Someone that is predisposed and it was useful in guiding them as were going ongoing through the epidemic i was wondering an opportunity to learn how the department handles communications. Im a little bit concerned. But cnn and fox and everybody the headlines by far most serious than ebola what is the role we think your department in terms of corrective communications or an updated accommodations the facts are the best way to get things out i find it effective as well as perhaps meeting some of the conditions of the Latino Community who is traveling back and forth and may have higher concerns. Right for the Latino Community that is actually a lot of dlament and intensive communication from the Health Organization theyve been good about getting out the information in english and spanish we agree were actively the process of redesigning how to communicate with the physicians at the city level we have a new vendor that is working on Emergency Communications for the city fast and were going to leverage that new program. You you know now those new programs you can get people to register how to get message by text or fabrication so were the process of looking at p one of the systems to adopt and use that with the Physician Community the challenges will be how we connect with the Physician Community this is actually things for the San Francisco medical 10sh9 we want the information to give us the most updated information and the way to be connected i think that is the biggest challenge of the communication dablts having the uptodate information were looking into moving into the 21st century and going beyond. I personally want to thank laughter . But the general a physicians are on text and probably on instagram. The translation from the Commission Getting giving the patients useful handout the fact the briefing and you have even more worthwhile private property this out this is a handful to give to our paternity or community regarding this concern. Usually we try to think the state those one page 40u67b89 in english and spanish but we try to connect people to the admissions were not the information changes so rapid we try to use the existing resources. As you see the beef circle it is ahead of the curve i appreciate the efforts of making us all keeping us save ensue feel safe that has harder task. Thank you. Yes. I wanted to also reemphasis i think fax has some merit should not be overlooked as you go to your communication how many of us get so many alerts if people that never get looked at so fax the office can pickup and realize this is something and actually, it is a useful tool the office then get the word i mean there is someone that picks up and seize it and i think there is really some value in maintaining the fax system and i think that i like that as dr. Said i get a lot of comments from the doctors it is very effective and they can actually since it is print they can distribute to the colleagues or associates so i think remains a valuable tool at least in this year. Well bill from there. You can build on it it looks like a valuable tool. Ill make sure. Okay. Thank you. Thank you. Shall i call the question . Further questions i want to commend the director on the directors report so it is so useful so many aspects all the way from the county hospital and the system to our Public Health i think this is really a model report that we gotten this time that really brought us up to date. Thank you, commissioners i wanted to compliment the directors Communication Office for the organization and insuring we get updated information. Thank you. Any further questions. If not well 0 move on the next item, please. Item 4. Ive not received any Public Comment general requests okay. So moving on to item 4 did report from the finance and Planning Committee commissioner johns. The finance and Planning Committee met right bra the Commission Meeting we actually had a very short agenda so it is all on the consent calendar for your approval which is the contracts report which is one contract and then also a new contract with j. T. C medical specifics for a little bit over 7 million seven hundred 24 thousand plus. So not millions i apologize and then last week a meagerly on tsthe requests to relocation from their Current Location to the other street location. Any questions commissioners. Right commissions questions toto commissioner chung on any of the items. If not well move on to the next item content. 3 stems that commissioner chung read does anybody wish to extract any of the future items for discussion if not the vote on the 3 items for the consent calendar. All in favor, say i. I. Opposed . The consent calendar has been accepted unanimously thank you thank you, commissioners we will take the item 9 out of order and do that next the resolution for the support for the city and county to amend the health code for the tobacco and smokeless tobacco and e cigarettes 18, 20 that with the consent of the commission well take item 4 out of order for the presentation being made i see no objection well precede yes. Im andreas power for the supervisors is supervisor wiener and others Board Members i think he came to the Committee Meeting earlier last month so the legislation before you today would increase the legal angle to purchase tobacco in San Francisco from 18 age of to 24 i want to thats correct supervisor mar, supervisor cowen and supervisor farrell their early cosponsorship to the board of supervisors and also id like to thank the Small Business commission, the school board and the Youth Commission all who have enforced this legislation and lastly thank the American Heart Association and and the San FranciscoTobacco Free Coalition for their strong support in increase the tobacco product from 18 to 21 the ordinance and e cigarettes and e cigarette products and official Tobacco Products that is left to supervisor mar for to work on that issue last year tobacco remains the leading cause of principle deaths in the United States for nearly 5 hundred thousand people every year and costing as much as one hundred and 70 billion 70 billion according to the usf the annual costs for smoking for San Francisco amounts to 4 400 million in direct and Indirect Health care costs when it comes to ugliest and condolence 1 3rd of High School Students naturally are users Tobacco Products and 5 percent of the High School Students smoke Second Degree and 13 percent use e cigarettes this mantels in San Francisco nearly one in 4 High School Students regularly consume Tobacco Products each day children under the age of 18 are regular smokers and 1 3rd will die premutually because of tobacco with this go trend nearly 6 million children will die from tobacco use nearly 95 percent of tobacco smokers smoke before the age of 121 people that start smoking are likely to become go live long smokers or smokes and theyre more likely to consume alcohol and 8 times more likely to use machinery and other products people that smoke will dropout and experience pregnant and nicotine and tobacco changes the brain chemical of the children according to a study by the institute of message medication if you increase the age of smoking youll see nearly a 25 percent drop a 12 percent drop in smoking across the board and a 12 percent drop in premature birthday nationally 80 jurisdictions have increased the age of purposed tobacco from the age of 21 the city and most recently about a month or so hawaii adopted a a statewide age to 24 here color to home the county have increased from age of 21 and the city and county high on a hill it calls to me beggar did so but were bullied by the Tobacco Industry and given 9 resources theyve decided to not enforce the legislation the city of benchmarking is considering enabling the age there as well and the state level in california they have been a couple of efforts for increasing the age to 21st last year and but the bill stalled because of the lobbying pressure if the Tobacco Industry and so this is the sort of the overall presentation i think we have staff from dph that can get into greater detail all to note that the paradigm weve created in terms of how enforcement will happen is exactly the same as in paradigm to the way we enforce the age today will be the same as we enforce tomorrow should that pals the only difference is the age ae and another question about has come up that was an ordinance about making it illegal to accepting sell the tobacco to minors and it is about enforcement the Public Policy pointofsale so get the tobacco from someone the household or outside that is not the point pointofsale is what with your trying to do is minimize the opportunity so ill be happy to answer any questions you may have. And staff from dph. Thank you very much from does staff wish to add or take a couple of testimonies. Well, we, very quickly run 0 through the gentleman did a great job of the overall so only limited information to add im 9 director of the tobacco project. Im jeanine with the Health Inspector and mark our friendly inspector. Great. All right. So essentially we want to let you know the overall issues from the Health Department and gene then is from the Health Department im from the Equality Branch were working in partnership you can see the system youre probably well aware relatively low smoking ooflt state of california a fairly flat level between 12 and 14 percent smoking i think ugly aware of the many, many Health Effects of tobacco really being linked to every type of cancer another concern youre quite aware of introducing regulating e cigarettes similar to cigarettes it is proliferating all over San Francisco as you can see there is a long, long arc of the last 17 years as decline in smoking were proud to work with the community as well as the health to bring down the smoking the overall population were a leader nationally in the last 17 years and really among the county the United States the top counties that are lower the smoking range it has to do with legislation and the programs as well as engaging the generations and 25ib8 tobacco youll notice disparities this is one segment many talks about smoking amongst africanamerican while pregnant and as well as cross smoking and a variety of communities of importance were working on those issues and to mention the work we are doing and the questions requests for the introduction of tobacco 21 ordinance that the request for resolution is very much in line with the Health Department and the efforts and particularly the black africanamerican Health Initiative weve reducing Breast Cancer and reducing the impacts of addiction and the products in the community and across the country Youth Smoking prevalence the information is below but continues to reduce the Youth Smoking and the San FranciscoUnified School District were presented to the board of education yesterday were tender to see the reduced smoking with cigarettes but unfortunately year by year cigarettes being used no San FranciscoUnified School District across the country and something were watching closely and Electronic Cigarettes 2 years ago in San Francisco are the same cigarettes this will owners will apply as well as so young people under 21 whether electronic or vap i apologize im not sure but the handful would great ill continue as we go. Smoking preference as i mentioned has reduced over time, however, the electronic smoking is increasing the concern thank you. The real concern this is about assess young people assessing products if youre underage youre not allowed to purchase you can if you know someone that is 18 the idea of tobacco 21 to reduce the access to the Tobacco Products so 15 years old are not like 18 but increasing to 16 or 17 theyll not get the Tobacco Products andrew mention it i know your pressured by the institute of health, i know this is generating interest a way to move forward and getting that down amongst the young people and basically stopping the future from tobacco use thats why berkley and state of hallway. And kansas city, missouri, of course, i dont recognize did this several years ago. Heres a map for your information about some of the jurisdictions that are 1k56r9 around the country massachusetts is a considerable decline and happening great this is good news in the community and then the policy generally as andrea said changes that age of sale for Tobacco Products to 18 those who are not 18, 19 or o or 20 only 21 can pretty much weve highlighted a few of the arc maybe the last 8 years and the policies that the commission alerted and was involved deeply that have continued to move along or not sing San Francisco is not as well as our youth assess reductions and then my colleague jeanine will speak. Thank you. So wanted to share with you the current enforcement process right now the Health Department partners with the San FranciscoPolice Department and in the minor decoy the retailers are not selling Tobacco Products and then we take action. So since 2008 the Health Department has been above one and 8 Tobacco Products and that ranks if zero to 70 days for the circumstances and whether or not a it Tobacco Products were sold to a minor on more than occasions at that location on the proposed legislation well provide a one year grace period during that grace period focus on the education and ouch to the approximately nine hundred retailers that have the tobacco product also during the grace period no retail will be penalize for selling Tobacco Products to a 18 or 18 or 20 but after that the process we shared earlier so as shared already 21 were calling this legislation has unanimous support from the Small Business commission the instead of board and the San FranciscoUnified School District is asking to partnering with the 4u9 to outreach to the community and Health Commission we have the issue that is up to the board of supervisors. So today, we request the Health Commission thirty to approve this in support of 21 ill ask my colleague to come if you have any questions for the two of us. There is a Public Comment request. Why not take the Public Comment and bob gordon for the Tobacco Free Coalition. Mr. Gordon i have a timer. Good afternoon commissioners and members of the public im gordon the castro resident and have with the lgbt positive community that started in 1991 called the last drag so there is support for the members of the community im cochair of the Tobacco Free Organization it is made up of many groups specifically working with people of all ages and young people with Youth Leadership with breed california and bay area resources and the Youth Development center to name a few of the members thank you for all your hard work to help with the information the purpose in speaking with you to say a few words to race the age to 21 with the tobacco will be beneficial for all san franciscans fewer people smoking will not only benefit the individuals near and dear to my heart but free from older people that start in 13 years started smoking is tremendous savings for the city and fewer people means safer home and environment and ills that are associated with over the 20 are 20 tobacco related diseases as cited by our Surgeon General with the health and lung diseases and overall environment so fewer people smoking mens less toxic and less associated with our city so