an introduction in december, and we've been building for many months now. this ordinance will amend our current health code in san francisco to prohibit the use of electronic cigarettes where smoking is otherwise prohibited. it will require a tobacco permit -- >> supervisor mar, stop blowing that in front of my face. >> for supervisor yee's health, i will stop and will be explaining the science behind why it's harmful, what i've just been doing. so, number two, it will require a tobacco permit for the sale of electronic cigarettes. and number three, prohibit the sale of electronic cigarettes where the sale of tobacco products is currently prohibited. in the past several months my office, and especially the hard work of victor lim from my staff and i have been working closely with the department of public health, the youth leadership institute, ucsf researchers, the tobacco free

project, the vietnamese youth development center, the san francisco unified school district, and members of the community. i'd like to say we also have letters in support in our files from the american cancer society, the american lung association, the american heart association, and americans for nonsmoker rights as well. in a moment you'll hear a presentation from our great staff from their department of public health. not only our lead dr. thomas, but also derek smith and others who are here from school board president sandra lee furer, professors and medical researchers [speaker not understood], and pro he if he iser stanton [speaker not understood] from ucsf, and many others. ~ with the growing popularity of e-cigarettes and public usage by youth, it's time to [speaker not understood] in line with cigarette youth in order to protect businesses and

individuals. the e-cigarette i was puffing on is a flavor called lime and coconut and it costs about 6 to $8, with about 400 puffs, i believe, and this device. there are many types of other flavors that are cotton candy and gumy bear and other flavors that clearly are to entice young people. my 13 year old daughter has told me how her friends purchase them online. currently there is a terrible marketing system right now and an ability for young people to buy online, but also in many different businesses throughout the city and you'll hear from youth leadership institute, youth who surveyed and did action-based research showing how they were able to purchase e-cigarettes very easily without being carded or questioned at all by many businesses. in the absence of food and drug

administration or fda regulations, e-cigarettes kind of are pretty much a [speaker not understood] youth leadership has called it a new growing industry with celebrities, from leonardo dee capery owe to scarlet joe hanson have it with product placement in shows on tv more and more. it is a growing industry trying to hook a new generation of nicotine addicted young people and others. this ordinance with the support of the san francisco small business commission ~, unanimous support by the small business commission and the san francisco unified school district will give our city agencies, departments, our local businesses and individuals clear guidelines for enforcement to protect the public's health. while the primary purpose of the legislation is to protect bystanders from the secondhand exposure to nicotine and other chemicals like formaldehyde and various metals and other volatile organic compounds as well that come from e-cigarette

aerosols, like i just blew in front of commissioner yee's face, it will also support enforcement of san francisco's current smoke-free law. because e-cigarettes often look almost exactly like regular cigarettes, allowing people to smoke them in restaurants, bars, schools, and workplaces would complicate and confuse potentially drive up the cost of enforcing existing laws. we're not the first. san francisco, i'm proud to say, has been in the lead of many efforts, but we want to reestablish ourselves as a strong lead among cities throughout this country. but we're joining the lead of other cities across the bay area and the country that are looking to restrict the use and sale of e-cigarettes. other cities like richmond, california, los angeles, new york, chicago, boston, seattle and others have already passed regulations and protection for the public's health. in addition, because there are so many regular cigarettes that

are already banned in hospitals, on airplanes and most airports as well. at this moment i'd like to ask the amazing staff of the department of public health to come up and present. we have derek smith from the department of public health. >> thank you. good afternoon, supervisors. derek smith, department of public health. i'm a tenderloin resident proudly, but i'm here on behalf of the department today. i'd like to start in case you're not familiar with these products, with visioning, turning back the clock. i'd like for you to imagine walk ugg into one of our fine local public library branches with your child at your hand, maybe you're going to story hour or something. in seeing all the adults in the place doing what looks like smoking, they're all puffing out something, just as the supervisor just did, you kind of think to yourself as a 1953, you maybe remember loved ones who are held in the grip of nicotine addiction throughout your lifetime. think of the same scene at a

stern growth concert, maybe at the san francisco zoo, at your kids school, or right here in the crowded board chambers. it's [speaker not understood] something in the past when cigarette use was rampant and unregulated and people didn't entirely understand the product or the harmful nature. these are nicotine addiction devices and can currently legally be used in elementary schools, muni buses is, parks and office buildings, grocery stores, on bart, at restaurants, movie theaters and shopping malls and even day care sites. essentially they can be used anywhere in san francisco. what is the impact of new generation of kids who see smoking as our generation did? well renormal eyes cigarettes in a way that reverses 40 years of health progress ~. let's talk about what they are. san diego bayer i is here to help me with visual wasv. we can pop the projector on. what they look like, how they operate, and what they contain. so, they have a battery which you see on one end which powers the thing. they have an atomizer which is

something that takes a liquid and turns it into an aerosol that can be inhaled and exhaled. a car districtv contains a liquid repellent as well as nicotine as well as flavor. they have an indicator light. it began in the united states in late 2000s and now there are many sleek designs, really cool graphics and packaging and a lot of different functionses. we know of over 350 retailers in san francisco where there were none in 2009. so, just in five years there's been tremendous growth. most all these retail have a tobacco permit [speaker not understood]. thea are just a sampling if you want to take a some if you haven't seen them already. they have different strengths, varying amounts of nicotine. nicotine comes from the tobacco plant it so be 100% clear about that. they are nicotine products. they come in different shapes and colors as well as many flavors as the supervisor said. there's a lot of very egregious flavors. banana is one that come to my

mind here. if you have a 30-year smoker, they're not likely to pick up a ba nan flavored e-cigarette or tootie-fruity. there is a skitles brand. it's aimed at young people. [speaker not understood]. state law prohibits the sale to minors, however there is no mechanism to checking if they are sold to minors. they are made to look like candy. [speaker not understood] canada, turkey, brazil, hong kong, singapore, argentina and jordan. and there are no state or local laws whatsoever about where these can be used. product can be used anywhere in san francisco. businesses and law enforcement are really struggling with this and they contacted the department of public health indicating they're not sure how to deal with complaints about use on transit this in their stores or offices. [speaker not understood] complicates enforcement of

existing laws. in school reporting use by students in classrooms. it can legally be used on school grounds. [speaker not understood]. i'd like to conclude with five major points about thing that you'll hear about these cigarettes. one, some people believe that the information we hear about the cigarettes from those selling the product which isn't really the best source. there is a lot of reliable research on the harms of e-cigarettes particularly to young people and you're going to be hearing that today. [speaker not understood] selling the product are not a good representation and they are not a good replacement for health studies. the fine print which we have shown here is actually from one brand, enjoy, which clearly states that the fine print on the product itself, warning, these products are not smoking cessation devices. they have not been tested as such. nicotine is habit forming and is toxic for [speaker not understood]. there are warnings on every single product.

second, some believe it is harmless [speaker not understood]. the industry created this concept that e-cigarettes and harmless water vapor which is simply not true. you'll be hearing from ucsf researchers about the harmful substances in the aerosol. they include nicotine as well as cancer causing substances and heavy metals. we currently live in a city that's really embraced a nonsmoking [speaker not understood] expectation for us and our kids, for our elders. e-cigarettes introduce a new pollutant indoors where people should be able to breathe clean air. third, some people believe it's a quitting device and is sometimes being marketed in that way. in a lawsuit the e-cigarette quotes these are not medical devices. beyond that studies are showing they're not effective for helping people to quit. and even so, you'll hear from people who are interested in this product and say it helped them quit, this ordinance allows individuals to continue using the product as they like as long as it doesn't expose

parties to the aerosol. four, some people say if you disallow these cigarettes indoors, smokers will return to more harmful cigarettes. locals are already used to going out to the curb in san francisco. we had rules in san francisco for over 20 years and that's why we're so ahead of the curve for environment. the tobacco industry just to let you know also owns most of the e-cigarette companies. so, they're really working to maintain nicotine addiction through the e-cigarette or traditional camel or other products. this is really a cause for healthy skepticism. five, [speaker not understood]. it's just that straightforward. a review of the department of public health is that this proposal clarifies the status of e-cigarettes treating them similar to traditional cigarettes. they will not be banned simply prohibited in certain playstations and better regulated so there are no illegal sales to minors. thank you.

>> thank you so much, mr. smith. the next speaker is dr. tomas aragon from our department of public health. >> good afternoon. [speaker not understood] i'm also the director of the division of the department of public health. i am your community public health doctor. my job is to protect and promote the health of everyone in san francisco, but especially our most vulnerable. i was born and raised in this city. i still live here with my wife and three children. my wife is a first grade teacher at betsy car michael elementary school in the south of market. and we are raising three children ages 13 ~, 16, and 17.

we care deeply about the health of our communities and keeping san francisco safe and healthy for families with young children. we are acutely aware of how this legislation can directly protect the health of family and communities. one of the things that i do in my role as health officer is to go out and speak to communities. and recently i went out and spoke to a group of seventh graders and i want to explain to you how i explained it to them. which i found very useful. that is, think about the tobacco industry. they are really like zombies, okay. and they're outside of our house and they want to get back in our house. we have built legislative -- we have legislative laws that have kept us out and they're now trying to get back in. to show you that this idea is not original at all, i want to

just show you this. this is from the american cancer society and the american cancer society also agrees that the tobacco industry is like zombies. what they're trying to do is they're trying to get -- they're trying to get to our children. as derek pointed out, some of the arguments you're going to be hearing from the other side is that smoking e. cigarettes is a safer alternative to smoking cigarettes. they may even call this a harm-reduction strategy. you will also hear about smoking being used to helping smokers to quit smoking. this is a smoking cessation argument. therefore, they will argue we should continue to allow anyone to smoke e cigarettes anywhere. why is this a disaster? it will reverse the social norms that we have already established around not smoking. it will basically be free advertisements in every space

of san francisco. and it's going to promote nicotine addiction. from my perspective, what is the real issue here? the real issue is the promotion of nicotine addiction, plain and simple. and please excuse me for using, as you've heard, what they're doing with e-cigarettes, putting flavors that are attractive to children. for the rest of my presentation i will call it as i see it, my role as a public health officer, i want to ask the question, are we going to let the zombie industry promote nicotine addiction in our communities and to our children? yes, e-cigarettes may eventually evolve into a harm reduction approach for people who are addicted to tobacco smoking. but as derek already pointed out, they will continue to consume normal cigarettes are consumed. so, we know that they're back. they want to get cigarettes into the hands of our kids.

toxic smoke -- we were able to get toxic smokes out of hospitals, offices, schools and restaurants and they're now back with a new product that they're pedaling to us. we know in the past we've had tremendous gains around preventing tobacco use. television, radio and other cigarette ads have not been legal since 1971, and yet if you turn on the radio now, you can currently hear we now have ads on the radio that i've listened to promoting e-cigarettes. why would we allow the zombie industry and the e-cigarette companies take control of our community and introduce a toxic new product in places where smoking isn't allow, where children and family eat and read books? san francisco has always been a leader in controlling this zombie industry. san francisco was an early adopter nationally of smoke-free workplaces, smoke-free bars and restaurants. san francisco has set a

standard in protecting our families and children from the harms of secondhand smoke and advertising that promotes nicotine addiction. examples include in 194 legislation banning smoking in workplaces, 1997, legislation banning vending machines, 2003 legislation requiring tobacco permits, and 2013, the ban of smoking in outdoor spaces. the result of these actions have been a major, major -- has had a major impact on the smoking rate decline in san francisco. we went from almost 20% in 1990 down to 12.5% today. taking the stand these products have saved many lives and millions of dollars in tobacco related medical treatments. the key benefit to smoke-free laws is to change the social norms around smoking and to make smoking and e-cigarette consumption less socially acceptable. e-cigarettes are contributing to a step backward with young

people smoking and tvs, movies, and advertising throughout san francisco. again, the real issue is are we -- the real issue is the promotion of nicotine addiction, plain and simple. are we going to let the zombie industry promote nicotine in our communities and in our children? i will now repeat all the disease, disability, and death caused by the products that they pedal. that's why i call them zombies. and i'm going to go ahead, i'm not going to go into the detail of the [speaker not understood]. you've heard that. we're going to have ucsf researchers coming to give you more information about that. but i want this to make no mistake, these products are designed to build brand loyalty, and building brand loyalty is a euphemism for getting our children addicted. the real issue is the promotion of nicotine addiction. are he we going to let the zombie industry promote nicotine addiction in our communities and for our children?

almost all current smokers began smoking as teens. 87% of adult smokers began smoking by the age of 18. according to the surgeon general's report ~. i just want to read a couple lines from a recent article on the effects of nicotine addiction by dr. neil ben witnesses who is part of ucsf. nicotine causes withdrawal, anxiety and stress both of which are powerful incentives to take up smoking again. cessation of smoking causes he the emergence of withdrawal symptoms, irritability, depressed mood, restlessness and anxiety. the intensity of these moods, mood disturbances is similar to that found in psychiatric outpatients. [speaker not understood], the feeling that there is little pleasure in life can also occur with withdrawal from nicotine like other drugs of abuse. smoking is a highly efficient -- smoking an e-cigarette is a

highly [speaker not understood]. it enters rapidly through the lungs and moves into the brain within second. rapid rates of absorption and entry into the brain cause a strongly felt rush and they reinforce the effects of the drug. there is considerable drug levels that basically a person stays exposed through the drug for over 24 hours a day. i want to point out that the american academy of pediatrics has also come out with a policy statement against e-cigarettes. they are urging parents to talk to their kids about the dangers of e-cigarettes. most cartridges have 20 milligrams of nicotine and a dose of literal 10 milligrams of nicotine can be fatal for a child. in addition, children can be easily hooked to nicotine. i want to point out that the san francisco medical society had a letter yesterday in the san francisco examiner also

supporting this ordinance. the last couple things i want to mention is the concept of the precautionary principles that we have been operating with here in san francisco. we choose to make decisions that affect the future of our city with caution and attention to research in mind. we want to make sure that we put the thing in place -- we don't want to happen what happened back in the earlier 20th century where people started smoking for several decades, the point where we had 42% of the u.s. population smoking before we found out about the harms of tobacco smoking. we don't want to go back to that era. we really have a chance to limit the spread of these products. again, remember, the real issue is the promotion of nicotine addiction, plain and simple. are we going to let the zombie industry promote nicotine addiction in our communities and to our children? do not be swayed by the harm reduction argument or the smoking cessation argument. you can prevent a public health

disaster here in the city. protect social norms that make smoking and nicotine addiction unacceptable. protect our communities, families, and children from this e-cigarette advertisement. protect us from nicotine addiction promotion, and please protect us from these zombies. thank you. >> thank you, dr. aragon. the next speaker, i actually forgot to mention that co-sponsors of this ordinance with me are supervisors avalos and president david chiu. and i'd like to thank mayor ed lee for his strong support as well. the next speaker is our president of the san francisco board of education, sandra lee furer. and she'll be followed by professors rachel grena and professor stanton from ucsf. >> hello, supervisors. thank you. for 20 years the san francisco unified school district has worked to reduce addiction to nicotine products. the school district is making

considerable progress with the declining use despite marketing almost entirely focused on young people starting up. as you heard before me, the speaker in front of me, the new surgeon general report indicates that almost all current adult smokers began speaking as teens, 87% of adult smokers began by the age of 18. in san francisco we are seeing the emergence of a new problem in e-cigarette use. between 2011 and 2013, the center for disease control and prevention found that in 2011 4.7% of teens were using while the next year of 2012 10% of high school students were using. we are very concerned about this growing trend of young people smoking e-cigarettes. e-cigarettes are being used on our campuses he [speaker not understood] acting to address this new challenge. the san francisco board of education is working to develop and extend [speaker not understood] tobacco use and e-cigarettes that will be

influenced this year as we see them are very dangerous to our students and also to the health of -- their health in the 21st century. we strongly support san francisco continuing to take a lead in tackling youth nicotine addiction. we are committed to providing the best possible education to the next generation of san franciscans and cannot afford losing them to the threat of tobacco addiction. thank you very much. >> thank you, president furer. the next speakers are dr. stanton glance and rachel [speaker not understood] from ucsf. and there's a bunch of other ucsf folks here as well and they'll be followed by [speaker not understood] from california, a leader in our tobacco free coalition in san francisco. free if he isers. ~ professors. >> thank you for inviting us. rachel, one of our brilliant [speaker not understood] wrote the hundred-page document

that's been making the rounds. i'm very pleased with some of the other researchers here, lauren [speaker not understood] just published a paper today showing e-cigarette use among kids is associated with increased smoking. you'll hear about that. i live in the sunset. my kids went to public school here. i now have a grandson in the public preschool right here. and i have to say i feel like i've gotten on a time machine. i appeared before the board back in 1983 when it was considering the original san francisco workplace smoking ordinance and we're just hearing all the same arguments again, that there was no evidence that secondhand smoke is dangerous, that it was somehow infringing on rights and business and all of that to restrict smoking, that there would be total chaos and the city would fall into the ocean. and none of that happened. the evidence has just continued

to pile up about the dangers of cigarette smoke and secondhand smoke. the city is working quite well with it. and i think that while the evidence, e-cigaretteses and the effect of e-cigarettes is just beginning to accumulate and be published, there is enough out there already to really see the handwriting on the wall. these things are addictive. they are associated with increased smoking among kids. they seem to be depressed -- reducing [speaker not understood] rates among adults. most importantly, they pollute the air. supervisor mar, when he spoked that, you saw there was a puff of white stuff that came out, water vapor is colorless. if you f you're close enough you can smell them, water vapor is colorless. they are putting ultra fine particles in the air. they're putting nicotine into the air, heavy metals in the air, and other chemicals. so, that's my piece.

i want to turn the microphone over to dr. grana who is like our most knowledgeable expert. >> thank you very much. thanks, dr. glance. i appreciate this opportunity to address the committee. again, my name is dr. rachel [speaker not understood]. i also live in the inner sunset. last fall we prepared this background paper. it's already been discussed. the world health organization, it reviewed 80 studies that have been published on e-cigarettes. we found some important and new conclusionses that i'm going to review today. so, in the past few years, e-cigarette use has increased rapidly. not only among adults, among children as well. youth, teens, and [speaker not understood] from the cdc just referenced reported back from 2011 to 2012, e-cigarette among youth doubled with about 3% of middle school [speaker not understood] and 10% of high

coolers. however, some of these kid had not even ever used tobacco cigarettes. the e-cigarette might represent a new way for them to create a nicotine addiction and puts them at risk for tobacco smoking. e-cigarettes come in kid friendly flavors aptly described today. [speaker not understood] electronic cigarette marketing online, and we found that e-cigarettes are promoted with health claims, [speaker not understood]. and also with the use of celebrities and many life-style appeals. these [speaker not understood] appeals suggest using e-cigarette will make one look cool, it's glamorous. this is an ad from the new electronic cigarettes. this is the whole ad. and [speaker not understood] you can see the [speaker not

understood] slim, charged and ready to go. this marketing -- this marketing is, you know, probably one reason why e-cigarette use among youth has increased. this is [speaker not understood]. the marketing is [speaker not understood] marketing is on television. and television has been a closed venue to tobacco cigarettes since the 1970s. so, anybody who is my age or younger has never seen an advertisement for a cigarette on tv. now they're seeing an advertisement for something that looks like a cigarette and emits an aerosol, [speaker not understood] model cigarette smoking. another main conclusion in our report as dr. glance mentioned, these product do not emit harmless water vapor. studies show it is a propylene glide kohl that also contains toxins ~, very damaging toxins like formaldehyde, [speaker not understood], the heavy metals

such as tin, nickel, and copper. and some of the same carcinogenses found in tobacco cigarettes. ~ they contain ultra fine and fine particles which go deep into the body and can trigger heart attacks or respiratory events. who needs to protect people from exposure to these things? and also it's important to note that nicotine is an aerosol and studies included in our review show that bystanders are exposed who are exposed to exhaled secondhand e-cigarette aerosol have found nicotine in their blood. finally, some people claim e-cigarettes help people quit smoking. however, the large population based survey do not show an association between e-cigarette use and successful cessation. some show e-cigarettes are less likely to succeed. so, in conclusion, based on the results of our review of the literature, [speaker not understood] as