November 8, 2019 The Honorable Alex Azar Secretary Department of Health and Human Services Washington, DC Dear Secretary Azar: We write to you as parents, grandparents and educators to support the President's call to "clear the markets" of all flavored e-cigarettes. Safeguarding the health of our nation's children is paramount to us. Children must be protected from becoming addicted to nicotine and the dangers posed by tobacco product. We ask for your leadership in ensuring that all flavored e-cigarettes, including mint and menthol, are removed from the marketplace. The dramatic increase in the number of youth vaping is staggering and we see it in our communities every day. Every high school in the nation is dealing with this epidemic. From 2017 to 2019, there was a 135 percent increase, and now one out of every four high school youth (27.5%) in America use these products. More than 6 out of 10 of these teens use fruit, menthol or mint- flavored e-cigarettes. The National Academies of Science, Engineering and Medicine concluded there is "substantial evidence" that if a youth or young adult uses an e-cigarette, they are at increased risk of using traditional cigarettes. Flavors in tobacco products attract kids. According to the Centers for Disease Control and Prevention, the candy and fruit flavors found in e-cigarettes are one of the primary reason’s kids use them. A 2015 study published in the Journal of the American Medical Association found that 81 percent of youth who have ever used tobacco products initiated with a flavored product. We need you to protect our nation’s youth from becoming another generation addicted to tobacco. We thank you for prioritizing the health of our nation's children and urge you to move forward with addressing the youth vaping epidemic by clearing the markets of all flavored e-cigarettes, including mint and menthol. I stand with the American Lung Association. Sincerely, Katie Steffens Alaska Lee Fisher Emily Vockeroth Larry Rundquist Alyssa Keill George Stewart Deborah Voves Please “Clear the Markets,” Secretary Azar: A Letter from Parents, Grandparents and Educators Ashley Peltier Kristie Sawyer Jennifer Chikoyak Anu Sanchez Levi Sutton Melissa Tubbs Jennifer Tschappat Kristen Stephens Emily Davis Sonya Wilson Julie Millington Mary Wyers Julie Saddoris Kelli Weinacker Amanda Estes Leah Johnston Dara Glass Craig Youngblood Diana Estes Edward Markushewski Julie Hasquet Jacqulyn Gates Cheryl Daniels Erica Frazier Andrea Gaspard Monica Hall Rick Hinkey Alissa Padgett Moses Tulim Leslie Flemming Victoria Galanopoulos Anne Brown Jennifer Brandt Anna Conley Victoria Shay Michael Lyerly Gabriele Larry Pamela Garrigus Christopher Lindsey Ellen Buckner Noel Crowley-Bell Kate White Marge Stoneking Danica Crane Laurie Orell Bobbie Shealey Aiden Keller Brenda Lindahl Wendy Ann Winant Mendez Sherry Lawrence Julie Manciagli Alabama Hope Helton Hilary Moreno Tracy Faust Ashley Lyerly Yvette Terhune Melanie Dickens Marissa Natelson Love Kimberly Cook Tammy Shikany Paige Willcutt Sherry Schnebel Wendy Pickard Nelson Brooke Tammy Nichols Carissa Anthony Tracy Ellis Kim Cochran Mark Kiel Kristin Rezek Bridgett Glasgow Janice Schuster Linda Rummell Rebekah Savage Anna Kittinger Tim MtHolt Deanne Guthrie Esther Brown Julie Renta Laura McGilberry Jada Shaffer Stephanie Lynn Rains Deanna Walton Johnson 2 Please “Clear the Markets,” Secretary Azar: A Letter from Parents, Grandparents and Educators Erin Cashen Goode Jennifer Smith Darlene Sanford Barbara Warren Diane Patterson Tingle Pat Bell Brenda Shaffer Jamie Grimes Debra Jones Cindy Bruce Luann Allen Mel Henshaw Shela Thomason Clemons Melvin Bautista Roxana Llovera-Olsson Michael Carpenter Alecia Jackson Keith Kaback Donald Landers Michael Acosta Bettina Bickel Arkansas Tania Malven Kirk Rhoads Patricia Always Douglas Spurlin MaryAnn Graffagnino Jennifer Parr Frank Graffagnino Heather Pearsom Martha Cast Michelle Frazier Lois Zeidman Rita Newman Tracy Cole Niq Marshall Helen Greer Sandra Tate Gregory Altmeyer Mary Groves JoAnna Strother Scout Simmons Robert Sorensen Shanna Bolin Stacey Mortenson Sharon Tipton Berry Cindy Kozlowski Debra Haywood Roxana Ashurst Johnna Murray Candace Alexander Peggy Chopp Stephanie Watkins Karmen Cummings Karen Lirange Ursula Mote Leigh Naig Karen VanDyke Candace Thrash Stephanie Gerardin Arizona Marilyn Stooks Eleanor Andersen Danielle Bowen-Weiszmann Gerry Milliken Don Awerkamp Melvin Bautista Tammy Rocker Jennifer Bonney Grant Smedley Bridget Clark-Cooper Jeffrey Garbe Danielle Parker David Sanderson Nicole Schenk Kathleen Rubi Eva Camacho Boyd Gregg Laridis Danielle Williams Sarah Aguilar Ellen Krikorian Anne Schmitz Jan Crews Beverly Kramer 3 Please “Clear the Markets,” Secretary Azar: A Letter from Parents, Grandparents and Educators Jayne Raffety Vic Bostock Marta Romano Kelly Lee Susan Wagemann Paul Belz John Fedyna David Lee Maria Ford Claire Warshaw Robin Golden Rojas Ware Kuschner Todd Koza Michael Sarabia Jackie Johns Jodie Langford Dolores Esquivel Mike Maritch Elliott Rothermond Lacey Hicks Kevin Kern Joanne Tenney Kevin Branstetter California David Bezanson Urmila Padmanabhan Bob Hahn Jenny Bard Debra Milne Stephanie Frazier Dori Neuman Shan Magnuson Diana Abasta Laura Fultz Warren M. Gold Margarita Loeza Mary F Platter-Rieger Terrie Johnson Samuel Durkin Erica Costa Karen Jakpor Kristi Cole Beti Webb Trauth James Howard Linda Weiner Ellen Sherwood Pat Munsch Michael Olivares Pamela Granger Rick Smith Karl Koessel Pierra Moise John Walton William Barrett Sharon Laabs Frances Mojica Eddamai Johnson David Flores Robert Davenport Gloria Escarcega Alicia Morin Catherine Bonniot Steve Graff Christine Imrey Paulette Collins Krista Boscoe Roberta Cohen JoAnn Covington Casee Maxfield Nicole Yargeau Martin Horwitz Dolores Philippon David Boyer Jennie Robles Carol Gordon Randa Talbott Elizabeth Weinberger Sarah McCoy John H Anderson Iris Gildfein Janet Maker Jeanine Cotter Melanie Moore Helene Whitson Isabella Amoroso 4 Please “Clear the Markets,” Secretary Azar: A Letter from Parents, Grandparents and Educators Charles Davis Nancy Jorgo Denise Couey Victoria Bermudez Mary Mote Michael Mann Tim Linerud Laura Applebaum Kelly Welton Laura Barrett Arthur Connor Don Yost Rob Seltzer Ana Aguirre Karen Molenda Ana Duarte Li-hsia Wang, MD Karina Funez Dale Hillard Donna Jackson Tami Phelps Ruth Bull Nancy Boyce Vivian Suh Marjorie Streeter Christopher Ware Gina Gatto Rita Redaelli Deanna Mousaw Eury Ramos Eblin Venegas Jordan Abushawish Julie Ford Susan Friedman Mario Zdybel Joseph Abushawish Deanna Knickerbocker Esther Woo Danny DeTora Denice Bragg Natalie Hall Scott Grinthal Therese DeBing Celica Abushawish Gilda Fusilier Jacqueline Hdez James Jett J Jesus Rivera Dan Larson Robert Mejia Maryellen Redish Mohammed Majrashi Sharmin Khajavi Aminah Majrashi Vlad Zavidovych Erika Pinto Colleen Lobel Susan Robinson Kate Ague Alicia Hechter Pauline Lau Broyles Maxine Tatlonghari Tina Brenza Karynn Merkel John Oda Sandra Ghazal Kathleen Lohmann Brittney Morales-Bravo Mary Strenn Leslie Gonzalez Melvin Taylor Anah Guerrero Delores Komar Franca Ayala Fiona Holtzclaw Harkeet Sappal Diana Allen Derinda Gates Diane Hart Gabriel Carrera Holly Hall Darla Deats Margarita Perez Robert Glover Winke Self William Fahr 5 Please “Clear the Markets,” Secretary Azar: A Letter from Parents, Grandparents and Educators Mark Di Giorgio Patricia Carlson Rebecca Rogers Terri Pilawa Karina Funez Roger H. Harrell Laren Tan Jason Park Kelsie Nagele Ruta Radzins Marissa Maxey Joan Cousins Brian Le John Holtzclaw Jill Arnstein Tonya Walker Laura Conger Teri Dovidio Reghina Crump Janice Carr Heidi He John Epperson Mark Horton Ms. Carla Compton Yenealem Dejene Pj Geise Cecilia Carson Kendra Knight Lauren Murdock Sandra Harris Afif Elhasan Charles Warner Philippe Montgrain Melissa Garcia Letisia White June Ehemann Joann Tuinei Luis Rodriguez Mary Prunicki Daniel Cobb Nancy DaSilva Myrna Nieto L'Tanya Byrd Kim Lu Maureen Bianco Jose Vello Benton Ashlock L. 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Streissguth Joyce Quiroga Kay Ward Kevin Nesbitt Richard J Jackson Blanca Jones Veronica An William Allen, Jr. Colorado Rozanne Vizcarra Nicole Rosa Jeff Byrom Ellen Penrod Cindy Williamson Boquist Melissa Van Deventer Mudd Holder Avalos Molly Weiss Joanzie Moss Monica Kennedy Sue Hahn Stephanie Seybold Joann Arvizu Ila Goldanloo Carole Champion Jill Zufelt Darby Kerr Julie Scates Anjali Rojas Carol Drage Kim Montano Cody Broussard DeaAnne Lang Emily Merrill Kaarina Lynnette Nash Jason Brown Marcie Smith Heather Price Lois Shubert Jll McLain Melanie Cohen Laura Feldman Debra Reynolds Kate Lipscomb Katherine Shurik Kady Gerhart Michelle Hall James Harmison lorrieann Gonzalez Rebecca Sellers Shirley Murphy We ylan Bryant Judy Willis Donna Bonetti Nancy Johnson James Lewis Randy Leon Dawn Vaughn Julie Vetrie