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02-19-19 Supplemental T21 - . Snowmass FF1c- r---/ Village t 4,,,,, --,...?. pou cE .„, 130 Kearns Road . P.O. Box 5010 Snowmass Village, CO 81615 February 15, 2019 p 970.923.5330 f 970.923.5867 Town Council, My apologies for being unable to attend the first reading of the Tobacco 21 Ordinance the town is adopting. I have a very important family obligation. I understand there may be some who plan to attend the first reading who are in opposition to our ordinance, specifically the inclusion of possession,use and purchase as a violation for under 21 years of age: , i . I feel compelled to reiterate my position for wanting to include these provisions in the ordinance: The National Tobacco 21 program does not support the addition of PUP Laws (Possession, Use and Purchase). They site the unfair targeting of youth as a primary reason. I don't intend to speak for any other law enforcement entity but ours. The Snowmass Village Police Department has practiced a successful style of law enforcement since before I started my career here 31 years ago. I intend to ensure that my predecessor embraces that same style. Our style is one of compliance through cooperation. Through my 31 year career I helped raise many generations of youth in our village. I am also a father of 17 years. I recognize the value of holding youth accountable for their judgment and decision making. As I mentioned in our last discussion regarding the tobacco ordinance, the addition of possession, use and purchase prohibition provides the police department with a tool to positively affect change of behavior. The fines attached to the violation are of a civil nature. There is no involvement in the Criminal Justice System. There would be no criminal record. Our preference would be to make positive and educational street contacts. This method would allow us to educate youth on the town prohibition of tobacco product use. The next step would be to require an offender to participate in a restorative justice targeted educational program regarding the use of tobacco products. This is a way we can partner with County Health and parents for a collaborative approach. If the youth failed to follow through in the program the pressure of a potential written violation could be used to further ensure compliance. In situations where there is chronic violation of the possession/use ordinance the youth could be directly fined or summoned to court. These situations would invariably involve the parent(s)too. By combining possession, use and purchase laws with retails sales laws Snowmass Village sends a powerful message to underage tobacco users and retailers alike. The Snowmass Village Police will be equipped with multiple options to apply to each unique circumstance to create the best result. I very much appreciate the support you have all shown. I hope you will continue to support our position and allow the Snowmass Village Police Department to continue a style of enforcement that works for our community. Sincer- , , 76?)( c 1 Brian son, Chief of Police Rhonda Coxon From: Alyssa Shenk Sent: Friday, February 15, 2019 12:47 PM To: council Subject: Fw: minor possession of tobacco. Attachments: Tobacco Youth Possession Brief_011819.pdf; PUP Fact sheet 0074.pdf Hi All, I am not going to be at the meeting on Tuesday, but I wanted to pass along some information I had Risa send me regarding tobacco and youth. I thought it might be helpful in anticipation of Tuesday's meeting. Alyssa From: Risa Turetsky<risa.turetsky@pitkincounty.com> Sent:Tuesday, February 12, 2019 7:45 AM To:Alyssa Shenk Subject: minor possession of tobacco. Hi Alyssa, I hope you're doing great. I'm sorry for the delay - I've been out since Wednesday. I am sharing with you some information on what is called Purchase-Use-Possession (PUP) for tobacco, which is like "minor in possession". Just a couple quick points and there's are 2 attachments on which I highlighted some of the key points. Key points: - From the literature on PUP, most municipalities that put in place PUP do it instead of retailer enforcement/compliance checks. It's only a partial solution that puts the onus on the kids who are being heavily marketed to, and is unclear how this builds better relationships with the community. - The experience of the schools this year is that (a) kids of all types are vaping, and (b) the kids who are caught are either those who are really trying to be deviant (few) or the kids who are otherwise really good and not used to hiding things. - It's way more important that we contact these kids' parents and provide them with educational resources and referrals. - The literature shows clear evidence that PUP laws often result in discrimination against certain groups of kids (selective enforcement, selective ticketing). Carbondale put PUP on their books, but they will tell you that they have NO intention of ticketing a kid. They use it as a way to approach kids and offer services. I think it's dangerous to have it on the 1 books because it can be interpreted differently by different officers or at different times. - It will be difficult for PUP to work for e-cigarettes. Juuls are so stealthy at this point that it's so easy for kids to hide them. Officers won't see it, and if they think they do, they can't search the kids. It's very different than cigarettes. Risa Risa Turetsky, MPH, FNP-C, PHN Health Promotion Program Administrator; Tobacco Specialist Pitkin County Public Health 405 Castle Creek Road, #204; Aspen, CO 81611 Office: 970-429-3327 / Cell: 970-618-1781 Email: risa.turetsky@pitkincounty.com Working Hours: Mon-Wed 7am-4pm; Thurs 7am-2pm We believe in the catalyzing power of equity to engage and enrich our community as we identify challenges and design solutions together. )g1K1.% "You're not designed to thrive by yourself" - Maya Moore 2 co( YOUTH ACCESS LAWS THAT PENALIZE KIDS FOR PURCHASE, USE, OR POSSESSION ARE NOT PROVEN TO REDUCE TOBACCO USE Research shows that youth access laws successfully reduce youth tobacco use when they are well enforced and disrupt the sale of tobacco products to minors.' Today, all 50 states and the District of Columbia have laws that restrict the sale of tobacco products to minors.2 But in addition to restricting the sale, 45 states and the District of Columbia have laws that also prohibit the purchase, use, and/or possession (PUP)of tobacco products by underage persons.3 Penalties for youth who violate a PUP law typically include a fine but may also include other penalties like community service, attending mandatory smoking education or cessation programs, or the suspension of a driver's license or permit.' Only five states—Maryland, Massachusetts, Nevada, New Jersey, and New York—do not have PUP laws.' Some states passed PUP laws with the intention of reducing youth smoking by making kids more personally responsible for buying and using tobacco products. Penalizing children, however, has not been proven to be an effective strategy for reducing youth smoking; and some experts argue that PUP laws could actually detract from more effective enforcement measures and tobacco control efforts.' PUP laws also unfairly punish and stigmatize children, many of whom became addicted at a young age as a result of the tobacco industry's aggressive marketing to kids. In this way, PUP laws shift the blame away from the industry's irresponsible marketing and retailers' irresponsible sales, to its victims. Penalties against youth become even more unreasonable when little is done to counter the tobacco industry's targeted marketing to kids. Rather than treat children as the wrongdoers, youth access laws should focus on limiting access to tobacco products by conducting ongoing retailer compliance checks with strong penalties for sales to underage persons. Additional Concerns about PUP Laws • Penalizing youth can divert enforcement officials' attention from stopping retailers from illegally selling tobacco to kids in the first place. PUP laws are more difficult to systematically enforce than sanctions against retailers, especially since PUP laws rarely provide additional enforcement resources. It is easier and more effective to conduct compliance checks for retailers, who are fewer in number compared to youth and whose locations are both known and constant.' • The ease of discretely possessing and using some tobacco products makes PUP laws more challenging to enforce than laws restricting sales to minors. Similarly, the perceived risk among youth of getting caught and punished is likely too low to have a meaningful impact on deterring tobacco use. In fact, there is little evidence showing that PUP laws have been enforced well enough to reduce youth smoking.' • Tobacco companies and their allies have a history of supporting PUP laws as alternatives to other laws that would produce greater declines in youth smoking, such as increasing the price of cigarettes.9 • Many youth smokers are addicted, making it difficult for them to quit, and some research suggests that penalizing youth could deter them from seeking support for cessation.10 Promoting interventions that provide cessation resources for youth interested in quitting could be a more beneficial alternative. Youth Access Laws Should Emphasize Restricting Sales to Minors Youth access laws that restrict sales to minors are better supported by research as a way to reduce youth smoking than laws that focus primarily on penalizing youth for purchase or possession of tobacco. Regardless of whether a state chooses to implement PUP provisions as part of its youth access law, rigorous enforcement of restrictions against sales to minors is critical to minimizing the accessibility of tobacco products and, ultimately, reducing youth tobacco use.The most successful youth access 1400 I Street NW • Suite 1200 • Washington, DC 20005 Phone(202)296-5469 • Fax (202)296-5427 www.tobaccofreekids.org PUP Laws Are Not Proven to Reduce Tobacco Use/2 programs incorporate routine retailer compliance checks which use minors to attempt tobacco purchases." Campaign for Tobacco-Free Kids, September 19, 2018/Becca Knox I DiFranza,JR,"Which interventions against the sale of tobacco to minors can be expected to reduce smoking?"Tobacco Control, doi:10.1136/tobaccocontrol-2011-050145,published online first October 12,2011. 2 Most states set the age for sale of tobacco products at 18. As of 3/28/16,Alabama,Alaska,New Jersey,and Utah set the age at 19,and Hawaii sets it at 21. 3 Institute of Medicine,Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products, Washington,DC:The National Academies Press,2015,http://www.iom.edu/-/media/Files/Report%20Files/2015/tobacco minimum ape report brief.pdf 4 Institute of Medicine,Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products, Washington,DC:The National Academies Press,2015,http:/fwww.iom.edu/-/medialFiles/Report%20Files/2015/tobacco minimum ape report brief.pdf 5 Institute of Medicine,Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products, Washington,DC:The National Academies Press,2015,http://www.iom.edu/-/media/Files/Report%20Files/2015/tobacco minimum ace report brief.pdf 6 Wakefield,M,and Giovino,G,"Teen penalties for tobacco possession,use,and purchase:evidence and issues,"Tobacco Control,12(Suppl I):i6-113,2003;Jason,LA,et al.,"Youth Tobacco Sales-to-Minors and Possession-Use-Purchase Laws:A Public Health Controversy,"J Drug Education,35(4):275-290,2005. Wakefield,M,and Giovino,G,"Teen penalties for tobacco possession,use,and purchase:evidence and issues,"Tobacco Control,12(Suppl I):i6-i13,2003. 8 Wakefield,M,and Giovino,G,"Teen penalties for tobacco possession,use,and purchase:evidence and issues,"Tobacco Control,12(Suppl I):i6-i13,2003 9 Hrywna,M,et al.,"Content Analysis and Key Informant Interviews to Examine Community Response to the Purchase,Possession,and/or Use of Tobacco by Minors,"J Comm Health,29(3):209-216,2004;Wakefield,M,and Giovino,G,"Teen penalties for tobacco possession,use, and purchase:evidence and issues,"Tobacco Control, 12(Suppl I):i6-i13,2003;Loukas,A,et al.,"Examining the Perspectives of Texas Minors Cited for Possession of Tobacco,"Health Promotion Practice,7(2):197-205,2006. 10 DiFranza,JR,"Which interventions against the sale of tobacco to minors can be expected to reduce smoking?"Tobacco Control, doi:10.1136/tobaccocontrol-2011-050145,published online first October 12,2011. Saint Louis Tobacco- Youth Possession: COUNTYIssue Brief PUBLIC HEALTH St.Louis County, Missouri Saint Louis County Department of Public Health January 2019 Introduction While cigarette smoking rates among middle and high school students are decreasing(15.8%to 7.6%for high schoolers and 4.3%to 2.1%for middle schoolers from 2011 to 2017) rates of youth electronic cigarette use are increasing dramatically and are projected to continue to rise. In 2017,around 20.8%of high school students reported using electronic cigarettes-an increase from 1.5%in 20111. Electronic cigarettes (E-cigarettes) are classified as noncombustible tobacco sources by the FDA.They use an "e-liquid" that can contain nicotine,varied flavorings, propylene glycol,vegetable glycerin, and other ingredients.The device heats this liquid to create an aerosol to inhale'. E-cigarette brands appeal to youth with their varied flavors, which lessen their perceived harmfulness'''.Ads and marketing techniques for e-cigarettes also appeal directly to youth 5. Understanding the changing landscape of tobacco products, including the rise of e-cigarettes and other alternatives to traditional cigarettes, is necessary to maintain strides made in cigarette use reduction. The harmful effects of cigarettes have been well documented and communicated to the general public. While potential harmful health effects of e-cigarettes are less well documented due to their relative newness on the market,there are many reasons to be cautious about youth use.They expose youth to nicotine at a young age, often contain harmful and unregulated substances, and may lead to future cigarette use 5'7'8.Given these risks, preventing and controlling youth access to all tobacco-based products, including e-cigarettes, should be a priority. Youth access to tobacco-based products can and should be controlled through higher tobacco taxes, enforceable smoke-free and point of sale laws, and comprehensive tobacco prevention and cessation programs. Possession, use,and purchase (PUP) laws, however, should not be a part of this comprehensive strategy.The implications of PUP laws are concerning.These laws move enforcement penalties from the tobacco industry and tobacco vendors to youth. Particularly concerning is the potential for the inequitable application of these laws across racial groups.Strengthening and continuing to enforce point of sale laws,as well as implementing comprehensive tobacco prevention and cessation programs in schools is a more equitable way of preventing youth from accessing and using tobacco products. Tobacco Possession Policy Policy Background Tobacco based possession, use, and purchase laws have been enacted in many states'.These laws intend to discourage underage youth from possessing, using, and purchasing tobacco-based products through punitive measures. Penalties for violating possession laws often include fines, but can also include community service, attending mandatory cessation or education programs,or the suspension of a driver's license or permit'''.The literature regarding the effectiveness of these policies in reducing smoking prevalence has been mixed.Some studies have found that if implemented correctly and with point of sale laws, possession, use,and possession laws can effectively reduce smoking prevalence in Tobacco Youth Possession: Issue Brief Page 2 of 8 communities 11'12 Other studies have found PUP laws are not actually effective in reducing youth smoking and that they relieve the tobacco industry of responsibility for marketing practices that encourage youth smoking. Rather than regulating the retailer for promoting a harmful product, PUP laws regulate consumers 13,14 Public Health Implications Targeting Youth for Enforcement Trends in tobacco control have shown that in terms of enforcement,youth are much more likely to receive punitive action for violations than retailers. In Minnesota, police doing compliance checks with youth were four times as likely to issue citations versus those who were doing in-store, retail observations for clerks ls.Similarly,with alcohol minimum age of sale laws,the arrest rate for minors using alcohol has been found to be more than 40 times the arrest rate for retailers 13. When the opportunity to place enforcement measures on youth rather than retailers is available,youth receive the bulk of punitive actions. Specifically Targeting Minority Youth for Enforcement Among youth targeted for enforcement, it is expected that minority youth will particularly be targeted for punitive measures.There are social and environmental factors that affect an individual's ability to access tobacco products-many of which put minority youth at higher risk. Price discounts, such as two for one offers, are used by the tobacco industry to encourage consumption. Blacks,youth, and women often take advantage of these discounts at higher rates, regardless of income 16.Tobacco outlet density, or the amount of tobacco retailers in a given area, has been shown to correlate with increased smoking rates'. In St. Louis County,areas with the highest amount of tobacco retailers are in North St. Louis County and along city borders 18.These are areas with a primarily Black demographic, putting these youth at higher risk of accessing cigarette and alternative cigarette products 19 Minority youth are also being targeted at higher rates by enforcement measures.Specifically,the enforcement of possession, use,and purchase policies have been shown to be applied unjustly across racial/ethnic groups. In Texas, Black and Hispanic youth reported a higher probability of citation than white youth for the violation of a possession, use,and purchase policy 20.This concern is especially relevant in St. Louis City and County where policies have been unjustly implemented and enforced. Across St. Louis County, Black individuals are being stopped for traffic violations at much higher rates than White individuals.Arrest rates as a result of those traffic violations are also higher for Black individuals 21. Black students in schools are suspended at consistently higher rates than White students 22.These examples demonstrate just a few of the many instances in which Black individuals have been targeted unjustly by the enforcement of laws.Given the inequitable application of laws in St. Louis and PUP laws generally,there is reason to believe that if implemented in St. Louis, PUP laws would also be unequally applied. cowry PUBLIC x.,..TH Saint Louis County Department of Public Health January 2019 Tobacco Youth Possession: Issue Brief Page 3 of 8 Alternative Recommendations to Address Youth Access to Tobacco There are many methods which can be used to prevent or address youth use of tobacco products.These methods need to be implemented equitably and in such a way that no specific group of students will be targeted unjustly. Recommendations for Enforcement Require a Specified Number of Compliance Checks: Per DPH enforcement procedure (Policy No.TOB 7.2), each year 50%of the licensed establishments receive a compliance audit.The FDA also separately conducts tobacco retailer compliance checks,the results of which are available publicly. During minimum-age compliance audits,youth are under the supervision of an adult.The establishments are randomly selected, and inspections are unannounced.An additional 10%of establishments are selected to compensate for potential unavailable operations on the 50% list. Citations are issued if the youth is sold tobacco products. Fines not paid within 30 days will be referred to the County Counselor's Office for prosecution. (St. Louis County, Missouri Municipal Code§ 602.369) Recommendations:DPH should increase the number of compliance checks done per year. Currently, DPH is doing 1 per year at 50%of establishments. An increased number of compliance checks per year, up to 3 or 4, can help decrease violation rates by retailers'. Retailers found in violation during FDA compliance checks should trigger a subsequent DPH re-inspection. Use of Fees as an Enforcement Sanction:According to St. Louis County Ordinance, if any person violates the Tobacco 21 (T21) measure (Code§ 602.300),they will be penalized through a progressive fee schedule. Violators are fined $150.00 for the first conviction,$250 for the second, and $500 for any subsequent convictions. (St. Louis County, Missouri Municipal Code § 602.370) Recommendations:Since T21 has been implemented, retailers have demonstrated that current fine amounts are little deterrent from selling tobacco products to youth,particularly since there is little follow up in place to fine repeat violators.Strict enforcement of fines for first time offenders and higher penalties have been shown to be effective in reducing violation rate 23'24 Fines should be increased in order to discourage repeat offenders. The recommended fee structure for violations should be comparable to other jurisdictions in the region. The enforcement measures of the public health department in the city of Chicago include a civil penalty of$1000 for the first violation, $2000 for the second and a license revocation on the third infraction in two years. In Columbus, Ohio, retailers are issued a$500 fine for the 1st violation and a$1000 fine for the second violation. Upon the third violation, the retailer's license is revoked. Fees should be levied only on store owners and removed from store clerks, as there is concern that clerks will be disproportionately harmed-bearing the burden of penalty fines 25. Use Threat of License Suspension or Revocation For Retailers as an Enforcement Sanction: St. Louis County Ordinance requires that tobacco retailers obtain a license to sell tobacco products. Failure to comply with the ordinance results in an administrative tobacco citation.Vendors in St. Louis County are COUNTY PUBLIC x.A.TM Saint Louis County Department of Public Health January 2019 Tobacco Youth Possession: Issue Brief Page 4 of 8 required to renew licenses annually in order to keep a current census of retailers. For non-compliance with license renewal or T21, retailers are at risk of license revocation or suspension.The progressive schedule for license revocation includes: 1. A seven business day suspension on the second violation within two years. 2. A thirty business day suspension on the third violation within two years. 3. A one hundred twenty day suspension on the fourth violation within two years. 4. Revocation of license on the fifth violation within two years. (St. Louis County, Missouri Municipal Code § 602.362, 602.366, and 602.370) Recommendations:Retailers not current on all incurred license and penalty fees prior to annual license renewal should not be allowed to renew license until all fines are paid. The progressive suspension/revocation schedule should also have stricter enforcement measures, based on recommended best practices and similar jurisdictions(see Chicago's fee and license revocation schedule above): 1. A thirty business day suspension on the second violation within three years. 2. A one hundred twenty day suspension on the third violation within three years. 3. Revocation of license on the fourth violation within three years. Use Threat of License Suspension or Revocation For Retailers Near Schools as an Enforcement Sanction:St. Louis County Ordinance prohibits the sale of any tobacco based product within 300 feet of a school. (St. Louis County, Missouri Municipal Code §716.225)When facilities apply for a permit to sell tobacco, DPH uses mapping software to determine if they are within the 300 feet proximity of the school. Facilities are alerted if they are within this range but are still able to obtain a license. Recommendations:St. Louis County ordinance 716.225 should be linked back to St. Louis County ordinance 602.370(T21)which has outlined enforcement measures for violations. If this ordinance were linked back to ordinance 602.370, the enforcement measures could be applied to code 716.225. Further enforcement measures could include: not allowing existing retailers within the 300 feet range to transfer their license to new owners, not giving new retailers licenses if they are within 300 feet, and revoking the license of any existing retailer with 2 violations who is in that range. The regulated distance should also be increased from 300 feet to 1000 feet. One study which looked at tobacco retailers in Missouri found that increasing the distance of retailers from schools to 1000 feet has the potential to reduce disparities of tobacco retailer density by income level 26. School Based Measures School-Based Prevention Programming: Evidence based tobacco prevention programs can be implemented in schools to prevent or stop youth tobacco use. These programs have been demonstrated to be effective in the short term in reducing smoking prevalence, initiation, and smoking intentions'. Programs which focus on prevention, rather than cessation, however, have been shown to sOCOUNTY "RUC HEALTH Saint Louis County Department of Public Health January 2019 Tobacco Youth Possession: Issue Brief Page 5 of 8 be associated with lower amounts of smoking and decreased school smoking violations 28. Programs recommended by the Missouri Department of Health and Human Services include 29: • Stanford's Tobacco Prevention Toolkit • Taking Down Tobacco Online Advocacy Training • SmokeSCREEN School-Based Tobacco Free Policies:School-based tobacco free policies that are clearly communicated and consistently applied and enforced across the student body have been shown to be effective in reducing tobacco use among students. However,the way these policies are enforced makes a difference in their effectiveness. Enforcing policies by assisting students to stop smoking(prevention and cessation programs) rather than punishing them for smoking is significantly related to lower amounts of adolescent smoking 28. School based tobacco free policies should focus on providing students with the tools and knowledge to prevent or stop tobacco use, not punish tobacco use.These policies and practices should be implemented at the school and school district setting to create support and structure for smoking cessation and prevention programs in schools. Conclusion While there is limited evidence that PUP laws may be effective when combined with youth access laws, there are concerns for the unintended consequences they may have if inequitably enforced. Historical practices across the United States and St. Louis specifically have demonstrated that laws meant to punish and enforce behaviors are not done so equitably-with vulnerable populations being penalized at a much higher rate. In areas where PUP laws have been implemented,they have already been shown to be penalizing Blacks and Hispanics at higher rates'.Alternative school-based measures and continued point of sale measures should be implemented to decrease youth access to tobacco products. Encouraging youth tobacco prevention efforts and strengthening the penalties and enforcement of retailer ordinances, rather than implementing PUP laws, can help further reduce youth access to tobacco products and minimize the inequitable application of tobacco policies. Suggested Citation Mohamed,S., Donaldson, K. (January 2019).Tobacco-Youth Possession: Issue brief.St. Louis County, MO: Department of Public Health. References 1. Centers for Disease Control and Prevention (CDC). (date). Youth and Tobacco Use. Atlanta, GA. Retrieved from: https://www.cdc.Rov/tobacco/data statistics/fact sheets/youth data/tobacco use/index.htm FusOOIMTY ucH *+ Saint Louis County Department of Public Health January 2019 Tobacco Youth Possession: Issue Brief Page 6 of 8 2. United States Food and Drug Administration (FDA). (2018). Vaporizers, E-Cigarettes, and other Electronic Nicotine Delivery Systems(ENDS). Silver Spring, MD. Retrieved from: https://www.fda.gov/tobaccoproducts/labeling/productsingredientscomponents/ucm456610.h tm. 3. Corey, K.G., Buka,S.L.,Ambrose, B.,Apelberg, B., &King, B. (online October 2, 2015). Flavored Tobacco Product Use Among Middle and High School Students - United States, 2014. Morbidity and Mortality Weekly Report 64(38), 1066-1070. 4. Pepper,J.K., Ribisl, K.M., Brewer, N.T. (online September 15, 2016).Adolescents' interest in trying flavoured e-cigarettes. Tobaccco Control 25, ii62-ii66. 5. Padon,A.A., Loch Buehler, K., Maloney, E.K., Cappella,J.N. (2018).A Randomized Trial of the Effect of Youth Appealing E-Cigarette Advertising on Susceptibility to Use E-Cigarettes Among Youth.Nicotine and Tobacco Research 20(8), 954-961.doi: 10.1093/ntr/ntx155 6. Soneji,S., Barrington-Trimis,J.,Wills,T., Leventhal,A., Unger,J., Gibson, L.,Yang,J., Primack, B., Andrews,J., Miech, R.,Spindle,T., Dick, D., Eissenberg,T., Hornik, R., Dang, R.,Sargent,J. (2017). Association Between Initial Use of E-Cigarettes and Subsequent Cigarette Smoking Among Adolescents and Young Adults:A Systematic Review and Meta-Analysis.JAMA Pediatrics 171(8), 788-797. doi:10.1001/jamapediatrics.2017.1488 7. Bunnell, R.,Agaku, I., Arrazola, R.,Apelberg, B.,Caraballo, R., Corsey, C., Coleman, B., Dube,S., King, B. (2014). Intentions to Smoke Cigarettes Among Never-Smoking US Middle and High School Electronic Cigarette Users: National Youth Tobacco Survey, 2011-2013. Nicotine and Tobacco Research 17(2), 228-235. https://doi.org/10.1093/ntr/ntu166 8. United States Department of Health and Human Services. (2012). Preventing Tobacco Use Among Youth And Young Adults:A Report of the Surgeon General. Rockville, MD. https://www.ncbi.nlm.nih.gov/books/NBK99237/pdf/Bookshelf NBK99237.pdf 9. American Lung Association (2018). Tobacco Policy Project/State Legislated Actions on Tobacco Issues(SLATI). Chicago, IL. Retrieved from: http://www.Iungusa2.org/slati/ 10. Institute of Medicine(IOM). (2015). Public health implications of raising the minimum age of legal access to tobacco products.Washington, DC:The National Academies Press. https://www.nap.edu/read/18997/chapter/1 11. Jason, L., Pokorny,S.,Adams, M. (2008).A randomized trial evaluating tobacco possession-use- purchase laws in the USA. Social Science and Medicine 67, 1700-1707. doi: 10.1016/j.socsci med.2008.09.028 12. Fichtenberg, C.M., Glantz,S. (2002).Youth Access Interventions Do Not Affect Youth Smoking. Pediatrics 109, 1088-1092. doi: 10.1542/peds.109.6.1088 13. Wakefield, M., Giovino, G. (2003).Teen penalties for tobacco possession, use, and S'C tmTY � TM Saint Louis County Department of Public Health January 2019 Tobacco Youth Possession: Issue Brief Page 7 of 8 purchase: evidence and issues. Tobacco Control 12, i6-i13. 14. Knox, B. (2016).Youth Access Laws That Penalize Kids For Purchase, Use, Or Possession are not Proven to Reduce Tobacco Use. Campaign for Tobacco-Free Kids. https://www.tobaccofreekids.org/assets/factsheets/0074.pdf 15. Forester,J.L., Komro, K.A.,Wolfson, M. (1996).Survey of City Ordinances and Local Enforcement regarding Commercial Availability of Tobacco to Minors in Minnesota, United States. Tobacco Control 5(1),46-51. 16. Washington University in St. Louis, Center for Public Health Systems Science (2014). Point-of- Sale Strategies:A Tobacco Control Guide. St. Louis, MO. https://cpb-us- w2.wpmucdn.com/sites.wustl.edu/dist/e/1037/files/2004/11/CPHSS TCLC 2014 PointofSaleStr ategiesl-2ips9wi•pdf 17. Chan,W., Leatherdale, S. (2011).Tobacco Retailer Density Surrounding Schools and Youth Smoking Behaviour:A Multi-Level Analysis. Tobacco Induced Diseases 9(1), 1-7. 18. St. Louis County GIS Service Center(n.d.). n.t. http://sticogis.maps.a rcgis.com/apps/webappviewer/index.html?id=07c6ca59ed52486fbc87af7 c00840c13 19. For the Sake of All/Health Equity Works (n.d.). Segregation in St. Louis: Dismantling the Divide. St. Louis, MO. https://forthesakeofall.org/wp- content/uploads/2018/04/SegregationinSTL DismantlingDivideReport.pdf 20. Gottlieb, N., Loukas,A., Corrao, M., McAlister,A., Snell, C., Huang, P.(September 13, 2004). Minors'tobacco possession law violations and intentions to smoke: implications for tobacco control. Tobacco Control 13(3), 237-243. 21. Harvey,T. McAnnar,J., Voss, M., Conn, M.,Janda, S., Keskey,S. (2014).Arch City Defenders: Municipal Courts White Paper. St. Louis, MO. Retrieved from: http://03a5010.netsolhost.com/WordPress/wp-content/uploads/2014/11/ArchCity-Defenders- Municipal-Courts-Whitepaper.pdf 22. Missouri ACLU. (2017). Missouri's Pipeline of Injustice:From School to Prison. Retrieved from: https://bloximages.newyorkl.vip.townnews.com/stltoday.com/content/tncros/assets/v3/editor ial/6/02/602ce8ee-551e-5025-bdd3-8241cf56ffcd/59df8d8a07075.pdf.pdf 23. DiFranza,J. (2005). Best Practices for Enforcing State Laws Prohibiting the Sale of Tobacco to Minors.Journal of Public Health Management Practice 11(6), 559-565. 24. Rigotti,N., DiFranza,J.,Chang,Y.,Tisdale,T., Kemp, B.,Singer, D. (1997).The Effect of Enforcing Tobacco-Sales Laws on Adolescents'. The New England Journal of Medicine 337(15), 1044-1051. COUNTY ■ riex *+i Saint Louis County Department of Public Health January 2019 Tobacco Youth Possession: Issue Brief Page 8 of 8 25. Upstream Public Health. (2015). Tobacco Retail Licensing Policy:A Health Equity Impact Assessment. https://www.pewtrusts.org/-/media/assets/external-sites/health-impact- proiect/upstream-2015-tobacco-licensing- report.pdf?la=en&hash=3C0CFC78C11D7CA1570E56EFD04FD7050453D54B 26. Ribisl, K.M., Luke, D., Bohannon, D.,Sorg, A., Moreland-Russell, S. (2017). Reducing Disparities in Tobacco Retailer Density By Banning Tobacco Product Sales Near Schools. Nicotine and Tobacco Research 19(2), 239-244. https://doi.org/10.1093/ntr/ntw185 27. Dobbins, M. DeCorby, K., Manske,S., Goldblatt, E. (2008). Effective practices for school-based tobacco use prevention. Preventative Medicine 46(4), 289-297. 28. Pentz, M.A.,Johnson, A., Dwyer,J.H., MacKinnon, D.M., Hansen,W.B., Flay, B.R. (1989).A comprehensive community approach to adolescent drug abuse prevention: effects on cardiovascular disease risk behaviors.Annals of Medicine 21(3), 219-222. 29. Missouri Department of Health and Senior Services. (2018). Department of Health and Senior Services, Comprehensive Tobacco Control Program, Electronic Cigarette Education and Cessation Resources. https://health.mo.gov/living/wellness/tobacco/smokingandtobacco/pdf/e-cigarette- education.pdf COUNTY WALT+ Saint Louis County Department of Public Health January 2019 Rhonda Coxon From: Bob Sirkus Sent: Friday, February 15, 2019 2:58 PM To: Rhonda Coxon Subject: Fwd:Age Requirement for Purchase of tobacco products Rhonda, Please add this email from Randy Kennedy to Tuesday's discussion of tobacco 21. Thanks Bob Sent from my iPad Begin forwarded message: From: Randy Kennedy<Randv@clarksmarket.com> Date: February 15, 2019 at 1:32:25 PM MST To: "ckinney@tosv.com" <ckinney@tosv.com> Cc: "bsirkus@tosv.com" <bsirkus@tosv.com>, Snowmass Manager <Snowmass Manager@clarksmarket.com> Subject:Age Requirement for Purchase of tobacco products Clint and Bob, In talking with Bob this morning about the age requirement for purchasing tobacco products, I had a meeting with our Store Director(Trevor Moodie) at Clarks Market—Snowmass, he oversees the operation at the Express store also, he informed me that he had already changed the age requirement to (21) when the Town of Aspen and Sundance (Snowmass) changed theirs... so the Clarks-Express is already requiring the age of(21) to purchase Tobacco products.. I also had a meeting with Tom Clark (President of Clarks Market) and we have made a decision to stop selling Tobacco Products at the Clarks Express store (Snowmass) so starting Saturday 2-16-2019 there will not be any Tobacco products for sale at the Express Store and we have not or will not sell them at our Main Grocery store in Snowmass ! -Any questions please call,Thanks Randy Randy Kennedy Operations Director 215 S. Monarch G 103 Aspen Co. 81611 0 , ''' - 1 0 1 o ' MARKET Randy@clarksmarket.com 970-948-4004 1 Rhonda Coxon From: Bill Madsen Sent: Friday, February 15, 2019 2:55 PM To: Risa Turetsky Cc: council; Clint Kinney;John Dresser Subject: Re: tobacco/vaping info Thanks Risa, I will encourage the council to show support for bill 1033. Once passed, I am confident Pitkin County will put T21 in place. Bill From: Risa Turetsky<risa.turetsky@pitkincounty.com> Date: Friday, February 15, 2019 at 2:47 PM To: Bill Madsen <BMadsen@tosv.com> Subject: Re: tobacco/vaping info Hi Bill! Thanks for your email. In terms of the county,what a great question -we're waiting to find out the outcome of house bill 1033. It just passed in the senate committee yesterday and now needs to pass on the senate floor. If that passes, it will give counties the ability to license and increase the price. Currently the county is only able to put in place T21 without those other components. So we're waiting on that. Otherwise, my impression is that the county is very interested. Best, Risa Risa Turetsky, MPH, FNP-C, PHN Health Promotion Program Administrator; Tobacco Specialist Pitkin County Public Health 405 Castle Creek Road, #204; Aspen, CO 81611 Office: 970-429-3327 / Cell: 970-618-1781 Email: risa.turetsky@pitkincounty.com Working Hours: Mon-Wed 7am-4pm;Thurs 7am-2pm We believe in the catalyzing power of equity to engage and enrich our community as we identify challenges and design solutions together. 1 Rhonda Coxon From: Jodi Radke <jradke@TobaccoFreeKids.org> Sent: Monday, February 18, 2019 7:08 PM To: Markey Butler;Tom Goode; Bill Madsen; Alyssa Shenk; Bob Sirkus Cc: council; Rhonda Coxon Subject: Letter of Support for Raising the Age of Sale Tobacco to 21 - Campaign for Tobacco- Free Kids Attachments: Snowmass Letter of Support 2.16.19.docx Mayor Butler and Esteemed Members of Snowmass City Council, I am the Regional Director for Colorado with the Campaign for Tobacco-Free Kids, and a member of the Colorado Tobacco-Free Alliance. I am also a Board Member for the Colorado Public Health Association. I've had the opportunity to watch your proceedings regarding your upcoming considerations on raising the age of sale of tobacco from 18 to 21, as well as your inclusion of strong enforcement/tobacco retail licensure requirements. Please find attached letter on behalf of our organization, and related research/commentary. Look forward to watching the discussion tomorrow evening. Please let me know if I can assist in anyway. Thus far, I've assisted and worked with the elected officials and their considerations in Aspen, Basalt, Carbondale, Avon, Lakewood, and the recent discussions in Steamboat Springs. I am also working closely on the state legislation being considered currently, HB 1033. I am happy to serve as a resource, and to answer any questions, if you have any I can help with. Best,Jodi Jodi L. Radke Director, Rocky Mountain/Great Plains Region Campaign for Tobacco-Free Kids PO Box 784 Loveland, CO 80539 0- 202.481.9385/800.803.7178, ext 3085 C- 970.214.4808/F-866.743.8418 jradke@tobaccofreekids.org 1 aoorp-oa 6 tp F SEE 1°1' e 1400 EYE STREET, N.W. • SUITE 1200 • WASHINGTON, DC 20005 t PHONE (202) 296-5469 • FAX (202) 296-5427 February 16, 2019 Mayor Butler& Snowmass Councilmembers, My name is Jodi Radke. I am the Regional Director with the Campaign for Tobacco-Free Kids for Colorado. Our organization works within the United States and around the world to advocate for public policies proven to prevent kids from using tobacco, help tobacco users quit and protect everyone from secondhand smoke. For more information about our policy priorities, please visit our website, www.tobaccofreekids.org. It is public health heroes, such as yourselves,who help achieve the outcomes mentioned above. Thank you for leading the way in protecting Colorado's kids by considering raising the age of sale on tobacco in Snowmass from 18 to 21, and more importantly, for strengthening the ordinance by ensuring tobacco retail licensure is part of this policy. Comprehensive tobacco retail licensure has demonstrated its effectiveness in Colorado and outlying states by significantly increasing compliance levels by our retailers, diminishing illegal sales to kids, and subsequently decreasing their use. Licensure is a critical part of this conversation. In 2018, FDA compliance checks revealed there were over 420 successful sales of tobacco products to kids statewide. Of these violations,42%were cigarette sales, 38%ecigarette- related sales, 17%cigar sales, and 3%smokeless tobacco products. One of those violations included selling cigarettes to a youth at Sundance Liquor and Gifts, as recently as November 2018. Reviewing the data from the Department of Revenue for 2018,there were an additional 148 violations statewide,which between the two enforcing agencies,totals over 570 violations. Tobacco retail licensure holds our retailers who sell to kids accountable, and creates common ground amongst businesses who sell legalized substances for recreational use (like alcohol and marijuana).Tobacco is the only legalized, recreational substance that does not require a retail license to sell their products. Thank you for your awareness to include it. About 95 percent of adult smokers began smoking before they turned 21. Policies, such as the one being considered, are a critical part of impacting the rate of initiation by kids, and will help to eliminate a point of access. We know these policies are an effective barrier as social circles reflect daily interaction amongst high school aged peers.This policy will have a positive impact on public health and will save lives. The tobacco industry spends $140 million annually in Colorado to market its products. We must continue to be vigilant in protecting Colorado's kids from the tobacco industry's outreach and efforts to addict them. We understand part of your consideration is to include the penalization of kids for purchase, use or possession of tobacco (referred to as PUP). We feel it's important to share with you that penalizing children has not been proven to be an effective strategy for reducing youth smoking and could actually detract from more effective enforcement measures and tobacco control efforts, and by placing them into a system (even when non-criminal),this can negatively impact the trajectory of a young person's life. We strongly oppose this approach and its stigmatization of children, many of whom become addicted at a young age as a result of aggressive marketing by the tobacco industry, and lack of retail accountability. Colorado is one of only a WWW.TOBACCOFREEKIDS.ORG handful of states across the country that does not require tobacco retail licensure, which we know is an effective deterrent in keeping kids from accessing tobacco products. PUP laws unfairly punish and stigmatize children, many of whom became addicted at a young age as a result of the tobacco industry's aggressive marketing to kids. In this way, PUP laws shift the blame away from the industry's irresponsible marketing and retailers' irresponsible sales, to its victims. Rather than treat children as the wrongdoers, youth access laws should focus on limiting access to tobacco products by conducting ongoing retailer compliance checks with strong penalties for sales to underage persons. Additional Concerns about PUP(Purchase, Use, Possession) Laws • Tobacco companies and their allies have a history of supporting PUP laws as alternatives to other laws that would produce greater declines in youth smoking, such as increasing the price of cigarettes.Tobacco companies have also promoted the passage of PUP laws to get additional provisions enacted that make implementing or enforcing additional tobacco control measures more difficult(e.g., preemption of strong local laws/ordinances). • Despite the fact that many youth smokers are addicted, making it difficult for them to quit, few laws include provisions ensuring that quit smoking resources are made available to them. Some research even suggests that penalizing youth could deter them from seeking support for cessation. Promoting interventions that provide cessation resources for youth interested in quitting could be a more beneficial alternative. Thus far, six states and more than 425 localities across the United States, including Colorado communities such as Aspen, Avon and Basalt, have passed policies to raise the age of sale to 21, have included comprehensive tobacco retail licensure, and do not penalize kids. We strongly advise states and localities to exclude punishing youth for purchase, use or possession of tobacco products, and to keep the focus on establishing a higher age of sale for retailers and enforcing it, which has been proven to reduce use rates amongst kids. I wanted to also close by drawing your attention to federal laws regarding the use of tobacco vending machines, after listening to the public hearing on February 4th. For more information, you can access this link, https://www.fda.gov/TobaccoProducts/GuidanceComplianceRegulatorylnformation/ucm246129.htm. Vending machines which dispense tobacco products for sale are only permitted in adult-only facilities. It might be an opportunity to educate your businesses, and to determine if they are in compliance with the federal law specific to the sale of this product, and related requirements. If you have any questions, please feel free to contact me directly. Thank you again for your leadership and partnership to protect Snowmass' kids. Respectfully, Jodi L. Radke Jodi L. Radke Regional Director Campaign for Tobacco-Free Kids 970-214-4808 jradke@tobaccofreekids.org WWW.TOBA000FREEKIDS.ORG Rhonda Coxon From: Jodi Radke <jradke@TobaccoFreeKids.org> Sent: Tuesday, February 19, 2019 1:50 PM To: Markey Butler;Tom Goode; Bill Madsen;Alyssa Shenk; Bob Sirkus Cc: council; Rhonda Coxon Subject: Followup to Materials Online - Letter of Support for Raising the Age of Sale Tobacco to 21 - Campaign for Tobacco-Free Kids Mayor Butler and Snowmass City Council, I wanted to take a moment to followup to my earlier correspondence after noting the materials online for consideration. Our organization would like to point out a few items for your consideration. 1. From what I see,there are three groups subject to penalties under this ordinance: a. Clerk selling to underage customer($50.00 for the first offense, $150.00 or a summons with fine up to $2,650.00 for the second offense, and$300.00 or a summons with fine up to $2,650.00 for the third offense, and a summons with fine up to$2,650.00 for the fourth and any subsequent offense(s)) b. Furnishing tobacco to underage customer(Any person who sells,gives, or otherwise supplies any Tobacco Product(s)to a person under the age of 21 is subject to a civil penalty of$50.00 the first violation, $150.00 for the second violation, and $300.00 for the third and any subsequent violation(s).) c. Retail Proprietor when clerk sells (up to $1,000.00 for the first violation, up to $1,500.00 for the second violation, and up to$2,000.00 for the third and any subsequent violation(s)) Our general recommendation per the above is to ensure that first/foremost the retailer is cited as the responsible party, and that the accountability isn't shifted to the clerk,which research demonstrates is effective in yielding outcomes. 2. Revocation of the license. It is important that the license requirements are comprehensive, and include graduated fines over a look-back period of 36 months (ideally 60 months), and the authority to suspend and revoke selling privileges of tobacco should sales to youth violate the law(similar to what we see with both alcohol and marijuana). 3. Commitment to enforcement. I'd noted that in your considerations the PD will meet annually with licensees. All compliance will be done at PDs discretion based on prior compliance checks etc. Accountability within the language is critical to its success. We recommend including language specifying a required (minimum of 2/year) number of compliance checks/year, and language that speaks to followup within a specified period of time should a retailer violate through a sales order to an underage purchaser. An important inclusion is to ensure your retailers are being educated on the law, its requirements, and expectations. 4. It appears the language isn't changed to reflect Snowmass Village, but references Basalt: a. The police department will meet with licensee's annually, or more often as determined,to review training programs, signage and general procedures as they relate to preventing retail sales of tobacco products to persons under the 21 years of age. When the Basalt Police Department deems appropriate, the compliance checks shall determine compliance with other laws applicable to Tobacco Products. Please let me know if I can be helpful in anyway- Respectfully,Jodi 1 From: Jodi Radke Sent: Monday, February 18, 2019 7:01 PM To: 'mbutler@tosv.com'; 'tgoode@tosv.com'; 'bmadsen@tosv.com'; 'ashenk@tosv.com'; 'bsirkus@tosv.com' Cc: 'council@tosv.com'; 'rcoxon@tosv.com' Subject: Letter of Support for Raising the Age of Sale Tobacco to 21 - Campaign for Tobacco-Free Kids Mayor Butler and Esteemed Members of Snowmass City Council, I am the Regional Director for Colorado with the Campaign for Tobacco-Free Kids, and a member of the Colorado Tobacco-Free Alliance. I am also a Board Member for the Colorado Public Health Association. I've had the opportunity to watch your proceedings regarding your upcoming considerations on raising the age of sale of tobacco from 18 to 21, as well as your inclusion of strong enforcement/tobacco retail licensure requirements. Please find attached letter on behalf of our organization, and related research/commentary. Look forward to watching the discussion tomorrow evening. Please let me know if I can assist in anyway. Thus far, I've assisted and worked with the elected officials and their considerations in Aspen, Basalt, Carbondale, Avon, Lakewood, and the recent discussions in Steamboat Springs. I am also working closely on the state legislation being considered currently, HB 1033. I am happy to serve as a resource, and to answer any questions, if you have any I can help with. Best,Jodi Jodi L. Radke Director, Rocky Mountain/Great Plains Region Campaign for Tobacco-Free Kids PO Box 784 Loveland, CO 80539 0 - 202.481.9385/800.803.7178, ext 3085 C- 970.214.4808/F -866.743.8418 jradke@tobaccofreekids.org 2