The County of Santa Clara
California

Report
71488

9 Consider recommendations relating to regulation of electronic smoking devices. (Public Health Department)

Information

Department:Public Health DepartmentSponsors:
Category:Report

Attachments

  1. Printout
  2. Proposed Findings - FINAL (This file has not yet been converted to a viewable format)
  3. Summary of Proposed Regulation of E-Cigarettes - FINAL (This file has not yet been converted to a viewable format)
  4. Resolution for Permit Fee - FINAL (This file has not yet been converted to a viewable format)
  5. Ord No 625 7 (Tobacco E-Smoking Restrictions Generally) - Final - CLEAN (This file has not yet been converted to a viewable format)
  6. Ord No 625 7 (Tobacco E-Smoking Restrictions Generally) - Final - REDLINE (This file has not yet been converted to a viewable format)
  7. Ord No 625 8 (Tobacco E-Smoking Restrictions in MUR) - Final - CLEAN (This file has not yet been converted to a viewable format)
  8. Ord No 625 8 (Tobacco E-Smoking Restrictions in MUR) - Final - REDLINE (This file has not yet been converted to a viewable format)
  9. Ord No NS-300 873 (Retailer Permits) - Final - CLEAN (This file has not yet been converted to a viewable format)
  10. Ord No NS-300 873 (Retailer Permits) - Final - REDLINE (This file has not yet been converted to a viewable format)
  11. Public Comment - Parcel Letter
  12. Speaker Form

Multiple Recommendations

Possible action:
a. Accept report relating to feasibility and timeline for incorporating regulation of electronic smoking devices into the current tobacco prevention and control ordinances.
b. Forward a recommendation to the June 10, 2014 Board of Supervisors meeting to adopt findings for Ordinances NS-625.7, NS-625.8, and NS-300.873.
c. Forward a recommendation to the June 10, 2014 Board of Supervisors meeting to adopt Ordinances NS-625.7, NS-625.8, and NS-300.873, relating to regulation of electronic smoking devices and tobacco products in the County unincorporated areas.
d. Forward a recommendation to the June 10, 2014 Board of Supervisors meeting to notice and hold a hearing to adopt a Resolution establishing fees for permits to be obtained by retailers of electronic smoking devices and/or tobacco products.

Body

FISCAL IMPLICATIONS

There is no impact to the General Fund as a result of accepting the report. Recommendations regarding the creation of any necessary educational materials, including signage, could be covered by existing resources within the Public Health Department.  Costs associated with the permitting of any retailers of electronic smoking devices alone will be covered through permit fees.  However, retailers that sell tobacco products and electronic smoking products and that already have a valid tobacco retailer permit will not be required to obtain another permit or pay another fee.

REASONS FOR RECOMMENDATION

Santa Clara County has been a leader in protecting the health of its residents, children and youth in particular, from the devastating consequences caused by tobacco use. In 2009, the Board expanded the County’s No Smoking Policy (Board Policy Manual, Section 3.47) to protect the health of all employees, clients and visitors from secondhand smoke exposure. The policy further restricted smoking inside County facilities, created a smoke-free campus at the Santa Clara Valley Medical Center, including all current and future Valley Health Centers, as well as increased the smoke-free zones surrounding County-owned and leased facilities.

In 2010, the Board adopted three tobacco prevention ordinances to reduce and prevent tobacco use, particularly among youth, and reduce exposure to secondhand smoke. Under the Smoking Pollution Control Ordinance, smoking is banned in any enclosed structure owned or leased by the County; all enclosed and unenclosed places open to the public in the unincorporated areas of the County; and nearly all places of employment in the unincorporated areas of the County. (County of Santa Clara Ordinance Code, Div. B13, Ch. V (§ B13-79 et seq.).) The Smoking Pollution Control in Multi-Unit Residences Ordinance bans smoking in all units and common areas (other than designated smoking areas) of all multi-unit residences, including apartments, condominiums and townhouses. (Id. at Div. B13, Ch. VIII (§ B13-105 et seq.).) The Tobacco Retailer Permit Ordinance requires all retailers in the unincorporated areas of the County to obtain and maintain an annual permit to sell tobacco products. (Id. at Div. A18, Ch. XXIII (§ A18-367 et seq).) The ordinance also, among other things, restricts future retailers from operating in areas located within 1,000 feet of a school or 500 feet of an existing retailer. Adopting these ordinances helped to pave the road for 12 other cities in Santa Clara County to pass similar types of policy changes, impacting over 1.6 million County residents.

The rapidly increasing use of electronic smoking devices (referred to variously as electronic cigarettes, electronic cigars, electronic cigarillos, electronic pipes, electronic hookahs, electronic vapes, vaporizers, and otherwise) threatens to undo much of the social norm change around tobacco use that has largely resulted from policies like the ones implemented by the County. Electronic smoking devices are a class of electronic and/or battery-operated products generally designed to look like and be used in the same manner as conventional cigarettes, cigars, and pipes, often with a light-emitting diode (LED) light at the tip that mimics the glow of a traditional cigarette.  They generally contain cartridges filled with nicotine, flavor and other chemicals, which are aerosolized or vaporized for inhalation by the user.

On December 17, 2013, the Board directed the Public Health Department to report through the Health and Hospital Committee on the feasibility and timeline for incorporating regulation of electronic smoking devices into the County’s current tobacco prevention and control ordinances and policies, and report on impacts to external stakeholders. On March 25, 2014 the Board approved a resolution amending the County’s No Smoking Policy (Board Policy Manual, Section 3.47) and Santa Clara Valley Health and Hospital System’s No Smoking Policy (Policy #810.1).  Together, these policies prohibit the use of electronic smoking devices within any enclosed structure owned or leased by the County; all current and future County-operated health facilities and clinics, extending at least as far as the property line; all unenclosed places within 30 feet of any operable doorway, window, vent or other opening into such a building; and all County vehicles.  The County policy also prohibits the sale of tobacco products and electronic smoking devices on County-owned and -operated property.

Electronic smoking devices are currently unregulated by the federal government, and few restrictions exist at the state level.  In 2010, the U.S. Court of Appeals for the D.C. Circuit held that the Food and Drug Administration (FDA) could regulate e-cigarettes as a tobacco product under the Family Smoking Prevention and Tobacco Control Act. The FDA could, therefore, require the e-cigarette industry to follow the same regulations that guide the tobacco manufacturing process, including: ingredient listing, good manufacturing practices and advertising restrictions.[1] The FDA just recently issued a proposed rule on April 24, 2014, establishing its authority to regulate electronic smoking devices. Consistent with currently regulated tobacco products, under the proposed rule, makers of electronic smoking devices would, among other requirements: 1) Register with the FDA and report product and ingredient listings; 2) Only market new tobacco products after FDA review; 3) Only make direct and implied claims of reduced risk if the FDA confirms that scientific evidence supports the claim and that marketing the product will benefit public health as a whole; and 4) Not distribute free samples. In addition, under the proposed rule, the following provisions would apply to electronic smoking devices: minimum age and identification restrictions to prevent sales to underage youth; requirements to include health warnings; and prohibition of vending machine sales, unless in a facility that never admits youth.[2] California law, by contrast, merely prohibits anyone from selling or otherwise providing electronic cigarettes to minors (Health and Saf. Code, § 119405) and prohibits certain online and mobile marketing and advertising of e-cigarettes to minors (Bus. & Prof. Code, § 22580, subd. (a), (b), and (i)(17)).

In the absence of government oversight, manufacturers and retailers have advertised their products as a healthy, safe alternative to cigarettes.[3] Furthermore, the electronic smoking device industry advertises through multiple media platforms such as television, magazines and social media sites – practices that the tobacco industry has not been allowed to engage in for many years.[4] Electronic smoking device companies are also marketing electronic smoking devices as smoking cessation devices3, and yet, despite these aggressively marketed claims, no electronic smoking device company has submitted an application to market electronic smoking devices as either smoking cessation aids or reduced risk products to the FDA.

The current lack of regulation and widespread availability of electronic smoking devices have contributed to increasing social acceptance of electronic smoking devices and dangerous perceptions that these products are safe or safer than conventional tobacco products.  Children and adolescents are particularly vulnerable to the renormalization of smoking through the use of electronic smoking devices. Youth are now witnessing smoking behaviors in public spaces that have been smoke-free for most, if not all, of their lives. Youth are also being exposed to electronic smoking device advertising on television, something that has been prohibited for decades for traditional tobacco products. An April 2014 Congressional Report investigating the marketing practices of nine of the largest electronic cigarette manufacturers, found that all nine of the companies were using various marketing practices to appeal to youth.[5] These practices, many of which were self-reported by the companies, include sponsoring youth-oriented events such as music festivals, and handing out free product samples at as many as 348 events between 2012-2013.5 The result of all this is that youth are rapidly turning to electronic smoking devices. A Centers for Disease Control and Prevention (CDC) study showed that, in 2011, 4.7% of all high school students had tried electronic smoking devices and that, in 2012, that number increased to 10.0% of all high school students.[6] Electronic smoking devices and other unapproved nicotine delivery products have a high appeal to youth due to their high tech design and availability in child-friendly flavors like cotton candy, bubble gum, chocolate chip cookie dough and cookies and cream milkshake.4,5 The FDA has raised concerns that electronic cigarettes, including but not limited to flavored electronic cigarettes, can increase nicotine addiction among young people and may lead youth to try conventional tobacco products.[7]

According to a survey by the CDC, the number of Americans who had ever used electronic smoking devices quadrupled from 2009 to 2010, and 1.2 percent of adults, or nearly three million people, reported using electronic smoking devices in the previous month.[8] In addition, studies have shown that there are high levels of dual use among users of electronic smoking devices and conventional cigarettes.8,[9]

The Surgeon General has found that the chemical nicotine is a powerful pharmacologic agent that acts in the brain and throughout the body and is highly addictive[10] and the use of nicotine may cause or contribute to cardiovascular disease, complications of hypertension, reproductive disorders, cancer, gastrointestinal disorders, including peptic ulcer disease, and gastro esophageal reflux[11], and immediate adverse physiologic effect after short-term use that are similar to some of the effects seen with tobacco smoke.[12] A recent CDC study found the number of calls to poison centers involving e-cigarette liquids containing nicotine rose from one per month in September 2010 to 215 per month in February 2014.[13] Because there is little control or regulation of electronic smoking devices products, the amount of nicotine inhaled with each “puff” may vary substantially, and testing of sample cartridges found that some labeled as nicotine-free in fact had low levels of nicotine.[14] A study published in the European Respiratory Journal found that e-cigarette users get as much nicotine from e-cigarettes as smokers usually get from tobacco cigarettes.[15]

The FDA has determined that since there is virtually no regulation of electronic cigarettes, consumers have no way of accurately knowing the doses of nicotine that they are inhaling when using these products; and, the FDA has warned the public about the potential health risks of using electronic cigarettes and has found carcinogenic chemicals and toxic ingredients in some electronic cigarettes.1 Electronic smoking device packages do not supply any warnings about possible adverse effects on health comparable to FDA-approved nicotine replacement products or conventional cigarettes[16]; and the World Health Organization does not consider electronic smoking devices to be a legitimate therapy for smokers trying to quit tobacco[17] as there is no scientific evidence that electronic smoking devices can help smokers to quit smoking.

Electronic smoking devices contain and emit propylene glycol, a chemical that is used as a base in the electronic smoking device solution and is one of the primary components in the aerosol emitted by electronic smoking devices. Even though propylene glycol is FDA approved for use in some products, the inhalation of vaporized nicotine in propylene glycol is not. Some studies show that heating propylene glycol changes its chemical composition, producing small amounts of propylene oxide, a known carcinogen.[18] 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 cancer,[19] such as formaldehyde, acetaldehyde, lead, nickel, and chromium.[20],[21]  Additionally, studies have found the presence of PM2.5,  acrolein, tin, toluene, and aluminum, 20,21,[22],[23] which are associated with a range of negative health effects such as skin, eye, and respiratory irritation,[24] neurological effects,[25] damage to reproductive systems,24 and even premature death from heart attacks and stroke.[26]  Such substances appear to be contained in and emitted from electronic smoking devices, regardless of whether the cartridges contain nicotine.

For all of the foregoing reasons, local regulation is needed. Many communities across the United States and California agree and have moved forward with prohibiting the use and sale of electronic smoking devices in their jurisdictions. Over 100 cities and counties across the United States, including more than 40 counties and cities in California, have placed restrictions on the use and sale of electronic smoking devices.[27],[28]

In addition, the Public Health Department recommends a prohibition on retailers’ use of vending machines for the sale of either electronic smoking devices or tobacco products, as well as a prohibition on retailers’ use of self-service displays of electronic smoking devices in retail locations other than vape shops.  A requirement for face-to-face transactions (i.e., no vending machine sales or self-service displays), are a proven strategy for reducing minors’ access to tobacco products, as they require assistance from the store merchant, and prevent shoplifting of tobacco products.[29],[30]

CHILD IMPACT

The onset of tobacco use generally occurs before age 18; therefore, prevention of smoking initiation among children and adolescents is a powerful strategy for preventing much of the illness and mortality associated with tobacco use. If no action is taken, children would continue to be exposed to the use of electronic smoking devices and secondhand aerosol emitted from electronic smoking devices, normalizing the action of smoking in public places that were previously smoke-free.

SENIOR IMPACT

If no action is taken, seniors would continue to be exposed to the use of electronic smoking devices and secondhand aerosol emitted from electronic smoking devices, normalizing the action of smoking in public places that were previously smoke-free. Observing smoking behavior can also be a trigger for people who are trying to quit smoking.

SUSTAINABILITY IMPLICATIONS

The recommended action will have no/neutral sustainability implications.

BACKGROUND

This section will: 1) Describe how the Public Health Department worked with internal and external stakeholders in developing the proposed recommendations; 2) Outline the proposed changes to each of the County’s tobacco prevention and control ordinances and the scientific findings and rationale for regulation; 3) Provide a summary description of current research including what is less known, and requires additional research; and 4) Describe the timeline and next steps regarding implementation, should the recommendations be approved.

This section addresses issues that were raised at the March 25, 2014 Board of Supervisors meeting, including the request to address areas of state law not previously covered by County policy and ensuring sufficient outreach is conducted with various stakeholders including businesses, tobacco retailers, Stanford University, County Youth Task Force, and multi-unit residence landlords, owners and tenants.

Public Outreach and Stakeholder Engagement:

Since March 25, 2014, the Public Health Department convened two meetings with internal stakeholders, including representatives from Department of Environmental Health and County Counsel. Outreach was also conducted with the Tri-County Apartment Association, Stanford University, County Parks, County Sheriff’s Office, and the County Youth Task Force, as was requested by the Board of Supervisors. Additionally, letters were mailed to all businesses (tobacco retailers, restaurants, bars, worksites, hotels/motels, etc.) and multi-unit residences (apartments, townhomes, condos) in the County unincorporated areas outlining the proposed changes to the current tobacco prevention ordinances, and soliciting any feedback on the proposed changes. 

The Tri-County Apartment Association has not taken an official position on the regulation of electronic smoking devices but conducted outreach with their members to solicit input on the County’s proposal. Stanford University conducted outreach with various campus stakeholders.

Currently there are 24 tobacco retailers permitted in the County unincorporated areas, of which nine (9) currently sell electronic smoking devices. At this time, staff have not identified any retailers that sell electronic smoking devices but do not sell traditional tobacco products in the unincorporated areas. Should there be any new retailers of electronic smoking devices, the permit fee would be the same as the fee for sellers of traditional tobacco products ($425 annually). Retailers with current tobacco retailer permits who are also selling electronic smoking devices would not be required to obtain any additional permit or pay any additional fee.

Additionally, the Public Health Department-coordinated youth tobacco prevention coalition, Community Advocate Teens of Today, is conducting educational presentations and discussions with youth organizations, including city-run Youth Advisory Commissions, the County’s Youth Task Force and Santa Clara County Office of Education, to further explore this issue and its impacts on youth in our county.

Finally, per request by the Board of Supervisors, the Public Health Department has conducted initial outreach to the Planning Department to further understand current and potential regulatory mechanisms, such as conditional use permits, as it relates to advertising of electronic smoking devices. The proposed changes to the County ordinance would require any retailers that sell electronic smoking devices to comply with the current regulation of not covering more than 15% of windows and clear doors with any type of ads or signs, which applies to sellers of traditional tobacco products. The Department of Environmental Health checks for compliance of this provision on an annual basis. Earlier this year the Public Health Department conducted preliminary observations in tobacco retail stores countywide, including unincorporated areas, and has found that advertising practices for electronic smoking devices mirrors those of traditional tobacco products. The Public Health Department, if requested, will continue to keep the Board informed as additional research is conducted on this issue.

Proposed Changes

See attachment “Proposed Regulation of Electronic Smoking Devices” for a detailed description of the proposed changes to each of the three Santa Clara County No-Smoking Ordinances. In summary, the proposed changes are to prohibit the use of electronic smoking devices wherever tobacco use is currently prohibited by state or local law, with the exception of private units of multi-unit residences.  Additionally, any business that sells electronic smoking devices would be required to obtain a local retail permit, if they do not already have a valid Santa Clara County Tobacco Retailer Permit, and abide by certain requirements in order to maintain that permit. A summary of the current evidence, including areas where more research is needed, it outlined for each ordinance below. A separate document [“Ordinance Findings”], outlines the findings that provide the rationale for the recommendations.

Smoking Pollution Control and Smoke-free Multi-Unit Residences Ordinances

Summary of Related Research: Studies of electronic smoking devices demonstrate a lack of standards for electronic smoking devices, discrepancies between stated nicotine levels in e-cartridges and actual content levels, and wide variability in electronic smoking device constituents and toxicants. The studies examining what is in electronic smoking devices, including their component parts, are limited by the selection of a handful of products examined (from the hundreds on the market). Long-term health impacts are unknown at this stage because the products and their use are very new and evolving rapidly. However, early studies indicate that electronic smoking devices pose potential dangers for users, as well as for non-users who passively inhale these chemical vapors. At minimum, these studies show that electronic smoking device aerosol contains nicotine, ultrafine particles and low levels of toxins that are known to cause cancer. The thresholds for human toxicity of potential toxicants in electronic smoking device aerosol are not known, and the possibility of health risks to primary users of the products and those exposed passively to the product emissions must be considered. Given the unknown public health impacts and the current lack of regulation, the Public Health Department recommends a precautionary approach in regulating the use of electronic smoking devices, until their safety is conclusively established.

Tobacco Retail Permit Ordinance

Summary of Related Research: Youth use of electronic smoking devices is increasing and many of those youth are using both traditional tobacco products and electronic smoking devices. The number of stores selling electronic cigarettes is rapidly increasing in the County and California, as is the amount of advertising and marketing of these products in stores, on television and online. The dangers of nicotine are well documented in the literature and are particularly hazardous to children, adolescents, pregnant women, and nursing mothers. The number of poisonings due to exposure to electronic smoking device liquids containing nicotine has been rapidly increasing. While their long-term health effects remain largely unknown, early studies indicate that electronic smoking devices pose potential dangers for users, as well as for non-users who passively inhale these chemical vapors. Given the unknown public health impacts and the current lack of regulation, the Public Health Department recommends a precautionary approach in regulating the sale of electronic smoking devices, particularly to protect children and youth from access and exposure to these products.

Timeline and Next Steps:

Should the Board approve the proposed changes to the County Ordinances, the Smoking Pollution Control and Smoke-free Multi-Unit Residences would take effect after 30 days and the Tobacco Retailer Permit changes would take effect after 60 days. The Public Health Department will work with internal and external stakeholders including the Department of Environmental Health, County Parks, Stanford, Tri-County Apartment Association, and the County Sheriff’s office on implementation, including posting signage and notifying businesses, multi-unit residence owners and residents. Public Health Department will provide signage to owners and managers of the impacted locations.

The Public Health Department plans to continue to outreach to cities and school districts in the County to share the research and models that were developed to address this issue and further protect the public’s health across all areas of the County.

CONSEQUENCES OF NEGATIVE ACTION

Failure to accept the report would result in the Committee not receiving the information requested, and result in no change to existing policies, leading to an inability to act upon this critical public health issue.


[1] U.S. Food and Drug Administration. “Regulation of E-Cigarettes and Other Tobacco Products.” FDA. April 25, 2011. Available at: http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm252360.htm 

[2] U.S. Food and Drug Administration. “FDA proposes to extend its tobacco authority to additional tobacco products, including e-cigarettes.” April 24, 2014. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm394667.htm

[3] Grana, R and Ling, P M. (2014). “Smoking revolution: A content analysis of electronic cigarette retail websites. Am J Prev Med 46(4): 395-403.

[4] Grana, R; Benowitz, N; Glantz, S. “Background Paper on E-cigarettes,” Center for Tobacco Control Research and Education, University of California, San Francisco and WHO Collaborating Center on Tobacco Control. December 2013.

[5] U.S. Congress, Senate and House of Representatives Report. “Gateway to Addictions?: A survey of popular electronic cigarette manufacturers and targeted marketing to youth. April 2014. Available at: http://democrats.energycommerce.house.gov/sites/default/files/documents/Report-E-Cigarettes-Youth-Marketing-Gateway-To-Addiction-2014-4-14.pdf

[6] 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

[7] U.S. Food and Drug Administration. “Consumer Updates: E-Cigarettes Questions and Answers” Available at: http://www.fda.gov/forconsumers/consumerupdates/ucm225210.htm

[8] 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.

[9] Regan AK, Promoff G, Dube SR, Arrazola R. (2013). Electronic nicotine delivery systems: adult use and awareness of the ‘e-cigarette’ in the USA. Tob Control. 2013 Jan;22(1):19-23.

[10] The Health Consequences of Smoking: Nicotine Addiction, a report of the Surgeon General (1988), available at http://profiles.nlm.nih.gov/NN/B/B/Z/D_/nnbbzd.pdf

[11] The Health Consequences of Smoking: Nicotine Addiction, a report of the Surgeon General (1988), available at http://profiles.nlm.nih.gov/NN/B/B/Z/D_/nnbbzd.pdf

[12] Vardavas CI, Anagnostopoulos N, Kougias M, Evangelopoulou V, Connolly GN, Behrakis PJK. Short-term Pulmonary Effects of Using an Electronic Cigarette. CHEST. 2012;141(6):1400-1406. Doi:10.1378/chest.11-2443.

[13] Chatham-Stephens, K, Law, R, Taylor, E, et al. (April 2014). “Notes from the Field: Calls to Poison Centers for Exposures to Electronic Cigarettes — United States, September 2010–February 2014” Morbidity and Mortality Weekly Report

[14] FDA and Public Health Experts Warn about Electronic Cigarettes (July 22, 2009), available at www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm173222.htm.

[15] Etter, J.F. and Bullen, C. (2011) Saliva cotinine levels in users of electronic cigarettes. European Respiratory Journal. Vol 38, 1219-1220.

[16] FDA and Public Health Experts Warn about Electronic Cigarettes (July 22, 2009), available at www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm173222.htm.

[17] World Health Organization, Press Release, “Marketers of electronic cigarettes should halt unproved therapy claims” (September 19, 2008), available at www.who.int/mediacentre/news/releases/2008/pr34/en/index.html

[18] Henderson, TR; Clark, CR; Marshall, TC; Hanson, RL; & Hobbs, CH. “Heat degradation studies of solar heat transfer fluids,” Solar Energy, 27, 121-128. 1981.

[19] 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

[20] 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.

[21] 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: http://www.ncbi.nlm.nih.gov/pubmed/23467656.

[22] 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

[23] 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

[24] Agency for Toxic Substances and Disease Registery (ATSDR). (2008). Toxic Substances Portal. Available at http://www.atsdr.cdc.gov/substances/index.asp

[25] 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

[26] Environmental Protection Agency. (2012). Particle Pollution and Health. Available at: http://www.epa.gov/pm/2012/fshealth.pdf

[27] 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

[28] 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

[29] Caldwell MC, Wysell MC, Kawachi I. (1996). Self-service tobacco displays and consumer theft. Tob Control.5:160–161.

[30] Lee RE, Feighery EC, Schleicher NC, Halvorson S. (2001). The relation between community bans of self-service tobacco displays and store environment and between tobacco accessibility and merchant incentives. Am J Public Health.91(12):2019-21.

Meeting History

May 16, 2014 2:00 PM Video Health and Hospital Committee Regular Meeting

Two individuals expressed concern regarding Countywide electronic cigarette regulation.

RESULT:FORWARDED [UNANIMOUS]
MOVER:S. Joseph Simitian, Vice Chairperson
SECONDER:Ken Yeager, Chairperson
AYES:Ken Yeager, S. Joseph Simitian

Transcript

May 16, 2014 2:00 PMVideo (Windows Media) MP4 VideoHealth and Hospital CommitteeRegular Meeting

 
2:34 PMWith the numbers in a real sense. That the public doesn't perceive this as a voila, we are able to change the numbers and now at 90%. But it's good to have an outside team looking at that and verifying, we looked at numbers, and some of it had to be corrected. And then also the response time getting better. So it doesn't sound like it should be that complicated. Sounds like a lot of that information is readily available. Hope it doesn't delay your final recommendations to us in august or whatever. But to get them on board and double-check the numbers it would give everyone an additional level of comfort. It's a very good report. I am glad that the city and our team are working cooperatively together. Okay, we will forward that on to the full board as well.

2:35 PMIs regulation of electronic smoking devices. Dan, I think we are going to turn this over to you. The way we work this, we get a report from staff. And I know we have two speakers that want to address us. And after that we'll turn to the board for discussion.
Thank you, supervisor yeager, we were pleased to bring forward today our findings and recommendations for revision of the three tobacco control ordinances previously adopted by the board in 2010. And quickly, those three ordinances are ns-625. 7, that is the pollution control ordinance, we have nomenclature change for that ordinance. And ns-625. 8, that is the control, and ns-300. 873, that is the retail permit. Before I turn this over to staff, I want to give a call out and thank you to nicole on our staff that is herclean that brings this before you and jenny, I want to thank you the two of you. We will turn it over to Dr. Cody to go through a brief powerpoint presentation.
2:37 PMThank you, dan, I will go over brief slides and staffer here to answer questions. First to provide some brief background on electronic smoking devices which I will refer toas ecigarettes from here on out. These devices are increasingly available of tobacco providers that have quadrupled. From 11% in 200011, to 45% in twaend 13 n our county, 47% of our tobacco retailers were selling ecigarettes. And that number is intend to increase given the growing market for these products. Although ecigarettes are less harmful, but there is harm. We know that nicotine is highly addictive and can cause cardiovascular disease. And in high doses nicotine can cause acute poise inning particularly in ingested. Ecigarettes are currently unregulated by the federal government and few restrictions are at state level. Because these are unregulated consumers have no way of knowing the amount of nicotine in the product or health risks. The fda has warned the public about using ecigarettes and found sarsgenic and harmful ingredients in ecigarettes. This is increasing of social effect of ecigarettes and the misconception that these products are somehow safe. Of great concern of public health that ecigarettes threaten to do the social norm change around tobacco use. Norm change that has saved lives and resulted from policies of the one that was implemented by the county. We are concerned about the apid uptake of ecigarettes by youth. In a study in 2011, 4. 5% had tried, and that number in 2013 inside to 10%. The county has a way to reduce youth from accessing tobacco, ensuring that tobacco retailers are serving all laws regarding tobacco products. The county is adopting policies to ensure that the public is not exposed to second-hand smoke. And dan mentioned the three tobacco ordnonce sinances that the board adopted. So for all of these reasons just discussed. Local regulation around ecigarettes is needed. Indeed many communities across the u. S. And california have moved forward in pro hibiting the use of ecigarettes in their jurisdictions. More than 100 counties and including in california and sunnyvale have placed restrictions on the use of ecigarettes. In twaend the board asked for the public health department to report on ecigarettes into the current ordinances. Since -- next slide, since late March the public health department has convened two meetings with internal stakeholder, including representatives from the department of environmental health and county council to address how to incorporate ecigarettes into the county's three existing tobacco ordinances adopted in 2010. In this process we conducted outreach to other counties and departments, including sheriff office and county parks and the county youth task force as well as with external stakeholders including the tri-county apartment association in in the university. As directed by the board. And this was presented to hotels and motels and residents in the county and with the proposed ordinances and any feedback. The tri-county association has not taken a position on the position of ecigarettes but solicited outreach to the members. Stanford university conducted outreach with various campus stakeholders. Currently there is 24 tobacco retailer in the county, and nine currently sell ecigarettes. And at this time staff has not identified any retailers that sell ecigarettes but do not sell traditional tobacco products in unincorporated areas. The proposed changes to the county ordinance would include first restricting the use of ecigarettes where smoking is prohibited by state or local law. This includes indoor and outdoor areas and parks and outdoor dining, etc. I want to call out one exception, private units within multiunit residents. This exception was made because ecigarettes were determined to be less of a threat in social norm change in a private space. And lack of research regarding the harms of second-hand vapor drifting into ventilation, as there is with second-hand smoke. The public health department will continue to monitor the research in this in regard and revisit the issue as evidence develops. The change in the ordinance would require retailers of ecigarettes to obtain local permits and follow the same ordinance to tobacco retailers, and prohibit the of these products in vending machines. This product will not apply to electronic smoking devices at this time. But this could requested on a flavored to babbo plan are discussed. And that's all we have. And we are here for questions. Thank you.
2:43 PMWe have two speakers, and we will call you up now. Jim rout, and jan parcel. Afternoon.
2:44 PMGood afternoon, my name is jim rout, with california vapor association. I want to say you guys are so nice and polite. It's positively. Wonderful. I speak in front of a lot of committees and everyone gets along here, that's wonderful, I wanted to give you you a complement. The california vapor association we are target on vapor retailers. We are not a consumer group and focused on regulation, and our goals are not in opposition of public health. We have is the same goal. To hold retailers accountable through a licensing program. The fda and the state are currently assessing both of these issues. For you guys to create regulations without their guidance I think is premaur ma tour and should be profit poened. We support your regulation of private property and those should be allow to make that determination. Evidence of harmful effects is still unclear, and I am glad that she included that in her report. At this point our recommendation is that you guys take a stand on your own properties, to ban vaping like you ban eating and drirnging from the chambers. But don't take that freedom away from property owners to make their own decisions in the county. The findings of fact in the staff report are lacking in actual facts. There are several reference to possible effects and possible consequences to e-cig use. And these are not founded. And with these regulations in california making it seem like a larger problem. We have retailers check i. D. And we ask that you take local standards in account and not rely on information from the keft of the county.
2:46 PMThank you, jim, jan.
I am shorter, I want to have all of my shots but the third hep-b thank you for listening to me today. I am a vapor and a grandmother and a software engineer, and almost ex-smoker, I haven't given up the first one in the morning or the after dinner one. And my friends say that it's because I am vap inging the flavors and if you try a real cigarette it tastes really bad. And they vary in age from 30 to 90. I believe as a citizen and of the county and a vapor whose life is at stake whether I can stay off of cigarettes. And I should be considered as a steak holder. I didn't hear about this until monday. I submitted a nine page of corrections where the report is out-of-date information. And even the cdc's data is out-of-date. Yes less kids are smoking. For adults and kids, vaping is cutting down on the smoking. The cigarette companies lost 6. 7% for the previous two years, and this year they only lost 4. 7 percent. I am asking you to correct the report. There is one paragraph in the report that recommends smoking over vapor. And said about the report, that is horrifying. As far as changing the law, the licensing laws I don't feel strongly about. But some jurisdictions are thinking about paychecking them have licenses for tobacco and putting a moratorium on tobacco licenses. And any shop that sells only vaporing shouldn't have a moratorium against tobacco. And the third thing, in order to justify the anti-vaping where smoking is not allowed. Your ordinances showed that they had to throw away all the reasons for their original smoking ordinances. All the dangers had to be crossed out to add vaping to that, and that should be considered.
2:48 PMThank you, jan.
And I consider myself an owner of county property.
Thank you, I know that I received jan's letter, I assume public health did, if not, we can get you a copy of it, and anything that she said that you assume is inaccurate in the report, I assume that changes can be made before the full board. I want to thank staff and I know that many people have been involved in this over the last several months. We are fortunate that when we did our tobacco and anti-smoking ordinances that was a lot of the heavy lifting. So then we were in some ways able to incorporate the ecigarettes into it. Although with all the pages of legal documents everything takes a very long time. But I think many of us are continued to be surprised at how slow the state and the federal government is in regulating ecigarettes. It could be years before the fda comes up with reg uldzs. And even then we are not quite sure how strong they will be. I think there is sufficient, abundant evidence that ecigarettes are really just another form of smoking of tobacco. And they need to be regulated. I think because there are no reg ulgdzs at the state level, the fact that you can't sell ecigarettes to someone who is 18 or youngerment. I think that a lot of stores and places are unclear what the regulations are. And even though this applies to the unincorporated area, and it makes is clear for someone that has a complaint for the store owner to say that is against county ordinance. I am very concerned and there is more evidence that there is direct marketing towards young people. The ecigarettes because it's fun and hip. And perhaps not as dangerous. So therefore, certainly can begin smoking ecigarettes without understanding the full dangers involved. Just as we are with our anti-smoking and anti-tobacco regulations. I am proud of the county going forward with this ordinance, should is the board approve it when it comes before us. And I think just as we did with our other ordinances. We have seen cities sort of be able to use our ordinances because we have done all the heavy lifting. And easier for them then to just adopt the same ordinance for their cities. And again there is no regulations. I think other estates will be looking at what we have done, and try to hopefully incorporate the same things into their ordinances. Supervisor simitian.
2:51 PMWell, it's sort of a momma bear, poppa bear, baby bear question to me. We can go too fast or too slow. And I think you just got it about right. I am prepared to support the measure before us today. I had expressed concern previously about potential for overreach, in terms of folks and private residences whether they are rentals or condominiums, that is not part of ordinance. At this point showing restraint and more record on the evidence is probably appropriate. And for me this is a pretty sensible middle ground. I think it's always a tough call, frankly, how soon do you step in when you see something that you believe is a matter of concern and you have evidence in the record that reflects it's a matter of concern. How long do you wait for answers that May or May not ever come. How long do you wait for other agencies who May or May not act. I think we are in the right place as far as I am concerned and recommend to the full board.
2:53 PMGreat, we will move that on to the full board for consideration.

2:53 PMFrom the health care reform stakeholders working group.
Good afternoon, the stakeholder group of several points of information to provide to the committee. First the ltss subcommittee has been formed. They had their first meeting, the co-chairs are gary stafrngy and jim lamoda, and it will be before the full group next meeting to receive any comments. And formal establishment. There is a subcommittee of the main stakeholder group.