AGENDA ITEM #2
January 22, 2015
Public Hearing
MEMORANDUM
January 20, 2015
TO:
FROM:
SUBJECT:
County Council
<
Amanda Mihill, Legislative Attorney(}f14JiU
Public Hearing:
Bill 56-14, Health and Sanitation - Smoldng - Electronic
Cigarettes
Bill 56-14, Health and Sanitation - Smoking - Electronic Cigarettes, sponsored by Councilmember
Floreen, then Council Vice President Leventhal, and Councilmembers Branson, Navarro, Rice,
EIrich, Riemer,
Katz,
Hucker and Berliner, was introduced on November 25, 2014. A Health and
Human Services Committee worksession is tentatively scheduled for January 29, 2015 at 9:30 a.m.
Bill 56-14 would:
• prohibit the use of electronic cigarettes in public places where traditional tobacco smoldng
is prohibited;
• restrict the sale ofcertain liquid nicotine or liquid nicotine containers in retail outlets unless
the nicotine is in a container considered child resistant packaging;
• prohibit the sale of electronic cigarettes in any place that is accessible to buyers of the
product without the intervention of the seller (similar to tobacco products); and
• generally amend County law regarding smoking, electronic cigarettes, and health and
sanitation.
Background
Before the introduction of Bill 56-14, the Health and Human Services Committee met twice on the
issue of electronic cigarettes. All the materials from those worksessions are not reproduced in this
packet, but can be found at the following links:
• July 21: http://W\i\'W.montgomerycountymd.gov/councillResources/Filesiagend
alcml
2014/140721/20140721
HHS l.pdf
• September 18: http://vv'WW.montgomerycountvrnd.gov/councillResourceslFiles/agendal
cm/20 141140918/20140918
HHS
1.
pdf
At the July 21 worksession, the Committee received briefings from the National Institutes of
Health and the Legal Resource Center for Public Health Policy on electronic cigarettes. These
briefings included a discussion of the current medical understanding ofthe health risks and public
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policy concerns with electronic cigarette usage. The presentation from Dr. Walton and Dr. Boone
from the National Institute on Drug Abuse is on ©1O. After the briefings, Committee members
expressed specific concerns about the use of electronic cigarettes by minors and directed staff to
provide options to restricting youth access to electronic smoking devices. Committee members
discussed these options, including a prior draft of Councilmember Floreen's bill, at its September
18
worksession. Also at its September
18
worksession, Committee members received a briefing
from the Department of Liquor Control's Licensing and Regulatory Enforcement staff on its
program to identify entities that are selling tobacco to minors.
This packet contains:
Bill 56-14
Legislative Request Report
Presentation from National Institute on Drug Abuse
Fiscal and Economic Impact statement
Circle
#
1
9
10
36
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Bill No.
56-14
Concerning: Health and Sanitation ­
Smoking - Electronic Cigarettes
Revised:
9/912014
Draft No._4_
Introduced:
November 25. 2014
Expires:
May 25. 2016
Enacted: _ _ _ _ _ _ _ __
Executive: _ _ _ _ _ _ _ __
Effective: _--:-:_ _ _ _ _ __
Sunset Date: --:...:,No=n=e_ _ _ _ __
Ch, _ _, Laws of Mont. Co. _ __
COUNTY COUNCIL
FOR MONTGOMERY COUNTY, MARYLAND
By: Councilmember Floreen, Council Vice President Leventhal, and
Councilmembers Branson, Navarro, Rice, EIrich, Riemer, Katz, Hucker and Berliner
AN
ACT
to:
(1)
(2)
(3)
(4)
(5)
prohibit the use of electronic cigarettes in certain public places;
restrict the sale of certain liquid nicotine or liquid nicotine containers in retail
outlets unless the nicotine is in a container considered child resistant packaging;
restrict the accessibility of certain tobacco products in retail settings, and require
retail sellers of those products to take certain actions;
prohibit the use of electronic cigarettes by minors; and
generally amend County law regarding smoking, electronic cigarettes, and health
and sanitation.
By amending
Montgomery County Code
Chapter 24, Health and Sanitation
Section 24-9
By adding
Chapter 24, Health and Sanitation
Sections 24-13 and 24-14
By renumbering
Chapter 24, Health and Sanitation
Sections 24-2,24-3,24-4,24-5,24-6,24-7,24-8, 24-9B, 24-9C, 24-9D, 24-10, 24-11,
24-11A
By repealing
Chapter 24, Health and Sanitation
Section 24-9A
By renaming
Chapter 24, Health and Sanitation
Article II
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Bill No. 56-14
Boldface
Underlining
[Single boldface brackets]
Double underlining
[[Double boldface bracketsD
* * *
Heading or defined term.
Addedto existing law by original bill.
Deletedfrom existing law by original bill.
Added by amendment.
Deletedfrom existing law or the bill by amendment.
Existing law unaffected by bill.
The County Council for Montgomery County, Maryland approves the following Act:
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BILL
No. 56-14
1
Sec. 1. Sections 24-2, 24-3, 24-4, 24-5, 24-6, 24-7,24-8,24-10, 24-11, and
24-11A are renumbered as follows:
24-2, 24-3. [Reserved.] .
24-[4J.!. Communicable diseases generally - Warning signs.
2
3
4
5
6
7
*
24-[5JJ.. [Same]
warnine: signs.
*
*
Unauthorized removal of
Communicable diseases
8
9
10
24-[6]~.
*
*
24-[7J~.
*
*
*
*
*
*
*
[Same] Communicable diseases - Control in food establishments.
11
12
Use of certain shoe-fitting devices or machines prohibited.
*
24-[8]~.
*
*
*
*
*
13
14
Commitment of chronic alcoholics.
*
*
24-[IIJ~.
15
16
24-[10J1. Catastrophic health insurance plan.
Massage.
17
18
*
*
*
*
19
24-[IIAJ8A. Fitness centers - defibrillators.
Sec. 2. Article II is renamed; Section 24-9 is amended; Section 24-9A is
repealed; Sections 24-9B, 24-9C, and 24-9D are renumbered; and Section
24-13 is added as follows:
Article II. [ReservedJ Smokina:, Tobacco, and Nicotine.
24-9. Smoking and using electronic cigarettes in public places.
(a)
Defmitions.
In
this [SectionJ Article, the following words and phrases
have the meanings indicated:
20
21
22
23
24
25
26
27
28
*
*
*
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Bill
No. 56-14
29
30
31
32
33
34
35
36
37
38
Electronic cigarette
means an electronic device that delivers vapor for
inhalation, including any refill, cartridge, or any other component of
an electronic cigarette.
Electronic cigarette
does not include any
product approved
Qy
the Food and Drug Administration for sale as
drug or medical device.
~
*
*
*
Smoking
or
smoke
means the act of lighting, smoking, or carrying a
lighted or smoldering cigar, cigarette, or pipe, of any kind.
*
*
*
~
Vape shop
means any store that primarily sells electronic cigarettes.
Vape shop
does not include an area of
electronic cigarettes are sold.
(b)
39
40
41
larger store in which
Smoking and using an electronic cigarette are prohibited in certain
public places.
A person must not smoke or use any electronic
42
43
44
45
46
cigarette in or on any:
*
(c)
*
*
Exceptions.
Smoking or using an electronic cigarette is not prohibited
by this Section:
(1)
(3)
In a tobacco shop or
~
vape shop;
*.
47
48
49
50
51
52
*
*
When smoking or using an electronic cigarette is necessary to
the conduct of scientific research into the health effects of
tobacco smoke and is conducted at an analytical or educational
laboratory;
53
54
55
*
(d)
*
*
Notwithstanding paragraph (b)( 11), the Director of the Department of
Health and Human Services may designate an outside area on
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BILL No. 56-14
56
57
58
59
property that is owned or leased by the County where smoking or
using an electronic cigarette is allowed if the Director finds that a
complete prohibition on that property would impede a program's
mission or effective delivery of services.
(e)
Posting signs.
60
61
62
(1)
Except as provided in paragraph (e){4), signs prohibiting or
permitting smoking or using an electronic cigarette, as the case
may be, must be posted conspicuously at each entrance to a
public place covered by this Section.
63
64
65
66
(2)
Where smoking or using an electronic cigarette is prohibited by
this Section, the sign either must read "No smoking or using an
electronic cigarette by order of Montgomery County Code § 24­
9. Enforced by (department designated by the County
Executive)" or be a performance-oriented sign such as "No
Smoking or Using an Electronic Cigarette" or "This is a Smoke
Free Establishment."
The international no-smoking symbol
67
68
69
70
71
72
73
may replace the words "No smoking."
'"
(f)
'"
'"
74
75
Duty to prevent smoking in certain areas.
The owner or person in
control of a building or area covered by this Section must refuse to
serve or seat any person who smokes where smoking or using an
electronic cigarette is prohibited, and must ask the person to leave the
building or area if the person continues to smoke after proper warning.
76
77
78
79
80
81
82
'"
(k)
'"
'"
Enforcement and penalties.
(1 )
Any violation of this [Section] Article is a class C civil
violation. Each day a violation exists is a separate offense.
®
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BILL
No. 56-14
83
84
(2)
The County Attorney or any affected party may file an action in
a court with jurisdiction to enjoin repeated violations of the
Section.
85
86
87
88
(3)
The County Executive must designate J::!y Executive order one
or more County departments or agencies to enforce this Article.
The Director of the Department of Health and Human Services
may suspend a license issued under Chapter 15 for up to 3 days
if the Director finds, under the procedures of Section 15-16,
that the operator of an eating and drinking establishment has
knowingly and repeatedly violated any provision of this
Section.
ill
89
90
91
92
93
94
95
96
97
98
[24-9A. Reserved.]
24-[9B] 10.
Availability
of tobacco
products to minors.
*
*
*
*
*
*
24-[9C]I1. Distribution of tobacco products to minors.
24-[9D]12. Tobacco and electronic cigarette [Products - Placement] products
99
100
101
102
103
104
105
106
107
108
=
placement.
(a)
Placement.
A retail seller of any tobacco or electronic cigarette
product must not display or store the product in any place that is
accessible to buyers of the product without the intervention of the
seller or an employee of the seller.
(b)
Definitions. Tobacco product
means any substance containing
tobacco, including cigarette, cigars, smoking tobacco, snuff, or
smokeless tobacco.
(c)
Applicabilif)?.
This Section does not apply to:
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BILL
No,
56-14
109
110
111
112
113
(1)
the sale of any tobacco or electronic cigarette product from a
vending machine that complies with all requirements of state
law; and
(2)
any store where only or primarily tobacco or electronic
cigarette products are sold.
114
115
116
117
118
119
[(d)
Enforcement.
The County Executive must designate by Executive
order one or more County departments or agencies to enforce this
Section.]
[24-12. Reserved.]
24-13. [Reserved] Use of electronic
cigarettes
!!I
minors prohibited.
A person under
li
years old must not use an electronic cigarette.
24-14. Child Resistant Packaging
of Liquid
Nicotine Container Required.
120
121
ill
Definitions.
In
this Section, the following words have the meanings
122
indicated:
Child resistant packaging
means packaging that is:
123
124
125
ill
designed or constructed to be significantly difficult for children
under
~
years of age to open or obtain
~
toxic or harmful
~
126
127
amount of the substance contained therein within
time; and
reasonable
128
129
ill
not difficult for normal adults to use properly.
~
~
Child resistant packaging
does not mean packaging which all such
130
131
132
133
children cannot open or obtain
reasonable time.
toxic or harmful amount within
Liquid nicotine container
means
~
container that is used to hold liquid
containing nicotine in any concentration.
(j)
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BILL No. 56-14
134
135
136
137
138
139
140
141
142
143
144
145
®
Child resistant packaging required.
A retail seller of any liquid
nicotine or liquid nicotine container must not sell, resell, distribute,
dispense, or give away:
ill
ill
(£1
any liquid or gel substance containing nicotine unless the
substance is in child resistant packaging; or
any nicotine liquid container unless the container constitutes
child resistant packaging.
Exceptions.
This Section does not apply to
~
liquid nicotine container
that is sold, marketed, or intended for use in an electronic cigarette if
the container is prefilled and sealed
Qy
the manufacturer and not
intended to be opened
Qy
the consumer.
24-[12]15-24-21. Reserved.
Approved:
146
147
148
149
Craig
L.
Rice, President, County Council
Date
150
151
152
153
Approved:
Isiah Leggett, CoWlty Executive
Date
154
155
156
157
This is a correct copy o/Council action.
Linda M. Lauer, Clerk of the COWlcil
Date
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LEGISLATIVE REQUEST REPORT
Bill 56-14
Health and Sanitation
-
Smoking
-
Electronic Cigarettes
DESCRIPTION:
Bill 56-14 would prohibit the use of electronic cigarettes in public
places where traditional tobacco smoking is prohibited; restrict the
sale of certain liquid nicotine or liquid nicotine containers in retail
outlets unless the nicotine is in a container considered child resistant
packaging; prohibit the sale of electronic cigarettes in any place that
is accessible to buyers of the product without the intervention of the
seller (similar to tobacco products); and prohibit the use of electronic
cigarettes by minors.
Electronic cigarettes are not currently regulated by the FDA or the
state. Many youth could perceive electronic cigarettes as less harmful
than
traditional tobacco smoking. Current statistics show that e­
Cigarette use by high school students increased from less than 5% to
almost 10% from 2011 to 2012 and that reasons students gave for
using e-Cigarettes include: curiosity, attraction of flavors, use by
friends and family, desire to quit smoking, availability, and it is a
sign of independence.
In part, to protect the health of minors by restricting the use and
availability of electronic cigarettes to minors.
Health and Human Services
To be requested.
To be requested.
To be requested.
To be researched.
Amanda MihiU, Legislative Attorney, 240-777-7815
To be researched.
PROBLEM:
GOALS AND
OBJECTIVES:
COORDINATION:
FISCAL IMPACT:
ECONOMIC
IMPACT:
EVALUATION:
EXPERIENCE
ELSEWHERE:
SOURCE OF
INFORMATION:
APPLICATION
WITIDN
MUNICIPALITIES:
PENALTIES:
Class C violation.
f:\Iaw\bills\1456 electronic cigarettes\lrr.doc
(j)
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Electronic Cigarettes:
An Overview
Presentation to
Montgomery County Council
July 21, 2014
Kevin Walton, PhD
Division of Pharmacotherapies and Medical Consequences of Drug Abuse
Ericka Boone, PhD
Office of Science Policy and Communications
National Institute on Drug Abuse, NIH
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Conventional Tobacco Use in the U.s.
Associated morbidity and mortality
-
-
480,000 Americans die each year from smoking
16 million suffer from tobacco-related illnesses
(~1
in 5 deaths)
Economic cost: nearly
$3008
annually
-
-
$133B in direct medical care
$156B in lost productivity
18.1%
of all
u.s.
adults smoke (42% in
1965)
However, in the past year
68.9%
of adult smokers wanted to stop smoking
42.7% of adult smokers made a quit attempt
Source: HHS, The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General.
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Youth Smoking Continues as a Concern
• 90%
of smokers begin while in their teens or earlier
• 14%
of high school students (grades
9-12)
smoke
• Use of multiple tobacco products is common
• With current trends,
6
million teens alive today will die
from smoking-related diseases
However...
• The percent of
teens who are
current smokers*
has been declining
for more than a
decade
-+-8th Grade
...... 10th Grade
-lIt-12th Grade
~
____
~
__- i____
i -__
-L____L-__
~
__
~L-
__
~
__
~~
__
~
__
~
____
i -___L----l
1997 1999 2001 2003 2005' 2007 2009 2011 2013
Source: HHS, Preventing Tobacco Use Among Youth and Young Adults, A Report of the Surgeon General, 2012
CDC, MMWR 62{No. 45), November 15,2013; Johnston, MTF National Results on Drug Use:1975-2013
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Electronic Cigare.tte (E-cigarette) History
• An e-cigarette is a smokeless nicotine delivery device
o E-cigarettes can also contain no nicotine, just producing a flavored
aerosol (vapor)
• First introduced in China in 2003
• Available in the U.S. since 2007
• Made by U.S. tobacco companies and independent
non-conventional-tobacco companies
-
-
Lorillard (blu), Reynolds American (Vuse), Altria (MarkTen)
Independent large players include NJOY and Logic
• Over 250 e-cigarette brands in the U.S.
• E-cigarette use has doubled every year since 2010
• Estimated to be
greater than $1.58
industry
@
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Most People Are Aware of
Electronic Cigarettes
Source: Zhu et ai, 2013
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Adult
Use of
Electronic Cigarettes
Primarily by Current Smokers
25
20
~
15
::J
:u
10
. .
>
w
~
112010
~80%
5
of current users
report
dual
use with
conventional
cigarettes
0
Current
Smoker
Former
Smoker
Never Smoker
• .Health
reasons primary motivator for e-cigarette use
Believe less harmful than conventional cigarettes
Desire to cut down and/or quit conventional cigarettes
Help with reducing cravings and withdrawal symptoms
Want to prevent relapse to conventional cigarettes
Don't want to disturb others with smoke or for use in smoke-free
places
Source: King et ai, 2013; Pearson et ai, 2012; Lee et ai, 2014; Brown et ai, 2014;
Etter, 2010; Kralikova et ai, 2013; Pearson et ai, 2012; Vickerman et ai, 2013
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Electronic Cigarette Use
by
Youth Increasing
15 ·
.
r···········..···..··..•· ..···•····•·..·..·•··•·•·•..•·•..··.........
.
112011
.2012
~
10+·············
:J
U.I
...
~
5 ..
I···········..······..·········•···..······
"#.
76.3% of students
who used in the past
month aIso smoked
conventiona I
cigarettes
o .......--.. . . . . .
High School
Middle School
• 1 in 5 middle school students that reported ever using e-cigarettes
have never tried conventional cigarettes
• Reasons given for using e-cigarettes
Curiosity
Attraction of flavors
Use by friends and family
Desire to quit smoking
Availability
Sign of independence
Source: CDC, MMWR 62:893-97, 2013; Camenga, et ai, 2014; Kong et ai, 2014
®
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Current E-Cigarette Regulation is Limited
• E-cigarettes mostly unregulated under federal law
-
-
FDA currently seeking to regulate the sale, manufacture, and
distribution of e-cigarettes
Unknown when regulations will be finalized
• There are no official standards of design or contents
• There is no requirement to provide public information
on the contents of e-cigarettes
• Many states, including Maryland, regulate the sale of
e-cigarettes to minors
Source; http://tobacconomics.org!wp-contentjuploads/2014/06/EcigStateLaws_SCTCENDS.pdf
®
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What are the Concerns About
Electronic Cigarettes??
• In general use but risks and benefits not fully evaluated
• Lack of standards over design and contents
• Potential relapse for former smokers or use by never
smokers
• May renormalize smoking or encourage poly-use
• Potential for use with controlled substances
• Marketing that may attract kids
-
Kid-friendly flavors (e.g.} chocolate} fruit} gummi bear} cotton
candy} etc) and characters or famous actors; ads in media
- -
-
- -
• • L
I - - - -
. -
• L
- - -
ch
®
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Anatomy of an Electronic Cigarette
Consists of a power source,
heating device
(aerosolizer/vaporizer), and
liquid-containing cartridge
Puffing activates the
battery-powered heating
device, which heats the
nicotine solution into an
aerosol (vapor), which is
then inhaled
Early devices designed to
resemble conventional
tobacco ciga rettes
Source: http://science.howstuffworks.com/innovation/everyday-innovations/electronic-cigarettel.htm
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Types of Electronic Cigarettes
Disposable
~elgarette
NJOV,
White Cloud,
Greensmoke
~
Rechargeable e-cigaretle
Sealed device
or cartridge
Markten, Mistic,
blu, VUSE
medium-sized
rechargeable e-clgarette
Pen-styl~
eGo, Vaporking,
Totally Wicked
Tank-style,
large-sized
rechargeable
e-cigart!tte
User adds liquid
!III:I-
d.
to eVlce
Volcano Lavatube
Source: Grana,-et at, 2014
®
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Tank Systems and Liquid Refills
• Tank systems give users access to an extensive
assortment of flavors and nicotine concentrations
100+ FLAVORS
•. These devices are gaining in popularity
• Can have larger, more powerful batteries
• Concerns about accidental liquid nicotine poisoning
CDC
reports increase in poison control center calls regarding
e-cigarettes: 1 call/month in 2010, 214 calls/month in 2014
Regulatory efforts discussed to require child-safe packaging
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Electronic Cigarette Liquid Contents
1. Nicotine (0% to 3.6%)
2. Propylene Glycol (PG)
3. Vegetable Glycerin (VG)
(Glycerol)
• Experience with PG and ,VG
-
The Food and Drug Administration classifies
PG
and
VG
as
"Generally Recognized As Safe" (GRAS)
PG/VG used in medicines, cosmetics, and food products
-
PG for inhalation (e.g., asthma inhalers) at concentrations
much lower than in e-cigarettes
4. Water
5.
Flavorings
-
-
VG
does not have a history of use for inhalation
PG
and
VG
used to create artificial theatrical fog
©
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Electronic Cigarette Aerosol Contents
• Long-term safety of aerosol inhalation is unknown
-
-
-
It is not just water vapor; little experience with some constituents
Some compounds same as in tobacco smoke: acrolein,
acetaldehyde
Generally lower levels of toxins (9-4s0x) than in tobacco smoke
• Variable voltage devices can alter the aerosol
-
-
-
Higher voltage produces higher temps, more nicotine in aerosol
This can increase levels of toxic compounds: e.g., formaldehyde
Levels can approach those measured in conventional cigarettes
• E-cigarette aerosol is less complex than tobacco smoke
There are an estimated 5000 compounds in tobacco smoke
Tobacco smoke includes 70 known carcinogens
Many fewer compounds in e-cigarette aerosol
Goniewicz et ai, 2014; Kosmider et ai, 2014
®
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Addiction Potential:
Conventional vs. Electronic Cigarette
• Conventional cigarette delivers nicotine rapidly
25
I
PLASMA
NICOTIN~-
*
20
~.
Arrow indicates
smoking initiation:
10 puffs/3D seconds
• Other compounds in smoke may enhance addiction
• Association of smoking with specific behaviors
-
Social interactions, drinking, stress
• Children and teenagers may be highly susceptible to
nicotine addiction
Source: Vansickel, et ai, 2010
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Addiction Potential:
Conventional vs. Electronic Cigarette
E-cigarettes have been less effective at nicotine delivery
However
-Newer devices can deliver
more nicotine
-Nicotine delivery can be
by puffing behavior
30
20
10
IlL!
~_----
'---------II
o
~I'--~-----------------------------.
0 10 20 30 40 50 60
minutes
Unknown effects of flavors and additives
Situational use is similar - social, drinking, stress
Use by children and teenagers is a significant concern
Source: Farsalinos et ai, 2014
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Secondhand and Thirdhand Exposure
• E-cigarettes have no sidestream emissions like a
conventional cigarette (generates smoke while holding)
• Exhaled aerosol may be inhaled by nearby individuals
(secondhand exposure)
• Surfaces can be coated with the nicotine-containing
aerosol as it settles (third hand exposure)
• Health effects of indirect aerosol exposure are unclear
• Extensive experience with conventional cigarettes is
being used as a guide to investigate these questions
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Electronic Cigarettes: Nicotine Cessation
• Nicotine replacement therapy (NRT) is an approved
cessation treatment
• E-cigarettes may be a uniquely effective
NRT
due to
their potential to mimic conventional cigarettes
More rapid nicotine delivery than approved
NRT
Behavioral aspects: 'mouth feel, exhaling aerosol, touch
-
-
-
E-cigarette with nicotine
E-cigarette w/o nicotine
Nicotine patch
50
100
150
200
Days to Rei apse
Source: Bullen et aI, 2013
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Electronic Cigarettes: Harm Reduction
• "People smoke for the nicotine but they die from the
tar
ll
Prof Michael Russell}
1976
• In a harm reduction model} smokers would replace
conventional cigarettes with e-cigarettes
• There is active debate on the proper approach
Some advocates support the immediate routine use of e­
cigarettes to replace conventional cigarettes
A more cautious view seeks a better understanding on safety
and t heir impact on conventional cigarette use
• No peer-reviewed harm reduction studies
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NIH
Supported Research into
Electronic Cigarettes
Device design and function
Health effects of aerosol constituents
Biomarkers (physiological measures of exposure)
How does marketing influence use
What are the effect of flavorings on preferences
Longitudinal surveys of use by youth and adults
Potential for cessation and harm reduction
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There are More Questions than
Answers for Electronic Cigarettes
• How safe are e-cigarettes for long term use?
• Will conventional cigarette smokers who use e­
cigarettes completely switch or become dual users?
• Will
e-cigarettes alter a
smokerJs
intentions to quit?
• Can e-cigarettes be an effective tool in cessation?
• Will
non-smoking youth routinely use e-cigarettes?
• How will e-cigarettes affect youth smoking of
conventional cigarettes?
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Electronic Cigarette Advertising
• Advertising of traditional.cigarettes TV
ads banned since 1971
• Increased youth exposure to e-cig ads
- Between 2011-2013, e-cig TV ads that reach
children increased
by
256% and young adults
by
321%
<_.PlP.O~QP~'
TV.,a(l
sPendil'igfor,
EfC)gar1!tt:e
S
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• Ads during 2013 Super Bowl reached
more than 10 million viewers
• In 2013, $30 million spent on ads in
for 'blu' e-Cig brand
(increase planned for 2014)
• In 2014, $30 million budgeted to
promote NJOY e-Cigs in the US
(spending
triple that of 2013)
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Source: Wall Street Journal (online)· Dec 2013; Duke, et al (2013) . http://pediatricsde.aap.org/pedlatrlcs/july_2014?pg=S9#pgS9
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Regulatory Options Enacted by States
• Taxing e-cigs similar to tobacco products
• Restrict or prohibit redemption of coupons for tobacco
products, including e-cig products
• Prohibit distribution of free samples
• Regulate sale and distribution of flavored non-cigarette tobacco
products with characterizing flavors (similar to New York)
• Comprehensive youth access laws prohibiting sale to minors,
requirement to be kept behind counters, sold only in places
where adults permitted to enter and raise minimum age to
purchase
• Include e-cigs in smoke and tobacco-free restrictions
• Regulate the sale and marketing of e-cigs, health warnings at
point-of-sale
Source: http://publichealthlawcenter.org/sites/defauit/files/pdf/tclc-fs-regulatory-options-e-cigarettes-2013.pdf
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Current State Regulations
United States 100% Smokefree Air Laws
American Nonsmokers'
RIghts
Foundation
As
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Jm,
3, 2014
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State and Local
Ten1toria. end
C~Cb.
Laws Regulating Use of Electronic Cigarettes
All
of
July
3,
2014
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Physiological Effects of Nicotine
• Nicotine is rapidly delivered to the bloodstream via
conventional cigarettes.
• Nicotine stimulates the adrenal glands to release the
hormone epinephrine (adrenaline), increasing blood
pressure, respiration, and heart rate.
• Nicotine increases release of the neurotransmitter
dopamine, affecting brain pathways controlling reward
and pleasure.
• Long-term brain changes induced by continued nicotine
exposure result in addiction-a condition of compulsive
drug seeking and use, even in the face of negative
consequences.
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ROCK\1]LLE, MARYLAND
MEMORANDUM
January 12,2015
TO:
George Leventhal, President. County Council
Jennifer
A.
Hughes, Director, Office of
M1i:ttal~!*~
Joseph F.
Beach. Director, Department
FEIS for Bill 56-14, Health and Sanitation - Smoking - Electronic Cigarettes
Please
find attached the fiscal and economic impact statcments for the above­
FROM:
SUBJECT:
referenced legislation.
JAH:fz
cc: Bonnie Kirkland, Assistant Chief Administrative Officer
Lisa Austin, Offices ofthe County Executive
Joy
Nurmi, Special Assistant to the County Ex.ecutive
Patrick Lacefield, Director, Public Information Office
Joseph F. Beach, Dircctor, Department of Finance
Vma Ahluwalia., Director, Department of Human Health Service
David Piatt, Department of Finance
Pofen Salem. Office of Management and Budget
Alex Espinosa,. Office of'Management and Budget
Naeem Mia, Office of Management and Budget
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Fiscal Impact Statement
Council Bill 56-14
HeaJth
and
Sanitation - Smoking - Electronic Cigarettes
1. .Legislative Summary.
am
56-14 would:
• prohibit the use ofelectronic cigarettes
in
public places where traditional tobacco
smoking is prohibited;
• restrict the sale of certain liquid nicotine
or
liquid nicotine containers
in.
retail outlet.')
unless the nicotine
is
in a container considered child resistant packaging;
• prohibit the sale ofelectronic cigarettes in any place
that
is
accessible to buyers of the
product '\\-lthout the intervention of the
sel~er
(similar
to
tobacco products); and
• generally amend County law regarding smoking, electronic cigarettes, and health and
sanitation.
2. An estimate of changes in County revenues and expenditures regardless of whether the
revenues or expenditures are assumed in the recqmmended or approved budget.
Includes source of information, assumptions, and methodologies used.
There
will
be no increase in revenues.
Based on experience from other smoking related legislation, response to complaints is
minimal.
Enforcement ofchild resistant packaging will have a fiscal impact if
the
Department of
Health and Human Services (HHS) is charged with enforcement through inspection.
Expenditures based on 857 markets requiring
bi~arttlual
inspection is 428 inspections
annually.
Checking for child resistant packaging would add approximately 15 minutes
to
each inspection which results in an additional 107 hours of inspection or .05 PTE. At $50
per hour, the additional county expenditure 'wQuld be approximately $5,350 annually.
The Department ofGeneral Services (DGS) estimates expenditures of $18,220 for 400
to
be
posted conspicuously at each entrance to a public place covered under the legislation.
Costs are for new sign fabrication ($8,000), installation ($10,000) and hardware ($220).
The Department of Transportation
(DOn
estimates expenditures of$341,OOO are needed to
rede~ign
and install Ride-On signs reflecting proper No Smoking or E-Smoking
s}1Ubq1s
and
enforcement language in order to
fulty
jrnplement the law.
3. Revenue and expenditure estimates covering at least the next 6
fiscal
years.
The expenditure identified in Question 2 would remain
the
same for each subsequent
fiscal
year.
DOS estimated costs would cover the next six fiscal years.
4. An actuarial analysis through the entire amortization period for each bill that would
affect retiree pension or group insurance costs.
Not applicable.
5. An estimate of expenditures related to County's information technology (IT)
~y$tems,
including Enterprise Resource
Planning
(ERP) systems.
Not applicable.
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6. Later actions that may
affect
future revenue and expenditures
if
the bill authorizes
future spending.
Not appHcable.
7.
An
estimate
of
the staff time
needed to
implement the bill.
It would require 20 hours
training
based on one hour for 20 Environmental Health
Speci
atists.
DOS estimates 672 staffhours for sign installation, inspection. and contractor oversight.
Hours
deployed for this effort
are
assumed
during
nonna!
working hours.
However~
this will
reallocate staff from other facility repairs and emergencies, such
that
backfiII overtime may
be
incurred. The average overtime cost for DOS
~
(public Sef\.1ce Craftworker, G
15)
is
$36.4 per hour.
8.
An explanation
of
how the addition of newstatf responsibilities would affect other
duties.
OveraU average time to inspect a
food
service facility
is
two hours. Based on an additional
107 hours oftime to inspect for child resistant packaging.
it
would result
in
approximately 53
fewer
food
service inspections completed annually.
9.
An estimate
of
costs when an additional appropriation
is
needed.
Not applicable.
10. A description of any variable that could affect revenue and cost estimates.
If
entorcement
ofchild resistant packaging is moved from 11118 to Liquor Control there
would
be
little or no
fiscal
impact on HHS.
11. Ranges of revenne or expenditures that are uncertain or difficult to project.
Not applicable.
12.lf a bUl is likely to hav'C no fISCal impact,
why that
is
the
case.
Not applicable.
13. Other
tlScaI
impads or comments.
None.
14. The
fonowing
contribnted to
and
concurred
with
thiS
analysis:
Clark ReB, Sr. Administrator, Licensure and Regulatory Services, DHHS
Kenneth Welch, Environmental Health Manager, Litensttre and Regulatory Services, DHHS
Patricia Stromberg, Budget Team Manager, DHHS
Beryl
1..
Feinberg. Deputy Director,
Departmei1t
ofGeneral Services
Richard Jackson, Division Chief, Department of General Services
Darlene Flynn, Chief of Management Services for Transit, Department of Transportation
Pofen Salem." Senior Management and
Budget
Analyst,
Office
of Management and
Budget
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Economic
Impaet
Statement
Bill 56-14, Health and Sanitation - SIiloking - EleetFonicL1garettes
Background:
This legislation would:
• prohibit the use of electronic cigarettes in public places ,vhere traditional tobacco
smoking is prohibited,
• restrict the sale ofcertain liquid nicotine or liquid nicotine containers in retail
outlets unless
the
nicotine
is in a
container considered child
resistant
packaging,
and
• prohibit the sale of electronic cigarettes in any place
that
is accessible
to
buyers of
the
product without
the
intervention of
the seller.
1. The sources of information, assumptions, and methodologies used.
Sources of infonnation include the Montgomery County Department of Health
and
Human Services (HHS) and the
u.s.
Center for
Disease
Control and Prevention
(CDC).
The methodology used
in
the preparation ofthe economic
impact statement
is a
re"iew
of various documents from the CDC related to
the
use
of
the products
prohibited and restricted under Bill 56-14 and infonnation provided
by
HHS.
Included
in
the
review is a description of the products, the results
of
a study
conducted
by
the jmunal entitled
Nicotine
&
Tobacco Research,
andinfonnation
provided by HHS.
According to the latest issue of
Morbidity andMortality WeekiyReport
from the
CDC dated December 12,2014, "electronic nicotine delivery systems (ENTIS),
including electronic cigarettes (e-cigarettes) and other devices such as electronic
hookahs. electronic cigars, and vape pens, are battery-powered devices capable of
delivering aerosolized
.nicotine
and
additives to the user." According to the article,
experimentation
"'ith
and current
use
ofe-cigarettes has risen
sharpJy
among youths
and adults.
A new study published in
NiCOline
&
Tobacco Research
focused on middle and high
school students who
neVer
smoked cigarettes but who used e.-cigarettes. According to
researchers from CDC, Food and Drug Administration (FDA), and Georgia State
University.
the number ofyouths who had never smoked a cigarette but had used e­
cigarettes
at
least once increase three-fold. That is, the number of"never-smoking
youth' who used e-cigarettes increased from 79,000 in 2011 to more
than
263,000 in
2013.
The. study also
focused
on
the impacts of advertising on students. The fmdings reveal
that ninety percent of "never-smoking youth" reported some level of exposure to
advertising
or promotions
for cigarettes or other tobacco products. Researchers
Page 1 of2
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EeoDomie Impact Statement
Bill
56-14, Health and Sanitation - SmokiBg - Electronic Cigarettes
concluded that the greater .number ofadvertising sources to which young people were
exposed,
the
greater
their rate
of intention
to smoke cigarettes.
According to data
collect from
websites.
there are 52 e-cigarette
and
vapor
stores
in
Maryland and eight
sto.res
are
located
in Montgomery
County. According to
infonnation provided by HHS,
there
are
no data on
the number of e-cigarettes
or
vapor
devices sold
in
the County.
However~
there are 847 licensed markets
in
the
County including
grocery stores, mini-marts, and gas
stations
that
could sell e­
cigarettes
but currently may
not. Therefore
data on the
sale
and
consumption of e­
cigarettes and vapor devices in the County are not available
to
estimate
\Vith
any
degree ofcertainty the economic impact ofBi1156-14.
2. A description of
any
variable that could
affect
the
economic
impact estimates_
The
variables
the
could
affect
the
ecQnomic
impact
estimates are the
number
of e­
cigarettes and
vapor
devices
sold in the
County and the
consumption
of
such products
by
minors as
defined
by
the
CDC
study.
3. The BiD!s positive or negative effect,
if
any
on emplo,)'lUent, spending, saving
t
investment,
income~
and
property
values
in
the County.
Without
specific data on the sales, businesses
that
sell
e-cigarettes
and vapor devices,
and on consumption,
it
is difficult to
detennine
the
Bill's effect on employment,
spending, savings, investment, incomes, and property values in
the
C()unty. Such
data could
be
obtained through a survey of
establishments that
are likely to sell such.
products.
4.
If
a
Bill
is
likely to have no economic impact, why is that the case?
It is difficult
\\ithout
specific
data
as noted
in
paragraph #3 to determine the Bill's
economic
impact.
5. The following contributed to or concurred
with
this analysis: Mary Casciotti.
David Platt
and
Rob Hagedoorn, Finance; Patricia Stromberg, HHS
~
Dep
J
sep F. .
ch,
Director
en!
ofFinance
.tl~~
Date
l/I-;l-
It
s-
f
Page 2
of2