HomeMy WebLinkAbout2019-06-27 Board of Health Minutes North Andover Board of Health
Meeting Minutes
Thursday—June 27, 2019
7:00 p.m.
120 Main Street,2°d Floor Selectmen's Meeting Room
North Andover, MA 01845
Present: Frank MacMillan Jr.,Joseph McCarthy,Michelle Davis,Patrick Scanlon,Brian LaGrasse,Toni K.
Wolfenden,Caroline Ibbitson,Stephen Casey Jr.
I. CALL TO ORDER
The meeting was called to order at 7:01 pm.
II. PLEDGE OF ALLEGIANCE
III. APPROVAL OF MINUTES
Meeting minutes from May 23,2019 were presented for signature.
Motion was made by Joseph McCarthy to approve the minutes,the motion was seconded by Patrick
Scanlon,all were in favor and the minutes were approved.(4-0-0)
IV. OLD BUSINESS
V. NEW BUSINESS
160 Carlton Lane—Septic Variance Request by Thorsen Akerley,R.S.,Williams and Sparages.
The homeowners of 160 Carlton Lane are applying for an upgrade to the existing septic system due to
failure. The original system is from 1986 and will be replaced in the same location. Due to several
property constraints,the system needs a variance. The percolation rate was fair for the size of the field,
which was larger than expected. Mr.Akerley would have had to request a variance or setback reduction to
the property line. This is a required 10' setback,which they did meet,or 20' from the foundation which
could not be met due to the bulkhead. It was just under the requirement at 16.4'. Mr.Akerley is in front of
the Board to request a variance to reduce the leaching trench to the foundation setback from 20'to 16.4ft.
All the homes in the area have municipal town water with no operating wells. The homeowner is looking
to repair the failed septic system as soon as possible. Frank MacMillan asks if there is any other
appropriate place on the property for the system to be placed. Mr.Akerley explains that the slope,
topography,and location of house,utilities and driveway made it the only feasible location. Brian
LaGrasse has no problems with the request. See Appendix A—Town of North Andover Minimum
Requirements for The Design,Construction and Maintenance of Onsite Wastewater Treatment and
Disposal Systems.Revised February 25,2010
A.
MOTION made by Michelle Davis-In Accordance with 310 CMR 15.405(1)(b).A Reduction in
the Required 20' Setback from a Foundation Wall to a Leaching Facility to 16.9' be Approved.
Motion seconded by Joseph McCarthy.All were in favor and the motion was approved. (4-0-0)
2019 North Andover Board of Health Meeting Page 1 of 4
Board of Health Members:Dr.Francis P.MacMillan,Jr.,MD,Chairman/Town Physician;Joseph McCarthy,Member/Clerk;
Michelle Davis,RN,Member;Daphnee Alva-LaFleur,Member;Patrick Scanlon,DO,Member Health Department Staff:
Brian LaGrasse,Health Director;Stephen Casey Jr.,Health Inspector;Caroline Ibbitson,Public Health Nurse;Toni K.
Wolfenden,Health Department Assistant
VI. COMMUNICATIONS,ANNOUNCEMENTS,AND DISCUSSION
A. Caroline Ibbitson,Public Health Nurse,discusses with the Board camp requirements and deadlines.
The Commonwealth of Massachusetts have updated and amended the regulations last April. The state
requires applications and additional paperwork to be in by May 1st however,camps require everything
to be in June 1st,causing compliance issues. Caroline would like to update the town's camp deadlines
to better coincide with state regulations starting in 2020. Caroline will move forward with the Board's
permission to begin drafting the updates. She will bring the changes back to the Board upon
completion. See Appendix B-North Andover Board of Health Recreational Camp for Children
Regulations.and Appendix C—Department of Public Health 105 CMR 430.000:Minimum Standards
for Recreational Camps for Children State Sanitary Code,Chapter IV)
B. Tobacco Regulations Discussion
1. Dr.Lester Hartman,has come to discuss strengthening the towns tobacco regulations in attempt to
stop childhood addiction to nicotine and nicotine products. Dr.Hartman is the senior pediatrician
at Westwood-Mansfield Pediatrics and has been practicing medicine for 33 years. He attended
Harvard School of Public Health where he received his MPH in Health and Social Behavior. Dr.
Hartman has been in the forefront of tobacco flavor control.According to data from the Truth
Initiative,75%of children are exposed to vapes from convenient stores. Students who frequent
convenient stores twice a week are twice as likely to buy tobacco products as opposed to a student
that goes every two weeks. According to the CDC,Massachusetts is the 9tn worst state for teen
vaping. Teen and elementary school youth including fourth and fifth graders are now vaping at a
rate six times greater than adults in Massachusetts. YRBS studies showed 42%of Massachusetts
children have tried vaping,which Dr.Hartman feels is a gross underestimate. In 2009,the FDA
banned flavored cigarettes however mint and menthol were exempt. Pods for mint and menthol
are readily available. Menthol smokers delay quitting 20%longer non-mentholated users. Bill
1902 is now looking to try to ban flavors from the state. Flavors and the"head rush"feelings of
vapes are more addictive for students. Banning flavors will help adults quit and students less
likely to start. Vapes double the risk of heart attack. Vapes have multiple toxins. The nicotine
health risks include ADHD,learning disabilities and physical disabilities. See Appendix D—Dr.
Hartman's presentation,Truth Initiative Where are kids getting JUUL?,Menthol:Facts, Stats and
Regulations,Keith Wailoo,PHD—The FDA's Proposed Ban on Menthol Cigarettes,and The
New York Times—Tobacco and E-Cigarette Lobbyists Circle as F.D.A Chief Exits
2. Ronald Beauregard,Health Communities Tobacco Control Programs,has come to the meeting to
discuss updating The Sale and Use of North Andover Tobacco Products Regulations. Ron serves
17 communities including North Andover as our Tobacco Control Agent. Patrick Scanlon
comments as a practicing pulmonologist,he has zero patients that have ever quit with the
assistance of vapes. Most that have switched over is due to taste with the belief that it is a great
alternative. The American College of Chest Physicians have not,at this time taken a stand on
vapes and vape products because of lack of data. The American College of Chest Physicians did
come out and say,that vapes affect mucus clearance in kids. This affects mucociliary clearance
within the large and small airways. Because the products are different from traditional cigarettes,
health issues will be different. Brian LaGrasse explains that the regulations being presented are in
draft form,this reference tool will be used to narrow down the changes. A public hearing will be
called with retailers notified to discuss the tobacco regulation changes.The regulation changes
have been reviewed by the Massachusetts Association of Health Boards and are based on a model
regulation. Ron and the Board review each of the possible changes highlighted in the regulations.
See Appendix E—Town of North Andover Board of Health Draft Regulating the Sale and Use of
Tobacco Product. Ron explains that products with CBD or hemp vapes regardless of nicotine
content falls under the tobacco regulation if the product is vaporized or aerosolized. Frank asks if
a cannabinoid type product can challenge the regulation. A THC product would fall under
cannabis control because it is a marijuana product. Hemp and CBD are not marijuana products;
the Massachusetts Department of Agriculture regulates them. The Mass Department of
Agriculture has indicated that food products with CBD or other products that indicate they are for
therapeutic use are not permitted for sale.
C. Brian LaGrasse has been researching through the Commonwealth,colleagues and food specialists
about CBD oils in food. Around the state,restaurants and bars have been using it in cocktails and
entrees. At this time,CBD is not allowed to be an additive in food in Massachusetts. The Cannabis
Control Commission does not regulate CBD;the Department of Agriculture and FDA—Food and
North Andover Board of Health
Meeting Minutes
Thursday—June 27, 2019
7:00 p.m.
120 Main Street, 2nd Floor Selectmen's Meeting Room
North Andover, MA 01845
Drug Administration,regulate it. CBD is an unapproved food additive at this time;it comes from an
FDA controlled substance so therefore it cannot be used as an uncontrolled substance. Although,it can
be sold as a supplement. See Appendix F.—Massachusetts Department of Public Health CBD
(Cannabidiol)in Food Manufactured or Sold in Massachusetts.
D. Baba's Pizza has chosen to label the baked goods sold at the restaurant. The variance request is
withdrawn.
E. See Appendix G-June 27,2019 BOH Meeting Notes provided by Brian LaGrasse
VII. CORRESPONDENCE/NEWSLETTERS
Vlll. ADJOURNMENT
MOTION made by Joseph McCarthy and Michelle Davis to adjourn the meeting.Patrick Scanlon
seconded the motion and all were in favor.The meeting adjourned at 9:00 pm.(4-0-0)
Prepared bv:
Toni K. Wolfenden, Health Dept.Assistant
Reviewed bv:
All Board of Health Members&Brian LaGrasse, Health Director
Signed bX:
\ 0,�,d ,sl qA2 Z,1,0?
os ph cCarthy, Clerk of theXoard Date Signed
2019 North Andover Board of Health Meeting Page 3 of 4
Board of Health Members:Dr.Francis P.MacMillan,Jr.,MD,Chairman/Town Physician;Joseph McCarthy,Member/Clerk;
Michelle Davis,RN,Member;Daphnee Alva-LaFleur,Member;Patrick Scanlon,DO,Member Health Department Staff:
Brian LaGrasse,Health Director;Stephen Casey Jr.,Health Inspector;Caroline Ibbitson,Public Health Nurse;Toni K.
Wolfenden,Health Department Assistant
Documents Used At Meeting:
Agenda—June 27,2019
Town of North Andover Board of Health Minimum Requirements for the Design,Construction and
Maintenance of Onsite Wastewater Treatment and Disposal Systems revised February 25,2010
North Andover Board of Health Recreational Camp for Children Regulations
Truth Initiative—Where are kids Getting JUUL?
Truth Initiative-Menthol: Facts,Stats and Regulations
The FDA's Proposed Ban on Menthol Cigarettes by Keith Wailoo,PHD
The New York Times"Tobacco and E-Cigarette Lobbyists Circle as F.D.A.Chief Exits"by Sheila Kaplan
and Matt Richtel March 15,2019
Town of North Andover Board of Health Draft—Regulating the Sale and Use of Tobacco Products
Massachusetts Department of Public Health CBD(Cannabidiol)in Food Manufactured or Sold in
Massachusetts
June 27,2019 BOH Meeting Notes
North Andover Board of Health
Meeting Agenda
Thursday,June 27, 2019
7:00 p.m.
120 Main Street,2°d Floor Selectmen's Meeting Room
North Andover,MA 01845
I. CALL TO ORDER
II. PLEDGE OF ALLEGIANCE
III. APPROVAL OF MINUTES
IV. PUBLIC HEARINGS
V. OLD BUSINESS
VI. NEW BUSINESS
A. 160 Carlton Lane-Septic Variance
VII. COMMUNICATIONS,ANNOUNCEMENTS,AND DISCUSSION
A. Camp Discussion
B. Tobacco Regulation Discussion
VIII. CORRESPONDENCE/NEWSLETTERS
IX. ADJOURNMENT
2019 North Andover Board of Health Meeting-Meeting Agenda Page 1 of 1
Note: The Board of Health reserves the right to take items out of order and to discuss and/or vote on items that are not listed on
the agenda.
Board of Health Members: Dr.Frank MacMillan,Jr.,Chairman/Town Physician;Joseph McCarthy,Member/Clerk;Michelle
Davis,RN,Member;Daphnee Alva-LaFleur,Member;Patrick Scanlon,D.O.,Member Health Department Staff:Brian L.aGrasse,
Health Director;Stephen Casey Jr.,Health Inspector; Caroline Ibbitson,Public Health Nurse;Toni K.Wolfenden,Health
Department Assistant
TOWN OF NORTH ANDOVER BOARD OF HEALTH
MINIMUM REQUIREMENTS FOR
THE DESIGN, CONSTRUCTION AND MAINTENANCE OF
ONSITE WASTEWATER
TREATMENT AND DISPOSAL SYSTEMS
REVISED February 25,2010
w
TABLE OF CONTENTS
I. INTRODUCTION AND.LEGAL STATEMENTS................................................................3
1. AUTHORITY AND PURPOSE ............................................................................................ 3
2. SEVERABILITY........................................................................................3
II. PROCEDURES AND STANDARDS FOR PROPERTY OWNERS AND ONSITE
WASTEWATER PROFESSIONALS............................................................................................ 4
1. INSPECTIONS OF EXISTING ONSITE WASTEWATER SYSTEMS ("TITLE 5
INSPECTIONS")...........................................................
2. SOIL TESTING PROCEDURES..........:................................................................................... 4
3. DESIGN REQUIREMENTS..................................................................................................... 4
4. ONSITE WASTEWATER SYSTEM CONSTRUCTION........................................................ 7
5. POST CONSTRUCTION.........................................................................................................: 8
6. MAINTENANCE REQUIREMENTS ...................................................................................... 9
7. PERMITS.................................................................................................................................. 9
7.1 FORMS AND FEES..........................................................................................................:. 9
7.2 DISPOSAL SYSTEM INSTALLER'S PERMIT.............................................................. 10
7.3 SEPTAGE HAULER PERMIT......................................................................................... 10
7.4 TITLE 5 SYSTEM INSPECTORS.................................................................................... 11
7.5 LICENSE OR PERMIT REVOCATION.......................................................................... 11
8. VARIANCES...................................................................... 11
Page 2
I. INTRODUCTION AND LEGAL STATEMENTS
1. AUTHORITY AND PURPOSE
The Board of Health of the Town of North Andover,Massachusetts,acting under the authority of
the General Laws of the State of Massachusetts, Chapter 111, section 31, has made and adopted
the following regulations in the interest of, and for the preservation of,the public health, in
addition to all Laws of the Commonwealth of Massachusetts and Town of North Andover
relating to Public Health.
It is the intention of these regulations to supplement Title 5 of the State Environmental Code,
310 CMR 15.000. These regulations are intended to amend or repeal.certain Board of Health
regulations adopted prior to revisions of Title 5;to re-organize existing regulations; and to create
new regulations.
The North Andover Board of Health adopted these regulations because the unique conditions in
North Andover require a more stringent standard than found in Title 5 (310 CMR 15.000).
These regulations were adopted after public hearings demonstrated that 310 CMR 15.000 et. seq.
was not sufficient to protect the public health in the Town of North Andover. These regulations
were adopted by majority vote at a public hearing on February 25, 2010 and become effective
immediately upon adoption.
2. SEVERABILITY
If any paragraph, sentence, clause,phrase or word of this regulation is declared invalid for any
reason whatsoever,that decision shall not affect any other portion of this regulation,which shall
remain in full force and effect. To this end the provisions of this regulation'are declared
severable.
ADOPTED
Sept. 27, 1984
REVISED
March 21, 1991; June 1997; February 25, 2010
- Page 3 --
II. PROCEDURES AND STANDARDS FOR PROPERTY OWNERS AND
ONSITE WASTEWATER PROFESSIONALS
1. INSPECTIONS OF EXISTING ONSITE WASTEWATER SYSTEMS ("TITLE 5
INSPECTIONS")
1.1 When identified in the course of a Title 5 inspection, cesspools and privies are deemed
failed systems and shall be replaced with a new onsite wastewater system.
1.2 Any Title 5 inspection that identifies a tank or distribution box at an elevation of greater
than 36 inches below grade, without an access riser, shall have a riser and cover installed within
9 inches to grade by a North Andover licensed onsite wastewater system installer.
2. SOIL TESTING PROCEDURES
2.1 After review of a completed soil test application, the Health Department will contact the
applicant to set up a soil testing date.
2.2 The Health Department reserves the right to adjust estimated seasonal high
groundwater elevation, as it deems necessary.
2.3 Soil evaluation and percolation test results shall be submitted by the soil evaluator on
current forms as created by the Massachusetts Department of Environmental Protection(DEP).
2.4 If soil testing is conducted on a vacant lot, all deep observation test pits and percolation
tests shall be located on a scaled site plan. Tie distances from two permanent monuments or
structures to each test pit and percolation test shall be provided. If no permanent monuments or
structures are within 200 feet of the testing area then the test pits and percolations tests shall be
survey located in reference to the property lines.
3. DESIGN REQUIREMENTS
3.1 Three(3) sets of plans shall bear a wet stamp and original signature of the onsite
wastewater system designer; or, one (1) set of plans bearing a wet stamp and original signature
of the onsite wastewater system designer and an electronic file of the plans,may be submitted to
the Health Department for review. If a professional engineer stamps a.design plan the
engineering discipline must be provided.
3.2 Design plans and specifications must include the following:
a. Names of abutters from recent tax map
b. Lot area and dimensions
c. A scaled profile of the onsite wastewater system no less than 1"=2' vertical and 1"=20'
horizontal
d. A notation that all piping shall be a minimum of schedule 40 PVC
Page 4 -
` o
e. A cross section of the leaching facility
f. Existing and proposed contours at a minimum spacing of two foot contour intervals
g. Name and address of the record owner and applicant if different from the owner
h. Name and address of the designer
i. A statement identifying whether the property either is, or is not,within the designated
Watershed of Lake Cochichewick.
j. Show all streams, open and subsurface drains, interceptor drains,wetlands, wells,etc.
within 150 feet of the onsite wastewater system,whether on the lot or on adjoining lots.
(In the Lake Cochichewick Watershed this distance shall be 400 feet.)
k. For onsite wastewater systems intended to serve a new building or structure,location and
elevation of any foundation drain serving or intended to serve the proposed building. All
foundations shall be assumed to have a foundation drain unless otherwise stated on the
design plan.
1. A depiction of the distances from all tanks, and primary and reserve soil absorption
system areas to the following:
1. subsurface, interceptor and foundation drains
2. catch basins
3. property lines
4. dwellings or other structures
5. private water supply or irrigation wells
6. watercourses or wetlands
m. A note or chart listing all Title 5 variances, Title 5 local upgrade approvals, and/or North
Andover Board of Health regulation variances being sought in conjunction with the
onsite wastewater design plan
n. The designer shall specify all components of the proposed system such as pump brand
and model,filter brand and model,treatment system or leach field brand and model. If
the specific components are not used in the installation then the designer shall approve
any changes in writing and submit to the Health Department for review.
o. Notation that concrete tanks with a capacity of 2,500 gallons or less are required to have
joints or seams above the liquid level(known as"monolithic tanks")
p. Notation that all concrete distribution boxes must be H-20 load bearing
q. Design plans shall indicate the location of the existing onsite wastewater system to be
abandoned
r. Design plans shall note when an operation and maintenance contract is required in
accordance with Title 5
s. Design plans shall be based on field survey and are to bear the following signed
statement:
I certify the locations, elevations and ties shown on this plan result from an actual survey made
on the ground.
Signature of Designer Date
3.3 The current Massachusetts.Department of Environmental Protection(DEP)-issued
Approval Letter shall be provided with the design plan when a proprietary system or device is
proposed.
Page 5
3.4 Design plans for a tight tank shall require approval of the Board of Health at a public
hearing.
3.5 All drilled or dug wells shall meet all setbacks and be considered potable water supply
wells.
3.6 Wetlands resource area setbacks as described in these regulations and in Title 5 are to be
measured from the resource as may be jurisdictional under federal, state or North Andover
requirements.
3.7 No well shall be constructed or placed within the distance specified in Table 1
from the component of an existing onsite wastewater system.
3.8 If a variance to the North Andover Board of Health regulations, Title 5 Local Upgrade
Approval and/or Title 5 variance can be met with the incorporation of a Massachusetts
Department of Environmental Protection(DEP)-approved device which reduces wastewater to
levels below 30 mg/L BOD and 30 mg/L TSS,then the design plan can be approved by the
Health Department and does not require a hearing before the Board of Health unless otherwise
required.
3.9 Per the current fee schedule,the fee for the onsite wastewater system plan review shall be
paid upon initial submission and will cover the first revision if applicable. Each subsequent
revision will require a separate fee.
TABLE 1 - SETBACK DISTANCE TABLE
Resource Build Septic Tanks,Pump Tanks, Soil
ing Treatment Units,Tight Absorption
Sewer Tanks,Grease Traps (feet) System(feet)
Deck on footings 5 10
Tributaries to Surface -
Water Supply 325 325
Watercourses or Wetland -
Resource Areas 75 100
Wetlands Bordering -
Surface 150 150
Water Supply or Tributary
(in.watershed district)
Private Well 50 - -
(setbacks are supplemental to M4DEP 310CMR 15)
Page 6 — -
4. ONSITE WASTEWATER SYSTEM CONSTRUCTION
4.1 A Disposal System Construction Permit shall not be issued until all necessary
documentation has been submitted to the Health Department, including any required
maintenance agreements, easements, deed restrictions or approval from the Department of
Environmental Protection(DEP).
4.2 Installation of onsite wastewater systems,shall take place between March 1st and
December 1 st;weather permitting,with all systems completed by December 1 st of each year. All
applications for onsite wastewater system installations in any given year shall be made prior to
November 15th of that year.
4.3 For new construction, a foundation as-built plan(in equal scale to the approved onsite
waste water design plan) and floor plans of the structure must be submitted prior to issuance of a
Disposal System Construction Permit. This is required to review the location and elevation of
the foundation and to confirm its placement and leaching capacity with the approved onsite
wastewater system design plan.
4.4 A pre-construction meeting is required to occur with the Health Director for each onsite
wastewater system construction project to review design plans, conditions of approval, and
unique conditions specific to the site.
4.5 Concrete tanks with a capacity of 2,500 gallons or less are required to have joints or
seams above the liquid level (known as "monolithic tanks"). All 2-piece concrete tanks shall be
vacuum tested once placed in the ground at the site by the manufacturer or an independent third-
party testing company. Certification that the tank is watertight shall be supplied by the
manufacturer or an independent third-party testing company to the Health Department once
testing has been completed. Tanks constructed of fiberglass,plastic or which are made from
concrete but include a treatment device are excluded from-the vacuum testing requirement.
4.6 All concrete distribution boxes must be H-20 load bearing
4.7 The leaching facility location will be required to be staked out by the designer if there are
no permanent structures within 50 feet of the proposed area or as otherwise required.
4.8 Deviations less than the following may be made with the designer and Health
Department verbally notified.
a. Horizontal—building sewer 3'; watertight tanks 3';soil absorption
b. system 1'
c. Vertical—building sewer 1';watertight tanks 0.5% soil absorption
d. system 0.1'
e. Deviations greater than the above must first obtain written or verbal authorization from
the designer and Health Department. Verbal approval may be granted for these deviations
or a revised plan may be required.
Page 7
4.9 Retaining walls specified on the design plan are to be inspected by the designer during
construction. A letter or statement on the as-built is to be provided indicating if the wall was, or
was not, constructed in accordance with the intended design and any manufacturer's
specifications.
4.10 Each onsite wastewater system.being constructed will require at least(4)inspections:
1. Bottom of tank inspection to ensure a proper base
2. Bottom of leaching area inspection to ensure proper removal of unsuitable soil
3. Final inspection of installed onsite wastewater system to determine proper c
omponents, locations,.elevations and operation
4. Final grading inspection including observation of loam and seed
Additional inspections may be required if unique site conditions or system complexity requires
additional attention.
4.11 The Health Department may require the sand fill used during installation of a system to
be tested to ensure the sand meets the specification of 310 CIVM 15.255. If a sieve analysis of
the sand is required the installer is responsible for all costs associated with the testing. The
Health Department will take the sand sample and arrange for the sand to be tested at a designated
laboratory. The installer is required to pay for the cost of the sieve analysis prior to the issuance
of the Certificate of Compliance.
4.12 All required inspections must be requested by the installer and will be conducted within a
reasonable time per the availability of the Health Department staff.
4.13 Prior to scheduling the final inspection,the designer shall conduct an inspection to ensure
the system has been installed in accordance with local and state regulations and the approved
design plan. If the designer determines that the installed onsite wastewater system is in
compliance then the designer shall notify the Health Department that the inspection has been
completed. After an acceptable examination by the designer,the licensed installer shall schedule
the final inspection.
5. POST CONSTRUCTION
5.1 The onsite wastewater system designer shall submit an as-built plan bearing a wet stamp
and original signature of the onsite wastewater system designer along with either a stamped and
signed Certificate of Compliance form, or sign the original Certificate of Compliance form on
file at the Health Department. These activities are to occur within(30) days of completion of the
final inspection by the Health Department. If more than two (2) as-built plans or certificates of
compliance are outstanding,no further design plans will be accepted for review until all
outstanding as-built plans and/or Certificates of Compliance have been submitted.
5.2 The onsite wastewater system installer shall complete final grading or other construction
and sign the required Certificate of Compliance within 30 days of-completion of the final
inspection by the Health Department. If more than two (2) Certificates of Compliance are
Page 8
t
outstanding, a thirty day notice will be sent indicating no further Disposal Systems Construction
Permits will be issued until all outstanding Certificates of Compliance have been submitted.
5.3 As-built plans shall be prepared in accordance with Title 5,provide ties from a permanent
structure to all system components, depict system components located at or within six(6)inches
of finished grade and shall bear the following statement.
I certify the locations, elevations,ties, cover material, exposed component covers etc. shown on
this as-built substantially agree with the approved plan and have determined that the break out
elevations, if applicable,have been met.
Signature of Designer Date
5.4 Loam and seed must be installed prior to the issuance of the Certificate of Compliance or
a letter from the owner must be submitted explaining the reason the loam and seed cannot be
installed.
6. MAINTENANCE REQUIREMENTS
6.1 Systems incorporating pressure distribution of the effluent shall be maintained for the life
of the onsite wastewater system. A valid operation and maintenance contract with a minimum
length of two years must be on file at the Health Department and must be renewed at least sixty
(60) days prior to expiration. Maintenance shall be performed by a Massachusetts-licensed Class
2 Wastewater Treatment Plant Operator or a licensed Disposal Systems Installer.
6.2 Systems incorporating an alternative treatment device shall be maintained for the life of
the onsite wastewater system.A valid operation and maintenance contract with a minimum
length of two years must be on file at the Health Department and must be renewed at least sixty
(60) days prior to expiration. Maintenance shall be performed by a Massachusetts-licensed Class
2 Wastewater Treatment Plant Operator.
6.3 Tight tank systems shall be maintained for the life of the onsite wastewater system. A
valid operation and maintenance contract with a minimum length of two years must be on file at
the Health Department and must be renewed at least sixty(60) days prior to expiration.
Maintenance shall be performed by a North Andover licensed septage hauler.
6.4 All maintenance reports shall be submitted to the Health Department within(30) days of
the site visit to perform the work.
7. PERMITS
7.1 FORMS AND FEES
7.1.1 All applications for licenses or permits shall be on the most current form as created by the
Health Department.
Page 9
7.1.2 All fees shall be as indicated on the most recent fee schedule as created by the Health
Department.
7.1.3 All licenses shall expire on December 31st of each year. A nonrefundable fee for annual
permit shall be paid to the Town of North Andover pursuant to the current fee schedule.
7.2 DISPOSAL SYSTEM INSTALLER'S PERMIT
7.2.1 The initial application for certification shall include copies of licenses from other
Massachusetts communities or two (2)years experience working for a licensed onsite wastewater
system installer,three(3) letters of reference, copies of heavy equipment operator's license and
proof of possession of at least$100,000 of general liability insurance.
7.2.2 Initial certification to install or repair any individual onsite wastewater system or
component of said system will require a 75% score on a written and field examination,prepared
by the North Andover Board of Health. The examination will test the applicant's knowledge of
sections of Title 5 and these regulations which pertain to onsite wastewater system construction.
The examination will be scheduled within thirty(30) days after receipt of a completed
application.
7.2.3 If an individual receives below 75%on the written portion of the exam,but above 75%
on the field portion,the Director will approve the issuance of a single onsite wastewater system
installation permit. Extra oversight will accompany this installation. If satisfactory practices are
observed by the Health Department,the Director may approve the certification of that individual
at his or her discretion.
7.2.4 A Disposal Systems Installer's Permit shall rest with an individual, not with a company.
7.2.5 The licensed installer shall be on-site at minimum for all scheduled construction
inspections and specific construction points as detailed in the guidance document entitled
"Installer Obligation Form" and shall maintain the construction permit.and a copy of the
approved plan on site at all times.
7.3 SEPTAGE HAULER PERMIT
7.3.1 Permits to transport septage are to be maintained per vehicle which operates within North
Andover. A copy of vehicle registration and proof of possession of at least$100,000 of general
liability insurance shall be required for issuance of an annual license for each vehicle.
7.3.2 Septage pumping records shall be submitted monthly to the Health Department.
7.3.3 Vehicles shall have company name and gallons printed on vehicle. Vehicle and
equipment must be in good condition,free from leaks, safe and secure. Inspections of new or
additional trucks shall take place prior to initial permit issuance of each vehicle and episodic
inspections will be conducted on renewals per Health Department discretion.
Page
in
7.3.4 Transfer of septage from one truck or tanker to another for transport except in cases of
emergency shall be prohibited.
7.3.5 Pumping records shall be submitted on the most current form as provided by the
Massachusetts Department of Environmental Protection(DEP) ("System Pumping Record
form")
7.4 TITLE 5 SYSTEM INSPECTORS
7.4.1 Title 5 system inspectors certified by Massachusetts Department of Environmental
Protection(DEP) shall be licensed to work in the Town of North Andover. Inspections
performed by inspectors not licensed by the Health Department will be prohibited.
7.4.2 Application for licensing shall include a copy of Massachusetts Department of
Environmental Protection(DEP)'s Title 5 System Inspector certification.
7.5 LICENSE OR PERMIT REVOCATION
7.5.1 Enforcement of theses regulations shall be in accordance with 310 CMR 15.000 and any
other applicable law. The Board of Health may issue such notices and orders as the Board of
Health, in its discretion, determines to be appropriate to enforce these regulations.
7.5.2 The Board of Health may suspend or revoke any license which has been issued under this
regulation.
7.5.3 The Board of Health may also enforce these regulations under the noncriminal
procedures set forth in M.G.L. c. 40s. 21D.
8. VARIANCES
8.1 Variances to these local regulations shall be granted for seriously aggrieved parties by the
Board of Health when,in its opinion:
The person requesting a variance has established that enforcement of the provision of these
regulations from which a variance is sought would be manifestly unjust, considering all the
relevant facts and circumstances of the individual case; and
The person requesting a variance has established that a level of public health and environmental
protection, that is at least equivalent to that provided under these regulations, can be achieved
without strict application of the provision of the regulation from which a variance is sought.
With regard to variances for new construction, enforcement of the provision from which a
variance is sought must be shown to deprive the applicant of substantially all beneficial use of
Page
99
the subject property in order to be manifestly unjust.
8.2 Every request for a variance shall be made in writing on a variance request form and shall
state the specific variance(s) sought and the reasons therefore. The request for variance must
indicate the current property owner as well as the applicant, if different.
8.3 No variance request shall be heard except after the applicant has notified all abutters by
certified mail at his own expense at least(10) days prior to the Board of Health meeting at which
the variance request will be on the agenda. The notification shall state the specific variance(s)
sought and the reasons therefore, shall indicate the.date,place and time of the hearing, and shall
indicate that the abutter may view the proposal at the Health Department during regular business
hours.
8.4 No hearing will be scheduled unless the design plan or other information submitted has
been reviewed and found to be technically complete and accurate.
8.5 Cancellation of a public hearing shall require re-notification of abutters as described in
Section 8.3
An advertised public hearing was held by the North Andover Board of Health on April 16,2009.
These regulations were adopted at a subsequent meeting on February 25, 2010 and are effective
as of February 25,2010.
February 25,2010
Thomas A. Trowbridge,M.D.,D.D.S., Chairman Date of Signature
N A dover B a o ealth
February 25,2010
F ncis P. acM' .,Member Date of Signature
North Andover Board of Health
February 25,2010
Larry Figer,RfPh.,Mem er Date of Signature
North Andover Board of Health
—:p February 25,2010
saz���—
nne Brennan,Member Date of Signature
North Andover Board of Health
February 25,2010
Joseph McCarthy,Member Date of Signature
North Andover Board of Health
Page
19
13
North Andover Board of Health
Recreational Camp for Children Regulations
Authority
Massachusetts General Laws (M.G.L.), Chapter 1 11 , Section 31
and 105 CMR 430.000 Minimum Sanitation and Safety Standards
For Recreational Camps for Children (State Sanitary Code:
Chapter IV).
Purpose And Scope
Acting in accordance with the above-cited authorities, the
North Andover Board of Health hereby adopts the following
Recreational Camp for Children Regulations as reasonable
requirements for the protection and promotion of the health and
safety of all users of such facilities. All provisions of 105 CMR
430.000 are hereby adopted as local Board of Health regulations
and are incorporated into these regulations by such adoption.
The purpose of these regulations is to supplement those areas
insufficiently or unclearly addressed in 105 CMR 430.000 Minimum
Sanitation and Safety Standards For Recreational Camps for
Children.
Section I Identification of Individuals on Premises/Intruder
A. It is the responsibility of all staff to identify any individual
(adult or child) not associated with the camp that is on the
premises, verify the purpose of the visit and report to the
Camp Director.
B. The camp must have a written policy and procedure
regarding any real or perceived threat by an intruder or
unregistered guest.
C. Training of staff and volunteers must be incorporated in the
staff orientation process.
Page 1 of 1
D. Campers are to be instructed on the procedure to follow if
they encounter an unknown person on the camp property.
This instruction should be done on the first day of each
camping session.
Section II Timing of Paperwork Submission
A. All new camps and renewing camps shall submit a
complete application, including their Administration
Handbook, Parent Information, Staff Orientation materials,
and completed license application by May 1 st of each
year for review by the North Andover Health Department.
B. Immunization records, as required in Section III, shall be
complete and ready for review by the North Andover
Health Department no less than one (1 ) week prior to the
first day of camp.
C. Health records and physicals as required under 105 CMR
430.150 and 430.151 of the current Minimum Sanitation and
Safety Standards for Recreational Camps for Children
(State Sanitary Code: Chapter IV), shall also be complete
and ready for review no less than one (1 ) week prior to the
first day of camp.
Section III Required Immunizations
A. For campers and staff under 18 years of age, the required
immunizations shall be in compliance with the current
Massachusetts Immunization Requirements for School Entry.
Each immunization date should include month, day and
year of the immunization.
B. For campers and staff 18 years of age and older the
requirements shall be in compliance with 105 CMR
430.152(B) of the current Minimum Sanitation and Safety
Page 2 of 2
Standards for Recreational Camps for Children (State
Sanitary Code: Chapter IV).
Section IV Additional Fees
A. If a re-inspection is required for any reason, an additional fee
will be incurred at that time per the current fee schedule.
Section V Severability
A. So far as the Board of Health may provide each section of
these Rules and Regulations shall be construed as separate
to the end that if any section, sentence, clause or phrase
shall be held invalid for any reason, the remainder of the
Rules and Regulations shall continue in full force.
Effective Date: March 1, 2005
Jonathan Markey .2/2-4/oS
Jonathan Markey, Chairman Date of Signature
North Andover Board of Health
Cheryi Barczak 2/24/oS
Cheryl Barczak, Clerk Date of Signature
North Andover Board of Health
Thomas Trowbridge 2/24/oS
Thomas Trowbridge, D.D.S., M.D., Member Date of Signature
North Andover Board of Health
Page 3 of 3
105 CMR: DEPARTMENT OF PUBLIC HEALTH e-2
105 CMR 430.000: MINIMUM STANDARDS FOR RECREATIONAL CAMPS FOR CHILDREN
(STATE SANITARY CODE,CHAPTER M
Section
430.001: Purpose
430.010: Scope
430.020: Definitions
430.0.50: License Required
430.090: Background Information
430.091: Staff Orientation and Training
430.093: Prevention of Abuse and Neglect
430.100: Camp Counselor and Junior Counselor Requirements
430.101: Required Ratio of Counselors to Campers
430.102: Camp Director Requirements
430.103: Supervision of Specialized High Risk Activities
430.140: Medical Waste
430.145: Maintenance of Records
430.150: Health Records
430.151: Physical Examinations by Physician and Certificate of Immunization
430.152: Required Immunizations
430.153: Physical Examination or Immunization Exemptions
430.154: Injury Reports
430.155: Medical Log
430.156: Availability of Health Records and Logs
430.157: Communicable Disease Reporting and Parental Education Requirements
430.159: Health Care Staff to Be Provided
430.160: Storage and Administration of Medication
430.161: Emergency/Medical Facilities and Equipment
430.162: Personal Hygiene and Laundry
430.163: Protection from the Sun
430.165: Tobacco Use
430.166: Alcohol and Recreational Marijuana Use
430.190: General Program Requirements
430.191: Requirements for Discipline
430.201: Riflery Program Requirements
430.202: Archery Program Requirements
430.203: Personal Weapons Restricted
430.204: Waterfront and Boating Program Requirements
430.205: Crafts Equipment
430.206: Playground,Athletic Equipment and Facilities Requirements
430.207: Storage and Operation of Power Equipment
430.208: Horseback Riding Program Requirements
430.209: Telephones Required
430.210: Plans Required to Deal with Natural Disasters or Other Emergency(Residential and
Day Camps)
430.211: Special Contingency Plans for Day Camps
430.212: Field Trips
430.213: Emergency Communication System Required
430.214: Storage of Hazardous Materials
430.215: Fire Prevention
430.216: Smoke and Carbon Monoxide Detectors Required
430.217: Requirements for Tents
430.250: Vehicles Requirements
430.251: Transportation Safety
430.252: Qualifications of Driver
430.253: Automobile Insurance
430.300: Potable Water Required
430.301: Installation and Maintenance of Plumbing
430.302: Cross Connections Prohibited
430.304: Common Drinking Cup Prohibited
(MA REG.# 1363,Dated 4-20-18)
105 CMR: DEPARTMENT OF PUBLIC HEALTH
Section: continued
430.320: Food Service-Compliance with105 CMR 590.000: Minimum Sanitation Standards for
Food Establishments(State Sanitary Code, Chapter J9,Required
430.321: Special Provisions for Primitive,Travel and Trip Camps
430.330: Nutritious Meals to Be Served
430.331: Minimum Daily Food Requirements for Residential,Travel,or Trip Camps
430.332: Minimum Daily Food Requirements for Day Camps
430.333: Therapeutic Diets
430.334: Feeding
430.335: Meals Provided from Home
430.350: Facilities for Solid Waste Storage
430.355: Final Disposal of Solid Wastes
430.360: Sewage Disposal
430.370: Toilet Facilities Required
430.371: Urinals May Be Substituted
430.372: Location and Maintenance of Toilet Facilities
430.373: Handwashing Facilities
430.374: Bathing Facilities
430.375: Ventilation Required
430.376: Hot Water Temperatures
430.377: Maintenance of Sanitary Facilities
430.378: Toilet Facilities for Campers with Special Needs
430.379: Handwash Basins for Campers with Special Needs
430.380: Shower Facilities for Campers with Special Needs
430.400: Rodent and Insect Control-Residential and Day Camps
430.401: Weed Control-Residential and Day Camps
430.430: Swimming Pools-Compliance with 105 CMR 435.000: Minimum Standards for Swimming
Pools(State Sanitary Code, Chapter i), Required
430.432: Bathing Beaches-Compliance with 105 CMR 445.000: Minimum Standards for Bathing
Beaches(State Sanitary Code, Chapter Vll),Required
430.450: Site Location
430.451: Certificate of Inspection Required
430.452: Screening Required
430.453: Lighting Required
430.454: Structural and Interior Maintenance
430.456: Egresses
430.457: Shelters for Day Camps
430.458: Shelters for Residential Camps
430.459: Non-ambulatory Campers
430.470: Separate Beds to Be Furnished
430.471: Sleeping Prohibited in Food Areas
430.472: All Bedding and Towels to Be Cleaned
430.631: Application for a License
430.632: Board of Health Shall Grant,Suspend or Revoke License;Annual Notification
430.633: Posting of License
430.650: Inspections Required
430.651: Inspection Report Forms
430.700: Orders to Correct Violations
430.701: Violation Which May Endanger or Materially Impair the Health,Safety or Well-being of the
Public
430.702: Contents of Order
430.703: Service of Orders
430.730: Request for Hearing
430.731: Hearing to Be Held
430.732: Decision of Board of Health
430.733: Public Record
430.734: Appeal of the Board of Health Decision
430.735: Compliance
430.750: Operation without License
430.751: Failure to Comply with Order of the Board of Health
105 CMR: DEPARTMENT OF PUBLIC HEALTH
Section: continued
430.752: Failure to Comply with Provisions of 105 CMR 430.000
430.800: Board of Health May Grant Variance
430.830: Severability
430.001: Purpose
The purpose of 105 CMR 430.000 is to provide minimum standards for housing,health,
safety and sanitary conditions for minors attending recreational camps for children in the
Commonwealth.
430.010: Scope
(A) No person,corporation,trust,authority,government agency,political subdivision or any
other entity shall operate a recreational camp for children in the Commonwealth which does not
comply with the requirements of 105 CMR 430.000.
(B) Any building which is required to conform to the minimum sanitation and safety standards
contained in 105 CMR 430.000 shall not be required to comply with 105 CMR 410.000:
Minimum Standards ofFitnessfor Human Habitation(State Sanitary Code,Chapterll)during
the period of its use as a part of a recreational camp for children.
430.020: Definitions
Age means the age of a person on the day a camp session begins.
Aquatics Director means a trained water safety professional with current certifications as a
lifeguard who has responsibility for supervising aquatic activities. The aquatics director shall
be at least 21 years of age and have experience in a management or supervisory position at a
similar aquatics area of at least six weeks duration.
Bathing Beach means the land where access to the bathing water is provided pursuant to
105 CMR 445.000: Minimum Standards for Bathing Beaches (State Sanitary Code,
Chapter VII). For the purposes of 105 CMR 430.000, Bathing Beaches shall not include
swimming pools,wading pools and other artificial bodies of water.
Board of Health means a municipal board of health,a municipal health department,a regional
health district,or any other legally constituted city,town,or county governmental unit within the
Commonwealth serving as a public health agency,as established under M.G.L c.41, § 1,or
M.G.L. c. 111, §§ 26, 26A, 27A, or 27B, or its authorized agent or representative under
M.G.L.c. 111,§30. Board of Health shall also mean an inspectional services department in a
city or town where the inspectional services department is responsible for the enforcement of
105 CMR 430.000.In any case in which a camp extends into the geographic jurisdiction of two
or more boards,those boards may coordinate activities in effecting compliance with 105 CMR
430.000.
Camp Director means an individual who has primary and direct responsibility for the day to day
operation and supervision of a recreational camp for children including oversight of program
operations, supportive services, business affairs, health matters, food, staff supervision and
transportation.
Camper means a child who attends a recreational camp for children,including Counselors-in-
Training.
Certificate of Immunization shall mean either:
(1) any form or letter signed and dated by a physician or designee,or
(2) a dated report from the Massachusetts Immunization Information System;
provided that either document specifies the month and year of administration and the type/name
of the vaccines(s) administered to the camper or staff person, or alternative evidence of
immunity.
105 CMR: DEPARTMENT OF PUBLIC HEALTH
430.020: continued
Child and Children means individuals who are younger than 18 years old.
Counselor means an individual who supervises campers and who may have exclusive
responsibility for campers.
Counselor-in-training means a camper who is training to become a counselor.
CPR Certificate means a current certification in cardiopulmonary resuscitation(CPR)including
the American Red Cross CPR Certificate for the Professional Rescuer, American Heart
Association CPR Certificate for Health Care Provider,National Safety Council CPR Training
or any equivalent CPR training recognized by the Department.
Day Camp means a program which:
(1) operates on a site for more than two hours but less than 24 hours a day;
(2) operates for at least four days during a 14 consecutive day period in a city or town;
and
(3) meets the definition of a recreational camp for children.
Department means the Massachusetts Department of Public Health.
First Aid Training means at least current certification in American Red Cross Standard First Aid,
American Heart Association,or its equivalent with a current CPR Certificate.
Garbage means the animal, vegetable or other organic waste resulting from the handling,
preparing,cooking,consumption or cultivation of food, and containers and cans which have
contained food unless such containers and cans have been cleaned or prepared for recycling.
Habitation means a portion inside a building,tent,or other structure which is used for living,
sleeping,cooking,or consumption of food.
Health Care Supervisor means a person on the staff of a recreational camp for children who is
18 years of age or older and who is responsible for the day to day operation of the health program
or component. The Health Care Supervisor shall be a Massachusetts licensed physician,
physician assistant,certified nurse practitioner,registered nurse,licensed practical nurse,or other
person specially trained in first aid.
Junior Counselor means an individual who assists counselors in the performance of their duties,
but who does not have exclusive responsibility for supervising campers.
Lifeguard means a trained water safety professional who is at least 16 years old and holds the
following current certifications:
(1) An American Red Cross Lifeguard Training Certificate,Royal Bronze Medallion,Boy
Scouts of America Lifeguard Certificate, National YMCA Lifeguard Certificate, or an
equivalent certification,as determined by the Department;
(2) A CPR Certificate;and
(3) An American Red Cross Standard First Aid Certificate,Red Cross Community First Aid
and Safety Certificate, or National Safety Council First Aid Training, Level 2, or an
equivalent certification recognized by the Department.
Medical Specialty Camp means a camp with a primary purpose to provide programs for campers
with special medical or health needs.
Mild Disability means a condition in which a person can function on his or her own in providing
total self-care but needs assistance in other camp activities.
erator means any person who:
(1) alone or jointly with others owns a recreational camp for children;or
(2) has care,charge or control of a recreational camp for children as agent or lessee of the
owner or as an independent contractor;or
(3) is the camp director.
105 CMR: DEPARTMENT OF PUBLIC HEALTH
430.020: continued
Person or Entity means an individual or his or her estate upon his or her death,or a corporation,
a government agency,a partnership,a trust,an association,or an organized group of persons,
whether incorporated or not, or any receiver,trustee,or other liquidating agent of any of the
foregoing while acting in such capacity.
Primitive or Outpost Camp means a portion of the permanent camp premises or other site at
which the basic needs for camp operation such as places of abode,water supply systems and
permanent toilet and cooking facilities may not be provided.
Qualified Dietitian means a person who is eligible for registration by the American Dietetic
Association or has at least a baccalaureate degree in food and nutrition,dietetics,or food service
management.
Recreational Camp for Children means:
(1) Any day,primitive or outpost,residential,sports,travel or trip camp conducted wholly
or in part for recreation or recreational instruction which:
(a) operates for profit or philanthropic or charitable purposes,whether or not a fee is
charged;
(b) serves five or more children who are not members of the family or personal guests
of the operator;and
(c) operates for any period of time between June I'and September 30`h of any year or
fewer than 15 business days during any other time of the year.
(2) Provided it is not promoted or advertised as a camp,none of the following shall be
deemed to be a recreational camp for children:
(a) a child care program licensed by the Department of Early Education and Care in
accordance with M.G.L.c. 15D;
(b) single purpose classes,workshops,clinics or programs sponsored by municipal
recreation departments,or neighborhood playgrounds designed to serve primary play
interests and needs of children,as well as affording limited recreation opportunities for
all people of a residential neighborhood,whether supervised or unsupervised,located on
municipal on non-municipal property,whether registration is required or participation
is on a drop-in basis as provided in M.G.L.c. 111,§ 127A;
(c) a program operated solely on a drop-in basis;
(d) a classroom-based instructional program provided no specialized high risk activities
(see 105 CMR 430.103)are conducted as part of the program;
(e) a summer school program accredited by a recognized educational accreditation
agency,where the accreditation includes standards for specialized high risk activities,
if the program involves such activities(see 105 CMR 430.103),and the summer program
meets those accreditation standards.
Residential Camp means a program which:
(1) meets the definition of a recreational camp for children;
(2) operates on a permanent site for three or more consecutive overnights;and
(3) operates for at least four days during a 14 consecutive calendar day period in a city or
town.
Rubbish means waste materials including, but not limited to, such material as paper, rags,
cartons,boxes,wood,rubber,leather,tin cans,metals,machine or machine parts,mineral matter,
glass,plastic bags and containers,crockery,dust and the residue from the burning of wood,coal,
coke,and other combustible materials.Rubbish does not include garbage,yard waste,recyclable
material,or bulk items.
Severe Disability means a condition in which a person needs assistance in self-care and camp
activities.
105 CMR: DEPARTMENT OF PUBLIC HEALTH
430.020: continued
Specialized High Risk Activities means those activities posing an inherent risk of serious injury
or death due to the nature of the activity regardless of reasonable precautions and supervision.
Such activities present an increased risk to health and safety beyond the routine risk of exercising
and being active in various weather conditions. Specialized high risk activities shall include,but
not limited to,horseback riding,hiking,scuba diving,rock climbing,firearms,archery,challenge
courses, climbing walls, and aquatic activities (e.g., swimming, watercraft activities, scuba
diving).
Sports means athletic activities including,but not limited to,football,soccer,dance,baseball,
gymnastics,swimming,horseback riding,tennis,skating and basketball.
Sports Camp means a program which:
(1) meets the definition of a recreational camp for children;
(2) has a primary focus on one or more sports activities;
(3) operates on a site for more than two hours but less than 24 hours a day;and
(4) operates for at least four days during a 14 consecutive calendar day period in a city or
town.
Staff means any person employed by a recreational camp for children,not including a volunteer,
who:
(1) is or may be present at any time at the camp when campers are present and is in the
service of the camp under any contract of hire,express or implied,oral or written,where the
camp operator has the power or right to control and direct the person in the material details
of how his or her work is to be performed;and
(2) is paid directly by the camp operator.This does not include any person at the camp
performing contracted services(e.g.,delivery person,maintenance staff,bus driver,or third
party vendors)while under the supervision of the camp operator or his or her designee.
Stairway means any group of stairs having three or more risers.
Swimming and Diving Areas means aquatic facilities and operations generally known as
swimming pools,wading pools,diving tanks,beaches,rivers,lakes,other natural bodies or water
and similar areas and facilities.
Swimming Pool means every artificial pool of water licensed as a swimming pool by the Board
ofHealth in accordance with 105 CMR 435.000:Minimum StandardsforSwimmingPools(State
Sanitary Code, Chapter i/).
Tent means any structure of which 25%or more of the roof or walls or both are constructed of
canvas,or covered or protected by any fabric material.
Travel Camp means a program which provides care for not less than a 72-hour period,uses
motorized transportation to move campers as a group from one site to another and meets the
definition of a recreational camp for children.
Trip Camp means a program which provides care for not less than a 72-hour period,moves
campers under their own power or by a transportation mode permitting individual guidance of
a vessel,vehicle or animal from one site to another and meets the definition of a recreational
camp for children. Trip Camp includes,for example,a program which leads campers by bicycle,
canoe or horseback from one site to another.
Volunteer means any person who perform services in an unpaid capacity at a recreational camp
for children.
430.050: License Required
No recreational camp for children shall operate without a license from the Board of Health.
Any person or program that promotes or advertises itself as a camp,even if it does not meet the
criteria of a Recreational Camp as defined within 105 CMR 430.020,must be licensed as a
recreational camp for children prior to operating.
105 CMR: DEPARTMENT OF PUBLIC HEALTH
430.090: Background Information
(A) The operator shall develop and follow written procedures for the review of the background
of each staff person and volunteer.
(B) Each staff person and volunteer shall have a background free of conduct that bears
adversely upon his or her ability to provide for the safety and well-being of the campers. The
operator shall determine whether each staff person's and volunteer's conduct, criminal or
otherwise,shall disqualify that person from employment or service at the camp. In making this
determination,the operator shall consider at a minimum information required under 105 CMR
430.090(C)and(D).
(C) At a minimum the operator shall require for each camping season the following with regard
to each staff person:
(1) Prior work history,including name,address and phone number of a contact person at
each place of employment for the previous five years,and
(2) Three positive reference checks from individuals not related to the staff person
including,but not limited to,previous employers or school administrators. Returning staff
persons may use prior references on record with the camp provided if there is a gap in
employment with the camp for one or more camp seasons,new references shall be required.
(3) Inquiry by the operator into each staff person's prior criminal history. Such inquiry shall
include,at a minimum,a criminal history inquiry as indicated:
(a) The operator shall obtain a sex offender registry information check from the
Massachusetts Sex Offenders Registry Board for all prospective staff. International staff
entering the country pursuant to a visa and who have not previously been in the United
States are exempt.
(b), In accordance with M.G.L.c. 6, § 172G,operators shall obtain a CORI/Juvenile
Report from the Department of Criminal Justice Information Services for all prospective
staff.
(c) For prospective staff whose permanent residence is not Massachusetts(out of state
and international),the operator,where practicable,shall also obtain from the applicant's
state criminal information system, local chief of police,or other local authority with
access to relevant information, a criminal record check or its nationally recognized
equivalent(e.g.,biometric data).
(d) If there is no interruption in the staff person's employment by the camp or
organization operating the camp from the time of the initial background check,a new
criminal or sex offender history is required at a minimum every three years. This applies
only to permanent employees of the same camp or organization operating the camp. Any
break in employment service requires a new criminal history and sex offender inquiry for
the staff person.
(D) At a minimum,the operator shall require for each camping season the following with regard
to each volunteer:
(1) Prior work or volunteer history,including name,address and phone number of a contact
person at each place of employment or volunteer service for the previous five years.
(2) A sex offender registry information check from the Massachusetts Sex Offenders
Registry Board.
(3) In accordance with M.G.L.c.6,§172G,operators shall obtain a CORI/Juvenile Report
from the Department of Criminal Justice Information Services.
(E) The operator shall maintain written documentation verifying the background and character
of each staff person and volunteer for three years,or as required by M.G.L.c. 149, § 52C,if
applicable.
(F) No person shall be employed or allowed to volunteer at a recreational camp for children
until such time as the operator is in receipt of,reviews and makes a determination with regard
to all background information required pursuant to 105 CMR 430.090(C)and(D).
105 CMR: DEPARTMENT OF PUBLIC HEALTH
430.091: Staff Orientation and Training
The operator shall provide orientation and training for all counselors,junior counselors,and
other applicable camp staff and volunteers.The operator shall describe,in writing,the camp's
plan for orientation including at a minimum the camp's organization,policies and procedures.
Training shall include any necessary training specific to overseeing certain camp activities or any
specialized training to meet the needs of campers with unique physical or behavioral needs,as
applicable. As part of the orientation, all counselors,junior counselors, and other staff and
volunteers shall complete one online head injury safety training program,such as the Centers for
Disease Control and Prevention's"Heads-Up"training,or an equivalent training approved by
the Department. The operator shall not assign any person to be responsible for a group of
children nor utilize any staff or volunteer to supervise others until such person has received the
minimum orientation described in 105 CMR 430.091. Documentation of specific training
components and attendance records for such trainings shall be maintained according to 105 CMR
430.145.
430.093: Prevention of Abuse and Neglect
(A) The operator shall have written policies and procedures in place to protect campers from
both abuse and neglect(as defined in 110 CMR 2.00: Glossary)while in the camp's care and
custody.
(B) The operator shall develop and follow written procedures for reporting of any suspected
incidents of child abuse or neglect in accordance with procedures described in M.G.L.c. 119,
§51A. The procedures shall include:
(1) All staff shall immediately report any suspected child abuse or neglect. The report shall
be made either to the Massachusetts Department of Children and Families or its successor,
or to the camp director.
(2) The camp director shall immediately report suspected abuse or neglect to the
Massachusetts Department of Children and Families,or its successor.
(3) The camp director shall notify in writing the Department and the Board of Health if a
report is filed pursuant to M.G.L.c.119,§51 A alleging abuse or neglect of a child while in
the care of the recreational camp for children or during a program-related activity. The report
filed pursuant to M.G.L.c. 119,§ 5 1 A itself shall not be forwarded to the Department or
Board of Health.
(C) The operator shall cooperate in all official investigations of abuse or neglect,including
identifying parents of campers currently or previously enrolled in the camp who may have been
in contact with the subject of the investigation.
(D) The operator shall ensure an allegedly abusive or neglectful staff person shall not have any
unsupervised contact with campers until the Massachusetts Department of Children and Families
investigation is completed.
430.100: Camp Counselor and Junior Counselor Requirements
(A) Each counselor in a recreational camp for children shall:
(1) have at least four weeks experience as a junior counselor,have participated in structured
group camping,or have at least four weeks experience in a supervisory role with children;
and
(2) have satisfactorily completed a camp counselor orientation and training program as
specified in 105 CMR 430.091 prior to the arrival of campers.
(B) Each junior counselor in a recreational camp for children shall have satisfactorily completed
a junior counselor orientation program prior to the arrival of campers.
(C) The age of counselors shall be as follows:
(1) in residential,primitive,sports,travel,trip and medical specialty camps:
(a) counselors shall be 18 years of age or older or have graduated from high school;
(b)junior counselors shall be 16 years of age or older;
105 CMR: DEPARTMENT OF PUBLIC HEALTH
430.100: continued
(2)In a day camp
(a) counselors shall be 16 years of age or older;
(b)junior counselors shall be 15 years of age or older.
(3) All counselors and junior counselors shall beat least three years older than the campers
whom they supervise.
430.101: Required Ratio of Counselors to Campers
Each recreational camp for children shall have the following minimum ratio of counselors
to campers:
(A) Residential and Day Camps. Residential,day,and sports camps shall have at least one
counselor for every ten campers seven years of age or older and one counselor for every five
campers younger than seven years old. To meet these required ratios,counselors shall be within
the line of sight or close proximity to campers at all times. Junior counselors may be included
in meeting up to 50%of the camper to staff ratio within each unit, living or general activity
group,but shall always be under the direct supervision of a counselor. Each residential or day
camp serving campers with mild or severe disabilities shall have a staffing plan in place to
ensure adequate staffing to supervise children with disabilities.
(B) Primitive,Travel and Trip Camps. Each primitive,travel and trip camp shall have at least
one counselor for every ten campers,with a minimum of two counselors,one of which shall be
at least 21 years old. Each primitive,travel or trip camp serving campers with mild or severe
disabilities shall have a staffing plan in place to ensure adequate staffing to supervise children
with disabilities.
430.102: Camp Director Requirements
Each recreational camp for children shall have at the camp at all times a director who meets
the following:
(A) Residential Camp. Each residential camp shall have a director who is 25 years of age or
older and who meets at least one of the following:
(1) Successful completion of a course in camping administration such as those offered by
national professional camping associations,national agencies or their equivalent,or
(2) At least two seasons of previous experience working as part of an administrative staff
of a recreational camp for children.
(B) Day Camp. Each day camp shall have a director who is 21 years of age or older and who
meets at least one of the following:
(1) Successful completion of a course in camping administration such as those offered by
national professional camping associations,national agencies,or their equivalent,or
(2) At least two seasons of previous experience working as part of the administrative staff
of a recreational camp for children.
(C) Primitive, Travel and Trip Camps. Each primitive, travel and trip camp shall have a
director who shall:
(1) Be 25 years of age or older;and
(2) Possess demonstrated proof of experience supervising a recreational camp for children
in similar camping activities.
(D) The operator shall inform all staff on duty as to who is responsible for administration of the
camp at any given time. In the event of the absence of the director,the director or operator shall
appoint a designee who shall be at the camp at all times. The designee shall meet the
qualifications as required by 105 CMR 430.102(A),(B)or(C).
105 CMR: DEPARTMENT OF PUBLIC HEALTH
430.103: Supervision of Specialized High Risk Activities
Each recreational camp for children which conducts specialized high risk activities,either
on or off-site, including, but not limited to, horseback riding, hiking, scuba diving, rock
climbing,firearms,archery,challenge courses,climbing walls,watercraft and aquatic activities,
shall conduct such activities only under the supervision of a counselor who has evidence of
appropriate training,certification and experience in each activity under his or her supervision.
Said counselor shall be present during periods of specialized high risk activity. The operator
shall make adequate provisions to assure any special training necessary for camp personnel to
protect the safety and health of campers with disabilities.
(A) Swimming and Other Aquatics Activities. Swimming and other aquatics activities shall be
supervised by one counselor for every ten campers in the water or near the water. For every 25
campers,or portion thereof,there shall also be at least one lifeguard. If 50 or more campers are
in the water or near the water,the aquatics director must be present to directly supervise the
activities and may be one of the on-duty lifeguards to meet the requirement above. If swimming
activities occur at a location separate from the camp,the camp shall provide supervision by
lifeguards as required in 105 CMR 430.103 but is not required to provide an aquatics director.
Supervision of swimming,if not provided by camp staff,may be allowed through a contractual
agreement between the camp and the owner or operator of the swimming venue to supply
dedicated lifeguards at the required ratio of one lifeguard for each 25 campers in or near the
water.
(B)Watercraft.
(1) All watercraft activities shall be supervised by a minimum of one counselor for every
ten campers in watercraft. Each counselor shall hold a lifeguard certification or American
Red Cross certification in Small Craft Safety and Basic Water Rescue,or an equivalent
certification recognized by the Department that demonstrates water rescue procedures
specific to the type of water and activities conducted.
(2) All watercraft activities carried out on white water,or hazardous salt or fresh water,
regardless of the number of campers, shall have a minimum of two counselors, each in
separate watercraft, supervising the activity. hi addition to the certification and training
required by 105 CMR 430.103(B)(1),each counselor shall have evidence ofprevious training
and experience with this type of water activity totaling at least six hours on the water.
(3) Campers shall possess at least an American Red Cross Level 4 or higher Program
Certificate,or an equivalent recognized by the Department,in swimming proficiency before
being allowed to participate in white water,hazardous salt water or hazardous fresh water
boating activities. All white water activities must be carved out on water determined to be
no more difficult than Class III as defined by the International Scale of River Difficulty. No
trips shall be taken on unclassified white water.
(4) All staff and participants engaging in watercraft activities shall wear U.S.Coast Guard
approved personal floatation devices appropriate to the activity.
(C) Scuba Diving. Scuba diving activities shall be supervised by individuals who are currently
certified by a national or regional scuba training program such as the YMCA, National
Association of Scuba Diving Schools,Professional Association of Diving Instructors,National
association of Underwater Instructors, Scuba Schools International, or equivalent program
recognized by the Department.
(D) Firearms. All firearm activities shall be directly supervised by an individual who possesses
a current National Rifle Association Instructor's certification and maintains compliance with
M.G.L.c.140,§129B-Firearm identification cards;M.G.L.c.140,§129C(m)-Exemption for
instruction,or M.G.L.c. 140,§ 131 -Licenses to carry firearms,as applicable. A ratio of one
counselor for every ten campers on the range shall be maintained at all times. This ratio may
include the instructor.
(E) Archery. A ratio of one counselor per ten campers shall be maintained on the archery range
at all times.
(F) Horseback Riding. All riding instructors used by a recreational camp for children whether
staff of the camp or of another facility used by the camp,shall be licensed in accordance with
M.G.L.c. 128,§2A.
105 CMR: DEPARTMENT OF PUBLIC HEALTH
430.103: continued
(G) Challenge Course or Climbing Wall. All challenge courses or climbing walls shall:
(1) Be licensed and maintained pursuant to 520 CMR 5.00: Amusement Devices;
(2)Comply with the following requirements of American Camp Association Accreditation
Process Guide Standard PD 24.1:
(a) at least an annual inspection by qualified personnel to ensure the integrity of the
hardware,material and equipment for each element of the challenge course,climbing
wall or other apparatus,and
(b) a written report of such inspection(s)including recommendations concerning the
safety of the challenge course or climbing wall and appropriate remedial actions needed
to correct any deficiencies noted in the report;and
(3) Maintain a ratio of one counselor for every ten campers at all times.
430.140: Medical Waste
Any medical waste, as defined in 105 CMR 480.000: Minimum Requirements for the
Management of Medical or Biological Waste (State Sanitary Code, Chapter VIII), shall be
maintained and disposed of in accordance with the requirements of 105 CMR 480.000.
430.145: Maintenance of Records
Camp operators shall maintain all records relating to campers, staff and volunteers for a
minimum of three years.
430.150: Health Records
Each recreational camp for children shall maintain a health record for each camper and for
each staff person who is younger than 18 years old. The health record shall be readily available
at all times in electronic or hard copy form that is secure from unauthorized access and shall
include at least the following:
(A) The camper's or staff member's name and home address;
(B) The name,address and telephone number of the camper's or staff member's parent(s)or
guardian(s);
(C) A written authorization for emergency medical care signed by a parent or guardian;
(D) The travel location(s)and telephone number(s)of the camper's or staff member's parent(s)
or guardian(s)if the parent(s)or guardian(s)will be traveling during the camping season;
(E) The name,address and telephone numbers of the camper's or staff member's family health
care provider or health maintenance organization,if any:
(F) If the camper or staff member brings a prescribed medication from home, a written
authorization to administer the medication signed by a parent or guardian;
(G) Copies of injury reports,if any,required by 105 CMR 430.154;
(H) A certificate of immunization indicating compliance with 105 CMR 430.152;and
(I) In addition,in each residential,sports,travel and trip camp: the health history and report of
physical examination required by 105 CMR 430.151.
430.151: Physical Examinations by Physician and Certificate of Immunization
(A) Every camper and full time staff person shall prior to attending or after receiving a
conditional offer of employment from a residential,travel,sports,or trip camp,furnish to the
camp the following,prepared and signed by a licensed health care provider:
105 CMR: DEPARTMENT OF PUBLIC HEALTH
430.151: continued
(1) A current medical history which lists allergies,required medications,and any health
conditions or impairments which may affect the individual's activities while attending the
camp;
(2) A report of a physical examination conducted during the preceding 18 months;and
(3) A certificate of immunization.
(B) Every camper and full time staff person shall prior to attending or after receiving a
conditional offer of employment from a day camp,furnish to the camp:
(1) A current medical history which lists allergies,required medications,and any health
conditions or impairments which may affect the individual's activities while attending the
camp. The medical history shall be signed by a parent or guardian,or by a licensed health
care provider,however, in the case of a staff member 18 years of age or older, the staff
member's signature shall be sufficient;and
(2) A certificate of immunization.
(C) No person known to be suffering from tuberculosis in a communicable form,or having
evidence of symptoms thereof, shall be allowed to work or attend a recreational camp for
children in any capacity which might bring him or her into contact with any camper at such
camp. Screening and testing for tuberculosis shall be in accordance with the most current
guidance issued by the Department's Tuberculosis Prevention Program.
430.152: Required Immunizations
Written documentation of immunization in accordance with the most current Department
immunization schedules developed pursuant to recommendations of the Centers for Disease
Control and Prevention shall be required for all campers and staff.
430.153: Physical Examination or Immunization Exemptions
(A) Religious Exemption. If a camper or staff member has religious objections to physical
examinations or immunizations,the camper or staff member shall submit a written statement,
signed by a parent or legal guardian of the camper or staff member if a minor,stating that the
individual is in good health and stating the general reason for such objections.
(B) Immunization Contraindicated. Any immunization specified in 105 CMR 430.152 shall
not be required if the health history required by 105 CMR 430.151 includes a certification by a
physician certifying he or she has examined the individual and in the physician's opinion the
physical condition of the individual is such that his or her health would be endangered by such
immunization.
(C) Exclusion. In situations when one or more cases of a vaccine-preventable or any other
communicable disease are present in a camp, all susceptible children, including those with
medical or religious exemptions,are subject to exclusion as described in 105 CMR 300.000:
Reportable Diseases and Isolation and Quarantine Requirements.
430.154: Iniury Reports
A report shall be completed on a form available from the Department for each fatality or
serious injury as a result of which a camper,staff person,or volunteer is sent home or brought
to the hospital or physician's office,and where a positive diagnosis is made. Such injuries shall
include,but shall not necessarily be limited to, those for which suturing or resuscitation is
required,bones are broken,or the camper,staff person,or volunteer is admitted to the hospital.
A copy of each injury report shall be sent to the Department,as well as the Board of Health,as
soon as possible but no later than seven calendar days after the occurrence of the injury. In
addition,any camp operator that is an owner of a challenge course or climbing wall operating
at the camp and licensed pursuant to 520 CMR 5.00: Amusement Devices shall comply with the
reporting requirements in 520 CMR 5.00 for each fatality or serious injury, as defined in
520 CMR 5.00,related to the challenge course or climbing wall.
105 CMR: DEPARTMENT OF PUBLIC HEALTH
430.155: Medical Log
Each recreational camp for children shall maintain a medical log which shall contain a record
of all camper and staff health complaints and treatment. The medical log shall list the date and
time,name of patient,complaint,and treatment for each incident. The medical log shall be
maintained in a readily available format and shall be signed by an authorized staff person.
430.156: Availability of Health Records and Lags
(A) All medical records and logs shall be readily available to the health care supervisor,camp
nurse or camp doctor or other health personnel.
(B) All medical records and logs shall be made available upon request to authorized
representatives of the Department and of the Board of Health which licenses the camp. The
Department and the Board of Health shall maintain the confidentiality of information relating
to individual campers and staff.
430.157: Communicable Disease Reporting and Parental Education Requirements
(A) The operator of a recreational camp for children,in consultation with the camp's healthcare
consultant,shall immediately report each case of communicable disease listed as reportable
under 105 CMR 300.000: Reportable Diseases and Isolation and Quarantine Requirements
occurring in a camp to the Board of Health and the Department. Such report shall include the
name and home address of any individual in the camp known to have or suspected of having
such disease. Until action on such case has been taken by the camp health care consultant,strict
isolation of affected individuals shall be maintained.
(B) The operator of a recreational camp for children,in consultation with the camp's healthcare
consultant, shall be responsible for ensuring each suspected case of food poisoning or any
unusual prevalence of any illness in which fever,rash,diarrhea,sore throat,vomiting,or j aundice
is a prominent symptom is reported immediately to the Board of Health and to the Department,
by email or telephone. This report shall be made by the health care consultant,health care
supervisor,or the camp director or operator.
(C) Information regarding meningococcal disease and immunization shall be provided annually
to the parent or legal guardian of each camper in accordance with M.G.L.c. 111,§219.
430.159: Health Care Staff to be Provided
The operator of each recreational camp for children shall provide:
(A) A designated Massachusetts licensed physician,certified nurse practitioner,or physician
assistant having documented pediatric training, as the camp's health care consultant. The
consultant shall:
(1) Assist in the development of the camp's health care policy as described in 105 CMR
430.159(B);
(2) Review and approve the policy initially and at least annually thereafter;
(3) Approve any changes in the policy;
(4) Review and approve the first aid training of staff;
(5) Be available for consultation at all times;and
(6) Develop and sign written orders,including for prescription medication administration,
to be followed by the on-site camp health care supervisor in the administration of his or her
health related duties;and
(7) Provide trainings as required by 105 CMR 430.160 to the healthcare supervisor(s)and
other camp staff.
(B) A written camp healthcare policy,approved by the Board of Health and by the camp health
care consultant. Such policy shall include, but not be limited to: daily health supervision;
infection control;medication storage and administration,including self-administration when
appropriate,pursuant to the requirements of 105 CMR 430.160;procedures for using insect
repellant;conducting tick checks;promoting allergy awareness;handling health emergencies
and accidents,including parental/guardian notifications;available ambulance services;provision
for medical,nursing and first aid services;the name of the designated on-site camp health care
105 CMR: DEPARTMENT OF PUBLIC HEALTH
430.159: continued
supervisor;the name,address,and phone number of the camp health care consultant required by
105 CMR 430.159(A); and the name of the health care supervisor(s)required by 105 CMR
430.159(E),if applicable.
(1) Each full time staff member shall receive a copy of the policy and shall be trained in the
program's infection control procedures and implementation of the policy during staff
orientation.
(2) Prior to admitting a child to the camp, parents and guardians shall be provided a copy
of the policy pertaining to the care of mildly ill campers,administration of medication and
the procedures for providing emergency health care. A complete copy of the policy shall be
furnished to parents and guardians upon their request.
(C) At least one health care supervisor,or more as determined by the camp operator based on
camp size and ability to provide for the needs of the camp,who is present at the camp at all
times. Primitive,travel,and trip camps shall have at least one individual who is trained in first
aid in addition to the health care supervisor accompanying the campers. Said individual shall
possess at least current certification in Red Cross Standard First Aid,or its equivalent.
(D) In residential camps in which the total number of campers and staff is less than 150 and in
all day camps,the health care supervisor may have additional non-health related duties,but shall
at all times be available at the camp to render emergency first aid.
(E) In camps operated specifically for children with mild or severe disabilities, medical
specialty camps,residential camps for children where the total number of campers and staff is
150 or greater and at any other camp when so advised by the health care consultant described in
105 CMR 430.159(A),the health care supervisor shall be:
(1) A nurse registered to practice in the Commonwealth;
(2) A physician licensed to practice in the Commonwealth;
(3) A certified nurse practitioner or physician assistant licensed to practice in the
Commonwealth;or
(4) A Massachusetts licensed practical nurse.
430.160: Storage and Administration of Medication
(A) Medication prescribed for campers shall be kept in original containers bearing the pharmacy
label,which shows the date of filling,the pharmacy name and address,the filling pharmacist's
initials,the serial number of the prescription,the name of the patient,the name of the prescribing
practitioner,the name of the prescribed medication,directions for use and cautionary statements,
if any,contained in such prescription or required by law,and if tablets or capsules,the number
in the container. All over the counter medications for campers shall be kept in the original
containers containing the original label, which shall include the directions for use.
(M.G.L.c.94C,§21).
(B) All medication prescribed for campers shall be kept in a secure manner(e.g.,locked storage
or in the controlled possession of the individual responsible for administering them,according
to American Camp Association Standard HW.19). Medications requiring refrigeration shall be
stored at temperatures of 360 to 46'F in accordance with Massachusetts Board of Registration
in Pharmacy guidance regarding proper storage of refrigerated and frozen medications.
(C) Medication shall only be administered by the healthcare supervisor or by a licensed health
care professional authorized to administer prescription medications. If the healthcare supervisor
is not a licensed health care professional authorized to administer prescription medications,the
administration of medications shall be under the professional oversight of the health care
consultant. The health care consultant shall acknowledge in writing a list of all medications
administered at the camp. Medication prescribed for campers brought from home shall only be
administered if it is from the original container, and there is written permission from the
parent/guardian.
105 CMR: DEPARTMENT OF PUBLIC HEALTH
430.160: continued
(D) A written policy for the administration of medications at the camp shall identify the
individuals who will administer medications. This policy shall:
(1) List individuals at the camp authorized by scope of practice(such as licensed nurses)
to administer medications;and/or other individuals qualified as health care supervisors who
are properly trained or instructed,and designated to administer oral or topical medications
by the health care consultant.
(2) Require healthcare supervisors designated to administer prescription medications to be
trained or instructed by the health care consultant to administer oral or topical medications.
(3) Document the circumstances in which a camper, heath care supervisor, or other
employee may administer epinephrine injections. A camper prescribed an epinephrine
auto-injector for a known allergy or pre-existing medical condition may:
(a) Self-administer and carry an epinephrine auto-injector with him or her at all times
for the purposes of self-administration if:
1. the camper is capable of self-administration;and
2. the health care consultant and camper's parent/guardian have given written
approval
(b) Receive an epinephrine auto-injection by someone other than the health care
consultant or person who may give injections within their scope of practice if:
1. the health care consultant and camper's parent/guardian have given written
approval;and
2. the healthcare supervisor or employee has completed a training developed by the
camp's health care consultant in accordance with the requirements in 105 CMR
430.160.
(4) Document the circumstances in which a camper may self-administer insulin injections.
If a diabetic child requires his or her blood sugar be monitored,or requires insulin injections,
and the parent or guardian and the camp health care consultant give written approval,the
camper,who is capable,may be allowed to self-monitor and/or self-inject himself or herself.
Blood monitoring activities such as insulin pump calibration,etc.and self-injection must take
place in the presence of the properly trained health care supervisor who may support the
child's process of self-administration.
(E) The camp's health care consultant shall train health care supervisors on the signs and
symptoms of hypo or hyperglycemia,and appropriate diabetic plan management.
(F) The camp shall dispose of any hypodermic needles and syringes or any other medical waste
in accordance with 105 CMR 480.000: Minimum Requirements for the Management ofMedical
or Biological Waste.
(G) The required training for health care supervisors and other camp employees designated to
administer an epinephrine auto-injector pursuant to 105 CMR 430.160(D)(3)shall:
(1) be provided under the direction of the health care consultant;and
(2) at a minimum, include content standards and a test of competency developed and
approved by the Department;
(H) The health care consultant shall:
(1) document the training and evidence of competency of unlicensed personnel designated
to assume the responsibility for prescription medication administration;and
(2) provide a training review and informational update at least annually for those camp staff
authorized to administer an epinephrine auto-injector pursuant to 105 CMR 430.160(D)(3).
(1) When no longer needed,medications shall be returned to a parent or guardian whenever
possible. If the medication cannot be returned,it shall be disposed of as follows:
(1) Prescription medication shall be properly disposed of in accordance with state and
federal laws and such disposal shall be documented in writing in a medication disposal log.
(2) The medication disposal log shall be maintained for at least three years following the
date of the last entry.
105 CMR: DEPARTMENT OF PUBLIC HEALTH
430.161: Emer-gency/Medical Facilities and Equipment
(A) The operator of each residential camp and each day camp shall provide a single facility
identified as an infirmary or first aid facility. Such facility in a residential camp shall be easily
recognizable and accessible during the day and the night.
(B) In accordance with guidance from the Department, every residential camp shall have
designated space for isolation of a child ill with a communicable disease or suspected of such
illness or otherwise in need of quiet and rest,at a location suitably separated from the regular
living and sleeping quarters so as to ensure both quiet to the patient and safety to other persons.
The space shall be suitably equipped, including a ventilation system capable of providing
negative pressure. An isolated child shall be provided with adequate adult supervision. Camps
shall notify parents or guardians as soon as possible if their child is isolated.
(C) First aid supplies shall be readily available to the staff wherever the health care consultant
deems necessary,and shall be part of the written orders required by 105 CMR 430.159(A). First
aid kits shall meet American National Standards Institute Z308.1-2015 requirements including,
at a minimum,one Class B Kit and one or more Class A Kits,as necessary.
430.162: Personal Hygiene and Laundry
The operator shall provide adequate facilities and time for the campers and staff to carry out
good personal hygiene practices. In a residential camp,campers and staff who are in attendance
for more than 14 consecutive calendar days shall be provided laundry facilities and encouraged
to wash personal laundry at least once every 14 days.
430.163: Protection from the Sun
The operator shall at all times encourage campers and staff to reduce exposure to ultraviolet
exposure from the sun. Such measures shall include,but need not be limited to,encouraging the
use of wide brim hats,long sleeve shirts,long pants,screens with a solar protection factor of 25
or greater and lip balm. The operator shall establish written procedures for the topical
application of sunscreen,including parent or legal guardian authorization.
430.165: Tobacco Use
Tobacco use in any form,including nicotine delivery systems(e.g., electronic cigarettes)but
excluding cessation products approved by the U.S.Food and Drug Administration,shall not be
allowed by staff,campers or any other person at a licensed recreational camp for children.
430.166: Alcohol and Recreational Mariivana Use
Use of alcohol and recreational use of marijuana in any form is prohibited at a recreational
camp for children during camp operating hours.
430.190: General Program Requirements
(A) The operator of each recreational camp for children shall provide a program of activities
and physical environment which shall meet the generally recognized needs of the campers and
shall in no respect be in conflict with their best interests nor a hazard to their health and safety.
(B) The operator shall release campers only to the camper's parent or legal guardian or an
individual designated in writing by the camper's parent or legal guardian unless alternative
documented arrangements are authorized in writing by the Board of Health.
(C) The operator shall print on any promotional literature or brochures the following,"This
camp must comply with regulations of the Massachusetts Department of Public Health and be
licensed by the local board of health."
105 CMR: DEPARTMENT OF PUBLIC HEALTH
430.190: continued
(D) The operator shall inform parents at the time application forms are provided they may
request copies of background check,health care and discipline policies as well as procedures for
filing grievances.
(E) The operator shall maintain and implement an effective protocol for the appropriate
identification and handling of unrecognized persons (i.e., non-campers, staff, volunteers,
contractors,or parents or legal guardians)at camp.
430.191: Requirements for Discipline
(A) Discipline and guidance shall be consistent and based upon current American Academy of
Pediatrics Childcare Guidance on effective discipline or other guidance approved by the
Department,and an understanding of the individual needs and development of a child. The
operator shall have written policies and procedures to direct discipline to the goal of maximizing
the growth and development of the children and for protecting the group and individuals within
it.
(B) Prohibitions
(1) Corporal punishment,including spanking,is prohibited;
(2) No camper shall be subjected to cruel or severe punishment,humiliation,or verbal
abuse;
(3) No camper shall be denied food,water or shelter;
(4) No child shall be punished for soiling,wetting or not using the toilet.
(C) The operator shall describe in writing the camp's procedures for disciplining campers. The
written plan shall also include the prohibitions of 105 CMR 430.191(B)(1)through(4).
430.201: Riflery Program Requirements
If riflery is a camp activity it shall be conducted with the following precautions:
(A) Firearms shall be kept in good condition and stored in a locked cabinet when not in use.
Ammunition shall also be stored in a locked facility in a location separate from the firearms.
(B) Shooting ranges shall be located well away from other activity areas and shall be
constructed and operated in accordance with standards of the National Rifle Association.
(C) Only a non-large capacity rifle loaded with a single shot shall be used.
(D) Campers and staff shall stay behind the firing line at all times except when ordered by the
range instructor to retrieve targets.
(E) All rifles shall be unloaded with actions open,and shall be verified to be unloaded by the
range instructor,prior to any camper or staff member crossing the firing line,at the conclusion
of instruction,or at any other time the range instructor directs.
430.202: Archery Program Requirements
If archery is a camp activity it shall be conducted with the following precautions:
(A) Archery equipment shall be kept in good condition and stored under lock and key when not
in use.
(B) The archery range shall be located in an area well away from other program activities,
clearly marked to warn passersby away from the danger area. The shooting area shall be large
enough to provide at least 25 yards(75 feet)of clearance behind each target. All bowmen shall
fire from a common firing line. A ready line shall be marked at a sufficiently safe distance
behind the firing line.
105 CMR: DEPARTMENT OF PUBLIC HEALTH
430.203: Personal Weapons Restricted
No personal weapons,bows,rifles or similar equipment shall be brought to camp without the
camp operator's written permission. If articles of such nature are brought into camp,they shall
be kept under lock by the camp operator or director and used by the owner only under the
supervision of an individual who meets the requirements of 105 CMR 430.103(D)and(E),and
in accordance with camp safety policies.
430.204: Waterfront and Boating Program Requirements
The following waterfront safety requirements shall be observed:
(A) Swimming shall be prohibited at sites other than the permanent camp waterfront without
the prior approval of the camp operator and the aquatics director required by 105 CMR
430.103(A).
(B) All bathing beaches utilized by the campers shall be in compliance with 105 CMR 445.000:
Minimum Standards for Bathing Beaches(State Sanitary Code, Chapter VII).
(C) All recreational camps having swimming or diving activities,excluding those activities at
swimming pools,wading pools and other artificial bodies of water,shall,at a minimum,meet
the requirements of M.G.L.c. 111,§ 127A'/s(Christian's Law)and all applicable Department
regulation and guidelines issued thereunder.
(D) A method of supervising and checking bathers such as the "buddy system" shall be
established and enforced. A written"lost swimmer plan"shall be established and all staff shall
know exactly what their duties are in case of an emergency at the waterfront.
(E) Swimming shall be prohibited during the hours of darkness unless adequate lighting is
provided and swimming is restricted to shallow water.
(F) All piers,floats,and platforms shall be in good repair.
(G) Small craft shall be used only by a qualified person having permission of the aquatics
director or camp director. No small craft shall be allowed in the swimming area unless operated
by lifeguards on waterfront duty.
(H) All watercraft shall be equipped with U.S.Coast Guard approved personal flotation devices
of types I, II, III or IV as prescribed for the specific type of craft and number and age of
occupants. Water skiers shall wear a vest approved by the U.S.Coast Guard for that particular
activity. Watercraft towing a water skier shall have an observer aboard.
(I) Campers shall possess at least an American National Red Cross Level 4 or higher Program
Certificate or its equivalent before being allowed to participate in either white water or hazardous
salt water boating activities. All white water activities must be carried out on water determined
to be no more difficult than Class III as defined by the International Scale of River Difficulty.
No trips shall be taken on unclassified white water.
430.205: Crafts Equipment
Equipment used for arts and crafts shall be in good repair,of safe design,properly installed
and used with proper safety precautions.
430.206: Playground,Athletic Equipment and Facilities Requirements
(A) Athletic equipment used for,gymnastics,volleyball,basketball,football,hockey,soccer
and other sports shall be set up and maintained in accordance with the manufacturer's guidelines.
(B) All playing fields and surfaces shall be kept free of holes and other obstructions which may
create an accident hazard.
105 CMR: DEPARTMENT OF PUBLIC HEALTH
430.206: continued
(C) Playground equipment including,but not limited to,climbing apparatus,slides,and swing
sets shall:
(1) be in good repair and of safe design in accordance with the Consumer Product Safety
Commission Public Playground Safety Handbook. Safe design includes being free of rough
edges,protruding bolts and possibility of entrapment of extremities;
(2) be securely anchored to a concrete or other suitable footing;
(3) not have an asphalt or concrete surface under or around it;and
(4) have canvas or other pliable seats on swings.
430.207: Storage and Operation of Power Equipment
Power equipment shall not be stored,operated,or left unattended in areas accessible to the
campers without proper safeguards. All power tools shall be stored in a locked place. Power
tools and outboard motors shall be used by campers only under the direction and supervision of
counselors.
430.208: Horseback Riding Program Requirements
If horseback riding is a camp activity:
(A) A competent riding instructor(see 105 CMR 430.103(F)) shall determine each camper
riding experience and level of skill and take these into account in assigning horses and
determining whether the camper shall ride in the ring or on the trail. Each rider shall wear a hard
hat at all times. At least one experienced instructor shall be assigned for every ten riders for each
trail excursion,and a minimum of two staff members shall accompany any such excursion.
(B) All horses must be boarded in a stable licensed by the Board of Health in accordance with
M.G.L.c. 111,§§ 155 and 158.
430.209: Telephones Required
All residential and day camps shall have immediate access to a reliable telephone. The
operator shall maintain and post by each phone,or otherwise have readily accessible,a current
roster of telephone numbers of the health care consultant described in 105 CMR 430.159(A)and
of all police,emergency medical services and fire departments serving the camp,as well as
dialing instructions for each phone.
430.210: Plans Required to Deal with Natural Disasters or Other Emergencies(Residential and Day Camps)
The operator of each residential camp and each day camp shall develop written contingency
plans and related procedures dealing with circumstances such as natural disasters and other
emergencies and shall develop a written fire evacuation plan. All staff shall be trained in the
procedures contained in these plans.
(A) Fire Drills. Fire drills shall be held within the first 24 hours of the beginning of each
camping session. The fire evacuation plan shall be in writing and approved by the local fire
department. The plan shall indicate the frequency of fire drills to be held during the camping
season.
(B) Disaster/Emergency Plans. Each camp shall have at the campsite written disaster/
emergency plans in accordance with American Camp Association Standard Accreditation
Process Guide OM 8.1. All campers and staff shall be advised of the procedures contained in
the plan. Arrangements for transporting individuals from the camp to emergency or other
facilities shall be included in the plan.
(C) Lost Camper and Swimmers Plan. Written lost camper and lost swimmer plans shall be
formulated and kept on file.
105 CMR: DEPARTMENT OF PUBLIC HEALTH
430.210: continued
(D) Traffic Control. A written plan relating to the control of the movement of vehicular traffic
through the camp shall be on file.
430.211: Special Contingency Plans for Day Camps
Day camp operators shall set forth and follow procedures to deal with the following
contingencies:
(A) Children who are registered and on the camp roll but fail to arrive for a given day's
activities.
(B) Children who fail to arrive at the point of pickup following a given days activities.
(C) Children who appear at camp without having registered and without prior notification.
430.212: Field Trips
(A) The operator of each camp,including primitive,travel and trip camps,shall establish a
written itinerary before departure for all field trips,and shall provide a copy of this itinerary to
the parent(s)or guardian(s)of each camper before departure. Whenever feasible camps shall
notify parents/guardians of any changes to the itinerary prior to departure of any field trips.
(B) Sources of Emergency Care. All field trips away from any camp shall include at least one
designated health care supervisor.Forprimitive,travel and trip camps,the sources of emergency
care such as hospitals,police and park patrol,and the method of communicating with them shall
be identified for each point on the itinerary prior to departure,and shall be included in the written
itinerary.
(C) Health Records, Medications and First Aid Kits. For all day and residential camps,
including primitive,travel and trip camps,having field trips away from camp,the operator shall
ensure health records and medications for each staff person and camper in attendance on the trip
are readily accessible and that a first aid kit is available.
(D) Contingency Plan. Written contingency plans for natural disasters, lost campers, lost
swimmers, illnesses and injuries shall be established and accompany all field trips from the
camp. Staff shall have the ability to carry out these plans.
430.213: Emergency Communication System Required
Each recreational camp for children shall have an operating system for emergency
communication to alert all campers and staff and elicit a predetermined response. Such system
may include, but not necessarily be limited to, various electronic devices, signals, a public
address system,triangle,bell or voice.
430.214: Storage of Hazardous Materials
(A) Storage of Gasoline and Flammable Substances. The operator of each recreational camp
for children shall ensure all containers for gasoline, kerosene, explosives and flammable
materials are plainly marked and stored in a locked building not occupied by campers or staff,
and located at a safe distance from other buildings. Campers shall not have access to such
locked buildings and the materials described above shall be used only under qualified
supervision.
(B) Storage of Disinfectant and Other Hazardous Chemicals. The operator of each recreational
camp for children shall ensure all containers for insecticides,disinfectants,and other hazardous
chemicals are plainly marked and stored in a locked closet or compartment separate from food
storage areas and not accessible to campers.
105 CMR: DEPARTMENT OF PUBLIC HEALTH
430.215: Fire Prevention
The operator of each recreational camp for children shall provide such facilities,equipment,
and fire breaks,for fire prevention and firefighting,as may be recommended by the local fire
department. A written statement of compliance from the local fire department shall be available
to the Board of Health which licenses the camp.
430.216: Smoke and Carbon Monoxide Detectors Required
Smoke and carbon monoxide detectors shall be required for existing and new residential units
in accordance with 780 CMR: State Board of Building Regulations and Standards and
527 CMR 1.00: Massachusetts Comprehensive Fire Safety Code. Tents and other temporary
shelters which are designed to sleep fewer than eight persons and which have an open side
consisting of greater than t i6 of the perimeter of the shelter or which have built-in provisions for
emergency escape are exempted from 105 CMR 430.216.
430.217: Requirements for Tents
Any temporary,transportable tent,less than 400 square feet,used at a recreational camp for
children shall be clearly identified by the manufacturer as constructed of fire-resistant material.
No open flames shall be used in or near any tent.
430.250: Vehicle Requirements
(A) Any motor vehicle used for the transportation of children enrolled in a camp program shall
be in compliance with the pertinent sections of M.G.L c.90,in particular,§§7B and 7D,and
with all applicable regulations of 540 CMR:Registry of Motor Vehicles.
(B) Any vehicle used for transportation of children shall have passed an annual safety
inspection in accordance with the laws of the Commonwealth.
430.251: Transportation Safety
(A) Only that number of children or adults for whom there is seating space shall be transported
in a vehicle,however,when loaded with passengers and gear,the gross weight of the vehicle
including trailer tongue weight, shall not exceed the gross vehicle weight specified by the
manufacturer regardless of whether or not the number of passengers is within the specified
number of seats.
(B) Passengers shall not be allowed to stand while in transit,sit on the floors or in the aisles,
ride in the open beds of trucks and project head or limbs outside of the vehicle.
(C) All campers,attendants and drivers shall utilize seat belts in accordance with Massachusetts
laws.
(D) When more than eight campers under the age of five are being transported, and when
transporting more than two campers with physical handicaps,an attendant other than the driver
is required.
(E) A minimum of at least one staff person shall accompany and monitor campers during any
bus or van transport,either from the morning pickup to the camp or an afternoon return trip,for
off-site drop-off.
(F) Unless safely secured,sharp,heavy or potentially dangerous objects shall not be allowed
in vehicles transporting campers.
(G) The camp operator shall communicate any need or problem of campers or staff which may
cause difficulty during transport, such as seizures, a tendency towards motion sickness, or
disabilities,to the driver of any vehicle transporting campers.
105 CMR: DEPARTMENT OF PUBLIC HEALTH
430.251: continued
(H) The driver of the vehicle shall release campers only to the camper's parent or guardian or
an individual designated in writing by the camper's parent or guardian unless alternative
arrangements are approved in writing by the parent or guardian.
(I) Campers under the age of seven shall not be transported for periods longer than one hour
non-stop.
430.252: Qualifications of Driver
(A) The camp operator shall ensure all drivers of vehicles transporting campers and staff are:
(1) 18 years of age or older;
(2) have at least two year's driving experience as a licensed driver;
(3) possess the required license for the type of vehicle;and
(4) possess a current American Red Cross Standard First Aid Certificate,or its equivalent.
If there is a second staff person in the vehicle possessing the required first aid certification,
the driver need not be certified.
(B) The driver of any vehicle transporting children shall have a valid driver's license recognized
by the Commonwealth.
430.253: Automobile Insurance
The camp operator shall not allow any camp-owned or staff member's vehicle to transport
campers unless it has the following minimum amounts of liability insurance:
(1) injury per person, $100,000
(2) injury per accident, $300,000
(3) property damage, $5,000
430.300: Potable Water Required
(A) The operator of each recreational camp for children shall provide water of safe and sanitary
quality in an amount and pressure necessary to meet the needs of the campers and staff and the
requirements of 105 CMR 430.000.The water supply shall be obtained from:
(1) A public water supply;or
(2) A private water supply meeting the following requirements:
(a) If the camp serves 25 or more persons,60 or more days per year,the water supply
shall be obtained from a source approved by the Department of Environmental Protection
and subject to 310 CMR 22.00: Drinking Water.
(b) If the camp serves less than 25 persons,or operates less than 60 days per year,the
water obtained from a private source shall be collected and analyzed by a laboratory
certified by the Department of Environmental Protection,no more than 45 days prior to
the annual opening of a camp,in order to meet requirements of and be approved by the
Board of Health.
1. Water test analyses may include,but not be limited to the following:
a. coliform bacteria,nitrate,nitrite,sodium and lead;
b. other contaminants identified by the Department of Environmental Protection
in its document entitled,Parameters and Testing Frequency for Private Wells;
and
c. any other tests required by the Board of Health or the Department.
2. The results of these analyses must not exceed the Maximum Contaminant Level
(MCL) or Action Level listed in the Massachusetts Drinking Water Regulations
310 CMR 22.00.Drinking Water and shall be kept on file for ten years.
(B) In each residential or day camp,adequate drinking facilities shall be centrally located.
105 CMR: DEPARTMENT OF PUBLIC HEALTH
430.301: Installation and Maintenance of Plumbing
The operator shall install all pipes,pumps and other plumbing fixtures in accordance with
248 CMR: The Massachusetts State Plumbing Code and shall maintain them in good working
order.
430.302: Cross Connections Prohibited
The operator shall not permit any physical connection to exist between any pipe carrying
drinking water and any waste pipe,soil pipe,service drain or any pipe carrying water from any
source or system not approved by the Massachusetts Department of Environmental Protection
(DEP), unless said connection is maintained in compliance with 310 CMR 22.22: Crass
Connections promulgated by DEP,and said connection has been approved in writing by DEP.
430.304: Common Drinking Cup Prohibited
The operator shall not make available nor permit the use of any common drinking utensil.
Every drinking fountain shall be of a sanitary design and construction.
430.320: Food Service-Compliance with 105 CMR 590.000: State Sanitary Code Chapter X—Minimum
Sanitation Standards for Food Establishments.Required
(A) The operator of each recreational camp for children which prepares and/or serves meals
shall provide and maintain all food service areas and facilities in a sanitary manner and in
compliance with applicable provisions of 105 CMR 590.000 State Sanitary Code Article X-
Minimum Sanitation Standards forFood Establishments,and shall have and prominently display
a food service permit issued by the Board of Health.
(B) Camp operators using a federal United States Department of Agriculture(USDA)Summer
Food Service Program managed by the Massachusetts Department of Elementary Education and
Secondary Education,or its successor,shall provide written documentation of a food compliance
inspection conducted by either the municipality,the state or a contracted third party,pursuant
to 105 CMR 590.000: State Sanitary Code Chapter X—Minimum Sanitation Standards for
Food Establishments
430.321: Special Provisions for Primitive,Travel and Trip Camps
(A) All food taken with the camp,or purchased,or prepared en route by campers and/or staff,
shall be appropriate to the length and type of trip, taking into consideration the lack of
refrigeration and problems of sanitation that may be encountered.
(B) Commercially packaged dry milk products and dry egg products maybe utilized but shall
be consumed within one hour after being reconstituted,and shall be discarded if not consumed
within one hour of being reconstituted.
430.330: Nutritious Meals to Be Served
The operator of camps where food is prepared and/or served shall provide sufficient numbers
of adequately trained personnel to plan,prepare and serve nutritionally adequate meals.
(A) Menus shall be planned and written at least two weeks in advance, and provide for a
sufficient variety of foods.
(B) Current menus shall be posted and copies of all menus used during the season shall be kept
on file.
430.331: Minimum Daily Food Requirements for Residential,Travel or Trip Camps
(A) The operator of each residential,travel or trip camp shall provide at least three meals per
day for every full day that campers are present and shall provide nutritious meals suited to the
specific needs of the campers.
105 CMR: DEPARTMENT OF PUBLIC HEALTH
430.331: continued
(B) Foods served shall meet the recommendations of the Dietary Guidelines for Americans-
Nutritional Goals for Age/Sex Groups Based on Dietary Reference Intakes and Dietary
Guidelines,of the Federal Dietary Guidelines Advisory Committee,adjusted for age,sex and
activity. The only exception shall be by written medical direction.
430.332: Minimum Daily Food Requirements for Day Camps
All day camps providing one or two meals per day shall serve meals meeting the Dietary
Guidelines for Americans-Nutritional Goals for Age/Sex Groups Based on Dietary Reference
Intakes and Dietary Guidelines,of the Federal Dietary Guidelines Advisory Committee,adjusted
for age,sex and activity.
430.333: Therapeutic Diets
All camps which serve meals and accept campers who are on medically prescribed diets,
including but not limited to weight reduction camps,shall provide food which adequately meets
the requirements of such diets. All therapeutic diets shall:
(A) Be prescribed,dated(no earlier than two months before arrival at camp)and signed by a
licensed physician;
(B) Be precise as to specific dietary requirements or limitations;
(C) Be planned,prepared and served with the consultation from a qualified dietitian;and
(D) Meet,if possible,the Dietary Guidelines for Americans-Nutritional Goals for Age/Sex
Groups Based on Dietary Reference Intakes and Dietary Guidelines,of the Federal Dietary
Guidelines Advisory Committee.
430.334: Feeding
(A) Adequate Staff and Equipment. All camps accepting campers with mild or severe
disabilities shall provide sufficient numbers of adequately trained personnel and proper
equipment to ensure campers are eating nutritionally adequate meals.
(B) Meals Shall Not Be Denied. No camper shall be denied a meal for any reason other than
by written medical direction.
(C) Meals Shall Not Be Forced. Campers should be encouraged to eat a well-balanced diet,but
no camper shall be forced or otherwise coerced to eat against his or her will.
430.335: Meals Provided from Home
(A) The operator shall have a method of properly storing meals provided from home to
maintain safe temperatures and to protect from contamination.
(B) The operator shall have a method for providing a nutritious meal to a camper who arrives
at camp without a bag lunch.
430.350: Facilities for Solid Waste Storage
The operator of each recreational camp for children shall provide and maintain in a clean and
sanitary condition as many receptacles for the storage of garbage and rubbish as are necessary
to contain the accumulation between collections,and shall so locate them where no objectionable
odors enter any facility used for habitation.
(A) Garbage and mixed garbage and rubbish shall be stored in water tight receptacles with tight
fitting covers. Said receptacles and covers shall be of metal or other durable, rodent-proof
material. Rubbish shall be stored in receptacles of metal or other durable rodent-proof material.
105 CMR: DEPARTMENT OF PUBLIC HEALTH
430.350: continued
(B) Plastic bags shall be used to store garbage or mixed rubbish and garbage only if used as a
liner in watertight receptacles with tight-fitting covers as required in 105 CMR 430.350(A),or
placed in enclosures that are rodent,insect and pest proof. Plastic bags may be put out for
collection on the day of collection except in those places where such practice is prohibited by
local rule or ordinance or except in those cases where the Board of Health determines such
practice constitutes a health problem due to evidence of strewn garbage,torn garbage bags or
evidence of rodents.
430.355: Final Disposal of Solid Wastes
The operator of each recreational camp for children shall be responsible for the final
collection or ultimate disposal of garbage and rubbish by means of:
(A) the regular municipal collection system;or
(B) any other collection system approved by the Board of Health;or
(C) when otherwise lawful,a garbage grinder which grinds garbage into the kitchen sink drain
finely enough to ensure its free passage,and is otherwise maintained in a sanitary condition;or
(D) any other method of disposal which does not endanger any person and which is approved
in writing by the Board of Health and the Department of Environmental Protection.
430.360: Sewage Disposal
The operator of each recreational camp for children shall provide for all waste waters a
sanitary drainage system connected to the public sewerage system;provided however,that if
because of non-availability, distance or ground conditions, connection to a public sewerage
system is not practicable,any other means of such disposal of sewage approved in writing by the
Board of Health and in compliance with 310 CMR 15.00: The State Environmental Code, Title
5: Standard Requirements for the Siting, Construction,Inspection, Upgrade and Expansion
of On-site Sewage Treatment and Disposal Systems and for the Transport and Disposal of
Septage or approved by the Massachusetts Department of Environmental Protection in
compliance with 310 CMR 15.00,314 CMR 3.00: Surface Water Discharge Permit Program,
or 314 CMR 5.00: Ground Water Discharge Permit Program,as applicable.
430.370: Toilet Facilities Required
The operator of each recreational camp for children shall provide at least two toilets or privy
seats for each gender,and,
(A) For each camp other than a day camp where the number of persons of one gender is in
excess of 20,the operator shall provide one additional toilet or privy seat for each additional ten
persons or fraction thereof of that gender.
(B) At a day camp where the number of persons of one gender is in excess of 60,the operator
shall provide one additional toilet or privy seat for each additional 30 persons or fraction thereof
of that gender.
430.371: Urinals May Be Substituted
For males,one urinal or two lineal feet of urinal trough may be substituted for up to 33%of
the number of toilets or privy seats required.
105 CMR: DEPARTMENT OF PUBLIC HEALTH
430.372: Location and Maintenance of Toilet Facilities
The operator of each recreational camp for children shall locate the toilets so they are not
more than 200 feet from the door of the sleeping rooms of those people who are expected to use
them. The operator shall provide an adequate supply of toilet paper and shall screen each
window or other exterior opening with screening containing not less than 16 meshes per inch.
Every screen door shall be equipped with a self-closing device.
430.373: Handwashing Facilities
The operator of each recreational camp for children shall provide handwashing facilities in
compliance with 248 CMR 10.00: Uniform State Plumbing Code,and shall meet the following
minimum requirements:
(A) Residential camps shall provide at least one lavatory or wash basin,or space for one person
at an industrial-type lavatory,for every ten people.
(B) Day camps shall provide at least one lavatory or wash basin or space for one person at an
industrial-type lavatory,for every 30 people.
(C) Wash basins shall be located so as to facilitate their use,particularly after use of toilets.
430.374: Bathing Facilities
(A) Minimum Requirements-Residential Camps. The operator of each residential camp shall
provide at least one shower head or bathtub for each 20 people. A bathtub/shower combination
shall count as a single unit.
(B) Required Cleaning of Shower-room Floor. The operator shall cause every shower-room
floor to be washed daily with a suitable detergent and hot water and rinsed with a sanitizer at the
manufacturer's recommended concentration.
(C) Duckboards Prohibited. The operator shall not permit the use of wooden duckboards in a
shower.
430.375: Ventilation Required
All bathhouses,dressing rooms,shower rooms,and toilets at both indoor and outdoor pools
shall be properly and adequately ventilated pursuant to 780 CMR: The Massachusetts State
Building Code.
430.376: Hot Water Temperatures
Where hot water is provided to hand wash basins,lavatories,showers and bathtubs it shall
be:
(A) In a quantity and pressure sufficient to satisfy the ordinary use of all plumbing fixtures
which normally need hot water for their proper use and function.
(B) Ina temperature range of not less than 110°F(43°C)and not greater than 130°F(54°C)for
fixtures other than a bathtub or shower.
(C) Ina temperature range of not less than 100°F(38°C)and not greater than 112°F(44°C)for
a bathtub and shower.
430.377: Maintenance of Sanitary Facilities
The operator shall maintain all lavatories,wash basins,showers,bathtubs,and toilets in good
working order and in a clean and sanitary condition.
105 CMR: DEPARTMENT OF PUBLIC HEALTH
430.378: Toilet Facilities for Campers with Special Needs
Campers with special toilet needs or practices shall be assured privacy and be provided with
facilities meeting their needs.
430.379: Handwash Basins for Campers with Special Needs
All wash basins or lavatories used by campers with special needs shall be so adapted as to
allow for easy access and use.
430.380: Shower Facilities for Campers with Special Needs
All showers or bathtubs used by campers with special needs shall have aids such as chairs
on casters,stools and footrests,non-slip surfaces,and flexible shower heads attached to hoses
in order to provide for the increased independence of the campers and to make it easier and safer
for the staff to assist the campers.
430.400: Rodent and Insect Control-Residential and Day Camps
(A) Buildings and Structures to be Maintained Free. The operator shall maintain every building
used or intended for human habitation free from insect infestation,rodents,and other pests.
(B) Extermination Methods. Extermination methods and other measures to control insects and
rodents shall conform with the requirements of 333 CMR(Pesticide Board of the Massachusetts
Department of Agriculture).
430.401: Weed Control-Residential and Day Camps
(A) Harborage Places to be Controlled. The growth of brush,weeds,grass and plants shall be
controlled in central camp areas to minimize harborage of ticks, chiggers, and other insects
which may adversely affect public health.
(B) Noxious Plants to be Controlled. The central camp area shall be maintained to prevent
growth of ragweed,poison ivy,poison oak,poison sumac,and other noxious plants considered
detrimental to health.
430.430: Swimming Pools-Compliance with 105 CMR 435.000:Minimum Standards for Swimmink Pools
(State Sanitary Code, Chapter R Required
(A) The operator of each recreational camp for children shall ensure all swimming and wading
pools used by campers and staff shall be in compliance with 105 CMR 435.000: Minimum
Standards for Swimming Pools (State Sanitary Code: Chapter V), including the pool fence
requirements in M.G.L.c. 140,§206,and 780 CMR:The Massachusetts State Building Code,
and drain cover safety provisions as provided in the federal Virginia GraemeBakerPool and Spa
Safety Act. A copy of the written approval to operate the pool,issued by the Board of Health,
shall be kept on file at the camp whether or not the swimming pool is located on the camp
property or is part of the camp facility.
(B) At the first pool swimming session,a camp operator shall ensure a determination is made
of each camper's swimming ability.Campers shall be confined to swimming areas consistent
with the limits of their swimming ability or to swimming areas requiring lesser'skills than those
for which they have been classified.
430.432: Bathing Beaches-Compliance with 105 CMR 445.000: Minimum Standards forBathinQBeaches
(State Sanitary Code, Chapter VU).Required
(A) Physical and Bacteriological Water Quality. Bathing and swimming shall not be permitted
at any bathing beach:
(1) that does not meet the requirements of 105 CMR 445.000: Minimum Standards for
Bathing Beaches(State Sanitary Code, Chapter VII);or
105 CMR: DEPARTMENT OF PUBLIC HEALTH
430.432: continued
(2) that has limited water visibility when a black secchi disk,six inches in diameter,on a
white field placed at a depth of at least four feet of water is not readily visible from the
surface of the water;or when,under normal usage,such disk is not readily visible from the
surface of the water when placed on the bottom where the depth is less than four feet.
(B) Diving Areas.
(1) There shall be a minimum water depth of ten feet for a one meter diving board and 12
feet for a three meter diving board.
(2) For natural diving areas,the bottom shall be cleared of stumps,rocks,weeds and other
obstacles.
(3) Diving boards shall be mounted on a firm foundation and never on an insecure base that
can be affected by shifting weight loads and wave action. The entire length of the toe surface
of diving boards shall be covered with non-skid material. The front end of the board shall
project at least six feet beyond the edge of the pool or dock. Clearance from the sides of the
board shall be at least ten feet,the distance between diving boards shall be at least eight feet,
and at least 13 feet of free and unobstructed head room shall be provided above all
divingboards and platforms.
(4) There shall be an adequate number of stairs or ladders for all diving towers,platforms,
and flats. All stairs and ladders shall be provided with a handrail. Treads of stairs and
ladders shall be of nonslip material.
(C) Required Safety Equipment. For each 2000 square feet or major fraction thereof of water
surface area used for bathing,the owner shall provide,in a readily accessible location,one ring
with a minimum inside diameter of 15 inches,weighing 2'/z pounds and with an attached'/a inch
rope no less than 60 feet in length. All swimming pools and man-made swimming areas shall
have at least one safety hook with a minimum handle length of 12 feet.
430.450: Site Location
No person shall operate a recreational camp for children unless it is located:
(A) so as to be accessible at all times during the designated camping season;
(B) where surface drainage conditions create no health or safety hazard;
(C) where approved water supply and sewage disposal facilities can be and are provided;and
(D) where traffic conditions create no undue safety hazards.
430.451: Certificate of Inspection Required
All camp structures used for sleeping or assembly purposes shall have a current certificate
issued by the local building inspector(see 780 CMR: The Massachusetts State Building Code).
Furthermore,the buildings shall be easy to keep clean and have a roof which is weathertight and
waterproof.
430.452: Screening Required
The operator of each recreational camp for children shall provide the exterior openings in
every building used for food preparation,food service,and every permanent building used for
sleeping,with screens containing not less than 16 meshes per inch. Screen doors shall open in
the direction of the flow of traffic out of the building. If no screen door is possible,the building
door shall be equipped with a self-closing device. Every screen door shall be equipped with a
self-closing device.
105 CMR: DEPARTMENT OF PUBLIC HEALTH
430.453: Lighting Required
The operator of each recreational camp for children shall provide adequate lighting for the
safe and sanitary use of each kitchen,dining room,mess hall,infirmary,toilet room and stairway.
430.454: Structural and Interior Maintenance
All structural elements of camp facilities including,but not limited to,foundations,cellars,
floors, walls, doors, windows, ceilings, roofs, staircases, porches, and chimneys, shall be
maintained in good repair,fit for the use intended,and in compliance with the requirements of
780 CMR: The Massachusetts State Building Code. The interior of the facility shall be
maintained in good repair and in a safe,clean,and sanitary condition,free from accumulation
of dirt and rubbish.
430.456: Egresses
All egresses shall be in compliance with the requirements of 780 CMR:The State Building
Code and maintained free of obstructions.
430.457: Shelters for Day Camps
The operator of each day camp shall provide shelter,on or off the site,sufficiently large to
house and provide for on-going camp activities. Such structure shall comply with 105 CMR
430.451.
430.458: Shelters for Residential Camps
In all permanent buildings or structures space shall be so arranged as to provide a minimum
of 40 square feet of floor area for each person occupying a single bed. 35 square feet of space
shall be provided for each person occupying a two tiered(bunk)bed. 50 square feet per person
of sleeping space shall be required for persons needing special appliances or equipment such as
wheelchairs or walkers for ambulation. Space shall include the area occupied by the bed,but
shall not include space such as closets or bathrooms.
430.459: Non-ambulatory Campers
All campers and staff members with problems of mobility shall be housed on ground floor
level with the egresses leading directly to grade or to a ramp inclined no greater than one foot
in 12 feet.
430.470: Separate Beds to Be Furnished
The operator of each residential camp shall furnish in each sleeping cabin or tent a separate bed,
bunk or cot for each camper or staff member. Sleeping shall be so arranged as to provide a
minimum of three feet between individuals if single decked and 4'/z feet if double decked. A
distance of at least six feet shall be provided between the heads of individuals while sleeping.
Triple decked beds shall not be used. 105 CMR 430.470 shall not apply to primitive,short-term
group,travel and trip camps.
430.471: Sleeping Prohibited in Food Areas
The operator of each recreational camp for children shall not permit sleeping in kitchens or
rooms used for food preparation,storage or service.
430.472: All Bedding and Towels to Be Cleaned
The operator of each recreational camp for children shall maintain all operator-supplied
mattresses and pillows in a clean and sanitary condition. Bedding and towels provided by the
operator shall be washed or dry cleaned prior to distribution.
105 CMR: DEPARTMENT OF PUBLIC HEALTH
430.472: continued
(A) The operator shall ensure sheets,towels,and pillow cases are laundered at least once a
week whether they are operator or camper supplied. Sleeping bags shall be aired at least every
five days.
(B) The operator shall not allow a common towel to be used.
430.631: Application for a License
An applicant for a license for a recreational camp for children shall file an application with
the Board of Health at least 90 days prior to desired opening date,using a form provided by the
Department or available from the Board of Health documenting all required information
including,but not limited to,a plan showing the buildings,structures,fixtures and facilities,as
needed.
430.632: Board of Health Shall Grant,Suspend or Revoke License;Annual Notification
The Board of Health shall grant, suspend or revoke licenses for recreational camps for
children in accordance with the provisions of M.G.L.c. 140,§§32B and 32C. All licenses for
recreational camps granted under 105 CMR 430.000 shall state the maximum number of
occupants authorized for such camp and the capacity shall not be exceeded by the operator at any
time. Upon the issuance of a license, the Board of Health shall notify the Massachusetts
Department of Environmental Protection and the Department annually on a form provided by
the Department. Said notification shall include the name and address of the camp,the name of
the owner,the number of campers and staff,and the number of days per year the camp will be
in operation.
430.633: Posting of License
The operator of each recreational camp for children shall post the license in a prominent
place at the camp site.
430.650: Inspections Required
No recreational camp for children shall receive a license to operate in each year until it has
been inspected by the Board of Health and found by the Board to meet all the requirements of
105 CMR 430.000. Provided,however,a day camp timely applying for renewal of licensure,
pursuant to M.G.L.c. 140,§32B,may,at the discretion of the Board of Health,be granted a
license without prior inspection if:
(1) the camp is under the same ownership and directorship as the prior camping season;
(2) the camp has had a satisfactory inspection report the prior camping season;
(3) the Board of Health determines,based upon the record of the camp,there is no evident
risk to the health and safety of the campers;and
(4) the camp is subsequently inspected by the Board of Health during the camping season.
The Board of Health shall also inspect a recreational camp for children at any time the Board
has reason to believe a violation of 105 CMR 430.000 exists,or upon the request or complaint
of any person.
430.651: Inspection Report Forms
(A) The Board of Health shall prepare for each inspection a written report which must include,
but need not be limited to the following:
(1) the name of the inspector;
(2) the date and time the of inspection or investigation;
(3) the location of the facility inspected;
(4) the date and time of any scheduled follow-up inspection;
(5) a description of each condition constituting a violation of 105 CMR 430.000;and
(6) a listing of each specific provision of 105 CMR 430.000 that appear to be violated.
105 CMR: DEPARTMENT OF PUBLIC HEALTH
430.651: continued
(B) A copy of the inspection report shall be completed and mailed or delivered to the operator
within seven days of the day of inspection.
430.700: Orders to Correct Violations
If an examination pursuant to 105 CMR 430.650 or pursuant to 105 CMR 400.100: State
Sanitary Code Chapter I:General Administrative Procedures reveals a recreational camp for
children does not comply with the provisions of 105 CMR 430.000,the Board of Health shall
order the operator to comply with the violated provision of 105 CMR 430.000.
430.701: Violation Which May Endanger or Materially Impair the Health,Safety or Well-being of the
Public
If an examination pursuant to 105 CMR 430.650 or pursuant to 105 CMR 400.100:State
Sanitary Code Chapter I: General Administrative Procedures reveals any condition at a
recreational camp for children fails to comply with the provisions of 105 CMR 430.000 so as to
endanger or materially impair the health,safety,or well being of the occupants or the public,the
Board of Health shall order the operator to comply with 105 CMR 430.000 or may order any
building condemned and vacated if appropriate or may order the camp program to be terminated.
430.702: Contents of Order
Subject to the emergency provisions of 105 CMR 400.200(B):Emergency Procedures,any
order issued under the provision of 105 CMR 430.000 shall:
(A) Include a statement of the violation or defect,a citation of the provision which is violated,
and may suggest action which if taken will effect compliance with 105 CMR 430.000;and
(B) allot a reasonable time for any action it requires;and
(C) inform the person to whom it is directed of the right to a hearing;of the deadline and proper
procedure for requesting a hearing; the right to inspect and obtain copies of all relevant
inspection or investigation reports,orders,notices and other documentary information in the
possession of the Board of Health; the right to be represented at the hearing and that any
interested person has a right to appear at said hearing and present evidence, testimony or
argument.
430.703: Service of Orders
Every order authorized by 105 CMR 430.000 shall be in writing. Orders issued under the
provisions of 105 CMR 430.700 and 430.701 shall be served on the operator or his authorized
agent:
(A) personally,by any person authorized to serve civil process,or
(B) by leaving a copy of the order at his last and usual place of abode,by any person authorized
to serve civil process,or
(C) by sending him a copy of the order by registered or certified mail,return receipt requested,
if he is within the Commonwealth,or
(D) if his last and usual place of abode is unknown or outside the Commonwealth,by posting
a copy of the order in a conspicuous place on or about the building or portion thereof affected.
105 CMR: DEPARTMENT OF PUBLIC HEALTH
430.730: Request for Hearing
The person orpersons to whom any order served pursuant to 105 CMR 430.700 and 430.701
has been directed may request a hearing before the Board of Health by filing within seven days
after the day the order was served in the office of the Board of Health a written petition
requesting a hearing on the matter.
430.731: Hearing to Be Held
Upon receipt of a petition pursuant to 105 CMR 430.730 the Board of Health shall set a time
and a place for such hearing and shall inform the petitioner thereof in writing. The hearing shall
be commenced not later than ten days after the day on which the petition was filed;provided,
upon application of the petitioner the Board of Health may postpone the date of the hearing for
a reasonable time beyond such ten-day period if in the judgment of the Board of Health the
petitioner has submitted a good and sufficient reason for such postponement. At the hearing the
petitioner shall be given an opportunity to be heard and to show why the order should be
modified or withdrawn.
430.732: Decision of Board of Health
The Board of Health shall sustain modify, or withdraw the order and shall inform the
petitioner in writing of its decision within seven days after the conclusion of the hearing. If the
Board of Health sustains or modifies the order,it shall be carried out within the time period
allotted in the original order or in the modification.
430.733: Public Record
Every notice,order or other record prepared by the Board of Health in connection with the
hearing shall be entered as a matter of public record in the office of the clerk of the city or town,
or in the office of the Board of Health.
430.734: Appeal of the Board of Health Decision
Any person aggrieved by the decision of the Board of Health with respect to the provisions
of 105 CMR 430.000 may seek relief therefrom in any court of competent jurisdiction, as
provided by the laws of the Commonwealth.
430.735: Compliance
If a written petition for a hearing is not filed in the office of the Board of Health within seven
days after an order as provided in 105 CMR 430.700 and 430.701 through 430.703 inclusive has
been issued,or if after a hearing the order has been sustained in any part,each days failure to
comply with the order as issued or modified shall constitute an additional offense.
430.750: Operation without License
Whoever operates a recreational camp for children without a license shall upon conviction
be fined not less than$10 nor more than$100 in accordance with M.G.L.c. 140,§32E.
430.751: Failure to Comply with Order of the Board of Health
Any person who fails to comply with any order issued pursuant to 105 CMR 430.000 shall
upon conviction be fined not less than$10 nor more than$100. Each day's failure to comply
with an order shall constitute a separate violation.
430.752: Failure to Comply with Provisions of 105 CMR 430.000
Any person who shall violate any provision of 105 CMR 430.000 shall upon conviction be
fined not less than$10 nor more than$100.
105 CMR: DEPARTMENT OF PUBLIC HEALTH
430.800: Board of Health May Grant Variance
Variances may be granted only as follows:
(A) The Board of Health may vary the application of any provisions of 105 CMR 430.000 with
respect to any particular case when,in its opinion:
(1) the enforcement thereof would do manifest injustice;
(2) the applicant has proved the same degree of protection required under 105 CMR
430.000 can be achieved without strict application of the particular provision(s); and
(3) when insurance is utilized,the applicant has provided written confirmation from the
insurance carrier confirming the continuation of full coverage(s)if the minimum health and
safety provision(s)are varied.
(B) Every request for a variance shall be made in writing and shall state the specific variance
sought and the reasons therefore. Any variance granted by the Board of Health shall be in
writing.Any denial of a variance shall also be in writing and shall contain a brief statement of
the reasons for the denial. A copy of each variance shall be available to the public at all
reasonable hours in the office of the city or town clerk or the office of the Board of Health while
it is in effect. Notice of the grant of each variance shall be filed with the Department.
430.830: Severability
In the event any section of 105 CMR 430.000 is found to be invalid or unconstitutional,the
remaining sections shall not be affected.
REGULATORY AUTHORITY
105 CMR 430.000: M.G.L.c. 111,§§3 and 127A.
7/18/2019 Where are kids getting JUUL? J
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Nome -3 Research and resources-> Where are kids getting JUUL?
NEWS ARTICLE
Where are kids getting JUUL?
May. 29, 2018 I min read
The e-cigarette is marketed as a smoking alternative for adults, but has been
making headlines and prompting crackdowns from the Food and Drug
Administration for the large number of kids who use the product.
The popularity of JUUL among youth has helped the product capture more than half
of the entire e-cigarette market share in just two years. Many are attributing the
product's rise to its sleek design that could be mistaken for a flash drive — which
makes it easy to disguise — and array of available youth-appealing flavors, such as
fruit medley, mango, cool cucumber and creme brulee.
By law, people under the age of 18 (or 21 in some area) should not be able to
purchase any tobacco products, including JUUL. So, how are so many young people
getting their hands on JUUL? Truth InitiativeO surveyed a national sample of more
than 1 ,000 12- to 17-year-olds in April 2018 to find out.
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Youth who had used JUUL in the past 30 days reported that they got the product in
one or more of these ways:
1. Physical retail locations: The most common way youth got JUUL is through
physical retail locations. Nearly three quarters — 74 percent — of youth said that
they obtained JUUL at a store or retail outlet. In recent weeks, the FDA
issued warning letters to retailers, including gas stations, convenience stores and
vape shops, for selling the product to minors. The letters warned establishments
that an FDA inspector observed a clerk selling the device to a minor, and that
"failure to correct these violations may lead to federal enforcement actions,
including monetary penalties."
2. Social sources: Just over half — 52 percent — reported that they received JUUL
from a social source, such as a friend or family member.
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FDA issued its first warning letters about JUUL to retailers, it also announced that it
contacted eBay to express concerns about JUUL product listings. "We're thankful
for eBay's swift action to remove the listings and voluntarily implement new
measures to prevent new listings from being posted to the web retailer's site," FDA
Commissioner Scott Gottlieb said in a statement. However, some JUUL products
are still available on eBay.
The FDA crackdown on JUUL also includes asking the maker, JUUL Labs, to turn
over documents related to marketing, health effects and use among youth. While
recent FDA action is encouraging, problems with tobacco products like JUUL won't
be addressed until the FDA fully regulates e-cigarettes and establishes a strong
pre-market review process to prevent these kinds of products from being sold in the
first place.
Truth Initiative and five other public health and medical groups called on the FDA
to take action on JUUL in April. The groups specified five actions, including removing
certain JUUL flavors, suspending internet sales and prohibiting branded
merchandise.
A Truth Initiative study published in Tobacco Control underscores the problem with
youth use of JUUL. It found that 63 percent of young JUUL users did not know that
the product always contains the addictive chemical nicotine, and that many reported
that use of this product is called "JUULing," indicating that this product is so
distinctive, it is perceived as its own category.
TAGS: e-cigarettes, youth /young adults
TOPIC
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What is JUUL?
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RESEARCH ARTICLE
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May. 21, 2019
NEWS ARTICLE
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6 important things to know about IQOS, the new heated cigarette product
Sign up for our newsle .. .'.%'�; ,,
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Nome a Research and resources> Menthol: Facts,stats and regulations
FACT SHEET
Menthol: Facts, stats and regulations
Aug. 31, 2018 1 7 min read
The chemical compound menthol makes cigarettes easier to smoke and harder to quit.
Menthol creates a cooling effect, reduces the harshness of cigarette smoke and
suppresses coughing. Those effects may make menthol cigarettes more appealing to
young, inexperienced smokers, and research shows that they are more likely to addict
youth.
download report
What Is Menthol?
• Menthol is a chemical compound extracted from peppermint or corn mint plants, or
created synthetically. It reduces the harshness of cigarette smoke due to its
characteristic cooling effects on the mouth and throat. It also suppresses the coughing
reflex, which makes inhaling smoke from cigarettes more tolerable.
• Menthol was first added to cigarettes in the 1920s and 1930s, and became widespread
in the 1950s and 1960s.
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• Current Law prohibits the use of characterizing fLavorings in cigarettes, except for
menthol.
Menthol creates a cooling effect, reduces the
harshness of cigarette smoke and suppresses
coughing. These effects may make menthol cigarettes
more appealing to young, inexperienced smokers.
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Youth (12-17 years old)
Non-menthol
6.3%
4.6%
Menthol
2.5%
2.2%
2004 2014
Young adults (18-25 years old)
Non-menthol
26.9%
Menthol 14.8%
12.9%
14.0%
2004 2014
Adults (26+ years old)
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--- — 13.4%
Menthol 7.8%
7.1 %
2004 2014
Source: National Survey on Drug Use and Health, 2004-2014.
Patterns of Use in the U .S.
• In 2016, 7.26 percent of people aged 12 or older used menthol cigarettes.
• Menthol cigarettes are slowing the reductions in overall cigarette smoking rates. From
2004 to 2014, the decline in cigarette consumption was greater for non-menthol
cigarettes than menthol cigarettes.
o For adult smokers aged 18 and older, there were significant increases in menthol
cigarette use from 2008 to 2014.
o Menthol smoking prevalence now exceeds non-menthol smoking prevalence
among both youth and young adult smokers.
o Youth smokers remain the age group most likely to use menthol cigarettes.
• Among current cigarette smokers (those who have smoked in the past 30 days), 39
percent used menthol cigarettes from 2012 to 2014, compared with 35 percent from
2008 to 2010.
• Menthol cigarette smoking is more prevalent among smokers who are young, female,
part of a sexual minority, or part of a racial or ethnic minority. There is also significant
menthol use among smokers with mental illness.
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Menthol
, cigarette
iw i among current smokers
by age, 2012-2014
Ages 12-17
Ages 18-25
Ages •
Ages •
A g e ' 32.
•
10% 20% 30% 40% 50% 60%
Source: Tobacco control
YOUTH AND YOUNG ADULTS
Menthol cigarettes are disproportionally used by young smokers and may facilitate
addiction.
• Menthol reduces the harshness of cigarette smoke, which may appeal to young,
inexperienced smokers.
• Longitudinal studies show that initiation with menthol cigarettes facilitates progression
to established cigarette use among young smokers.
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menthol cigarette use in 2014.
• In 2014, the prevalence of menthol cigarette use among current cigarette users was
54.5 percent among all high school students and 48.4 percent among all middle school
students.
• A nationally representative study found that, among youth and young adults, non-
menthol cigarette prevalence declined from 2004 to 2010. By contrast, menthol
cigarette prevalence remained constant among youth and increased among young
adults over this period.
• Menthol cigarette use is higher among young adult smokers than older adult smokers.
Among adults surveyed from 2012 to 2014, current smokers aged 18-25 had the
highest prevalence of menthol cigarette use at 50 percent.
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II : 1 i46.
Hispanic
I 1
11 : I 1 30.3
Asian
1
11 : I 1 ,
White
2012-2014 28.9
11 : 1 1 : .
Black
I 1 •
20% 40% 60% 80% 100%
Source: Tobacco control
MINORITY GROUPS
• Most jrican-American youth smokers use menthol cigarettes. From 2008 to 2010,
94.9 percent of African-American youth current smokers used menthol cigarettes.
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•
smokers [aged 18 to 25J was 93.9 percent among Atrican-Americans, compared with
36.3 percent among whites, 47.3 percent among Hispanics and 49.7 percent among
Asian-Americans.
• In 2010, the prevalence of menthol cigarette use among current adult smokers was
36.3 percent among LGBT smokers, compared with 29.3 percent among heterosexual
smokers. This difference was even more pronounced among LGBT female smokers
(42.9 percent) compared with heterosexual female smokers (32.4 percent).
Health Effects
Menthol cigarettes offer no health benefit to smokers, and, in fact, are easier to start
smoking and more difficult to quit than regular cigarettes. Truth Initiative® agrees with
the Tobacco Products Scientific Advisory Committee that menthol cigarettes pose a
threat to public health above and beyond that posed by regular cigarettes.
• Menthol flavoring contributes to addiction in youth smokers.
• There are no health benefits associated with smoking menthol cigarettes, compared
with smoking non-menthol cigarettes.
• Menthol cigarettes are as dangerous to an individual's health as non-menthol
cigarettes, and menthol cigarette smokers are as likely to experience premature
morbidity and mortality as non-menthol cigarette smokers.
• Adult menthol smokers report taking less time to have their first cigarette after waking
than non-menthol smokers. Time to first cigarette is an important measure of nicotine
addiction.
• Scientific evidence indicates that adult menthol smokers are less likely than non-
menthol smokers to successfully quit smoking despite increased quit intentions and
quit attempts. Studies show significantly reduced rates of quitting among African-
American and Hispanic menthol smokers compared with non-menthol smokers.
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Marketing in the U .S.
• Menthol makes up a large portion — 35 percent in 2016 — of the cigarette market in
the U.S.
• The tobacco industry has a well-documented history of developing and marketing
mentholated brands to racial and ethnic minorities and youth.
• Evidence from tobacco industry documents shows that the industry studied smokers'
menthol preferences and manipulated menthol levels to appeal to a variety of
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• A 2011 review found that menthol marketing is higher in publications and venues that
appeal to African-American audiences.
• Numerous studies show targeted marketing of menthol cigarettes at the point of
sale in African- American communities throughout the U.S.
Policy in the U .S.
• The 2009 Family Smoking Prevention and Tobacco Control Act gave the Food and Drug
Administration the authority to regulate tobacco products. The law specifically
prohibits the use of characterizing flavorings in cigarettes, except for menthol.
Nonetheless, it preserves the FDA's regulatory authority to ban menthol.
• Thus far, the FDA's activities on menthol include:
o The TPSAC was required by the Tobacco Control Act to conduct a review of
menthol cigarettes' effect on youth and other vulnerable populations. The
committee published a report in March 2011 , concluding that "the removal of
menthol cigarettes from the marketplaces would benefit public health in the
United States."
■ Lorillard Tobacco Company (now R.J. Reynolds Tobacco Company]
challenged the integrity of the TPSAC in a lawsuit against the FDA, alleging
that several experts the agency appointed to the committee were conflicted
and therefore must be removed. The judge in the case sided with Lorillard
and prohibited the FDA from using the TPSAC menthol report.
■ The FDA appealed, and, in January 2016, the D.C. Circuit reversed the district
court's decision, allowing the agency to rely on the TPSAC menthol report to
take action to regulate menthol tobacco products.
o In July 2013, the FDA published its own report that also concluded that the
removal of menthol cigarettes from the market would improve public health. At
the same time, the FDA requested public comment seeking additional information
to help the agency make informed decisions about menthol in cigarettes.
o Five years later, in March 2018, the FDA again requested public comment on the
role that menthol in tobacco products plays in attracting youth, in the likelihood of
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Tobacco Industry Opposition
At the local, state and national levels, the tobacco industry has worked hard to
undermine government efforts to restrict the availability of menthol tobacco
products.
For example, in June 2017, San Francisco, California, prohibited the sale of all
flavored tobacco products, including menthol. R.J. Reynolds, the maker of Lorillard
cigarettes, formed a campaign, "Let's Be Real San Francisco," and contributed
$10.69 million to repeal the law before it was implemented. On June 5, 2018, 68
percent of San Francisco voters upheld the flavors and menthol ban and the
ordinance went into effect 10 days after the vote was certified.
The industry often cites a concern that menthol bans will lead to a market for
dangerous illicit trade, despite sparse evidence to support that concern. The tobacco
industry has also attempted to spread fear that menthol bans unfairly target African-
Americans and would lead to further criminalization of the community. R.J. Reynolds,
also the maker of the leading menthol cigarette brand Newport, recruited prominent
black leaders, including civil rights activist Rev. Al Sharpton, to host town halls
across the country on the subject. The public health community criticized these
events as deceptive and exploitative.
STATE AND LOCAL POLICIES
While many localities have prohibited flavored tobacco products in some way, most of
these exclude menthol, mint or wintergreen. However, several localities do include
https://truthinitiative.org/research-resources/trad itional-tobacco-prod ucts/menthol-facts-stats-and-regulations 11/20
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• Berkeley, California, prohibits the sale of flavored tobacco products, including menthol,
within 600 feet of schools.
• Chicago, Illinois, prohibits the sale of flavored tobacco products, including menthol,
within 500 feet of any city high school.
• Contra Costa County, California, prohibits the sale of flavored tobacco products,
including menthol, within 1,000 feet of "youth-sensitive places," including public and
private schools, playgrounds, parks and libraries.
• El Cerrito, San Mateo County, Santa Clara and Yolo County, California, prohibit the sale
of flavored tobacco products, including menthol.
• Duluth and Falcon Heights, Minnesota, Los Gatos, Oakland and Palo Alto, California,
prohibit the sale of flavored tobacco products, including menthol, except in adult-only
tobacco stores.
• Minneapolis and St. Paul, Minnesota, prohibit the sale of flavored tobacco products,
including menthol, except in adult-only tobacco stores and liquor stores.
• Despite research showing that menthol cigarettes are easier to start smoking and
harder to quit, only 1 .71 percent of the U.S. population is covered by a menthol
cigarette ban.
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7/18/2019 Menthol:facts,stats and regulations
•
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percent ot tne
U.S.
poputation
is covered by
menthot
cigarette ban,
ESTIMATED EFFECTS OF NATIONAL MENTHOL BAN
• If menthol cigarettes were banned, 38.9 percent of all menthol smokers and 44.5
percent of African-American menthol smokers reported that they would try to quit.
• Among young adult menthol smokers (aged 18-24), 64.6 percent reported that they
would quit smoking and not use any other products if menthol cigarettes were banned.
• If a menthol cigarette ban had gone into effect in 2011, researchers estimate that more
than 320,000 smoking-attributable deaths would be averted by 2050, almost a third of
them among African-Americans.
https://truthinitiative.org/research-resources/traditional-tobacco-products/menthol-facts-stats-and-regulations 13/20
7/18/2019 Menthol:facts,stats and regulations
•
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•
,y
Action Needed : Menthol in Tobacco
Products
Consistent with a vision of a future where tobacco is a thing of the past, Truth
Initiative supports the following policies regarding menthol in tobacco products:
• Given its well-documented appeal to youth, menthol should be eliminated from all
tobacco products, with the limited exception described below.
• The FDA must issue a product standard eliminating menthol as a characterizing
flavor from all tobacco products, particularly cigarettes, cigars and other
combustible tobacco.
• A narrow exception may apply to proven harm-minimized products if a
manufacturer can demonstrate that the harm-minimized menthol product helps
smokers completely switch from combustible tobacco to the product and show that
it does not appeal to or attract a substantial number of youth (verified with careful
post-market surveillance of actual use patterns).
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restricted so that it does not target youth.
These actions are especially urgent because the FDA has repeatedly failed to act,
despite long-standing, overwhelming evidence that a menthol ban would benefit
public health. The agency's decision to issue an additional request for public
comment in March 2018 is further delaying meaningful action. The FDA should
immediately issue a proposed rule to accelerate the process of protecting the public
from menthol tobacco products.
https://truthinitiative.org/research-resources/traditional-tobacco-products/menthol-facts-stats-and-regulations 15/20
INS WING �.
TOBACCO-FREE
LIVES
f
1
r
Percentage of
who smoke and use
cigarettes:
54.5% RI•R•IY 48.4% Nearty
high school middle school
inlO
African-American smokers
aged 12 and older use
menthol cigarettes.
Nearly
of young menthol
smokers
if menthol
- r
cigarettes were banned.
If a menthol cigarette ban had been
enacted in 20111 it could have saved
...a .. , lives by 2050.
7/18/2019 Menthol:facts,stats and regulations
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TAGS: flavors, the truth about
TOPIC
Traditional tobacco products
SUBTOPIC
Menthol
RELATED MATERIALS
Flavors fact sheet
Menthol cigarettes: attitudes, beliefs and policies
More in traditional tobacco products
RESEARCH ARTICLE
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•
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Youth frequently switch between different tobacco products, study finds
REPORT .
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Menthol cigarettes: Attitudes, beliefs and policies
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Comprehensive review provides further proof that FDA should ban menthol
cigarettes
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TAKING AIM AT CONTRACEPTIVE COVERAGE
PERSPECTIVE
Finally, the rules could lead to fective and harmful. Physicians accommodations for coverage of certain
preventive services under the Affordable
further disparities in contraceptive can advocate for their patients Care Act. Final rules. Fed Regist 2018;
care.By returning the cost burden right to make their own repro- Z3( 21)-57s3for Medicare & Medicaid Set-
of contraception to women, they ductive decisions and against „ices(CMS),Department of Health and Hu-
would disproportionately affect the government's attempts to pri- man services.Moral exemptions and accom-
women who are least able to pay oritize the interests of a select Services under coveragethe of certain
trainCar preventive
for contraception,including young group of businesses over women's Final
rules.Fed Regist 2018;83(221):57592-631.
women, poor women,and women health. 3. Finer LB,Zoina MR.Declines in umn-
Of color. Disclosure forms provided by the authors tended pregnancy in the United States,
are available at NEJM.org. 2008 2011.N Engl J Med 2016;374:843-52.
Eroding the ACA's contracep- 4. Snyder AH,Weisman CS,Liu G,Leslie D,
tive mandate is just one Of several From the Division of General Internal Medi- Chuang CH.The impact of the Affordable
attacks the Trump administration cine,Department of Medicine(C.H.C.),the Care Act on contraceptive use and costs
Department of Public Health Sciences among privately insured women.Womens
is waging on family planning. In (C_H.C., C.S.W.), and the Department of Health Issues 2018;28:219-23.
addition to threatening to limit Obstetrics and Gynecology(C.H.C.,C.S.W.), 5. Rosenbaum S,Wood S,Strasser J,Sharac
Title X funding, the Penn State College of Medicine,Hershey,PA. J,Wylie J,Tran T C.The Title X family plan-
An audio interview ning proposed rule:what's at stake for com-
with Dr.Chuang I administration Sup- This article was published on January 30, munity health centers?Health Affairs Slog.
is available at NEJM.org Pow Programs that 2019,at NEJM.org. June 25,2018(https:llwwwhealthaffairs.orgl
promote abstinence do110.1377)hblog20180621.6757641fullp.
1. Centers for Medicare & Medicaid Ser-
until marriage,despite overwhelm- vices(CMS),Department of Health and Hu- DOI,10.10561NEJMp1815738
ing evidence that they are inef- man Services. Religious exemptions and copystght m 2o19 Masrachuutts Medical Society.
The FDA's Proposed Ban on Menthol Cigarettes
Keith Wailoo, Ph.D.
n November 2018, the Food and menthol-flavored cigarettes dates cultivating along lines of sex, race,
Drug Administration(FDA) pro- back to June 2009,when President age, and economic status, even as
posed issuing a ban on menthol- Barack Obama signed into law the Congress enacted broad reforms.
flavored cigarettes, which, noted Family Smoking Prevention and Just as Philip Morris built Marl-
FDA Commissioner Scott Gottlieb, Tobacco Control Act. The law boro's working-class masculine
"represent one of the most com- granted the agency new powers image, and Virginia Slims brand-
mon and pernicious routes by to regulate tobacco products and ed itself with appeals to women,
which kids initiate on combusti- banned almost all flavored tobac- Brown &Williamson pitched the
ble cigarettes" and "disproportion- co products, which were known mentholated Kools to black smok
ately and adversely affect under- to entice young people to begin ers in the 1960s,while RJ•Reyn-
served communities.i'The tobacco smoking.But menthols won a re- olds aimed its Salem mild men-
industry responded that the pro- prieve. Instead of an immediate thoss at women. These appeals,
posal lacked scientific justifica- ban, the law created the FDA's which the industry nurtured
tion and predicted that it would Tobacco Products Scientific Advi- through advertising and support
not withstand a court challenge. sory Committee(TPSAC) to study for community and civic causes,
The battle over banning menthols "the impact of the use of men- proved highly effective in attract-
is not new. But the announce- thol in cigarettes on the public ing women and black people as
groups
ment marks a new chapter in a health, including such use among customers; today, those g P
decades-long debate over the sci- children, African-Americans, His- remain more likely than other
ence of menthol and addiction, panics, and other racial and eth- smokers to smoke menthols.
the public health costs, the mar- nie minorities," and to make rec- in n heals hm cigarettes ers, the has et-
keting practices of tobacco com- ommendations? g
panies, the politics of tobacco The menthol exemption reflect ways walked a dangerous line be-
control in vulnerable populations, ed the tobacco industry's power to tween shrewd and deceitful. Long
and the FDA's authority. protect its lucrative menthol mar- before the FDA's involvement, fed-
The FDA's jurisdiction over ket, which it had spent decades eral regulators struggled to rein
N ENGIJ MEO 380;11 NE)M.ORG MARCH 14,2019
995
FDA'S PROPOSED BAN ON MENTHOL CIGARETTES
PERSPECTIVE
scheme for tobacco products[that]
4o squarely rejected proposals to give
the FDA jurisdiction." Without
ss federal legislation, then, the FDA
30 -� -m a.� could not regulate cigarettes or
00 2s nicotine, let alone menthol.
20 Even after the industry admit
w 15 led that smoking posed enormous
m ao disease risks in the 1998 Master
Settlement Agreement and abid-
V 5
ed by the agreement's ban on
0
1�yy3�y�� ���fi�11�1A�,° '' ,
1� �`s� °�ya°'�'A�ryo°yryryo°ry��ry�~ryn�e cigarette-ad billboards, it cont>n-
ued forcefully defending nicotine
and menthol. When critics mar-
Menthol Cigarettes as a Percentage of the Total Cigarette Market,1950-2U16. shaled evidence that menthol
in the promotion of menthols.In rise of urban billboards, and the cigarettes resulted in deeper in-
1942, for example, the Federal crafty use of gender and ethnic halation, made quitting more dif-
Trade Commission ordered Brown imagery as particularly egregious ficult, and were disproportionate-
& Williamson to "cease and de- examples of industry tactics. Yet ly used by minorities,the industry
sist" from trying to link its prod- the companies pushed forward. insisted that menthol did not in-
uct to health by claiming that In 1990, R.J. Reynolds announced crease the dangers of smoking.
"doctors know the beneficial head- that Uptown, a new menthol- The FDA's marginal role in
clearing quality of menthoLn3 By heavy brand, would be test-mar- these debates changed dramati-
the time such explicit campaigns keted primarily in black neighbor- cally in June 2009, when an em-
were ended, the industry had hoods in Philadelphia, provoking boldened Democratic majority in
created enduring associations be- a fierce backlash. Louis Sullivan, Congress, led by Representative
tween menthol and health, and Secretary of Health and Human Henry Waxman (D-CA), passed
menthol-cigarette consumption Services under President George comprehensive legislation regular
continued to increase even after H.W. Bush, labeled the company ing the tobacco industry, grant-
the Surgeon General's report on "slick and sinister,"joining grass- ing the FDA the regulatory author-
smoking was issued in 1964 and roots activists in denouncing the ity it had long sought,and banning
after Congress banned television scheme.'The backlash halted Up- flavored cigarettes.
and radio advertising of cigarettes town's rollout and fueled calls for But menthol, the most popu-
in 1970. By the 1980s, menthol- banning all menthol cigarettes. lar flavor for cigarettes, was ex-
igarettes represented These battles increased pres- cluded from the ban. Big Tobac-
flavore c of the total market, a sure on officials to regulate to- co's strategy of supporting civic
nearly 300/6 d
level that has held steady through bacco, a goal that often tran- causes, organizations, cultural
recent decades (see graph). scended party lines. Tobacco events, and politicians — espe-
In the 1990s, public and legal products had long been shielded cially in the black community—
scrutiny of menthol intensified, from FDA oversight, but David had worked well. In 2009, the
thanks to lawsuits brought against Kessler, FDA commissioner under Congressional Black Caucus was
cigarette companies by private lit President George H.W. Bush and split on a menthol ban, with
igants, state attorneys general, President Bill Clinton, sought to long-time beneficiaries of indus-
and the U.S. Department of Jus- classify nicotine as a drug in or- try dollars opposing a ban and
tice. The cases highlighted the der to assert FDA authority over other caucus members deeply
industry's history of denying links tobacco products. In response, concerned about protecting the
between smoking and cancer and the industry launched a vigorous health of the black community.
other diseases, as well as its defense of its multibillion-dollar Waxman, the law's chief archi-
methods of targeting customers product. After years of litigation, tect, said he could not afford to
on the basis of their age, class, the Supreme Court sided with in- lose any members of the caucus.
and race. Critics saw the use of dustry, affirming that Congress "Congress punted the question
the cartoon figure Joe Camel,the had"created a distinct regulatory of a menthol ban to the FDA,"
996 N ENGLJ MED 380;11 NE)M.ORG MARCH 14,2019
FDA's PROPOSED BAN ON MENTHOL CIGARETTES
PERSPECTIVE
Waxman recently noted. Menthol winding, and uncertain. Oppo- and e-cigarettes, will also hinge
remained legal, pending review nents worry that a ban would on the history of marketing —
by the newly created TPSAC. create a black market for men- how companies have used these
In referring the issue to the thol cigarettes and profound dif- products to encourage blacks,
FDA,Congress set the stage for a ficulties in enforcement; propo- women,and young people to take
decade of litigation. In 2011, the nents insist that the science and up a behavior with serious pub-
TPSAC determined that evidence the law are on their side and that lic health consequences.
suggested that "removal of men- the public health benefits are Disclosure forms provided by the author
thol from the marketplace would overwhelming. Bans or restric-
are available at NEJM.org.
benefit public health in the Unit tions have been instituted in From the Woodrow Wilson School of Public
ed States" but made no recom- Canada and in several U.S. cities, and International Affairs,Princeton Univer-
mendations about banning prod- including Somerville, Massachu- city,Princeton,NJ.
ucts s Tobacco companies quickly setts, and San Francisco. New This article was published on February 20,
challenged the committee's legiti- York's City Council recently be- 2019,at NEJM.org.
macy, charging that some of its gan hearings on a ban. With bil- 1. Gottlieb S. statement from FDA com-
members harbored conflicts of lions of dollars at stake, it may missioner
Sc tt Gottlieb,tect .D.,on proposed
a
interest. In 2014, a U.S. District take years of litigation for Gott new steps to flavored tobacco products and ban-
Court agreed, but in 2016, a fed- lieb's promise of better health to ning menthol in cigarettes. Silver Spring,
eral appeals court overturned this be realized. MD:Food and Drug Administration,Novem-
ruling.For the next 2 years, how- The questions surrounding ber 15,2018(https:llwKw.f&gov1Ne''sEvents1
Newsroom lPressAnn ouncements)UCM625884
ever, the FDA was reluctant to act menthol are intertwined with ht.),
on menthol. the agency's decisions regarding 2. Family Smoking Prevention and Tobacco
Control Act,Pub.L. No. 111-31, 123 Stat.
Now, nearing the loth anni- e-cigarettes. Although the indus- 1804(e)(1)(ilith conga(https:11wwvvgovinf0
versary of the 2009 legislation, try argues that there's no scien- Aeontentlpkg/PLAW-Ilipubi3llht nlIPLAW
Gottlieb seems poised to act, tific evidence that menthol is haz- -illpubl3l.htm).
though the agency has yet to take ardous or addictive, the health 3. Brown&williamson Tobacco Corpora-
tion.Stipulation as to the Facts and Agreement
the next crucial step by propos- effects of menthol smoking are to cease and Desist,file no.1-14737.1942
ing the new rule. To date, no worrisome; similar concerns sur- May 22. Brown & Williamson Records:
Minnesota Documents(https:llwww.industry
hearings on banning combustible round e-cigarettes. As the case is documentstibrary.ucsfeduftobaccoldocsl
menthol tobacco products have made against menthols, the scien- mrdc0136).
been scheduled.The industry has tific issues will be extensively de- Jan Quinn
ary M.
90(aimtictpack at t htne oml
responded to the proposal with a bated: the likelihood of increased time)magazine(arti(htt :licon6 nt.tim.corn/
familiar tactic: claiming that sci- addiction, the question of added 5. Food and Drug Administration.Prelimi-
ence does not support such a ban difficulty in quitting smoking, nary scientific evaluation of the possible
and the health consequences of public health effects of menthol versus
and threatening litigation. nonmenthol cigarettes(https:ljwww.fda.govl
If the past is prologue, any deep inhalation. But the regula- dowraoadslucm361598.pdf).
path to removing menthol ciga- tory debates and legal challenges DOI;10.1056JNEJMp1900204
rettes from shelves will be long, to come, regarding both menthol Copyright D 2oi9Massachaseas Medical Society.
When Sparks Fly — Or How Birding Beat My Burnout
Joshua Schor, M.D.
" little more than a year ago, I the tragic disappearance of hob- my cognition and stave off other
1. ---,.took up binding as a hobby. bies from young people's lives, erosions by a few more years.
As a child and into my 20s, I though given that I'm approach- What I've.discovered is that a tiny
built model airplanes, shot rifles ing 60,my adoption of a new hob- part of me that long reveled in
(don't ask),and chased the planets. by won't really move the needle making a "great diagnosis" was
Since that time, I have not had a for the young. Nevertheless, I burning out, and birding has
bona fide hobby.I have read about thought maybe it would preserve helped me have some fun again.
N ENGLJ MED 380;11 NE)M.ORG MARCH 14,2019 997
7/18/2019 Tobacco and E-Cigarette Lobbyists Circle as F.D.A.Chief Exits-The New York Times
Zhe New York&MC0
Tobacco and E-Cigarette Lobbyists Circle as
F.D.A. Chief Exits
By Sheila Kaplan and Matt Richtel
March 15, 2019
Dr. Scott Gottlieb became commissioner of the Food and Drug Administration in 2017 with
an ambitious plan to reduce cigarette smoking, a habit that kills nearly half a million
Americans each year, by shifting smokers to less harmful alternatives like e-cigarettes.
But he was quickly embroiled in an unexpected crisis: the explosion of vaping among
millions of middle and high school students, many of whom were getting addicted to
nicotine.
Dr. Gottlieb will depart at the end of this month, following his sudden announcement last
week that he would resign, with his plans to toughen regulation of both vaping and smoking
unfinished and powerful lobbying forces quietly celebrating the exit of a politically canny
administrator who aggressively wielded his regulatory powers.
Opponents are already swooping in, making their case to Congress and reaching out to the
White House. A coalition of conservative organizations that oppose government
intervention in the marketplace has harshly criticized Dr. Gottlieb's crackdown on e-
cigarettes. Retailers, including convenience store and gas station owners, are on Capitol Hill
lobbying against guidelines Dr. Gottlieb proposed on Wednesday to restrict sales of most
flavored e-cigarettes to separate adult-only areas and to require age verification of
customers.
And major tobacco companies are likely to seize on his departure to try to scuttle his long-
term plans to lower nicotine levels in cigarettes to nonaddictive levels and to ban menthol
cigarettes, which make up more than a third of the cigarette market and dominate sales to
African-Americans. Some longtime officials inside the F.D.A. said privately that they fear
these ideas could be delayed indefinitely.
"There have been well-intentioned commissioners before Gottlieb," said Jonathan Havens, a
former F.D.A. tobacco lawyer now in private practice. "But they were not as good at
capturing the attention of the nation, of the stakeholders. I think that momentum could very
well stall on some of these products, or be lost completely."
https://www.nytimes.com/2019/03/15/health/tobacco-e-cigarettes-lobbying-fda.html 1/7
7/18/2019 Tobacco and E-Cigarette Lobbyists Circle as F.D.A.Chief Exits-The New York Times
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This pivotal moment in regulation of smoking and vaping comes just months after Altria,
maker of Marlboro cigarettes and the nation's largest tobacco company, with a market value
of $100 billion, bought a 35 percent stake in Juul, the nation's dominant vaping company
whose valuation soared on the investment to $38 billion.
Juul's alliance with Altria has given it access to a far more muscular, experienced political
player. Altria gave $500,000 to Mr. Trump's inaugural committee, and spent more than $10
million on lobbying last year, according to the Center for Responsive Politics.
Dr. Gottlieb has expressed anger that Juul and Altria were negotiating their financial deal in
secret, while each was making promises to the F.D.A. that he believes the deal broke. The
investment in Juul means that Altria, with net sales of cigarettes and other products last
year amounting to $25.4 billion, is now selling flavored e-cigarettes, which it had told the
F.D.A. it would stop doing, he said.
"Proponents of vaping, who support these companies," he said in an interview, "ought to
realize just how much these companies are putting their short-term business objectives
ahead of any long-term goals for these technologies to be effective tools for adult smokers."
The question is whether Dr. Gottlieb's successor will continue his policies and enforce them.
On Tuesday, Dr. Norman E. "Ned" Sharpless, director of the National Cancer Institute, was
named to replace him in an acting capacity and is in the running to succeed him
permanently.
Dr. Gottlieb supports Dr. Sharpless, who said he would continue his predecessor's policies.
Alex M. Azar II, secretary of health and human services, said in a statement Wednesday
that the administration backs closing off children's access to e-cigarettes, while making
them available to adult smokers trying to quit.
https://www.nytimes.com/2019/03/15/health/tobacco-e-cigarettes-lobbying-fda.html 2/7
7/18/2019 Tobacco and E-Cigarette Lobbyists Circle as F.D.A.Chief Exits-The New York Times
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"I'm hearing from people who are gleeful that he's gone," Liz Mair, a Republican political
consultant who founded Vapers United, a group that supports vaping as a tool to stop
smoking, said of Dr. Gottlieb. "I think people who are doing a victory lap right now better
watch and see what direction things are moving in. It's not, `Oh, the vaper wars have been
won: I wouldn't bank on that."
Dr. Gottlieb's decision to leave just as his regulatory efforts on e-cigarettes were coming to
fruition has set off speculation that he had lost favor within the administration. Dr. Gottlieb
denied that, noting that the administration's budget includes his request for the e-cigarette
industry to pay fees, estimated at $100 million, that would primarily go toward enforcing
limits on flavored e-cigarettes to protect teenagers. "What that tells you is I got broad buy-in
into that," he said in an interview.
When he became commissioner in May 2017, his goal was to move smokers to less harmful
alternatives, such as e-cigarettes. That July, he allowed e-cigarette companies to keep their
vaping devices and nicotine pods on the market for an extra four years before they would
have to prove their products would benefit public health.
https://www.nytimes.com/2019/03/15/health/tobacco-e-cigarettes-lobbying-fda.html 317
7/18/2019 Tobacco and E-Cigarette Lobbyists Circle as F.D.A.Chief Exits-The New York Times
During that time, the F.D.A. also sought to limit nicotine in cigarettes to encourage smokers
to switch to vaping. But his original plan grew untenable as evidence of Juul's popularity
with teenagers mounted.
In an interview, he recalled the morning in August 2018 when Mitch Zeller, the director of
the agency's tobacco control unit, brought him the bad news: Vaping was up 78 percent
among high school students and 48 percent among middle school students, with 3.6 million
youths reporting they had used e-cigarettes, according to the 2018 National Tobacco Youth
Survey.
A few weeks later, Dr. Gottlieb called youth vaping an epidemic, and gave e-cigarette
makers 60 days to show how they would curb youth vaping, or risk having their products
pulled from the shelves. Juul pulled mango, creme and other flavors off the shelves but
continued to sell them on line.
The conservative leaders now fighting restrictions on flavored e-cigarettes include Grover
Norquist's anti-tax group, Americans for Tax Reform, the R Street Institute and the
American Legislative Exchange Council Action, a nonprofit. In a letter dated Feb. 4, a
coalition of these and 13 other groups urged President Trump to "halt the Food and Drug
Administration's aggressive regulatory assault on businesses who sell and consumers who
rely on less harmful alternatives to cigarettes in the United States."
Both Juul and Altria say they had nothing to do with this message to the president. But in
recent years, both companies have donated to Mr. Norquist's group and to some of the other
groups that signed the letter.
In 2017, Altria made contributions to the Goldwater Institute, the Rio Grande Foundation,
the R Street Institute, and the Independent Women's Forum, as well as Mr. Norquist's
group, according to an Altria annual philanthropy report that did not specify the amounts.
And Juul confirmed its contributions to Mr. Norquist's group, the R Street Institute, where
Tevi Troy, Juul's vice president of public policy, and a friend of Dr. Gottlieb's, was once a
board member, and to ALEC Action. Juul declined to disclose the size of its donations.
Joshua Raffel, a spokesman for Juul, said the company had not asked the conservative
coalition to write to the White House, but he acknowledged that one of the company's
lobbyists or consultants might have discussed it with the organizations involved. Juul
spokesman, Matt David, said the company backs the restrictions on sales in convenience
stores.
"We need category-wide action to further combat youth usage of all e-vapor products," he
said. That includes, Juul said, requiring the age restriction for tobacco and e-cigarette sales
to be raised nationwide to 21, a legislative proposal that Dr. Gottlieb has supported.
https://www.nytimes.com/2019/03/15/health/tobacco-e-cigarettes-lobbying-fda.html 4/7
7/18/2019 Tobacco and E-Cigarette Lobbyists Circle as F.D.A.Chief Exits-The New York Times
Public heath advocates remain dubious about Juul's commitment to curbing teenage use,
with some saying the company wants to have it both ways: supporting groups that oppose
restrictions on teenage access, while waging a public-relations campaign that it never
intended youths to use its product.
Juul has also been ramping up its lobbying operation and political contributions. In 2018, it
reported donations to the Democratic and Republican attorneys general associations, the
Democratic and Republican governors associations, and other federal and state political
committees. Juul's political action committee and affiliated individuals also gave a total of
$215,000 to federal candidates and their committees, according to the Center for Responsive
Politics. Juul spent more than $1.6 million on lobbying last year, the center noted.
Altria
now
IF
n
moo
z
h
N. w
Altria's Center for Research and Technology in Richmond,Va.Altria bought a 35 percent stake in Juul last year.
Khue Bui for The New York Times
For years, the tobacco industry has come under fire for marketing cigarettes, especially
menthol cigarettes, to African-American communities. Juul appears to be trying to court
various groups — perhaps to promote its menthol-flavored e-cigarettes — with various
https://www.nytimes.com/2019/03/15/health/tobacco-e-cigarettes-lobbying-fda.html 5/7
7/18/2019 Tobacco and E-Cigarette Lobbyists Circle as F.D.A.Chief Exits-The New York Times
donations. The San Francisco-based company has contributed to the Congressional Black
Caucus Foundation, and the National Newspaper Publishers Association, a trade group for
African-American owned community newspapers.
The company has also retained lobbyist Chaka Burgess, co-managing partner of the Empire
Consulting Group who serves on the governing boards of the black caucus' foundation and
the caucus' political action committee, and on that of the NAACP Foundation.
Juul has also announced a partnership with the Black Mental Health Alliance, although it
declined to give details, as did the alliance. The vaping company said its $35,000 donation to
the black caucus' foundation involved buying a table at an event.
Taking another page from the Big Tobacco playbook, Juul also started JLI Science, a
website showcasing Juul-funded research on electronic nicotine delivery system products.
The Centre for Substance Use Research, based in Glasgow, Scotland, conducted several
studies now listed on the site, including one that says adolescents who had never used an e-
cigarette had very low interest in using one in any of Juul's eight flavors, and another that
concluded most adolescents had never heard of Juul.
Representative Diana DeGette, a Democrat from Colorado who now heads a House
subcommittee that oversees the F.D.A., said she favors banning the sale of all flavored e-
cigarettes. She also said in an interview that she plans to demand marketing documents
that Juul submitted to the F.D.A., which has been investigating whether the company
deliberately targeted youths.
Senator Charles Schumer, Democrat of New York, said on Sunday in an interview that he
would press Dr. Gottlieb's replacement to follow through on restricting sales of flavored e-
cigarettes.
Dr. Gottlieb had planned to ultimately force tobacco companies to cut nicotine to
nonaddictive levels, and said in interviews that he believed he had the authority as F.D.A.
commissioner to issue such a policy, despite profound cigarette-industry opposition to
cutting the ingredient that makes smokers crave their next smoke.
Altria last year told the F.D.A. that it would oppose any effort to reduce nicotine levels in
cigarettes, and disputed the agency's authority to do so. And it maintains two websites that
cranked out thousands of virtually identical letters to the F.D.A. against nicotine reduction,
signed by smokers.
Dr. Gottlieb had also suggested pursuing a ban on menthol cigarettes, and said that the
F.D.A. is now developing that rule, which would need to win White House approval.
https://www.nytimes.com/2019/03/15/health/tobacco-e-cigarettes-lobbying-fda.html 6/7
7/18/2019 Tobacco and E-Cigarette Lobbyists Circle as F.D.A.Chief Exits-The New York Times
In comments on its website, Altria contends that a ban on menthol would damage public tax
revenues generated by cigarette sales and lead to illegal black markets.
The American Lung Association often cites a study indicating that more than three-quarters
of African-American cigarette smokers said they prefer menthol cigarettes, compared to
less than a quarter of white smokers. Menthol cigarettes make up 35 to 40 percent of the
market in the United States, according to the Centers for Disease Control and Prevention.
Asked if this effort would continue without Dr. Gottlieb's leadership, a spokeswoman for
H.H.S. declined to comment, but sent links to previous statements in support of the F.D.A:s
tobacco plans.
Dr. Gottlieb has acknowledged it would take years to move a proposed menthol ban forward.
"Big tobacco companies will want to educate whoever takes that position," said Marc
Scheineson, a lawyer who works with smaller tobacco companies. He said that these groups
would inevitably try to reverse any move toward a menthol ban, which he called "a Scott
Gottlieb priority."
"He was definitely running this train," Mr. Scheineson said.
A version of this article appears in print on March 16, 2019,Section A, Page 1 of the New York edition with the headline:Tobacco Lobby Seizes
Opening In Exit at F.D.A.
READ 33 COMMENTS
https://www.nytimes.com/2019/03/15/health/tobacco-e-cigarettes-lobbying-fda.html 7/7
Let's level the playing field - H.1902!
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MGH Division of General Academic Pediatrics Jonathan P.Winickoff,M.D.,M.P.H.
125 Nashua Street,Suite 860 t-T Professor of Pediatrics
Boston,MA 02114
Tel:617-724-1062/Fax:617-726-1886 MassGeneral Hospital
Email:jwinickoff@mgh.harvard.edu for Children"
To the Esteemed Members of the Massachusetts House of Representatives,
RE: H.1902 (Rep Gregoire and others)An Act Regulating Flavored Tobacco Products
I am a pediatrician at Massachusetts General Hospital for Children in the Pediatric Group Practice
and Professor of Pediatrics at Harvard Medical School. I'm honored to care for many children across Y
the Commonwealth in my practice—most reside in Boston(Beacon Hill, Dorchester, Southie, East
Boston,Jamaica Plain,Back Bay, Charlestown), Chelsea,Revere, Somerville, Cambridge, and
Brookline. But I have patients from as far away as Belmont, Springfield, Lowell, Lawrence,
Andover,Newburyport,and Quincy. My expertise and training includes neurobiology, statistics,
behavioral theory, and tobacco control. My academic credentials in tobacco are summarized in a
footnote at the end of this letter. I write in support of H.1902 which would have a profound benefit
for the health of children and fellow residents across the Commonwealth.
All major health groups including the American Heart Association,American Cancer Society,
American Lung Association,American Academy of Pediatrics,American Medical Association,
Mass Medical Society, and The Tobacco Free Mass Coalition support banning flavored tobacco
including mint and menthol.It is also supported by the Attorney General of Massachusetts,
Maura Healey.
Eliminating sales of flavored tobacco is a necessary move at this critical time given the 78%
rise of adolescent electronic cigarette use in the past year and the reversal of decades of
progress in tobacco control. Unfortunately,Massachusetts is now the 8th worst state in the
country in terms of high school use of electronic cigarettes.Every day in my clinical practice, I
have patients who I've known for years coming in with nicotine addiction due to JUUL and other
flavored e-cigarettes. We were down to single digits of tobacco use in Massachusetts. Now every
teenager I treat is either using JUUL or has friends who currently use.Although 20%of high
school students are current users of e-cigarettes(YRBSS 2018 survey data),the rate in higher socio-
economic towns tends to be even higher because the kids have more money to spend on their pods.
Kids who use electronic cigarettes are over three times more likely to transition to combusted
tobacco. For the first time in recent years,the combusted tobacco use rate is increasing in
adolescents.Those who graduate to combusted tobacco often use mint and menthol products
because it acts as an anesthetic, allowing the toxins to be inhaled more deeply so that kids can
overcome their natural aversion to tobacco smoke.
Flavored cigarettes were banned by the Federal Government in 2009. The tobacco industry was
able to exempt menthol flavoring and non-cigarette tobacco products through intense lobbying
efforts.Menthol products have directly targeted African-American/black population through
advertisements. H.1902 closes this loophole. The tobacco industry needs menthol and mint in their
MGH Division of General Academic Pediatrics Jonathan P.Winickoff,M.D.,M.P.H.
125 Nashua Street,Suite 860 Professor of Pediatrics
Boston,MA 02114
Tel:617-724-1062/Fax:617-726-1886 MassGeneral Hospital
Email:jwinickoff@mgh.harvard.edu for Children"
products to get the next generation hooked on tobacco. That is why they are fighting so hard against
it Over half of adolescent smokers 12-17 years of age use menthol cigarettes(references 1-3).
Menthol is extremely dangerous given its ability to invoke a deep inhalation and increase addiction
(4-10). Nearly 95%of tobacco product users start before the age of 21. Over 85% of user say that
flavors are the reason they started using tobacco products.The use of e-cigarettes can cause
anxiety, depression,mood disorders,asthma, impacts brain development,may cause cancer,
and can alter the reward pathways of the brain to potentiate addiction to combusted tobacco
and other drugs. (National Academy of Sciences, Surgeon General Report on E-cig, and
NEJM)
Based on the Youth Risk Behavior Surveillance System Data,tens of thousands of kids are
initiating tobacco use in our Commonwealth each year,the majority initiating with flavored e-
cigarette products.Among adolescents who used e-cigarettes daily at some time in the past.
97% will still be using currently. Based on this data,from our own high schools,e-cigarettes
appear to be more difficult to quit than traditional cigarettes.As one example,the level of
nicotine in flavored JUUL products has tested at three times the limit of what is legal in the UK
and the European Union. (Tobacco Control 2019,NEJM 2019)Adolescents who use as little as
half a pod are becoming addicted.
By shutting down the flavors,this bill protects a large proportion of these kids.Nothing works 100%
but each measure the MA House of Representatives takes can be a piece of the solution.As we saw
with raising the tobacco sales age to 21,kids are most sensitive to what is advertised and for sale in
local retail stores. Even a single town's actions can have a big effect on tobacco use even when other
surrounding neighbors take more time to act. When Needham became the first town to raise the age
to 21,they saw a 47%reduction in teen tobacco use in their high school. Kids who are not addicted
will typically not travel to purchase product—most don't even drive. Studies now show that over
60%of kids get their flavored tobacco products from retail stores or from older friends who get them
from retail stores. It is this social sourcing from older friends who can buy from retail stores that
makes the elimination of flavors from the retail environment so important. Flavored tobacco is
simply too addictive and dangerous to be available in this environment. The MA DPH has run
compliance checks over the past 4 years and the failure rate is abysmal across our state. It only
takes a single store selling to known 18 or 19-year old high school seniors to supply product for
an entire high school. You may hear from industry groups that MA retailers have a better
compliance rate in some communities according to the FDA. FDA compliance checks are done
with children from different areas, as young as 14 and a maximum age of 17.The MA DPH
compliance checks use those who are 18-20 who are a better match for our state age of sale of
21.As part of H.1902,tobacco companies will not be able to sell flavored tobacco products
online in MA. (According to Attorney General Healey's Office—Personal Communication)
In Massachusetts the rate of those who started to use eCigarettes as adolescents is at least 10
times higher than those who started as adults. (NYTS and BRFSS 2018)If it sounds like the kids
MGH Division of General Academic Pediatrics Jonathan P.Winickoff,M.D.,M.P.H.
125 Nashua Street,Suite 860 Professor of Pediatrics
Boston,MA 02114
Tel:617-724-1062/Fax:617-726-1886 MassGeneral Hospital
Email:jwinickoff@mgh.harvard.edu for Children—
are the targets for JUUL and other flavored tobacco, its because they are. Adults who are trying to
quit, tobacco-have many evidence-hased options for quitting tobacco use FDA approved
nicotine replacement gum and patch quadruple the chances of cessation. Other FDA approved
medications when used in combination can achieve even higher cessation rates(Treating
Tobacco Use and Dependence Guideline 2008)A recent NEJM article demonstrated that when
adults try to quit smoking using e-cigarettes, 19% quit successfully but 80%of those who quit
remain addicted to electronic cigarettes a year later. In that same study 10%of smokers quit
using approved nicotine replacement medicine, but only 10%of them were still using the approved
nicotine product one year later. FDA approved nicotine patch and gum was 2.5 times more
effective than a-cigs at helping smokers get off all nicotine and tobacco products.The electronic
cigarette is a dream come true for the tobacco industry because they are so addictive. Most people
who try to quit using eCigarettes end up using BOTH products,generating two income streams
for the tobacco companies. Partly because of the perpetuation of addiction and partly because of the
unsafe nature of the products,the FDA has not approved e-cigarettes as a cessation device. As part
of H.1902, adults who may want to try e-cigs as a last resort to get off of traditional cigarettes
would still be able to buy tobacco flavored e-cigarettes.There is no evidence that tobacco
flavor e-cigarettes wouldn't work for adults trying to get off combusted tobacco cigarettes—
after all,smokers are already used to smoking tobacco.Luckily,kids who have never smoked
tobacco find tobacco flavor repulsive. H.1902 does not ban e-cigarettes,it restricts them and all
other tobacco products so that they cannot have the mint, menthol, and other flavors that
appeal to kids.
Historically,the tobacco industry added mint and menthol flavor to help get Black smoking rates
higher in the 1960's because they lagged behind the White smoking rate. In a nationally
representative study,the majority of Whites want mint and menthol banned from tobacco products.
However,an even larger majority of Blacks want mint and menthol banned than Whites. (AM
J Prev Med)
My interest in H.1902 is strictly as a volunteer with the public health of Massachusetts and children
at heart. I hope that this letter will help set the record straight on the benefits to Massachusetts of H.
1902. Please feel free to call or text with any questions or if you would like to meet to discuss any
scientific questions related to H.1902. Cell: 617-530-0575
Sincerely,
H� P. 49'-6�
Jonathan P. Wmickoff MD, MPH
Academic Credentials:In addition to over 100 peer-reviewed original research publications in tobacco,I've drafted
tobacco control policy and served as a scientific advisor for the CDC Communities Putting Prevention to Work,
Massachusetts Tobacco Control Program,Indiana Tobacco Control Program,Head Start,WIC,the Food and Drug
MGH Division of General Academic Pediatrics Jonathan P.Winickoff,M.D.,M.P.H.
125 Nashua Street,Suite 860 Professor of Pediatrics
Boston,MA 02114
Tel:617-724-1062/Fax:617-726-1886 MassGeneral Hospital
Email:jwinickoff@mgh.harvard.edu for Children'"
Administration,Department of Housing and Urban Development,the National Academy of Medicine,and the U.S.
Surgeon General through the Interagency Committee on Smoking and Health. I've received numerous awards including
the 1!1 1S Secretary's*ward fbi Distingmished Service fbi "pr oteeting the health of the United States public,"and the
2011 Academic Pediatric Association Health Policy Award for cumulative public policy and advocacy efforts that have
improved the health and well-being of infants,children,and adolescents.I participated in research that helped support
the creation of smokefree public housing in the city Boston,the state of Maine,and facilitated HUD's successful national
effort to make all public housing buildings smokefree in 2018.Recently,in four research papers,I studied raising the
tobacco sales age to 21 and co-founded a volunteer campaign to help communities raise the age to 21.As of April 2019,
over 450 communities as well as NYC,Kansas City,Cleveland,and the states of Hawaii,California,Massachusetts,
Oregon,New Jersey,Maine,Virginia,Washington,Illinois,Utah,and Arkansas have raised their age of sale to 21—
covering over 40%of the United States population.Currently,I've been researching electronic nicotine delivery systems
and volunteering with the Massachusetts Attorney General's Office and others across the country to combat the epidemic
of JUULing and eCig use in youth.
References
1.United States Department of Health and Human Services.Substance Abuse and Mental Health Services
Administration(SAMHSA).Center for Behavioral Health Statistics and Quality.National Survey on Drug Use and
Health,2016.Analysis run on October 12,2018.SAMHSA's public online data analysis system(PDAS).(Original Data
Source:NSDUH 2O16)
2.Substance Abuse and Mental Health Services Administration(SAMHSA).The NSDUH Report:Recent Trends in
Menthol Cigarette Use.Rockville,MD:U.S.Department of Health and Human Services,Substance Abuse and Mental
Health Services Administration,Center for Behavioral Health Statistics and Quality;2011.
3.Substance Abuse and Mental Health Services Administration(SAMHSA).National Survey on Drug Use and Health,
2014. [Public Use Data File].ICPSR36361-v1.Ann Arbor,MI: Inter-university Consortium for Political and Social
Research[distributor],2016-03-22.
4.Harris B.Menthol:A review of its thermoreceptor interactions and their therapeutic applications.International Journal
of Aromatherapy.2006;16(34):117-131.
5.Galeotti N,Di Cesare Mannelli L,Mazzanti G,Bartolini A,Ghelardini C.Menthol:a natural analgesic compound.
Neuroscience letters.2002;322(3):145-148.
6.Nishino T,Tagaito Y,Sakurai Y.Nasal inhalation of 1-menthol reduces respiratory discomfort associated with loaded
breathing.Am J Respir Crit Care Med. 1997;156(1):309-313.
7.Lawrence D,Cadman B,Hoffman AC.Sensory properties of menthol and smoking topography.Tob Induc Dis.2011;9
Suppl l(Suppl 1):53.
8.Garten S,Falkner RV.Continual smoking of mentholated cigarettes may mask the early warning symptoms of
respiratory disease.Preventive Medicine.2003;37(4):291-296.
9.Stahre M,Okuyemi KS,Joseph AM,Fu SS.Racial/ethnic differences in menthol cigarette smoking,population quit
ratios and utilization of evidence-based tobacco cessation treatments.Addiction.2010;105 Suppl 1:75-83.
10.Levy DT,Blackman K,Tauras J,et al.Quit attempts and quit rates among menthol and nonmenthol smokers in the
United States.Am J Public Health.2011;101(7):1241-1247.
11.Hoffman AC,Miceli D.Menthol cigarettes and smoking cessation behavior.Tobacco Induced Diseases.2011;
9(Suppl 1):S6: 1-5.
Additional references available upon request.
it' s Att About Flavorsin Schools MINT & fAENTHOL, too
Dr. Lester Hartman, MD, MPH
Senior Partner
Westwood-Mansfield Pediatric Associates
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When all other flavors were removed kids
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MENTHOL tobacco smokers delay quitting
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in my practice of 14100D
kids, notably , when MINT and
MENTHOL are exempt and left to be
Sold in convenience stores, mint-
based flavors are among the top
tVVO most popular flavors for teens.
I
Reminder:
a • Exposure in convenience store matters!
i
• Kids visit convenience stores once or twice a
week - prospectively the more frequently
� kids go to convenience stores the more likely
they are to use smoke and vaping products.
G
MENTHOL cigarettes are slowing the reductions in
overall cigarette smoking rates.
Fr
om 2004 to 2014, the decline in cigarette
consumption was greater for non-MENTHOL
p .
cigarettes than MENTHOL cigarettes.
group most likelyg
remain the age Youth smokers
to use MENTHOL cigarettes.
i
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t
thing wilt happen a n all f tarors includ i n
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* THEY CAN MORPH
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111 think it' S important that we update our law to address
to curb this (vaping) epidemic* I 'd like to start by
and try toproducts as we treat other tobacco
tr p odu ts• Ban flavors and tax them,"
Attorney General Maura Healey, April 1122019
General Maura Healey was the first state AG to sue JUUL
Attorney for it's marketing strategy•
I
Businesses Can Morph
• art of the 20th century discouraged brs astfeeding;
- physicians into to the office to learn how to mix formula
patients had to
- In hindsight, this was found to be a big mistake and unhealthy for children.
- I suspect th
is would have initially hurt physicians businesses.
Bu
t as with any business, they had to morph.
• totes know they're selling a deadly, product T They
have
rl convenience s ways to diversify your o g
become oo reliant on it. They must think fwa Subway shop or a Dunkin Donuts
become
could be to add a deli area or incorporate
to the store.
creates a cooling effect, it reduces the
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ake MENTH OL cigarettes and
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Does banning menthol have
any effect?
Yes
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• e papers are highly • .
I think these p p and town.
• mint and menthol in cities
banning m e after
doubting of adult it rat
Basically a do g quit
j menthol bans
quit rate.
Dr. Jonathan Win
ickoff MD, M P H It
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What harm does MINT and MENTHOL cause?
i. Easier to start, it anesthetizes the back of the
throat to reduce coughing
2. The nicotine does the rest
3. The Menthol users take 20% longer to try to quit
4. African American kids are especially vulnerable
through target advertising and 90% of 12-18
year old 's start with mentholated cigarettes
The nicotine in JUUL has a patented formulation linked with Benzoic Acid which
is suspected to cause a bigger he ad
rush than cigarettes making it more
addictive .
suspect MINT and MENTHOL augment this
furthering the a
ddiction even more!
Quotes from
Dr Winickoff's letter to Brookline banning all
flavors all ages
tin sales of flavored tobacco is a necessary move at
"Eliminating °
this critical time given the 78 /° rise in adolescent electronic
cigarette
use in and the reversal of decades of progress in
tobacco control."
"Kid
s who use electronic cigarettes are over three times more
likely to use combusted tobacco."
Over 85 /° of users say that flavors are the reason they started
using to product."roduct." This includes mint and menthol
JUUL and other vaping devices
are adolescent nicotine
initiation addiction devices
The largest tobacco company
•
•
::• truth
•': initiative
INSPIRING
TOBACCO-FREE
LIVES
t
1 t t
1 1 1
Percentage of ; menthol.
who smoke and use
cigarettes:
54.5% � 48.4% Nearly
high school middle school ■
in
African-American smokers
aged 12 and older use
menthol cigarettes.
Nearly TTTTTTT
of young menthol
smokers
s _: menthol
cigarettes were banned.
If a menthol cigarette ban had been
enacted in 2011, it could have saved
lives by 2050.
A14
Town of North Andover
Board of Health
REGULATING THE SALE and USE OF TOBACCO PRODUCTS
SECTION 1 PURPOSE
It is the intention of the North Andover Board of Health to regulate the sale of tobacco products-ate
^^tine- delive..,pr-aduetl,primarily to reduce youth and underage access to nicotine n ire
and to advance public health.
SECTION 2 DEFINITIONS
For the purpose of this regulation, the following words shall have the following meanings:
2.1 BLUNT WRAP: Any tobacco product manufactured or packaged as a wrap or as a hollow
tube made wholly or in part from tobacco that is designed or intended to be filled by the consumer with
loose tobacco or other fillers.
2.2 BUSINESS AGENT: An individual who has been designated by the owner or operator of
any establishment to be the manager or otherwise in charge of said establishment.
2.3 CIGAR: Any roll of tobacco that is wrapped in leaf tobacco or in any substance containing
tobacco with or without a tip or mouthpiece not otherwise defined as a cigarette under Massachusetts
General Law,Chapter 64C, Section 1, Paragraph 1.
2.4 CHARACTERIZING FLAVOR: A distinguishable taste or aroma, other than
the taste or aroma of tobacco, meet el, Mint- ^r Wmnternrnnn imparted or detectable
either prior to or during consumption of a tobacco OF niGetiRe delivepy product or
component part thereof, including, but not limited to, tastes or aromas relating to any
fruit, chocolate, vanilla, honey, candy, cocoa, dessert, alcoholic beverage, menthol,
mint or wintergreen ,herb or spice; provided, however, that no tobacco product or--
shall be determined to have a characterizing flavor solely
because of the use of additives or flavorings that do not contribute to the distinguishable
taste or aroma of the product or the provision of ingredient information.
2.5 COMPONENT PART: Any element of a tobacco OF RiGetiRe deliveFy pFe ,
including, but not limited to, the tobacco, filter, paper, mouthpiece, heating element
battery and/or electronic circuits but not including any constituent.
2.6 CONSTITUENT: Any ingredient, substance, chemical or compound, other
than tobacco, water added to a tobacco product or reconstituted tobacco sheet, that is
added by the manufacturer to a tobacco ^r ^iGGtiRe deli„on, product during the
processing, manufacturing or packaging of the tobacco product.
Such term shall include a smoke constituent from a tobacco product and a vapor or
aerolization constituent from a RiGetiRe deliver.-tobacco product.
2.7 DISTINGUISHABLE: Perceivable by either the sense of smell or taste.
2.8 E-CIGARETTE: Any electronic nicotine delivery product composed of a mouthpiece,
heating element,battery and/or electronic circuits that provides a vapor of liquid nicotine to the user,or
relies on vaporization of solid nicotine or any liquid. This term shall include such devices whether they
are manufactured as e-cigarettes,e-cigars,a-pipes or under any other product name.
2.9 EDUCATIONAL INSTITUTION: Any public or private college,school,professional
school,scientific or technical institution,university or other institution furnishing a program of higher
education.
ELECTRONIC CIGARETTE:Any electronic device composed of a mouthpiece,heating
element,battery and/or electronic circuits that provides vapor of liquids,regardless of nicotine content,or
relies on vaporization of any solid or liquid substance,regardless of nicotine content. This term shall
include such devices whether they are manufactured as e-cigarettes,e-cigars,a-pipes or under any other
product name.An electronic cigarette includes any component or part of an electronic
cigarette, regardless of nicotine content, that relyoporizatiion or aerosolization,
including but not limited to,pods,vape juice containers and cartridges.
2.10 EMPLOYEE: Any individual who performs services for an employer.
2.11 EMPLOYER: Any individual,partnership,association,corporation,trust or other organized
group of individuals,including North Andover or any agency thereof,which uses the services of one(1)
or more employees.
2.12 ENCLOSED: A space bounded by walls,with or without windows or fenestrations,
continuous from floor to ceiling and enclosed by one(1)or more doors, including but not limited to an
office,function room or hallway.
2.13 FLAVORED TOBACCO PRODUCT: Any tobacco product or component part thereof that
contains a constituent that has or produces a characterizing flavor. A public statement,claim or indicia
made or disseminated by the manufacturer of a tobacco product,or by any person authorized or permitted
by the manufacturer to make or disseminate public statements concerning such tobacco product,that such
tobacco product has or produces a characterizing flavor shall constitute presumptive evidence that the
tobacco product is a flavored tobacco product.
aoc ;oa 1;Rf-R:«
2.15 HEALTH CARE INSTITUTION: An individual,partnership,association,corporation or
trust or any person or group of persons that provides health care services and employs health care
providers licensed,or subject to licensing,by the Massachusetts Department of Public Health under
M.G.L. c. 112 or a retail establishment that provides pharmaceutical goods and services and subject to the
provisions of 247 CMR 6.00.Health care institution includes,but is not limited to,hospitals,clinics,
health centers,pharmacies,drug stores,doctor offices and dentist offices.
b
pfedttet of for other fliedieal par-poses and whiek is b
te, - et—e4es.
2.17 NON-RESIDENTIAL ROLL-YOUR-OWN(RYO)MACHINE: A mechanical device
made available for use(including to an individual who produces cigars, cigarettes, smokeless
tobacco,pipe tobacco, or roll-your-own tobacco solely for the individual's own personal
consumption or use)that is capable of making cigarettes, cigars or other tobacco products. RYO
machines located in private homes used for solely personal consumption are not Non-Residential
RYO machines.
2.18 OUTDOOR SPACE: An outdoor area,open to the air at all times and cannot be enclosed
by a wall or side covering.
2.19 PERMIT HOLDER: Any person engaged in the sale or distribution of tobacco Ar nieetine
deli-emsproducts directly to consumers who applies for and receives a tobacco
product sales permit or any person who is required to apply for a tobacco product
sales permit pursuant to these regulations,or his or her business agent.
2.20 PERSON: An individual,employer,employee,retail store manager or owner,or the owner
or operator of any establishment engaged in the sale or distribution of tobacco
products directly to consumers.
2.21 RETAIL TOBACCO STORE: An establishment which is not required to possess a
retail food permit whose primary purpose is to sell or offer for sale to consumers,but not for resale,
tobacco products and paraphernalia,in which the sale of other products is merely incidental,and in
which the entry of persons under the age of 21 is prohibited at all times,and maintains a valid
permit for the retail sale of tobacco products as required to be issued by the North Andover Board of
Health.
2.22 SELF SERVICE DISPLAY: Any display from which customers may select a tobacco
product^-a niev tine avr..o.y p-,.due without assistance from an employee or store personnel,
excluding vending machines.
2.23 SMOKING(or smoke): The lighting of a cigar,cigarette,pipe or other tobacco
product or possessing a lighted cigar,cigarette,pipe or other tobacco or non-tobacco product
designed to be combusted and inhaled.
2.24 SMOKING BAR: An establishment that primarily is engaged in the retail sale of
tobacco products for consumption by customers on the premises and is required by Mass. General
Law Ch.270, Section 22 to maintain a valid permit to operate a smoking bar issued by the
Massachusetts Department of Revenue. "Smoking Bar"shall include,but not be limited to,those
establishments that are commonly known as"cigar bars"and"hookah bars".
2.25 TOBACCO PRODUCT: Giga.eRe" siffs,,.hew g tebaee, pipe t,.baee bidis si+Hffer-
teb--aeee- in&gy ofits fe---• Andproduct containing, made, or derived from tobacco or
nicotine that is intended for human consumption, whether smoked, chewed, absorbed,
dissolved, inhaled, snorted, sniffed, or ingested by other means, including, but not
limited to: cigarettes, cigars, little cigars, chewing tobacco, pie tobacco, snuff; or
electronic cigarettes, electronic cigars, electronic pipes, electronic hookah, liquid
nicotine, "e-liquids" or other similar products, regardless of nicotine content, that rely on
vaporization or aerosolization. "Tobacco Product" includes any component or part of a
tobacco product. "Tobacco Product" does not include any product that has been approved
by the United States Food and Drug Administration either as a tobacco use cessation
product or for other medical purposes and which is being marketed and sold or prescribed
solely for the approved purpose.
2.26 VENDING MACHINE: Any automated or mechanical self service device,which upon
insertion of money,tokens or any other form of payment,dispenses or makes cigarettes,any other
tobacco product Aff Meet..°Delivery n..,,a,,,.t.
SECTION 3 TOBACCO "ern-rirnKriNE DE rvsov PRODUCT SALES TO PERSONS
UNDER THE AGE OF 21 PROHIBITED
3.1 No person shall sell or otherwise distribute tobacco eF nieetine deli F-products to persons under
the age of 21.
3.2 REQUIRED SIGNAGE
In conformance with and in addition to Massachusetts General Law,Chapter 270,Section
7,a copy of Massachusetts General Laws,Chapter 270,Section 6,shall be posted
conspicuously by the owner or other person in charge thereof in the shop or other place
used to sell tobacco products at retail. The notice shall be made available from the North
Andover Board of Health. The notice shall be at least 48 square inches and shall be
posted conspicuously by the permit holder in the retail establishment or other place in
such a manner so that it may be readily seen by a person standing at or approaching the
cash register. The notice shall directly face the purchaser and shall not be obstructed
from view or placed at a height of less than four(4)feet or greater than nine(9)feet from
the floor. The notice shall also disclose current referral information about smoking
cessation, as well as notice that the sale of tobacco products,
to someone under the age of 21 is prohibited,and that the use of e-
cigarettes is prohibited where smoking is prohibited in the Town of North Andover.
3.3 IDENTIFICATION: Each person selling or distributing tobacco products or nicotine
delivery products shall verify the age of the purchaser by means of a valid government-
issued photographic identification containing the bearer's date of birth that the purchaser
is 21 years old or older. Verification is required for any person who appears to be under
the age of-24 40.
3.4 All retail sales of tobacco @F nieetine must be face-to-face between the
seller and the buyer(except for the purchase of tobacco from vending machines)and all
retail sales of tobacco products must occur at a location with a valid
tobacco product sales permit.
SECTION 4 TOBACCO PRODUCT SALES PERMIT
4.1 No person shall sell or otherwise distribute tobacco A-r-;;i e atiine de" I products at retail within
North Andover without first obtaining a Tobacco and,.Teed.°„e4ve f Product Sales Permit issued
annually by the North Andover Board of Health. Only owners of establishments with a permanent,non-
mobile location in North Andover are eligible to apply for a permit and sell tobacco products or n:P.�e-
delier}ooproducts at the specified location in North Andover.
4.2 As part of the Tobacco Product Sales Permit application process,the
applicant will be provided with the North Andover Board of Health regulation. Each applicant is required
to sign a statement declaring that the applicant has read said regulation and that the applicant is
responsible for instructing any and all employees who will be responsible for tobacco and
delve product sales regarding federal, state and local laws regarding the sale of tobacco and this
regulation.
4.3 Each applicant who sells tobacco is required to provide proof of a current tobacco sales license
issued by the Massachusetts Department of Revenue before a Tobacco Product
Sales Permit can be issued.
4.4 The fee for a Tobacco Product Sales Permit shall be in accordance with the
most current Board of Health fee schedule. All such permits shall be renewed annually by June 301 of
every year.
4.5 A separate permit is required for each location where a retail establishment is selling tobacco er-
a*ime. &4 e....products.
4.6 Each Tobacco -Ana r,v4yei...Product Sales Permit shall be displayed at the retail
establishment in a conspicuous place.
4.7 No Tobacco Product Sales Permit holder shall allow any employee to sell
tobacco products until such employee reads this regulation and federal and
state laws regarding the sale of tobacco and signs a statement,a copy of which will be placed on file in
the office of the employer,that he/she has read the regulation and applicable state and federal laws.
4.8 A Tobacco Product Sales Permit is non-transferable
4.9 Issuance of a Tobacco Product Sales Permit shall be conditioned on an
applicant's consent to unannounced,periodic inspections of his/her retail establishment to ensure
compliance with this regulation.
4.10 Issuance and holding of a Tobacco Product Sales Permit shall be
conditioned on an applicant's on-going compliance with current Massachusetts Department of Revenue
requirements and policies including,but not limited to,minimum retail prices of tobacco products.
4.11 A Tobacco and,.ieat:.,o r,o':vefy Product Sales Permit will not be renewed if the permit holder
has failed to pay all fines issued and the time period to appeal the fines has expired and/or has not
satisfied any outstanding permit suspensions.
Permit Capping Option Samples:
a. "Basic" Cap: At any given time, there shall be no more than (number (XX)1
Tobacco Product Sales Permits issued in North Andover. [This phrase needs to be
removed if NOT using subsection B and left in if using Subsection B: "reduced by
the number of permits not renewed pursuant to subsection (b) below."] No permit
renewal will be denied based on the requirements of this subsection except any
permit holder who has failed to renew his or her permit within thirty (30) days of
expiration will be treated as a first-time permit applicant. NOTE: This is the
"basic" cap. When a town has the maximum number of permittees allowed, a
waiting list should be started with the name and contact information of prospective
tobacco retailers who are waiting to be contacted when a permit frees up.
OR
b. "Advanced" Cap: As of fdatel, anv permit not renewed either because a retailer no
longer sells tobacco products, as defined herein, or because a retailer closes the
retail business, shall be returned to the North Andoverr Board of Health and shall
be permanently retired by the Board of Health and the total allowable number of
Tobacco Product Sales Permits under paragraph (a) shall be reduced by the
number of the retired permits. NOTE: This is the "advanced" cap which has a
maximum number of permits to be issued, does not provide for a waiting list, and
automatically reduces the cap number when a retailer chooses to stop selling_
tobacco and returns their permit to the town. The only way a new retailer can
obtain a permit would be to buy an existing business. The conditions for this
occurrence are set out in subsection f.
c. Dual Cap: At any given time, of the allowed Permit number in subsection (a) above,
there shall be no more than [number(XX)1 Tobacco Product Sales Permits issued to
Adult-Only Retail Tobacco Stores, per the definition,in North Andover. No permit
renewal will be denied based on the requirements of this subsection except any
permit holder who has failed to renew his or her permit within thirty (30) days of
expiration will be treated as a first-time permit applicant. NOTE: This is a subcap
that can be used with either the"basic" cap above in subsection a, or the
"advanced" cap in subsection b. It would provide a maximum number of permits
within the general cap number that can go to qualifying"adult-only Retail Tobacco
Stores (which includes both tobacconists and vape shops).
d. New Retailers near Schools: A Tobacco Product Sales Permit shall not be issued to
any new applicant for a retail location within five hundred (500) feet of a public or
private elementary or secondary school as measured by a straight line from the
nearest point of the property line of the school to the nearest point of the property
line of the site of the applicant's business premises. NOTE: This bars NEW
retailers from selling,tobacco near a school, regardless of the cap policy used.
e. New Retailers near Existing Retailers: A Tobacco Product Sales Permit shall not be
issued to any new applicant for a retail location within five hundred (500) feet of a
retailer with a valid Tobacco Product Sales Permit as measured by a straight line
from the nearest point of the property line of the retailer with a valid Tobacco
Product Sales Permit to the nearest point of the property line of the site of the
applicant's business premises. NOTE: This bars NEW retailers from selling
tobacco near an existing tobacco permit holder, regardless of the cap polio
f. Required Paragraph!: Applicants who purchase or acquire an existing business
that holds a valid Tobacco Product Sales Permit at the time of the sale or acquisition
of said business must apply within sixty (60) days of such sale or acquisition for the
permit held by the Current Permit Holder if the Applicant intends to sell tobacco
products, as defined herein. Such applicant may choose to apply for a Tobacco
Product Sales Permit for an Adult-Only Retail Tobacco Store if the Current Permit
Holder possessed the same or if a Tobacco Product Sales Permit for an Adult-Only
Retail Tobacco Store is available per subsection (b). NOTE: This provision should
be included no matter which of the above five options are used by a board of health.
It permits a buyer to "capture" the seller's permit regardless of the type of capping
policy enacted.
SECTION 5 CIGAR SALES REGULATED:
5.1 No retailer,retail establishment,or other individual or entity shall sell or distribute or cause to be
sold or distributed a cigar unless the cigar is contained in an original package of at least four(4)cigars. A
package of four or more cigars must be priced at the retail market price or at five($5.00)dollars,
whichever price is higher.
5.2 This Section shall not apply to:
(a) The sale or distribution of any cigar having a retail price of two dollars
and fifty cents($2.50)or more.
(b) A person or entity engaged in the business of selling or distributing cigars for commercial
purposes to another person or entity engaged in the business of selling or distributing cigars
for commercial purposes with the intent to sell or distribute outside the boundaries of North
Andover.
5.3 The North Andover Board of Health may adjust from time to time the amounts specified in this
Section to reflect changes in the applicable Consumer Price Index by amendment of this regulation.
SECTION 6 THE SALE OF FLAVORED TOBACCO PRODUCTS
AND FLAVORED-
NI-GOTI-NE DELIVERY VERY R-RODUC4: PROHIBITED
No person shall sell or distribute or cause to be sold or distributed any flavored tobacco products ar-
�w.A_-.ed_ e6ne a ':,,a.,.pfaduet except in smoking bars and retail tobacco stores.
SECTION 7 THE SALE OF BLUNT WRAPS
No person or entity shall sell or distribute blunt wraps within North Andover,except that retail tobacco
stores are permitted to sell or distribute blunt wraps.
SECTION 8 FREE DISTRIBUTION AND COUPON REDEMPTION
, e
nieeeetinee deliver-y pr-e"ets for-free of eigar-ettes M a r-edueed pfiee b.plev.,the minimum retail priee-
1. No person shall distribute, or cause to be distributed, any free samples of tobacco
products, as defined herein;
2. Accept or redeem, offer to accept or redeem, or cause or hire any person to accept
or redeem or offer to accept or redeem any coupon that provides any tobacco
product, as define herein, without charge or less than the listed or non-discounted
price in exchange for the purchase of any other tobacco product.
3. Sell a tobacco product, as define herein, to consumers through any multi pack
discounts (e.g. "buy two get one free") or otherwise provide or distribute to
consumers any tobacco product, as define herein, without charge or for less than the
listed non-discounted price in exchange for the purchase of any other tobacco
product.
SECTION 9 OUT-OF-PACKAGE SALES
The sale or distribution of tobacco products as defined herein in any form
other than an original factory-wrapped package is prohibited. No person may sell or cause to be sold or
distribute or cause to be distributed,any cigarette package that contains fewer than twenty(20)cigarettes,
including single cigarettes.
1. The sale or distribution of tobacco products, as defined herein, in any form other than
an original factory-wrapped package is prohibited, including the repackaging or
dispensing of any tobacco product, as defined herein, for retail sale. No person may sell
or cause to be sold or distribute or cause to be distributed any cigarette package that
contains fewer than twenty (20) cigarettes, including single cigarettes.
2. Permit holders who sell Liquid Nicotine Containers must comply with the provisions
of 310 CMR 30.000, and must provide the [city/town] Board of Health with a written
plan for disposal of said product, including disposal plans for any breakage, spillage or
expiration of the product.
3. All permit holders must comply with 940 CMR 21.05 which reads: "It shall be an
unfair or deceptive act or practice for any person to sell or distribute nicotine in a liquid
or gel substance in Massachusetts after March 15, 2016 unless the liquid or gel product is
contained in a child-resistant package that, at a minimum, meets the standard for special
packaging as set forth in 15 U.S. C.&§1471 through 1476 and 16 CFR &1700 et. Seq."
4. No permit holder shall refill a cartridge that is prefilled and sealed by the manufacturer
and not intended to be opened by the consumer or retailer.
SECTION 10 SELF SERVICE DISPLAYS
10.1 All self-service displays of tobacco products are
prohibited. All humidors including,but not limited to,walk-in humidors must be locked.
10.1(a) EXEMPTION: Self-service displays that are located in facilities where the retailer ensures
that no person younger than twenty-one(21)years of age is present,or permitted to enter,at any time.
SECTION 11 TOBACCO VENDING MACHINES
11.1 All tobacco,,,,a',,,. ;ieA-6ne de4vo....product vending machines are prohibited.
11.1(a) EXEMPTION: Vending machines are permitted if equipped with a lock out device,in an
establishment with a valid pouring liquor license,and located in facilities where the retailer ensures that
no person younger than twenty-one(21)years of age is present,or permitted to enter,at any time. A
lock-out device locks out sales from the vending machine unless a release mechanism is triggered by an
employee. The release mechanism must not allow continuous operation of the vending machine and must
be out of the reach of all consumers and in a location accessible only to employees.
SECTION 12 NON-RESIDENTIAL ROLL-YOUR-OWN (RYO) MACHINES
All Non-Residential Roll-Your-Own (RYO) Machines are prohibited.
SECTION 13 RESTRICTIONS ON THE SALE OF TOBACCO ARID NIGOTINic nci niGpv
PRODUCTS AT HEALTH CARE INSTITUTIONS:
The North Andover Board of Health strongly encourages health care institutions that sell tobacco and-
products to store these products in a manner that is hidden from the view of customers
and the general public. The North Andover Board of Health reserves the right to enact regulations
eliminating the sale of tobacco A-aa ..:,,,tine&4*e...products at health care institutions if said institutions
are unsuccessful in storing these products in the aforementioned manner.
SECTION 14 PROHIBITION OF THE SALE OF TOBACCO AND NICOTINE nrr rvEvv
PRODUCTS BY EDUCATIONAL INSTITUTIONS:
No educational institution located in North Andover shall sell or cause to be sold tobacco ev nieetine
deliyer�-products. This includes all educational institutions as well as any retail establishments that
operate on the property of an educational institution.
SECTION 15 VIOLATIONS/ENFORCEMENT/PENALITIES
15.1 It shall be the responsibility of the permit holder and/or his or her business agent to
ensure compliance with all sections of this regulation pertaining to his or her distribution of tobacco
,ini-41 F-niecet.,e delivo....products.The violator shall receive:
a) In the case of a first violation,a fine of one hundred(100)dollars;
b) In the case of a second violation within twenty-four(24)months of the date of the first
violation,a fine of two hundred(200)dollars and the Tobacco Product
Sales Permit may be suspended for seven(7)consecutive business days.
c) In the case of a third violation within a twenty-four(24)month period,a fine of three hundred
(300)dollars and the Tobacco Product Sales Permit may be suspended for
thirty(30)consecutive business days.
d) In the case of more than three violations within a twenty-four(24)month period, a fine of
three hundred(300)dollars per additional violation and the Tobacco
Product Sales Permit may be revoked.
15.2 Refusal to cooperate with inspections pursuant to this regulation shall result in the
suspension of the Tobacco,-ad a-ad,.ieetine Pe4v-. .Product Sales Permit for thirty(30)consecutive
business days.
15.3 In addition to the monetary fines set above,any permit holder who engages in the sale or
distribution of tobacco or-nis products directly to a consumer while his or her permit is
suspended shall be subject to the suspension of all Board of Health issued permits for thirty(30)
consecutive business days.
15.4 The North Andover Board of Health shall provide notice of the intent to suspend or revoke a
Tobacco Product Sales Permit,which notice shall contain the reasons therefore and
establish a time and date for a hearing which date shall be no earlier than seven(7)days after the date of
said notice. The permit holder or its business agent shall have an opportunity to be heard at such hearing
and shall be notified of the Board of Health's decision,and the reasons therefore in writing. After a
hearing,the North Andover Board of Health may suspend or revoke the Tobacco
Product Sales Permit if the Board finds that a violation of this regulation occurred. For purposes of such
suspensions or revocations,the Board shall make the determination notwithstanding any separate criminal
or non-criminal proceedings brought in court hereunder or under the Massachusetts General Laws for the
same offense. All tobacco products shall be removed from the retail
establishment upon suspension or revocation of the Tobacco Product Sales Permit.
Failure to remove all tobacco products shall constitute a separate violation of this
regulation.
15.5 Non-Criminal Disposition: Whoever violates any provision of this regulation may be penalized
by the non-criminal method of disposition as provided in Massachusetts General Laws,Chapter 40,
Section 2 1 D or by filing a criminal complaint at the appropriate venue.
Each day any violation exists shall be deemed to be a separate offense.
15.6 Enforcement: Enforcement of this regulation shall be by the North Andover Board of
Health or its designated agent(s). Any resident who desires to register a complaint pursuant to
the regulation may do so by contacting the North Andover Board of Health or its designated
agent(s),and the Board may investigate.
SECTION 16 OTHER APPLICABLE LAWS
This regulation shall not be interpreted or construed to permit smoking where it is otherwise restricted by
other applicable health,safety and fire codes,regulations or statutes.
SECTION 17 PROHIBITING SMOKING IN WORKPLACES AND PUBLIC PLACES
17.1 The Board of Health adopts the Massachusetts Smoke-Free Workplace Law
(Massachusetts General Law Chapter 270, Sections 21 and 22)by reference and any future revisions as a
local regulation.
17.2 Pursuant to Massachusetts General Laws Chapter 270,Section 22 0)smoking is also
hereby prohibited in the following locations:
a) retail tobacco store,except that smoking will be permitted in this establishment if it is
housed in a freestanding building that is not occupied by any other business,
residence or workplace.
b) smoking bar
c) outdoor spaces of restaurants,bars,taverns and any other outdoor space where food
and/or alcoholic beverages,and/or non-alcoholic beverages are sold to the public and
served to the public,or otherwise consumed or carried by the public.
17.3 The use of e-cigarettes is prohibited wherever smoking is prohibited per Massachusetts
General Laws Chapter 270, Section 22 and Section 4.17.002 of this regulation.
SALE OF ELECTRONIC CIGARETTES PROHIBITED:
No person shall sell or distribute or cause to be sold or distributed any electronic cigarettes,
except in smoking bars and retail tobacco stores.
SECTION 18 THROUGH 21
Reserved for future regulations,amendments,etc.
SECTION 22 SEVERABILITY
If any provision of these regulations is declared invalid or unenforceable, the other provisions
shall not be affected thereby but shall continue in full force and effect.
SECTION 23
This regulation supersedes the prior regulation titled"Regulations Affecting Smoking in Certain Places
and Youth Access to Tobacco,"as adopted on January 1,2002 and thereafter amended.
Effective Date:
This regulation was adopted on
This regulation shall take effect on
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
i I 1 1Food
Manufactured or Sold in Massachusetts
If I have a Massachusetts license or permit it legal to add hulled hemp seeds, hemp seed
under 105 CMR 500 (Regulations for Good protein, and/or hemp seed oil to food I
Manufacturing Practices for Food) to manufacture and/or sell at retail?
manufacture food, is it legal to add Yes. The FDA has completed its evaluation of
cannabidiol (CBD) to that food? generally recognized as safe (GRAS) notices for
No. The Massachusetts Department of Public hulled hemp seeds, hemp seed protein and
Health (DPH) regulates food manufacturing in the hemp seed oil. These products can be legally
Commonwealth (see 105 CMR 500). These added to human food, provided they comply with
regulations require that all food must be from all other requirements.
approved sources that comply with federal, state,
and local law and must not contain any prohibited I have a license issued by the Massachusetts
ingredients. The FDA has concluded that federal Department of Agricultural Resources (MDAR)
law prohibits the addition of CBD to food under its Interim Commercial Industrial Hemp
products because CBD is an active ingredient in Program Policy. Is it legal for me to add CBD
FDA-approved drugs. Since CBD is not an to manufactured or retail food?
approved ingredient under federal law, it may not No. The MDAR Hemp Program does not provide
be added to manufactured foods. an exception to the federal prohibition against
If I have a Massachusetts permit under 105
adding CBD into food products.
CMR 590 (Minimum Sanitation Standards for May I market my hemp products (e.g., hulled
Food Establishments) as a food establishment, hemp seeds, hemp seed protein and hemp
is it legal to add CBD to food I distribute at
retail? seed oil) by making therapeutic claims
without FDA approval?
No. The DPH sets minimum sanitary standards No. The FDA has reiterated that cannabis products
for food establishments in the Commonwealth. (hemp-derived or otherwise)that are marketed with
These regulations are enforced by local boards claims of therapeutic benefit or any other disease
of health in partnership with the state (see 105 claim must be approved by the FDA.
CMR 590). The regulations incorporate the
FDA's Food Code, which requires that food be May I sell cosmetic products containing hemp
obtained from sources that comply with federal, or CBD at retail in Massachusetts?
state, and local laws and must not contain any
prohibited ingredients. As noted above, the FDA In DPH does not regulate cosmetics. The FDA
has concluded that federal law prohibits the has issued Frequently Asked Questions that
addition of CBD to food products because CBD is address cannabis and cannabis-derived
an active ingredient in FDA-approved drugs. ingredients in cosmetics.
Since CBD is not an approved ingredient under
federal law, it may not be added to foods What can I do if I had an adverse reaction to a
distributed at retail. cosmetic product labeled as containing CBD?
If I am licensed or permitted as a food
You can report a cosmetic related complaint
directly to the FDA.
manufacturer or retailer in Massachusetts, is
Massachusetts Department of Public Health
Bureau of Environmental Health
250 Washington Street, 7th Floor, Boston, MA 02108 �V V
Phone: 617-624-5757 1 Fax: 617-624-5777 1 TTY: 617-624-5286 '°� L' June 2019
-4)1- 9.
June 27,2019 BOH Meeting Notes
1. 160 Carleton Lane-Septic Variance Request
The engineer is present to discuss the project with you.
The owners of 160 Carleton Lane are applying to upgrade (replace) their existing septic system
with a new system. This is the original system from 1986 and will be replaced in the same
location. The site has several constraints that make it difficult or impossible to replace the
system without a variance. The slope and topography and location of the house and driveway
seem to limit the replacement area to the area behind the house. In this location the house itself
and lot lines also limit its construction and overall configuration. Narrow trenches are
proposed and are the best proposal for this site but still need a variance.
They are looking for a reduction in the setback from a leaching trench to the foundation. The
want to reduce the setback from 20' to 16.9'. The portion of the foundation they are closest to is
the bulkhead. This Local Upgrade Approval (LUA) or variance is required by Title 5 for this set
back reduction and our local regulations require a public hearing per Section 3.8. The overall
plan is still under general review for overall compliance but they will need this variance for that
approval and construction.
2. Camp Discussion
Caroline has been working on our summer camps and we are working with new state
regulations that were just updated this past year. We would like to discuss amending our local
regulations to mirror those new requirements or remove any overlaps and to amend the timing
of the required plan,immunization and documentation submittals that are required. I have
included our local regs in your packets and Caroline sent out the state and local regs earlier
today for your review. We would not be making any changes this season but would like to
have them completed by next camp season so there is no rush.
3.Tobacco Regulation Discussion
Ron and I met after our last meeting and we sat down to discuss all the revisions you talked
about at that meeting and all the possible additions or revisions to the regulations you were
contemplating. The draft revisions are in your packets and I sent them out to you earlier so you
have a digital copy. Ron is here to discuss
Dr. Hartman is also here to discuss flavored tobacco and children.
4. CBD in Food
Not on the Agenda but as an FYI,I have included a CBD in Food in Manufactured or sold in
Massachusetts memo that came out last week. I have been researching and discussing this with
colleagues and health professionals for a while now and the state finally came out with an
opinion. This is where we were all going but it is nice to get backup from above. No CBD
gummies,lollipops or foods are allowed for retail sale or at a restaurant.
5. Baba's Labelling Variance
They never came back for their variance after I spoke to him regarding our discussions last
meeting.When I spoke to him he was pretty sure he was going to start labelling his items.
Steve met with him and he has ordered a labelling machine.
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
i I 1 1Food
Manufactured or Sold in Massachusetts
If I have a Massachusetts license or permit it legal to add hulled hemp seeds, hemp seed
under 105 CMR 500 (Regulations for Good protein, and/or hemp seed oil to food
Manufacturing Practices for Food) to manufacture and/or sell at retail?
manufacture food, is it legal to add Yes. The FDA has completed its evaluation of
cannabidiol (CBD) to that food? generally recognized as safe (GRAS) notices for
No. The Massachusetts Department of Public hulled hemp seeds, hemp seed protein and
Health (DPH) regulates food manufacturing in the hemp seed oil. These products can be legally
Commonwealth (see 105 CMR 500). These added to human food, provided they comply with
regulations require that all food must be from all other requirements.
approved sources that comply with federal, state,
and local law and must not contain any prohibited I have a license issued by the Massachusetts
ingredients. The FDA has concluded that federal Department of Agricultural Resources (MDAR)
law prohibits the addition of CBD to food under its Interim Commercial Industrial Hemp
products because CBD is an active ingredient in Program Policy. Is it legal for me to add CBD
FDA-approved drugs. Since CBD is not an to manufactured or retail food?
approved ingredient under federal law, it may not No. The MDAR Hemp Program does not provide
be added to manufactured foods. an exception to the federal prohibition against
If I have a Massachusetts permit under 105 adding CBD into food products.
CMR 590 (Minimum Sanitation Standards for May I market my hemp products (e.g., hulled
Food Establishments) as a food establishment, hemp seeds, hemp seed protein and hemp
is it legal to add CBD to food I distribute at seed oil) by making therapeutic claims
retail? without FDA approval?
No. The DPH sets minimum sanitary standards No. The FDA has reiterated that cannabis products
for food establishments in the Commonwealth. (hemp-derived or otherwise)that are marketed with
These regulations are enforced by local boards claims of therapeutic benefit or any other disease
of health in partnership with the state (see 105 claim must be approved by the FDA.
CMR 590). The regulations incorporate the
FDA's Food Code, which requires that food be May I sell cosmetic products containing hemp
obtained from sources that comply with federal, or CBD at retail in Massachusetts?
state, and local laws and must not contain any
prohibited ingredients. As noted above, the FDA In DPH does not regulate cosmetics. The FDA
has concluded that federal law prohibits the has issued Frequently Asked Questions that
addition of CBD to food products because CBD is address cannabis and cannabis-derived
an active ingredient in FDA-approved drugs. ingredients in cosmetics.
Since CBD is not an approved ingredient under
federal law, it may not be added to foods What can I do if I had an adverse reaction to a
distributed at retail. cosmetic product labeled as containing CBD?
You can report a cosmetic related complaint
If I am licensed or permitted as a food directly to the FDA.
manufacturer or retailer in Massachusetts, is
Massachusetts Department of Public Health
Bureau of Environmental Health aV vim
250 Washington Street, 7th Floor, Boston, MA 02108
Phone: 617-624-5757 1 Fax: 617-624-5777 1 TTY: 617-624-5286 June 2019