standards tobacco is widespread.2 However, tion that military life somehow or face disciplinary action, includ- such a right has never been es- necessitates tobacco use. The ar- ing possible discharge.Yet despite tablished by the courts.The mili- gument that tobacco is a neces- the underlying expectations for tary frequently regulates the sale sity for military service members superlative fitness—and despite and use of legal products that it devalues their long-term quality the availability of state-of-the-art deems harmful to health, disci- of life and ignores the military's tobacco-cessation programs — pline, or public perception, and obligation to provide healthy, ef- N ENGLJ MED NEJM.ORG 1 The New England Journal of Medicine Downloaded from nejm.org at TUFTS UNIVERSITY on July 4,2014.For personal use only.No other uses without permission. Copyright©2014 Massachusetts Medical Society.All rights reserved, I_ PERSPECTIVE IS IT TIME FOR A TO BACCO-FREE MILITARY? fective means of stress relief to able income previously spent on to negatively affect the ability of service members. tobacco products would probably the military to recruit qualified The availability of convenient, be spent for other items. Numer- personnel. Because basic training cheap tobacco products is some- ous individual stores and some is tobacco-free now, recruits are times described as a benefit to large retail chains have stopped compelled to quit immediately on service members. Tobacco prices selling tobacco without long- enlistment.The current drawdown in military commissaries and ex- term financial damage. Surely a in military personnel means that changes are supposed to be set means can be found to subsidize recruitment standards are already within 5% of the lowest local Morale, Welfare, and Recreation becoming more stringent; being price. Recent studies, however, activities better than selling dead- tobacco-free could be among the have shown that this policy is fre- ly and addictive products to ser- new requirements.) Although ser- quently unenforced and that pric- vice members. vice members' breaks are offi- es can be as much as 73% lower Some observers may believe cially limited to two per day, than those at the local Walmart.4 that a tobacco-free military would many informants suggest that But we would argue that cheap to- be ideal but that trying to insti- smokers take breaks as frequently bacco is not a benefit unless dis- tute such a change might lead to as once per hour; eliminating ease and addiction are regarded problems with discipline, recruit- smoking breaks could increase as downstream benefits. ment, or retention. We believe efficiency and productivity. In Efforts to remove tobacco from these outcomes are unlikely,given combat zones,the light and odor military stores have been met with existing standards of military of a cigarette can give away troop the argument — stressed by the discipline. For example, the sub- locations.Tobacco use by military tobacco industry and its allies — marine fleet established a smoke- personnel is also associated with that such a policy would establish free policy in 2010 without nota- reduced physical fitness, increased a "slippery slope" ultimately lead- ble negative consequences. The risk of injury, retarded wound ing to the elimination of commis- Air Force has lower rates of healing, higher rates of mental saries. But many tobacco-control smoking than the civilian popu- health disorders, and greater fi- policies, such as clean-indoor-air lation; among officers, smoking nancial strain for junior enlisted laws and cigarette taxes,have been prevalence is in the single digits, personnel., similarly characterized as harbin- A plan for a tobacco-free military So why, given these arguments, gers of government intrusiveness that started in the Air Force could don't we already have a tobacco- that would lead to bans on dairy model norm change, gradually free military?The real reasons,we products,baked goods,and more, recharacterizing tobacco use as believe, are a lack of strong civil- yet none of these dire results "unmilitary." The current prac- ian advocacy, a powerful tobacco- have come to pass. In any case, tice of tobacco-free basic train- industry lobby, and congressional deciding to end sales of a.partic- ing also provides a starting point; representatives who continue to ularly harmful product is entirely preventing subsequent initiation protect industry profits at the different from deciding.to close or relapse, while offering cessa- expense of our service members' military stores. tion support to current smokers, health and the fitness of our Profits from exchanges sup- would be unlikely to cause dis- forces. port Morale, Welfare, and Recrea- ruption. Until recently, civilian tobacco- tion activities on military installa- Moreover, the argument that control advocates have been reluc- tions.The argument is sometimes banning tobacco use would be tant to take up the issue. Public made that eliminating tobacco excessively disruptive ignores the health leaders too frequently sub- sales at exchanges would reduce serious disruptions that tobacco scribe to the myths described funding for such activities. If to- use itself causes in the military, above.2 Historically, military bacco products were removed from Tobacco use is associated with tobacco-control efforts have been military stores without other pol- premature discharge during the halted repeatedly by tobacco- icy changes, it is possible that initial year of military service,' industry allies on the House and some financial loss would occur, which suggests that recruiting Senate Armed Services Commit- but if tobacco use by military per- only nonusers could increase re- tees.' Congressional interference sonnel were prohibited, dispos- tention. (Such a rule is unlikely has prevented the military from 2 N ENGLJ IVIED NE)M.ORG The New England Journal of Medicine Downloaded from nejm.org at TUFTS UNIVERSITY on July 4,2014.For personal use only.No other uses without permission. Copyright 0 2014 Massachusetts Medical Society.All rights reserved. PERSPECTIVE IS IT TIME FOR A TOBACCO-FREE MILITARY? acting at local command levels military as a whole. Military ser- western University College of Dental Medi- to address tobacco use. For ex- vice should not be a risk factor for cine,Downers Grove,IL(L.N.W.). ample, a smoke-free policy set at tobacco initiation: many young This article was published on July 2,2014,at an Army installation and a cam- people who join start to use tobac- NEJM.org. paign to motivate cessation at an co only after enlisting.We propose 1. Institute of Medicine.Combating tobacco Air Force Strategic Air Command that Congress quit doing the to- use in military and veteran populations.Wash- units were rescinded after tobacco- bacco industry's bidding,citizens ington,DC:National Academies Press,2009. 2. Smith EA,Malone RE.Military exception- industry allies in Congress inter- quit subsidizing cheap military alism or tobacco exceptionalism:how civil- vened. In fact, in response to the tobacco sales, and civilian public ian health leaders'beliefs may impede mili- latest announcement from the health organizations and mili- tary tobacco control efforts. Am J Public Health 2013;103:599-604. secretary of the Navy, the House tary supporters stand shoulder to 3. Stein RJ, Pyle SA, Haddock CK, Poston Armed Services Committee has shoulder with Secretaries Hagel WS,Bray R,Williams J.Reported stress and already included language in the and Mabus in moving toward a its relationship to tobacco use among U.S. e military personnel.Mil Med 2008;173:271-7. ill that stronger, healthier, tobacco-free r ML Poston Ws b dock CK H de new defense-authorizationg 4. Had y . could force the military to contin- U.S. military. Jahnke SA,Williams LN,Lando H.A longitu- ue cheap tobacco sales. As of late Disclosure forms provided by the au- dinal analysis of cigarette prices in military June, the language was not ln- [hors are available with the full text of this retail outlets. Am J Public Health 2014; article atNEJM.org. 104(4):e82-e87. cluded in the Senate bill. S. Arvey SR, Malone RE. Advance and re- Tobacco use harms military From the University of California,San Fran- treat:tobacco control policy in the U.S.mili- cisco, San Francisco (E.A.S., S.A.S., tary.Mil Med 2008;173:985-91. personnel, impairs readiness, and R.E.M.);the National Development and Re- incurs unnecessary costs to indi- search Institutes, Leawood, KS,and New DOI:10.1056/NEJMp1405976 vidual service members and the York (S.A.J., W.S.C.P., C.K.H.); and Mid- Copyright©2014 Massachusetts Medical Society. Flo N ENGLJ MED NEJM.ORG 3 The New England Journal of Medicine Downloaded from nejm.org at TUFTS UNIVERSITY on July 4,2014.For personal use only.No other uses without permission. Copyright©2014 Massachusetts Medical Society.All rights_reserved, -Hecsa New Eneand Convenience Store Association Testimony Submitted By: Stephen Ryan, Executive Director RE: Proposed Changes to Tobacco Regulations Salem Board of Health, Larry Ramdin Health Agent Town of Salem VIA EMAIL August 7, 2014 Dear Health Agent Ramdin, Chairman Poremba and Members of the Board of Health,thank you for allowing me to submit testimony regarding the proposal that would increase the legal age limit for purchasing tobacco products from 18 to 21. My name is Steve Ryan and I am the Executive Director of the New England Convenience Store Association. We represent convenience stores and fuel retailers throughout Salem. We wish to be recorded in respectful opposition to this proposal for a number of reasons. However well-intended the proponents of this proposal may be,tobacco is a legal product and one that is important to the economic viability of the convenience store industry in Salem. According to the National Association of Convenience Stores(NACS), tobacco product sales constitute over 30 percent of the average instore sales. We therefore ask that you consider the following information before making a decision that will significantly affect many small businesses in Salem: The data on compliance checks shows Salem retailers have an excellent record of compliance. It would seem that the underlying argument made by some of the proponents;of increased age restrictions and cigar pack restrictions is that cigarettes are being sold to minors. The data from the Federal Food and Drug Administration regarding cigarette compliance checks by the FDA shows that. with 178 checks done over the last 2+ years,the stores in Salem have achieved a 100%compliance rate. This data supports that retailers in Salem are committed to selling all of their products in a responsible manner. Raising the minimum age will simply send customers to stores in neighboring towns. If the ordinance is passed, then the affected adult customers will be free to go to any one of the many contiguous communities and legally purchase any tobacco product or they may order them over the Internet. In addition to being old enough to vote, serve in the military and marry, they are also old enough to drive and also purchase gasoline, beverages,and food. Therefore, if the minimum age is increased,then overall related sales will suffer along with our tobacco sales because these customers will simply head to any one of the dozens of nearby stores that are not in Salem to make their purchases. This will hurt local businesses by placing them at a competitive disadvantage:with neighboring retailers. Allow FDA to Finalize Study on the Health Impact of Raising the Legal Age. Finally, in August of 2013,the U.S. Food and Drug Administration's Center for Tobacco Products contracted with the Institute of Medicine to establish an ad hoc committee of public health, medical and other experts to conduct a study on the public health impact of raising the minimum age of purchasing tobacco products. The Institute of Medicine's study report is due to be submitted to the FDA in 2015. Information on the study is attached can be tound'hefe: http://www8.nationalacademies org/co/i)roiectviewasox?key=49594 For the foregoing reasons, we urge you not to raise the minimum age to purchase tobacco. Thank you for your consideration of our concerns. 1044 Central r tra Street Suite 203 Stoughton, MA 02072 Phone:781-297-9600^'F -Fax:781 297-9601 Print Preview http://www8.nationalacademies.orWcp/printpreview.aspx Print Close Pr oject Information Project Title: Health Implications of Raising the Committee Membership Minimum Age for Purchasing Tobacco Committee Membership Products PIN: IOM-BPH-13-02 Meetings 7 Meeting 1 -02/04/2014 Major Unit: Institute of Medicine Meeting 2-04/10/2014 } Meeting 3-06/04/2014 Sub Unit: Board on Population Health and Public } Meeting 4-07/22/2014 Health Practice Reports RSO: Stratton,Kathleen Reports having no URL can be seen at the Public Access Records Office SubjectlFocus Area: Health and Medicine Project Scope The Institute of Medicine(IOM)will establish an ad hoc committee of public health,medical and other experts to conduct a study and prepare a report to be issued to the Food and Drug Administration (FDA)/Center for Tobacco Products(CTP)on the likely public health impact of raising the minimum age for purchasing tobacco;products. The CTP will use the study report as a basis for creating Its own report to Congress. The IOM committee will undertake the following tasks: 1.)Examine existing literature on tobacco use initiation and; 2.)Use modeling and other methods,as appropriate,to predict the likely public health outcomes of raising the minimum age for purchase of tobacco products to 21 years and 25 years. The project is sponsored by the U.S. Food and Drug Administration (FDA). The approximate start date of this project is August 1,2013. A Final Report will be issued at the end of the project in approximately 18 months. Project Duration: 18 months Provide FEEDBACK on this project. Contact the Public Access Records Office to make an inquiry, request a list of the public access file materials,or obtain a copy of the materials found in the file. I of 1 8/7/2014 4:39 PM Dear Members of the Board, I understand and empathize with the desire to reduce smoking-both of adults and of underage smokers. I think reducing smoking rates is laudable. I don't think, however,that raising the age for tobacco purchases to 21 is ultimately an effective way of doing that. Given that the legal age for the possession and use of tobacco remains 18, I believe all we are doing is applying an additional burden to Salem businesses that sell tobacco and tobacco products.Were there a state-wide initiative to make the age for tobacco use higher, I'd likely be more supportive towards this measure before you. I think there are better ways to reduce tobacco use and presence in the city that the Board would be better-served in considering. Requiring the use of cigarette disposal poles and making sure that their use is enforced (most businesses already do have them) at bars. Banning tobacco use in some or all of our city parks.These would have more value in my eyes than a measure that simply makes a minor change at best to buying habits. Salem was a public health leader when we banned tobacco use in restaurants and bars.That was a wonderful accomplishment that improved the city for virtually all and set a path that most communities now follow. I believe this measure before you, however, does not have a comparable impact since it does not really affect the smokers themselves-it simply makes it more difficult for the businesses that legally sell tobacco to remain good citizens. Thank you for your consideration. Josh Turiel, Councillor Ward 5 City of Salem