Regulation of the Amherst Board of Health Restricting Youth Access and Exposure to Tobacco and Nicotine Delivery Products I. Statement of Purpose: Despite state laws prohibiting the sale of tobacco products to youth, access by youth to tobacco and nicotine delivery products is a major problem. In the interest of public health, it is the policy of the Town of Amherst to discourage youth from accessing and experimenting with tobacco and nicotine delivery products. The purpose of this regulation is to regulate establishments that sell tobacco and nicotine delivery products in a way that will: 1. reduce the number of youth who use tobacco and nicotine delivery products; 2. prevent the sale of tobacco and nicotine delivery products to individuals under the age of 21; 3. educate shop owners and employees who sell tobacco and nicotine delivery products within the Town of Amherst; and 4. reduce life-long consequences associated with tobacco and nicotine delivery product use. The Massachusetts Supreme Judicial Court has held that "...[t]he right to engage in business must yield to the paramount right of government to protect the public health by any rational means"[Druzik et al v. Board of Health of Haverhill, 324 Mass.129 (1949)]. Now, therefore the Amherst Board of Health intends to regulate the sale of tobacco and nicotine delivery products. II. Supporting Evidence: Tobacco use remains the number one cause of preventable disease, disability and death in the United States. Approximately 34 million American adults currently smoke cigarettes. Most tobacco product use begins during adolescence. In recent years, tobacco products have evolved to include various smoked, smokeless and electronic products(Adams, 2020; Wang et al, 2019). Cigarette smoking harms nearly every organ of the body, causes cancer, cardiac and respiratory diseases, stroke, adverse birth outcomes, and reduces the health of smokers in general. Tobacco use is the primary cause of premature death in the United States. Smoking cigarettes causes more Americans to die each year than alcohol, car accidents, HIV, guns and illegal guns combined. Smoking depresses pulmonary immune function and is a risk factor contracting other infectious diseases and more severe outcomes among people who become infected. Smoking is a risk factor for the progression of COVID-19, with smokers having higher odds of COVID-19 progression than never smokers (Patanavanich and Glantz, 2020; WHO,2020; Adams,2020; CDC,2015; American Cancer Society, 2018). In 2019, an estimated 53.3% of high school students (8.0 million) and 24.3% of middle school students (2.9 million) reported having ever tried a tobacco product. Recent increases in the use of e-cigarettes, especially JUULs, among youth in the US have risen exponentially. Surgeon General Jerome Adams declared vaping among youth in the U.S. an epidemic(Adams, J., 2018; CDC,2019; Wang, et al, 2019). The U.S. Food and Drug Administration and the U.S. Surgeon General have stated that flavored tobacco products are considered to be "starter" products that help establish smoking habits that can lead to long- term addiction (FDA,2011). The U.S. Food and Drug Administration and the Tobacco Products Scientific Advisory Committee concluded that menthol-flavored tobacco products increased nicotine dependence and decreased success in smoking cessation (CTCRE, UCSF 2011). E-cigarette aerosol is not harmless; a typical e-cigarette cartridge (pod)contains as much nicotine as a pack of20 cigarettes. Nicotine exposure during adolescence can harm the developing brain and have potentially severe consequences for teen addiction, cognition and emotional regulation manifested in learning, memory, and attention problems. In addition to nicotine, the aerosol from e-cigarettes can potentially expose both users and bystanders to other harmful substances, including toxic compounds (e.g. formaldehyde, acetaldehyde, nitrosamines, cadmium, nickel, tin, and lead), volatile organic compounds(VOCs), and ultrafine particles that can be inhaled deeply into the lungs (Berry, K.M., Fetterman, J.L., et al, 2019; Adams, 2018; Andrews, J.C., et al, 2018; Yuan, M., Cross, S., Laughlin, S. & Leslie, P., 2015). Many e-cigarettes come in flavors that make them more appealing to teens. Flavor additives can create acetyls when mixed with e-liquids; when inhaled, these acetyls irritate the lungs in ways similar to how asthma and inhaling smoke or fumes can bother the lungs. Some chemicals used to make certain flavors contain different levels of diacetyl that has been linked to a severe lung disease called bronchiolitis obliterans(Adams, J., 2018; Duke University Medical Center, October 18, 2018). Nicotine can prime the brain and increase the risk offuture addiction to other drugs and alcohol. The use of e-cigarettes may help spawn even more opioid addiction. It is known that nicotine is as addictive as heroin, so once hooked, most young e-cigarette users will become long-term users.(Berry, K.M.' Fetterman, J.L., et al, 2019; Adams, 2018; Drazen, Morrissey, & Campion, 2019) III. Authority; This regulation is promulgated pursuant to the authority granted to the Amherst Board of Health by Massachusetts General Laws Chapter 111, Section 31 which states "Boards of health may make reasonable health regulations". TV. Definitions For this regulation, the following words shall have the following meanings: Adult-only Retail Tobacco Store (also known as "Retail Tobacco Store" in MGL Ch. 270): An establishment that does not share space with another business, that has a separate entrance, that does not sell food or alcohol, that does not have a restaurant license or lottery license, whose only purpose is to sell or offer for retail sale, tobacco products (which includes nicotine delivery products) and tobacco paraphernalia, and in which the entry of persons under the age of 21 is prohibited at all times, and which maintains a valid permit for the retail sale oftobacco products as required by the Amherst Board of Health. Blunt Wrap: Any tobacco product manufactured or packaged as a wrap or as a hollow tube made wholly or in part from tobacco that is designed to be filled by the consumer with loose tobacco or other fillers (regardless of content) and not to be used by the consumer as a final product. Business Agent: An individual who has been designated by the owner or operator of any establishment to be the manager or otherwise in charge of said establishment. Characterizing flavor: A distinguishable taste or aroma, other than the taste or aroma of tobacco, imparted or detectable either prior to or during consumption of a tobacco product or component part thereof, including, but not limited to, tastes or aromas relating to any fruit, chocolate, vanilla, honey, candy, cocoa, dessert, alcoholic beverage, menthol, mint, wintergreen, herb or spice; provided, however, that no tobacco product shall be determined to have a characterizing flavor solely because of the provision of ingredient information or the use of additives or flavorings that do not contribute to the distinguishable taste or aroma ofthe product. Child-resistant packaging: packaging intended to reduce the risk of a child ingesting nicotine and that meets the minimum standards of 16 C.F.R. 1700 et seq., pursuant to 15 U.S.C. 1471 to 1476, inclusive. Cigar: Any roll of tobacco that is wrapped in leaf of tobacco or in any substance containing tobacco, with or without a tip or mouthpiece, that is in a readily usable state immediately when removed from its packaging without any modification, preparation or assembly required as in a kit or roll-your-own package, and is not otherwise defined as a cigarette under Massachusetts General Law, Chapter 64C, Section 1, Paragraph 1. Tobacco leaf in such kits or roll-your-own packages shall be considered "blunt wraps" for the purpose of this regulation. Component part: Any element of a tobacco product, including, but not limited to, the tobacco, filter and paper, but not including any constituent. Constituent: Any ingredient, substance, chemical or compound, other than tobacco, water or reconstituted tobacco sheet, that is added by the manufacturer to a tobacco product during the processing, manufacturing or packaging of the tobacco product. Such term shall include a smoke constituent. Coupon: Any card, paper, note, form, statement, ticket or other issue distributed for commercial or promotional purposes to be later surrendered by the bearer so as to receive an article, service or accommodation without charge or at a discount price. Distinguishable: Perceivable by either the sense of smell or taste. Educational Institution: Any public or private college, school, professional school, scientific or technical institution, university or other institution furnishing a program of higher education Electronic Nicotine Delivery System: An electronic device, whether for one-time use or reusable, that can be used to deliver nicotine or another substance to a person inhaling from the device including, but not limited to, electronic cigarettes, electronic cigars, electronic cigarillos, electronic pipes, vaping pens, hookah pens and other similar devices that rely on vaporization or aerosolization; provided, however, that "electronic nicotine delivery system" shall also include any combustible liquid or gel that is manufactures into a finished product for use in such electronic device; provided further, that "electronic nicotine delivery system" shall also include any component, part or accessory of a device used during the operation of the device even if the part or accessory was sold separately; provided further, that "electronic nicotine delivery system" shall not include a product that has been approved by the United States Food and Drug Administration for the sale of or use as a tobacco cessation product or for other medical purposes and is marketed and sold or prescribed exclusively for that approved purpose. Employee: Any individual who performs services for an employer. Employer: Any individual, partnership, association, corporation, trust or other organized group of individuals that uses the services of one(1) or more employees.