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 far as marketing

products and [speaker not understood]. thank you. >> chair yee, can i just ask the doctors about a number of e-mails we've been receiving from different people saying that e-cigarettes have helped them stop their smoking and we're harming a good thing and pushing people towards smoking. but i'm just wondering if you could address -- and i think a lot of them are coming from a nonprofit group that is a national group urging them to send us e-mails and letters. >> well, while, you know, the individual reports are there and there are people they may have helped. however, when we look at the whole population, you don't see the association. that means it might help some people, but it also might not help more people. so, that's why you're seeing no association or lower association. >> it may be helping some, but it's actually hurting others.

and on average it's hurting more people than it's helping. >> great, thank you. >> thank you. >> other questions, colleagues? thank you for the research and your leadership as well. >> thank you. >> thank you. >> the next speaker is karen [speaker not understood] who has been a leader in the tobacco free coalition in san francisco representing breathe california. >> good afternoon, supervisors. my name is karen [speaker not understood] and i'm with breathe california. i'm also one of the co-chairs of tobacco free coalition. the san francisco tobacco free coalition has conducted research and brought reliable information to the san francisco board of supervisors for decades. and we have supported the best practices in san francisco to improve health and provided successful policy options that have reduced -- that have openly impacted the smoking rate in san francisco limited and reduced youth initiation of smoking and reduced the public's exposure to secondhand smoke.

we've already heard from a lot of the other speakers here about this marketing to youth, how youth have taken smoking e-cigarettes has doubled. i wanted to add a couple more things about the youth issue, that -- to further impress upon the point we need to regulate e-cigarettes is that the youth, if they want to buy a cigarette online, they just check a box that says they're over 18. there is no monitoring and it is easy access. for the most part youth are getting it because they can easily buy it from the corner store. with this particular ordinance, retailers including e-cigarettes into the track of retailer license that would require retailers to sell e-cigarettes to have the tobacco permits which would allow city departments to conduct dee coy sting operations like we do with cigarettes right now to ensure that youth are not accessing or getting access to any kind of

tobacco products, both cigarettes and e-cigarettes. also i just want to make a comment that most retailers already are successfully enrolled in the tobacco retailer permit program. so, this wouldn't be an additional burden but would close that loophole and hold all retailers accountable so it is a level playing field. [speaker not understood] spent the evening responding to tweets. and one thing that we discovered through this whole process, a lot of the people that we're tweeting and facebooking and debunking our wonderful fact sheet was the fact they weren't san francisco residents which indicates to me that there is some sort of outside national not concerned san francisco residents, but also they're digging a little deeper we found that it seemed like those who blogged or wrote letters were going to receive some kind of free give away. so, that's really not a real grassroots activism [speaker

not understood]. quickly, i've been involved in the tobacco movement for 22 years. the introduction of e-cigarette is setting us back more than 30 years. with the proliferation of e-cigarettes, people are smoking in schools and [speaker not understood] bars and other places people are mentioning and public places where it's been historically banned. these laws, a we know, have been effective in reducing smoking and [speaker not understood]. it's also been reducing modeling to young people. young people who probably never seen smoking outside of a movie are now seeing in a lot of their places in their local neighborhoods. i just want to say that this is something that we need to [speaker not understood] in check -- i kind of liken it to the horse has left the barn and we need to make sure that we round it up before it leaves the yard.

tobacco free coalition as co-chair of the coalition, [speaker not understood] the variety of health and community agencies to san francisco commission, the san francisco small business commission, san francisco unified school district, breathe california, ucsf, american heart association, vietnamese youth development center, lung association, san francisco medical society, and other groups. we urge you to support this ordinance to protect the quality of health for all residents both young and old in san francisco. thank you very much for your [speaker not understood] and thank you very much, supervisor mar, for bringing this to our attention. >> and thank you to your leadership and the coalition as well. >> thank you. >> through chair yee, can we open this up now for public comment? and i've asked if we could limit comments, because we have about 60 cards. so, we're going to have to limit it to 1 minute per person. there's a soft bell that goes off with 15 seconds to gi would

ask people if you could try to stay within your time limit. we have a number of youth that are here with us from organizations and i'd like to ask if the young people could speak first and i'm going to start calling other names. but if you're a youth, please come forward. there are a number of people from the vietnamese youth development center, the youth leadership institute, tobacco youth reduction force, the san francisco unified school district as well. but i'll start calling several names as well. dr. john ma from the san francisco medical society. david goldman from california normal. >> excuse me, do you want them to line up first? >> yes, i would like the younger people to come up first. >> i don't think they understood it. >> and there are some that are in the other spill over room as well. so, if you're from one of those youth organizations or san francisco unified school district, please come forward.

and lining up on the right is good. and then please come to the microphone. please come forward. good evening, supervisors. my name is annie [speaker not understood]. i'm 17 years old and i [speaker not understood]. we researched e-cigarettes. my part was to find where you can and can't smoke e-cigarettes in san francisco. the answers were very confusing. i was not able to find conclusive answers and it what confusing for me. it probably is the same for those who smoke e-cigarettes. i would like to highlight that i've seen people in class at school smoking and i think that's a form of open free advertisement for these companies who target youth. and i also think that it's a form of peer pressure for other youth.

and, so, today i urge you supervisors to, for the sake of clarity and the public's health and the ewing, please pass this policy. thank you for your time. >> thank you, annie. next speaker. good afternoon, supervisors. my name is victoria. i live in district 1 and i attend thurgood marshall [speaker not understood]. e-cigarettes claim it helps people quit smoking. from what i've seen from my friends and other under aged teens, they began smoking because of e-cigarette. me take pictures and post them on instagram which is a popular app. they use hash tag e-cigarette. i have friend 16 and 17 smoking e-cigarettes. when you search hash tag, there are 800,000 posts of people smoking e-cigarette. the reason these minors want

these deviceses are because the [speaker not understood] do not have permits perctioner you aring them to ask for ids. my group conducted an experiment purchasing e-cigarettes. all of them we got none of the owners asked for ids. they sold it to us based on our appearance. i hold you supervisors responsible to pass [inaudible]. >> okay, thank you. thats was good. thank you. next speaker. good afternoon, board of supervisors. my name is michelle nguyen, i'm 17 years old. i'm speaking as a resident of the tenderloin that supports e-cigarette legislation. i lived in the tenderloin eight years and i notice advertisementses for these e-cigarettes are slowly showing up on liquor store windows. i was curious about these new forms of cigarettes so i decideded to research them. what i discovered was startling. ~. it includes fruit and candy flavors such as cherry, water mellon, cotton candy and cookies and cream, milk shake.

this is the same size [speaker not understood]. this is especially disturbing and remember that many of these smoke shops are located on the same block as youth centers like the boys and girls club in ellis park. living in the tenderloin you really get to see how tobacco companies target low-income residents and [speaker not understood]. and find that these same such as [speaker not understood] which owns newport are responsible for e-cigarette companies [speaker not understood]. [inaudible]. >> thank you so much. thank you. next speaker. hi, my name is crystal ortega and i currently go to san francisco state university. if you guys don't know, it is known for being a smoke-free campus. however, i see many students smoke e-cigarettes on campus and that includes the bus stops which is directly in front of the school, in the hallways,

and even in the classrooms. [speaker not understood] 32% of the students who are frequent users who use e-cigarettes. and with [speaker not understood]. they commonly use them at schools, at park, in the bus and bus stops. i sincerely urge you guys to pass this ordinance. >> thank you. next speaker. good afternoon, supervisors. [speaker not understood]. [speaker not understood]. i'm concerned because i have a friend who been smoking [speaker not understood]. now he transform to smoking e-cigarette because it is easier for him to get it.

i'm not sure even if online or in store, but i'm sure that he did not [speaker not understood]. so i'm here today to support the regulation and to ask you to [speaker not understood] permit to sell the e-cigarettes. >> thank you. i'm going to call a few more names before dr. ma comes up. david goldman, dr. john ma, aaron juchow. we also have dr. larry green from california's tobacco education and research oversight committee as well. and dr. lauren dutra from ucsf. good afternoon, my name is john ma. i'm a general surgeon in san francisco and a member of the american heart association and the san francisco medical sew shied. two organizations that strongly support the increased regulation of electronic cigarettes. [speaker not understood].

the patent for the first prototype was issued in 1963. the tobacco industry was approached decades ago with the technology as a safer alternative to cigarettes. it is unclear why the tobacco industry did not embrace electronic cigarettes decades earlier if they truly believed in harm reduction deviceses. addiction to nicotine is quite difficult even with agents like the patch and gum. thereby preventing san franciscans from becoming addicted should be a top priority. electronic cigarettes are not more effective than cessation aids and should be subject to the same regulations as other quit devices. i applaud supervisor mar for the intelligence and courage to call for this regulation of electronic cigarettes in our city and strongly urge an aye vote. thank you. >> thank you. mr. goldman? good afternoon, supervisors. my name is david goldman. i am a medical cannabis patient who is a four-year resident and homeowner in san francisco. for two years i served on the

city's medical cannabis task force as a patient advocates from from 2007 to 2013 i was chair of the san francisco chapter of americans for safe access, the nation's largest organization dedicated to the advocacy for the use of medical cannabis for therapeutics and research. i am urging you today not to ban the use of smokeless vaporizers for medical cannabis use for tobacco smoke is prohibited. ~ where even if the proposed ordinance were to exempt [speaker not understood] it's virtually impossible to distinguish them from vaporizers used for nicotine. how will law enforcement know the difference? i have two vapor pens here. one is for cannabis, one is for nicotine. how can you tell the difference? in fact, they are interchangeable. all you do is switch the cartridges because the bases which have the heating element and battery are identical. i have another important issue. [inaudible]. >> colleagues, i'd like to ask mr. goldman to continue. if you could try to wrap up.

i just need 30 more seconds, thank you. my husband is a medical cannabis patient as well. he he suffers from migraine headaches. can brigs has been shown to be the only effective treatment for him. when he feels a my drain coming on he needs to be able to get a quick delivery of medical cannabis into his system. it is only by smoking or vaporizing. indoor and outdoor areas in san franciscan biss ~ [speaker not understood] it will place a severe burden on him and his ability to get effective relief. the sponsor of this legislation have claimed cannabis doesn't affect cannabis patients by including a clause saying it doesn't affect any laws or regulations regarding medical cannabis. in fact, the proposal defines e-cigarettes and [speaker not understood] to include any vaporization device and there is no law or regulation currently protecting access to cannabis vaporizers.

>> mr. goldman, you haven't read the full item [speaker not understood] because it's talking about vaporizers that mimic smoking. so, they look like a cigarette. and you gave us some examples, but there are many other vaporizers, the vast majority, that do not mimic smoking sw. ~ as well. i've willing to meet with you. you met with my staff. i do feel this is an important issue impacting youth and hooking the new generation on harmful addicting substance. but i want to be sensitive to the medical marijuana users. so, we'll continue to communicate with you, but it's not intended to limit the use of medical marijuana. i don't want law enforcement arresting me saying that i'm smoking -- excuse me, vaporizing with a -- [multiple voices] >> thank you so much, mr. goldman. thank you. >> thank you. next speaker.

i'm lawrence green, aes are department of west portal area, but i'm here today as a member appointed by the governor to the california state tobacco education and research oversight committee commonly known as troc. we thank the supervisors for the opportunity to comment on the e-cigarette ordinance at hand. troc adopted last year an official position opposing the use of these cigarettes, i'm quoting, the use of e-cigarettes in all areas where other tobacco products are banned. we gave several reasons. one, smoke-free policies protect nonsmokers from exposure to toxins and encourage smoking cessation. two, introducing electronic cigarettes into clean air environments created by smoke-free policies reinforces the act of smoking and socially acceptable ~ as socially acceptable.

it makes enforcing of existing laws that protect the public from secondhand smoke difficult due to similarities with [inaudible]. >> thank you so much, dr. green. next speaker. and if there is any youth that are in the audience, please come forward to speak in the beginning. hello, cooper logan with the student advisory council. >> that's student advisory council from the san francisco unified school district? correct. >> yeah. many high school students don see e-cigarettes as a risk to their health [speaker not understood]. close friends have told me they see e-cigarettes more like candy or a harmless casual thing to do. from personal experience i'm comfortable saying the vast majority of teens who smoke these colorful flavorful e-cigarettes are not smoked cigarettes and have no interest

in smoking. however, while it makes sense intuitively these e-cigarette are healthier than cigarettes, the harmful effect are widely unknown. e-cigarettes are appealable to teens due to [speaker not understood]. while i'm not convinced of the toxicity or harmful effects of e-cigarette at this time, i do believe we should err on the side of caution so i endorse this legislation. >> great, thank you. next speaker. hello, my name is alison [speaker not understood] sip attend [speaker not understood] high school. i am also part of the student advisory council. i'm here to provide my support for the city ordinance [speaker not understood]. first i'd like to mention thats as a student i am exposed to e-cigarettes all the time almost every day. they are smoked everywhere by all ages and they are targeted to high school and middle school students because of their flavors. we have no idea what chemicals are in these e-cigarettes as they are so new.

furthermore, we have no data of what people are smoking or if there is any secondhand smoke effects. as a young person, i can tell you that e-cigarettes are extremely easy to get hold of as many placeses do not card students in san francisco. there are stores everywhere selling the e-cigarettes which makes people able to buy them with ease. and how friends get addicted to nicotine in them. i see students smoke them because they are hard to resist and are appealing. when you see these e-cigarettes, they want one because they look interesting, yet [speaker not understood] reaction of the youth wanting to smoke them from seeing them be smoked [inaudible]. >> thank you so much. thank you. next speaker. i'll call a few more names. cynthia [speaker not understood]. dee-dee [speaker not understood]. kenneth cohen. gwen [speaker not understood]. [speaker not understood] i

what born in san francisco and i live in the richmond district my entire life. i'm a freshman attending san francisco state university. this is what i'm witnessing at san francisco state. students are switching from cigarettes to cigars. [speaker not understood]. i believe students are using e-cigarettes as a way to get around the policy. with more campuses going smoke-free more and more are using e. cigarettes instead of cigars. this is a terrible problem. i've seen [speaker not understood]. it sends a mixed message about smoking. and third, i am concerned about the health of my closest peerses because i do not want them to fall into the misconception of e-cigarette being a safe alternative. >> great, thank you [speaker not understood]. next speaker. hi, my name is may how, i work with the sunset project and i'm a resident of outer mission district of san francisco. i am here today because i just

want to tell you guys that i really love the taste of peanut butter cup. i also love the color green and if i really believed all the many ads out there about e-cigarettes being harmless and cool, i would get myself a green colored peanut butter cup flavored one and i would not be here talking to you about how i feel the way e-cigarettes are advertised in the media today. what worries me while they claim they are marketing to people who are already smoking, most new users never smoked cigarettes and these include your high school and your middle school students. and they already told you about the cdc survey about how [speaker not understood]. but if you think about it with all the misleading advertising out there suggesting that it's safe and that it's harmless and with the wide variety of flavors and colorses e-cigarette companies use to attract consumers, who wouldn't want to try it? especially peanut butter cup flavored one. [speaker not understood] are creating a new generation [inaudible].

>> very good, thank you. thank you. i'm going to call several more names. bob gordon, also from the san francisco tobacco free coalition. michelle aldrick and [speaker not understood]. i think they may all be outside in the spill over room. so, next speaker. i think you called my name. [speaker not understood]? >> yes. yeah, darryl with california normal. and i'm here to express the view that e-cigarettes are, in fact, not smoking. they are a harm reduction device that have no public health hazard to bystanders, but they are [speaker not understood] deviceses for the use of cannabis. i am very proud to have myself sponsored and published research showing how effective vaporization is in eliminating

the harmful toxins from smoked cannabis. above you see what happens with smoke and you see hundreds and hundreds of carcinogenic hydrocarbons. with a vaporizer there's was no [speaker not understood] at all. for that reason the center for [speaker not understood] on the advisory board i sit found vaporization to be a safe and effective delivery system for medical cannabis. [inaudible]. >> thank you, sir. [inaudible]. >> thank you, sir. thank you. next speaker. good afternoon, city supervisors. my name is salvador barnes and i am the coordinator for the student advisory council for the san francisco unified school district. >> thank you for supporting such great young leaders. thank you, sir. as my colleagues already stated

earlier, i'm not going to get into the details of nicotine addiction and the health that it presents to the student body. i'd like to bring this board's attention to the current ordinance that permits our students to smoke e-cigarettes in public forums and school yards. places like where they hang out every day with their friends and eat lunch and do their homework. due to my role with the school district it has been brought to my attention [speaker not understood]. in fact, they do it in the bathrooms, hallwayses and outside the school yards. other areas are coffee shops like starbucks where they can vape where they can have a latte or restaurants and the school yard as well. the use of e-cigarettes in a public forum is effectively geting rid of the free smoking free environment that we are are we are all so accustomed to. as an educator of this program i would like to strongly encourage this board to support the [inaudible]. >> thank you [speaker not understood]. next speaker.

hi, i'm dr. lauren [speaker not understood], researcher at the university of california san francisco and i'm here to say -- to talk to you about this paper which dr. same glance published this morning in journal of pediatrics. i'm also a resident of the inner richmond. i want to give you a run down of our main finding. we found that adolescents who used e-cigarettes were more likely to be nicotine -- i'm sorry, tobacco cigarette smokers, they were also more likely to experimenting with cigarettes to becoming regular cigarette smokers. more likely to want to quit, but [speaker not understood] and they were likely to be heavier smokers of tobacco cigarettes. by allowing the use of these devices indoors, we're telling youth that it's okay, they are harmless, and we are not working against all of advertisers attempts to target youth and essentially initiate nicotine addiction among them. thank you. >> thank you so much. next speaker.

good afternoon and thank you so much for your time. my name is olga [speaker not understood]. i am coming [speaker not understood] and i have been working with community [speaker not understood] immigrants in san francisco about the issue relating to tobacco almost for 20 years. immigrants from the soviet union, one of the highest smoking populations in the entire world, [speaker not understood]. [speaker not understood]. we have ~ we are free people in this country, but [speaker not understood]. thank you so much again. >> thank you. next speaker. good afternoon.

thank you, my name is cynthia howard. i'm the executive director of americans for nonsmokers rights. we are a national advocacy organization working to clear the air of secondhand smoke and also [speaker not understood] as well as preventing another generation addict today nicotine. we fully support the proposal that's before the committee today to regulate electronic cigarettes, particularly with respect to usage in smoke-free environments. we view this as a worker health and safety issue and believe that patrons deserve protections as well. we may not have as much science [speaker not understood] secondhand aerosol as we do less than secondhand smoke, but there is a cause concern. [speaker not understood] billions of dollars in profits [speaker not understood] consumers use the product anywhere and everywhere as they currently advertise [speaker not understood]. smoke anywhere. don't fall for the intimidation tactics or diversionary tactics to delay and/or weaken this measure. keep it strong. protect public health and join the other cities and states that have passed these types of regulations. thank you. >> thank you.

next speaker. good afternoon. i'm dr. gwen [speaker not understood], faculty at ucsf and reside in district 9 and parent of a middle school student here in public school in san francisco. i'm here in strong support of the proposed regulation. our research team investigateses tobacco use among adolescent males and we reese entitlesly conducted a survey in san francisco. the results of the data indicates that smoking of electronic cigarettes is very common with nearly one in five reporting having smoked electronic cigarettes. this level of use is much higher than reported in the national tobacco survey and [speaker not understood] having smoked electronic cigarettes. 10% have done so in the last 30 days. many were using them in combination with other products. i support this regulation very strongly and i thank you for taking steps to protect the health of san francisco. thank you. >> thank you. and before mr. gordon comes, let me