October 3, 2019

Dear Board of Health Members:

As you are aware, the Massachusetts Association of Health Boards provides professional development to members of our local boards of health and is the body which is looked to by our member boards to help pass legislation and to provide local public health information to various agencies in Massachusetts.  As such, we are continually monitoring any trends which may have adverse  health consequences for our state’s inhabitants.

As you also know, a major crisis which has, unfortunately, risen to the foreground in recent weeks has been the identification of  “vaping” as a suspected cause of a rash of mysterious lung-related illnesses in the population that utilizes e-cigarette technology to ingest primarily flavored nicotine products.

Of utmost concern to us is the fact that vaping/Juuling/e-cigarette use among youth has risen to the level of being an epidemic.  The latest statistics, from the past week or so, indicate that more than 20% of our state’s high schoolers are now using e-cigarettes/Juul/vaping and Massachusetts is the 8th worst state in the country in terms of high school use of electronic cigarettes!

This has become the new look of nicotine addiction.  While we have seen cigarette smoking among youth take a sharp decline, the use of other tobacco products, including vaping and e-cigarettes has increased dramatically, nullifying the success we had shared as public health professionals until this new addiction was allowed to affect our students.

Governor Baker’s brave action of banning the sales and distribution of all vaping products was only a four-month emergency ban.  It is up to us as the voices of local health in our cities and towns to take independent and decisive action to assure that the end of that moratorium is not marked by a return to “business as usual.”

There are currently two bills pending, and we are following them closely and want to make you aware of both.  On the House side, Rep. Danielle Gregoire, of Marlborough, has proposed H.B. 4089, “An Act Regulating Flavored Tobacco Products.”   On the Senate side, Sen. John Keenan is sponsoring S.B. 2357, with the same name as the House Bill.  Both bills have passed their respective committees and are headed to the floors of the Senate and House for vote at any time, so we cannot stress the time-critical nature of what we are asking of you as your city or town’s voice on public health issues.

We are asking two things of you at this time.  First, we ask that you call your Senator and State Representatives and verbally ask them to sign onto the corresponding bill in their chamber as a co-sponsor.  While emailing is somewhat effective, we have found that telephone calls are far more effective – especially when the call is made by a familiar name, such as a member of a constituent municipality’s Board of Health. During this call, you should also ask that they set the tax rate for vape products at the same amount as that for combustible tobacco products. Second, we are asking that you pass the attached Resolution at your next Board of Health Meeting and sign it and forward it to your legislators as an email attachment that night, since timing is so tight.

If you do not know your legislator’s contact information, you may find it here: https://malegislature.gov/Search/FindMyLegislator.  For your convenience, we are putting a copy of the Draft Resolution on our website: www.mahb.org.  It is on the home page and can be downloaded from there.

In their efforts to hook a new generation of customers, the big tobacco companies now all hold a stake in the vaping industry, and they target young people in Massachusetts by using three primary tactics – making products sweet, cheap, and easy to get.

So that all Boards may be on the same page with the message, the following are several “talking points,” which we hope you will find informative and useful.

E-cigarettes are dangerous – nicotine is bad for you

One Juul pod contains the same amount of nicotine as ONE PACK of cigarettes.

Nicotine is derived from tobacco – it is addictive with harmful chemicals and is a gateway to traditional cigarette use.  Youth use of these products hinders brain development, leads to cardiovascular issues and short-term lung and health impacts.  These products are addicting a new generation to nicotine. And studies are conclusive and consistent that a person who is addicted to any substance at an early age has a lifelong proclivity to addiction to other substances.

Flavoring is designed to lure kids

In 2009, the Food and Drug Administration (FDA) banned the sale of flavored cigarettes because of evidence from the tobacco companies’ own documents that the tobacco industry targeted and marketed flavored cigarettes to kids.  Unfortunately, this ban doesn’t apply to vaping products.  The tobacco and vaping industries now use sweet flavoring to attract young people.  They use thousands of flavors designed to appeal to kids – like chocolate, cotton candy, fruit punch, gummi bear, banana, peach, lime and others. Kids that would never touch combustible traditional cigarettes are becoming addicted to these flavored nicotine products.

E-cigarettes are NOT a quit tool

These products have been marketed as an ‘alternative’ for adults.  The problem is that kids are starting them at a rate that is 6 times that of adults.

  • They are not approved by the FDA as a quit smoking aid.
  • The U.S. Preventive Services Task Force found evidence is insufficient to recommend e-cigarettes for smoking cessation in adults.
  • A recent CDC study found that many adults are using e-cigarettes in an attempt to quit smoking – however, most adult e-cigarette users do not stop smoking cigarettes and are instead continuing to use both products (“dual use”)
  • FDA approved cessation tools like patches are designed to wean you off of nicotine; E-cigarettes are designed to keep you addicted to nicotine

Big Tobacco continues to target our children with its brightly packaged, sweet and candy flavored products, including e-cigarettes, cigars, and cigarettes. We urge lawmakers to support a comprehensive approach to tobacco control aimed at protecting our kids from all tobacco products.

  • Flavors make it easier for kids to start using tobacco products. Flavors hide the bad taste of tobacco and make it easier for kids to try.  Menthol has the additional quality of soothing the irritation of combustible cigarettes, which is why so many young people start smoking using menthol cigarettes.
  • Young people use flavored tobacco products. 80% of Massachusetts high school youth who are current tobacco users reported using a flavored tobacco product in the past 30 days. This includes mint, wintergreen, and menthol flavors, as well as cotton candy, bubblegum, and other fruity flavors that are particularly attractive to kids.
  • Flavors motivate kids to use e-cigarettes. According to a report from the CDC and FDA, almost a third of the middle and high school students who used e-cigarettes in 2016 said the availability of flavors was a main reason they did.
  • Menthol makes it harder to quit. Menthol cigarettes are more addictive and may be more dangerous. Studies from the FDA and other scientific entities conclude that menthol cigarettes are associated with increased nicotine dependence and reduced success in quitting smoking.

In Massachusetts…

  • 1% of high school students use e-cigarettes.
  • 2,100 kids under 18 become new daily smokers each year.
  • If smoking continues at the current rate among youth, 103,000 of today’s kids will die prematurely from smoking.

If you or your Board needs further information, please contact Cheryl Sbarra, our Director of Policy and Law, at sbarra@mahb.org.

Thank you for your participation and promotion of public health.

Very truly yours,


Cheryl Sbarra, J.D. Senior Staff Attorney

Massachusetts Association of Health Boards Executive Board on behalf of

Marcia Testa Simonson, M.P.H., M. Phil., Ph.D.

President, MAHB Executive Board


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