Committee on Public Health and Human Services, March 4, 2025

COUNCIL OF THE CITY OF PHILADELPHIA COMMITTEE ON PUBLIC HEALTH AND HUMAN SERVICES Room 400, City Hall Philadelphia, Pennsylvania Tuesday, March 4, 2025 2:35 p.m. PRESENT: COUNCILWOMAN NINA AHMAD, CHAIR COUNCILWOMAN QUETCY M. LOZADA, VICE-CHAIR COUNCILWOMAN CINDY BASS COUNCILMAN MIKE DRISCOLL COUNCILWOMAN RUE LANDAU

241149 - - -

Good afternoon, everyone. Welcome to Philadelphia City Council's Committee on Public Health and Human Services. I now note that the hour has come. Mr. Sham, would you please call the roll.

Chair Ahmad.

Present.

Vice-Chair Lozada. (No response.)

Councilmember Thomas. (No response.)

Councilmember Driscoll.

Present.

Councilmember Bass.

Present.

Councilmember Landau. (No response.)

Councilmember O'Rourke.

Present.

I note for the record that a quorum of this Committee is present and this hearing is called to order. This is a public hearing of the Committee on Public Health and Human Services considering testimony on Resolution No. 241149. Before we begin, I want to just say a few words. First, thank you for being patient. I know we delayed our hearing from 2:00 to 2:30. That is to allow our stenographer who worked so very hard, she had another hearing she was covering so she could get a little break before she did this hearing. And so, I want to thank Councilmember O'Rourke for letting us know they were running over. So I appreciate all of you being here. This hearing is really about sounding the alarm and thinking of some solutions. We worked so very hard to reduce use of tobacco and we were quite successful, but now that trend is reversing with the use of e-cigarettes and vaping. And so, it's important for us to get ahead of this as much as we can. I think we're already a little behind and we must look at all the methods we have that were used for tobacco control, whether they are relevant for this issue and what are those tools that we have, including educating the public on smoking dangers, increasing the cost of products to taxes, restricting sales, banning tobacco advertising and passing smoke-free air laws. All of these things have helped reduce tobacco consumption. And now, we need to look at how we do this reduction of electronic cigarettes. And all of you here are experts, including young people whose voices are really important to inform us, what they see this issue as and how from their perspective and vantage point how we can work to make sure we make a safer world for them, because vaping and e-cigarettes cause harm. And I think there's a lot of misinformation out there that it is safer and all of that, and we'll hear from all our experts on that. So I thank you all for being here. I want to acknowledge the presence of my Vice-Chair Councilmember Quetcy Lozada who just came. And I will now ask if any of my Councilmembers starting with Quetcy Lozada, do you have any opening remarks? My Councilmember Cindy Bass. Thank you.

Thank you, Madam Chair. I wanted to thank you for bringing forward this legislation today and have this very important conversation. I do apologize. I'm going to have to miss a good portion of it because I have another commitment at this time. But I did want to be on the record and talk about just for a second vaping and the use of tobacco products and how much of a deficit here in the city of Philadelphia we are in terms of actively regulating tobacco usage, and particularly around those who sell tobacco actively in the city of Philadelphia and do not have a valid tobacco license, a tobacco retailer's license by the City of Philadelphia. Just recently we encountered what's called now a smoke shop here in a part of my District. We went into the smoke shop. They had, you know -- well, the first thing I want to point out is that they were selling illegal fake cigarettes. And it's one thing to be illegal. It's another thing to be both illegal and fake. And somebody said to me, well, what's a fake cigarette? And it's a cigarette that looks like a regular cigarette, but it's not made by the manufacturers. Actually I have it in my desk upstairs, what looks to be a pack of Newports and they're not actually Newports. They're actually some other product. We don't know what the product is you are inhaling. You are ingesting something that you don't know what it is and where it's from. And I think even among smokers, there was the assumption that what you take into your body in this country has been regulated and has been approved and authorized and is safe and is not going to make you sick and it's certainly not going to be poisonous. And we found that there are a number of cases where these kinds of things are happening on a regular basis. The fact that they are fake means not only are they illegal because they've been sold from another place with another stamp, they're not stamped with Pennsylvania tax stamps. So they're making a profit on that. And then they're selling you a product that isn't really the product that you think it is. So it's akin to -- particularly, ladies would get this. If you went into a retailer and you thought you were purchasing a very expensive designer handbag, Gucci, Louis product, whatever and then you go home and you realize that that is not manufactured by the retailer that you thought it was at the very expensive price that you paid. And so, now in this case you have a fake handbag. Smoking a fake product, a fake cigarette is much, much, much more dangerous obviously. And so, this is something that is happening. It's happening on the regular. And I just really want to again thank you for bringing it forward because this is something that we have to do something about. It was much to my dismay that when we went out and we saw this establishment and we saw the products they were selling and what was going on and we were trying to work around enforcement, we were advised that even though they were selling fake cigarettes that could harm people, that they still had time to get themselves in order. And so, I just want to point out that they had -- I should have had it pulled up already, but they had no license to operate through the city of Philadelphia, through L&I, no operating license, no permit to sell tobacco, no 20 permit to do the construction on the facility, plumbing violations with open pipes and things, you know, where radiators were removed, electrical code violations where wires were hanging from the ceiling. There were about 4 violations all very egregious, all 5 which could be very dangerous and 6 were still given a considerable 7 amount of time to be able to get 8 their act together, which is 9 incredibly disrespectful to our 10 neighborhood. 11 So I say all that to say 12 thank you so much for bringing this conversation to the forefront, Madam Chair. Thank you.

Thank you. Thank you, Councilmember Bass, who used to be the Chair of the Public Health Committee so it is fitting that we are continuing in that same vein. Anybody else with any remarks? (No response.)

Okay. Mr. Sham, would you please read the title of the resolution.

Resolution 4 No. 241149, authorizing the Committee on Public Health and Human Services to hold a hearing on the prevalence of vaping among children and the effectiveness of current enforcement efforts.

The Clerk will please call the first panel to testify on this bill.

Robert Listenbee, First Assistant District Attorney, Philadelphia District Attorney's Office; Ryan Coffman, Tobacco Policy and Control Program Manager, Philadelphia Department of Public Health. (Witnesses approached Witness table.)

Good afternoon. Please state your name for the record and proceed with your testimony.

Thank you very much, Madam Chairman. My name is Robert Listenbee. I'm First Assistant District Attorney for the District Attorney's Office here. I'm here on behalf of District Attorney Larry Krasner. I would like to thank the Chair Councilmember Ahmad and other members of the Council for inviting me here today to talk about this very important issue. It is not an issue that we've had extensive contact with in the District Attorney's Office. So I tasked our researcher to consult members of our staff and also statutes and so forth that are appropriate. And so, I'd like to present a testimony on those issues. Vaping is legal. However, there are restrictions on age of use, age to purchase and sales restrictions. Title 18, Section 6305 of the Pennsylvania Crimes Code states that any of the following sales violations are summary offenses. It's important to know that summary offenses are handled in the DA's Office by the Diversion Unit on the adult side. They're not handled in a regular course of municipal court or in a regular course of the felony sections of the office. Sales of tobacco products to underage purchasers, these are people who are under the age of unless they're in the 18 military, then it's the age of 18, 19 is prohibited. The furnishing of 20 tobacco products to underage 21 purchasers, again under 21 or 18 for the military members, is prohibited. Vending machines with tobacco products are prohibited in any place where an underage purchaser can gain access. Displaying or offering sale of cigarettes out of pack is prohibited, referring to loosies, I believe those were referred to by Councilmember Bass in her earlier comments. The penalties for the above sales include the following: If you're an individual, nonretailer, the first time offense is a fine of $100 to $250. The second time offense is a fine of $250 to $500. And the third time offense or subsequent offense is a fine of $500 to $1,000. That's for the individuals. For retailers, and I believe one of the focuses of this discussion today is about retailers, for retailers the first offense is again $100 to $250; second offense 250 to 500; and third offense or subsequent offense 500 to $1,000. 6305 states the following purchasing violations by minors are summary offenses: Again, summary offenses subject to punishment, a minor attempting to purchase a tobacco product, a minor falsely representing themselves to be years of age or a member of 12 the military to purchase tobacco 13 products. 14 Penalties for the above 15 purchases by minors include the 16 following: Up to 75 hours of 17 community service. Must complete a 18 tobacco use prevention and 19 cessation program approved by the 20 Department of Health or a fine of 21 up to $200. In addition to the above, students are also prohibited from having tobacco products on school property, including school vehicles and buses and so forth. Violation of these offenses can lead to summary offenses. Now, back to specifically what has the DAO done in terms of vaping? Youth and adults under the age of cannot 8 possess, purchase or use vaping 9 products in Pennsylvania. However, 10 the DAO has not charged or 11 prosecuted any youth that I'm aware 12 of for these charges. 13 I consulted again with 14 Caleb Arnold who is the supervisor 15 of our Diversion Unit this 16 afternoon. She stated that there 17 were only three offenses within the 18 last month when even charges in 19 cases involving tobacco products on 20 a SEPTA platform were actually 21 charged. So it's even in terms of possessing tobacco products, very limited work. And PPD has not provided any citations that we are aware of. So again, it's not something that's prosecuted or given citations by PPD or by the DAO. Discussion of vaping was important to me. What is vaping? It is a term used to describe smoking e-cigarettes that heat up a combination of nicotine flavoring and chemicals so that the user can inhale an aerosol byproduct.

In addition to nicotine, e-cigarettes can also be used to smoke THC or other black market liquids. So there's a lot of stuff going on with vaping that's not directly to products sold by the retailers, but they're combined with other products being sold on the black market. How does it affect health? Again, I was very curious as to what kinds of impact it's having on modern youth. Health experts believe that vaping exposes the user to fewer toxic chemicals than smoking traditional cigarettes. However, these products are still highly addictive and can cause health problems. In February 2020 the Center for Disease Control and Prevention, the CDC confirmed 2807 cases of e-cigarette or vaping use associated lung injury that's referred to as EVALI. EVALI is an acute respiratory illness which can cause symptoms such as difficulty breathing, chest pain, nausea, vomiting, cough or more. Of the identified cases, the CDC indicated that there were 68 deaths due to this condition so kids can die from it. The CDC has confirmed the deaths of 68 people involving this, and it's important to note that this is a risk that we're not often talking about or thinking about because it's not as widespread. The information is not as widespread. The CDC identified Vitamin E acetate as a chemical likely to cause EVALI. This chemical is a thickening agent used in e-cigarettes and was found in lung fluid samples of all the cases examined by the CDC. The CDC noted that EVALI appears to predominantly affect people who bought their e-liquids from the black market or modified their devices. So again, these aren't occurring just from direct sales by retailers, but people are modifying these products on the black market and this is something that's very difficult to control. In addition to concerns about EVALI, emerging data suggests that vaping is associated with lung disease and asthma. Additionally, nicotine is the primary ingredient and is a highly addictive substance which can raise your blood pressure or heart rate, increasing the likelihood of heart attack. Now, why do young people vape? And it's important to note that for many years public health campaigns were highly effective at preventing young people from smoking, so we were successful at preventing one problem. And then along came e-cigarettes. They're blamed for reversing the decades of progress. A 2019 CDC report found that despite tobacco use having decreased among teens since 1998, the use of tobacco products grew by 38% among high school students in the 2017-to-2018 school year, largely due to vaping products. So our high school kids are actively involved with vaping products. 8% of high school students reported use in the last 30 days, while no change was found in other tobacco products, the last 30 days I believe of the 2017-2018 period. Public health experts say that vaping has undone decades of prevention work and puts a new generation at risk for nicotine addiction. Is there any city or state agency tasked with supervising the vaping industry? S. Food and Drug Administration, the FDA Center for Tobacco Products regulates the manufacturing, marketing and distribution of tobacco products, including e-cigarettes. This FDA also monitors usage of tobacco products. This includes administering an annual use survey to measure the use by youth. Is there an agency tasked with encouraging youth to avoid or stop vaping? S. Department Food and Drug Administration, the FDA, announced the creation of a federal multi- agency task force to combat illegal sales and distribution of e-cigarettes. The task force was particularly concerned about the vaping industry's targeting of youth. No results are yet available. This will be again a good area for further research. We will follow up on that as well. The FDA has a public education campaign known as the Real Cause, which aims to educate teens of the dangers of smoking. In 2017, the campaign begin prioritizing e-cigarette prevention messaging.

Have other cities developed rules or regulations or laws concerning vaping? In 2019 Michigan became the first state to ban flavored-nicotine vaping products. In 2020 New York City banned the retail and online sale of flavored e-cigarettes. New York State banned the retail sale. In Massachusetts the sale of flavored cigarettes is restricted to smoking bars for onsite adult consumption only. California banned the sale of most flavored tobacco products in 2022. Federal law prohibits the sale of closed system devices, pods and cartridges containing e-liquid in flavors other than tobacco or menthol. However, this rule only applies to flavored cartridge-based e-cigarettes and does not prohibit the sale of flavored disposable e-cigarettes or refillable flavored e-cigarettes. How successful have they been? An NIH-funded study examined the effects of flavored bans. However, the study was exclusively done with adults so it's unclear about its findings, whether they apply to youth. Findings show that many people who use flavored vapes switched to unflavored vapes. Additionally, many retailers were still able to obtain banned flavors through legal channels. So those are the comments we have. We think there's a big problem. We think there needs to be obviously further research. But other states have jumped into the area and done what they could to stop or prevent or focus on vaping by young people. Perhaps there's an area for us to go further in this area. Thank you very much.

Thank you very much. We will have Mr. Coffman give his testimony and then we'll ask questions from my colleagues and myself.

Good afternoon, Chair Ahmad, Vice-Chair Lozada and members of the Committee on Public Health and Human Services. My name is Ryan Coffman. I'm the Philadelphia Department of Public Health Tobacco Policy and Control Program Manager. On behalf of Health Commissioner Dr. Raval- Nelson and the Health Department, I appreciate the opportunity to testify regarding Resolution 21 241149. One of the core purposes of the Tobacco Policy and Control Program is to prevent youth from using tobacco and vaping products, support Philadelphians who use tobacco and vaping products to quit and implement evidence-based citywide policies and public health strategies to protect residents from the leading cause of death and disability in our city. The Philadelphia Department of Public Health's Division of Environmental Health Services enforces Philadelphia's tobacco retail laws and partners with the Tobacco Policy and Control Program on their implementation. Youth vaping remains a significant public health concern both nationally and in Philadelphia. While national declines in youth vaping have been observed, the most recent data for Philadelphia show the highest youth vaping rate since data collection began in 2015. In 2023, 19% of high school students in Philadelphia had used an e-cigarette within the past 30 days compared to 17% in 2015. In 2023, 38% of Philadelphia high school students had tried e-cigarettes at least once. This exceeds the use of all other tobacco products, making vaping the most commonly used tobacco product among Philadelphia high school students. Even more troubling, the Tobacco Policy and Control Program has received reports of elementary and middle school students experimenting with vaping products. In no uncertain terms vaping products are erasing decades of hard-fought progress reducing youth tobacco use. According to local sales data from 2021 to 2023, analyzed by the Philadelphia Department of Public Health, about three-quarters of tobacco products sold in Philadelphia are flavored. Despite being illegal under federal law, vaping products continue to be sold in fruit, alcohol, dessert and candy flavors, deliberately designed by the tobacco industry to appeal to youth and are heavily marketed on social media platforms by youth and young adults. The types of vaping products used by our youth have also changed dramatically over the past decade. Today's products hold more e-liquids are cheaper and contain higher levels of nicotine than earlier generations of vaping products. In fact, some devices contain the nicotine equivalent of multiple packs of cigarettes. To enforce the City's tobacco sale laws, the Philadelphia Department of Public Health coordinates compliance checks with tobacco retailers, during which approved youth surveyors attempt to purchase tobacco products from retailers. In 2024, there were 291 vape sale checks conducted which resulted in violations or a 5% 8 violation rate. Encouragingly, 9 this is below the overall violation 10 rate for compliance checks of 17% 11 in FY24. 12 The Philadelphia 13 Department of Public Health plans 14 to increase the number of youth vape sale checks conducted in Calendar Year 2025. Community members also play a vital role in reporting illegal tobacco sales. The Tobacco Policy Control Program actively solicits and responds to reports of establishments violating Philadelphia tobacco retailer laws. In recent years some retailers have continued to sell tobacco products without the Philadelphia tobacco retailer permit and have repeatedly sold to minors, even after being shut down multiple times. The Philadelphia Department of Public Health works closely with the Law Department to act against these retailers. For youth vaping prevention, both the School District of Philadelphia and the Archdiocese of Philadelphia are essential partners for reaching large numbers of youth who are high risk for vaping or are already vaping.

The Tobacco Policy and Control Program and our partners provide content expertise, technical assistance and additional resources to help these institutions develop comprehensive strategies to reduce youth vaping through communication, training, prevention, treatment and policy revision. The ability to legislate at the local level to address youth vaping is currently obstructed by state law. In 2014, Philadelphia City Council added vaping products to the Clean Indoor Air Worker Protection law and prohibited their sale to minors. Subsequently in 2019, Philadelphia City Council restricted the sale of electronic smoking devices to adult-only establishments. However, this ordinance, Philadelphia Code 9-638, sale of electronic smoking devices and youth accessible establishments was challenged in court and ruled preempted by state law. A separate 2018 Pennsylvania law further preempts Philadelphia from passing local laws or regulations on tobacco and vaping product sales, limiting the City's ability to combat youth vaping effectively. On a positive note because of litigation by the Law Department, the City of Philadelphia recently received settlement payments from Juul Labs, Inc. and Altria Group. The Philadelphia Department of Public Health has submitted detailed budgets and proposals to use these funds to expand youth vaping prevention efforts, support youth-serving organizations and enhance enforcement efforts against illegal tobacco sales. Thank you very much for the opportunity to address you today. I'm ready to answer any questions that you may have at this time.

Thank you so much. I want to acknowledge that my colleague Rue Landau has joined us. I wanted to start with some questions for Mr. Listenbee. You mentioned there has been very few or zero prosecutions, correct --

Correct.

-- of young people, but any retailers who were found to violate the selling to minors is one question. And from what I understand, it's the Health Department who identifies these violations and then informs the Law Department. But where is the DA or police involved in this? Can you tell us about that?

Yes, Madam Chairman. To the best of my knowledge, the only time that we are made aware of any of these cases is once there's been an arrest by the police department, and those come in as summary offenses and then we respond. We handle the summary docket. And if there are various issues, they end up going to municipal court. But for the most part they handle the summaries by our staff. We're more than willing to go forward with these if they come in. We're more than willing to work with City Council to develop a comprehensive policy, working in conjunction with the Law Division and with the Health Department to do something that sort of addresses the overall problem as opposed to one part of it. But it's just not something that's been high on our agenda thus far. And again as I stated, we certainly welcome the participation by young people in helping us sort of develop an approach that will actually work for prevention, rather than just a new hammer that's going to hammer them for doing something that many of them might like to do. But again, I checked with the head of our Diversion Unit and they're only aware of four smoking violations, not even vaping, that involve smoking on SEPTA platforms, and that was within the last month. They don't have data on the overall period of time, but we're going to certainly be available to do more research, as you would request.

Seems like there's a disconnect between what data tells us who's using it, 19% of high schoolers, most of them probably underage, so clearly somebody is selling to them --

Correct.

And we don't know who's -- so I appreciate that we want to prevent rather than prosecute on these issues. But the prosecution is on the retailer side who know full well they're not supposed to sell to young people under the age of 8 unless they're military. And so, 9 we can address that issue and at 10 the same time look at a prevention 11 strategy for making sure our young 12 people understand what is at risk, 13 that they're going to have a lung 14 problem forever and how they can be 15 advised on what is the consequences 16 of engaging in vaping. 17 So there are two 18 separate things and we can do both 19 things, hopefully chew gum and walk 20 at the same time, because these 21 people are deliberately taking advantage of young people. And that lawsuit, the Juul lawsuit was about misrepresentation, that they were found guilty of that except they settled and they did not say they did anything wrong basically, but they just paid out, right, at the settlement. So it seems to me that we need to have a more cohesive way of addressing those who are violating the law by selling to minors and then work with including law enforcement and our DA's Office on a strategy with the Health Department and other entities who care about young people to have a campaign to inform people. This is how we did tobacco use way back when, right. And so, we have a model. We might obviously have to tweak it because we didn't have social media then. We didn't have that constant barrage of information and color and peach flavor and mango flavor coming our way. These are deliberate attempts to make people feel these are safer products. And I think that's the problem with this whole industry, is they are targeting young people and they're targeting young people in our city and we have to do something in response to that. So if there's any response from you, from the Public Health Department to understand the gap between finding those who are violating and sharing that with the police which would result in a summary offense, and then subsequent there would be a prosecution of that. Could you address that?

Yeah. Thank you for your remark. I can take careful note of that. We'd be happy to follow up with folks here and then also to talk with our colleagues in the District Attorney's Office.

So do you think there is a gap between sharing that information that you find with our law enforcement?

It's not something that I'm aware of at the moment, but I'd be happy to take a note and follow up with this Committee and with our colleagues in the District Attorney's Office.

We would love that, because it seems like this has not risen to the level of concern that we should have because we are putting, you know, we don't need it to become a bigger problem before we address it. We need to tamp it down before it becomes a bigger problem, before we had to do what we had to do for regular tobacco products. We don't want to go there. We should have learned some lessons, right. And so, that's why I think it is our duty to our young people who are the leaders and future leaders of our city to know that we care enough about them that we are going to have a concerted effort from all entities involved who could possibly make a difference, right. So I thank you for that and I look forward to that information from you. Anybody else have a question? We'll go to Councilmember Quetcy Lozada.

I just want to also thank you. I think that I agree, right. There is a disconnect somewhere along the line of how do we get this information to those who understand the severity of these puff bars or whatever vaping or whatever they are. We see them pop up in neighborhoods like ours that are poor neighborhoods, right. They feel like they can -- they're predators to young people, right. And so, helping young people understand how serious these puff bars are to their health I think is something that we also need to do better, right. We need -- the education piece around vaping and around puff bars is extremely important and not only for the street vendors, right, but for the vendors in their own spaces, right, I have a family member whose son was vaping and they took his vape off of him and when he came home from school, he already had another vape bar, right. So they're obviously available and very, very accessible to young people. We need to figure out how we build education campaigns around the effects, the long-term effects of vaping. To me, Madam Chair, I'd also like us to look at how do we work with our state partners, right, who preempt us on these types of situations. What are they doing at the federal and state level to make sure that the folks who are setting these illegally are held accountable and how do they help us educate and find funding to be able to create these campaigns in order to make sure that our young people understand the severity of vaping. Would love to continue to work with the District Attorney's Office. But if we're all preempted, then we can't have a productive conversation without parts --

Counterparts, yeah.

-- at the federal, state level who really are the enforcement piece to this puzzle.

But I do think even right now you gave us the gradation of fining, right. It starts at 250, goes up to 1000. I believe Massachusetts is a straight 1000, right. Yesterday we had a Streets Committee hearing about illegal dumping. Illegal dumping is 5000 and here we're putting poison into someone's lungs and causing damage to lungs and we're starting at 250. That we can fix. That we can fix right now, right. So I think while we're waiting for a more hospitable legislation of our legislative partners in state government, we have some ability to do something. That's one. Two, is really that education piece needs to go to our other legislators who are not aware what the impact of this is. The CDC already has shut down communication with the public. So just because that's happening doesn't mean we stop. The Public Health Department, all other entities, elected and appointed I think we need to stand in that gap to say, this is our time to show our children we care about them and that here's the campaign to advise you, advise your parents because we also have very young children getting involved in this when they're swallowing these liquids or they're inhaling the vapor. Secondhand, thirdhand is happening too. So there's a -- we can spend all hours just talking about the impact. But I just wanted to say that there are some things we can do now while we work to have this preemption clause get around it somehow. Are there any other questions? Yeah -- no. Okay. So thank you panel. We'll ask the next panel to come up.

Thank you very much.

Thank you very much.

We'll follow up with you.

Students of Palumbo High School, Constitution High School, Motivation High School. Will Cavance Snaith and Rochelle Meneses-Nieto make their way to the panel. (Witnesses approached Witness table.)

Please state your name and begin your testimony.

Hello. My name is Cavance Snaith. I am a senior at Constitution High School. I just turned recently, but I'm 7 happy to be here today to talk with 8 you all about young people and 9 vaping. 10

11 Just speak into it. Thank you. 12

So to get 13 started my testimony, I believe 14 that young people start vaping for 15 just one big reason, as a lack of 16 education. I think that our public 17 schools lack in just notifying 18 students of the health risks that they may have, that they will face with putting this poison into their bodies. Before coming today to City Council, I sent out a poll to students in my high school just to get a basic understanding so I can bring you all statistics, current statistics, from students from my high school. Since I said that most young people are not having enough education, 80% of the students who responded to my polls said that there is not enough education in public schools that give them a sufficient knowledge about vaping. I think that right there just says that that is the catalyst to why we have more vaping in young people, not enough people know about the health risks. Because of people not knowing about the health risk, 60% of students or respondents to the poll said that more of their peers are beginning to vape. So we can see a correlation or causation rather from just a lack of knowledge in them not knowing what they're putting into their bodies, which is causing more students to vape which is 60% of students responded. 73% of students said that they know people personally who have vaped in the past that are around their age. And so, again we see more peers that could possibly be influenced to vape because again they have people who are actually close to them who are close to their age who they know personally that vape. Also, 73% of students said that they know people that have vaped in a school setting. So now we see a problem of students vaping in schools. So this is not specific to Constitution High School, rather this is a problem that we are seeing Philadelphia high schools across the board. We're seeing that students are vaping in schools, making it more accessible for students to pass those vapes to other students to share which is creating more health risk. So I think the problem is I think part of the problem is that businesses are selling these vapes to students who are under -- just people who are underage. But also once they obtain these vapes, they're then passing them along and sharing them which is unsanitary and they're doing this stuff in school. Like I said, again 73% of respondents said that they know people who have vaped inside of a school setting. And so, I think some of the solutions that can come from what I've just said I have three: I think that the City of Philadelphia and the School District of Philadelphia can mention in the forms of the dangers of vaping in schools. So this doesn't have to be just a pamphlet that we pass out during orientation week. This can be something that we can integrate with what our schools call peer group connections. And basically if you don't know what peer group connections mean, that is a group where students, usually seniors or juniors, lead an advisory or seminar class with freshmen. And so, we can integrate the knowledge and have the seniors and juniors just talk about the dangers of vaping and what they have seen with vaping, and we give in the city of Philadelphia help, provide some more facts so that they can share with their peers. I think it will ring easier and it will encourage students from young age to start. And if we start this soon, eventually we'll see that the freshmen when they become sophomores, they are starting to have less vapes and when the sophomores become juniors and they're becoming the next PGC leaders, they're now teaching the next freshmen. And so, now we see in the cycle of just being more knowledge and more informed with our young people. Also, I think that we need more collaboration with our families. I think that we can work with families that are part of the Community Advisory Council in the School District of Philadelphia. They are parents and they are community members of people in the School District and students.

And so, we have parents, we have members of this community being more informed and hopefully they will inform their child and I would imagine that we will start to see less vaping because again more people are informed. They are actually getting this direct talk, not from people, not from other adults but rather from their parents and community members. I don't know how realistic my last solution would be with just the uncertainty with public education funding and other funding that schools are facing. But I think that the School District of Philadelphia and the City of Philadelphia can collaborate to purchase some sensors in these bathrooms. So one company that I know is called Halo, H-a-l-o. Some school districts around in our state, our Commonwealth, have already in place some of these sensors that would notify administrators in their schools if there is THC oil or vaping smoke in the air. And so, if these detectors in our school bathrooms, administrators and people who have access to that knowledge will immediately know that there's someone vaping in the school and hopefully it's addressed. I do not believe that we should automatically go to punishment. I think that again these are teenagers. Teenagers try out all types of things. What I think that we should do is focus more about education and more of like a progressive thing, like the first time you get caught, you need to talk about this, the second time you just see why are you still doing this and then a third time you can go on from there if they're not understanding or listening. And so, I think a lot of the policies that surround vaping in public schools are just more so what's going to happen to -- like what's the punishment when you get caught vaping in school rather than I don't see any policy that is meant to educate young people rather than they're just punishing the students, which again just not addressing the problem is temporarily putting a band-aid over the issue because once they get reprimanded, then we start to see more, start to see them take some actions. That concludes my testimony and I will be happy to share with you the results from my poll. It will be closed by this Thursday. And I will be more than happy to share with you everything. Thank you.

I'm so impressed. But we'll take the next testimony and then we'll come back to both of you. Please state your name and begin.

Good afternoon to the Councilmembers. My name is Rochelle Meneses-Nieto and I'm a senior at Academy at Palumbo. So vaping is a constant problem among teenagers and it's an issue that has been plaguing teens around my school, not just at my school but all around the country. Whether it's the pressure to fit in or just simple curiosity, there's no excuse for teenagers to end up addicted to something that's so dangerous. So I see it every day. There's vape pens all around school grounds and it's now just a casual part of their routine. You think it's safe because it smells like mango or cotton candy and it doesn't have this harsh stink of cigarettes, but I've done my research and according to all the statistics, vaping can cause lung damage, nicotine addictions and there's some risks that we don't even understand yet. It's not just for myself, but for my friends that I'm really worried about the situation. I watch kids make it through class -- they can't make it through class without a single puff as their hands start trembling and it's not normal. That's not okay because why are teenagers who should be focused on growing up and figuring out who they are being so focused -- being so dealing with withdrawal symptoms? Why is it becoming so normal for kids my age to carry pens, vape pens, as if it was a phone or a pencil? And that's what gets me the most, how easy it is to get them. I've heard stories of people bragging about how they got their hands on a vape with either shops, older friends or corner stores and how despite these laws and the warnings, it's a simple online post that can get them a ton of likes or attention. And why are they so accessible when we know the damages that they can do? There are health risks that are so -- that have so many threats that are happening right now to people I know and they are just getting worse, as if it's becoming a more accepted part of teenage life. Some of the solutions I concluded were, as was stated before, instead of punishing the students around the school, it's only going to convince them to do it more -- workshops, teachers talking, parent talks or meetings can help convince students that vaping shouldn't be a normal part of their life. Addiction is very dangerous and just a simple vape pen can lead to more dangerous and harmful drugs along the road. A teenage brain is still developing and just because it doesn't have this strong scent of cigarettes, just because it's supposed to help with depression or anxiety, that isn't actually true. Helping students understand is a very important part of just helping them grow into very successful young adults into the future.

I think we have two more students who can come up and testify. Then we'll have a whole student panel to talk to after you're done. So, Mr. Sham, would you call up the next two witnesses. You guys don't leave. Stay.

Kaseem Jefferson and Rahim English. (Witnesses approached Witness table.)

Please state your name and begin your testimony.

Good afternoon. My name is Rahim English. I'm in 11th grade from Motivation High School and here to talk about vaping. I believe young people started vaping because of the older people, the adults. They get it from the adults. They get influenced by the adults. And once they see it, they should try it too. And they think that it's cool. They think that's cool, but it's not. And I believe we should stop it. Vaping affects teen lives in many ways. I have friends that get lightheaded from vaping, tell them to stop multiple times but some cases it don't work out. Adults can help people my age not vape or start not vaping by just stopping in general. Adults smoke, vape, do all kinds of stuff in front of kids and they should just stop. And it will influence the kids to think it's cool to start vaping too. And I believe everybody just stop once and for all. That's it.

Good afternoon, City Council. My name is Kaseem Jefferson, senior at Motivation High School. I believe young people started vaping because of their friends and they see again adults smoking so they think it's cool, they think it's fun, not knowing that nicotine is a strong and addictive drug. I believe vaping affects teens' lives. It causes lung cancer, give people lightheadedness, you start throwing up, you can get stomach sickness. A lot of things that come with it. And I feel as though adults can help with teens stopping vaping by if we come into school, like extra pat-downs, you feel me, metal detectors. Parents should be more invested in what their kids are doing, checking on what they doing, you feel me. Like be more invested into them, give more time to your kids, make sure they're doing the right thing. And that's it.

Thank you so much. I so deeply appreciate all of you taking time out of your busy lives to come and share your thoughts here, very important ones. We have a whole survey done by someone. I'm sure we'll be able to connect and get that data because that's real data, right. And you're talking about peers, each other, influencing each other. But what I heard very clearly was adults in your lives normalizing this for you, right. And when I was your age, the issue was smoking caused a lot of smell and stink in your hair. So if I were to do anything like that, my mother would catch on like that, right, because my hair would be smelling. In fact, I did get caught once doing that. But in this case, you have these flavored, lovely, no 19 smell and it seems like the impact is that people think they're less dangerous and they're less detectable, right. So what I really appreciate from all of you are the thoughts you said, two things: One is punishment is just going to push it down temporarily and people will continue if people don't understand. Young people don't understand why we're telling them not to do this. So we've had very successful campaigns in the past around tobacco use. This is how tobacco use went down, just regular cigarettes because there was a concerted effort across the globe, not just this country, where they talked about the ill effects of tobacco. We need to ramp that up for this. That's what I heard from you, that let's not just focus on punishment. Yes, consequences are important but the biggest consequence is that your health is going to be impaired and you're forever going to have lungs that are compromised. If people knew that, maybe they would think twice about doing this. The second thing I heard was adults are a big factor. Adults are the ones selling these products. Adults are the ones who are using it and again normalizing it for young people. So, yes, we have a responsibility. I also heard education in schools for parents. We do have something called Parent University, and maybe we'll talk to our Superintendent to see if this can be part of the curriculum where parents get in terms of addressing this. But I can't tell you how impressed I am with all of you. I hope the rest of the city is watching you because we only hear when young people get into trouble. Here we see four smart young people sitting in front of us giving us real information, actionable information that we can actually put a campaign together based on your responses. So I thank you very much and hope we can stay in touch as we go ahead and think of ways and we can check in with you and test with you what we are doing, whether that makes sense in your community, in your age group. So if anybody else has any questions?

Yeah. I also want to say thank you for being here, right. It's always difficult as the legislator to make decisions about your future when you're not at the table. And so, thank you so much for being here. It is important for us to include you in the conversation or to have you lead conversations in order for us to build legislation that ultimately will have an impact on you for the next years or so, 4 right, and so grateful for the 5 opportunity to be here to hear 6 directly from you. 7 And I agree with you, 8 right, it doesn't always have to be 9 about the consequences, right, 10 about how do we punish you for 11 doing certain things. I think 12 that -- I'll go back to what I just 13 said earlier, right, how do we 14 build education campaigns that are 15 built by you for you, right. 16 My son takes every shot 17 he can when he says, mom, you're 18 not cool and nobody's going to 19 really listen to you, young people 20 are not going to listen to you, right. But they'll listen to someone their age or someone that they feel will understand why they're doing the things that they're doing. And so, I think it's important for you all to be in the forefront of this conversation and wanted to just let you know that I appreciate you having taken the opportunity to be here with us. Beyond today, continue to reach out to your elected officials and share information about the things that you're seeing at school and where you live in order to help us again make sure that your voices are heard and the things that we're working on. So grateful for you being here and looking forward to seeing more young people participate in these conversations in the future as we work towards a safer Philadelphia for all of us.

Me three. Just want to echo exactly what the Chair as well as the ViceChair have already lifted up. It means a lot to hear from you. We hear from so many folks day-in and day-out. I think that I have taken away great insight that I hadn't really considered about the responsibility of us on adults for our children. I'm a young man and I'm going to bring a child into the world this year. And so, I'm thinking a lot about the representation, the example that's being set before them. Maybe you would always assume or don't always recognize how impressionable just little things that we can do can be. And so, thank you for making that call, and also for making the point around the lack of education that you're experiencing within the schools or at least precautions that are being given, dangers of folks being made aware of as it relates to this. Duly heard. These are things that we probably would not known had you not taken out your own poll in your own high school. This also is what democracy looks like. I don't know if any of y'all are yet. When you do, you can 9 vote. But before you can vote, you 10 can also do this. And I thank you 11 for doing it today. It's a great 12 demonstration of what civic 13 engagement can be. Thank you so 14 much. 15

I 16 guess it's me four. Listen, I 17 can't thank you enough for sharing 18 your stories with us. The young folks in this city have a lot to offer and we always read about the bad things, as the Chair pointed out earlier. But when we see you coming in to civically engage with the leadership in City Council, it warms our heart because sometimes we make decisions in vacuums. We think we know what's best for you. Sometimes we do. Sometimes we don't. But your presence today made a difference and I want you to know that. Thank you.

And finally, me five. I want to thank you as well, but also want to remind you that we are always here for you. So if you have new ideas, please on this issue absolutely go to the -- you can write to the Chair of this Committee hearing and give us your ideas, but come to us for any of the other ideas that you have. We're all here for you. Your voices are so important. I'm saying this also to the other young people that are out here today. We want to hear from you guys. It's your city as well as all of our cities and we want to make sure that your voices are heard. So come to us with your ideas, your concerns and we'll see what we can do to help.

Once again, thank you. And can I just say having you here and we have written testimony from two others who couldn't be here and we have other young people in this room, you have made this a successful hearing already, right, you being here. This is our toughest nut to crack, to have those whose lives are most impacted to be at the table telling us what your thoughts are. So we're going to definitely work with the School District to reach you, to make sure you can reach us. And when we do something about this, I'm thinking about some legislation, I would love to invite you back to say that your conversation and contribution is pushing us to actually make change. So of course I'll invite everybody, but you will be our special guest if you're able to do it before you all graduate or whatnot, but we'll be in touch. Thank you very much. I really appreciate your time and make sure that you are the leaders of our city that we are looking to, right. You have the solutions. Thank you. We're done. You can be excused now and we'll go to the -- Mr. Sham, if you can call up the next witness panel. (Applause.)

Dr. Rob Bassett, Associate Medical Director at Children's Hospital of Philadelphia Poison Control Center and Dr. Jayme Banks, Chief of Student Support Services, School District of Philadelphia. (Witnesses approached Witness table.)

Please state your name and begin your testimony.

Madam Chair, I beg the Council's pardon on taking the selfie. But you've done me a great service at home as my kids simply cannot believe that there are smart people out there that care what daddy thinks. So thank you for that. Robert Bassett, on behalf of Children's Hospital Philadelphia and Poison Control Center. Council, Madam Chair Ahmad, Vice-Chair Lozada, Councilmembers, thank you so much for the opportunity to speak today about a public health crisis that is literally unfolding before our eyes, the epidemic of teen vaping and electronic cigarette use. As an emergency physician who subspecializes in medical toxicology and addiction care, I encounter adolescents struggling with the consequences of vaping and e-cigarette addiction literally every day. I am here to tell you that this is not a fad. This is not harmless experimentation. This is a crisis, one that is rewiring young brains, compromising mental health and taxing our health care system with cases of nicotine toxicity, respiratory pathology and all the downstream psychosocial harms of addiction, including depression and suicidality. To understand the gravity of this epidemic, let me introduce you to a patient Matt Murphy, a high-achieving athletic high school senior, high school student, who never touched cigarettes but found himself hooked on electronic cigarette device after just a few puffs at a party. I didn't personally take care of Matt. But after immersing myself in his story, as told to Jan Hoffman of The New York Times, I felt like I could have been his doctor or more excruciatingly, I could have been his parent. Forgive me, I get a little choked up when I read those words. There was a gut punch to watch domino after domino tumble. His first hit brought a euphoric head rush, but what followed was a relentless addiction that drained his savings, left him breathless on the hockey rink and turned his vape device into what he called his 11th finger as his dependence on the electronic nicotine delivery system was so strong that he felt like his vaping device became another appendage. His grades slipped. His anxiety skyrocketed. His social life revolved around the next nicotine fix. At his worst, he kept his vape device strapped to his nightstand so it would be the first thing he reached for each morning. It wasn't until a gut-wrenching confrontation with his parents that he realized he was no longer in control. And that story is unfortunately not unique. It's echoed in the halls of every high school in Philadelphia. It is the reality for millions of teenagers across the country and it's happening under our watch. The data is alarming. In our region alone, cases of e-cigarette exposure reported to the Philadelphia Poison Control Center at CHOP, where I serve again as the Associate Medical Director, have surged from just in 2020 to 248 in 2024, and 5 that is a staggering 640% increase. 6 And simply, these are 7 just not numbers. These are 8 children and teens suffering from 9 nicotine poisoning, respiratory 10 distress, psychiatric 11 complications. Many of these cases 12 involve young children ingesting 13 liquid nicotine, leading to severe 14 poisoning and hospitalizations, and 15 that I have taken care of 16 personally. 17 In my field of 18 toxicology, I will often paraphrase 19 the ancient philosopher of 20 Paracelsus, who's known to be the godfather of toxicology, in saying anything can be the poison, the dose makes the poison. These liquid cartridges deliver massive doses of nicotine. Single cartridges can include as much as cigarettes or more. This case 4 is as clear cut as it gets. The 5 dose is making the poison. 6 As devastating as the 7 physical harms of vaping can be, I 8 worry the insidious impact on 9 cognitive and mental health can be 10 even more catastrophic. We know 11 that nicotine hijacks the 12 developing adolescent brain, 13 worsening anxiety, depression, 14 impulse control.

Studies show that 15 teens who vape are at significantly 16 higher risk of developing mood 17 disorders and even transitioning to 18 combustible cigarettes. 19 We know that nicotine -- 20 excuse me. We also know that vaping exacerbates school absenteeism and academic struggles. Sarah Wagner is an Arizona high school student who wrote a prizewinning essay about how vaping has become so normalized that students casually vape in bathrooms and then just toss their empty nicotine cartridges in hallways, no longer shocked by their peers' addiction but resigned to it. But alas, we can turn this around. We are not powerless against this epidemic. This City and this Council have taken great strides to reduce the harms associated with e-cigarettes and vaping. But this war is far from over. Just as we fought to reduce youth smoking rates through policy, education, enforcement, we must continue to take swift and decisive action against e-cigarettes and vaping. I urge the City Council to explore implementing or advocating to the appropriate governing body some of the following policy changes: First, a full ban on flavored vapor nicotine products, except for FDA-approved cessation products. Research shows, and as you've all talked about earlier today, that youth believe that flavored e-cigarettes and vapes are designed for them, incentivizing resistance to age-gating. We'd also recommend a cap on nicotine concentrations. Teen use of highly concentrated nicotine pouches is rising alongside of vaping. Capping nicotine concentrations such as 10 to 15 milligrams per milliliter would align with efforts in other countries like Canada. Also urge to close loopholes for purchasing nicotine online. I heard the Council talk at great length about access and restricting access, and unfortunately we're seeing that access to online sales dramatically increasing. Despite Pennsylvania restricting sales to those over 21-plus, online purchases remain an important loophole used by many adolescents. Additional age verification efforts would help protect youth with developing brains while allowing adults with lower risks to access these products. We also recommend designate or emphasize via public promotion of vape-free zones like public transit stops, transportation hubs and parks or outdoor spaces frequented by families to limit secondhand smoke exposure. Research also shows that exposure to adult substance use like vaping in public parks models and normalizes its use for children and teens, and has been proven to increase minors likelihood of using. Matt Murphy eventually broke free from his addiction but not without months of withdrawal, anxiety and suffering. We cannot wait until more students fall into this cycle before we act. We have a moral obligation to protect the health and future of Philadelphia's youth. Let's get ahead of this crisis before we lose another generation to nicotine addiction. Thank you.

Dr. Jayme Banks. Thank you for having me this afternoon. Good afternoon, Councilmember Ahmad and members of City Council. My name is Dr. Jayme Banks and I serve as the Chief of Student Support Services at the School District of Philadelphia. Thank you for inviting the District to participate in this important hearing on youth vaping. We appreciate the opportunity to highlight the needs of our students and school communities while sharing our ongoing efforts to address this critical issue. The School District of Philadelphia prioritizes the physical, emotional, environmental safety of our students. The Superintendent's strategic plan makes that clear. Safe environments are essential for students to learn and grow. To truly address this issue, we must work together with the City and our partners to make this happen. 5%, have used a vape or e-cigarette at some point. 6% of high school students vape 20 or more days a month. Vaping presents a serious challenge in our schools because the technology behind vaping changes rapidly, making it harder to detect. Vaping products as discussed today are widely accessible, sold online, local stores, and there are limited proven strategies to effectively reduce the vaping. That's why we all have to come together and address from multiple sides. While again most Philadelphia youth are not vaping, the percentages continue to increase, right. This remains a major issue affecting student health, well-being and our learning environment. The School District of Philadelphia is committed to tobacco and vape-free schools. To achieve this, we take a multi- tiered approach working closely with the Philadelphia Department of Public Health and other key partners. One, around prevent -- first tier is around prevention and education of all students. So first is policy. We have Board Policy 222, which bans students from possessing, using purchasing and selling tobacco vaping products on school property. If a student is caught vaping, it's confiscated and not returned. But as we heard today, right, they easily get another. Progressive discipline actions follow. But as we have made it clear, it's not about discipline, right. It's about getting support and help in education. We're actually currently reviewing our Policy 222 right now to make it even more updated and current so it will be rather renewed this policy cycle this spring. Student education: Prevention is embedded throughout the K-12 health curriculum. Health education helps students build decision-making and self management advocacy skills, crucial since many students begin vaping due to kind of peer pressure or even as we saw adult modeling, right. Community partnerships with groups like Anti-Drug and Alcohol Crusaders, the Drug Enforcement Agency, CADEkids, they provide additional prevention programming through our partnership with Department of Behavioral Health in our schools. Family Education: The District provides families with vaping information through quarterly health updates and resources on our Student Health Services website. This spring we will host town halls for families, students and community members to discuss vaping and dangers of such. In addition, Councilmember Ahmad spoke to Family and Parent University. That's in my shop as well and we will definitely be including that in our offerings, as again it takes everyone to lean into this work in order to push the bar. The second tier is around support for at-risk students. Vaping harms students' mental health, contributing to anxiety, mood swings, impulsivity and learning difficulties. Many students vape to cope with stress, anxiety, even possibly depression. In our schools we continue to increase our counseling supports. So every school has a minimum one counselor with over 60% of our schools having more than one. 41 of our schools have an additional counselor called a behavioral health counselor, which is extensive experience in mental health.

In 45 of our schools through our partnership with DBH and CBH we have the STEP program, which is another layer of mental health but also we have case management services, family peers, again to reach the whole child, the whole ecosystem. In five of our schools, we have student-based health centers. Again, we have to target this through multi-lenses, multi- areas and that's how we're doing this. And then additionally, we have our Student Assistance Program, SAP as we call it, which connects students with mental health and substance abuse services, again via A partnership with DBH. And then of course, if additional mental health needs are identified, we have intensive behavioral health services in every one of our schools to help with that as well. The third tier is intervention for students who are actively vaping. Again, we said if a student is found vaping parents are notified, devices confiscated, but also looking at what else do they need in terms of support, what referrals need to be made, were they already connected to if they're not. Narcan is available in our schools. Again, you can put other things in the vape pens so we have to think about fentanyl and other substances that could be laced in these products and have responses for that. And again as I stated, if needed we will refer to our services that are in our schools or even other outpatient services, if needed. Through listening sessions with our students, staff in partnership with the Philadelphia Department of Public Health, we've learned the following: Students want stress- reducing activities, mentorship, access to cessation programs. Remember again, it's the whole child and the more that we -- I mean, our students just got up here and spoke about modeling behavior that they're seeing from adults. So if we can increase the positive modeling, those positive safe places, that will help this as well. Students need to kind of increase treatment as well as continue to increase our staff understanding of detection methods, more engaging as well as continue to update our education that we give, not talking at our students but speaking with our students, and making sure our policies align with the current research and understanding of the topic. To address youth vaping, we're launching a comprehensive awareness program with PDPH, which includes professional development and resources for staff, again family town halls which will start as early as this spring to help educate families and parents. We will also, as I said, include this as a strand within our Parent Family University that we're launching as well. Student engagement through assembly, social media awareness, but students have to help lead this. This cannot be us again talking at them. Increased access in cessation programs, partnerships with our City partners that can provide these resources and continue trauma-informed mental health supports and approaches, as sometimes this is just a symptom of a larger problem and issue. The School District of Philadelphia is committed to keeping our schools tobacco and vape-free while providing students with education resources and support they need to make healthy choices. Addressing this issue requires continued collaboration among City officials, public health partners, families and the broader community. We look forward to working together to protect the health and well-being of our students, and thank you again for taking the time to have this discussion.

Thank you so much. I appreciate both your testimonies. I have a question about how we compare vaping e-cigarettes to -- we talked about mental health, right. And how this becomes addictive and then can be really problematic. When we compare the engagement with vaping as opposed to marijuana, for example, right, do we see there's different -- is it mostly because they saw something, it looks cool and then they get addicted? They don't know that they're -- what benefit are they getting from vaping as opposed to, say, a good high from -- what's a good high -- a high from some other substance? And the reason I'm asking this, the campaign to getting to educate people and to hopefully help them stop can look very different, right, from somebody who's using a moodaltering substance to feel better because they have some issue at home and a mental health issue as opposed to starting vaping and then getting addicted to it. So I'm trying to understand how a campaign could work, given the fact that it seems more innocuous in how it starts, and I'm not sure that I understand why it starts.

Yeah, I'll start. It's a great question, and one that I think has probably many different answers truthfully. One thing I want to be very clear about is this is one of the misconceptions about vaping often purported at the youth level and in sort of secondhand advertising schemes is sort of what you say, Madam Chair, that this isn't combustible cigarettes, this is safe, this is just flavored water. And nothing could be further from the truth. Do you want to know how they get addicted? It has drugs in it. I mean, it simply has drugs. And to your point, it's not -- and to your point, ma'am, it's because it's not regulated very well. We don't know all the extent of the drugs. And there are people that literally get dependence issues, substance use disorder from multiple substances because they've been buying black market or gray market products and they didn't even know they were getting exposed to opiates or stimulants and stuff. But let's be very clear, nicotine is absolutely a drug just like caffeine and just like cocaine. And with enough repetitive exposure, it crosses the blood brain barrier. It provides this affinity. It affects their parts of the brain that are underdeveloped and inhibits their decision-making capabilities. And with repetition, their bodies start to depend on it and crave on it. And again, I don't want to grandstand about something that's near and dear to my heart. I'm sure all the physicians can attest to this. But when you're dealing with an addiction use disorder, this is a public health crisis for sure. We've tried to penalize and punish our way out of drug addiction in the past and it wasn't successful. And I urge us not to make that same mistake again when we're talking about things that can help. But part of the reason is absolutely that they're getting exposed to drugs. Now, I will also fully admit, and I don't want to take up too much time, that the reasons why or the propensity for developing dependence are multi- factorial, and there are some people that are genetically predisposed to addiction or alcoholism. We know that. That's been proven very, very well in the scientific literature. So without knowing the genetic makeup of all the people that are exposed, there's no way to predict if somebody's going to have a much higher likelihood given the same exposure between two students, or two adolescents, per se. And again, I think, to comment on something Dr. Banks was saying too about, you know, some of the reasons that people start, to answer your question, ma'am, I think there's a lot of inspiration that's given from modeling, social media and other peers. But I also think that it's a little bit of the chicken and the egg. And there are people who start using liquid nicotine and vaping products who develop behavioral health and psychosocial effects. But the reverse is true too, that there are many people that have unmet treatment and they are self medicating because they're desperate and they want help and this is what they turn to. And once they start using, they add dependency to their problem list.

And I would just add that at this point you're not really sure what you're vaping. So when you talk about dependency, depending on what is in, right, the solution, you don't know. It may not be just a liquid nicotine. It could be something else. And so, I think those are all the variables in this that make it very challenging and hard. I think a campaign for this has to be kind of multi- dimensional. There is everything that my colleague just shared plus just kind of social, peer interaction pressure as well as just normal curiosity, right. And so, I think there is just multi- layered approach to this to try to hit it at kind of multiple layers to really be successful.

The student who mentioned having detectors in bathrooms, to tell you truth I don't know that there are such things. That was news to me. Is that such a thing that we could at least identify that this is happening or alert us to say there's a presence of, I mean, just like the drug-sniffing dog in the bathroom kind of thing?

Yeah. I would have to come back with more research on that. From what I've seen, there's just so many -- these devices are -- again, the technology is changing really rapidly. There's so many different things in the contents that I think it's more challenging. You also don't want to overidentify, right. You don't want that. So I think we would have to kind of dive deeper to see the efficacy of such things.

As you said, it has to be multi-prong and we can't have one tool. It's going to be multi-factorial, but we can not do it because it seems daunting, where are we going to start. I think we've allowed it to go this far is our problem as adults who knew what the issue is and we should have acted sooner. But here we are. And I think if we collectively across the city everybody who's concerned, regardless of which angle you're coming from, so I look forward to working with all of you, to come up collectively with some way for the City of Philadelphia to say no 5 business as usual regarding vaping, right, and make sure our children know we're listening to them and responding. So thank you for your testimony. We will do some follow- up as we go through all our transcripts to see what rises to the top in terms of low-hanging fruit, right. So thank you again. Did you have any questions?

Yes.

Sorry.

Thank you, Madam Chair. And thank you both for your testimony and all that you provided with us today. Dr. Banks, you mentioned in your testimony the efforts that the School District has made to educate students on the dangers of vaping on a K through 6 level. And I was appreciating, as 7 we all did, the testimony from the 8 high school students, particularly 9 the gentleman from I think, 10 Constitution High who said that he 11 did his own poll and was about 80% 12 I think is the figure that he gave, of those at least within that high school, that felt like there was inadequate education around this. How often are they educated on the dangers of vaping? Is there a hard number that you can offer us?

I wouldn't say it's a hard number. It's definitely in the health curriculum. And so, depending on grade school how often it is provided kind of depends on that frequency. I can't give a number. I will say that we need to continue to think about doing more as well as thinking about again the talking at versus talking with, and engaging. So I think what we're really trying to do, especially with our partners with the city, is really thinking about how to bring in the youth to provide training support for them and their families in a way in which it feels more accessible and not a lesson.

Sure. And I also appreciated the affirmation that law enforcement may not be the focus here. I did want to ask though, you mentioned that you all were updating your protocols or updating your policy related to that. Could you give us a glimpse what that update might look like, just a little peek at what we might expect to see as it relates to those new policies?

So it's in process right now so I can't share the finished product, but within the next month or so is when it starts to go in front of the Board. So we'll have a couple sessions with our Board Policy Committee as well as then in front of the Board where the public will be able to comment, provide feedback before it's officially voted on. So it's coming. When I say coming, you know, this current season again.

Thank you both for your testimony. I appreciate you. Thank you.

Mr. Sham, if you would call the next panel.

Dr. Priya Shah, Pediatric Emergency Medicine, Children's Hospital of Philadelphia. (Witness approached Witness table.)

Please state your name and proceed with your testimony.

Hello, Councilmembers. My name is Dr. Priya Shah. I'm a third-year resident physician at the Children's Hospital of Philadelphia pursuing a specialization in pediatric emergency medicine. I began my research on policy work on child injury prevention and youth mental health during my time at Harvard Medical School. As a pediatrician, I ask every adolescent patient that comes before me about their diet, their exercise, their school life, their relationships or substance use. These conversations provide a lot of valuable insights into the environmental influences that shape their interests and behaviors. I'm here today to express my deep concern about the prevalence of vaping among youth in Philadelphia, the harmful effects of nicotine addiction on my patients' physical and mental well- being and accessibility and appeal of e-cigarettes and vaping devices. I care for a patient whom we'll call Alex in the intensive care unit with extensive lung damage from vaping, a disease coined E-cigarette or Vaping Product-Associated Lung Injury or EVALI. The pressures of balancing school work with a demanding sports practice schedule and a job to support his mother financially led this young man to be intrigued by a sleek USB look-alike device that his friends swore would help him relax and enjoy life a little more. Fastforward a few years, Alex could not break his nicotine addiction despite falling grades at school and strained relationships with loved ones. He was hospitalized for weeks with severe lung injury and for worsening symptoms of anxiety and depression due to the havoc that vaping had caused in his life. Philadelphia has made great strides in reducing cigarette use among high school students, but we now face a new crisis, alarmingly high rates of electronic vaping device use among middle and high school students. E-cigarettes are now the most widely-used tobacco products among students, and over a quarter of current youth vapor are using on a daily basis. I want to emphasize that vaping is not a safe alternative to smoking. Teens often think they are simply inhaling flavored water, but some vape pods contain as much nicotine as a whole pack of cigarettes and many teens use multiple pods in a day. The adolescent brain is uniquely vulnerable to the addictive and rewarding effects of nicotine. Vape aerosols also contain numerous other chemicals that can be toxic to both the user and bystanders. E-cigarettes were originally marketed to help adults quit smoking, a claim that itself lacks strong supportive evidence but have been particularly appealing to adolescents due to their discreet packaging and candy- flavored options. These products can look like pens, lipsticks, fidget spinners, key fobs and even asthma inhalers. Products boast sweet and fruity flavor profiles such as strawberry donut, tropical rainbow blast and red gummy bear. When these products are resembling household items and they taste like candy, teens find it hard to resist the temptation even if they're aware of the risks linked to vaping. These products lack the necessary regulation to properly safeguard kids and teens. While it's illegal to sell the e-cigarettes to anyone under in 14 Pennsylvania, we know that minors 15 are still accessing vaping products 16 without strict identity 17 verification. And although the 18 long-term health consequences of 19 vaping remain uncertain, the acute 20 risk of nicotine addiction, lung 21 damage and disrupted brain development are enough to raise alarm bells about the popularity of this addictive habit among Philadelphia's youth.

I have seen firsthand in my short time of training the devastating effects that vaping has had on the physical, mental and psychosocial health of young users and those around them as both a concerned constituent and a pediatrician in Philadelphia, I thank the Committee on Public Health and Human Health Services for bringing attention to this critical issue and for prioritizing the health and well-being of our city's children and families. Thank you.

Thank you for that testimony. I have a question about the impact on the lungs you were talking about, your patient. Is that reversible?

I think that there's been -- it's still a disease that we're learning a lot more about. There could be depending on the types of chemicals that a certain user is exposed to, I think that would play into whether it's reversible or permanent lung damage, but it is quite severe either way. This patient that I cared for was in intensive care unit for multiple weeks because of this. And just looking at his chest CT scan was quite -- that image will always stick with me, how abnormal his lungs were and how diffused the injury was throughout his lungs because of these ultra fine particles and these really dangerous chemicals that are found in car exhaust and that are used to preserve corpse bodies and things like that that are found in these vape pens and how those particles are able to get really throughout the entire lungs.

Deeply dangerous. In your opinion since you deal with young people in your practice, knowing this if we were to show what happened to Alex and showing Alex's lungs, you know, your brain on like the frying egg, your brain on drugs, do you think that is a viable path? Maybe one of many, but is that a tactic that would impact young people to see how severe the damage was?

Absolutely. I think that I often kind of think to myself I really wish that lawmakers and students alike could come and spend a day with me in the hospital sometimes and see the effects of some of these things that we see as kind of everyday habits when we're out walking around the streets of Philadelphia and they're not necessarily seeing the impacts that that's having on some of these patients who are spending many days to weeks in the hospital. So I think that using patient stories like this, like Alex's and from youth, and I really appreciate that you had so many youth on the panel today because I was also learned a lot from their personal experience and their reasons for why them and their friends are attracted to using these devices. So I think really using youth stories and youth voices, I do agree with the teens that were here today that I think that that's the best path forward because I think that they're going to listen to people who are near peers and who kind of maybe can understand their reasoning a little bit more. And using those stories can be really impactful.

One last question: When cigarettes, regular tobacco cigarettes were introduced many years ago, they were good for digestion and for women particularly they looked very cool, very sleek. To disrupt that similar kind of this is cool, you know, it's not very harmful because it's got these flavors and looks different, doesn't have a horrible smell, how much of that and then adding Alex's story in terms of impact on a campaign would you think that that could have? Because from this story, just this story, it sounded like Alex needed an outlet. He was a stressed young man doing a lot of things, right. And we have a lot of stressed young people in our city. So in sort of creating this vision that this is how you might start down this path, what alternatives are we giving people to say, if you feel like this, here are some other things you can do because this is what a vape pen will do to you eventually?

Absolutely. I think alongside kind of teaching teens about what vaping can do and the physical damage to their lungs and their mental health, I think giving them something else to go to when they're facing these stresses, whether it's school work or life at home or all of the things that these teens are dealing with in their lives, I think providing those alternatives are very important. My personal kind of background is in working with students at a university level in talking a little bit about strategies to help cope with stress, things like mindfulness and kind of positive ways to be able to cope with stress. And I think that alongside kind of warning them about the dangers we also need to pair that with giving them something else to help them deal with these stressors. And I think educating both the teens about those other options that are safer as well as parents so that they can reinforce that at home when they're starting to see some of these behaviors or see some more levels of stress is the best way to take something away. But even with a toddler if you take something away from them or tell them not to do a certain activity, you have to give them an alternative and you have to give them something else. We celebrate that kids are exploratory and we talk a lot about kids that are learning to put things in their mouth and that are exploring their environments, but I think that extends into teenagers too. We talk about teen experimentation because they're just kids. They want to know more about their environment and learn more from all of us adults that are modeling for them. And so, I think it was really profound how many of the students were talking about how they're seeing adults do this and that's normalizing it for them. And so, we also need adults to normalize healthy coping strategies when they deal with stress in their lives and if they're not going to vaping and if they're going to a walk in the park or mindfulness strategies and things like that, and they're seeing that in the adults that they're looking up to, I think that that can be really powerful.

Well, thank you very much. I think going forward after we have looked at all the testimony and done a little bit more research, hopefully we'll have you and your institution as partners into how we move. But we would like to see how we can make this a youth-led kind of initiative, which would probably be very helpful and we would love to have your expertise in working with young people to see how you can move the needle and what makes them tick from a perspective of a pediatrician as well as of course the other partners we've heard from so far. So thank you very much. You'll be hearing more from us.

Absolutely.

That was the long way of saying we've got more work to do.

Absolutely. I look forward to working with you. Thank you.

Thank you. Mr. Sham, do we have any more? Do we have another panel?

Yes, Madam Chair. Jacob Zychick, Community Advocacy Director, American Heart Association; and Marquita Young, Program Coordinator, Health Promotion Council. (Witnesses approached Witness table.)

Thank you. Please state your name and begin your testimony.

Absolutely. Good afternoon, everyone. My name is Marquita Young and I am the Alumni Network Coordinator at the Advocacy Institute, a program within the Health Promotion Council of Southeastern Pennsylvania. The Advocacy Institute, or AI for short, is a training program that empowers high school age youth in Philadelphia to identify and address public health issues that impact the way they learn, work and live. Since 2015, AI's youth participants have worked to fight the predatory practices of big tobacco and in recent years have pivoted to addressing the dangerous vaping epidemic. I got started in AI eight years ago as a youth participant when I was just 16 years old. I was drawn to AI because it was the first time I learned about the ways in which the commercial tobacco industry strategically target marginalized communities and vulnerable populations including, but not limited to, Black and Brown people, specifically those living in low-income communities, LGBTQIA+ individuals, those with intellectual disabilities and children and teens who have been labeled as replacement smokers. I was mortified to learn about the harms that were being inflicted upon my city, my neighbors and my peers every single day. It was the first time I learned about systematic racism and how intentional strategic and insidious these billion dollar commercial tobacco and vape companies are. Today I am not here as a participant but as a professional that is invested in finding solutions to this public health epidemic that is still plaguing the lives of youth in Philadelphia. The methods that this industry uses to indoctrinate a new generation of people to nicotine addiction have evolved. And as a public health advocate, we must protect this generation of young people. Young people are aware of the stigma associated with cigarettes so those products are not their top choice anymore. Instead they are using electronic cigarettes and vape devices. In recent years we've seen rapid changes to this technology. And as it evolves, it's critical for public health advocates to recognize why these advancements make e-cigarettes more appealing to youth. The sleek high-tech designs and flavor varieties make these devices enticing to young people. They look like USB flash drives, wireless earbud cases or smartphone accessories. I remember seeing one of my friends pull out a Juul while we were on stage at our high school graduation. I was surprised at how small, discreet and easily transportable the device was and even more shocked at how this trend has evolved. In the last two years, my organization has been contacted by a number of middle and elementary schools because there are students as young as 11 years old with a vaping addiction. We are talking about 5th and 6th graders that are addicted to nicotine and who face a potential lifetime of health challenges because this industry has been allowed a tremendous amount of access to them and these critical developmental years. 11-year-olds with nicotine addictions. Let's just sit with that for a moment. I cannot emphasize enough that the commercial tobacco industry needs replacement smokers. Half a million people die each year from tobacco-related illnesses and diseases, and the earlier they can get people addicted the better their profits. That means colorful advertisement, flavors that mimic candy and misleading claims that this is a safer alternative to cigarettes, all to attract young vulnerable consumers that will be customers for the rest of their lives. I would like to see our City leaders treat this youth vaping crisis like the public health crisis that it is and offer Philadelphia's youth population, their protection, care and support needed to push back against the tobacco e-cigarette and vape industry. Our youth deserve better and our city deserves better. Thank you.

Absolutely.

Jacob --

Yes, please proceed.

Jacob Zychick. Dear Councilmember Ahmad and members of the Committee on the Public Health and Human Services, on behalf of the American Heart Association thank you for the opportunity to provide testimony on the prevalence of electronic cigarette use and vaping among youth and the effectiveness of current prevention and control efforts intended to protect our young people from these harmful tobacco products. The American Heart --

Did you state your name?

Yes. Jacob Zychick.

Just because our stenographer needs to have your name. Okay.

My apologies.

No 8 problem.

The American Heart Association is deeply concerned about the prevalence of e-cigarette use by kids in Philadelphia. 38% of youth have tried and 19% are currently using e-cigarettes. Each year the tobacco industry sells over $300 million worth of deadly products in our city. 74% of e-cigarette sales are flavored products. Research has shown that most teens start using tobacco with flavored products. These products are appealing to young people and many mistakenly believe that these are less harmful. A study presented at the American College of Cardiology's annual Scientific Session showed that people who have used e-cigarettes at any point were 19% more likely to develop heart failure than those who have not used vaping products. In addition, another published report showed worrisome changes to heart function for those using e-cigarettes. The American Heart Association would like to reiterate that there is no such thing as a safe tobacco product. Unfortunately, preemption has limited municipalities in Pennsylvania from implementing evidence-based public policy as a strategy to reduce tobacco use in our communities. State preemption has prevented Philadelphia from implementing a prohibition on the sale of flavored-tobacco products, including e-cigarettes. But even with limited authority, Pennsylvania tobacco control advocates have found opportunities and success to address the use of these harmful products. One success has been the decline of tobacco retailer density by 20% in the three years that regulations were strengthened. In October 2020, the City of Philadelphia filed a lawsuit against Juul for being a significant contributor to the city's youth-vaping epidemic. With Philadelphia's limited authority to enact tobacco control policies is imperative that we use every available resource to address the youth e-cigarette vaping epidemic, specifically using evidence-based prevention control and cessation services in our city schools. I wanted to highlight a few notes from some of the comments and testimony also earlier. At the American Heart Association, we continue to oppose the preemption of tobacco policies here in Philadelphia and other municipalities in Pennsylvania. We've been joined by great stakeholder organizations. We are full agreement with schools that have a policy that really promotes education cessation services rather than punishment like suspensions, and we are available to provide education and cessation resources to help the school districts. We also agree completely with the remarks that have been said that we need to look at innovative outside-the-box policy solutions that cannot just wait for the preemption to be uplifted and we are very excited to work with City Council on that. Lastly, we just want to acknowledge that with the settlement dollars that have been received by the City of Philadelphia, we want to ensure that those are being fully funded towards youth vaping and to really enact a citywide approach that touches into schools and retailers. Once again, just wanted to say that when government agencies, elected officials, public health leaders and community stakeholders work together, we can address public health challenges like these harmful tobacco products. Thank you once again. We look forward to working with everyone.

Well, thank you for that. A quick question to you before we go to Marquita is you mentioned being able to do some innovative ways to address this. Do you have any suggestions around what policy implementation we could do outside of just the fee, the fine, increasing the fine and making it a first-time offense fine or something to that end for those who are supplying it? Do you have any policy perspectives in addition to what has been offered already?

Definitely. I think that we could share those with your office. I think one of the best approaches that we can take is look at other cities, like-minded and sizable cities, to see some of the work that they have done. I know the Philadelphia Department of Health had earlier mentioned, I know the School District of Philadelphia mentioned and other great advocates kind of a multi-pronged approach that has media and also addressing retailers and ensuring that schools have all of the available resources. So I would look at that while as we continue to develop, but we can definitely share with your fantastic office some of those opportunities and policy solutions that we have seen be implemented in other communities across the country.

And we will follow up. To you, Marquita, you mentioned this deliberate sort of marketing, right, intentional. We've seen that with tobacco products like traditional tobacco products with cigarillos and nice- colored wrapping. Also, previous to this I used to be a Deputy Mayor in the city a while ago and I did a little study with a group of young people who surveyed their peers, and one of their findings was that people thought mentholated cigarettes were safer, and similarly we're seeing that same sort of impact of these flavored cigarettes. So I just wondered what your thoughts were on really what elements of a campaign would be useful to really peel this art in a way to show that for young people to know that they're being targeted, not just that it's bad. We understand it's bad and do all of that, but the injustice of that is what I think can mobilize people and have some advocacy. If you marry the physical harm and the psychological harm this does along with saying you're like a sitting duck being targeted by people, you have agency to do something and the best thing you can do is say no and not use these products. And almost right now in the country we are going through this boycott for other reasons. These work. So I think it's a very powerful message if we were to organize our young people to say, you're not going to take advantage of me and my health to make a buck. And so, I would love to see your institution and others talk about how to do as we said a multi-factorial way of addressing this, including saying we boycott you because you're coming into the most underresourced spaces and marginalizing people further by impacting their health.

Absolutely. Thank you, Councilmember. There are a few members of my team who are present here today that will be more than happy to follow up with your team regarding that. We have led a few different campaigns in the past such as working to raise the legal smoking age to and 5 touching on what you mentioned 6 earlier about how intentional and 7 strategic this targeting is. 8 One important aspect of 9 a campaign that I think would be 10 important is also just highlighting 11 the amount of tobacco retailers 12 that are in low-income 13 neighborhoods such as, for example, 14 if you go to North Philadelphia, 15 you will see lots of tobacco 16 retailers within a three-block 17 radius, for example, but you might 18 not have that same experience if 19 you travel to an area like Chestnut 20 Hill. 21 So I most certainly think highlighting the very real numbers that are present within our communities that we're seeing and just the way that the ads are targeted to people within these communities as well. It's very aggressive and they tend to be very big. They're very colorful. They're meant to catch your eye. But once again, I don't think that many of the tobacco retailers or smoke shops that are in more affluent areas tend to be as aggressive. So, yeah, I totally agree.

Yes, they have muted colors, sage green, but I digress. So to the point that -- you bring up a point about having multiple smoke shops in a small area. As Councilmember Bass was saying, these are supposed to have licenses. So those licenses are issued. So we actually have an ability to look at how many licenses we are issuing to a certain area, right, to see are we sanctioning this, in other words, right. And we have an angle potentially to explore there to say how do we regulate how many of these things appear in certain spaces, and really have my team look at the heat map of how the concentration looks and then really put it out there to say, look at the targeting. I mean, you and I can talk about knowing that this is targeting, but the rest of Philadelphia has to join in to say, look at this heat map, look at where everything is, overlay that with lack of other resources, overlay that with the youth in that space and overlay that with health outcomes in that space, right. You could really come up with a very powerful look at where we need to target our efforts. But I want to thank you -- did you have a question?

Really just some of the stuff may have already been spoken. We have heard testimony from administrators, health officials, pediatricians on the individual impact of youth nicotine addiction. But you all can speak to the community impact that vaping has on the city's youth. And you mentioned limiting tobacco retailers in certain areas. And we've also heard that there are a number of places by which folks are able to get access, whether it be online or here or there. Where is this happening the most? Where are the purchases of these, the acquiring of these actually happening in terms of vapes being bought? And so, where is it happening the most? Does anyone know?

My team is more than happy to provide that information following the hearing. However, it is a little bit difficult to identify that because, as mentioned earlier, there are a great deal of smoke shops that are operating without permits that are just popping up. They're just pop-up shops so it's a little bit difficult to get that data. But as I mentioned, my team is more than happy to provide you with the information following this hearing.

Okay. That's it.

Well, thank you very much. Really appreciate you and everyone who have testified here today because this is the beginning of paying attention to this, right. We all need -- I know some of the spaces have and the people who testified are already engaged, but we need a legislative approach. We need a public health approach which is already underway, but I think we need to match all of it up to have a citywide alert sent to all of us that this is a problem. We need to stop it before it gets any worse. It's already further than we should have let it go, right. So I thank you all. I thank all of you for testifying today. Please look forward to hearing back from my office and others who will follow up on this to see what pathway is the path of least resistance to actually make an impact. I'm particularly interested in making sure our young people see something, right. It might not be the ultimate pathway, but I want them to know that they came and they did something and we would love your advice on that from everybody here to say what that could look like, including taking their feedback to really start with them first and then work our way up while we do the enforcement of the operational side of -- the supply side, so to speak. I mean, we have to do both. I mean, the supply side is an issue in this context, in our opioid context, in all the context. Supply if we cut that off, that would be optimal. But it's easier said than done. So we have to do all different pathways. So thank you again for your testimony and I look forward to working with all of you. I thank all of you for being here and we actually were very efficient with that time, I am happy to say. And thank you to my colleague for being here. Take care, everybody.

Thank you.

Do we adjourn this, the two of us -- oh, we have public comment. I forgot. Okay. Sorry. We're not done yet. All right. So now we are -- okay. Are there any other questions or comments from members of the Committee for the witness? No, me, not there. Okay. Now that we are done, seeing none is there anyone here in the chamber to testify on this resolution? (No response.)

Hearing none, we will now transition to our public comment session. Mr. Sham, would you please call the first speaker for public comment, if we have any.

We have Kristin Taylor, Harmony Ellis and Sean McCormick. (Witnesses approached Witness table.)

Love it. Please state your name and proceed with your testimony.

Okay. Hello. My name is Kristen Taylor. I'm years old. I live in 12 Philadelphia and currently attend 13 Temple University as a freshman. 14 I'm a part of the Advocacy 15 Institute, a program of Health 16 Promotion Council. I'm a peer 17 coach, youth leader and have worked 18 closely with Ms. Marquita Young who testified earlier on addressing youth vaping in Philadelphia. I am compelled to share my story today because people vape and smoke all the time in my dorm building and it does not just affect the people doing it. It causes alarms to go off at all hours of the morning and night, affecting me and my peers' schedules studies and health. Recently two students who live in my building had their dorm raided because they were vaping in the building. They were expelled. Instead of receiving immediate punishment, I think students who are caught vaping should be offered quick resources -- sorry.

Take your time.

I think they should be, um --

Do you want water?

Oh, no, I'm good. Thank you. I think they should be offered quick resources such as nicotine replacement therapy like gum or patches, support groups or counseling. I also don't think these students started vaping in college. They might not have even started vaping in high school. I remember classmates vaping when I was in 7th grade. If the only solution was punishment, I'm sure they're still addicted to nicotine and the dangerous chemicals and vape cartridges to this day. The thing is a lot of the time youth who vape or smoke are treated as bad kids or as kids who don't care about breaking the rules, but these young people have been preyed on by large corporations. They are your children, your nieces, your nephews, your kids' friends, they're my friends. According to the CDC, the brain is not fully developed until about years old and nicotine can have a negative impact on this development. My peers and I are under the age to buy tobacco and vape products, but they are still not difficult to get. Youth can't be the only ones that are held responsible for this epidemic. The corporations and retailers that make these devices accessible to people under need to be held 12 accountable. 13 Parents and guardians 14 need education about vapes and how 15 widespread they are. And young 16 people need to know that vaping is 17 just as addictive as cigarettes so 18 they feel empowered not to become 19 big tobacco replacement smokers as 20 older generations die off. Thank 21 you. 22

Hi. My name 23 is Harmony. I am a sophomore at 24 Frieri Charter High School and I am a part of the Advocacy Institute, a program of Health Promotion Council. I work as a peer coach along with Kristen and we help teach our peers about the dangers of vaping and how we are targeted by big tobacco and how I advocate for a healthier city. I have found my voice in the Advocacy Institute and I am eager to use it today on behalf of the youth of Philadelphia. At school I have seen kids sneak vapes out of their backpacks in class trying to take a hit when the teacher isn't looking. One of my friends got caught smoking in the bathrooms and was put on a contract and suspended. Not only did he miss important lessons, but the suspension did not help him overcome his nicotine addiction. It's gotten so bad that my school had to install vape detectors in the bathroom. I'm sorry -- the vape detectors in the bathroom. Now, every time someone vapes it alerts one of our deans and an alarm goes off. And anyone in the bathroom at the time gets questioned and is at risk of a suspension. Even if you weren't the one vaping, you're still at risk of getting in trouble. This isn't a disciplinary issue. It's a public health issue. If a student is caught vaping and just gets suspended, how does that help them quit? It doesn't. It sends them home stressed out, with no coping tools or guidance where they're likely to smoke even more. It's a dangerous cycle and we need to start looking at this differently. Don't punish young people for being the victims of vape company's predatory marketing. Schools should utilize their mental health and nursing staff to find out why the youth are so stressed that they feel the need to vape. We need more resources to prevent children from starting and to keep standing up to big tobacco. That's how we create a healthier future not just for our schools, but for our entire city. (Applause.)

That was excellent. Thank you so much. You put it in a nutshell for us, right. And I hope through the Advocacy Institute we can stay in touch with you because you're already peer educators. You already have understood how to talk to your peers who might be using these devices. So we look forward to having a pathway which is not punitive but actually promotes health. And the outcome is that we stop people from using this, and also make it not lucrative for these big companies to come here. If they don't make money here, hopefully they will move along but we have to stay united in saying we are not going to participate in this sort of hurting ourselves. I have a question for either one of you because you work with young people, you work with your peers. What have you found to be the most effective message that you might have given that you can see an impact in changing their behavior with respect to vaping?

The most effective thing I've noticed what we talk about a lot is what's actually in vapes, usually like that sorts of sticks with kids. Sometimes when we share it. I know when I took the course when I was in middle school -- not middle school, high school my freshman year and I would show all the slides and what's actually in the vape products. And then when I found out that there's at least 30 cigarettes in just a couple puffs of a vape, that sort of stuck with me more rather than all the other things I was hearing of just you should quit, it's not good for you. Hearing the actual facts of why it's not good for you, knowing what I want to be in the future and knowing like -- facts stand with me more rather than just hearing over and over why I shouldn't do something. It's like that stuck with me more in learning the facts of what's going on.

Were they posters or things with these facts? If we had a campaign, a bus wrap with this on, if we had information, this evidence way of thinking in your opinion, that would be effective if we had them in dorm rooms, in other spaces that young people frequent? Sounds like young people are smart. They want evidence and not just don't do so in their face, right. You had a response?

Another thing that I want to add to what she was saying, I feel like another thing that sticks with the youth is when you get on their level and actually try to talk to them as a person, instead of sitting there lecturing them I feel like when you interact with the youth and you really involve them in what you're talking about, it makes them feel more comfortable and to actually want to take in the information. Because a lot of the times when you lecture the youth, they get bored of it. It's like something that happens on a daily basis. It's as if there are in class. And a lot of people when they're in class, they're bored. So when you really involve the youth and let them interact with what's going on in these facts and you give them all of this, it really sticks with them because it shows that you actually care about them and it shows them that they don't have to do these things to fit in or to find their proper crowd. They can do other activities and other things that can actually help them involve themselves with people. It's just like -- because that's what I learned going through the Advocacy Institute. I learned that I don't need to vapor smoke to be cool. I learned that I can talk to my peers and educate them on this topic and they'll listen to me probably more than they'll listen to an adult because it's someone on their level telling them, hey, this will actually affect you in the future, this is something that's really important.

Absolutely. Do you have any --

I'll just say that I really appreciate hearing and I'm encouraged hearing from, you're not that young, you're in college and all, but hearing this recognition that criminalizing addiction is not going to cure the problem. The constant references to a need for us to address the corporations that are doing all the work to get folks hooked to this, I think is really important. I think that should be a note. I think when we think about law enforcement, the criminal legal system in general across the city, that just because you can give somebody a penalty yourself on the wrist, that's not going to care the issue. So just thank you for raising that point. I know it's been said all day, but I do appreciate hearing from you. Thank you again for your testimonies today.

And I look forward to staying engaged with all of you. I guess you will inform what we do next because I think you're the closest to the problem of being able to be heard by your peers. So thank you again for your testimony. I really appreciate it. Good luck to whatever you're doing. High school?

Yeah.

And college, right?

Yes.

Good luck. Thank you. Amazing. (Witness approached Witness table.)

Okay. Oh, sorry. I was ready to wrap it up again. Please go ahead and state your name and begin your testimony. DR. McCORMICK: Thank you. Good afternoon. My name is Dr. Sean McCormick. I'm the Associate Director of Public Health Programs at Latino Connection. We're one of the statewide contractors for the Pennsylvania Department of Health, Tobacco Prevention and Control. So from where we sit -- well, before I tell you what we do, I want to commend the Council for having this hearing. This is a severe problem that is greatly impacting the populations that we all care about and serve,and I want to commend all the other folks that gave testimony, especially young people. But, yeah, from our office we do a lot of different types of work. So we support individuals. We have programs that are meant to educate and prevent vaping addiction among students. So we work with students and young people. We also support schools, so principals, counselors, coaches. We work with hospital systems and we work with local elected officials like yourselves all across Pennsylvania. So I'll try not to repeat anything or too much of what was said, but there might be a couple pieces of information that I could add to just add a little extra depth of some angles that maybe haven't been brought up. So in terms of the severity of the addiction itself, one thing that hasn't been mentioned is that there were some advancements in nicotine chemistry. About 10 years ago companies all over the globe that started in China developed nicotine salts and started experimenting with different combinations in nicotine salts and landed on certain combinations that are more addictive, that affect the brain more quickly and at a higher level. Nicotine salt 215 and 11, in these ratios, not only do they impact the brain differently than traditional or commercial nicotine from cigarettes, this is a synthetic nicotine that changes the way the brain works in ways that tobacco- derived nicotine does not. In addition to that, those same forms in nicotine are also less irritating on the throat. So these advancements in nicotine chemistry combined with these flavors and the flashy devices, which are ridiculously cheap, there's video games built into some of them, the colors, the names, it is trendy and cool, but the effects on the brain are not. So people have mentioned the mental health impacts. One thing that was not mentioned so far today was the evidence that nicotine addiction at an early age sets the brain and behavior up for other addictions. So I'm a parent of a 4-year-old, one of the things that I'm going to be speaking to my kid and one of the things that our staff talks with the students that we work with, is this is going to change the way your brain works and it's going to make it harder for you to have a normal life, to feel happy in a normal way and it sets you up to get addicted to other things, sugar, alcohol, cannabis, gambling, video games, social media, porn. Do you really want to set your brain up to have this life where you're never actually happy, that you're always having to have a substance or do some kind of behavior to be happy? I don't think a 3rd or 4th or 5th grader and high schoolers, they don't quite recognize that they're setting their brain up and their well-being to live in this other way that's not natural and it's frankly just very unpleasant. And the young people that share their message, they say I wish I never did this. So the neurodevelopmental and potential for future addiction was something that I wanted to touch on in addition to the lung health impacts and the cardiovascular impacts. Parents are not aware of what many of the things that I just mentioned and how much this these chemical these chemicals, these new forms of nicotine and the 40,000 hits in nicotine in some of these devices, and it's like an $8 device. This should be illegal. Parents don't know enough. How do you get to parents? That's tricky.

At schools and communities, through social media, with tool kits, right. Some of the stuff works, some of it doesn't. You have to just keep trying. And working with other trusted organizations has been a helpful tactic for us. I definitely want to commend the School District and all the schools. They're dealing with not only a disciplinary issue but an academic issue and a student well-being issue. We get emails and calls from schools monthly saying, what do we do here. And sometimes it comes from the principal, sometimes it comes from the superintendent, sometimes it comes from a coach, sometimes it comes from a probation officer, the SAP officer. So I was very pleased to hear that there is this professional development opportunity being rolled out. I would love to see that being rolled out to any profession that engages with the schools at all. I wouldn't have even thought that a probation officer would be the one reaching out to organizations like us to help with the school. And it's tricky with, you know, schools are dealing with so much and the piece next to that is how do you identify and form champions within the schools, right. It could be the coach is the one or a band teacher is the one that wants to take this up, and that's good and you need that. Some folks don't -- they're not worried about that. There's violence and other issues happening at the school where it falls down their radar. And so, you almost have to find and create champions in schools and different organizations wherever you can find them. The vape detectors, they work. But from what we've heard, it's usually just overwhelming where it just becomes like, all right, this thing is going off 100 times a day. And one example I heard recently was a vice-principal set up his desk outside of the worst bathroom and would rotate around and sit outside different bathrooms, but kids are smart. They'll figure out a way to evade that. And I will reiterate the nonpunitive measures are being really important. I see this as an opportunity to help young people understand their brain and bodies, that folks, young people, could be going down a path that they don't really want to be going down and that if we show genuine compassion and care and provide the right opportunities and opportunities to build skills and to practice emotional regulation, that sort of thing, you could help someone really turn their life around. And it was vaping that was the thing that actually helped them. They can avoid that or get through that issue in high school, they could learn a lot about themselves. So as much as it's a threat to their health, it's also a potential opportunity in that sense. And that sort of framework or paradigm comes to bear at the school with the SAP program in the courts. We've worked with the magisterial and the juvenile courts, asked them, are you seeing cases for vaping. And they say, yeah, there's lots of cases where all it is a kid has nicotine addiction and it comes in front of a judge and is clogging up the courts. And then the judges, they don't know what to do. Some of them see it as you're getting fined and others say, no, we're going to -- let's have you do this cessation program, you can avoid the fine. All the judges respond differently. Every school responds differently. Every judge responds differently. Every parent responds differently. This is a mess. It's tricky. Just one or two other things that I don't think I've heard today is the environmental impact. A few people have asked what sorts of messages resonate. I think the industry being a manipulative, noncaring, aggressive industry, that's something that resonates with young people. They don't want to be taken advantage of. They don't respect those industries. And that message will say, you know what, I'm not going to succumb to what you want me to do, I don't want to lose my autonomy. That message resonates.

Another message that resonates is young people saying, I wish I never did this when it comes out of their own mouths. And then one that we're exploring right now, just us, is young people are pretty environmentally conscious, and there are three to four vapes thrown away every second. Millions and millions and billions of vapes are being thrown away. And so for us, it gets really interesting because now we start to connect with recycling and Streets Department and sustainability offices and say, how are you seeing this issue pop up. And suddenly I have a new sector that's involved with this. So we're working to create vape recycling programs. The United Kingdom has vape recycling, requires funding and staffing. You got to pull them apart and the lithium batteries are -- but that message we're doing some focus groups and going to be doing some studies to see do the environmental impact messages impact young people's decision- making. Anecdotally there was a social media influencer that was sharing her vape and nicotine addiction quitting journey. And one of her posts was, you know what y'all, I'm done. And then she went to talk about the environmental justice impacts. And the idea, the unfortunate truth that many of the heavy metals that go into the batteries are sourced with child and unfair labor practices. So for a young person and they think, well, the health is one thing, I might get a heart attack or this lung disease, that doesn't really happen. That message might not resonate, but this is terrible for the environment and human rights violations are happening all over the world and child labor is going into the mining of these batteries and there's no way to recycle them, and it's polluting. That message might resonate. So stay tuned to come sit more on that. Happy to share more about that. Last two bits. It was really cool that someone brought up a mapping issue, like where are these retailers. And so, one of the projects that our team is working on is a retailer mapping where we have access to not the unlicensed retailers, but all licensed retailers as well as the enforcement or sales violation data and we're mapping all that, and we've gone back in time a few years to look at, one, are there more vape and tobacco retailers than there were three, four, five years ago, are there more vape shops? The answer is yes. Where are those vape shops? Are they in poor communities? Yes. Are those the vape shops that are also illegally selling? Yes, yes, yes. Are those the poor communities? Yes. And then we're adding on some other -- I think it might have been you, Councilmember, that was asking, what can we layer on top of that. So, yeah, it's interesting. We're going to be looking at which of these among the newer locations how many of them are also selling things like kratom and CBD and other products that youth are attracted to, like energy drinks and pretzels and water ice and how are they -- these are a scourge on local communities. One more piece, right. The social justice environmental impact is a thing. The social justice angle is another type of message that I think is a nonhealth-related message that might resonate with young people. So if anybody's interested in talking about how we're doing that mapping, the way we've set it up is it's happening in Delaware County first. But the data is all coming from census data or statewide enforcement data. And so, the idea is to create a model that any county can take and map it for their own county. So happy to provide any technical assistance on that front. Last thing I'll say is, yep, appreciate you all mentioning there are some things that you can do here that go around the preemption-related restrictions, the fines, loss of retailer licenses. There was a story about one business having multiple, multiple code violations.

So I think there might be some ground to stand in with these nuisance businesses where if they're violating like this, this, this and this and then they're also violating on tobacco, then those things add up to be the last straw and you lose your license or whatever. The retailer density, locations to high-sensitive areas like schools, retail or low densities or proximity to schools I think is a big one. And then one other thing that hasn't been mentioned, I'm not sure if there are any policy-related solutions on this front, but a lot of these devices are placed very low to the ground and near candy. It goes like Starbursts, Sour Patch Kids, M&M's, and then the vapes are right next to it 3 feet off the ground and there might be some room to impose different fines or restrictions and that sort of thing. So thank you for letting me add a little bit extra detail and appreciate you having this hearing. Thanks.

Thank you so much because this was very valuable. I wanted to ask, your organization is a nonprofit funded by federal dollars? DR. McCORMICK: Latino Connection is actually a for-profit. We are a statewide contractor within the Pennsylvania Department of Health dollars. Our funding comes from both the master settlement agreement and the JLI statewide.

Okay. So not to be impacted by federal dollars being shut down. So it's important what resources will we have at our fingertips. And the second thing is the long- lasting impact of use of such things. We had asked the physician about we don't have enough longitudinal data yet, right. But in terms of your experience of even in the short- term people you have encountered, what is that trajectory look like for someone who just started vaping to five years out? I don't know if you have observed -- have that many years to observe. But I just wanted to kind of get a sense of what is happening to that person? DR. McCORMICK: It varies individual by individual and what their habit looks like. For people that are vaping a lot, they are very likely to experience some changes in lung function. Some of it -- yeah, there's just not enough time. But, yeah, there are people that experience coughing and shortness of breath. Since you brought that up, one of the other studies that we're looking at launching is related to vaping among student athletes and trying to quantify the extent to which student athletes are experiencing physical symptoms. Are you wheezing, are you coughing, how often do you think your vaping impacted your athletic performance. Is that happening, right. That might be a way -- and it is really interesting when the athletes are the ones that are actually vaping at a very, very high level. Since that has come up -- and I'm sorry to kind of keep going on -- we have not mentioned it because we're focusing on vaping, but we haven't mentioned the oral nicotine, the Zyn-type pouches, the nicotine pouches.

Oh, God. DR. McCORMICK: I'm a member of the YMCA. There's a lot of young people there and those urinals are full of nicotine pouches. Athletes are using nicotine as a stimulant. Nicotine is a stimulant. And so, that would explain a lot of why student athletes are vaping. I guarantee there are tons of student athletes also using oral nicotine. Now, thankfully you're not exposing the lungs to nicotine, heavy metals, aldehydes, oils, the different things that are in the vape juices. But nicotine itself is bad for your cardiovascular health and it creates these changes in the brain that could be devastating for someone's wellbeing over the long-term.

You're talking about chewing tobacco? DR. McCORMICK: No, they're little kind of papery pouches that don't disintegrate and there's nicotine inside the pouch. It's sort of like a chew tobacco, except for it's inside a tea bag almost.

Do you have any questions?

(Gestured).

Thank you so very much for that, very important. And we have all your information so we will be following up as we see what a path forward is. Are there any other witnesses to testify, Mr. Sham?

There are no other speakers on the public comment list, Madam Chair.

Say 4 that again -- sorry, yeah. 5 I would like to thank 6 all of our witnesses for joining us 7 today. This concludes the business 8 before the Committee on Public 9 Health and Human Services. Thank 10 you very much for your attendance. 11 (Committee on Public 12 Health and Human Services concluded 13 at 4:56 p.m.) 14 15 16 17 18 19 20 21 22 23 24 C E R T I F I C A T I O N I, hereby certify that the proceedings and evidence noted are contained fully and accurately in the stenographic notes taken by me in the foregoing matter, and that this is a correct transcript of the same. __________________________________ TANEHA CARROLL