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Testimony in support of e-cigarette regulation, for December 17 meeting

From: Dr. Bonnie Halpern-Felsher <"Dr.>
Date: Tue, 17 Dec 2019 07:20:54 +0000

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Dear Menlo Park City Council Members,

This prepared testimony below and attached will be presented on my behalf during the public comment period on Tuesday December 17. I wanted to send this in advanced along with some of my relevant research, attached. I have other scientific articles and other information if needed. I'm happy to answer any questions.


December 17, 2019

City Council Meeting: Discussion of proposed ordinance banning sale of flavored tobacco and e-cigarette devices

Dear Council Members:
Thank you for the opportunity to have provided testimony for your November 5, 2019 study session on this important and urgent topic, flavored tobacco and e-cigarette use. As I’d mentioned, I am a Professor of Pediatrics and Director of Research in the Division of Adolescent Medicine, Department of Pediatrics at Stanford University. I am a developmental psychologist with additional training in adolescent and young adult health. I am also the Founder and Executive Director of the Stanford Tobacco Prevention Toolkit, an online educational tool aimed at preventing youth use of all tobacco products including e-cigarettes. I have over 25 years of experience researching why youth use tobacco, with e-cigarettes at the core of my work.

I commend Menlo Park City Council on its pending action to adopt an ordinance:

  * prohibiting the sale of flavored tobacco and e-cigarettes, and;
  * prohibiting the sale of all tobacco products in pharmacies.

I will provide 4 brief sets of information in support of these requested regulations:

  1. Flavors hook kids
  2. Flavors mask tobacco-related risks
  3. Flavors and e-cigarettes in general do NOT help adults quit smoking
  4. Youth continue to access tobacco from retail shops including vape shops
The most common form of tobacco use among youth is e-cigarettes, with well over 27% of youth admitting to using e-cigarettes in the last month, and these numbers are undoubtedly underestimated, based on my experience talking with hundreds of educators and youth across the country.
There are over 7,000 flavors available for e-cigarettes, and numerous flavors in other tobacco products, including flavors that attract young and new users, such as honey doo doo, unicorn poop, and sugar booger. These are NOT adult flavors. These flavors are for youth! Also, youth use mint, menthol, fruit, and candy flavors, as clear from my own research and national data.
Most adolescent tobacco users cite flavors as a reason for use, as flavors mask the harsh taste of tobacco, resulting in a more pleasant taste and smell than that found with tobacco alone.
Most youth report they would quit tobacco including e-cigarette use if flavors were not available.
Also, flavors mask the risks that are inherent in tobacco, including the fact that many e-cigarettes and in particular the newer pod-based products have as much nicotine, and highly concentrated nicotine, as found in 1-2 packs of cigarettes.
Now, you will likely hear arguments that adults need flavors to successfully quit smoking conventional cigarettes. However, that is simply not borne out by research.
While adults may like flavors, they are more likely to quit smoking cigarettes without flavors, and the evidence that e-cigarettes help adults quit smoking conventional cigarettes is mixed, at best. If flavors truly help adults quit, then let them be regulated as a cessation product and given as a prescription, but not be readily available for youth. Further, we have FDA-approved and PROVEN ways to help adults quit smoking. We simply don’t need e-cigarettes.
Further, evidence is clear that adults are not quitting cigarettes and nicotine through e-cigarettes. Instead, they are simply SWITCHING from one tobacco product to another, and e-cigarettes are not necessarily safer. Indeed, much recent research shows that e-cigarettes are harmful to the lungs and heart, possibly as harmful as are cigarettes.
Anecdotally, there are examples of individuals who have quit nicotine through e-cigarettes. However, research shows that for every 1 person who quits tobacco through the use of e-cigarettes, another 81 people who had not used any other form of tobacco initiate tobacco through the use of e-cigarettes. As such, e-cigarettes represent more population-level harm than benefit. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0193328

Finally, lets discuss access. I know from my own scientific publications and others, that youth are easily accessing e-cigarettes and other tobacco products from retail and vape shops, and in pharmacies. Many local vape and retail shops are not IDing youth, or don’t recognize that the legal age to purchase tobacco in California is 21. We need better regulation and enforcement of these shops, and the only way to do that is to have stricter retail licensing fees, regulations and strict enforcement.

The evidence is clear. The extraordinarily high levels of nicotine get kids addicted, flavors including fruit, candy, mint and menthol, attract and keep kids addicted to tobacco, adults don't need flavored e-cigarettes to quit smoking, and we need to restrict youth access to all tobacco products. I urge you to pass a flavor ban and other regulations to protect the health of our kids.
Thank you.

Dr. Bonnie Halpern-Felsher, PhD, FSAHM
Professor of Pediatrics, Division of Adolescent Medicine, Stanford University
Founder and Executive Director, Tobacco Prevention Toolkit

Bonnie Halpern-Felsher, PhD, FSAHM
Professor of Pediatrics
Professor (By courtesy), Health Research & Policy
Director of Fellows’ Scholarship, Department of Pediatrics
Director of Research, Division of Adolescent Medicine
Associate Director, Adolescent Medicine Fellowship Program
Co-leader, Scholarly Concentrations, Pediatrics Residency Program

Founder and Executive Director, Tobacco Prevention Toolkit<http://med.stanford.edu/tobaccopreventiontoolkit.html> and the Cannabis Awareness and Prevention Toolkit<http://med.stanford.edu/cannabispreventiontoolkit.html>.

Division of Adolescent Medicine
Department of Pediatrics
Stanford University
770 Welch Road, Suite 100
Palo Alto, CA 94304
650-724-1981 (W)
650-736-7706 (F)

Received on Tue Dec 17 2019 - 10:19:42 PST

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