Transcripts For CSPAN2 House Oversight And Reform Subcommittee Hearing On E-Cigarettes PART 1 20240714

Good morning, the subcommittee will come to order without objection the chairs authorized to declare a recess of the subcommittee at any time. This hearing is entitled examining jewels role in the nicotine epidemic part one. I recognize myself for five minutes to give an opening statement. After years of steady decline, use, nicotine use has suddenly reversed course, seemingly overnight. Between 2017 and 2018, a youth ecigarette use also known as vaping, rose 78 in one year to the point where over 20 of High School Students now vape. The lingering question is why and what was the role of jewel, the countrys dominant maker of ecigarettes with almost 80 of ecigarette market share in the dramatic rise in vaping . The panel assembled today will help us address these questions and frame our discussion for part two of this hearing here tomorrow at 2 p. M. When jewel founder will testify. Today we will examine what exactly about jewels advising and marketing makes it irresistible to kids . The preeminent marketing scholar in the country will help us answer that question. Afterwards well understand how jewel appealed to youth and simultaneously avoided detection by adults. We will hear about jewels efforts to market directly to kids, including how jewel entered schools under the guise of antivaping presentations then after the School Personnel left the room, unfortunately the jewel presenters told kids that their vaping tools were safe. We will hear from the parents of kids who sat through one such presentation. Two devoted mothers were no angry they founded a nationwide Advocacy Group. I suspect that of all the schools jewel entered, it regrets going into that one the most because it incited the righteous anger that only comes from parents who feel their kids were being exploited. We will also hear that jewels targeting of vulnerable populations was not limited to kids. Ray oleary will discuss jewels attempts to market to native americans. Jewel tried to pay her tribe to give free jewel starters kits to members and told the tribe that its product is healthy and proposed pushing it through the tribes medical professionals. Jewel appeared to think it could get away with this on tribal land and tried to ensure no one else found out about it. The jewel product itself contains very high nicotine levels, three to times the amount of ecigarettes that came before it. Its formula eliminated the harsh taste that previous would have accompanied that much nicotine and masked it with flavors, flavors, which appealed to youth. Kids do not grasp this. 63 of users age 15 to 24 do not know jewel contains nick tenick nicotine and thinks its only flavoring and that its not harmful. And perhaps we can better understand what led to parents sending jewelers like one from june of last year stating, quote, my daughter is highly addicted to the nicotine in jewelling. It is very sad and occurred very quickly over the past several months. She is 16 and now has addictive behaviors that she never had before jewelling, such as stealing money and other teens jewels and she lies and sneaks out at night to get a nicotine fix. Perhaps we can understand why a therapy wrote to jewel disheartened how many of her clients came to her about jewel addiction how, quote, desperately they need to vape. She expressed concerns about kids using jewel to selfmedicate from Health Issues like anxiety and depression. We will also examine what about the jewel device makes it so attractive to teens. It is discrete in a way that no cigarettes or prior ecigarettes were. It puts off a limited cloud of aerosol and its smell doesnt linger, its small. Before jewel was a household name, parents could have looked right past it thinking it was a thumb drive. In fact, ive had one in my hand during this entire statement. Jewel hasnt provided satisfactory answers for these open questions. Its my sincere hope that our hearings today and tomorrow will help us better understand jewels role in the terrible epidemic and point us towards solutions to prevent teen vaping addiction, the chair recognizes the distinguished member from texas, mr. Cloud. Thank you, mr. Chairman and for appearing this morning. For decades weve known that smoking is linked to cancer and 400,000 preventible deaths in america each year. These deaths are preventible if individuals are able to stop smoking. To are years now smoking has been on the decline, but far from eradicating it. Its clear the message that exited for cessation, quitting cold turkey, patches or gum are simply not enough. Recent suggestions that ecigarettes could be viable components to cessation. Theres a growing concensus in the Scientific Community that Electronic Cigarettes are less harmful than tobacco. And a study found that theyre 95 less harmful than tobacco cigarettes and for some who wanted to quick turned to ecigarettes as a cessation aid though the fda has yet to determine that ecigarettes are effective for the purpose other studies found at that ecigarette use is associated with nearly twice the rate of cessation than other nicotine therapies. No one wants kids to be using tobacco, no one wants kids vaping and no one wants Vaping Companies to target children with products. Its illegal for children under 18 to use these products and the tobacco act also applies to ecigarettes. And members of congress and in order to the questions i hope to have questions today. What if any are the cigarettes. Can be part of an over all strategy in a way that ensures that kids are protected and many more questions that i hope to hear answers to today. As doctor said twothirds say they want to quit and to lead to less harmful products. In twothirds of smokers want to quit members of congress can move forward with making transitions, like anything else with regard to its use, whether its used access to marijuana or alcohol the first line of engagement is by parents, schools and local communities to educate them about the risk. Thank you for being here today. Thank you, mr. Cloud. And now id like to turn to our witnesses, first of all, thank you all for joining us today. We very much for coming here thank the audience for coming here on an otherwise fake news day. [laughter] and first from the parents of vaping ecigarettes and miss ray oleary, Turtle Mountain band of the chippewa and a Public Health analyst and researchers with Missouri Breaks Industries research in south dakota. Dr. Jonathan and the departmental chair at Stanford University medical school and a practicing surgeon. And finally, dr. Raymond niora of the department of social and Behavioral Sciences of the college of global Public Health at New York University. Thank you all for coming. If you would all please rise and raise your right hand, i will begin by swearing you in. Do you swear or affirm that the testimony you are about to give is the truth, the whole truth and nothing, but the truth so help you god . Thank you. Let the record show that the witnesses answered in the affirmative. Thank you and please be seated. Without objection, your written statements with be made part of the record. With that miss berkman youre recognized for five minutes let me explain the lighting system here so you have five minutes and its a countdown on the clock, green means youre in good shape. And unlike with stop lights, yellow means speed up and red means stop. So with that, please begin, miss berkman. Not stressful at all. Thank you for your words and thank you for the committee on economics and economic policy. I represent parents again ecigarettes, we call it pave. And it was started by three concerned moms. We have groups of activated parents across the country from california to new york and places in between. We have people with us here today from texas, from georgia, from virginia, new york, new jersey, et cetera. My cofounders, dina alesy and Dorian Fuhrman are behind me between us nine kids ages 7 to 19. Along with our friend mimi, we created this out of the juuling that came out of nowhere and they consider is one of the most serious adolescent crisis faced for decades. Our goal is to give voice to the 3. 6 million teens who are vaping, most of them juuling, this most recent figure from the c. D. C. Is already outdated and as you said between 2017 and 2018 theres a rise in the use of products by High School Students and 48 rise in use by middle School Students and experts believe that the new significance due this fall will likely be much higher to have them go down. We hear from desperate parents every day to contact us seeking resources and information and help for their juul dependent nicotine addicted kids, but theres not yet any fda approved treatment for this nicotine addiction. The stories are heart breaking coming from every state represented on the panel and probably for every state of people in this room, from massachusetts our advocate speaking about her son, a hockey player. He developed a cough and complained he could not breathe while skating. And he was distant and moody, extreme bouts of anger and home environment was toxic and turns out that cade has restrictive lung disease. He needs inhalers and oral steroids and he had been smoking a pod a day, equivalent of more than a pack of cigarettes a day for three years. Kelly from North Carolina is here with her son luca, whose addiction was so severe he spent 39 days as an inpatient at rehab in california. And kelly said we began living with a stranger. Our straight a students grades dropped to f. It was the extreme anger. It turned out our 14yearold had a Substance Abuse problem and that substance was juul. And now i want to share a personal story. The story of how juul went after our kids and their friends by coming into their school. Without the knowledge of the school or of us concerned parents, juul sent a representative to talk to our kids about its product under the guise of education. On april 3rd, 2017, my then 15yearold son caleb who is here told us there had been an antiaddiction talk at school for the ninth grade. The teachers left the room and the man named ali gave a confusing talk about juul telling its not for kids, but for adults. It was much safer than cigarettes. The fda would approve it any day. When he was done, caleb and his friend phillip, dorians son went up to him and ali repeated it was for adults and not kids, and took out the sleek looking juul, showed how it it worked and called the iphone of vapes. And thats when we moms decided to fight back. We discovered a couple months before our kids were juuling under our noses which is common, it doesnt mean youre a bad parents if your kids are juuling, its stealth by design. We knew that nicotine was harmful to our kids brains and as we researched and put pieces together we learned that juuls Deceptive Behavior seemed to be part of the marketing strategy. A retired super was offering people in his state and massachusetts money if theyd implement the antijuul, and came across the stanford medical prevention tool kit with an odd disclaimer we immediately realized was a reference to juul taking information it shouldnt have. None of this is surprising. As i said, juul is stealth by design. Juul says it no longer restocks retail orders of the flavors that research has proven are hooking the kids. Yet, just the other day, in one block radius in two Different Stores i was able to buy these menthol im sorry, these mango pods that juul says are no longer on the market, but theyre still online and thats the problem. If juul really wants to slow the vaping epidemic and keep kids from starting, they will immediately remove all flavors from the market, including menthol and mint, one of the most popular kid flavors, and they will stop spending millions of dollars on lobbyists to impose sensible legislation that pave and Many Coalition parters are fighting for all over the country to restrict access juul and other products. And we hope motivating members of congress on all sides. To hold them accountable for predatory practices and causing harm to so many kids in the country. Its not a political issue, but a moral one, if we dont take action now, we face an entire generation of kids addicted to nicotine who are human guinea pigs for the juul experiment overall. Thank you, miss berkman. Now, miss oleeary, youre on the clock. Good morning, members. Thank you for explaining to juuls marketing to the population. Im a fact witness representing the tribe. A coalition on the reservation, opposing use of Tobacco Products because of the tobacco historical targeting of American Indians which contribute to the deaths on the cheyenne reservation. They handed out Free Products to tribal Decision Makers and offered a switching program to the crc Health Committee and proposed that the Health Professionals from the crc Health Departments reefer smokers, 21 years or older to their switching programs. They would enroll on juuls online portal by entering Personnel Data and health behaviors. They would provide free starters kits to those in the program. And throughout the presentation they made multiple claims that the product is effective or smoking is Smoking Cessation and less harmful. And these are from the family Tobacco Control act. They claimed it was worth over 600,000 to the tribe. Initially, some Tribal Council members were convinced it would improve the quality of life for smokers and fewer Health Care Costs for the tribe. Despite initial interest in the juul switching programs they wisely requested documentation for the switching proposal. Juul did not provide that as requested. Instead sent a mutual nondisclosure agreement to the tribes attorney general with information that they had been discussed by the crc committee. The nondisclosure was not signed, as a result juul has not returned to the tribe. And earlier, passed a resolution that crc shall neither accept this is for other tribal nations as well as the health board. There are many reasons including grave safety concerns safety of exploding batteries and unknown probable health risks including cardiovascular risk. Even though its incontinueded for adult smokers, there are concerns that theyll use juul concealed in a highly flavorable product. This is supported by the American Indian middle School Opportunities in south dakota are using ecigarettes three times more than counterparts. And the other concern is at that juul a growing body that ecigarette users smoke more than. And its true that some have quit. But for every one that quit 81 adolescents will initiate ecigarette use. Nearly juul and other ecigarettes are being used mo more. And the ability to enforce tobacco regulations or publish reports of our 51 adult smoking preference, coupled with propensity to addiction and maybe drawn to crc because of the young population base or the pooshest county in the nation. Juul did not provide acceptable justification for the choice to offer the switching program to titled sovereign nations. I would challenge the committee to look into why juul is interested in partthering with prescribes. As an American Indian woman educated in Public Health and knowledgeable about the tobacco disparate that exists at indigenous populations, targeting American Indians and exploiting Tribal Industries is for too long. In the end, it was the lakota seventh generation beliefs that helped me to reach my decision to testify, what happened is too important not to be shared. Its time to take action to prevent juul and all Tobacco Companies on preying on atrisk populations. As considering policy following this hearing i challenge you to learn from the lakota people of seven generations, leaders must look at how it will affect our descendents seven generations into the future. Thank you. Thank you, miss oleary. Dr. , you have five minutes. Good morning, chairman, and Ranking Member cloud, members of the subcommittee. My name is dr. Jonathan winakof. I have experience treating children and adolescents. Im here prepping the american pediatrics. Juul use among adolescents have reached epidemic proportions and i see evidence of this every day in my practice. Every one of my teenage patients and even many of preteen patients uses these ecigarettes or have friends that use them. They know this theyre dangerous, but believe that juul is harmless. I have to explain that ecigarettes do know the have the same positive benefits at fruit favors that they copy. Rather that the liquid contains toxins and carcinogens and ecigarettes are not good for growing lungs and particularly bad for children with asthma, they can cause conditions, hypersensitivity and pneumoniaitis. Theyre not aware of the nicotine content and one juul pod contains as much as 20 cigarettes and impact the areas of the brain that control function, memory and mood. Nicotine addiction can take hold in only a few days, especially in the developing adolescent brain thats particularly vulnerable to addiction. Ecigarettes concern it because it can lead to combustible tobacco use. Compared to adolescents who do not use the cigarettes, those who use are three times more likely to begin smoking traditional cigarettes. Many of my patients use juul daily and find it impossible to stop. Nicotine withdrawal can cause headaches, insomnia, irritability and they have the only sure fire way to eliminate the use in adolescents is to stop it before it starts. Luckily we already know what needs to be done. We need to make ecigarettes less appealing to children, harder to access, regulated appropriately by the fda. First and foremost we must address juuls flavors. Juul pods come in a number of sweet flavors, mint, mango and creme. And that ecigarettes flavors are one of the prime reasons that they try them and mask the harsh flavor of nicotine and likely for addiction. And juul have mint and menthol pods for sale everywhere. Its completely false to suggest that mint is not attractive to children, from candy canes to toothpaste, children are introduced to mint at a young age and menthols Anesthetic Properties cool the throat and make it easier for children to inhale the poison. When juul withdrew many of the flavors, majority of my parents switched to mint. Nevertheless, children are gaining access to other flavored juul pods even though theyre now sold online. If the products are available for sale somewhere, children will get their hands on them. We must eliminate child friendly flavors from all Tobacco Products and we urge congress to pass legislation immediately to prohibit favored, including mint and menthol, from Tobacco Products. Mr. Chairman, members of the subcommittee, jewel is a fatally flawed product. A recent study showed 15 to 17 year olds are 15 times nor likely to report juul use than 25 to 34 year olds. Even though juul claims its products are only intended for adults. When so much of the product ends up in the hands of children, its time to declare it a failed product. The american pediatrics believe its a Public Health that must be removed from the market as soon as possible. Juul is eroding the progress in teenage tobacco use. Teens are using this when many would never have used a tobacco product. Juul must account for the epidemic its created and congress and the Administration Must take action to end it. Thank you. Thank you, doctor. You have five minutes. Thank you for the opportunity to testify before your subcommittee today. Almost all smoking begins during adolescence. Its part of teen rebellion, typically commencing between the ages and 12 and 19. It would indeed be a very rare 40yearold who woke up and said, hey, i think ill start smoking today. And once a teen becomes hooked on nicotine, its exceedingly difficult to quit. Many are stuck with a life long addiction. From the beginning, juul professed a Noble Mission of improving the lives of a billion smokers. Instead they have spurred an epidemic of nicotine addiction amongst youth. How did juul stray so far from its mission, majority of smokers 34 to 60, juul should have designed for a middle aged audience. Over the first year, could we have the slides, please, garrett . Okay. Over the first year after juul launched in june 2015, it held at least a series of 50 highly stylelized parties with youth oriented entertainment in industries across america. Thousands of young people were given free juuls, often by attractive young girls. Juuls initial campaign called vaporize was designed by an Advertising Agency whose goal it was to create a cultlike following, and they succeeded beyond their wildest dreams. Viperized featured models in their 20s in trendy appearing poses and exhibiting behavior more typical of underage teens than adults. Tobacco advertisers have long known that these imageries are exactly how to target underage kids. Just last week in a televised documentary on cnbc, juul cofounder adam bowen claimed that the 2015 vapized campaign on life style oriented and no impact on sales. Life style oriented, its obviously youth oriented in that way. Contradicting mr. Bowen, juuls cofounder a mere seven months after launch bragged now were the Fastest Growing ecigarette company in the world. Today they say that their advertising youth oriented made no difference, but at the time they were bragging they were the Fastest Growing in the world. That is revisionist history or intention, ill let you be the jud judge. Were juul mostly advertised online and paid influencers, social media stars with a number of online followers to praise juul. Juul multiplied its reach by the use of hash tags which began online gathering places for teenagers. Under intense regulatory pressure, juul halted its own social media postings in november 2018. However, this was a hollow gesture. It didnt matter much and the reason was that viral peertopeer promotion amongst teens assured a massive visibility of their products on an ongoing basis. For example, after juul quit its own postings last november, Community Posts and juul by kids surged, tripled and now theres 540,000 posts and millions of views of that youthful material. Juul leadership claims we were completely surprised by the youth usage of the product. Cofounder brags were the most educated company, the most diligent, the most wellresearched. They are, indeed a datadriven company. They know their market, to whom their products are distributed and the identity of their customers. The New York Times interviewed a former juul manager who disclosed that juul knew that their products were becoming popular with underage users within the first months on the market. And like many Tech Startups as the money starts rolling in, juul made many compromises at that their grand vision. What should have become an offramp for adult smokers instead has been a heavily traveled onramp to nicotine addiction to teens, many to graduate to combustible cigarettes. And the way to keep teens to stop in the first place. Finding the leading youth initiation cigarette marlboro with the youth initiating cigarette juul. That flair agreement joint juul and marlboro marketing has been a great concern. Juul has been unmasked for hypocrisy, rather than up leading big tobacco juul is part of it. Its as though they lit the kindling and stood by and no way to stop the fire, and stoked it and when the Fire Department came they expressed dismay and widely protesting that their actions had nothing to do with it. Thank you. Thank you, dr. Jackler. Doctor, you are on the clock. Thank you. Mr. Chairman and members of the committee, thank you for holding this important hearing on a topic of great concern to the nations Public Health and im privileged to appear before you this morning to testify about the challenges we face regarding youth use of ecigarettes and other Tobacco Products. My name is dr. Ray niora, a clinical psychologist professional and Behavioral Sciences and epidemiology at New York University and ive spent my entire professional career engaged in research on understanding and treating tobacco dependence and finding and testing ways to help smokers quit smoking. As a Public Health and tobacco use scientist, i, too, share concerns about the tobacco use including vaiping. I believe that no teen should be using tobacco or product. And we should have counseling and make it difficult for youth to purchase the products. And companies that sell vaping products do all they can making sure its marketed only to adult smokers. I take some comfort that Marketing Strategies and Health Claims will eventually be subject to the u. S. Food and Drug Administration review and approval. During the fall of 2018, the fda and the u. S. Centers for Disease Control and prevention expressed acute concern about youth vaping when they looked at data from National Surveys and this prompted dr. Scott gottlieb who was the fda commissioner at the time to declare that youth vaping is an epidemic. We this concern was ree reinforced by the Youth Tobacco survey in 2018 when t. When the data was released to the public we could confirm past 30day vaping increased from the prior year. And while an increase in use is of concern, our analysis showed that most adolescent vaping was occasional and that most regular use was concentrated in adolescents who had already been smokers and this i think this is an important point. Yes, we need to be concerned about vaping, but we also need to be concerned about use of other Tobacco Products. And we also looked at youth who had never used Tobacco Products and thankfully vaping rates were quite low. Again, this is not to minimize the importance of concern about youth vaping. Cigarettes, smoking, remains a major concern here in the United States of america. And id also like to emphasize another point, which is that ecigarettes have the potential to help adult smokers stop smoking. Weve seen evidence accumulating that adult smokers who use ecigarettes can quit smoking. Regular cigarette studies have come out in the new england journal of medicine indicating the same. Last week a report that smokers to switched to ecigarettes and used them every day were more likely to quit smoking compared to those who did not use ecigarettes. These results were important because we know that despite their effectiveness, smokers dont often use quitting messages such as nicotine replacement therapy or other medications. So as they stand now, ecigarettes are a Consumer Product proving to be very popular with smokers, and helping them to actually quit smoking cigarettes. Quitting smoking is the Number One Health priority for cigarette smokers and we need to use all the tools available to help reduce this burden, which prematurely claims the lives of over half a million americans every year. So currently, about 38 million adults in the u. S. Smoke and clearly, this is and ought to be a youth Public Health priority. Id like to close by saying, i think that this set of issues, both youth, tobacco, nicotine use and adult smoking, have been portrayed as at odds with one another and they really should not be and that we in the Public Health community and congress ought to find ways where we can do both. I think were smart enough know figure out how. But i dont think we have all the answers yet. Thank you very much. Thank you, dr. Niaura. I now recognize myself for five minutes of the questions. First of all, mrs. Berkman and mrs. Fuhrman after you discovered that a presenter representing juul gave a closed assembly at your school and you formed Advocacy Group around the country about adolescent ecigarette use. Thank you. And as a parent after teenager, i was surprised to find out that juul had access to them without teachers and mrs. Berkman and fuhrman id like to ask a couple of questions of your sons, if thats okay. Yes. Phillip and caleb can you please come to the table for a couple of minutes . Id like to first address caleb. Caleb, what grades were you and phillip in the year of the juul presentation . Ninth grade. Can you speak directly into the microphone. Ninth grade. Thank you. What were students told about the presentation before it began. We were told that we were having a Mental Health addiction seminar, that we had three times a year, and teachers are told to leave the room so its a safe space for kids to talk. Did most of your classmates believe juul was safe prior to the presentation . I think many kids were already juuling and had their doubts to if it was safe, but i think a lot of kids still thought it was possibly dangerous. Did the presenter ever mention his connection to juul and were your teachers in the room when he spoke . He did mention his connection to juul and my teachers were not in the room when he spoke. Did the presenter ever say that juul was safe . Yes. Did the presenter call juul quote, unquote, totally safe, more than once . Yes. What impact did those quote, unquote, totally safe comments have on your classmates, some of whom may have already started vaping . For my classmates already vaping was a sigh of relief because then they could vape without concern. And were children more likely to start juuling quote, unquote because its now totally safe . I cant say for sure, but i would say after this meeting kids were more inclined to vape because now they thought it was just a flavor device that didnt have any harmful substances in it. You and phillip approached the assembly when the it concluded. What motivated you to approach him in the first place. In my belief representation that it was totally safe, but following up every statement, but we dont want you as customers. I saw a mixed nature and playing on the rebellious side of teens when teens are told not know do something, they are more likely to do it. Phillip, let me ask you a couple of questions. What was your experience speaking to the presenter . So we went up and talked to him and caleb asked a question about what can you do if your friend is addicted to nicotine. Phillip, were you addicted to juul at the time of this presentation . I was. And when caleb asked the presenter what he should do if he had a friend addict today nicotine, was caleb referring to you . He was. How did the presenter answer calebs question how he could help his nicotine addicted friend, namely you . Since caleb was not specific on what kind of nicotine addicted to, ecigarette or cigarettes, the speaker thought he was talking about cigarettes and he said he should mention juul to his friends and because thats a safer alternative than some cigarettes and would be better for the kids to use that. Let me get this straight, he wanted you to switch from a combustible cigarette to juul. Yes. Did the presenter demonstrate it to you . He didnt use it, but did take it out and show it to us. Okay, this is very disturbing behavior to say the least. A person connected to juul pulled out a juul device to demonstrate its safety to teenagers, and then lied about the product being quote, unquote, totally safe. Did he say anything else about whether the government had approved juul . He mentioned that the fda was about to come out and say that juul was 99 safer than cigarettes and he said that that would very happen soon and that it was in fda approval while the talk was going on. Thank you, caleb and phillip. Let me ask dorian, phillips mother to say a couple of words here. Dorian, thank you for coming today. Thank you. Your son phillip just started he was addicted to juul. Yes. How did his addiction impact your family . It was difficult and at first we didnt understand what was going on. As a young 14yearold he was interested in so many Different Things from surfing to cooking to his little sister. And i started to find these flash drives and these green plastic caps in his pockets and i didnt really know what it was at first. And so, he kept saying, now, they belonged to a friend and wed have fights about it and i figured out what it was because i googled the name on the side and it was difficult. He changed kind of overnight. He started spending a lot of time in his room in the dark. He became moody. We had a very contentious relationship. I became very suspicious, obviously, and i think he didnt really understand what was going on himself, and neither did we. Thank you, dorian. Thank you. Let me now recognize Ranking Member cloud for five minutes of questioning. Thank you, chairman. Ms. Berkman, im curious the reaction, i assume you approached the school board, the principal, what was the reaction . The school had no idea that the outside group had brought a juul representative into the school. The school had no idea. They had hired a group that had yes, and we believe that the outside group was naive, definitely, but in good faith because when i called to ask about this presentation the staffer who answered the phone said, oh, you found the right person. I was researching antijuul Education Online and i came across the name of a woman named Julie Henderson listed there and no longer on the juul website as its youth prevention coordinator and then she called and this woman, miss henderson said i have the perfect person and sent ali. Okay. Thank you. Doctor niaura. Did i pronounce that right . Yes. Could you explain the difference from a health perspective, i guess between a traditional cigarette and ecigarettes . Is there one . Yeah, there are many, many differences. You know, traditional cigarettes, you know, consist of a preparation of tobacco leaves, which when burned create, you know, smoke and contains roughly 7,000 different chemicals, most of which are not good for the human body. Ecigarettes contain far fewer ingredients in addition to nicotine, usually Something Like pro peen glycol, glycerin, commonly found in food stuffs and some flavoring. And this, in general, the difference in terms of the number of compounds in ecigarettes make them in general safer although they can vary from product to product. A lot of the safety of ecigarettes depends upon temperature control. So, for example, if products have adequate temperature control they tend to be, you know, less toxic. Okay. I guess weve known cigarettes for a while cause cancer and talking about prevention, i remember in third grade seeing a lung sitting in a jar of be is who passed away from cigarette use. But i guess what im trying to get down to is what are the health affects of combustible side of it and the Health Effects of the nicotine side . Well, yeah, and thats actually an important, you know, point to raise. So if we look at nicotine in and of itself, its not riskfree, but its probably a lot less toxic compared to the other chemicals that come out of cigarette smoke. Its not risk so, for example, nicotine probably does not cause cancer. It may have some small effect on existing cardiovascular disease and so forth. You know, it can, you know, the brain might have to adapt to, you know, having a drug on board these adaptations which are true for any drug. But the nicotine itself is not the culprit when it comes to things like, you know, cancers. At least as far as we know. Okay. We seem to have a kind of a competing set of facts here. We have data that shows that teens ecigarette use has gone up a lot and then dr. Niaura, you mentioned that a lot of thats, i guess transitional or is it not . Is it new use . I guess, if dr. Jackler and dr. Niaura, if you can clarify that for us, have a better understanding whats new use, thats transitional use . Well, yeah, thats an important question, that i dont think we have a good handle on yet because a lot of the surveys that we look at are what are called cross sectional, meaning its a dip stick or its a slice in time and you know, we see kids that report to us how theyre using one or two days, you know, or every day and so forth. And what we need are studies that track kids over time to actually see whether the ones who are starting out, you know, one or two days go on to use more. And, but, you know, once again, we dont know what the real implications are of these different patterns of use and i want to emphasize the shared concerns that kids shouldnt be trying the products and certainly shunting using them on a frequent basis. And the c. D. C. Data show a huge use over, over two million american High School Students and many hundreds of thousands of middle School Students. A fraction of them, of course, experiment and others become regular user. I just want to touch, as a physician, on the healthfulness of vaping. You know, if you start smoking today, its 20, 30, 40 years before you get emphysema or lung cancer. Nobody knows what it does to breathe in aerosol propylen glycol. When you breathe them in, for example, the classic example is buttered popcorn, microwave buttered popcorn. The compounds in the industrial setting cause severe restrictive lung disease on the part of the industrial worker. Were taking a wide variety the ecigarette industry has taken flavored chemicals thousands of different ones, cotton candy and flavors and mixed them and theyre exposed over and over in the lungs. Theres no doubt in my mind that vaping is safer than conventional smoking, but that doesnt mean that its safe. Thank you, i now recognize congresswoman tlaib for five minutes of questioning. Thank you for being here. Mrs. Berkman, i can sense your frustration. And being here seven months, i dont call it some people call it rhetoric or discredit a lot of things were pushing forward. I want you to know you have the truth on your side and just be be stronger for that because we dont need more studies. We already know the truth here. In the few years after juul was founded in 2015, it dominated the market through a targeted Advertising Campaign that seems to be a Winning Strategy as juul now accounts for 76 of the u. S. Ecigarette market. Just simply staggering. What i find troubling is in the same time frame, the rate of teen nicotine addiction skyrocketed, the c. D. C. Found 75 increase in ecigarette use among High School Students from 2017 to 2018. So its no coincidence to me that teens who use ecigarettes almost exclusively refer to the activity as juuling. So professor jackler, you have studied juuls marketing practices since the Company Started in 2015. Based on your expertise, should juul have been aware that its Marketing Campaign would appeal to youth and teens . Absolutely. You know, huge teenage fads dont happen by accident. You know, the beatles and beanie babies were promoted by cleaver clever advertising. And ad agencies understand the difference between marketing to baby boomers and gen z to are looking at their phones and they dont work independently. The company new well when it chose instagram who the heaviest users are, and the New York Times validates it, in the article. And i dont think theres any question that jewel knew they were perpetuating this. Youre at stanford, the same as founders attended as students. Have you ever met james or adam bowen . Yes, i met james monsy in my Research Team and we went up to juul last summer in august. You know, he was quite interesting. He thanked us for the data base that we have of 50,000 traditional tobacco ads online. He said they were very helpful as they designed juuls advertising and this struck us so much that as the seven of us left the twohour meeting was the very first thing we talked about how surprising it was that he indicated that juul was grounded in traditional advertising and in fact, we know very well having studied tobacco advertising, that juuls marketing faithfully recapitulates the message used by the Tobacco Industry to target young people and that includes brands such as marlboro which they closely emulated, american spirit, newport. Theyre direct derivatives in juul advertising in those. Thank you. And so juuls Mission Statement asserts that it aims, quote, to improve the lives of the worlds one billion adult smokers. Do juuls marketing practices which you studied for years align with that stated mission . Not for its first three and a half years. On the fourth year, at that point when already the youth fad was raging, their ads became more calibrated to an adult audience and the channels that they used did as well. Theyve now switched campaign depicting middle age and older adults and its in printed newspaper and television and no longer theyre promoting on social media. Now, this only happened long after there was a youth epidemic and it was because of the unwanted and intense attention by regulators and also, interestingly, as mr. Munsey pointed out when we visited with them, they were concerned about their investors, particularly National Companies like fidelity, an early investor, who didnt want to be widely seen no, it always leads to profit. And juul have we seen influence on social media on kids today . Juul taking down its marketing didnt affect the hash tags. The juul hash tag, there were a quarter million posts mostly by young people on juul. Since last november to now doubled to over half a million. And professor, and i appreciate that before, chairman, its important to note what astounded me the most. Its been mentioned today the potential possible correlation with tobacco and cigarettes. Dr. Niaura comes to conduct a lot of research and published several studies on this very topic. How reliable of a predictor of future use of Tobacco Products is current use of vaping for use . Well, there is a Statistical Association between use of ecigarettes and subsequent cigarette smoking. But what weve looked at and we looked at this in the population assessment of tobacco and health study which is funded and sponsored the fda and the nih. So we did find that, but the also found if kids had started with a cigarette, they were 20 times more likely to continue smoking cigarettes. So the message we take from this is that use of all or any nicotine or tobacco containing products for kids probably will increase the risk for subsequent cigarette smoking. The worst thing to start with would be a combustible product like the cigarette. Has the rate of decline in smoking among adults decreased or increased since 2010 when ecigarettes started to rise in popularity . Weve seen steady declines in cigarette smoking, both in youth and adult populations, which we should take as good news. Absolutely. We certainly have more work to do. And yes, there is sort of the verging of the trains with ecigarettes picking up and use of cigarettes going down. Thats the area of active research is to see whether those two things are actually connected with one another. It if ecigarettes were a gateway to smoking, wouldnt evidence show a substantial increase in smoking in adults . Weve seen a decrease in use of other Tobacco Products right now it doesnt appear that ecigarettes or translate into subsequent use of cigarettes, at least as far as we can tell right now. Does evidence show that teens are diverting to ecigarettes instead of taking up smoking . Well, thats an important question now a think we need more research to address. Kids are trying a lot of different products, including vaping, and we need to understand more about who are the high risk kids who might try a lot of products, who may inadvertently become more addicted to nicotine. We really need more and better understanding of those factors so that i think we could do a better job at doing some kind of intervention. I just want to make a point here that i certainly opposed the youth vaping. Im opposed to Youth Smoking. Im not a smoker, never have been. I am a farmer and they do represent probably the biggest tobacco growing district in america, without a doubt. This is something that has been a big economic boom the kentucky. Having said that, we recognize the risks and the danger and the bad effects of cigarette use and tobacco use. The industry i think has tried to do things to curb underage smoking. I know that senator mcconnell has a bill that i support to raise the minimum age to purchase cigarettes. And i think that something that needed to be mentioned today, that tobacco is still legal. And i know this is about ecigarettes that i have to conclude with this because its a big industry in my district and its come in kentucky youre not able to grow fruits and festivals because of the commissary limited to what types of crops you can grow fruits and vegetables. Is still a Legal Industry and as long as its it still a legh i would rather tobacco be grown in kentucky by middleclass farmers, small farms, which is who grow tobacco, then inputting tobacco from other countries. Having said that, i certainly want to work with my colleagues on both sides of the aisle to make sure that youth use of ecigarettes goes down, and certainly as ive always been a proponent of doing everything we can to prevent underage smoking. With that, mr. Chairman, i yield back. Thank you. Ms. Pressley, you have five minutes. Thank you mr. Chairman, and thanks to all of our witness for sharing your expertise and sound sounding alarm on this. In addition to the experts and those that are at the dais here, i did want to acknowledge and acknowledge the African Leadership control council who are interested and we thank you for your good work. The growing youth vaping epogen has taken in the commonwealth which are represented by storm across the state it is estimated nearly one in five High Schoolers and one in 20 middle schoolage kids are using these products. Student advocates report School Bathrooms have turned into juul lounges that smell fruity enmity. Enmity. I spent the last ten years of my life as an elected official at the getty for a school nurse in every school and we learn from our School Nurses that 80 High School Students are vaping, thats from their Youth Risk Behavior surveys. Leaders of the local and state level in massachusetts from our city council to our attorney general who was the one to initiate the first investigation into the problematic marketing and sales practices and a boston City Councils looking to push it on banning flavored vaping products. We have to act on the federal level. Id be remiss not to highlight how many center of jewels tactics into the right of the big tobacco playbook. For decades tobacco targeted black community to the point were almost 90 of all black smokers use min false. Nearly 45 of black menthol smokers state state they would quit smoking it menthol were altogether band. It is extremely disturbing. Weve been here before. We dont need a bunch of studies. The only studies we need are the millions of casualties that are behind this and that we run the risk of seeing ahead of us. This is very disturbing. Its a crisis in worse for children. It was found believe ecigarettes only contained flavors as we learn from the youth who spoke today and we thank you for telling your story. It seems obvious elimination of flavors would help eliminate this confusion, so dr. Winickoff, why are mental flavored Tobacco Products particularly exploited in the context of ecigarettes . Well, thanks for the question. The Tobacco Industry has a long history of targeting midand menthol flavored Tobacco Products to africanamericans, and specifically africanamerican children. A recent study in the american journal of preventive medicine, however, showed the majority of americans believed it should be banned as a flavor and Tobacco Products. Interestingly, in contrary to what the Tobacco Industry at the tobacco product industry claims, if you just look at the opinions of blacks and africanamericans and even greater majority believed it should be banned, so i think no one is fooling anyone here. Agreed. Aside from potentially pouring upon the black committee, juuls marketing playbook as we learned as target children in native populations. Ms. Berkman, you were so disturbed that you create an organization to spread awareness of juuls of dangers to families across the country. We know the expression hell hath no fury like a woman. They need to make a point about months, okay, because thats next level. We thank you for your advocacy. Thank you. What have parents told you about how juuls marketing influence their children use of the product . Well, i wish we had those slides because i hope everyone will get to see them. When you see the sexy young influencers ever giving this product away, when you see how similar the old tobacco ads, they are almost identical. So juul knew what it was doing what we tell parents is youre not a bad parent. Because unfortunately, as you said, everyone is doing it. The scary thing is in this case its true. Its stealth by design. As you said we are very upset. These are kids who would otherwise not have been initiated into tobacco juice. We are talking about kids, known harm to kids versus potential benefit for adults. I hope there is potential benefit for adults, in general, but known harm to kids who cant, who cant make those decisions for themselves because they are being deceived through the use of social media. Thats a problem. I want to pick up on the perception and how that affects adults. Did you make any claims to the sioux tribe about its product helping people quit smoking . Did they claim these products were healthy . Yes. You can see and slide 21 from attachment that it states quote, have smokers they cant quit . Juul can help them switch with minimum cost. Using words like quit and switch, cessation is in flight and those impression the Tribal Council members who were on the other end of this presentation. I think that the other claim that was made was the Harm Reduction in slide six. They state elimination of combustible sigrid is crucial to reduce risk of harm. Slight welcome vaping is a fraction of the risk of smoking. Less harmful. I want to point out in that study that found that, this was done with not juul but other ecigarettes that that much less nicotine content. I cant tell the clock, do i still have time here . , out of time or do i still have time . Okay, all right. Thank you, mr. Chairman. Thank you. Ms. Miller, you have five minutes. Thank you, mr. Chairman. And thank you all for being here today. My home state of West Virginia ranks among the top state in the nation for the highest percentage of adult smokers, about 26 of our population. 38 Million People people in the United States smoke. I agree that we need to ensure that we keep Nicotine Products like ecigarettes out of the hands of youth, but we must also ensure that we do not overregulated this industry to the point that there are no longer available for those people of legal age who would like to use them either recreationally or as as a meano quit smoking. When i was a child one of my chores was to empty the trash every day. Both of my parents were smokers. That was really icky. I will tell you, if anything would keep you from smoking it would be emptying ashtrays every single day. And i believe it was in 1963 when the Surgeon General came out and said that cigarette smoking cause cancer, and both my parents quit. My father just plain old quit cold turkey. My mother spoke threequarters of a cigarette, and than half of a cigarette, and a quarter of a cigarette that she did a very slowly but that ashtray thing is what really kept me from ever wanting to smoke. And coming into a house that smelled like smoke, it was really nasty. Dr. Niaura, in your research define that most youth who faith also utilize other nicotine or Tobacco Products as well . Yes. As indicated in my testimony, close to threequarters of kids at least based on the most recent survey data that we have, have also been, tried or are using other Tobacco Products. Is the use of ecigarettes by youth correlated to the smoking cigarettes made in light . Thats the milliondollar question that were all concerned about and try to figure. As least as i i mentioned, thee is some statistical correlation. I dont know if we can say that one causes the other. Thats a pretty high bar to prove scientifically. But nonetheless, i maintain my position, im in agreement with the one that kids should not just be using any tobacco or nicotine containing products. I know when it went to college the girls all had little cigarette cases and Little Things they always carried. And oftentimes i felt like, is it more of a crutch because you wanted to do something with your hands, or was it because it really was addicting . Often younger people, they want to carry keys or they just wanted something to do with her hands, and thats more of an observation that a question. In your testimony to talk about protecting youth from accessing Nicotine Products and getting smokers a useful tool to quit smoking and shouldnt be a tradeoff. And that we can do both of these things at the same time. Could you elaborate on suggestions on how you think we could accomplish both of these goals . I wish i had all the answers, but im hoping that the fda, with the power of the Tobacco Control act, can work hard, and i know theyre working hard, hard to figure out how to achieve both goals, which is to minimize if not eliminate use use and maximize the ability of adult smokers to access safe and effective products. I think were still in the early stages of figuring out which ecigarette products, type products are approved to be the most useful but that is what the fda is there for, to review applications and use their scientific powers to determine which products are, in fact, it for approval. In regard to adult smokers, how can the health risks associate with cigarettes be mitigated by the use of ecigarettes . The major thing is, cigarette smokers can switch completely to an ecigarette product. We know that that, in fact, will result in pretty quick changes in biological markers of harm that are normally associated with smoking cigarettes. So in other words, we have signals that their bodies are actually kind of Getting Better and improving. But dr. Jackler is right in saying we need more information about longterm effects of use of these products, and so thats an area of active research. But at least in the short term it looks like people switch to these products, they actually are in some ways improving their health. Do you mean like coughing . More like biological markers that are associate with high risk of cancer. Some blood levels of certain chemicals, things like that. Thank you, mr. Chairman. Thank you, congresswoman. And now mr. Desaulnier for five minutes. Thank you, mr. Chairman. Thank you for having this hearing. I must admit, the laundry of these political jobs, the more depressing it becomes sometimes when you see human beings doing things other human beings. Im old enough to remember and it is a Secondhand Smoke ordinance as a Restaurant Owner in california 30 years ago. And also old enough to remember a Public Health or to send all hearings shall preclude Tobacco Industry is marching directly through retailers all across the country where they put their ad placement of advertising, so close was to other products that could would be drawn to, literally research they had done not showing the hype when kids can also remember being a Restaurant Owner and having on multiple liquor licenses that when we went through mothers against drunk driving or were colleagues of mine in the Restaurant Business said if we try to assume or liability, and will go out of business. We should protect small business, and thinking and talking to college at the California Restaurant Association saying why would want to be in business if thats the course would pass laws that of help with that. So here we are again, and ms. Berkman, ive had some fairly regular group of young people thats growing in my district in the San Francisco bay area, into my office and theyre trying to do similar things that we did with Tobacco Settlement money, getting youg people to help advocate. But they are also telling me stories pretty compelling that on their campuses, this is pervasive and theres a reinforcement from the marketing from here to peer that its not dangerous, that people taken care of all that. You have at the same extremes ii take. Yes, and actually we have a paid group in San Francisco where we are working overtime paid but peertopeer even now and theres been so much talk about the harmful content of these sweet juul pods, that no toxins, the nicotine. Kids still dont get it. They think its water vapor. We heard those numbers earlier. And as you said we have been here before and we should not be here again. We dont want our kids to be guinea pigs for this experiment, especially when we saw what happened the first time around when big tobacco 1. 0 targeted our kids. Juul is big tobacco 2. 0, and we cant wait. This is a race against time. If we dont act soon and take the flavors of the market because the flavors continue to hook the kids, then this is a generation of nicotine addicts, and worse. In West Virginia, for example, i know that the member just left the room, but theres Research Even of cardiovascular damage caused by ecigarettes. So theres no damage not only to developing brains but cardiovascular leak. I keep hearing over and over, we dont know yet. We are waiting. These are kids. There is no harm now. Why wait . And god forbid, see what happened the first time around. We dont have that time. So thank you. Dr. Winickoff for dr. Jackler, Secondhand Smoke, it strikes me is what we were effective with the background particularly say in Northern California where he starred in california as a Public Health issue to employees having been in the restaurant employee in the 70s, im dating myself to you couldnt we are closing a second day because of the stench of tobacco. Someone who has never been a smoker. Why shouldnt take long for us to look at the measurement in the content of what in these products and measure it against what we already know about Secondhand Smoke . Pediatricians were a lot about this. The family context we had some smokers which have gotten the message and spoke outside. But for parents they will be vaping right next to the child. Those ultrafine particles are getting into their childrens lungs. In fact, when they date indoors, the entire surface of that home becomes coated in ultrafine particulate of nicotine and other chemicals. Kids interact with their environment in a very intense way. They exhibit mouthing behavior. The various they may only weigh onetenth as much as adults of the indepth eating and getting in level of toxic aerosol thats probably 20 times higher than what a nonsmoking adults in that household will get, and thats concerning for us. Anything to add . Just the place of use regulations around smoking and vaping need to peril of it otherwise what happens is smokers will use them in the workplace and recreational places, and automobiles with the kids and things, and thats not a good thing. Those local policies are very important. Ms. Oleary, can you talk about how the industry has targeted native americans and the Tribal Community . I think theres been historical tactics by the industry to target many groups that are at risk included American Indians as well as others that instated already. But i think the main thing is getting product to the reservation. I think that Tobacco Industry feels a little bit invisible on the reservation. We have no compliance checks happen on the reservation by fda because of its a sovereign nation. Theres great concern about what juul coming to the reservation and trying to hide behind nondisclosure agreements could result in. Ive heard theres multiple of the tribes that a been approached by juul but i really struggle to find anyone is willing to speak to me about it. Its likely because theres been in das signed by these tribes. Its ruthless, the attempts that are going on to embed these populations. Thank you so much and thank you to all the panelists. I yield back, mr. Chairman. Thank you. Mr. Mr. Grothman, you have five minutes. Okay. I dont know a lot of people use ecigarettes. You should go see them around like you sissy cigarettes around when i was a child when i was in high school that he smokers lounge in the high school. But at least the one person i know well who face credits this who vapes, stop smoking cigarettes. I wonder, do you feel this is an effective way . If thats too where saving lots of lives. Could you respond to you i get its an effective way to stop smoking . There is certainly potential that Electronic Cigarettes, particularly those that are high nicotine, that when a user breeze then and has a similar spike in nicotine people must know by now, doesnt work or not work . Is this an effective way to stop smoking . We actually does scientifically very well. There are anecdotes as in your friend. Some adults will do is use, keep their nicotine loci. So it can be returned to adults. Certainly it is probably better than patches and gum that still marginal. I would just add that weve not seen strong evidence that flavored ecigarettes are necessary for adults to stop smoking. And i think if a manufacturer develops flavored ecigarettes that generates data and proves it would help adults quit smoking and not attract children, then the manufacturer is able under the laws to ask fda to approve it as a cessation device, or authorize it as any Tobacco Products. But for now the evidence is strong in favor of taking flavored products off the market. Doctor, you wanted to speak. Yes. I just take issue with the notion that there is not strong evidence. We do have, you know, the results of a randomized controlled trial which is the Gold Standard for scientific evidence, published in probably the most prestigious medical journal in the world, new new england journal of medicine, earlier this year demonstrating that smokers who managed to switch to ecigarettes quit at twice the rate compared to those they use nicotine replacement therapy. So the Evidence Base is buildin building, so you know, i dont think we can any longer say we dont have evidence that these products can help smokers quit. America, police were told, is supposed to be a free country. Why do you think of what is the reason for these other people do not want to allow people to use ecigarettes if there is some strong evidence out there thats a way to stop smoking . What is their motivation, do you know . I dont know. I think a lot of this has to do with, you know, these are relatively new product. There are a lot of unknowns. And i understand the tendency to want to rely on proven methods such as medications in nicotine replacement therapy, but this is not a Consumer Product that has taken things by storm. Again, were seeing signals tt are positive, so from my point of view if this is a type of product that actually is consumer friendly and is more apt to be used by smokers compared to some of these other products, then we ought to look for ways to leverage that opportunity to help smokers switched. I have one general thing. They give us all this date and im not sure whether this is right or not. I guess in 2018 the fda claimed that 20 of High School Students vape in the last 30 days but i know how the world works. If your buddy has to vape maybe you United States. Also hears is only 6 use more than 20 20 days a month and on describe themselves as daily users. It seems like one of those things that kids have one, thy pass at around the really we are under 4 . Does anybody think those numbers are wrong . Thats exactly how tobacco use starts. Tobacco products begin as an intermittent use and they graduate to daily use. So that nothing surprising about that date. In fact, the Gold Standard i me we are here, we are trolled and harassed and threatened all the time by the provaping committee. Im going to run out of time so just ask you, so youre saying when i have this fda data that only less than 4 of the kids vape every day, you think that if the data is wrong . Im telling you that kids underreport. They dont admit it, and some of those early studies, unless you ask someone if they are juuling, if you ask them if they are vaping, they will say no because kids to not associate vaping and juuling. Its like kleenex or bandaids, and there have been articles written about this instead written about this. I know because my son and i commented on those stores. Kids think they are julie. They dont think they are vaping. They just know they are juuling. Thats the truth. Thank you. I also ask you, would you say that nicotine addiction is something that goes away after a couple of days . Or is it just a fad . I dont know. I dont have an opinion. Well, hank you. We have two final lines of questioning, three minutes each. This will be all a bit of a lightning round here. Ms. Tlaib, you have three minutes. But it was getting so good, mr. Chairman. [laughing] ms. Oleary, thank you for being an want to give you the majority of my time because i read on february 1 juul came before your h. E. L. P. Committee of your tribe, and was proposing the product and so forth. One of the things i would love for you to talk about is the statement they said quote, the letter said from juul, promote juul of the tribes that the would promote juul as a healthy weight for patients to quit smoking. Juul one of the Tribe Health Department to provide the juul starter kits for free of charge to tribal members tried to quit smoking. Thats part of our Smoking Cessation program. Answer if you can talk a little bit about that and who were in the room i know some people had to sign some sort of right to come forward and disclose. Mr. Chairman, as ms. Buller starts, i think for the record, you know, juul from a number of folks up here has misled the american people, has lied, has used our broken system to honestly to target and then manipulate and say that its not going to cost certain things. We can continue to say were going to study, study. What i can tell you what i going to kids, they always asking what i do for a living. I tell them i make laws and things, and theyre still look at me. I said when i was a kid when i went to with a how may people in your party . The second question asked was you want smoking or nonsmoking . All the kids look at me, the second and third graders like what are you talking a . I said they used to smoke and restaurants. No way. They used to smoke or airplanes. In hospitals. You know, and its like these kids are like dont, thats crazy but they used to gaslight as to believe that second smoking wasnt killing us. And im not going to sit here and allow this committee to be used by anybody even from the other side to say that ecigarettes, vaping, juul is not killing our people. They are. Its leading to help harm coming to addictions adequate hurt people. So with that im so sorry, ms. Oleary, you can have the rest of my typing i really do want to put in the record what they did in your tribe. I share your passion. Thank you for common what happened is when they came it was in front of initially the Tribal Council and thats when handed out free product to our decisionmakers, free product, and we have councilmembers now who are regular users of juul. When it initiated at that meeting. They were then rerouted back to the process through the Committee Level of the tribal government system so they went to the h. E. L. P. Committee. At that meeting thats when they made those claims of less arm and Smoking Cessation. Ill reiterate, thats not allowed. They cannot claim Smoking Cessation or less arm at this point. I also want to say that theres been a lot of questions about, that it might be effective for smokers, but theres also dated that suggests for every one person is able to quit using juul, 81 kids will start. So the rate at which the smokers are finding this product helpful is incredible the amount of uptick were in our youth. The Tobacco Industry in general as well as juul specifically targeting atrisk populations like American Indians and africanamericans and youth, its again i say ruthless. There is no end in sight for these companies unless theres some regulations that take place by congress. Mr. Chairman, i hate calling it regulations because theyve hijacked that word. Its called accountability. Thank you. Thank you, congresswoman. And our final threeminute line of questioning, mr. Cloud. With that build up i just had three question. We will try to get through them in three minutes. Wanted to clear up the data. I guess team vaping use is up. We talked about that. Overall teen cigarette use is down. In the latest year, actually for the first year [inaudible] team uses increasing actually in the last year according to National Data from the cdc. Theres differences sets of data, do you agree . Their media flatlined but flatlined but it is not increasing. The data show is increasing but we can we will submit. Id be interested to see the study, dr. Niaura. Its in my written testimony. Yes, yes, i look at it. Why the increase . Why the decline i guess . Well, i think what we wouldve seen had juul not been around, adhesive its up and run i think a very steep decrease in adolescent tobacco use. Unfortunately what weve seen is a flatlined as dr. Niaura mentioned. Thats a slight uptick in the past year. This is a problem because when i ask is speeded i only have a little time. Recovered what you are saying now. If you look at if you look at the patterns over the past four or five years, again we are at record low for Youth Smoking which is hard to reconcile with the fact teen vaping is up. Those are just the facts. When you say Youth Smoking come that includes cigarette smoking . No here. That was my question. Total product use is up for o medical in the last few years. Okay. But that includes vaping, okay. Thats the question i start to get you, thank you. Both you, dr. Jackler and dr. Niaura touched on patches and other could detach about 20 seconds on ecigarettes compared to those of the alternative, patches, what have you . Right. Nicotine patches are a form of nicotine replacement therapy, proven to be effective to help smokers quit. Again, this one study appears to show that ecigarettes or even better than nicotine patches. But my interpretation of that is that ecigarettes are actually a form of nicotine replacement therapy. They are just more efficient. They are better at doing it compared to products like patches. And, of course, will talk outside the context of teens when were talking no, this is for adults. How can policy makers ensure noncombustible nicotine product like Electronic Cigarettes are available for smokers wanting to make a transition while limiting the access to youth . What are your recommendations . I dont have any concrete recommendations because i think this is a very tough issue. We are seeing a lot of suggestion coming out from folks in terms of different types of restrictions in terms of our products can be sold, may be restricting flavors and so forth. These are important conversations of we ought to continue to have to figure out the best road forward. My time is i let dr. Jackler finish. So high Nicotine Products like a juul that has exceptionally potent nicotine gum from my point of view should be available by doctors prescription for adult smokers. I care very much about adult smokers and would like to products to help them quit and i think its a separate product compared to patches and gum. But they should not be on the market to be bought over the counter in sweet and fruity flavors by kids. Thank you very much, doctor i thank you to the first panel for the testimony. With regard to the panelists if you could please come back to this rumor going to switch out and were going to have our final panelists, senator dick durbin, and well hear from him. Well take a twominute break just to switch up the panelists. And please come audience, you stay seated for senator durbin. [inaudible conversations] well, welcome, senator dick durbin, to the committee on oversight and reform subcommittee on economic and consumer policy. My favorite senior senator from home state of illinois. Senator dick durbin needs no introduction on the issue of his valiant advocacy efforts on smoking among youth and also to combat smoking in general. He is the author of the ban on smoking on flights in america, which came into being in 1990, 29 years ago, when he was a member of this house. At that time powerful interests in the Tobacco Industry fought his efforts to put this law into place. But now we know the tremendous, positive impact of that law. And when senator durbin to thank. Hes also been housed an advocate on the issue of fighting ecigarettes for youth, and so we welcome him to our Committee Without objection, your written statement will be made heart of the record. And with that, senator durbin, you are now recognized restatement. Thank you, chairman krishnamoorthi and Ranking Member cloud for holding the support hearing. Its good to be back in the peoples house, representative and also be in a hearing flight i Campaign Tobacco for kids. Seems like old times. But i know today to take a close look at the role of juul and the fda and how we reached this point where we are facing literally in the words of the fda a vaping epidemic. You know the numbers. Unless you alone 80 increase and High School Students vaping. 50 increase in middle School Students using ecigarettes. Today, because of devices like a juul and the accompanying did friendly flavors, 4 million children nationwide are vaping. Juul and other ecigarette Companies Like to claim their products are only meant for adults looking to quit cigarettes. But a a look at the facts quicy dispels that notion. Heres the starting point. There is no Clinical Trial proving that juul devices help adults quit smoking cigarettes. None. Despite all the marketing claims and all the paid testimonials, there is no credible medical evidence of jules most fundamental marketing claim. None. Further, more than 20 of children of the age of 18 are using ecigarettes compared with less than 3 of adults. Juul knows exactly where the money can be found, and is not from adults looking to quit smoking here its kids here todays youth vaping epidemic is a new version of an old battle that are personally familiar with. I wont go into the details but on friday november 13, 1959, 1 week before my 15th birthday i stood at my fathers hospital bedside as he died from lung cancer, two packs of camels a day. He was 53. When i came to congress i decided to make tobacco might issue. We had some successes as you noted. 1987 in my third term in the house, second term on the appropriations committee, i successfully passed and appropriations amendment banning smoking on 80 of Airline Flights in the United States. It was a major miracle. No one expected this young congressman from illinois with the opposition of both republican and democratic leadership to pass this measure on the floor. What they fail to understand is the house of representatives is a largest frequent flyer club in america, and they were sick and tired of Secondhand Smoke on airplanes and loaded with me. The bill was signed into law by president ronald reagan, despite big tobacco fighting all the way. They called my bank quote an intrusion on individual rights. You may hear echoes of that in this room today. It was just the first day. I didnt realize that eliminating this inconvenience was a tipping point, but it was. It turned out that a lot of people thought it Secondhand Smoke is dangerous on a plane, why isnt it dangerous in the Movie Theater come in a restaurant in a Bowling Alley . We also went directly after big tobaccos efforts to protect children which is why we made cigarettes more expensive with the taxes. That the single greatest deterrent to children turning to cigarettes. We dumped joe camel and the marlboro man as part of a national lawsuit. We prohibited kid friendly flavors and cigarettes like strawberry and great. And since these historic changes, the percentage of youth smokers declined from 28 in the year 2000 the less than 8 today. However, anyone who believed that the multibilliondollar Tobacco Industry would go quietly, ignore the power of their greed. And thats why we are here today. Losing their precious market share, big tobacco put the researchers and marketers to work. First, he needed a new product that didnt carry the moral taint of cancercausing tobacco. Even better, itll look like a usb flash drive, it could easily slip into a kids laptop. They needed a campaign that included an unproven positive health claim such as juuls wrote make the switch slogan. They relied on a multibilliondollar, 12. 8 billion investment from an old standby, algeria, formally known as philip morris. They needed a special strategy focus on kids because they knew that children for variety of reasons but most susceptible new users of products, it worked for cigarettes. Its going to work again with juul and vaping. How did the other with the kids . I have a bag full of them here. All of the different flavors, i wont go through them mall, but they include fruit medley, gummy bear, whip cream, unicorn poop, arousal berry and cotton candy. Not go tell me thats all about adults switching from cigarettes to vaping. Finally, and this is critical, they need the fda to look the other way as the massive empire motion and metastasized. Unfortunately, the fda has been happy to serve as that accomplice. Delaying commonsense regulation of the ecigarette industry by years, refusing to remove illegal products on the market and standing sign and the face of these false Health Claims by juul. Ive made it clear to the acting da to fda commissioner and mission got laid before him that fda hapless spectatorship has to come to an end. Whether by law in relation, court order for discovery the political will to get off the sidelines. So whats been the result . Big tobacco and big vapes efforts, between 20172018 the number of american teenagers using any tobacco product increased by nearly 30 . This was the largest single year increase in Youth Tobacco use ever. Thats right. All of our significant hardearned gains to reduce youth use of Tobacco Products are being reversed because of ecigarettes like a juul and a company kid friendly flavors. And all of the fullpage juul adds decrying children, you know where you see them, you see them in the hill, roll call, politico, washington post, New York Times, wall street journal. This isnt a new tactic. Thats exactly what big tobacco did. When we said lay off the kids. They bought fullpage ads in the wall street journal saying we dont want kids to Smoke Cigarettes. How many kids do you think get up in the morning to read the wall street journal . Exactly none. This is just a pr campaign now by juul, once by big tobacco, to try to say that they have a Business Model that really isnt directed at kids. The facts tell us otherwise. To combat the days vaping epidemic, ive introduced bipartisan bicameral legislation to crack down on kid friendly ecigarette flavors. Im joined by senator lisa murkowski, republican of alaska and represented to get an raskin for our safe kids act would give ecigarette Companies One year to prove their products meet three criteria. First, companies would have to prove that the products actually help adult cigarette smokers to quit. Second, they would have to prove their products dont harm the people using them. Third, ecigarette covers have to prove their products did not cause children to start using nicotine. If a federal tobacco 21 bill mst in the city, its imperative that the legislation includes strong provisions to crack down on kid friendly ecigarette flavors that are addicting torque it. As someone who lost his father as a kid to smoke related lung cancer, i hope ecigarettes would prove to be a Smoking Cessation for adults. To date there is no proof. Instead, these devices and the candy dessert fruit flavors are causing children to develop this addiction at far greater rate than their helping adults quit smoking cigarettes. A recent dartmouth study found that ecigarette use leads to 81 new smokers for every one smoker quits. According to the truth initiative, 1517yearolds are 16 times more likely to use juul compared to people over the age of 25. A recent study published in the journal for the American Medical Association found that teenagers who start vaping are three times more likely to go on to Smoke Cigarettes than teenagers who dont. And consider this. Juul is widely popular with kids and accounts for 70 70 of ecigarette sales in the United States. Make no mistake, juul now partnered with tobacco giant altria is driving this epidemic even as they come before this committee and pose for holy pictures. Congress waited far too long to start protecting children from cigarettes. History is now repeating itself with ecigarettes. Our inaction combined with fdas licensee is doing an entire new generation of children to nicotine addiction. Most parents care when the teenager is lost in the cloud of vape smoke. Does congress . I look for to working with you on a bicameral basis to address this Public Health epidemic had on. I will close by saying this. I never dream when i went after taking sigrid smoking off of airplanes, in my third term in the house, for gods sake, that id the chance to win, but i did. The net result of it because of Unforeseen Development was a dramatic change in america in the view towards smoking or we step in at that moment pilot and took on big tobacco. The question is, can we work with bipartisan political will to take on big vaping now for the benefit of the young people sitting behind me and those across america . Thank you, mr. Chairman. Thank you very much, senator durbin, for the eloquent statement thank you for your efforts, lifelong efforts to combat nicotine use. I want to thank all the panelists. I want to thank the entire audience for taking time out of your busy schedules to be here. Part two of this very, very important hearing is tomorrow when we have the founder of juul before us at 2 p. M. In this very same room. I ask unanimous consent to insert the following items into the official record of the hearing. The statements from doctor halford from standing for some statement from doctor brian, and letter from president of teachers, teens against vaping, and a letter from doctor Frances Leslie from unit is california irvine. During no objection, so ordered. We are adjourned. [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] coming up shortly well bring you take two of this House Oversight subcommittee investigation into ecigarettes. The cofounder of juul labs will take questions from Committee Members on whether his company markets to minors and on the addictive nature of nicotine. On our companion network cspan our live coverage continues of democratic president ial candidates at the iowa state fair in des moines. You can watch the online at cspan. Org and listen with the free cspan radio app. This week and on after words, Terry Mcauliffe discuss at the events that led up to the tragedy in charlottesville, virginia, wallowing unite the right rally in 2017. Heres a preview. A lot of the started when president obama got elected, and for many people just the concept of a black president in the oval office, for me was offensive. But he did not act on of it. They may have done on social media, and then you have a president who comes in the spent a lot of time on the birth of limiting the present, present obama wasnt born in america, that all the other, hes tweeting, retweeting White Supremacy neonazi activities while hes running for president and then trump comes in and the band and all the things. I think its time to signal the people, the present can come out and say this, i can, too, at that emboldened them. Thats why they felt comfortable, to charlottesville. If he can gets it publicly, son i. I make the point people used to wear hoods gunther used to do this at night. They dont think have to wear hoods anymore. Charlottesville they came out, this was a big comingout party. They got hurt badly in charlottesville and they got pushed, i agree with your point, they were not able to do another charge so because they were so injured in wounded and charged and so forth that they were not able to do it. But it has gone now underground on the web that this person from el paso, this killer who wrote his manifesto and we specifically talks about White Supremacy, white identity directly quoting Donald Trumps tweets. So youre right, and the president , he failed us this week in his speech. I wished he had come out and said open his speech up and said you know what . Im sorry your my rhetoric has created division and hatred in this country and i was wrong. Its time for us to come together. If President Trump had done that, he could have turned the entire corporate it wouldve been a great moment for nation would then have any. He gave the speech come talk to all speech out there but he didnt mention hes the number one out there with the hate speech. Then i wish he had said on calling senator mitch mcconnell, the senate leader, to come back into session tomorrow, the house voted for a universal background check, 160 days ago, bring, bring that built up. I won on the floor of the center and i wanted voted this week. Thats what he couldve done it was just words. In fact, its sad. Watch this conversation with Terry Mcauliffe talking by his book beyond charlottesville, this weekend on after words. [inaudible conversations] good afternoon. Sorry for the delay. The committee will come to order. Order. Without objection the chair is authorized to declare a recess of the committee at any time. This hearing is titled examining juuls role in your use of youth epidemic part two. I want to briefly address the spectators in the hearing room today we see theres tremendous inre