Skagit County Public Health

1. Skagit County Board of Health Smoking & Vaping in Public Places: Ordinance Proposal & Consideration for Call for Public Hearing Skagit County Public Health March 12, 2019Julie de Losada, Public Health Analyst julied@co.skagit.wa.us

2. Agenda • Overview of tobacco prevention challenges & public health concerns • WA’s laws on public smoking and vaping • Ordinance proposal • Request for consideration of Call for Public Hearing

3. MARCH 11, 2019 “One of our most important public health efforts is to continue standing up a framework to make sure we can put e-cigarettes through an appropriate series of regulatory gates, and aggressively confront youth use of these products to make sure children don’t become addicted to nicotine.” Statement from FDA Commissioner Scott Gottlieb, M.D

4. Overview of tobacco prevention challenges & public health concerns 1

5. Tobacco use is the leading preventable cause of death in the United States

6. Harmful Chemicals in Secondhand Smoke

8. Public Health Concerns with Vaping in Public Places • Vapor Product Overview • Potential health effects from exposure to vapor, especially for vulnerable populations • Rapidly increasing use by teens and young adults • Vaping other drugs, including marijuana and illegal drugs

9. Vapor Product Overview

10. What Are Vapor Products?

11. JUUL 75% of e-cigarette sales nationally “Juuling” as the verb; not “vaping” Small device; looks like thumb drive; can be charged using laptop Uses nicotine salt formulation; allows for higher nicotine levels 1 pod has same nicotine as 1 pack of cigarettes

12. Potential Health Effects

13. Potential Health Effects:What’s in the Vapor? Results of limited indoor air quality studies show vaping increases levels of: Nicotine Volatile organic compounds, including known carcinogens Metals Ultrafine particles Centers for Disease Control Nonsmokers near vaping have nicotine in their blood. No safe level of nicotine exposure for pregnant or breastfeeding women.

14. Nicotine in Vapor Nicotine content varies between vape products. Nicotine dose deliveredoften not as stated on vape-product packaging. WA Poison Center graphic Snohomish Health District Infographic

15. Do e-cigarettes help with smoking cessation? Not approved by FDA as smoking cessation aides. Research results are mixed on whether vaping is associated with quitting smoking. Vaping or dual use (vaping + smoking) may delay efforts to quit nicotine use.

16. Rapidly Increasing Use

17. Rapidly Increasing Use: Youth 2016 WA Healthy Youth Survey

18. 2016 WA Healthy Youth Survey: Skagit County

19. Flavorings attract youth Federal law prohibits flavored cigarettes, except menthol. Flavorings are allowed in other tobacco products. Nicotine e-juices come in a wide variety of flavors, many sweet.

20. Youth Use & Perceived Risk National Institute onDrug Abuse

21. Vaping other drugs

22. Vaping Other Drugs: THC (Marijuana) 2016 WA Healthy Youth Survey

23. Marijuana Vapor Products Thevape.guide

24. WA’s laws on public smoking and vaping 2

25. WA State Laws on Public Smoking and Vaping Smoking prohibited: • Indoor public places • School grounds, indoor/outdoor • Places of employment, indoor/outdoor Vaping prohibited: • Schools and childcares, indoor/outdoor • Outdoor playgrounds, during daylight when children present • Inside school buses and elevators Marijuana use prohibited: • In view of the general public • Indoor public places • Outdoor public places per definition, e.g. streets, parks, beaches, playgrounds

26. WA’s No Smoking in Public Places Law RCW 70.160 passed by voter initiative in 2005. aka “SIPP”

27. Regulation of E-Cigarettes Began in 2016 • The FDA Rule does NOT address where e-cigarettes can be used. • The WA Law limits vaping in a few locations, to reduce exposure for children. FDA Deeming Rule WA Vapor Products Law No sales to minors under 18. No free samples. No sales through vending machines. Internet sales must use age verification. Child-proof packaging. Nicotine warning label. No false advertising or health claims. Since 2016, WA State has required licenses for vapor product retailers.

28. WA Vapor Products Law RCW 70.345Vaping in Public Prohibitions & Allowances Unlike WA’s No Smoking law: No Signs Required. No Penalty or Enforcement. PROHIBITS VAPING: • Inside and Around Childcare Facilities • Inside and Within 500 Feet of Schools • In Outdoor Playgrounds With Children • Inside School Buses and Elevators • ALLOWS TASTINGS Inside Licensed Vapor Product Retail Outlets, provided that: • Entry restricted to 18 years or older. • Tasting sample is zero nicotine orcustomer consents to tasting nicotine e-juice. • Retailers provide disposable mouthpiece or device. • Tasting samples cannot be removed from premises by customer. • FDA Deeming Rule prohibits free samples of nicotine e-juice.

29. Tobacco 21 (HB 1074) “Raising the age to 21 to purchase tobacco will drastically reduce the number of Washingtonians who smoke and significantly decreasing the disease burden and health-care costs for our young people as they grow up.” — The Seattle Times, December 30, 2018 Would raise the minimum legal age of sale of tobacco and vapor products, including e-cigarettes such as Juul, from 18 to 21. As of February 20, 2019, the WA House of Representatives passed HB 1074 with a vote of 66-30. March 14 - Scheduled for public hearing in the Senate Committee on Ways & Means

30. Local Regulations on Tobacco & Vapor Products (Federal/State Preemption) Local Jurisdictions Can • Adopt state No Smoking law to allow local enforcement. • Restrict Use of Vapor Products in Indoor Public Places. • Restrict Use of Vapor Products in Outdoor Public Places Where Children Congregate. • Require No Smoking/No Vaping signs. • Establish civil penalties for violations. Local Jurisdictions Cannot X Enact laws that conflict with federal and state laws, unless stricter local laws allowed. XRegulate sales and promotion. Local laws cannot: • license retailers • change purchase age • ban flavorings • ban ads specifically XAllow smoking or vaping in public places where it is prohibited under state law. XProhibit tastings inside licensed vapor product retail outlets.

31. Vapor Products Regulations by Counties Local Board of Health Codes passed prior to 2016 WA State law: King, Pierce, Grant, Clark, Snohomish, San Juan …passed after 2016 WA State law: Kitsap, Spokane, Kittitas, Whatcom

32. Current Ordinances in Skagit County Skagit County Chapter 12.52 Smoking Regulations • No smoking in county workplaces, facilities, autos Some municipal ordinances: • Sedro-Woolley: adopted state SIPP law • No smoking in town facilities: Concrete, La Conner, Mount Vernon • No smoking in parks: Anacortes, La Conner, Mount Vernon, Sedro-Woolley Statewide Smoking in Public Places (SIPP) law & Vapor Products Law apply county-wide.

33. Ordinance proposal 3

34. Proposal Background Online survey conducted in May-June 2018 with school district superintendents, Behavioral Health Organizations, and Housing Authorities. S/VIPP work session presentation the Board of Health in July 2018; staff given approval to begin acquiring public feedback on potential ordinance. Presentations to Parks and Recreation, Housing Authorities, and other community stakeholders. Presentations to city councils in 2018: • Anacortes (8/20); Concrete (9/24); La Conner (9/25); Sedro-Woolley (10/10); and Burlington (10/11) • Unable to present to Mount Vernon due to the Council schedule being full with end-of year budgeting items.

35. Smoking and Vaping in Public Places: Ordinance Proposal Officially adopt the state Smoking in Public Places law (RCW 70.160) and prohibit vaping in specific types of public places as allowed under the state Vapor Products law (RCW 70.345). • No person may smoke or vape in any indoor public place or in any place of employment. • Includes a minimum outdoor distance of twenty-five (25) feet. • No person may smoke or vape in any outdoor public place that is on the grounds of a child care facility or school, and outdoor public places where children congregate. • Includes, but not limited to: playgrounds, parks, beaches, athletic field, and stadiums.

36. Signage Requirements • Signage required in all indoor public places and places of employment. • For exterior of buildings, “No Smoking or Vaping Allowed within 25 Feet of Doorway or Entrance.” • Signage required for all outdoor public places where smoking and vaping are prohibited. • Signs to be posted in appropriate prominent locations. • Signs prohibiting vaping may be combined with signs prohibiting smoking, such as “No Smoking. No Vaping.” or “No Smoking or Vaping Allowed.”

37. Enforcement • Skagit County Board of Health has the authority to enact local rules and regulations as are necessary in order to preserve, promote and improve the public health pursuant to RCW 70.05.060. • The Health Officer is authorized to administer and enforce this Chapter. • Enforcement may include, but is not limited to, issuance of notices that a person is in violation of a requirement under this Chapter and issuance of enforcement orders.

38. Consideration for Call for Public Hearing 4

39. Next Steps • Public Comment Period • March 12, 2019 throughApril 9, 2019. • Public Hearing • For the purpose of considering public comment regarding the proposed Skagit County Code Chapter 12.51. • April 9, 2019 at 2:00 p.m. • Commissioners Hearing Room, County Administration Building, 1800 Continental Place, Mount Vernon, WA,

40. Call For Public Hearing • Written comments may be submitted online, by mail, or in-person. • Online comments • Post at https://www.skagitcounty.net/health • Email to Julie de Losada at julied@co.skagit.wa.us • Mailed comments • Mail/deliver to: 700 South Second StreetMount Vernon, WA 98273-1071 • All written comments must be received by April 9, 2019.