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 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 vi