Raise the Tobacco Sales Age to 21. Raise a Tobacco-Free Generation

Will County Health Department

TOBACCO 21 Raise the tobacco sales age to 21. Raise a tobacco-free generation.

VISIT WWW.WILLCOUNTYHEALTH.ORG OR CALL (815)-727-8769 TO LEARN MORE ABOUT TOBACCO 21. This toolkit is designed for Will County Policy Makers and Municipalities who are looking to implement a Tobacco 21 policy. This toolkit offers suggestions and resources to assist with the development of a Tobacco 21 ordinance. This toolkit is intended to provide guidance for policy makers and municipalities who wish to protect the health and safety of our youth through the implementation of a Tobacco 21 policy. All legal questions or advice should be reviewed and answered by your attorney. This information is not legal advice and should not be treated as such. The Will County Health Department Tobacco Control & Prevention program is not responsible for providing any legal advice or documents. TABLE OF CONTENTS

TOBACCO 21 INFOGRAPHIC……………………………………………………………………………………………………… 3

WILL COUNTY BOARD OF HEALTH RESOLUTION…………………………………………………………………… 5

TOBACCO 21 FACTSHEETS………………………………………………………………………………………………………… 7

NATIONWIDE TREND

WILL COUNTY POLICY MAP………………………………………………………………………………………………………….. 11

STATES AND LOCALITIES THAT HAVE PASSED T21………………………………………………………………………… 13

HEALTHY TOWNS, HEALTHY KIDS……………..…………………………………….….……………………………..………… 17

CREATING POLICIES/ORDINANCES

MAYWOOD, IL T21 ORDINANCE…………………………………………………………………………………………………… 23

EXAMPLE DEFINITION OF ELECTRONIC CIGARETTE………………………………………………………………………. 29

GENERAL SAMPLE ORDINANCE……………………………………………………………………………………………………. 30

TOBACCO 21 raises the legal age to purchase tobacco products- including e-cigarettes, hookah, etc. from 18 to 21

of smokers start 95% before age 21

41%

of Will County high school seniors used any tobacco products in the Smoking causes last 30 days (IYS, 2018) deaths 1 in 5 TEENAGE YEARS ARE A CRITICAL TIME FOR TOBACCO PREVENTION

QUALITY ECONOMIC OF LIFE? IMPACT

1 in 13 Economists project that Americans age 17 or nationally, Tobacco 21 younger will die early from a could save smoking-related illness $212 BILLION unless we do something to in medical costs reduce their tobacco rates Each year, tobacco use costs 230,000 Illinois- Illinois teens alive today will die $5.49 BILLION prematurely from smoking in healthcare costs Really?? $5.27 BILLION "Today's teenager is in lost productivity tomorrow's potential regular customer, and the overwhelming majority of smokers first begin to smoke Philip Morris while still in their teens..." Executive (1981) T21 WILL SAVE LIVES TOBACCO 21 is being adopted by hundreds of communities and will ultimately save billions in healthcare costs, save lives, and immediately improve community health.

Page 3 Developedwith funds paid for by the Illinois Department of Public Health Page 4 Page 5 Page 6 Tobacco 21 – Raising the Minimum Legal Sales Age to Prevent Youth Tobacco Use Initiation Every year tobacco use COSTS Illinois nearly $2 BILLION in Medicaid spending

Health Impact:  March 2015, Institute of Medicine study estimates that Tobacco 21 would reduce smoking among 15-17 year olds by 25% and among 18-20 year olds by 15%  Preventing smoking before age 18 means fewer long-term smokers, reducing the overall smoking rates by an estimated 12%  Young people’s brains are particularly susceptible to nicotine addiction while they’re still maturing neurologically.  480,000 annual premature deaths in US are caused by tobacco use. 18,300 in Illinois alone.  Tobacco use causes more premature deaths than AIDS, auto crashes, homicides, alcohol use, illegal drug use, suicides and fires COMBINED. Economic Consequences to Illinois:

 Annual health care costs in Illinois directly caused by smoking = $5.49 Billion  Portion covered by state Medicaid program = $2 Billion  Illinois residents’ state & federal tax burden from smoking-caused government expenditures = $982 per household  Smoking-caused productivity losses in Illinois = $5.27 Billion  Each pack of cigarettes consumed costs our society $18.05 in increased health care and work related expenditures.

The primary cigarette source for underage smokers is their 18 to 20 year old peers.

 Increasing the legal age of sale would virtually eliminate the ability for high school students to purchase tobacco products and share those products with younger kids. Why now?

 After a decade of consistent decreases in tobacco use by teenagers, the National Youth Tobacco Survey reports that in 2014 overall use of tobacco among youth rose, exposing dangerous new trends.  Increased marketing by the tobacco industry of alternative products, such as small cigars, hookahs, and flavored e-cigarettes has put millions of young people at risk of lifelong deadly nicotine addiction.

National Support for Tobacco 21:

 A July 2015 CDC study found 75% of U.S. adults, including 70% of current smokers support Tobacco 21.

For more information, please contact Kathy Drea at (217)971-7274 or [email protected] or contact Shana Harrison at (309)645-6909 or [email protected] Page 7 Nationwide momentum: (As of July 2016)

 170 cities in 13 states, plus the states of Hawaii and California have passed Tobacco 21 legislation.  Locally: the City of Evanston, the City of Chicago and Oak Park already have a Tobacco 21 ordinance in place. (**Please see later pages in this toolkit for more updated information regarding this section)

E-cigarettes:

 While youth cigarette smoking in our community and across the country is slowly declining, e- cigarette use among youth has more than doubled in recent years.

 The health consequences of the use of e-cigarettes and exposure to secondhand e-cigarette emissions are unknown. There is currently no scientific evidence establishing the safety of e- cigarettes.  E-cigarette marketing mirrors strategies used by cigarette companies in the past, which they are no longer allowed to use because they appeal to youth.  E-cigarettes produce an aerosol that has nicotine, harmful chemicals, and toxins known to cause cancer among other things.  E-cigarettes are NOT approved by the US FDA to help people quit smoking. Scientific studies are mixed on whether e-cigarettes help people quit using tobacco and nicotine. The argument: If you can go to war and bear arms at 18 you should have the right to smoke.

 The Department of Defense (DoD) has a goal for tobacco-free installations (bases, posts, etc.) by 2020. The joint military base in Hawaii is complying with the state Tobacco 21 law.  The U.S. Army, the Department of the Navy and the Marine Corps have each announced their support of Hawaii's new law (source article here: http://www.huffingtonpost.com/entry/hawaii- becomes-first-state-raise-smoking-age-to-21_us_568577d5e4b0b958f65ba00b)  Legal age to purchase and consume alcohol on U.S. installations (bases, posts, etc.) is 21. Other age restrictions:

 Illinois current law requires 21 years of age to buy alcohol, gamble in a casino, to obtain an Illinois Concealed Carry License. In addition, there are age restriction polices to rent cars and hotel rooms.

A similar strategy was highly successful in addressing alcohol related problems.

 A national age 21 law for alcohol sales resulted in reduced alcohol consumption among youth, decreased alcohol dependence and has led to a dramatic reduction in drunk driving fatalities.

For more information, please contact Kathy Drea at (217)971-7274 or [email protected] or contact Shana Harrison at (309)645-6909 or [email protected] Page 8 FACT SHEET TOBACCO 21 lungchicago.org TOBACCO 21 The initiative to raise the tobacco purchase age from 18 to 21

Current tobacco use trends are driving new prevention strategies • In Illinois, 6,300 teens become new daily smokers each year.1 In suburban Cook County, 29 percent of high school seniors use tobacco products.2 • While great strides have been made in tobacco prevention, declines in tobacco use rates have slowed and products like cigarillos, hookah, and e-cigarettes are now used at double the rate of cigarettes.2 • Reducing teens’ access to tobacco products is a proven means to reduce current use and prevent initiation.

The age of 21 is important for prevention • 95 percent of smokers start before the age of 21.3 • The majority of underage tobacco users get their tobacco from a peer; however, 90 percent of those suppliers are themselves often under the age of 21.4 • Drawing the line at 21 gets legal tobacco purchasers out of high schoolers’ social circles. Tobacco 21 saves lives and improves health • The Institute of Medicine (IOM) projects that Tobacco 21 could reduce overall smoking by 12 percent by the time today’s teenagers become adults; the biggest declines in tobacco use would be seen among 15-17 year olds (25%) and 18-20 year olds (15%).5 • Tobacco 21 would immediately improve community health by reducing inflammation, improving immune function, and reducing premature births and SIDS. • Based on the IOM report, Tobacco 21 in Illinois would save more than 8,000 lives. The economic impact of Tobacco 21 • Economists project that nationally, Tobacco 21 could save $212 billion in medical costs.6 • Each year, tobacco use costs Illinois $5.49 billion in health care costs and $5.27 billion in lost productivity.1 • The impact of Tobacco 21 on retail sales would be minimal since the 18-21 year old age group only accounts for 2 percent of overall tobacco sales.7 • Applying tobacco economic data to IOM’s projected declines in tobacco use resulting from Tobacco 21, Illinois would save more than $2+ billion dollars in future healthcare costs. This doesn’t even include savings in lost productivity costs, which could be nearly as much.11 Tobacco 21 enjoys broad support across Illinois and the U.S., even from smokers! • A 2015 CDC study found that 75 percent of adults support Tobacco 21, including 70 percent of current smokers.8 A recent study also found that 68 percent of 18-24 year olds would support Tobacco 21.9 • More than 300 cities nationally and five states (HI, CA, OR, NJ, ME) have enacted Tobacco 21.10 • In Illinois, Tobacco 21 has already been adopted by Evanston, Chicago, Oak Park, Highland Park, Naperville, Deerfield, Maywood, Lincolnshire, Vernon Hills, Berwyn, Buffalo Grove, Elk Grove Village, Mundelein, Lake County, and Bolingbrook, and is being considered by dozens more communities.

CITATIONS 1 Campaign for Tobacco-free Kids. (2017). The Toll of Tobacco in Illinois. Available at http://www.tobaccofreekids.org/facts_issues/toll_us/illinois. 2 University of Illinois, Center for Prevention Research & Development. (2016). Illinois Youth Survey. Available at https://iys.cprd.illinois.edu/. 3 Centers for Disease Control and Prevention. (2014). Youth and Tobacco Use [fact sheet]. Available at http://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/. 4 Berman, M., Crane, R., Hemmerich, N. (2015). Running the Numbers – Raising the minimum tobacco sales age to 21 will reduce tobacco use and improve public health in Franklin County, Ohio. The Ohio State University, College of Public Health, Columbus, OH. 5 Institute of Medicine of the National Academies. (2015) Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products. Available at www.iom.edu/tobaccominimumage. 6 Counter Tobacco. (2015). Raising the Minimum Legal Sale Age to 21 [fact sheet]. Available at www.countertobacco.org/raising-minimum-legal-sale-age-21. 7 Winickoff, J.P., Hartman, L., Chen, M.L., Gottlieb, M., Nabi, E., DiFranza, J. (2014). Minimum Retail Impact of Raising Tobacco Sales Age to 21. Am J Pub Health, 104(11): e18-e21. 8 King, B.A., Jama, A.O., Marynak, K.L., Promoff, G.R. (2015). Attitudes toward raising the minimum age of sale for tobacco among U.S. adults. Am J Prev Med, 49(4):583-588. 9 Morain, S.R., Winickoff, J.P., Mello, M.M. (2016). Have Tobacco 21 Laws Come of Age? N Engl J Med, 374: 1601-1604. 10 Campaign for Tobacco-free Kids. (2017). States and Localities that have Raised the Minimum Legal Sale Age for Tobacco Products to 21. Available at http://www.tobaccofreekids.org/content/what_we_do/state_local_ issues/sales_21/states_localities_MLSA_21.pdf. 11 Campaign for Tobacco-free Kids. (2017). Comprehensive Statewide Tobacco Prevention Programs Save Money. Retrieved from https://www.tobaccofreekids.org/assets/factsheets/0168.pdf. Page 9 Page 10 NAPERVILLE WOODRIDGE Will County Home Rule Municipalities AURORA BOLINGBROOK with Tobacco 21

ROMEOVILLE

PLAINFIELD HOMER GLEN

LOCKPORT Municipalities with Tobacco 21 CREST HILL JOLIET

ORLAND PARK YES TINLEY PARK MOKENA JOLIET NO SHOREWOOD NEW LENOX NON-HOME RULE ROCKDALE FRANKFORT

PARK FOREST MINOOKA SAUK VILLAGE STEGER UNIVERSITY PARK CHANNAHON MANHATTAN ELWOOD CRETE MONEE

WILMINGTON BEECHER

SYMERTON PEOTONE

COAL CITY DIAMOND

BRAIDWOOD

GODLEY

0 2.5 5 10 Miles BRACEVILLE [ *Data current as of April 2018

Page 11 Page 12 STATES AND LOCALITIES THAT HAVE RAISED THE MINIMUM LEGAL SALE AGE FOR TOBACCO PRODUCTS TO 21

As of January 8, 2019, six states – California, New Jersey, Massachusetts, Oregon, Hawaii and Maine – have raised the tobacco age to 21, along with at least 430 localities, including New York City, Chicago, San Antonio, Boston, Cleveland, Minneapolis, both Kansas Cities and Washington, DC. Some of the localities are in states that subsequently enacted statewide laws.

States Hawaii (effective 1/1/16) California (effective 6/9/16) New Jersey (effective 11/1/17) Oregon (effective 1/1/18) Maine (effective 7/1/18) Massachusetts (effective 12/31/18)

Localities Connecticut (1) Illinois (cont’d) Alaska (1) 1. Hartford 30. Wilmette 1. Sitka Hawaii (1) Kansas (22) Arizona (2) 1. Hawaii County 1. Bonner Springs 1. Cottonwood 2. Douglas County2 2. Douglas Illinois (30) 3. Garden City 1. Arlington Heights Arkansas (3) 4. Holcomb 2. Aurora 5. Iola 1. Harrison 3. Barrington 2 2. Helena/West Helena 6. Johnson County 4. Berwyn 7. Kansas City/Wyandotte Cty 3. Phillips County 5. Bolingbrook 8. Lansing 6. Buffalo Grove 1 9. Leavenworth California (16) 7. Chicago 1. Arvin 10. Leawood 8. Deerfield 11. Lenexa 2. Elk Grove 9. Elgin 3. Fairfax 12. Merriam 10. Elk Grove 13. Mission Hills 4. Healdsburg 11. Evanston 5. Kern County 14. Olathe 12. Glen Ellyn 15. Overland Park 6. Los Gatos 13. Gurnee 7. Novato 16. Parsons 14. Highland Park 17. Prairie Village 8. Palo Alto 15. Hopkins Park 9. San Francisco City/Ctny 2 18. Roeland Park 16. Lake County 19. Shawnee County2 10. Santa Clara County 17. Lake Zurich 11. Santa Cruz County 20. Topeka3 18. Lincolnshire 21. Westwood Hills 12. Saratoga 19. Maywood 22. Westwood 13. Scotts Valley 20. Mundelein 14. Sonoma County 21. Naperville Maine (1) 15. South El Monte 22. Normal 16. South Pasadena 1. Portland 23. Oak Park 4 Colorado (4) 24. Peoria Massachusetts (231) 1. Aspen 25. Riverwoods 1. Acton 2. Avon 26. Skokie 2. Acushnet 3. Basalt 27. Vernon Hills 3. Adams 4. Carbondale 28. Washington 4. Agawam 29. Wheaton 5. Amesbury 6. Amherst

Page 13 Massachusetts (cont’d) Massachusetts (cont’d) Massachusetts (cont’d) 7. Andover 62. Essex 117. Marshfield 8. Arlington 63. Everett 118. Mashpee 9. Ashburnham 64. Fall River 119. Maynard 10. Ashby 65. Falmouth 120. Medfield 11. Ashland 66. Fitchburg 121. Medford 12. Athol 67. Foxboro 122. Medway 13. Attleboro 68. Framingham 123. Melrose 14. Avon 69. Franklin 124. Mendon 15. Ayer 70. Georgetown 125. Methuen 16. Barnstable 71. Gill 126. Middleton 17. Bedford 72. Gloucester 127. Milford 18. Belchertown 73. Grafton 128. Millbury 19. Bellingham 74. Great Barrington 129. Millis 20. Belmont 75. Greenfield 130. Milton 21. Beverly 76. Groton 131. Montague 22. Billerica 77. Hadley 132. Nantucket 23. Blackstone 78. Halifax 133. Natick 24. Bolton 79. Hamilton 134. Needham 25. Boston 80. Hanover 135. New Bedford 26. Bourne 81. Harvard 136. Newton 27. Braintree 82. Harwich 137. Norfolk 28. Brewster 83. Hatfield 138. North Adams 29. Bridgewater 84. Haverhill 139. North Andover 30. Brimfield 85. Hingham 140. North Attleboro 31. Brockton 86. Hinsdale 141. Northborough 32. Brookline 87. Holbrook 142. Northbridge 33. Buckland 88. Holden 143. Northampton 34. Burlington 89. Holliston 144. North Reading 35. Cambridge 90. Holyoke 145. Norton 36. Canton 91. Hopedale 146. Norwell 37. Carver 92. Hopkinton 147. Norwood 38. Charlemont 93. Hudson 148. Oak Bluffs 39. Chatham 94. Hull 149. Orange 40. Chelmsford 95. Ipswich 150. Orleans 41. Chelsea 96. Kingston 151. Otis 42. Chicopee 97. Lancaster 152. Oxford 43. Chilmark 98. Lanesborough 153. Palmer 44. Clinton 99. Lawrence 154. Peabody 45. Cohasset 100. Lee 155. Pembroke 46. Concord 101. Lenox 156. Pittsfield 47. Conway 102. Leominster 157. Plainville 48. Danvers 103. Leverett 158. Plymouth 49. Dartmouth 104. Lexington 159. Provincetown 50. Dedham 105. Lincoln 160. Quincy 51. Deerfield 106. Littleton 161. Randolph 52. Dighton 107. Longmeadow 162. Raynham 53. Dover 108. Lowell 163. Reading 54. Dracut 109. Ludlow 164. Revere 55. Duxbury 110. Lynn 165. Rockland 56. East Longmeadow 111. Lynnfield 166. Rockport 57. Eastham 112. Malden 167. Rowley 58. Easthampton 113. Mansfield 168. Rutland 59. Easton 114. Marblehead 169. Salem 60. Edgartown 115. Marion 170. Salisbury 61. Egremont 116. Marlborough 171. Saugus

Page 14 Massachusetts (cont’d) Massachusetts (cont’d) New Hampshire (2) 172. Scituate 227. Winchester 1. Dover 173. Sharon 228. Winthrop 2. Keene 174. Sheffield 229. Woburn 175. Shelburne 230. Worcester New Jersey (28) 176. Sherborn 231. Yarmouth 1. Belleville 177. Shrewsbury 2. Bergenfield 178. Somerville Michigan (2) 3. Bloomingdale 179. South Hadley 1. Ann Arbor 4. Bogota 180. Southampton 2. Genesee County3 5. Bradley Beach 181. Southborough 6. Cedar Grove 182. Southbridge Minnesota (21) 7. East Orange 183. Southwick 1. Bloomington 8. East Rutherford 184. Spencer 2. Brooklyn Center 9. Englewood 185. Springfield 3. Eden Prairie 10. Fairlawn 186. Stockbridge 4. Edina 11. Garfield 187. Stoneham 5. Excelsior 12. Haledon 188. Stoughton 6. Falcon Heights 13. Hanover 189. Stow 7. Hermantown 14. Highland Park 190. Sturbridge 8. Lauderdale 15. Maplewood 191. Sudbury 9. Mendota Heights 16. Oradell 192. Sunderland 10. Minneapolis 17. Paterson 193. Sutton 11. Minnetonka 18. Princeton 194. Swampscott 12. North Mankato 19. Raritan 195. Swansea 13. Otter Tail County 20. Rutherford 196. Taunton 14. Plymouth 21. Sayreville 197. Templeton 15. Pope County 22. Teaneck 198. Tewksbury 16. Richfield 23. Tenafly 199. Tisbury 17. Roseville 24. Trenton 200. Topsfield 18. Shoreview 25. Union City 201. Townsend 19. St. Louis Park 26. West Orange 202. Tyngsboro 20. St. Peter 27. Westwood 203. Uxbridge 21. Waseca 28. Wyckoff

204. Wakefield Mississippi (1) 205. Walpole 2 New York (25) 1. Adams County 1. Albany County 206. Waltham 207. Wareham Missouri (17) 2. Baxter Estates 208. Watertown 1. Columbia 3. Cattaraugus County 209. Wayland 2. Crestwood 4. Chautauqua County 210. Wellesley 3. Des Peres 5. Cortland County 211. Wellfleet 4. Excelsior Springs 6. Essex County 212. Westboro 5. Gladstone 7. Great Neck Plaza 213. West Boylston 6. Grandview 8. Hempstead 214. Westfield 7. Independence 9. Long Beach 215. Westford 8. Jackson County2 10. Nassau County 216. Weston 9. Jefferson City 11. New Castle 217. Westport 10. Kansas City 12. New York City 218. West Tisbury 11. Lee’s Summit 13. North Hempstead 219. Westwood 12. Liberty 14. Onondaga County 220. Weymouth 13. Parkville 15. Orange County 221. Whately 14. Peculiar 16. Port Washington North 222. Whitman 15. Raymore 17. Putnam County 223. Wilbraham 16. St. Louis City 18. Rockland County 224. Williamstown 17. St. Louis County 19. Schenectady County 225. Wilmington 20. Suffolk County 226. Winchendon 21. Sullivan County

Page 15 New York (cont’d) 22. Tompkins County 23. Ulster County 24. Westchester County 25. Williston Park

Ohio (20) 1. Akron 2. Bexley 3. Cincinnati 4. Cleveland 5. Cleveland Heights 6. Columbus 7. Dublin 8. Euclid 9. Grandview Heights 10. Green 11. Kent 12. Mogadore 13. New Albany 14. Norton 15. Powell 16. Richfield 17. Twinsburg 18. Upper Arlington 19. Wickliffe 20. Worthington

Oregon (1) 1. Lane County

Rhode Island (2) 1. Barrington3 2. Central Falls

Texas (1) 1. San Antonio

Washington, DC

1CA localities courtesy of ANR 2 Only applies to unincorporated areas of the County 3Challenged in court 4 MA localities courtesy of the Municipal Tobacco Control Technical Assistance Program

Page 16 TOBACCO21

Page 17 Just 2% of tobacco sales help produce 90% of new smokers. Cigarette sales to those under 21 account for only 2.12% of total sales. But, because 90% of smokers start by the age of 21, these are the very sales that help lead to 9 out of every 10 new smokers. This means that the impact on 1

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%).

This strategy is already working.

In 2005, Needham, MA voted to raise and enforce theminimum tobacco sales age of 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

Many people who purchase for distribution to minors are between the ages of 18 and 20.5

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.6,7 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

2 1This 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. 3 CDC. Morbidity and Mortality Weekly Report. “Current Cigarette Smoking. Among Adults — United States, 2011.” November 9, 2012. 61(44);889-894.

5 4 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. 6 Wagenaar 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. 7 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.

8 NHTSA’s National Center for Statistics and Analysis, March 2005. Washington, DC, U.S., DOT. Page 18 Nearly 90% of smokers started smoking by age 20.1

mature and neurobiologically mature.2

vulnerable.2

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 26.2

.4 ,5 The tobacco industry knew all of this as early is 1986

“Raising the legal minimum age for cigarette purchaser to 21 could gut our key young adult market...” -Philip Morris report, January 21, 19866

Brain health is public health

1 SAMHSA. Calculated based on the data in the 2011 National Survey on Drug Use and Health. 2 The Surgeon General Report. 2012. “Preventing Youth Tobacco Use.” http://www.surgeongeneral.gov/library/reports/preventing-youth-tobacco-use/factsheet.html. 3 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 5U.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.

Smoking and Health, 2014. 6Philip Morris Discussion Draft of Sociopolitical Strategy http://legacy.library.ucsf.edu/tid/aba84e00/pdf Page 19 T21

Big tobacco (RJR and Philip Morris USA) have been working through the retailers. The arguments you may hear:

We will go out of business.

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.1

Tobacco sales to 18-20 year olds are only 2% of retail tobacco sales.2

CVS and Target have decided to stop selling all tobacco products, leaving more tobacco business for convenience stores. We make our pro!ts from the ancillary purchases (milk and bread) when people come in to buy cigarettes.

98% of tobacco sales and all associated ancillary purchases will be una!ected.2

18-20 year olds will have more money for other in-store purchases that are not tobacco.

They will just go to other 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.3 Research has shown a minimal retail impact of raising the sales age to 21.2 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.4,5 We want this to go to the state legislature to make it a level playing !eld.

The banning of tobacco in bars and restaurants was won on the local level "rst before it went to the state. This is a ploy by the Tobacco Industry. When Utah’s Senator Reid was asked why Tobacco21 didn’t pass at the state level, he explained it to us in three words: “The Tobacco Lobby.”

1 Hahn, EJ, “Smokefree Legislation: A Review of Health and Economic Outcomes Research,” American Journal of Preventive Medicine 39(6S1):S66-S76, 2010. 2 Winicko! 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 2 3 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, O"ce on Smoking and Health, 2014. 4Scully M, Mcarthy M, Zacher M, Warne C, Wake#eld M, White V. 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. 5Henriksen L, Feighery EC, Schleicher NC, Cowling DW, Kline RS, Fortmann SP. 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. Page 20 T21

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 signi!cant climb. Raising the sales age back to 21 caused the death rate to drop signi!cantly.1

Casino gambling Get a ‘license to carry ‘ gun permit. Rent a car (must be age 25 - crash rates don’t drop signi!cantly 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 bene!ciaries, 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

1 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 pg108-115 2 http://www.army.mil/standto/archive/issue.php?issue=2012-11-20 3 A Study of Cancer in the Military Bene!ciary 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 4http://www.iom.edu/~/media/Files/Report%20Files/2009/MilitarySmokingCessation/Combating%20Tobacco%20Military%20for%20web.pdf Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Example Definition of Electronic Cigarettes

Definition written by the Illinois Attorney General’s Office in 2018

"Electronic cigarette" means: (1) any device that employs a battery or other mechanism to heat a solution or substance to produce a vapor or aerosol intended for inhalation; (2) any cartridge or container of a solution or substance intended to be used with or in the device or to refill the device; or (3) any solution or substance, whether or not it contains nicotine intended for use in the device. "Electronic cigarette" includes, but is not limited to, any electronic nicotine delivery system, electronic cigar, electronic cigarillo, electronic pipe, electronic hookah, vape pen, or similar product or device, and any components or parts that can be used to build the product or device.

"Electronic cigarette" does not include: cigarettes as defined in Section 1 of the Cigarette Tax Act and tobacco products as defined in Section 10-5 of the Tobacco Products Tax Act of 1995; tobacco product and alternative nicotine product as defined in this Section; any product approved by the United States Food and Drug Administration for sale as a tobacco cessation product, as a tobacco dependence product, or for other medical purposes, and is being marketed and sold solely for that approved purpose; any asthma inhaler prescribed by a physician for that condition and is being marketed and sold solely for that approved purpose; or any therapeutic product approved for use under the Compassionate Use of Medical Cannabis Pilot Program Act.

Page 29 Sample Ordinance Creating a Minimum Legal Sales Age of 21 for Tobacco Products

Tobacco products kill half a million Americans each year. Youth access to tobacco products compounds this problem because young people exposed to nicotine are particularly likely to become lifelong users. In 1992, Congress took a step to address this issue with the Synar Amendment, which penalizes states that do not effectively prohibit the distribution of tobacco products to minors. Recently, many communities, including the state of Hawaii, have gone even further to restrict youth access by raising the minimum legal sales age (“MLSA”), prohibiting the sale of tobacco products to people under the age of 21. A large majority of Americans supports raising the MLSA for tobacco products to 21, and evidence suggests that doing so will lower smoking rates while only minimally impacting retail tobacco sales.

A strong tobacco MLSA 21 ordinance would contain the following:

ü A definition of tobacco products that includes current and future tobacco products; ü A prohibition on the distribution of tobacco products to recipients under the age of 21; ü A requirement that tobacco retailers post notices stating that no person under the age of 21 may purchase tobacco products; and ü Authority for the county or municipality to inspect distributors for compliance.

The Tobacco Control Legal Consortium has created the following sample ordinance to assist counties and municipalities that are considering a measure to raise the minimum legal sales age for tobacco products. The document provides detailed annotations explaining the reasoning behind the policy language, and is intended to be used only as a guide. Each county or municipality should consider modifications that reflect local needs and situations. Be sure to review your policy with an attorney familiar with the laws of your jurisdiction to ensure consistency with other laws in your jurisdiction, especially if you change terms or delete provisions. You might also want to research to what extent state authority might preempt any part of your ordinance, and to what extent your ordinance might conflict with other local authority.

The Consortium’s publication Raising the Minimum Legal Sale Age for Tobacco and Related Products provides an in-depth discussion about legal issues related to raising the tobacco MLSA. For more information about general policy drafting, please refer to our website at www.publichealthlawcenter.org and our Policy Drafting Checklists. The Consortium also offers training to certain local communities on effective drafting methods, and may be able to review a draft of your ordinance. Please check our website at www.publichealthlawcenter.org for the latest version of this model ordinance. To request assistance or provide suggestions, e-mail [email protected].

Page 30 Sample Ordinance Creating a MLSA of 21 for Tobacco Products / 2

I. Findings of Fact and Purpose Findings: a. [County/municipality] recognizes that the use The purpose of including of tobacco products has devastating health and findings in a tobacco MLSA economic consequences. 21 ordinance is to clearly identify the problems to be b. Tobacco use is the foremost preventable cause addressed with the policy. of premature death in America.1 It causes half 2 Findings can provide a million deaths annually and has been guidance to not only the responsible for 20.8 million premature deaths policy drafters and decision in the U.S. over the past 50 years since the first makers, but the readers of the Surgeon General’s report on smoking in 1964.3 policy as well. Common findings associated c. This leads to more than $300 billion in health with a comprehensive care and lost worker productivity costs each 4 tobacco MLSA policy will year. identify health concerns and other problems related to use d. [County/municipality] further recognizes that and/or access to tobacco. young people are particularly susceptible to the addictive properties of tobacco products, Findings specific to your and are particularly likely to become lifelong jurisdiction, such as use rates users. among local teens and young adults, will provide further e. An estimated 5.6 million youth aged 0 to 17 rationale for your ordinance. are projected to die prematurely from a tobacco-related illness if prevalence rates do not change.5

f. National data show that 95 percent of adult smokers begin smoking before they turn 21. The ages of 18 to 21 are a critical period when many smokers move from experimental smoking to regular, daily use.6

g. Young minds are particularly susceptible to the addictive properties of nicotine.7 Tobacco industry documents show that those who start smoking by the age of 18 are almost twice as likely to become lifetime smokers as those who start after they turn 21.8 Electronic Smoking h. Electronic smoking device use among minors 9 Devices: has recently tripled. This finding supports the i. In 2015, the Institute of Medicine concluded inclusion of electronic that raising the minimum legal sales age for smoking devices in the sales tobacco products nationwide will reduce restriction. tobacco initiation, particularly among adolescents aged 15 to 17, improve health

Page 31 Sample Ordinance Creating a MLSA of 21 for Tobacco Products / 3

across the lifespan, and save lives; and that raising the minimum legal sales age for tobacco products nationwide to 21 would, over time, lead to a 12 percent decrease in smoking prevalence.10

j. The Institute of Medicine also predicts that raising the minimum legal sales age for tobacco products nationwide to 21would result in 223,000 fewer premature deaths, 50,000 fewer deaths from lung cancer, and 4.2 million fewer years of life lost for those born between 2000 and 2019, and would result in near immediate reductions in preterm birth, low birth weight, and sudden infant death syndrome.11

k. A growing number of communities, including the state of Hawaii, have enacted MLSA 21 Retail impact: 12 laws to further restrict access to tobacco. Tobacco retailers may oppose a tobacco MLSA 21 l. Three-quarters of adults favor raising the ordinance out of concern that MLSA for tobacco products to 21, including 13 they may lose business. This seven in ten smokers. finding addresses that concern. m. The financial impact of tobacco MLSA 21 ordinances on retailers is likely to be minimal, decreasing tobacco sales by only 2%.14

n. Raising the minimum age to purchase tobacco products is consistent with raising the legal Legal drinking age: drinking age to 21, which led to reduced alcohol Raising the legal drinking use and dependence among youth, and contributed 15 age to 21 has had to the decline in drunk driving fatalities. significant public health benefits. Raising the o. [County/municipality] adopts the following tobacco MLSA to 21 may tobacco MLSA 21 ordinance to reduce tobacco have similar benefits. use by keeping tobacco products out of the hands of young people.

II. Jurisdiction

Pursuant to [provide applicable citation], this ordinance applies throughout [describe area subject to regulation].

Jurisdiction:

Some ordinances include a description of where the regulations that follow will apply.

This type of provision can be particularly important when one type of local government (such as a county) has the authority to enforce its regulation within another unit of government (such as a city or village).

Page 32 Sample Ordinance Creating a MLSA of 21 for Tobacco Products / 4

III. Definitions As used in this ordinance:

Definitions:

A thorough definitions section explains the language and wording used in an ordinance and also helps ensure the language is consistent throughout the entire document. A well- thought -out definition section can help reduce ambiguity and confusion. For example, defining “tobacco products” is important so those responsible for enforcing the policy know what products are included. This is critical because the tobacco industry is developing new ways to deliver nicotine to users.

Before writing a definitions section, you need to determine to what extent your county or municipality has the power to define terms. It is also important to see if any of these terms are already defined in other local authority. If one or more of these terms are defined differently, you might consider using an alternative term to avoid confusion.

“Distribute” and a. “Distribute” or “Distribution” means to “distributor” are common furnish, give, provide, or to attempt to do so, terms in local ordinances, whether gratuitously or for any type of and may already be defined compensation. elsewhere. If so, and if they mean something different b. “Distributor” means a person who than what you intend, distributes a tobacco product. consider using other terms instead to avoid confusion.

c. “Electronic smoking device” means any device that can be used to deliver aerosolized or Electronic smoking devices: vaporized nicotine to the person inhaling from the device, including, but not limited to, an e- Electronic smoking devices cigarette, e-cigar, e-pipe, vape pen or e-hookah. should be defined because Electronic smoking device includes any they are included in this component, part, or accessory of such a device, ordinance’s age-based sales whether or not sold separately, and includes any restriction. substance intended to be aerosolized or vaporized during the use of the device. Electronic smoking device does not include drugs, devices, or combination products authorized for sale by the U.S. Food and Drug Administration, as those terms are defined in the Federal Food, Drug and Cosmetic Act.

Page 33 Sample Ordinance Creating a MLSA of 21 for Tobacco Products / 5

d. “Person” means any natural person, partnership, joint venture, society, club, trustee, trust, association, organization, or corporation, or any officer, agent, employee, factor, or any other personal representative thereof, in any capacity.

e. “Recipient” means any person who obtains or attempts to obtain a tobacco product.

f. “Tobacco product” means any Tobacco product: product that is made from or derived A strong tobacco control policy must from tobacco, and is intended for contain a thorough “tobacco human consumption or is likely to be product” definition. consumed, whether smoked, heated, chewed, absorbed, dissolved, inhaled First, a comprehensive definition(s) or ingested by any other means, will cover all current, known tobacco including, but not limited to, a products (as well as pipes, rolling cigarette, a cigar, pipe tobacco, papers, electronic smoking devices, chewing tobacco, snuff, snus, or an and other “related” devices), and will electronic smoking device. The term be likely to cover future products as includes any component or accessory well. used in the consumption of a tobacco product, such as filters, rolling papers, Second, unless cessation products pipes, or liquids used in electronic are specifically exempted, the sale of smoking devices. Tobacco product those products to persons under 21 does not include drugs, devices, or may also be prohibited. combination products authorized for Finally, providing a comprehensive sale by the U.S. Food and Drug definition of “tobacco products” can Administration, as those terms are aid in compliance and enforcement defined in the Federal Food, Drug and by clearly specifying what exactly is Cosmetic Act. being prohibited.

IV. Minimum Legal Sales Age for Tobacco Products

The sale or distribution of any tobacco product to a person under the age of 21 is prohibited.

Grandfather Clause: Some tobacco MLSA laws contain an exemption for those who were 18 or older at the time the new regulation went into effect: It shall be unlawful for any person to distribute a tobacco product to any person under twenty-one years of age, with an exception provided for any person who was eighteen years of age or older on ______, 201_.

Page 34 Sample Ordinance Creating a MLSA of 21 for Tobacco Products / 6

Possession, Use, and Purchase by Underage Individuals:

Prohibiting the possession, use, and purchase (PUP) of tobacco products by underage persons is a part of many ordinances. However, this ordinance does not include restrictions on the possession or use of tobacco products by those under 21.

PUP provisions may be unlikely to reduce youth smoking significantly. Also, they may undermine other conventional avenues of youth discipline, divert attention from more effective tobacco control strategies, and relieve the tobacco industry of responsibility for its marketing practices. Some communities are concerned that PUP provisions may be enforced inconsistently with respect to youth from certain racial and ethnic groups, resulting in their introduction into the criminal justice system.

If a PUP provision seems politically necessary, it could be worded as follows:

The purchase or attempted purchase of any tobacco product by or on behalf of a person under the age of 21 is prohibited.

It may also be possible to include non-monetary consequences in the penalties section:

Individuals under the age of 21 who unlawfully purchase or attempt to purchase tobacco products may be subject to tobacco-related education classes, diversion programs, community service, or other penalties that [County/municipality] believes will be appropriate and effective.

For a discussion of the merits of PUP laws, see Gary Giovino & Melanie Wakefield, Teen Penalties for Tobacco Possession, Use and Purchase: Evidence and Issues, 12 TOBACCO CONTROL 6 (2003), http://tobaccocontrol.bmj.com/content/12/suppl_1/i6.full.

V. Age Verification

Before distributing any tobacco product, the distributor shall verify that the recipient is at least 21 years of age.

Each distributor shall examine the recipient’s government-issued photographic identification. No such verification is required for a person over the age of 30. That a recipient appeared to be 30 years of age or older shall not constitute a defense to a violation of this section.

Age Verification: Federal regulations require distributors to “card” cigarette and smokeless tobacco recipients who look younger than 27 years old. 21 C.F.R. § 1140.14(b)(2). However, state and local governments generally can adopt more restrictive tobacco regulations without being preempted by federal law. 21 U.S.C.A. § 387p. Because this ordinance raises the minimum legal sale age for tobacco products, it makes sense to make a corresponding increase to the minimum carding age. For example, 30 years old is a simple, intuitive visual age line.

Page 35 Sample Ordinance Creating a MLSA of 21 for Tobacco Products / 7

VI. Signage Signage: No person shall sell or permit the sale of Requiring tobacco sellers to post a tobacco products in [county/municipality] standardized notice raises unless a clearly visible notice is posted at the awareness of the age restriction location where tobacco products are (both among distributors and the available for purchase. The general public) and helps promote [County/municipality] shall provide this compliance. notice, which shall state “No person under the age of 21 may purchase tobacco If a state or local authority has an products,” legibly printed in letters at least existing age-related signage one-half inch high. requirement, mirroring that standard may be preferable.

Enforcement: VII. Enforcement [County/municipality] or An enforcement section empowers your county or its authorized designee municipality to inspect distributors for compliance. may conduct random, unannounced inspections It may be helpful to grant enforcement authority to at locations where multiple agencies, such as law enforcement agencies, tobacco products are the health department, and the local agency that distributed to test and enforces general business licensing laws. ensure compliance with this ordinance. This can help ensure that youth can be used to test for compliance. It may also result in compliance checks of stores without a tobacco retailer license. VIII. Penalties Penalties: a. In General. Any person found to have violated this ordinance shall be subject A penalties section specifies the to a fine of no less than $300 for the first consequences for violations. offense, no less than $600 for the second offense, and no less than $1000 for each Local governments often have the offense thereafter. Each violation, and ability to impose criminal and/or every day in which a violation occurs, civil penalties for ordinance shall constitute a separate violation. violations.

b. Licensees. In addition to any other When deciding what penalty to penalty, a licensee who violates any attach to these violations, you may provision of this ordinance may be want to review the authority for subject to license suspension, revocation, penalties provided for similar and/or non-renewal. offenses in your county or municipality.

Page 36 Sample Ordinance Creating a MLSA of 21 for Tobacco Products / 8

Licensing Consequences: When distributors are licensed by the county or other municipality, the threat of license suspension revocation may be a more effective deterrent than a fine or other related sanction. Regardless of whether tobacco retailer licensing exists in your jurisdiction, penalties can be imposed against any general business license. See the Consortium’s publication License to Kill?: Tobacco Retailer Licensing as an Effective Enforcement Tool for further discussion of tobacco license penalties.

c. Criminal Prosecution. Nothing in this section shall prohibit the [County/municipality] from initiating criminal proceedings for any alleged violation of this ordinance.

IX. Exceptions and Defenses Employment Exemption:

a. The penalties in this This exemption clarifies that underage employees ordinance do not apply to can sell or otherwise handle tobacco products. a person younger than 21 Because young retail clerks are more likely to sell years old who purchases tobacco to underage buyers, an ordinance may want or attempts to purchase to omit this exception. For an argument against tobacco products while allowing retail clerks under the age of 21 to sell under the direct tobacco, see Joseph DiFranza & Mardia Coleman, supervision of Sources of Tobacco for Youths in Communities with [County/municipality] Strong Enforcement of Youth Access Laws, 10 staff for training, TOBACCO CONTROL 323 (2001), education, research, or http://tobaccocontrol.bmj.com/content/10/4/323.full. enforcement purposes.

b. Nothing in this ordinance prohibits an underage person from handling tobacco products in the course of lawful employment.

c. It shall be an affirmative defense to a violation of this ordinance for a person to have reasonably relied on proof of age as described by state law.

X. Severability Severability Clause: If any provision of this ordinance, or the application thereof to any person or circumstance, A severability clause is held invalid, such invalidity shall not affect any improves the likelihood that other provision of this ordinance that can be given even if some part of this effect without the invalid provision or application. ordinance is found invalid, Each invalid provision or application of this the rest will stand. ordinance is severable.

Page 37 Sample Ordinance Creating a MLSA of 21 for Tobacco Products / 9

XI. Effective Date Effective date: This ordinance shall take effect on [effective date]. A county or municipality should select an effective date that will provide Last updated: February 2016 sufficient time to educate distributors and the public of these new restrictions.

Notes

1 Ctrs. for Disease Control & Prevention, Current Cigarette Smoking Among Adults, United States, 2011, 61(44) MORBIDITY & MORTALITY WLY. REP. 889, 889 (2012), http://www.cdc.gov/mmwr/pdf/wk/mm6144.pdf. 2 U.S. DEP’T OF HEALTH & HUMAN SERVS., THE HEALTH CONSEQUENCES OF SMOKING – 50 YEARS OF PROGRESS: A REPORT OF THE SURGEON GENERAL, ch. 12 p. 659 (2014), http://www.surgeongeneral.gov/library/reports/50-years-of-progress/index.html. 3 Id. 4 Id. at 679; see also Xin Xu et al., Annual Health Care Spending Attributable to Cigarette Smoking: An Update, 48 AM. J PREV. MED. (2015). 5 U.S. DEP’T OF HEALTH & HUMAN SERVS., supra note 2. 6 Calculated by the Campaign for Tobacco-Free Kids based on data in the National Survey on Drug Use and Health (2013), http://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHr esults2013.pdf. 7 Angelica M. Morales et al., Cigarette Exposure, Dependence, and Craving Are Related to Insula Thickness in Young Adult Smokers, 39 NEUROPSYCHOPHARMACOLOGY 1816 (2014), http://www.nature.com/npp/journal/v39/n8/full/npp201448a.html. 8 Estimated Change in Industry Trend Following Federal Excise Tax Increase, LEGACY TOBACCO DOCUMENTS LIBRARY (Sept. 10, 1982), at 2, https://industrydocuments.library.ucsf.edu/tobacco/docs/#id=nnnw0084. 9 E-cigarette Use Triples Among Middle and High School Students in Just One Year, CTRS. FOR DISEASE CONTROL AND PREVENTION (Apr. 16, 2015), http://www.cdc.gov/media/releases/2015/p0416-e-cigarette-use.html. 10 INST. OF MED., Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products (2015), http://iom.nationalacademies.org/Reports/2015/TobaccoMinimumAgeReport.aspx.

Page 38 Sample Ordinance Creating a MLSA of 21 for Tobacco Products / 10

11 Id. 12 Tobacco 21 Cities, TOBACCO21.ORG (Apr. 2015), http://tobacco21.org/state-by-state; HAW. REV. STAT. § 709-908 (2015) (effective Jan. 1, 2016). 13 Brian A. King et al., Attitudes Toward Raising the Minimum Age of Sale for Tobacco Among U.S. Adults, 49 (4) AM. J. PREVENTATIVE MED. 583, 583 (2015). 14 See Jonathan P. Winickoff et al., Retail Impact of Raising Tobacco Sales Age to Twenty-One, 104 AM. J. PUB. HEALTH 18, 18 (2014). 15 William DeJong & Jason Blanchette, 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 108 (SUPP. 17 2014).

Page 39

Updated 2/08/19

Joliet, IL 60433 60433 IL Joliet, 501 Ella Avenue Avenue Ella 501 Phone: (815) 727-8769 727-8769 (815) Phone: www.willcountyhealth.org Tobacco Control & Prevention Prevention & Control Tobacco Will County Health Department Health County Will

Tobacco 21 This project was made possible by funds received from the Illinois Department of Public Health Public of Department Illinois the from received funds by possible made was project This Will County Health Department

Tobacco Control & Prevention Program

Restricting the Use of Electronic Cigarettes in Public Places

For more information: Visit www.willcountyhealth.org or call (815) 774-7312 This toolkit is designed for Will County policymakers and municipalities who are looking to implement a policy restricting electronic cigarette use in public places. This toolkit offers suggestions and resources to assist with the development of this policy. This toolkit is intended to provide guidance for policymakers and municipalities who wish to protect the health and safety of the Will County community.

All legal questions or advice should be reviewed and answered by your attorney. This information is not legal advice and should not be treated as such. The Will County Health Department, Tobacco Control & Prevention Program is not responsible for providing any legal advice or documents. TABLE OF CONTENTS

INFOGRAPHIC ……………………………………………………………………………………………………… Pg. 3 FACT SHEETS • “Electronic Cigarettes – What’s the Bottom Line?” …………………………………… Pg. 4-8 • “E-Cigarette Use Among Youth and Young Adults” …………………………………… Pg. 9-10 STATEWIDE AND LOCAL GROWING TREND • Will County Map of Policies ……………………………………………………………………… Pg. 11 • List of Illinois Municipalities with Laws Regulating the Use of Electronic Pg. 12 Cigarettes …………………………………………………………………………………………………. POLICY RESOURCES • Example Definition of Electronic Cigarettes ………………………………………………. Pg. 13 • Model California Ordinance Regulating Electronic Smoking Devices …………. Pg. 14-29

• • • • • • • • • • • • • •

Restricting the Use of ELECTRONIC CIGARETTES in Public Places

8th 10th 12th grade grade grade 8% 13% 35%

Electronic cigarette use in the past 30 days by Will County Youth

Source: Illinois Youth Survey, 2018 ABOUT ELECTRONIC CIGARETTES (E-CIGARETTES) There are many names for e-cigarettes including: e-cigs, e-hookah, mods, vape pens, vapes, and electronic nicotine delivery systems (ENDS) YOUTH are more likely to use e-cigarettes than adults in the United States The FDA has NOT approved e-cigarettes as a quit smoking aid Most e-cigarettes contain the highly addictive chemical, NICOTINE, which can have long-term health effects

Source: Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, 2018 Join the growing trend in Illinois and Will County to protect our youth

So far, over 30 communities in Illinois have restricted e-cigarette use indoors

Communities are located in Will County Source: American Nonsmokers' Rights Foundation, 2019 FOR MORE INFORMATION, CONTACT THE WILL COUNTY HEALTH DEPARTMENT TOBACCO CONTROL & PREVENTION PROGRAM

CALL US NOW (815) 774-7312 3 CS284159-B » » » » WHAT AREE-CIGARETTES? » » » » E-cigarettes canbeusedto deliver marijuanaandotherdrugs. breathe inthisaerosol whentheuserexhales into theair. that helpto make theaerosol. Users inhalethisaerosol into theirlungs.Bystanders canalso drug inregular cigarettes, cigars,andothertobacco products—flavorings, andotherchemicals E-cigarettes produce anaerosol by heating aliquidthat usually contains nicotine—the addictive USB sticks, andothereveryday items. Some e-cigarettes are madeto looklike regular cigarettes, cigars,orpipes.Someresemble pens, “mods,” “vape pens,” “vapes,” “tanksystems,” and“electronic nicotine delivery systems.” E-cigarettes are known by many different names. They are sometimes called “e-cigs,” “e-hookahs,” ELECTRONIC CIGARETTES E-pipe » » » » » » » » don’t start. If you’ve never smoked orusedothertobacco products ore-cigarettes, effective for quittingsmoking. others, scientists still have alotto learnaboutwhethere-cigarettes are While e-cigarettes have thepotential to benefitsomepeopleandharm adults whodonotcurrently usetobacco products. E-cigarettes are notsafe for youth, young adults,pregnant women, or other smoked tobacco products. pregnant ifusedasacomplete substitute for regular cigarettes and E-cigarettes have thepotential to benefitadultsmokers whoare not E-cigar tank devices Large-size 4 Medium-size tank devices WHAT’S THEBOTTOMLINE? Rechargeable e-cigarette Disposable e-cigarette

WHAT IS IN E-CIGARETTE AEROSOL?

THE E-CIGARETTE AEROSOL THAT USERS BREATHE FROM THE DEVICE AND EXHALE CAN CONTAIN HARMFUL AND POTENTIALLY HARMFUL SUBSTANCES:

CANCER-CAUSING VOLATILE CHEMICALS ORGANIC COMPOUNDS ULTRAFINE HEAVY METALS SUCH AS PARTICLES NICKEL, TIN, AND LEAD

NICOTINE FLAVORING SUCH AS DIACETYL, A CHEMICAL LINKED TO A SERIOUS LUNG DISEASE

It is difficult for consumers to know what e-cigarette products contain. For example, some e-cigarettes marketed as containing zero percent nicotine have been found to contain nicotine.

ARE E-CIGARETTES LESS HARMFUL THAN REGULAR CIGARETTES?

E-cigarette aerosol generally contains fewer toxic chemicals than the deadly mix of 7,000 chemicals in smoke from regular cigarettes. However, e-cigarette VS aerosol is not harmless. It can contain harmful and potentially harmful substances, including nicotine, heavy metals like lead, volatile organic compounds,

YES, but that doesn’t and cancer-causing agents. mean e-cigarettes are safe.

5 WHAT ARE THE HEALTH EFFECTS OF USING E-CIGARETTES?

SCIENTISTS ARE STILL LEARNING ABOUT THE LONG-TERM HEALTH EFFECTS OF E-CIGARETTES. HERE IS WHAT WE KNOW NOW.

Most e-cigarettes contain nicotine, which has known health effects

»»Nicotine is highly addictive. 1»»Nicotine is toxic to developing fetuses. »»Nicotine can harm adolescent brain development, which continues into the early to mid-20s.

»»Nicotine is a health danger for pregnant women and their developing babies.

Besides nicotine, e-cigarette aerosol can contain substances that harm the body.

»»This includes cancer-causing chemicals and tiny particles that reach deep into lungs. However, e-cigarette aerosol generally contains fewer harmful chemicals than smoke 2from burned tobacco products.

E-cigarettes can cause unintended injuries.

»»Defective e-cigarette batteries have caused fires and explosions, some of which have resulted in serious injuries. 3»»In addition, acute nicotine exposure can be toxic. Children and adults have been poisoned by swallowing, breathing, or absorbing e-cigarette liquid.

6 CAN E-CIGARETTES HELP ADULTS QUIT SMOKING CIGARETTES?

E-CIGARETTES ARE NOT CURRENTLY APPROVED BY THE FDA AS A QUIT SMOKING AID.

The U.S. Preventive Services Task Force, a group of health experts that makes recommendations about preventive health care, concluded that the evidence is insufficient to recommend e-cigarettes for smoking cessation in adults, including pregnant women.

HOWEVER, e-cigarettes may help non-pregnant adult smokers if used as a complete substitute for all cigarettes and other smoked tobacco products.

TO DATE, THE FEW STUDIES ON THE ISSUE ARE MIXED.

Evidence from two randomized controlled trials found that e-cigarettes with nicotine can help smokers stop smoking in the long term compared with placebo (non-nicotine) e-cigarettes.

A recent CDC study found that many adults are using e-cigarettes in an attempt to quit smoking. However, most adult e-cigarette users do not stop smoking cigarettes and are instead continuing to use both products (“dual use”). Because smoking even a few cigarettes a day can be dangerous, quitting smoking completely is very important to protect your health.

7 WHO IS USING E-CIGARETTES?

E-CIGARETTES ARE THE MOST COMMONLY USED TOBACCO PRODUCT AMONG YOUTH.

In 2018, more than 3.6 MILLION U.S. middle and high school students used e-cigarettes in 4.9% the past 30 days, including: MIDDLE SCHOOL 20.8% IN THE U.S., STUDENTS HIGH SCHOOL YOUTH ARE STUDENTS MORE LIKELY THAN ADULTS TO USE E-CIGARETTE

AMONG CURRENT E-CIGARETTE USERS AGED 45 YEARS AND OLDER in 2015, most were either current or former regular cigarette smokers, and 1.3% had never been cigarette smokers.

IN CONTRAST, AMONG CURRENT E-CIGARETTE USERS AGED 18–24 YEARS, 40.0% had NEVER BEEN regular cigarette smokers

In 2017, 2.8% IN 2015, AMONG ADULT E-CIGARETTE of U.S. adults were current USERS OVERALL: e-cigarette users 29.8% were former regular cigarette 58.8% were current regular smokers cigarette smokers 11.4% had never been regular cigarette smokers 8 E-Cigarette Use Among Youth and Young Adults A Report of the Surgeon General

Fact Sheet This Surgeon General’s report comprehensively reviews the public health issue of e-cigarettes and their impact on U.S. youth and young adults. Studies highlighted in the report cover young adolescents (11-14 years of age); adolescents (15-17 years of age); and/or young adults (18-25 years of age). Scientific evidence contained in this report supports the following facts:

E-cigarettes are a rapidly emerging and diversified E-cigarette use among youth and young adults has product class. These devices typically deliver nicotine, become a public health concern. In 2014, current use flavorings, and other additives to users via an inhaled of e-cigarettes by young adults 18-24 years of age aerosol. These devices are referred to by a variety of surpassed that of adults 25 years of age and older. names, including “e-cigs,” “e-hookahs,” “mods,” “vape pens,” “vapes,” and “tank systems.” Among young adults 18-24 years of age, e-cigarette use more than doubled from 2013 to 2014. As of 2014, more than one-third of E-cigarettes are battery-powered devices that heat a liquid young adults had tried e-cigarettes. into an aerosol that the user inhales. The most recent data available show that the prevalence of past The liquid usually has nicotine, which comes from tobacco; 30-day use of e-cigarettes was 13.6% among young adults (2014) flavoring; and other additives. and 16.0% among high school students (2015). E-cigarette products can also be used as a delivery system for The most recent data available show that the prevalence of past marijuana and other illicit drugs. 30-day use of e-cigarettes is similar among middle school students (5.3%) and adults 25 years of age and older (5.7%). E-cigarettes are now the most commonly used tobacco Among young adults, e-cigarette use is higher among males, whites product among youth, surpassing conventional cigarettes in 2014. E-cigarette use is strongly associated with the use and Hispanics, and those with less education. of other tobacco products among youth and young adults, including cigarettes and other burned tobacco products. The use of products containing nicotine poses dangers to In 2015, more than 3 million youth in middle and high school, youth, pregnant women, and fetuses. The use of products including about 1 of every 6 high school students, used e-cigarettes containing nicotine in any form among youth, including in e-cigarettes, is unsafe. in the past month. More than a quarter of youth in middle and high school have tried e-cigarettes. Many e-cigarettes contain nicotine, which is highly addictive. Among high school students, e-cigarette use is higher among males, The brain is the last organ in the human body to develop fully. whites, and Hispanics than among females and African-Americans. Brain development continues until the early to mid-20s. Nicotine There is a strong association between the use of e-cigarettes, exposure during periods of significant brain development, such as cigarettes, and the use of other burned tobacco products by young adolescence, can disrupt the growth of brain circuits that control people. In 2015, for example, nearly 6 of 10 high school cigarette attention, learning, and susceptibility to addiction. smokers also used e-cigarettes. The effects of nicotine exposure during youth and young adulthood Research has found that youth who use a tobacco product, such as can be long-lasting and can include lower impulse control and e-cigarettes, are more likely to go on to use other tobacco products mood disorders. like cigarettes. The nicotine in e-cigarettes and other tobacco products can prime young brains for addiction to other drugs, such as cocaine and methamphetamine.

U.S. Department of Health and Human Services 9 Fact Sheet (continued)

Nicotine can cross the placenta and affect fetal and postnatal Action can be taken at the national, state, local, tribal and development. Nicotine exposure during pregnancy can result in territorial levels to address e-cigarette use among youth multiple adverse consequences, including sudden infant death and young adults. Actions could include incorporating e-cigarettes into smokefree policies, preventing access syndrome (SIDS). to e-cigarettes by youth, price and tax policies, retail Ingestion of e-cigarette liquids containing nicotine can cause acute licensure, regulation of e-cigarette marketing likely toxicity and possible death if the contents of refill cartridges or to attract youth, and educational initiatives targeting bottles containing nicotine are consumed. youth and young adults.

E-cigarette aerosol is not harmless. It can contain harmful The Food and Drug Administration (FDA) now regulates the and potentially harmful constituents including nicotine. manufacturing, importing, packaging, labeling, advertising, Nicotine exposure during adolescence can cause addiction promotion, sale, and distribution of e-cigarettes. and can harm the developing adolescent brain. • In August 2016, FDA began enforcing a ban on vending machine sales unless in adult-only facilities and a ban on The constituents of e-cigarette liquids can include solvents, free samples and sales to minors. flavorants, and toxicants. Parents, teachers, health care providers, and others who The aerosol created by e-cigarettes can contain ingredients that are influence youth and young adults can advise and inform them harmful and potentially harmful to the public’s health, including: of the dangers of nicotine; discourage youth tobacco use in any nicotine; ultrafine particles; flavorings such as diacetyl, a chemical form, including e-cigarettes; and set a positive example by being linked to serious lung disease; volatile organic compounds such as tobacco-free themselves. benzene, which is found in car exhaust; and heavy metals, such as nickel, tin, and lead.

E-cigarettes are marketed by promoting flavors and using Citation: U.S. Department of Health and Human Services. E-Cigarette Use a wide variety of media channels and approaches that Among Youth and Young Adults: A Report of the Surgeon General—Executive have been used in the past for marketing conventional Summary. Atlanta, GA: U.S. Department of Health and Human Services, Centers tobacco products to youth and young adults. for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2016. E-cigarettes are an estimated $3.5 billion business in the United States. In 2014, e-cigarette manufacturers spent $125 million Website: E-cigarettes.Surgeongeneral.gov advertising their products in the U.S. In 2014, more than 7 of 10 middle and high school students said they had seen e-cigarette advertising. Retail stores were the most frequent source of this advertising, followed by the internet, TV and movies, and magazines and newspapers. The 2012 Surgeon General’s Report on tobacco use among youth and young adults found that tobacco product advertising causes young people to start using tobacco products. Much of today’s e-cigarette advertising uses approaches and themes similar to those that were used to promote conventional tobacco products. E-cigarettes are available in a wide variety of flavors, including many that are especially appealing to youth. More than 85% of e-cigarette users ages 12-17 use flavored e-cigarettes, and flavors are the leading reason for youth use. More than 9 of 10 young adult e-cigarette users said they use e-cigarettes flavored to taste like menthol, alcohol, fruit, chocolate, or other sweets.

U.S. Department of Health and Human Services 10 NAPERVILLE WOODRIDGE Will County Municipalities AURORA BOLINGBROOK that Restrict the Use of E-Cigarettes in Public Places

ROMEOVILLE Legend

PLAINFIELD HOMER GLEN Local Indoor Smoke-Free Policy

LOCKPORT E-Cigarette Included CREST HILL JOLIET

ORLAND PARK TINLEY PARK MOKENA JOLIET SHOREWOOD NEW LENOX ROCKDALE FRANKFORT Date: 2/7/2019

PARK FOREST MINOOKA SAUK VILLAGE STEGER UNIVERSITY PARK CHANNAHON MANHATTAN ELWOOD CRETE MONEE

WILMINGTON BEECHER

SYMERTON PEOTONE

COAL CITY DIAMOND

BRAIDWOOD

GODLEY

0 2.5 5 10 Miles BRACEVILLE [ *Data current as of February 2019

11 Illinois Municipalities with Laws Regulating the Use of Electronic Cigarettes

1. Arlington Heights 19. Oak Park 2. Aurora 20. Ogle County 3. Barrington 21. Palatine 4. Braidwood 22. Park Ridge 5. Buffalo Grove 23. Savanna 6. Chicago 24. Schaumberg 7. Deerfield 25. Shorewood 8. Dekalb 26. Skokie 9. East Peoria 27. Washington 10. Elgin 28. Western Springs 11. Elk Grove Village 29. Wheaton 12. Evanston 30. Wilmette 13. Hanover Park 31. Yorkville

14. Highland Park Illinois - e-cigarettes are 15. Hoffman Estates prohibited on all campuses of 16. Lincolnshire State-supported institutions of 17. Naperville higher education 18. New Lenox

Communities listed in bold are located in Will County

Source: Americans for Nonsmokers' Rights, "States and Municipalities with Laws Regulating the Use of E-Cigarettes, " 2019 Updated: January 2, 2019 12 Example Definition of Electronic Cigarettes

Definition written by the Illinois Attorney General’s Office in 2018

Model California Ordinance Regulating Electronic Smoking Devices (with Annotations)

Updated June 2015 (Originally published October 2013)

Developed by ChangeLab Solutions

This material was made possible by funds received from Grant Number 14-10214 with the California Department of Public Health, California Tobacco Control Program.

ChangeLab Solutions is a nonprofit organization that provides legal information on matters relating to public health. The legal information provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.

changelabsolutions.org/tobaccoquestions

Introduction

ChangeLab Solutions developed this Model Ordinance to help local governments regulate the use and sale of Electronic Smoking Devices (also known as electronic cigarettes, e-cigarettes, or electronic nicotine delivery systems) and their component parts. By restricting the use of electronic smoking devices in places where smoking is prohibited, cities and counties can protect their residents from involuntary exposure to the secondhand byproducts of electronic smoking devices, such as vapor; reduce the likelihood that children will associate the use of electronic smoking devices with healthy behavior; and reduce the likelihood that smoking in public places and places of employment will become “re-normalized.” By regulating how electronic smoking devices and their component parts are sold, cities and counties can help promote compliance with local laws regulating business practices, and reduce youth access to electronic smoking devices.

In the most recent update of this Model Ordinance (June 2015), the definition of “Electronic Smoking Device” was revised to omit the exemption for products approved by the United States Food and Drug Administration (FDA) for use in the mitigation, treatment, or prevention of disease. This Model Ordinance now prohibits the use of Electronic Smoking Devices—with no exception for FDA-approved products—in any place where smoking is prohibited by law. However, FDA-approved products remain exempt from the sales requirements and prohibitions contained in this Model Ordinance.

Note: Many jurisdictions in California already have local laws restricting the use of tobacco products in public places and places of employment. Similarly, many jurisdictions in California already have local laws regulating the sale of tobacco products, such as local tobacco retailer licensing laws or local prohibitions on tobacco sampling. Communities that already have these local laws in place should consider regulating electronic smoking devices by amending their existing tobacco control laws to treat electronic smoking devices like traditional tobacco products. Please see ChangeLab Solutions’ flowchart, How to Regulate E-Cigarettes and Other Electronic Smoking Devices in Your Community, to determine whether amending existing local laws is the best approach for your community. ChangeLab Solutions can assist you with this customization. Jurisdictions that do not currently have local laws regulating tobacco products but still wish to regulate electronic smoking devices can use this Model Ordinance.

The Model Ordinance offers a variety of options. In some instances, blanks (e.g., [ ____ ] ) prompt you to customize the language to fit your community’s needs. In other cases, the ordinance offers you a choice of options (e.g., [ choice one / choice two ] ). Some options are followed by a comment describing the legal provisions in more detail. Some degree of customization is always necessary in order to make sure the ordinance is consistent with a community’s existing laws. Your city attorney or county counsel will likely be the best person to check this for you.

If you have questions about how to adapt this ordinance for your community, please contact ChangeLab Solutions through our website at www.changelabsolutions.org/tobaccoquestions for assistance.

Model California Ordinance Regulating Electronic Smoking Devices 2 15

AN ORDINANCE OF THE [ CITY / COUNTY ] OF [ ____ ] AMENDING THE [ ____ ] MUNICIPAL CODE TO REGULATE ELECTRONIC SMOKING DEVICES

The [ City Council of the City / Board of Supervisors of the County ] of [ ____ ] does ordain as follows:

COMMENT: This is introductory boilerplate language that should be adapted to the conventional form used in the jurisdiction.

SECTION I. FINDINGS.

The [ City Council of the City / Board of Supervisors of the County ] of [ ____ ] hereby finds and declares as follows:

WHEREAS, electronic smoking devices, commonly known as “electronic cigarettes,” “e- cigarettes,” “e-cigars,” “e-cigarillos,” “e-pipes,” “e-hookahs,” “electronic nicotine delivery systems,” etc., are battery operated devices designed to deliver nicotine, flavor, and/or other substances through a vapor inhaled by the user1; and

WHEREAS, use of electronic smoking devices has increased significantly in recent years, as evidenced by the fact that:

 Between 2011 and 2012 the percentage of all youth in grades 6 to 12 who had tried electronic smoking devices doubled;2  6.8% of all youth between 6th and 12th grade report trying electronic smoking devices; 3  10% of high school students have tried electronic smoking devices;4  9.3% of youth who have used electronic smoking devices have never smoked conventional cigarettes;5  Between 2010 and 2011, rates of both awareness and use of unregulated electronic smoking devices by adults also increased significantly;6 and

WHEREAS, existing studies on electronic smoking devices’ vapor emissions and cartridge contents have found a number of dangerous substances including:

 Chemicals known to the State of California to cause cancer7 such as formaldehyde, acetaldehyde, lead, nickel, and chromium;8, 9 10,11,12,13  PM2.5, acrolein, tin, toluene, and aluminum, which are associated with a range of negative health effects such as skin, eye, and respiratory irritation,14,15,16,17 neurological effects,18 damage to reproductive systems,19 and even premature death from heart attacks and stroke;20  Inconsistent labeling of nicotine levels in electronic smoking device products; 21 and  In one instance, diethylene glycol, an ingredient used in antifreeze and toxic to humans;22 and

Model California Ordinance Regulating Electronic Smoking Devices 3 16

WHEREAS, more than one study has concluded that exposure to vapor from electronic smoking devices may cause passive or secondhand vaping;23,24,25 and

WHEREAS, some cartridges used by electronic smoking devices can be re-filled with liquid nicotine solution, creating the potential for exposure to dangerous concentrations of nicotine,26 and as a result:

 Poisonings from electronic smoking devices have increased dramatically in the last three and half years from “one [a month] in September 2010 to 215 a month in February 2014;” 27  Analysis of reports of poisonings from electronic smoking devices finds that calls reporting exposure to electronic smoking devices are much more likely to involve adverse health effects when compared to calls reporting exposure to conventional cigarettes;28 and

WHEREAS, clinical studies about the safety and efficacy of these products have not been submitted to the FDA29 for the more than 400 brands of electronic smoking devices that are on the market30 and for this reason, consumers currently have no way of knowing:31

 Whether electronic smoking devices are safe;  What types or concentrations of potentially harmful chemicals the products contain; and  What dose of nicotine the products deliver; and

WHEREAS, the World Health Organization has strongly advised consumers against the use of electronic smoking devices until they are “deemed safe and effective and of acceptable quality by a competent national regulatory body”;32 and

WHEREAS, the World Medical Association has determined that electronic smoking devices “are not comparable to scientifically-proven methods of smoking cessation” and that “neither their value as therapeutic aids for smoking cessation nor their safety as cigarette replacements is established”;33 and

WHEREAS, the State of California’s Tobacco Education and Research Oversight Committee (TEROC) “opposes the use of e-cigarettes in all areas where other tobacco products are banned.”34

WHEREAS, a study published in the Journal of Environmental and Public Health suggests that electronic smoking devices “may have the capacity to ‘re-normalize’ tobacco use in a demographic that has had significant denormalization of tobacco use previously”;35 and

WHEREAS, electronic smoking devices often mimic conventional tobacco products in shape, size, and color,36 with the user exhaling a smoke-like vapor similar in appearance to the exhaled smoke from cigarettes and other conventional tobacco products;37 and

WHEREAS, the use of electronic smoking devices in smokefree locations threatens to undermine compliance with smoking regulations and reverse the progress that has been made in

Model California Ordinance Regulating Electronic Smoking Devices 4 17

establishing a social norm that smoking is not permitted in public places and places of employment;38

WHEREAS, more than 59 jurisdictions within California require retailers to obtain a license to sell electronic smoking devices39 and at least 44 local jurisdictions in California prohibit the use of electronic smoking devices in specific locations.40

NOW THEREFORE, it is the intent of the [ City Council / County Board of Supervisors ], in enacting this ordinance, to provide for the public health, safety, and welfare by discouraging the use of electronic smoking devices around non-users, especially children; by protecting the public from exposure to secondhand byproducts of electronic smoking devices where they live, work, and play; by facilitating uniform and consistent enforcement of smokefree air laws; by reducing the potential for re-normalizing smoking in public places and places of employment; by reducing the potential for children to associate the use of electronic smoking devices with a normative or healthy lifestyle; and by prohibiting the sale or distribution of electronic smoking devices to minors.

SECTION II. [ Article / Chapter ] of the [ ____ ] Municipal Code is hereby amended to read as follows:

Sec. [ ____ (*1) ]. DEFINITIONS. The following words and phrases, whenever used in this [ article / chapter ] shall have the meanings defined in this section unless the context clearly requires otherwise:

(a) “Business” means any sole proprietorship, partnership, joint venture, corporation, association, or other entity formed for profit-making purposes.

(b) “Electronic Smoking Device” means an electronic device that can be used to deliver an inhaled dose of nicotine, or other substances, including any component, part, or accessory of such a device, whether or not sold separately. “Electronic Smoking Device” includes any such device, whether manufactured, distributed, marketed, or sold as an electronic cigarette, an electronic cigar, an electronic cigarillo, an electronic pipe, an electronic hookah, or any other product name or descriptor.

COMMENT: This definition is broad enough to cover all Electronic Smoking Devices that are used to deliver nicotine or other substances. Regulating the use of all varieties of Electronic Smoking Devices, regardless of their nicotine content, protects bystanders from exposure to the hazardous substances found in Electronic Smoking Device vapor, reduces the risk that children may view the use of Electronic Smoking Devices in smokefree areas as normative, and facilitates uniform enforcement. Should a jurisdiction wish to limit its regulation of Electronic Smoking Device sales to only those products that contain nicotine, there is optional language in section [ ____ (*3)(e) ] below.

(c) “Electronic Smoking Device Paraphernalia” means cartridges, cartomizers, e-liquid, smoke juice, tips, atomizers, Electronic Smoking Device batteries, Electronic Smoking Device chargers, and any other item specifically designed for the preparation, charging, or use of Electronic Smoking Devices.

Model California Ordinance Regulating Electronic Smoking Devices 5 18

COMMENT: This definition is meant to cover only those products that are exclusively designed for use with Electronic Smoking Devices. Products that are designed for general use with other types of devices, such as standard format USB cables, standardized batteries, etc., would not be covered because such devices are not specifically designed for use with Electronic Smoking Devices.

(d) “Employee” means any Person who is employed or retained as an independent contractor by any Employer in consideration for direct or indirect monetary wages or profit, or any Person who volunteers his or her services for an Employer.

COMMENT: This definition makes clear that volunteers and independent contractors are Employees for purposes of this section.

(e) “Employer” means any Business or Nonprofit Entity that retains the service of one or more Employees.

(f) “Nonprofit Entity” means any entity that meets the requirements of California Corporations Code section 5003 as well as any corporation, unincorporated association or other entity created for charitable, religious, philanthropic, educational, political, social or similar purposes, the net proceeds of which are committed to the promotion of the objectives or purposes of the entity and not to private gain. A government agency is not a Nonprofit Entity within the meaning of this [ article / chapter ].

COMMENT: This definition is broader than the IRS designation of a nonprofit organization in order to cover more informal groups and associations.

(g) “Nominal Cost” means the cost of any item imposed for the transfer from one person to another for less than the total of: (1) [ twenty-five percent (25%) ] of the fair market value of the item exclusive of taxes and government fees; plus (2) all taxes and government fees previously paid and all taxes and government fees still due on the item at the time of transfer.

COMMENT: “Nominal cost” is used in the definition of “nonsale distribution” below. This definition provides a bright-line rule as to what price is so low for Electronic Smoking Devices as to be prohibited by this ordinance.

(h) “Nonsale Distribution” means to give, furnish, or cause or allow to be given or furnished within the jurisdictional limits of the [ city / county ], an Electronic Smoking Device or Electronic Smoking Device Paraphernalia at no cost or at Nominal Cost to a Person who is not a Retailer.

(i) “Person” means any natural person, cooperative association, Employer, personal representative, receiver, trustee, assignee, or any other legal entity including a government agency.

Model California Ordinance Regulating Electronic Smoking Devices 6 19

COMMENT: The Municipal Code may already contain a definition of “person”; review any existing definition of “person” in the Municipal Code to determine whether to include the above definition in your ordinance.

Note: If Section [ (*5)(g) ]—private citizen enforcement—is included in the ordinance, keep this specific definition of “Person.”

This definition incorporates numerous entities including Business, Employer, Nonprofit Entity, landlord, and individual. In addition, it includes the City or County.

(j) [ “Public Place” means any place within the [ city / county ], public or private, that is open to the general public regardless of any fee or age requirement, including, for example, bars, restaurants, clubs, stores, stadiums, parks, playgrounds, taxis, and buses [ and means any place used by a membership association or club at which non- member guests are present or permitted, including, for example and without limitation, fraternity and sorority houses ] ].

COMMENT: This entire definition is optional and, if added, can be used to limit the ban on Electronic Smoking Device sampling to sampling that occurs in public places only. Without this provision, all nonsale distributions of Electronic Smoking Devices with a business purpose, even if on private property not open to the public, will be restricted (e.g., private parties such as raves). Note that nonsale distributions that are not for a business purpose, such as friends giving friends Electronic Smoking Devices, are not prohibited by this ordinance.

If a “public place” limitation on Electronic Smoking Device sampling is desired, then the jurisdiction must choose whether to regulate membership organizations. To regulate membership organizations, include the phrase that is underlined and bracketed above. However, if membership organizations are to be excluded from coverage, omit that language. Note that membership organizations are covered if the “public place” limitation is not imposed (i.e., no part of this definition is included).

(k) “Retailer” means any Person who sells, offers for sale, or does or offers to exchange for any form of consideration, Electronic Smoking Devices or Electronic Smoking Device Paraphernalia. “Retailing” means the doing of any of these things. This definition is without regard to the quantity of the Electronic Smoking Devices or Electronic Smoking Device Paraphernalia sold, offered for sale, exchanged, or offered for exchange.

(l) “Self-Service Display” means the open display or storage of Electronic Smoking Devices or Electronic Smoking Device Paraphernalia in a manner that is physically accessible in any way to the general public without the assistance of a Retailer or Employee of a Retailer and a direct person-to-person transfer between a Retailer or Employee of a Retailer and any other Person. A vending machine is a form of Self- Service Display.

Model California Ordinance Regulating Electronic Smoking Devices 7 20

(m) “Smoking” means inhaling, exhaling, burning, or carrying any lighted, heated, or ignited cigar, cigarette, cigarillo, pipe, hookah, Electronic Smoking Device, or any plant product intended for human inhalation.

COMMENT: This is a conventional definition of smoking, which does not explicitly include the vapors produced by Electronic Smoking Devices. This definition is appropriate for jurisdictions that do not have a local smokefree air law but nevertheless want to adopt a local law in order to restrict the use of electronic cigarettes in places covered by the California Smoke Free Workplace Law. This model ordinance achieves this goal by prohibiting the use of Electronic Smoking Devices in all places where smoking, as that term is conventionally defined, is prohibited.

Jurisdictions that wish to adopt a local smokefree air law that prohibits the use of combustible tobacco products and Electronic Smoking Devices in locations that are not covered by the California Smoke Free Workplace Law, or that wish to amend such a law, should use the definition of “Smoking” contained in ChangeLab Solutions’ Comprehensive Smokefree Places Ordinance.

Sec. [ ____ (*2) ]. PROHIBITION OF ELECTRONIC SMOKING DEVICE USE IN SMOKE-FREE PLACES

(a) It shall be a violation of this [ article / chapter ] to use an Electronic Smoking Device in any place within the [ City / County of ____ ] where Smoking of tobacco products is prohibited by law.

COMMENT: This provision makes it unlawful for a person to use an Electronic Smoking Device in all places where smoking is prohibited by law, including all places of employment subject to the California’s Smoke Free Workplace Law (Labor Code Section 6404.5).

(b) No Person, Employer, or Nonprofit Entity shall knowingly permit the use of Electronic Smoking Devices in an area under the legal or de facto control of that Person, Employer or Nonprofit Entity and in which Smoking is prohibited by law.

COMMENT: This provision makes anyone who is in control of an area responsible for Electronic Smoking Device use in violation of this and other no-smoking laws. Thus, enforcement actions can be taken against a Business, landlord, Employer, or Nonprofit Entity, in addition to an individual user, who knowingly breaks the law.

Sec. [ ____ (*3) ]. RETAILING REQUIREMENTS AND PROHIBITIONS

(a) Sale to minors prohibited. It shall be a violation of this [ article / chapter ] to sell, give or furnish, or cause to be sold, given or furnished, an Electronic Smoking Device or Electronic Smoking Device Paraphernalia to a natural Person under 18 years of age in any place within the [ City / County of ____ ].

Model California Ordinance Regulating Electronic Smoking Devices 8 21

COMMENT: California Health and Safety Code Section 119405 prohibits the sale of e- cigarettes containing nicotine to anyone under the age of 18. This provision covers a broader range of products because it also includes e-cigarettes that do not contain nicotine. This provision gives a city or county additional enforcement options with regard to e- cigarettes; the jurisdiction can enforce Health and Safety Code section 119405 (pursuant to Penal Code section 830.1) and/or use the enforcement mechanisms created by this ordinance depending on the type of violation.

(b) Positive identification required. No Retailer shall sell, give or furnish an Electronic Smoking Device or Electronic Smoking Device Paraphernalia to a natural Person who appears to be under the age of [twenty-seven (27)] years without first examining identification to confirm that the recipient is at least 18 years of age.

COMMENT: This provision eliminates the excuse that a purchaser arguably looked to be 18 years old. Perhaps more importantly, it allows compliance checks to be conducted with persons who are 18 or 19 years old, which eliminates the need to seek immunity from the district attorney for youth who act as decoys in operations testing a Retailer’s compliance with youth access laws. It also eliminates the issue of potentially putting minors in harm’s way.

COMMENT: This provision prohibits retailers from storing Electronic Smoking Devices and Paraphernalia in places where they are easily accessible to youth, such as on counter tops. It also prohibits the sale of Electronic Smoking Devices or Electronic Smoking Device Paraphernalia through vending machines, because the definition of Self-Service Display includes vending machines.

(d) Nonsale Distribution Prohibited. No Person, motivated by an economic or a business purpose, shall engage in the Nonsale Distribution of any Electronic Smoking Device or Electronic Smoking Device Paraphernalia [in any Public Place.]

COMMENT: This provision prohibits Nonsale Distribution throughout an entire jurisdiction by default. The prohibition can be limited to Public Places by including the underlined text. If such language is included, the “Public Place” definition noted in the Definitions section must also be included.

(e) Exception. No provision in this Sec. [ ____ (*3) ] shall apply to any product specifically approved by the United States Food and Drug Administration for use in the mitigation, treatment, or prevention of disease.

COMMENT: Although to date no Electronic Smoking Device has been approved by the FDA as a cessation product, this exception exempts Electronic Smoking Devices from the requirements and prohibitions in this section should FDA approval be granted in the future.

Model California Ordinance Regulating Electronic Smoking Devices 9 22

(f) [ Subsections (a) - (d) above do not apply to any product that does not contain nicotine and is not customarily used to deliver nicotine. ]

COMMENT: By default, section [ ____ (*3) ] is designed to regulate the sale of all Electronic Smoking Devices, regardless of whether they are being used to deliver nicotine or other substances. This allows for consistency in application of the ordinance. This optional provision provides an exemption for jurisdictions that do not wish to regulate the sale of Electronic Smoking Devices that do not contain nicotine and are not used to deliver nicotine.

Sec. [ ____ (*4) ]. NON-RETALIATION.

No Person, Employer, or Nonprofit Entity shall intimidate, threaten any reprisal, or effect any reprisal, for the purpose of retaliating against another Person who or which seeks to attain compliance with this [ article / chapter ].

Sec. [ ____ (*5) ]. PENALTIES AND ENFORCEMENT.

(a) The remedies provided by this [ article / chapter ] are cumulative and in addition to any other remedies available at law or in equity.

COMMENT: The following provisions are designed to offer a variety of enforcement options to the drafter and the enforcing agency. Drafters may choose to include some or all of these options. Once the ordinance is enacted, the enforcing agency will have the discretion to choose which enforcement tools to use in general and in a particular case. As a practical matter, these enforcement options would not be applied simultaneously, although multiple remedies might be used against a particularly egregious violator over time. If the City or County Code already includes comprehensive enforcement provisions that apply generally to violations of the Code, these sections of the model ordinance can be replaced with a cross reference to the general enforcement chapter: “A violation of this [ article / chapter ] is punishable as provided in [ article/ chapter] of this Code.”

(b) Each use of an Electronic Smoking Device in violation of this [ article / chapter ] is an infraction subject to a [ one hundred dollar ($100) ] fine [ or otherwise punishable pursuant to section ___ of this code ]. Other violations of this [ article / chapter ] may, in the discretion of the [ City Prosecutor / District Attorney ], be prosecuted as infractions or misdemeanors when the interests of justice so require. Enforcement of this chapter shall be the responsibility of [ ____ ]. In addition, any peace officer or code enforcement official also may enforce this chapter.

COMMENT: The first sentence establishes the penalty for using Electronic Smoking Devices where they are prohibited. The fine amount can be modified but cannot exceed $100 for a first infraction. (See California Government Code section 36900(b).) It is separated from the main enforcement provision that follows, so that law enforcement officers can simply write a ticket for illegal Electronic Smoking Device use.

The second sentence, sometimes called a “wobbler,” affords the prosecuting attorney discretion whether to pursue other types of violations as infractions (like a parking ticket) or misdemeanors (punishable by up to a $1,000 fine and/or six months in County Jail). Alternatively, violations can be set as either an infraction or a misdemeanor in all

Model California Ordinance Regulating Electronic Smoking Devices 10 23

circumstances. Misdemeanors are more serious crimes for which a jury trial is available to defendants. Fines and other criminal penalties are established by the Penal Code and are typically reflected in the general punishments provision of a local code.

This provision also designates a primary enforcement agency, which is recommended, but remains flexible by permitting any enforcement agency to enforce the law.

(c) Violations of this [ article / chapter ] are subject to a civil action brought by the [ City / County of ____ ], punishable by a civil fine not less than [ two hundred fifty dollars ($250) ] and not exceeding [ one thousand dollars ($1,000) ] per violation.

COMMENT: This provision provides civil fines for violating the ordinance. It requires that the city or county file a traditional civil suit. The fine amounts can be adjusted but cannot exceed $1,000 per violation. Government Code section 36901.

(d) Causing, permitting, aiding, abetting, or concealing a violation of any provision of this [ article / chapter ] shall also constitute a violation of this [ article / chapter ].

COMMENT: This is standard language that is typically included in a city or county code and may be omitted if duplicative of existing code provisions.

(e) Any violation of this [ article / chapter ] is hereby declared to be a nuisance.

COMMENT: By expressly declaring a violation of this ordinance to be a nuisance, this provision allows enforcement by the city or county via the administrative nuisance abatement procedures commonly found in municipal codes. It also facilitates injunctive relief (where a court orders that a defendant do certain things or refrain from doing certain things, such as selling Electronic Smoking Devices to minors).

(f) In addition to other remedies provided by this [ article / chapter ] or by other law, any violation of this [ article / chapter ] may be remedied by a civil action brought by the [ City Attorney / County Counsel ], including, but not limited to, administrative or judicial nuisance abatement proceedings, civil or criminal code enforcement proceedings, and suits for injunctive relief.

COMMENT: It is common to provide that the local government’s lawyers may go to court to seek injunctions and other penalties in addition to fines. The express provision for injunctive relief reduces the showing required to obtain a preliminary or permanent injunction as described in IT Corp. v. County of Imperial, 35 Cal. 3d 63 (1983).

Think carefully about the nuisance abatement procedure you choose. A local government may provide for treble damages for the second or subsequent nuisance abatement judgment within a two-year period, as long as the ordinance is enacted pursuant to Government Code section 38773.5. Treble damages are not available, however, under the alternative nuisance abatement procedures in Government Code section 38773.1 and Health & Safety Code section 17980. Government Code section 38773.7 (authorizing treble damages) establishes a procedure for nuisance abatement where the cost of the abatement

Model California Ordinance Regulating Electronic Smoking Devices 11 24

can be collected via the property tax roll as a special assessment against the property on which the violation occurs.

(g) Any Person acting in the interests of him-, her- or itself, its members, or the general public (hereinafter “Private Enforcer”) may bring a civil action in any court of competent jurisdiction, including small claims court, to enforce this [ article / chapter ] against any Person who has violated this [ article / chapter ] two or more times. Upon proof of the violations, a court shall grant all appropriate relief, including: (1) awarding damages; and (2) issuing an injunction or a conditional judgment. [ If there is insufficient or no proof of actual damages for a violation, the court shall award [ one-hundred and fifty dollars ($150) ] for that violation as statutory damages. ]

COMMENT: This provision enables private citizens (“Private Enforcers”) to go to court— including a trial court or small claims court—to seek compliance with the ordinance through an injunction (a trial court order to do or not do something) or a conditional judgment (a small claims court order requiring the defendant to pay money or to do or refrain from doing something). Monetary damages are available to compensate for actual financial losses. If the optional last sentence is included, a court could award statutory damages of $150 per violation when actual damages are difficult or impossible to prove. The amount of statutory damages can be adjusted but should not exceed $1,000 to avoid an argument that it is a fine in excess of the City of County’s authority under Government Code section 36901.

A private citizen may bring a lawsuit against an individual or organization only for alleged repeated violations of the law. This limitation is intended to address concerns about the potential for abusive lawsuits.

Note: It is recommended that the term “Person” be included in the list of definitions in Section [ ____(*1)], even if the Municipal Code already contains another definition of “person,” because this subsection relies on the broadly inclusive definition of “Person” in Section [ ____(*1)],

[ (h) Notwithstanding any other provision of this [ article / chapter ], a Private Enforcer may bring a civil action to enforce this [ article / chapter ] only if the following requirements are met:

(1) The Private Enforcer’s civil action is begun more than [ sixty (60) ] days after the Private Enforcer has given written notice of the alleged violations of this [ article / chapter ] to the [ City Attorney / County Counsel ] and to the alleged violator.

(2) On the date the Private Enforcer’s civil action is filed, no other Person acting on behalf of the [ City / County ] or the state has commenced or is prosecuting an administrative, civil, or criminal action based upon, in whole or in part, any violation which was the subject of the Private Enforcer’s notice.

[(3) A Private Enforcer shall provide a copy of his, her, or its action to the [ City Attorney / County Counsel ] within [ seven (7) ] days of filing it. ]

Model California Ordinance Regulating Electronic Smoking Devices 12 25

Upon a settlement or judgment based upon, in whole or in part, any violation which was the subject of the Private Enforcer’s notice, the Private Enforcer shall give the [ City Attorney / County Counsel ] notice of the settlement or judgment and final disposition of the case within [ thirty (30) ] days of the date of the settlement or judgment. No settlement by a Private Enforcer of a violation of this [ article / chapter ] shall be valid or enforceable if, within [ thirty (30) ] days of receiving notice of the settlement, the [ City Attorney / County Counsel ] determines the settlement to be unreasonable in light of the purposes of this [ article / chapter ]. Any settlement or judgment that does not meet the requirements of this subsection may be set aside upon motion to a court of competent jurisdiction by the [ City Attorney / County Counsel ]. ]

COMMENT: This optional provision enables a City Attorney or County Counsel to exercise “oversight” of private citizen enforcement actions permitted in Section [ ____(*5)(g)], above. If included, this provision allows a City Attorney or County Counsel to track and monitor Private Enforcer lawsuits, and if desired, pursue local government enforcement instead. This oversight provision is intended to address concerns about the potential for abusive lawsuits or collusive settlements by which a Private Enforcer lets a violator off too easily.

This provision requires a Private Enforcer to notify the City Attorney or County Counsel prior to filing the lawsuit. If the optional double-underlined language is included, it would also require the Private Enforcer to share a copy of the complaint with the City Attorney or County Counsel. No affirmative action is required by the City Attorney or County Counsel upon receipt of any of these documents; response is optional.

The last part of this subsection requires the Private Enforcer to submit a copy of the final settlement or judgment to the City Attorney or County Counsel. The City Attorney or County Counsel then has the opportunity to review and evaluate settlement agreements (but not court-issued judgments) to assess whether or not such agreements reasonably address the violation. This is designed to avoid potentially collusive or otherwise abusive settlement agreements (i.e., “sweetheart deals”). Finally, the City Attorney or County Counsel also has the authority to ask a court to set aside a court judgment if a Private Enforcer fails to comply with the requisite notice requirements.

SECTION III. STATUTORY CONSTRUCTION & SEVERABILITY. It is the intent of the [ City Council / Board of Supervisors ] of the [ City / County ] of [ ____ ] to supplement applicable state and federal law and not to duplicate or contradict such law and this ordinance shall be construed consistently with that intent. If any section, subsection, subdivision, paragraph, sentence, clause or phrase of this ordinance, or its application to any person or circumstance, is for any reason held to be invalid or unenforceable, such invalidity or unenforceability shall not affect the validity or enforceability of the remaining sections, subsections, subdivisions, paragraphs, sentences, clauses or phrases of this ordinance, or its application to any other person or circumstance. The [ City Council / Board of Supervisors ] of the [ City / County ] of [ ____ ] hereby declares that it would have adopted each section, subsection, subdivision, paragraph, sentence, clause or phrase hereof independently, irrespective of the fact that any one or more other sections, subsections, subdivisions, paragraphs, sentences, clauses or phrases hereof be declared invalid or unenforceable.

COMMENT: This is standard language. Often this “boilerplate” is found at the end of an ordinance, but its location is irrelevant.

Model California Ordinance Regulating Electronic Smoking Devices 13 26

1 U.S. Food and Drug Administration. (2001). Electronic Cigarettes. Retrieved on September 22, 2013 from www.fda.gov/newsevents/publichealthfocus/ucm172906.htm. 2 Corey, C., Johnson, S., Apelberg, B., et al. (2013). “Notes from the Field: Electronic Cigarette Use Among Middle and High School Students - United States, 2011- 2012.” Morbidity and Mortality Weekly Report (MMWR). 62(35):729–730. Available at: www.cdc.gov/mmwr/preview/mmwrhtml/mm6235a6.htm. 3 Ibid. 4 Ibid. 5 Ibid. 6 King, B., Alam S., Promoff, G., et al. (2013). “Awareness and Ever Use of Electronic Cigarettes Among U.S. Adults, 2010-2011.” Nicotine and Tobacco Research, doi: 10.1093/ntr/ntt013, 2013. 7 State of California Environmental Protection Agency, Office of Environmental Health Hazard Assessment, Safe Drinking Water and Toxic Enforcement Act of 1986. (2013) Chemicals known to the State of California to cause cancer or reproductive toxicity. Available at: http://oehha.ca.gov/prop65/prop65_list/files/P65single091313.pdf. 8 German Cancer Research Center. (2013). “Electronic Cigarettes - An Overview” Red Series Tobacco PRevention and Control. Available at: www.dkfz.de/de/tabakkontrolle/download/Publikationen/RoteReihe/Band_19_e- cigarettes_an_overview.pdf. 9 Goniewicz M, Knysak J, Gawron M, et al. Levels of selected carcinogens and toxicants in vapour from electronic cigarettes. Tob. Control. 2013;1:1–8. Available at: www.ncbi.nlm.nih.gov/pubmed/23467656. Accessed August 2, 2013. 10 German Cancer Research Center. (2013). “Electronic Cigarettes - An Overview” Red Series Tobacco Prevention and Control. Available at: www.dkfz.de/de/tabakkontrolle/download/Publikationen/RoteReihe/Band_19_e- cigarettes_an_overview.pdf. 11 Goniewicz M, Knysak J, Gawron M, et al. (2013). Levels of selected carcinogens and toxicants in vapour from electronic cigarettes. Tob. Control. 1:1–8. Available at: www.ncbi.nlm.nih.gov/pubmed/23467656. 12 Williams, M., Villarreal, A., Bozhilov, K., Lin, S., & Talbot, P. (2013). Metal and silicate particles including nanoparticles are present in electronic cigarette cartomizer fluid and aerosol. PloS one, 8(3), e57987. doi:10.1371/journal.pone.0057987 13 Schober W, Szendrei K, Matzen W, et al. (2013). Use of electronic cigarettes (e-cigarettes) impairs indoor air quality and increases FeNO levels of e-cigarette consumers. Int. J. Hyg. Environ. Health. Available at: http://dx.doi.org/10.1016/j.ijheh.2013.11.003 14 Agency for Toxic Substances and Disease Registery (ATSDR). (2008). Toxic Substances Portal – Aluminum. Available at: www.atsdr.cdc.gov/phs/phs.asp?id=1076&tid=34. 15 Agency for Toxic Substances and Disease Registery (ATSDR). (2005). Toxic Substances Portal – Tin. Available at: www.atsdr.cdc.gov/phs/phs.asp?id=541&tid=98. 16 United States Environmental Protection Agency. (N.d.) EPA Schools Monitoring Initiative Fact Sheet. Available at: www.epa.gov/air/sat/pdfs/acroleinupdate.pdf. 17 Agency for Toxic Substances and Disease Registery (ATSDR). (2007). Toxic Substances Portal – Acrolein. Available at: www.atsdr.cdc.gov/PHS/PHS.asp?id=554&tid=102.

18 State of California Environmental Protection Agency Office of Environmental Health Hazard

Model California Ordinance Regulating Electronic Smoking Devices 14 27

Assessment. (n.d.). Chronic Toxicity Summary: Toluene. CAS Registry Number: 108-88-3. Available at: http://oehha.ca.gov/air/chronic_rels/pdf/108883.pdf. 19 State of California Environmental Protection Agency Office of Environmental Health Hazard Assessment. (n.d.). Chronic Toxicity Summary: Toluene. CAS Registry Number: 108-88-3. Available at: http://oehha.ca.gov/air/chronic_rels/pdf/108883.pdf. 20 Environmental Protection Agency. (2012). Particle Pollution and Health. Available at: www.epa.gov/pm/2012/fshealth.pdf. 21 Department of Health and Human Servics Food and Drug Administration. (2009). “FDA Evaluation of E-Cigarettes.” Available at: www.fda.gov/downloads/drugs/Scienceresearch/UCM173250.pdf. 22 Department of Health and Human Services Food and Drug Administration. (2009). “FDA Evaluation of E-Cigarettes.” Available at: www.fda.gov/downloads/drugs/Scienceresearch/UCM173250.pdf. 23 German Cancer Research Center. (2013). “Electronic Cigarettes - An Overview” Red Series Tobacco PRevention and Control. Available at: www.dkfz.de/de/tabakkontrolle/download/Publikationen/RoteReihe/Band_19_e- cigarettes_an_overview.pdf. 24 Schripp, T., Markewitz, D., Uhde, E., & Salthammer, T. (2013). Does e-cigarette consumption cause passive vaping? Indoor Air. 23(1), 25–31. Doi:10.1111/j.1600-0668.2012.00792.x 25 Schober W, Szendrei K, Matzen W, et al. (2013). Use of electronic cigarettes (e-cigarettes) impairs indoor air quality and increases FeNO levels of e-cigarette consumers. Int. J. Hyg. Environ. Health. Available at: http://dx.doi.org/10.1016/j.ijheh.2013.11.003. 26 Yamin C, Bitton A, and Bates D. (2010). “E-Cigarettes: A Rapidly Growing Internet Phenomenon.” Annals of Internal Medicine, 153:607-609. 27 Chatham-Stephens, K., Law, R., Taylor, E., Melstrom, P., Bunnell, R., Wang, B., & Apelberg, B. (2014). Calls to Poison Centers for Exposures to Electronic Cigarettes - United States, September 2010 – February 2014. Morbidity and Mortality Weekly Report (MMWR), 63(13), 292–294. 28 Chatham-stephens, K., Law, R., Taylor, E., Melstrom, P., Bunnell, R., Wang, B., & Apelberg, B. (2014). Calls to Poison Centers for Exposures to Electronic Cigarettes - United States, September 2010 – February 2014. Morbidity and Mortality Weekly Report (MMWR), 63(13), 292–294. 29 U.S. Food and Drug Administration. (2009) FDA Warns Of Health Risk Posed By E-Cigarettes. Available at: www.fda.gov/downloads/forconsumers/consumerupdates/UCM173430.pdf. 30 Chen, L. (2013). “FDA Summary of Adverse Events on Electronic Cigarettes.” Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco. 15(2): 615–6. Doi:10.1093/ntr/nts145. 31 U.S. Food and Drug Administration. (2009). FDA Warns Of Health Risk Posed By E-Cigarettes. Available at: www.fda.gov/downloads/forconsumers/consumerupdates/UCM173430.pdf. 32 World Health Organization. (2013). Questions and Answers on Electronic Cigarettes or Electronic Nicotine Delivery Systems (ENDS). Available at: www.who.int/tobacco/communications/statements/eletronic_cigarettes/en/. 33 World Medical Association. (2012). Statement on Electronic Cigarettes and Other Electronic Nicotine Delivery Systems. Available at: www.wma.net/en/30publications/10policies/e19/index.html.pdf?print-media-type&footer- right=[page]/[toPage].

34 State of California Tobacco Education and Research Oversight Committee. (2013). Position on Electronic Cigarettes (e-cigarettes). Available at:

Model California Ordinance Regulating Electronic Smoking Devices 15 28

www.cdph.ca.gov/services/boards/teroc/Documents/Positions/TEROC%20Official%20Position%20of %20E-Cigs_June%202013_final.pdf. 35 McMillen R, Maduka J and Winickoff J. (2011). “Use of Emerging Tobacco Products in the United States.” Journal of Environmental and Public Health. Doi:10.1155/2012/989474. 36 Legacy Foundation. (2012). Tobacco Fact Sheet: Electronic Cigarettes (E-Cigarettes). Available at: www.legacyforhealth.org/PDFPublications/ECIGARETTE_0909_temp.pdf. 37 Kuschner WG, Reddy S, Mehrotra N, et al. (2011). “Electronic Cigarettes and Thirdhand Smoke: Two Emerging Health Care Challenges for the Primary Care Provider.” International Journal of General Medicine. 4: 115–120. Available at: www.ncbi.nlm.nih.gov/pmc/articles/PMC3068875/. 38 American Cancer Society Cancer Action Network, American Heart Association, Campaign for Tobacco Free Kids, American Lung Association. (2011). Policy Guidance Document Regarding E‐Cigarettes. Available at: www.acscan.org/content/wp-content/uploads/2013/06/Policy-Guidance-on-E- Cigarettes-.pdf. 39 American Lung Association in California, the Center for Tobacco Policy and Organizing. (2013). Tobacco Retailer Licensing and Electronic Cigarettes. Available at: http://center4tobaccopolicy.org/wp-content/uploads/2013/08/E-cigarettes-in-TRL-8.9.13.pdf. 40 American Lung Association in California, the Center for Tobacco Policy and Organizing. (2013). Local Policies on the use of Electronic Cigarettes. Available at: http://center4tobaccopolicy.org/wp- content/uploads/2013/11/Local-Policies-on-Use-of-E-Cigs-Nov-2013.pdf.

Model California Ordinance Regulating Electronic Smoking Devices 16 29 Will County Health Department

Tobacco Control & Prevention 501 Ella Avenue Joliet, IL 60433 Phone: (815) 727-8769 www.willcountyhealth.org

This project was made possible by funds received from the Illinois Department of Public Health E-CIGARETTES SHAPED LIKE USB FLASH DRIVES: INFORMATION FOR PARENTS, EDUCATORS, AND HEALTH CARE PROVIDERS

Electronic cigarettes (e-cigarettes) are battery-powered devices that can deliver nicotine and flavorings to the user in the form of an aerosol. E-cigarettes come in many shapes and sizes.

WHAT’S THE BOTTOM LINE?

A new e-cigarette shaped like a USB Nicotine is highly addictive and can flash drive is being used by students harm brain development, in schools. which continues until about age 25.

The use of any tobacco product Parents, educators, — including e-cigarettes—is & health care providers can unsafe for young people. help prevent and reduce the use of all tobacco products, including e-cigarettes, by young people.

CS292347-A >> Learn HOW in this fact sheet. AN INCREASINGLY POPULAR E-CIGARETTE DEVICE, CALLED JUUL, IS SHAPED LIKE A USB FLASH DRIVE.

JUUL’s nicotine liquid refills are called “pods.” JUUL is available in several flavors such as Cool Cucumber, Use of JUUL is sometimes Fruit Medley, Mango, and called “JUULing.” Mint.

All JUUL e-cigarettes have a JUUL became available for sale in the United States high level of nicotine. in 2015. As of December 2017, JUUL is the top-selling According to the manufacturer, e-cigarette brand in the United States. a single JUUL pod contains as much nicotine as a pack News outlets and social media sites report widespread of 20 regular cigarettes. use of JUUL by students in schools, including in class- rooms and bathrooms.

Other devices are becoming available that look like USB flash drives. Examples include the MarkTen Elite, a nicotine delivery device, and the PAX Era, a marijuana delivery device that looks like JUUL.

JUUL MarkTen Elite PAX Era E-CIGARETTE USE IS NOT SAFE FOR YOUNG PEOPLE.

E-cigarette aerosol is not harmless. It can contain harmful ingredients. However, e-cigarette aerosol generally contains fewer harmful chemicals than smoke from burned tobacco products, like regular cigarettes.

VOLATILE CHEMICALS ORGANIC COMPOUNDS ULTRAFINE HEAVY METALS SUCH AS PARTICLES NICKEL, TIN, AND LEAD

NICOTINE

FLAVORING SUCH AS DIACETYL, A CHEMICAL LINKED TO A SERIOUS LUNG DISEASE

Most e-cigarettes contain nicotine, YOUNG PEOPLE which is highly addictive and can WHO USE E-CIGARETTES , harm brain development MAY BE MORE which continues until about age 25. LIKELY TO GO ON TO USE REGULAR CIGARETTES. PARENTS, EDUCATORS, AND HEALTH CARE PROVIDERS CAN HELP PREVENT AND REDUCE THE USE OF E-CIGARETTES BY YOUNG PEOPLE.

PARENTS CAN: EDUCATORS CAN: »»Learn about the different shapes and types of »»Learn about the different shapes and types e-cigarettes and the risks of all forms of of e-cigarettes and the risks of all forms of e-cigarette use for young people. e-cigarette use for young people.

»»Talk to their children about the risks of »» Develop, implement, and enforce tobacco-free e-cigarette use among young people. Express school policies. firm expectations that their children remain tobacco-free. »»Reject youth tobacco prevention programs sponsored by the tobacco industry. These »»Set a positive example by being tobacco-free. programs have been found to be ineffective for preventing youth tobacco use.

PARENTS, EDUCATORS, AND HEALTH CARE PEDIATRIC HEALTH CARE PROVIDERS PROVIDERS CAN: CAN HELP »»Ask about e-cigarettes, including devices shaped like USB flash drives, when screening patients for the use of any tobacco products.

»»Warn patients about the risks of all forms of tobacco product use, including e-cigarettes, for young people. E-Cigarette Use Among Youth and Young Adults A Report of the Surgeon General

U.S. Department of Health and Human Services Fact Sheet (continued)

U.S. Department of Health and Human Services Tobacco 21 & Restricting E-Cigarette Use Indoors Will County Health Department Tobacco Control & Prevention  Tobacco 21 (T21) is a growing national campaign aimed at raising the minimum legal sales age for tobacco and nicotine products in the United States from 18 to 21  The National Youth Tobacco Survey reports that in 2017, 1 in 5 high schoolers used tobacco products, and 1 in 10 used What is multiple tobacco products Tobacco 21  Clever marketing by the tobacco industry targets youth by and Why Now? pushing small cigars, hookahs, e-cigarettes, and flavored vaping products Will County Illinois Youth Survey Data  Within the past 30 days…  41% of Will County 12th graders used any tobacco or vaping product  17% of Will County 10th graders used any tobacco or vaping But Why Do product We Need It?  35% of Will County 12th graders used e-cigarettes  13% of Will County 10th graders used e-cigarettes  Average age of first use of cigarettes and other tobacco products (Will County, 2016)  Cigarettes - 14.8 years old  Other tobacco products - 15.5 years old  Since 2016 Tobacco 21 (T21) has continued to gain momentum throughout the country Tobacco 21 is a  There are currently over 400 Growing cities and counties in the United States with a T21 National Trend ordinance  Six states (not including D.C. and Guam) have passed statewide T21 laws since 2015  Illinois currently has over 30 Tobacco 21 is a cities and counties with a T21 ordinance Growing Trend  Bolingbrook was the first in Illinois municipality in Will County to pass Tobacco 21 in March 2018 Let’s Add More Green! • Electronic cigarettes (e-cigarettes) are battery-powered devices that can deliver nicotine and flavorings in the form of an aerosol • The aerosol is not just harmless water vaper: • Nicotine is highly addictive • Heavy metals such as nickel, tin, & lead What are E- • Flavorings such as diacetyl, are linked to serious lung Cigarettes? disease • Nicotine can harm brain development, which continues to age 25 • E-cigarettes come in many shapes and sizes • While youth cigarettes smoking is slowly declining, e- cigarette use among youth has more than doubled in recent years • The health consequences of using e-cigarettes and Why Should E- exposure to secondhand e-cigarette emissions are Cigarettes be unknown. However, there is currently no scientific evidence Included in establishing the safety of e-cigarettes • E-cigarettes produce an aerosol that has nicotine, harmful These Policies? chemicals, and toxins known to cause cancer • E-cigarettes are NOT approved by the US FDA to help people quit smoking • Prohibit sales to individuals under 21

• Penalize the sale instead of the Model Tobacco possession – hold vendors and the 21 Legislation tobacco industry accountable • E-Cigarettes should be included

• Include Signage • Many local municipalities have locally adopted the Illinois Smoke-Free Illinois Act – prohibiting smoking in a public place or place of employment and within 15 feet of entrances/exits Including • Plainfield has adopted the Village of Plainfield Clean Air E-Cigarettes in Ordinance to mirror the Smoke-Free Illinois Act • Local municipalities have the power to strengthen the Local Indoor state law Smoke-Free • We recommend adding e-cigarettes to an existing Policies definition or adding a separate definition to the Village of Plainfield Clean Air Ordinance • In Will County, Aurora, Naperville, New Lenox, Shorewood, and Braidwood have included e-cigarettes in their local smoke-free ordinances Let’s See More Blue! Questions?

Tobacco Control & Prevention THANK YOU Will County Health Department 815-727-8769