A doctor chief Deputy Director for chief medical date executive officiant. Doctor elizabeth, state Health Director and shes medical officer of North Carolina formative human services. Doctor lee norman, secretary of the chemists department of health and environment and doctor monica rl, the commissioner of the Massachusetts Department of Public Health. I want to thankf all of you for appearing before the committee today. You know aware that the committee is holding an investigative hearing and we do so, have a practice the taking of testimony on oath. You have any any objections to testifying on oath today . No. Let that reflect that the witnesses have responded no. On the rules of the house, and the rules of the committee, entitled to be accompanied by counsel. Through do any of you request to be accompanied by counsel today. Now let the record reflect that the witnesses have stated no. If you would then, please rise and raise your right hand so you may be sworn in. Do you swear the testimony you are about to give is the truth the whole truth and nothing but the truth . Let the record reflect the witnesses responded in the affirmative and you are already seated. You are now on oath and the penalty set for the top title i of the United States code. The chair will now recognize our witnesses for five minutes. For a summary of their statements. The light will turn yellow we do have a minute left in red to indicate when the time is come to anic end. Let me start with you doctor calhoun, w we will and you know recognized for five minutes. Thank you the opportunity to speak with you today regarding the Public Health crisis of youth ecigarette youth use. As a mothersi of three children, state Public Health official, there is nothing astounding than the fact that we have led an entire new generation help start to use Nicotine Products. As a society, im stuck onto the market that went out proper oversight. We can no longer stand idly by while this Public Health crisis ravages our communities. Nationwide, ecigarette use among middle and High School Students in christ 900 percent between 20,112,015. The total number of children who are currently using ecigarette rose and an astonishing 3. 6 million in 2018. 1. 5 million mark in the previous year. In some counties in michigan, more than a third of High School Students are using ecigarette. This epidemic can be attributed to the large part and that appeal and marketing and advertising glamorize the Nicotine Products nationwide. Layers such as strawberry milk, banana split, cotton candy and gummy bear. Clearly is targeting children. Advertising for vaping products are often visuallyar appealing. Candy on the packaging. Studies show that many young people use these products that went out understanding the content or the fact that they have nicotine in them. I recently spoke with the parents of one ofha my childrens friends, was devastated that they found these products in f e childs bedroom. In their nowe display try to fid resources or support for the childs addiction. Earlier this month, on the leadership of governor question michiganan became the first stae to announce a ban on the sale of all flavored nicotine baby products. Our emergency rules also ban fraudulent or misleading advertising and islam marketing of these products at the pointofsale. A strong leadership is this necessary given the significant toll of this has taken on our society and particularly our youth. In addition to this Public Health crisis of youth ecigarette p use as of september 20th weve had 530 confirmed or probable cases of Vaping Associated lung injury across the country. In nine deaths. Intr michigan, we know of 15 confirmed or probable cases of this illness and are investigating several more. During our investigation and these vaping illnesses, its been heartbreaking to speak to families of young people who are otherwise healthy. They are now barely clinging to live. They are keeping, first we need strong leg territory oversight a recent raspberry they should not be allowed in the market unless they are proven to be safe. Company selling these products should not not be allowed to market to youth. Our fraudulently market the products and safe. Second, more research is need it in order to understand the longterm use. Ecigarette uses effective fruit Smoking Cessation are not scientifically proven and the fda has not approved ecigarettes as part off a Smoking Cessation program ecigarette also contain cancercausing toxins and we need to make sure that we fully understand Health Impact of these products before we allow them to be on the market. And finally, we need to make sure there are sustained and increased funding for tobacco provision education as well as funding for the efforts for youth and adult prevention efforts are a critical part of looking into this epidemic. Nd the data, are the epidemic of youth vaping is very clear. We love to do more to regular these products and no one youth or adult is harmed. Thank you for h allowing me to participate in the subcommittee hearing today. I look forward to working with you. Thank you for the opportunity to testify today on the Public Health threats the cigarettes post to the youth. I surf as a state Health Director and chief medical director. As you know the Surgeon General called this an ebony. Pediatrician and Preventive Medicine physician, i see this epidemic playing out across schools and communities in North Carolina. Our most recent North CarolinaYouth Tobacco survey found that off of combustible cigarette smoking was at the lowest ever recorded amongst High School Students 8. 9 percent, ecigarette use increased 894 percent since 2011, ecigarette have become the most commonly used tobacco product amongst youth in North Carolina. Further concerns of numbers and with the investigation of severe lung illness. Before i go on, let me put a face on this of you. Look as a teenager for my. North Carolina High School freshman, started to use joule as a weight to f fit in. He quickly became addicted to the nicotine in the product even to the point n of selling his close and other items in order to support his nicotine addiction. He let his grades fall and dropped out of extra curricular activities. Usually a well behaved 15iv yearold, became irritable and angry even throwing violently outbursts of rage. Finally nicotine related seizure, and it him up in the emergency department. At that. , they knew they had to do everything they could to get he the treatment for the nicotine addiction. He participated in a Treatment Program in california twice. Thankfully is now living Substance Free but hes not alone with her 70 stories from across the street the state and our nation. We must protect our children. Ecigarette his are not safe. Nicotine is the major substance found and is highly addictive. There particularly effects on their brain. And because harm to venus, and nicotine use can increase emphysema. Further illness associated with ecigarettene products, and six cases have been reported North Carolina almost all requiring hospitalization. More than half requiring into the care. Thankfully weve had no deaths today. We have not identified exactly the cause of illness in the state. Key factors may be driving out among our youth, marketing strategies, the Delivery Systems, theyre easy to conceal. But do notcr recognize the use f flavors that attract the youth to the products in a highly addictive nicotine which keeps them coming back. They have challenge the resources of our state to address. Despite her 100 percent tobacco spfree school policy, or finding ecigarette on school grounds. As problematic contributing to learning disruptions. And they do not have the resources to address this. The insufficient resources to do evidencebased map Health Promotions and campaigns with ecigarette and meant basic messages. Our quick line, is only resource to about one eighth as recommended by best practices. Our local Health Departments cannot sustain a longterm response to this new health break. As a Public Health wreck one policy or we need a comprehensive approach. Best practices. Policy consider include curbing advertising and marketing to youth, limiting access, reducing access to flavored tobacco flavors a implementing price policies and adding ecigarette smokefree indoor air policies. Increase funding should be allocated to further adopt and expand the cdclo recommended bad state and local tobacco use prevention. Community intervention, mass re cath mass media. Evidence based, infrastructure management. Thank you for the opportunity to testimony. Thank you for putting a human face on the supreme. Good afternoon tear. Ranking member guthrie, and some Committee Members and thank you for the opportunity to speak with you today. My name is doctor leif norman. Im against secretary of the department of health and environment. Most of the state Health Official and i am an Army Lieutenant colonel. On first give you a brief update as to what we are seeing in kansas. We now have ten hospitalizations confirmed. This is from vaping and ecigarette illnesses. Including two deaths in adults. Thats an increase of the numbers of the recorded by the cdc from last week. Just a new adult list. We have the same baking paving patterns. From the vaping solutions. Some have been thc only. Some a combination of both. Including cbd oil. The final analysis is pending the return of thein test results from the fda. And what i just told you was of what we took in my way of history from the deceased. On their family members. Similar demographics, two thirds are an 18 to 34 yearolds, 16 percent are on the age of 18. 17 percent are on the age of 35 in three force of the users are male. In kansas, the nationwide, over one half of all ecigarette users also smoke combustible cigarettes. Ar 80 percent of use First Contact with nicotine is through vaping. What were doing in kansas similar to my colleagues, intensive health campaign, working closely with the department of education on School Programs for vape free toolkits. Intensive medical professional education and alerts. We are working with the fda and cdc of course, in our local municipalities to incorporate ecigarette his into state indoor clean air act. On a comment briefly on military. Theres anonymous trend going on and ecigarette use in the military. Military and aggregate right now is at itsag lowest rate of combustible cigarette use in modern history. But in a trendline especially due to vaping shows it to be on the rise. Now alarmingly, ecigarette users outnumber combustible cigarette smokers in military service members. In my 2017, to 2018 deployment in the middle east, i saw vaping related lung injury percent. This is an emerging military Health Protection issue. The hard earned anti tobacco games are being weakly swept away by vaping and ecigarette. We need help. At the state loophole. Regulating marketing and the flavors attract the youth, no question about it. Ti ninetyst 696 percent of the youh who end up using tobacco started with flavored products. Joe kamel and then marble man taught us valuable lessons on marketing to youth. We must counter the track. We must regulate cells. Should it sells Tobacco Products to those less than 21 years of age. No Internet Sales of Nicotine Products. Regulating contents of vaping and ecigarette products, is important. There is no consistent labeling of the products. There should be. Weha dont know what the offendg substances are. We need to know what those are. We need time for the science to catch up with the epidemic of illnesses and death. We need to broaden the anti smoking laws to include ecigarette. We need to support Tobacco Control and prevention funding. In some right, ecigarette his are wildly efficient nicotine Delivery Systems designed to expose an addict you to nicotine. Currently approved Smoking Cessation are not approved for those on 18. We muchnd prevent addiction to nicotine. Vaping is effectively showing them to nicotine use and addiction. U. S. Preventive Services Task force, and other professional research organizationsns say insufficient evidence to support ecigarette as an effective Tobacco Cessation intervention. Other proven methods of cessation do exist. Given that we dont fullyst know the Health Effects of vaping solutions, or oftentimes even the contents, must apply Consumer Protection from the metals to protect our citizens much as we would malfunctioning automobile airbags. I will we will your questions of course. Thank you very much for this opportunity. Thank you very much and good afternoon. Thank you for the opportunity to provide testimony on this pressing issue today. As a Massachusetts Commission of Public Health is the come physician in a community member. Im extremely concerned about vaping especially monarchies. I commend you for shining light in this crisis today. Lets take a few minutes to share with you today what we are staying and what we are doing about this critical Public Health issue in massachusetts. I probably have a long history of being at the forefront of Public Health. With the current vaping epidemic we are continuing to be proactive in our response based on evidence Tobacco Cessation and education programming. Last year, massachusetts raise the minimum age to purchase Tobacco Products including ecigarette to 21. We also prohibited vaping was illegal to smoke and became the first state in the nation to ban the sale of all Tobacco Products in pharmacy. Massachusetts has made significant progress in curbing both youth and Adult Tobacco use over the last few decades. Look back to 1996 our Youth Smoking rate in 1996 was 38 percent. Now that rate w today is 6. 4 percent. Enter adult smoking rate is one of the lowest in the nation at less than 14 percent. The cornerstone of our work has always beenne prevention. We have a strong cessation and prevention infrastructure and a network of Community Partners and dedicated advocates to help educate our communities on what we know. Unfortunately, this progress is now at risk. The industries are using the same old techniques to bring new products cheap sweet and attractive to youth. And its working. In massachusetts and across the country. We heard time and time again Horror Stories on children who are talking about vaping in the bathrooms at school with two short of breath to participate in our sports activities. Children 11 and 12 years a old sweep these devices underneath the pillows because they are so addicted and their waking up in the middle of the i night to use them. We know that in t massachusetts, that 40 percent of High Schoolers have tried these products and one in five, 20 percent are using them regularly. Now were confronted with the emergence of the series vaping related lung disease. We are seeing this across the country. Two weeks ago, exercise my authority as Public Health commissioner to mandate the physicians immediately began reportingmm any unexplained vapg associated pulmonary disease to us at the Public Health. We immediately started here about cases. We are now looking at 66 reported cases and already reported to the cbc confirmed cases and to possible ones. What this tells me that what i am afraid of, is this is just the tip of the iceberg. And what we will see related to ecigarette. We dont know what is causing these illnesses yet. I want to to protect our children. And yesterday massachusetts, we took a landmark step. Our governor declared a Public Health emergency in the commonwealth. And put in place an immediate four months and on the sale of all vapingn products. Both nicotine and thc. Both in retail and online. This ban on Product Sales will enable our states to take those much mediated need it pause. And gather more information and data to inform our next step to protect our publict health. We cant stand by and watch the industry hook another generation on these deadly products. Its up to us to confront the facts, t sound the alarms and protect