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HomeMy WebLinkAbout2019-10-24 Board of Health Minutes North Andover Board of Health Meeting Minutes Thursday—October 24,2019 7:00 p.m. 120 Main Street,2nd Floor Selectmen's Meeting Room North Andover, MA 01845 Present: Frank MacMillan Jr.,Joseph McCarthy,Patrick Scanlon,Brian LaGrasse,and Stephen Casey Jr I. CALL TO ORDER The meeting was called to order at 7:00 pm. II. PLEDGE OF ALLEGIANCE III. APPROVAL OF MINUTES Meeting Minutes from September 26,2019 were presented for signature. Motion was made by Joseph McCarthy to approve the minutes,Patrick Scanlon seconded the motion,all were in favor and the minutes were approved.(3-0-0) IV. PUBLIC HEARINGS Continuation of Proposed Amendments to Regulating the Sale and Use of Tobacco&Nicotine Delivery Products.See Appendix A. A. MOTION made by Patrick Scanlon to open the public hearing,Joseph McCarthy seconded,all were in favor and the motion was approved.(3-0-0) Microphone opened for testimony,with observing the guidelines of: discussion being limited to,two times per person at the microphone with a three-minute limit of debate per time. Speaker must identify themselves,and who they are representing if applicable. 1. Michael E.Brangwynne,Coalition for Responsible Retailing(CRR) Mr.Brangwynne submitted in between the two meetings an affidavit by Dr.Michael Siegel(See Appendix B.). Dr. Siegel is an expert and a 30 year anti-tobacco activist,who is now working against the type of regulations that are being considered. The affidavit was submitted in a lawsuit that was filed by local storeowners in Somerville,to prevent these types of regulations from going into place. Mr. Brangwynne encourages the Board to read the affidavit. The Board of Health is facing two very serious issues now:youth vaping and vaping related illness,which ultimately led to the proposed ban. Understandably,the Board is seeking to address these concerns. Mr.Brangwynne suggests that the regulations the Board is considering do nothing to address the concerns facing the Board. Local FDA compliance checks show a 97%compliance rate with the local stores. They are effective at providing preventative sales to minors. The Board's goal is to prevent sales to minors; 2019 North Andover Board of Health Meeting Page 1 of 5 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 which is the same goal of the local storeowners. At the last meeting,the FDA data was questioned which was submitted to the Board. However,he does not see how you can question the only available data as to your local stores compliance rate. It is ridiculous to speculate that it is somehow inaccurate data because of how these compliance checks are conducted. If the compliance rate was 40%,Mr.Brangwynne doesn't think that number would be questioned. It would be demonstrated to show your stores aren't doing what they should be. The local storeowners are the innocent bystanders. They are not the ones that are responsible for creating these issues. The Attorney General is taking action to address online sales. There is a 97% compliance rate during the time period where these statistics of youth tobacco use have shown these massive increases,it only stands to reason that local store owners are not the ones responsible. Mr.Brangwynne suggests working with local storeowners on things that will actually address the problem such as point-of-sale systems or product limitations on the amount of sales. 2. Cheryl Sbarra. Senior Staff Attorney for the Massachusetts Association of Health Boards. Ms. Sbarra would like to correct a statement. The Board of Health goal is not only to prevent sales but also to protect youth from the marketing strategies. Ms. Sbarra went through the statistics of how many kids actually purchase products from brick-and-mortar stores,which is about 33%,which is more than the FDA checks would indicate. Ms.Sbarra discusses an article that was published today(October 24,2019)In American Journal of Preventive Medicine titled,"Short-Term Impact of a Flavored Tobacco Restriction:Changes in Youth Tobacco Use in a Massachusetts Community. (See Appendix C.) This article compared Lowell Massachusetts to Malden Massachusetts. Lowell has a restriction on flavored tobacco products to adult only retail tobacco stores and Malden does not. Both cities have similar geography,and income. The study done by the Department of Public Health concluded that policies that restrict the sale of flavored tobacco have the potential to curb youth tobacco use in as few as 6 months. 3. Helen Picard,447 Waverly Road—serves as a school committee member but is not here on that official capacity. Ms.Picard is not a public health person but she did have a constituent approach her since the last Board of Health meeting to discuss the youth brain and nicotine. Ms.Picard found a study on the National Institute of Health and a number of other studies that do state that nicotine products prime the youth brain for all addictions. With the crises with opioid addictions and other things,communities are talking about concerns of young people being seduced by marketing strategies,addicted to nicotine,which results in them being more vulnerable to all addictions.Ms.Picard supports the process the Board of Health is having. 4. Ronald Beauregard—Healthy Communities Tobacco Control Program. Mr.Beauregard has been working with Brian LaGrasse,Town of North Andover,Health Director in terms of technical advice for the new regulations. Restrictions matter. Menthol,mint and wintergreen are flavors. There has been concern with potential legal fallout about flavors. The sample size that 97% compliance rate is based on 34 checks over a course of less than 2 years. Ron has always supported the retail community through education and overall they do a very good job but he would like to submit his own records in regards to the compliance checks that the Board of Health does as opposed to the FDA. Ron looked at compliance checks from July 11,2014 through September 30,2019 with a larger sample size of 97 compliance checks which resulted in 11 sales, which is an 11%non-compliance rate as opposed to 3%. Retailers do work hard to try to be compliant;it is generally a negligent act not an intentional act. This is something that needs to be called out in regards to a discrepancy between the data that has been provided. (See Appendix D.- North Andover Compliance Checks) 5. Ashley Hall—Program Manager of the Northeast Tobacco-Free Community Partnership that serves North Andover. Part of the goal is to prevent sales to minors but also there is the goal to limit exposure. Youths that are exposed to tobacco industry tactics,frequent stores that sells tobacco or advertises tobacco products two or more times a week are four times more likely to become lifelong tobacco and nicotine users. The advertisements in adult-only stores decreases the effects that the tobacco industry has on our youth,whose brains are undeveloped,and we do not want to teach children at a young age that tobacco is normal,nicotine addiction is normal. We want to prohibit this from happening. 6. Michael Brangwynne—second time at podium,CRR. Mr.Brangwynne reviews his statistics with the Board. The 30%data in reference to brick and mortar purchases,Mr.Brangwynne believes,is North Andover Board of Health Meeting Minutes Thursday—October 24,2019 7:00 p.m. 120 Main Street, 2"d Floor Selectmen's Meeting Room North Andover, MA 01845 a national statistic for Massachusetts. Mr Brangwynne did not have the local statistics compiled by the Board of Health,which shows an 89%compliance rate. The Board of Health should be considering those local statistics. Dr.Frank MacMillan explains to Mr.Brangwynne that the Board has been working with Ronald Beauregard for decades with the Healthy Communities Tobacco Control Program,who conduct the local compliance checks for the Town of North Andover. Mr.Brangwynne recommends implementing a point of sale id checks to prevent against sales with fake identification,have stricter enforcement mechanisms for a rogue employee that negligently or carelessly sells to a minor,instant firing offense,anything that will actually address the problem. If the concern is with minors viewing cigarettes and advertisements,then put them somewhere where they will not be seen. The stores would agree to all of these things in order to continue selling to adults. Mr.Brangwynne is concerned that the strict regulations will force the small retail businesses out through loss of customer base. The retail stores are willing to work with the Board to stop the problems at hand,rather than what is proposed. Dr.Patrick Scanlon asks Mr.Brangwynne about the statistics of adults who frequent stores of North Andover,looking for flavored,not wintergreen or menthol that are actively using for smoking cessation only. Mr. Brangwynne directs Dr. Scanlon to Dr. Siegel's affidavit with respect to the medicine behind it. Mint,menthol and wintergreen have been associated with tobacco products for much longer than vaping ever was existent. The FDA is concerned that the ban of vaping-flavored products will force people to go back to using combustible products. Dr.Patrick Scanlon asks that since the statewide vaping ban has gone into effect,has any convenience store in North Andover gone out of business,the answer is no. What is not included in the statewide ban is mint,menthol and wintergreen traditional tobacco products. This is a key piece of the retailer's revenue. 7. Ronald Beauregard—second time at podium. Mr.Beauregard read Dr.Siegel's affidavit. Newport Cigarettes are the second largest brand in the country and started by RJ Reynolds. Dr. Siegel is not going to argue that we should benefit from mint,menthol or wintergreen in the form of cigarettes or in chewing tobacco products. Vapes have not been around long enough to be considered traditional. Newport's where launched in 1957 and has been considered a traditional flavor,unfortunately this flavor helps suppress the cough,makes the smoke less harsh and keeps addiction strong,and more difficult to quit. Dr. Siegel is not promoting cigarettes;he is doing the opposite. 2019 North Andover Board of Health Meeting Page 3 of 5 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 8. Cheryl Sbarra—second time at podium. Ms.Sbarra explains that the retailers cannot just agree to put their products somewhere where not visible. This is a violation of the First Amendment Right for Commercial Free Speech. Past regulations recommended that cigarettes to be sold would stay behind the counter. 9. Michael Brangwynne—third time at podium. The current position of the Coalition for Responsible Retailers and the stores they represent is willing to consider any and all of the things that Mr.Brangwynne mentioned rather than creating a new store that does not exist in the community. This is untested,a new person that has not ever held a tobacco permit before. We are entrusting a new storeowner as opposed to someone who has been in business for decades with an 89%compliance rate. The storeowners are willing to work with the Board of Health. Brian LaGrasse does explain that most of the time that hired workers are selling the products not the owners of the stores themselves. The Board of Health has tried training and card all policies(Fenway Rule). The Board of Health only does one compliance check per year per establishment with failures reported. Some establishments fail three times in a row,which is three sales over three years being checked three times. Additional steps are taken and it is an ongoing problem. Dr.Frank MacMillan asks Mr.Brian LaGrasse to review the proposed changes from the last Board of Health meeting dated September 26,2019. See Appendix A. —Revisions Synopsis and Town of North Andover Board of Health Regulating the Sale and Use of Tobacco Products. Items discussed have been highlighted and revised in Appendix A. Dr.Frank MacMillan asks the Board if any revisions are to be extracted for further discussion,amendment or removal. No member of the Board wishes to discuss any item further. MOTION made by Joseph McCarthy to accept the revised Regulating the Sale and Use of Tobacco Products as presented with the adoption date of October 24,2019 and the effective date of January 1,2020.Motion seconded by Dr.Patrick Scanlon.All were in favor and the motion was approved. (3-0-0) With no further discussion,Dr.Frank MacMillan closed the Public Hearing. (3-0-0) V. OLD BUSINESS A. Board of Health Update—Mosquito Control(See Appendix D.) VI. COMMUNICATIONS,ANNOUNCEMENTS,AND DISCUSSION A. Future meeting,the Board will discuss the Body Art Regulations B. Future meeting,the Board will discuss the Food Protection Program with the revisions of plan review guides and food permits North Andover Board of Health Meeting Minutes Thursday—October 24, 2019 7:00 p.m. 120 Main Street, 2nd Floor Selectmen's Meeting Room North Andover,MA 01845 VII. ADJOURNMENT MOTION made by Joseph McCarthy to adjourn the meeting.Patrick Scanlon seconded the motion and all were in favor.The meeting adjourned at 7:45pm.(3-0-0) Prepared by: Toni K. Wolfenden, Health Dept.Assistant Reviewed bv: All Board of Health Members&Brian LaGrasse, Health Director Si need by: '�,Jjepd McCarthy, erk of# Board Date Signed Documents Used At Meeting: Meeting Agenda—October 24,2019 Revision Synopsis Town of North Andover Board of Health Regulating the Sale and Use of Tobacco Products—working draft Tobacco Control Regulations—documents submitted by Mr.Michael Brangwynne American Journal of Preventive Medicine—Short-Term Impact of a Flavored Tobacco Restriction: Changes in Youth Tobacco Use in a Massachusetts Community North Andover Compliance Checks—submitted by Mr.Ronald Beauregard Board of Health Update 10/22/2019 Re:Mosquito Control 2019 North Andover Board of Health Meeting Page 5 of 5 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 North Andover Board of Health Meeting Agenda Thursday, October 24, 2019 7:00 p.m. 120 Main Street, 2nd Floor Selectmen's Meeting Room North Andover,MA 01845 I. CALL TO ORDER II. PLEDGE OF ALLEGIANCE III. APPROVAL OF MINUTES IV. PUBLIC HEARINGS- A. Continuation of Proposed Amendments to Regulating the Sale and Use of Tobacco&Nicotine Delivery Products V. OLD BUSINESS VI. NEW BUSINESS VII. COMMUNICATIONS,ANNOUNCEMENTS,AND DISCUSSION A. Halloween and Mosquito Control Update 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 LaGrasse, Health Director;Stephen Casey Jr.,Health Inspector; Caroline Ibbitson,Public Health Nurse;Toni K.Wolfenden,Health Department Assistant Revisions Synopsis: Suzanne and I included all the revisions about what was discussed at the public hearing and created this latest version. Here are some of the things incorporated into the latest draft: We revised the Purpose Section in the beginning and added in all the background info and research citations that Cheryl Sbarra sent us. I added in a"Whereas" statement on page 2 regarding the overall cap number basis. 16 total which will include the 1 adult only permit Revised section numbers to include all revisions,new sections, etc; Added in the Adult Only Tobacco Retail Store definition on page 3; Added in Retail Establishment definition on page 5; Revised Tobacco Product Definition, added a Tobacco Sales Permit Definition and added in Vaping definition on page 6; Added in section 4.12 which states Adult-only tobacco only stores may sell flavored products with conditions, ie. it does not share space,has a separate entrance, from any other business, does not sell food etc, on page 8 Added in sections 4.13 through 4.18 on page 9. These sections state: 1.Tobacco retailers (ie convenience stores)may only sell natural flavored tobacco products; 2. Cap the permits at 16 in total, including 1 Adult only establishment 3.No retailers within 500' of a school or another retailer 4. New business owners of existing location have 60 days to transfer existing permit to their name. Added in governors emergency order into out of package sales on page 11 Section 11.1 prohibit tobacco vending machines. We have none in town so we revised this one on page 11; Section 13 prohibits sale of tobacco at health care institutions which is now state law on page 12; Section 15 was added in and bans the sale of electronic cigarettes, vapes etc. Suzanne added it in and as it is written it will ban them everywhere but I thought you wanted to allow them after the governor's ban is lifted at adult only tobacco retailers. I have it as they would be allowed after the ban but this should be discussed at the continued public hearing and decided on then; Page 12 Section 16 adopts MGL smoke-free workplace law and prohibits smoking in adult only tobacco stores, smoking bars (meaning we can't have one), etc; I also added in a new Section 16.2(d) which will state "Smoking within 25' of the entrance to a public building is prohibited. Just so people don't sit right next to a building entrance in the winter and smoke away allowing all the smoke to get sucked into the foyer. I had an inquiry recently about people smoking right next to a doorway and we have no set distance...Page 12 The fines in Section 17 have been increased to $300 on page 13 Section 18 was added and mimics state law and allows a fine to be issued to someone smoking where it's not allowed. Page 14. I think this pretty much covers it... Town of North Andover Board of Health REGULATING THE SALE and USE OF TOBACCO PRODUCTS SECTION 1: STATEMENT OF PURPOSE WHEREAS there exists conclusive evidence that tobacco smoking causes cancer,.respiratory and cardiac diseases,negative birth outcomes, irritations to the eyes,nose and throat[I]; WHEREAS the U.S. Department of Health and Human Services has concluded that nicotine is as addictive as cocaine or heroin[2] and the Surgeon General found that nicotine exposure during adolescence, a critical window for brain development, may have lasting adverse consequences for brain development,[3] and that it is an addiction to nicotine that keeps youth smoking past adolescence[4]; WHEREAS a Federal District Court found that Phillip Morris,RJ Reynolds and other leading cigarette manufacturers "spent billions of dollars every year on their marketing activities in order to encourage young people to try and then continue purchasing their cigarette products in order to provide the replacement smokers they need to survive" and that these companies were likely to continue targeting underage smokers[5]; WHEREAS more than 80 percent of all adult smokers begin smoking before the age of 18,more than 90 percent do so before leaving their teens, and more than 3.5 million middle and high school students smoke[6]; WHEREAS 18.1 percent of current smokers aged<18 years reported that they usually directly purchased their cigarettes from stores (i.e. convenience store, supermarket, or discount store)or gas stations, and among 11'grade males this rate was nearly 30 percent[7]; WHEREAS the Institute of Medicine (IOM) concludes that raising the minimum age of legal access to tobacco products to 21 will likely reduce tobacco initiation,particularly among adolescents 15 - 17, which would improve health across the lifespan and save lives[8]; Whereas cigars and cigarillos, can be sold in a single"dose;"enjoy a relatively low tax as compared to cigarettes; are available in fruit, candy and alcohol flavors; and are popular among youth[9]; WHEREAS research shows that increased cigar prices significantly decreased the probability of male adolescent cigar use and a 10% increase in cigar prices would reduce use by 3.4%[10]; WHEREAS 59% of high school smokers in Massachusetts have tried flavored cigarettes or flavored cigars and 25.6% of them are current flavored tobacco product users; 95.1 %of 12— 17-year old's who smoked cigars reported smoking cigar brands that were flavored[11]; 1 a WHEREAS the Surgeon General found that exposure to tobacco marketing in stores and price discounting increase youth smoking[12]; WHEREAS the federal Family Smoking Prevention and Tobacco Control Act(FSPTCA), enacted in 2009,prohibited candy- and fruit-flavored cigarettes,[13] largely because these flavored products were marketed to youth and young adults,[14] and younger smokers were more likely to have tried these products than older smokers[15],neither federal nor Massachusetts laws restrict sales of flavored non-cigarette tobacco products, such as cigars, cigarillos, smokeless tobacco,hookah tobacco, and electronic devices and the nicotine solutions used in these devices; WHEREAS the U.S. Food and Drug Administration and the U.S. Surgeon General have stated that flavored tobacco products are considered to be "starter"products that help establish smoking habits that can lead to long-term addiction[16]; WHEREAS the U.S. Surgeon General recognized in his 2014 report that a complementary strategy to assist in eradicating tobacco-related death and disease is for local governments to ban categories of products from retail sale[17]; WHEREAS the U.S. Food and Drug Administration and the Tobacco Products Scientific Advisory Committee concluded that menthol flavored tobacco products increased nicotine dependence, decreased success in smoking cessation[18]; WHEREAS menthol makes it easier for youth to initiate tobacco use[19]; WHEREAS the number of tobacco retail establishment permit holders in North Andover declined from 20 to 15 permit holders in 2019 and there has only been one adult only retail tobacco establishment permit that has been applied for; WHEREAS the U.S. Centers for Disease Control and Prevention has reported that the current use of electronic cigarettes, a product sold in dozens of flavors that appeal to youth, among middle and high school students tripled from 2013 to 2014[20]; WHEREAS 5.8% of Massachusetts youth currently use e-cigarettes and 15.9%have tried them[21]; WHEREAS the Massachusetts Department of Environmental Protection has classified liquid nicotine in any amount as an"acutely hazardous waste"[22]; WHEREAS in a lab analysis conducted by the FDA, electronic cigarette cartridges that were labeled as containing"no nicotine"actually had low levels of nicotine present in all cartridges tested, except for one [23] WHEREAS according to the CDC's youth risk behavior surveillance system,the percentage of high school students in Massachusetts who reported the use of cigars within the past 30 days was 10.8% in 2013[24]; 2 WHEREAS data from the National Youth Tobacco Survey indicate that more than two-fifths of U.S. middle and high school smokers report using flavored little cigars or flavored cigarettes[25]; WHEREAS the sale of tobacco products is incompatible with the mission of health care institutions because these products are detrimental to the public health and their presence in health care institutions undermine efforts to educate patients on the safe and effective use of medication, including cessation medication; WHEREAS educational institutions sell tobacco products to a younger population,who are particularly at risk for becoming smokers and such sale of tobacco products is incompatible with the mission of educational institutions that educate a younger population about social, environmental and health risks and harms; and WHEREAS the Massachusetts Supreme Judicial Court has held that" . . . [t]he right to engage in business must yield to the paramount right of government to protect the public health by any rational means"[26]. Now, therefore it is the intention of the North Andover Board of Health to regulate the sale of tobacco products. SECTION 2: DEFINITIONS For the purpose of this regulation, the following words shall have the following meanings: 2.1 ADULT-ONLY RETAIL TOBACCO ESTABLISHMENT: An establishment that does not share space with another business, that shall have a seperate public entrance,that does not sell food or alcohol, that does not have a restaurant license or lottery license,whose only purpose is to sell or offer for retail sale tobacco products and/or tobacco product paraphernalia, in which entry of persons under the age of 21 is prohibited at all times, and which maintains a valid permit for the retail sale of tobacco products as required to be issued by the North Andover Board of Health and any applicable state licenses. Entrance to the establishment must be secure so that access to the establishment is restricted to employees and to those 21 years of age and older. The establishment shall not allow anyone under 21 to work at the establishment. 2.2 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. 2.3 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. 2.4 CHARACTERIZING FLAVOR: A distinguishable taste or aroma imparted or detectable either prior to or during consumption of a tobacco product or component part thereof, including,but not limited to, tastes or aromas relating to any fruit, chocolate, vanilla, honey, 3 candy, cocoa, dessert, alcoholic beverage, menthol, mint or wintergreen,herb or spice. "Characterizing flavor"does not include the taste or aroma of tobacco, additives, or flavorings that do not contribute to the distinguishable taste or aroma of the product or the provision of ingredient information. 2.5 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. 2.6 COMPONENT PART. Any element of a tobacco, including,but not limited to,the tobacco, filter,paper,mouthpiece,heating element battery and/or electronic circuits but not including any constituent. 2.7 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 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 aerosolization constituent from a tobacco product. 2.8 DISTINGUISHABLE: Perceivable by either the sense of smell or taste. 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. 2.10 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 rely on vaporization or aerosolization, including but not limited to,pods,vape juice containers and cartridges. 2.11 EMPLOYEE: Any individual who performs services for an employer. 2.12 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. 2.13 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. 2.14 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 4 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. 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's offices and dentist's offices. 2.16 NON-RESIDENTIAL ROLL-YOUR-OWN (RYO)MACHINE: A mechanical device made available for use (including 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. 2.17 OUTDOOR SPACE: An outdoor area, open to the air at all times and cannot be enclosed by a wall or side covering. 2.18 PERMIT HOLDER: Any person engaged in the sale or distribution of tobacco products 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. 2.19 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. 2.20 RETAIL ESTABLISHMENT: Any establishment selling, goods, articles or personal services to the public, including but not limited to convenience stores, gas stations, grocery stores, department stores, barber shops, nail salons, hair salons and tanning salons. 2.21 SELF SERVICE DISPLAY: Any display from which customers may select a tobacco product without assistance from an employee or store personnel, excluding vending machines. 2.22 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. 2.23 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 5 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". 2.24 TOBACCO PRODUCT: Any product 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 any other means, including,but not limited to: cigarettes, cigars, little cigars, chewing tobacco,pipe 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. 2.25 TOBACCO PRODUCT SALES PERMIT: A permit issued by the Board of Health upon application and in accordance with Section 4 of these regulations. Approval and a Tobacco Product Sales Permit is required by any retail establishment or adult only tobacco retail establishment to sell any tobacco product in North Andover. Selling any tobacco product in North Andover without a valid Tobacco Product Sales Permit is a violation of these regulations and subject to enforcement. 2.26 VAPING PRODUCTS: 1) any product intended for human consumption by inhalation regardless of nicotine content,whether for one-time use or reusable,that relies on vaporization or aerosolization, including but not limited to electronic cigarettes, electronic cigars electronic cigarillos, electronic pipes, electronic vaping product delivery pens,hookah pens, and any other similar devices that rely on vaporization or aerosolization; and 2) any component,part, or accessory of a product or device defined in subsection 1), even if sold separately. "Vaping products" do not include any product that has been approved by the Federal 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. 2.27 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. SECTION 3: TOBACCO PRODUCT SALES TO PERSONS UNDER THE AGE OF 21 PROHIBITED 3.1 PROHIBITION UNDER TWENTY ONE YEARS OF AGE: No person shall sell or otherwise distribute tobacco products to persons under the age of 21. 6 3.2 REQUIRED SIGNAGE: In conformance with G.L. c. 270, § 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 40. 3.4 FACE TO FACE SALES: All retail sales of tobacco products 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 products at retail within North Andover without first obtaining a Tobacco 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 products 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 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. 7 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 30'of every year. 4.5 A separate permit is required for each location where a retail establishment is selling tobacco products. 4.6 Each Tobacco 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 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. 4.12 An Adult-Only Retail Tobacco Establishment may be issued a Tobacco Product Sales Permit authorizing the sale of flavored tobacco products or blunt wraps provided the Adult-Only Retail Tobacco Establishment meets with the following conditions: a)The business establishment does not share retail or business space with another business establishment. It has a separate public entrance from any other business establishment. The entrance is secured so that access is restricted to employees and individuals twenty one (21)years of age or older. b)It does not sell food, drinks, alcohol, lottery tickets, goods or services nor shall it hold a license to sell food, a restaurant license, an alcohol license, or a lottery license. c) No person under the age of twenty one(21) shall enter the premises or be employed by the establishment. 8 d) It shall not be located within five hundred(500') feet of a retailer with a tobacco product sales permit. e) It shall hold all permits and licenses required by the Commonwealth of Massachusetts. 4.13 A Tobacco Product Sales Permit limited to the sale of natural tasting tobacco products that does not have a characterizing flavor may be issued to other retail establishments that meet the criteria of the North Andover Board of Health regulations and all state and federal laws pertinent to the sale of natural tasting tobacco products. 4.14 At any given time, there shall be no more than SIXTEEN (16) Tobacco Product Sales Permits issued in the Town of North Andover. This section shall only apply to permits newly issued after the effective date of this regulation. No renewal of an existing valid permit will be denied based on the permit capping requirements described herein. A valid existing permit shall not include any permit that has not been renewed within thirty(30) days of its expiration. Any such permit shall be treated as a New Permit. 4.15 At any given time there shall be no more than ONE (1)Tobacco Product Sales Permits issued to an Adult-Only Retail Tobacco Establishment. 4.16 A Tobacco Product Sales Permit shall not be issued to any new applicant for a retail establishment located 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. 4.17 A Tobacco Product Sales Permit shall not be issued to any new applicant for a retail establishment located 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. 4.18 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 4.15. 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 9 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 PROHIBITED 6.1 No person shall sell or distribute or cause to be sold or distributed any flavored tobacco products except in smoking bars and adult-only retail tobacco establishments. SECTION 7: THE SALE OF BLUNT WRAPS 7.1 No person or entity shall sell or distribute blunt wraps within North Andover, except in adult-only retail tobacco establishments are permitted to sell or distribute blunt wraps. SECTION 8: FREE DISTRIBUTION AND COUPON REDEMPTION 8.1 No person shall: (a)Distribute, or cause to be distributed, any free samples of tobacco products. (b)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 defined herein,without charge or less than the listed or non-discounted price in exchange for the purchase of any other tobacco product. (c) Sell a tobacco product, as defined 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 defined herein,without charge or for less than the listed non-discounted price in exchange for the purchase of any other tobacco product. 10 SECTION 9: OUT-OF-PACKAGE SALES 9.1 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. (a)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. (b)Pursuant to the Governor's September 24, 2019 Public Health Emergency Order, no Permit holder shall sell Liquid Nicotine Containers. The North Andover Board of Health may reconsider this prohibition at the time the Public Health Emergency has been deemed to be resolved. If the prohibition ends thereafter,the Permit holder who sells Liquid Nicotine Containers must comply with the provisions of 310 CMR 30.000, and must provide the North Andover Board of Health with a written plan for disposal of said product, including disposal plans for any breakage, spillage or expiration of the product. (c)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." (d)No permit holder shall refill a cartridge that is pre-filled 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. SECTION 11: TOBACCO VENDING MACHINES 11.1 All tobacco product vending machines are prohibited. SECTION 12: NON-RESIDENTIAL ROLL-YOUR-OWN (RYO)MACHINE 12.1 All Non-Residential Roll-Your-Own(RYO) Machines are prohibited. 11 SECTION 13: RESTRICTIONS ON THE SALE OF TOBACCO PRODUCTS AT HEALTH CARE INSTITUTIONS 13.1 No Health Care Institution located in the Town of North Andover shall sell or authorize the sale of tobacco products within its buildings, or facilities or on its grounds. G.L. c. 111, § 61A, as amended 2018 SECTION 14: PROHIBITION OF THE SALE OF TOBACCO PRODUCTS BY EDUCATIONAL INSTITUTIONS: 14.1 No educational institution located in the Town of North Andover shall sell or cause to be sold tobacco products. This includes all educational institutions as well as any retail establishments that operate on the property of an educational institution. SECTION 15: SALE OF ELECTRONIC CIGARETTES PROHIBITED: 15.1 Consistent with the Governor's September 24, 2019 Declaration of a Public Health Emergency, no person shall sell, distribute, or cause to be sold or distributed any vaping products as defined herein. If the Public Health Emergency Ban has been deemed to be resolved or rescinded,the sale of electronic cigarettes and all vaping products or accessories will be restricted to only Adult-Only Tobacco Retail Establishments. SECTION 16: PROHIBITING SMOKING IN WORKPLACES AND PUBLIC PLACES 16.1 The Board of Health adopts the Massachusetts Smoke-Free Workplace by reference and any future revisions as a local regulation. G.L. c. 270, §§ 21, 22. 16.2 Pursuant to G.L. c. 270, § 22 0), smoking is also hereby prohibited in the following locations: (a)Adult-Only Retail Tobacco Store; (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; (d)Within Twenty-Five (25) feet of a building entrance or enclosed space where smoking is prohibited. 16.3 The use of e-cigarettes or any vaping product is prohibited wherever smoking is prohibited. G. L. c. 270, § 22 and North Andover Board of Health regulation § 4.17.002. 12 SECTION 17: VIOLATION OF TERMS OF PERMIT AND REGULATIONS 17.1 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 products. The violator shall receive: (a)In the case of a first violation, a fine of Three Hundred($300) dollars; (b) In the case of a second violation within twenty-four(24)months of the date of the first violation, a fine of Three Hundred($300) 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. 17.2 Refusal to cooperate with inspections pursuant to this regulation shall result in the suspension of the Tobacco Product Sales Permit for Thirty(30) consecutive business days. 17.3 In addition to the monetary fines set above, any permit holder who engages in the sale or distribution of tobacco 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. 17.4 The North Andover Board of Health shall provide notice of their 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. 13 SECTION 18: VIOLATIONS OF REGULATIONS 18.1 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 21D or by filing a criminal complaint at the appropriate venue. Each day any violation exists shall be deemed to be a separate offense. 18.2 An individual or person who violates the provisions of G.L. c. 270, § 21 and 22 by smoking in a place where smoking is prohibited shall be subject to a civil penalty of$100 for each violation. G.L. c. 270, § 22(m)(2). Any individual or person who violates the provisions of Section 16.2 of these regulations shall be subject to a fine of$25.00. Each occurrence of a violation shall be a separate offense. 18.3 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 19: OTHER APPLICABLE LAWS 19.1 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 20 THROUGH 21 Reserved for future regulations, amendments, etc. SECTION 22: SEVERABILITY 22.1 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: PREVIOUS REGULATION SUPERCEDED 23.1 This regulation supersedes the prior regulation titled"Regulations Affecting Smoking in Certain Places and Youth Access to Tobacco,"as adopted with an effective date of September 1, 2015 and thereafter amended. 14 G Effective Date: This regulation was adopted on October 24, 2019. This regulation shall take effect on January 1, 2020. Signatures: Francis P. MacMillan, M.D., Chairman Date of Signature Joseph McCarthy, Clerk Date of Signature Michele Davis,R.N., Member Date of Signature Patrick Scanlon, D.O., Member Date of Signature Daphnee Alva-LaFluer, Member Date of Signature 15 [1] Center for Disease Control and Prevention, (CDC)(2012), Health Effects of Cigarette Smoking Fact Sheet. Retrieved from: http://www.cdc.gov/tobacco/data—statistice/fact_sheets/health_effects/effects—Cig_smoking/index. htm. [2] CDC(2010),How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking Attributable Disease. Retrieved from:http://www.cdc.gov/tobacco/data—statistics/sgr/2010/. [3]U.S. Department of Health and Human Services.2014. The Health Consequences of Smoking—50 Years of Progress:A Report of the Surgeon General.Atlanta:U.S.National Center for Chronic Disease Prevention and Health Promotion,Office on Smoking and Health,p. 122.Retrieved from: http://www.surgeongeneral.gov/library/reports/50-years-of-progress/full-report.pdf. [4]Id. at Executive Summary p. 13.Retrieved from: http://www.surgeongeneral.gov/library/reports/50-years-of-progress/exec-summarypdf [5]United States v. Phillip Morris,Inc.,RJ Reynolds Tobacco Co.,et al.,449 F.Supp.2d 1 (D.D.C. 2006) at Par. 3301 and Pp. 1605-07. [6] SAMHSA,Calculated based on data in 2011 National Survey on Drug Use and Health and U. S. Department of Health and Human services(HHA). [7] CDC(2013)Youth Risk Behavior, Surveillance Summaries(MMWR 2014: 63 (No SS-04)). Retrieved from:www.cdc.gov. [8]IOM(Institute of Medicine)2015.Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products. Washington DC: The National Academies Press,2015. [9]CDC(2009), Youth Risk Behavior, Surveillance Summaries(MMWR 2010: 59, 12,note 5). Retrieved from: http:www.ede.gov/mmwr/pdf/ss/ss5905.pdf. [10]Ringel,J.,Wasserman,J.,&Andreyeva,T. (2005) Effects of Public Policy on Adolescents'Cigar Use: Evidence from the National Youth Tobacco Survey. American Journal of Public Health,95(6), 995-998,doi: 10.2105/AJPH.2003.030411 and cited in Cigar, Cigarillo and Little Cigar Use among Canadian Youth: Are We Underestimating the Magnitude of this Problem?, J.Prim.P. 2011,Aug: 32(3-4):161-70. Retrieved from:www.nebi.nim.gov/pubmed/21809109. [11]Massachusetts Department of Public Health,2015 Massachusetts Youth Health Survey(MYHS); Delneve CD et al.,Tob Control,March 2014: Preference for flavored cigar brands among youth,young adults and adults in the USA. [12]U.S.Department of Health and Human Services.2012.Preventing Tobacco Use Among Youth and Young Adults:A Report of the Surgeon General.Atlanta:U.S.National Center for Chronic Disease Prevention and Health Promotion,Office on Smoking and Health,p. 508-530, wwwsurgeo eiaeral.gov/librarv/reports/Rreventing-youth-tobacco-use/ull-report.12 [13]21 U.S.C. § 387g. 16 [14]Carpenter CM,Wayne GF,Pauly JL, et al.2005. "New Cigarette Brands with Flavors that Appeal to Youth: Tobacco Marketing Strategies."Health Affairs.24(6): 1601-1610;Lewis M and Wackowski O. 2006. "Dealing with an Innovative Industry: A Look at Flavored Cigarettes Promoted by Mainstream Brands."American Journal of Public Health. 96(2): 244-251;Connolly GN. 2004. "Sweet and Spicy Flavours:New Brands for Minorities and Youth."Tobacco Control. 13(3): 211-212;U.S. Department of Health and Human Services. 2012.Preventing Tobacco Use Among Youth and Young Adults:A Report of the Surgeon General.Atlanta:U.S.National Center for Chronic Disease Prevention and Health Promotion,Office on Smoking and Health,p. 537, wwwsurgeonyeneral.gov/librarv/reports/preventing youth-tobacco-tobacco -report,12df. [15]U.S.Department of Health and Human Services.2012.Preventing Tobacco Use Among Youth and Young Adults:A Report of the Surgeon General.Atlanta: U.S.National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health,p. 539, www surgeongeneraL-aov/library/rraorts/�reventing-youth-tobacco-use/full-resort pdf. [16] Food and Drug Administration.2011.Fact Sheet:Flavored Tobacco Products, www;fda.gQv/downloads/TobaccoProducts/Protecting&�4fromTobacco/FlavoredTobacco/UCM183214,12 U.S.Department of Health and Human Services. 2012.Preventing Tobacco Use Among Youth and Young Adults:A Report of the Surgeon General.Atlanta:U.S.National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health,p. 539, wwwsuMeongeneral.gov/librarv/reports/preventing-Youth-tobacco-use/ Il-r port.12 [17]See fa. 3 at p. 85. [181 www.fda.gov/downloads/ucm361598.pdf, Https://tobacco,ucsf.edu/tpsac-gave-fda-what-it-needs-to-ban-menthol [19] www.tobaccofreekids.org/assets/factsheet/0390.pdf [20]Centers for Disease Control&Prevention.2015. "Tobacco Use Among Middle and High School Students—United States,2011-2014,"Morbidity and Mortality Weekly Report(MMWR) 64(14): 381-385; [21]Massachusetts Department of Public Health,2015 Massachusetts Youth Health Survey(MYHS) [22]310 CMR 30.136 [23]Food and Drug Administration,Summary of Results:Laboratory Analysis of Electronic Cigarettes Conducted by FDA, available at: hU://www.fda.goy/newsevents/gublichealthfocus/ucml73146.htm. [24]See fn. 7. [25]King BA,Tynan MA,Dube SR,et al. 2013. "Flavored-Little-Cigar and Flavored-Cigarette Use Among U.S.Middle and High School Students."Journal of Adolescent Health. [Article in press], www.iahonline.org/article/51054-139X'I2813%290041 S-1/abstract. [26]Druzik et al v.Board of Health of Haverhill, 324 Mass.129(1949). 17 10/2/2019 Town of North Andover Mail-Tobacco Control Regulations n �� NORTH ANDOVER Massachusetts Toni Wolfenden <twolfenden@northandoverma.gov> Tobacco Control Regulations 3 messages Mike Brangwynne <mbrangwynne@fletchertilton.com> Tue, Oct 1, 2019 at 11:56 AM To: "twolfenden@northandoverma.gov" <twolfenden@northandoverma.gov>, "blagrasse@northandoverma.gov" <baagrasse@northandoverma.gov> Hello Director Lagrasse, I have attached correspondence related to the Town of North Andover Board of Health's consideration of certain revisions to its tobacco control regulation. At the most recent hearing, the Board had asked for specific information regarding medical and scientific literature that was discussed at the hearing. Could you please provide this correspondence to the Board members prior to the next meeting of the Board? Thank you. Please feel free to get in touch if you have any questions or concerns. Very truly yours, Michael E. Brangwynne FLETCHER TILTON PC 12 POST OFFICE SQUARE 16TH FLOOR BOSTON, MA 02109 P: (617)336-2281 1 F: (617)336-4481 E: MBRANGWYNNE@FLETCHERTILTON.COM VISIT US AT: FLETCHERTILTON.coM r ieteherT lton -1.--j i .. .:. Attorneys at law BEST wO.RCESTER-FRAMINGHAM [AW FIRMS 905TON:CAPE COD M7 DFIEI,13-PROVIOENCE 2o>s FletcherTilton.com To the extent that this communication contains any federal tax-related advice, please be advised that such advice is not intended to be used, and may not be used, for the purpose of: (i)avoiding tax-related penalties under the Internal Revenue Code, or(ii) promoting, marketing or recommending to another party any tax-related matter(s) addressed herein. This e-mail message is generated from the law firm of Fletcher Tilton PC, and may contain information that is confidential and may be privileged as an attorney/client communication or as attorney work product. The information is https://mai l.goog le.com/mail/u/0?ik=aOc6f4e4cf&view=pt&search=al I&permthid=thread-f%3AI 646207087027462268&simpl=msg-f%3AI 64620708702... 1/3 10/2/2019 Town of North Andover Mail-Tobacco Control Regulations intended to be disclosed solely to the addressee(s). If you are not the intended recipient, any disclosure, copying, distribution or use of the contents of this e-mail information is prohibited. If you have received this e-mail in error, please notify the sender by return e-mail and delete it from your computer system. mn Itr N.Andover BOH 10.1.19 (03277221xA166B).pdf 2725K Toni Wolfenden <tolfenden@northandoverma.gov> Tue, Oct 1, 2019 at 12:19 PM To: Mike Brangwynne <mbrangwynne@fletchertilton.com> Cc: "b lag rasse@northandoverma.gov" <blagrasse@northandoverma.gov> Received, thank you. Toni K. Wolfenden Health Department Assistant 978-688-9540 L_,�cid:image002.jpg@01 CD02A1.85A49B40 [Quoted text hidden] image001.jpg 4K Mike Brangwynne<mbrangwynne@fletchertilton.com> Tue, Oct 1, 2019 at 1:28 PM To: Toni Wolfenden <tolfenden@northandoverma.gov> Cc: "blagrasse@northandoverma.gov" <blagrasse@northan dove rma.gov> Thanks Toni. Michael E. Brangwynne FLETCHER TILTON PC 12 POST OFFICE SQUARE 16TH FLOOR BOSTON, MA 02109 P: (617)336-2281 1 F: (617)336-4481 E: MBRANGWYNNE@FLETCHERTILTON.COM VISIT US AT. FLETCHERTILTON.COM https://mail.goog le.com/mail/u/0?ik=aOc6f4e4cf&view=pt&search=a II&permth id=th read-f%3AI 646207087027462268&simpl=msg-f%3AI 64620708702... 2/3 10/2/2019 Town of North Andover Mail-Tobacco Control Regulations i`letcherTilton.. F::J t>,,. . Attorneys at law BEST WORCESTER-FRAM04GHAM I AW FIRMS BOSTON•CAPE COD ►- MWFIELO-PROVIDENCE 2" FletcherTilton.com From: Toni Wolfenden [mailto:twolfenden@northandoverma.gov] Sent: Tuesday, October 01, 2019 12:20 PM To: Mike Brangwynne <mbrangwynne@fletchertilton.com> Cc: blagrasse@northandoverma.gov Subject: Re: Tobacco Control Regulations CAUTION: EXTERNAL EMAIL [Quoted text hidden] All email messages and attached content sent from and to this email account are public records unless qualified as an exemption under the Massachusetts Public Records Law. Visit us online at www.northandoverma.gov. https://mai l.google.com/mail/u/0?ik=aOc6f4e4cf&view=pt&search=all&permth id=th read-f%3A1646207087027462268&simpl=msg-f%3A164620708702... 3/3 FletcherTilton Attorneys at law October 1, 2019 VIA EMAIL ONLY (blagrasse@northandoverma.gov) Town of North Andover Health Department, Board of Health c/o Brian Lagrasse, Director 120 Main Street North Andover, MA 01845 Re: Town of North Andover Health Department, Board of Health Proposed/Amended Regulation of Sale of Tobacco and Nicotine Products Dear Director Lagrasse and Members of the Board of Health: As you know,this firm represents the Coalition for Responsible Retailing ("CRR"). This letter is in follow up to the Board's public hearing of September 26, 2019, at which the Board considered amendments to its tobacco control regulation. I thought it would be appropriate to provide the following information in advance of the Board's continuation of the discussion at its next meeting. As you may know, in December of 2018,the City of Somerville Board of Health voted in favor of a city-wide ban on the sale of menthol.mint and wintergreen tobacco products from retail stores. Said ban also includes a prohibition on the sale of certain non- combustible electronic products from retailers (e.g. e-cigarettes or vape pens). Other municipalities, including Barnstable, Walpole, Framingham, and Swampscott have passed similar flavor bans which include a prohibition on the sale of menthol, mint and wintergreen products. Please note that certain retail storeowners and clients of Fletcher Tilton PC have filed civil lawsuits against the foregoing boards of health in connection with the above-described ban. We do anticipate the initiation of future, similar actions against municipalities that seek to follow suit. Further, it is our position that the mint, menthol and wintergreen products are widely used by adults, not youth, as a method to quit combustible,traditional tobacco products. As a part of the lawsuits that have been filed to date, we have also obtained the support of Dr. Michael Siegel, a physician,tobacco control researcher, anti-tobacco advocate, and professor in the Department of Community Health Sciences at the Boston University School of Public Health. Dr. Siegel has submitted affidavits in support of CRR's position in the pending civil lawsuits in which he sets forth the basis for his opposition to the regulations that are being considered by the North Andover Board of Health, as well as citations to medical and scientific literature supporting his position. (See Attachment A). Client Files/4 8 1 06/00 0 1/0327 7 05 6.DOCX FletcherTilton.com WORCESTER I FRAMINGHAM I BOSTON I PROVIDENCE I CAPE COD FletcherTilton, Attorneys at law Town of North Andover Health Department, Board of Health October 1,2019 Page 2 of 3 In any event,the current lawsuits allege, among other things,that the menthol,mint and wintergreen ban does not constitute a public health decision, is arbitrary and capricious, and exceeds the subject board's authority. In other words,the ban constitutes an abuse of discretion and must be stricken. Indeed,the ban simply stands to keep on retailers' shelves the more dangerous combustible tobacco products,while removing e-cigarettes,which have been recognized as less harmful than, and an important tool in reducing the use of, combustible cigarettes by health experts at the New England Journal of Medicine,among many others. Moreover, a number of recent news stories regarding mysterious health complications,or even deaths, were linked to marijuana"vape pens"—not the e-cigarettes that my client retailers sell to legally purchasing adults. For example,the Washington Post recently stated that: The nationwide investigation has found no particular vaping devices or products linked to all cases and is looking into potential contamination or counterfeit, as many victims report buying marijuana on the street rather titan from a store. See"What we know about the mysterious vaping-inked illness and deaths", Washington Post, September 12,2019(httDS://www washinglogpost com/health/2019/09/07/what-we- know-about-mysterious-vapinp,-linked-illnesses-deaths/?noredirect=on)(emphasis added). If the North Andover BOH affirmatively votes to effectuate any restriction on the sale of menthol,mint or wintergreen tobacco products and/or electronic cigarettes,we expect that other retail owners and clients of Fletcher Tilton PC will seek to prosecute similar litigation against this BOH. It is our understanding that many prudent cities and towns are now waiting to confirm the outcome of the foregoing litigation matters before promulgating any further restrictions relative to the sale of tobacco products and/or electronic cigarette products. We respectfully suggest that the North Andover BOH do the same. It is important to note that,from 2017 to the present, convenience stores within the Town of North Andover have a compliance rate of 97%,as reflected by available FDA records regarding compliance check inspections performed in the Town. (See Attachment B). This data indicates that underage use and access of these products is not a result of convenience store sales. Rather,underage use of these products is stemming from other accessible sources, such as the internet. Client Files/48 1 06/000 1/0327705 6.DOCX FletcherTilton Attorneys at law Town of North Andover Health Department, Board of Health October 1, 2019 Page 3 of 3 Last, I do hope the North Andover BOH recognizes that its contemplated restrictions will unquestionably compel tobacco and nicotine consumers to purchase combustible products. There is ample,valid evidence that combustible products,e.g. certain Marlboro or Camel products, are far more dangerous than the non-combustible e-cigarettes. The contemplated ban simply communicates to your adult tobacco and nicotine consumers that the more dangerous combustible products somehow warrant greater accessibility in the Town of North Andover. Respectfully, how is that a public health decision? Please do not hesitate to contact me directly with any questions or concerns. Thank you for your professional courtesies and for your consideration. Very truly yours, " t - (`) Michael E.Brangwyn FLETCHERTILTON PC 12 Post Office Square, 6"'Floor Boston,MA 02109 P: 617-336-2281 1 F: 617-336-4481 Email: mbrangwynnegfletchertilton.com MEB Enclosures Client Files/48106/0001/03277056.DOCX ATTACHMENT A COMMONWEALTH OF MASSACHUSETTS MIDDLESEX, ss. SUPERIOR COURT DOCKET NO.: 1981 CV366 HIMGIRI ENTERPRISES,INC.,d/b/a ) K2 BEER AND WINE,BIKAS PRADHAN, ) GHULAM ABBAS,FAISAL ABBAS, ) GOHA LLC d/b/a STOP AND SAVE, ) and HAJURI SINGH, ) Plaintiffs, ) V. ) BRIAN GREEN,PAULA MACHADO,and ) ROBERT CICCIA,as they are Members of the ) City of Somerville Board of Health, ) Defendants. ) AFFIDAVIT OF AHCHAEL SIEGEL I,Michael Siegel,hereby depose as follows: 1. 1 make this Affidavit based on my personal knowledge of the factual statements contained herein,and my stated opinions are based upon the sum of my education,training,reading and extensive professional experience. The cited reference material,scientific or medical literature upon which I rely for certain factual information,research data,and in supporting my expert opinions, is typical of the types of reference material, scientific or medical literature upon which I and other medical experts in my field regularly rely upon in our professional work. 2. I am a physician and a professor in the Department of Community Health Sciences at the Boston University School of Public Health. For the past 32 years,I have been a tobacco control researcher and anti-tobacco advocate. Client Files/4 8 1 0 6/0 00 1/0 30725 6 8.DOCX 1 3. I have testified in eight(8) different lawsuits against the tobacco industry. I consider myself to be a long-time, committed anti-tobacco researcher and advocate. 4. I summarize my educational background as follows: a. University of California at Berkeley/UCSF General Preventive Medicine Residency Program August, 1991 to June, 1993 M.P.H.completed:May, 1992(Epidemiology) b. Berkshire Medical Center,Pittsfield,MA PGY-1 Year in Internal Medicine July, 1990 to June, 1991 c. Yale University School of Medicine M.D. completed:May, 1990 d. Brown University B.A.,Environmental Studies: May, 1986 5. Affixed hereto as Tab 1 is a true and accurate copy of my current curriculum vitae. 6. I am intimately familiar with the Somerville Board of Health's (the"Board")recent December 13,2018 decision whereby the Board enacted a modification to its tobacco control regulation. In pertinent part,the Board decided, effective April 1,2019,that Somerville convenience stores and retailers shall be prohibited from selling: (i)tobacco products of the mint,menthol and wintergreen variety; and/or(ii)e-cigarettes of any flavor, including tobacco flavor(the "Regulation"). 7. The Regulation will allow Somerville convenience stores to only sell non-menthol combustible cigarettes, e.g., most Marlboro and Camel brand cigarettes,while excluding menthol cigarettes, e.g.,most Newport cigarette brands, since the vast majority of Marlboro and Camel brands are non-mentholated and the vast majority of Newport brands are mentholated. Adult only stores, also known as 21-and-up stores,will be permitted to sell e-cigarettes and tobacco products of all Client Files/4 8 1 06/000 1/0307256 8.DOCX 2 flavors and varieties. I do not know how many such adult only stores, if any, exist in Somerville. The Regulation Only Serves To Harm Public Health In Somerville. 8. Based upon my approximate 32 years of experience and knowledge of the subject matter relative to underage and adult use of tobacco and nicotine products, it is my expert opinion to a reasonable degree of medical probability and certainty,that the Board's enactment of the Regulation does not constitute a decision in the interest of public health. Stated differently,in my expert opinion,the net result of the Regulation will be to harm the public health and the citizens of Somerville. I will set out the basis and rationale for my expert opinions below. 9. It is my understanding that the Board enacted the Regulation as a purported method to reduce the number of Somerville youth who use tobacco and/or e-cigarette products. The Board seemingly ignored the fact that adults,not teenagers,are far more inclined to use e-cigarette products. Indeed,millions of former adult smokers rely upon non-combustible tobacco products, like flavored e-cigarettes,to help themselves abstain from the highly addictive and deadly tobacco burning cigarettes. Unlike combustible tobacco products,non-combustible tobacco products do not contain tobacco or as many of the other toxins and carcinogens that are the leading causes of lung disease and cancer in users of combustible tobacco products. 10.Notably,the current commissioner of the Food and Drug Administration("FDA"), Scott Gottlieb,M.D., issued a press release in November of 2018, stating that we"must acknowledge the possibility that the availability of... flavors in [e-cigarettes]may be important to adult smokers seeking to transition away from cigarettes."I Commissioner Gottlieb went further by stating that we must avoid creating"a situation where the combustible products have features Statement from FDA Commissioner Scott Gottlieb,M.D.,FDA Statement. November 15,2018. b=s://www fda yov/NewsEvents/Newsroom/PressAnnouncements/ucm625884.htm Client Files/48106/0001/03072568.DOCX 3 that make them more attractive than the non-combustible products"or"a situation where those who currently use menthol-flavored cigarettes might find it less attractive to switch completely to an e-cigarette." 11.Moreover, a recent peer-reviewed study provides that 85%of adults using non-combustible tobacco products prefer flavored e-cigarettes.' This study from the Harm Reduction Journal, surveyed approximately 16,000 adult former smokers who had quit smoking combustible cigarettes by using e-cigarette products. 12. The Board simply cannot ignore the fact that there are at least 2.5 million adults in the United States who rely upon e-cigarettes as a method for quitting the use of combustible cigarettes.3 13.Furthermore,the New England Journal of Medicine recently published a study finding that e- cigarettes are twice as effective as nicotine patches in helping smokers quit completely.4 It cannot be overstated that these non-combustible e-cigarette products are literal life-savers for millions of former smokers. 14.Accordingly,the truth of the matter is that this Regulation will simply eliminate the sale of all e- cigarettes at Somerville convenience stores and allow for the sale of the majority of combustible cigarettes to continue unabated. In my expert opinion to a reasonable degree of medical probability and certainty,this will result in many former smokers going back to smoking combustible cigarettes—which are undoubtedly far more dangerous than e-cigarettes.Indeed, a 2017 Working Paper from The National Bureau of Economic Research, a private,non-profit, 2 Russell C,McKeganey N,Dickson T,Nides M.Changing patterns of first e-cigarette flavor used and current flavors used by 20,836 adult frequent e-cigarette users in the USA.Harm Reduction Journal 2018; 15:33. hgps://hannreductionioumal.biomedcentral.com/track/pdf/10.1 186/sl 2954-018-0238-_6 3 Rodu B.FDA Tobacco Director Ignores 2.5 Million"Anecdotal Reports"About E-Cigarettes.Tobacco Truth. October 28,2016.b=s//rodutobaccotruth blo snot com/2016/10/fda-tobacco-director-ignores-25-million.html 4 Hajek P,et al.A randomized trial of e-cigarettes versus nicotine-replacement therapy.New England Journal of Medicine 2019;380:629-637.https://www.neim.org/doi/full/10-1056/NEJMoal8O8779 Client Files/48106/0001/03072568.DOCX 4 and non-partisan organization,found that a ban on all e-cigarettes flavors would increase the number of combustible smokers.5 15.According to the American Cancer Society's February 2018 position statement,"Combustible tobacco products,primarily cigarettes,are the single greatest cause of cancer and kill about 7 million people worldwide each year. In the United States,98%of all tobacco-related deaths are caused by cigarette smoking."The statement goes on to observe that, "[b]ased on currently available evidence,using current generation e-cigarettes is less harmful than smoking cigarettes...."Accordingly,the American Cancer Society concludes that,although it is preferable for smokers to quit"cold turkey,"those who will not stop smoking cigarettes"should be encouraged to switch to the least harmful form of tobacco product possible," i.e., e-cigarettes or other non-combustible products,because "switching to the exclusive use of e-cigarettes is preferable to continuing to smoke combustible products." 16.Respectfully, it is my expert opinion to a reasonable degree of medical probability and certainty, that there is simply no public health justification for banning e-cigarettes while allowing combustible tobacco cigarettes to remain on convenience store shelves. Assuming there is a government interest in protecting youth from access to electronic cigarettes,then there is a much stronger government interest in protecting youth from access to real, combustible tobacco cigarettes. I do not believe there is any public health justification for banning the sale of a less dangerous product while allowing the sale of a much more dangerous product in the same product category to continue unfettered. s Bucknell J,Marti J,Sindelar JL,Should Flavors be Banned in Cigarettes and E-cigarettes?Evidence on Adult Smokers and Recent Quitters from a Discrete Choice Experiment,Tobacco Control 2019;28:168-175. hns•//tobaccocontrol bmi com/content/tobaccocontrol/28/2/169.full.pdf. 6 American Cancer Society Position Statement on Electronic Cigarettes,February,2018. https•//www cancer org/healthy/stay-away-from-tobacco/e-cigarette-position-statement.html Client Files/48106/0001/03072568.DOCX 5 17.The Regulation will have the net effect of harming the public health in Somerville because it serves to remove the safer non-combustible products from convenience store shelves, leaving behind the more dangerous,traditional combustible cigarettes. Such a scenario will make it far easier for Somerville residents to purchase tobacco products which are far more harmful than the non-combustible flavored products. In my opinion to a reasonable degree of medical probability and certainty,this will result in many former smokers returning to cigarette smoking,as the electronic cigarettes they are currently relying upon to keep from smoking,or. could transition to in the future, are taken off the shelves of the stores where they typically purchase these products. A Decision To Ban Certain Cigarette Brands Over Others Is Arbitrary. 18. In addition to actually harming the health of Somerville's citizens,the Regulation also will give a competitive advantage to the manufacturers of the Marlboro and Camel cigarette varieties, which are traditional combustible cigarettes,and most of which shall remain on convenience store shelves if the Regulation proceeds,because most Marlboro and Camel varieties are non- mentholated while nearly all Newport varieties are mentholated. 19. In my opinion to a reasonable degree of medical probability and certainty,by choosing to ban menthol cigarettes,but leaving all other cigarettes untouched,the Board would be making a decision that is arbitrary and capricious. Practically speaking,the Regulation essentially bans the Newport,Kool and Salem brands,but allows the continued unfettered sale of Marlboro and Camel brands. There is no public health rationale for singling out certain cigarette brands because all such brands have proven to be equally deadly.Treating Newport,Kool, and Salem brands differently from the similarly situated Marlboro and Camel brands is dangerous because there is no difference in public health risk associated with these cigarette brands. Scientific Client Files/48 106/000 1/03 0725 6 8.DOCX 6 evidence shows that menthol cigarettes are no more dangerous than non-menthol cigarettes.7 Further,the FDA has made it clear that there is no cigarette brand that is any safer than another cigarette brand. In fact, it is unlawful for any cigarette brand to claim that its product is any safer than another cigarette brand.$ 20. What the Board also has ignored is that the majority of youth smokers prefer non-menthol cigarettes. The overwhelmingly most popular brand among youth smokers is Marlboro,with Newport being a distant second.' It thus defies logic that the Board has decided to ban Newport sales,but not Marlboro sales,even though we know that youth smokers undoubtedly prefer the Marlboro brand. 21. Public health laws,by definition,must have the effect of protecting the public's health and saving lives—and they must not be arbitrary.For all of the reasons I have stated in support of my opinions,the Regulation at issue will actually harm the public's health in Somerville by making it more difficult for ex-smokers to choose a less harmful option.Moreover,the Regulation is irresponsible and unreasonable because,among other things, it seeks to regulate cigarette brands differently with no valid health justification. [Intentionally Blank—Signature Page Follows] 7 Lung Cancer Study Finds Mentholated Cigarettes No More Harmful Than Regular Cigarettes,Journal of the National Cancer Institute(May 18,2011)hos://academic.oup.com/inci/article/I 03/10/810/2516529 a See Family Smoking Prevention and Tobacco Control Act(Public Law 111-31),section 911(21 U.S.C.§387k). 9 Perks SN,Armour B,Agaku IT.Cigarette brand preference and pro-tobacco advertising among middle and high school students—United States,2012-2016.Morbidity and Mortality Weekly Report(MMWR)2018;67(4);119- 124.httys://www.cdc.gov/mmwr/volumes/67/wr/mm6704a3.htm Client Files/48106/0001/03072568.DOCX 7 Signed under the pains and penalties of perjury this /3•day of March,2019 Michael Siegel • is 1 • I I • 11Fr ' F Client Files/48106/0001/03070502.D0CX O • f • 't ATTACHMENT B Compliance Check Inspections of Tobacco Product Retailers Through 08/31/2019-Search Results You searched for: City contains:North Andover State is:MA Decision Date:01/01/2017 through 1 010 1/20 1 9 Minor Involved:Yes 34 record(s)returned RETAILER MINOR SALE PRODUCT INSPECTION DECISION INSPECTION CHARGES NAME ADDRESS INVOLVED TO TYPE BRAND DATE DATE RESULT 525 TURNPIKE ST NO RITE AID NORTH YES NO N/A N/A NOT 12/19/2017 VIOLATIONS N/A ANDOVER AVAILABLE OBSERVED MA-01845 980 OSGOOD ST NO NORTH NORTH ANDOVER NORTH YES NO N/A N/A NOT 12/19/2017 VIOLATIONS N/A ANDOVER AVAILABLE OBSERVED SHELL MA-01845 342 WINTHROP WINE AND AVE NO BEER AT THE NORTH YES NO N/A N/A AVAILABLE 12/19/2017 VIOLATIONS N/A ANDOVERS ANDOVER OBSERVED MA-01945 342 WINTHROP WINE AND AVE NO BEER AT THE NORTH YES NO N/A N/A NOT 02/13/2019 VIOLATIONS N/A ANDOVERS ANDOVER OBSERVED MA-01845 350 WINTHROP NO MARKET AVNOT BASKET NORTH YES NO N/A N/A 12/19/2017 VIOLATIONS N/A AVAILABLE ANDOVER OBSERVED MA-01845 350 WINTHROP NO MARKET AV BASKET. NORTH YES NO N/A N/A V 02/13/2019 VIOLATIONS N/A AVAILABLE ANDOVER OBSERVED MA-01845 J AND M 701 SALEM ST NO CONVENIENCE NORTH YES NO N/A N/A NOT 12/19/2017 VIOLATIONS N/A ANDOVER AVAILABLE OBSERVED STORE MA-01845 1503 OSGOOD NO RACE WAY STREET CONVENIENCE NORTH YES NO N/A N/A AOVAILABLE 12/19/2017 O OLEAIO S N/A STORE ANDOVER MA-01845 1503 OSGOOD NO RACE WAY STREET NOT CONVENIENCE NORTH YES NO N/A N/A AVAILABLE 02/13/2019 VIOLATIONS N/A STORE ANDOVER OBSERVED MA-01845 1503 OSGOOD NO RACEWAY STREET NOT CONVENIENCE NORTH YES NO N/A N/A AVAILABLE 0Y26/2017 VIOLATIONS N/A STORE ANDOVER OBSERVED MA-01845 J AND M 701 SALEM NO CONVENIENCE STREET T E y NO N/A N/A AVAILABLE NOT 05/08/2019 VIOLATIONS N/A R.IZ STORE AND ANDOVER OBSERVED DELI MA-01845 rD�N ROCK 54 PETERS ST NO E AND NORTH ygg NO N/A N/A NOT 12/19/2017 VIOLATIONS N/A ANDOVER AVAILABLE OBSERVED ITS MA-01845 ROCK 54 PETERS ST NO E AND NORTH YES NO N/A N/A NOT 02/13/2019 VIOLATIONS N/A ANDOVER AVAILABLE OBSERVED SPIRITS MA-01845 Pagel of 3 Compliance Check Inspections of Tobacco Product Retailers Through 08/31/2019-Search Results 1725 TURNPIKE A L PRIME ST NO ENERGY NORTH YES NO N/A N/A NOT 12/19/2017 VIOLATIONS N/A ANDOVER AVAILABLE OBSERVED MA-01845 1725 TURNPIKE A L PRIME ST NO ENERGY NORTH YES NO N/A N/A AVAILABLE 02/13/2019 VIOLATIONS N/A ANDOVER OBSERVED MA-01845 4 MAIN ST NO RICHDALE NORTH YES NO N/A N/A NOT 12/19/2017 VIOLATIONS N/A FOOD STORES ANDOVER AVAILABLE OBSERVED MA-01845 4 MAIN ST NO RICHDALE NORTH YES NO N/A N/A NOT 12/1312019 VIOLATIONS N/A FOOD STORES ANDOVER AVAILABLE OBSERVED MA-01845 64 MAIN ST NO MAIN STREET NORTH YES NO N/A N/A NOT 12/19/2017 VIOLATIONS N/A LIQUORS ANDOVER AVAILABLE OBSERVED MA-01845 531 CHICKERING � NO MCALOONS NORTH qYESN(O O N/A N/A NOT 12/19/2017 VIOLATIONS N/A LIQUORS AVAILABLE OBSERVED ANDOVER MA-01845 64 NO MAIN STREET NORTH ST N/A N/A NOT 02/13/2019 VIOLATIONS N/A LIQUORS ANDOVER AVAILABLE OBSERVED MA-01845 531 CHICKERING NO MCALOONS RD NOT LIQUORS NORTH YES NO N/A N/A AVAILABLE 02/13l2019 VIOLATIONS N/A ANDOVER OBSERVED MA-01845 220 MIDDLESEX NO MIKE'S ST O N/A I AVVAILABLE 02/13/2019 VIOLATIONS N/A MARKET NORTH YES N ANDOVER OBSERVED MA-01845 220 MIDDLESEX NO MIKE'S STNOT MARKET. NORTH YES NO N/A 1`l/A 12/19/2017 VIOLATIONS N/A AVAILABLE ANDOVER OBSERVED MA-01845 12 MASSACHUSETTS NO MOBIL MART AVENUE YES NO N/A N/A NOT 12/19/2017 VIOLATIONS N/A NORTH AVAILABLE OBSERVED ANDOVER MA-01845 12 MASSACHUSETTS NO MOBIL MART AVENUE YES NO N/A N/A NOT 02/13/2019 VIOLATIONS N/A NORTH AVAILABLE OBSERVED ANDOVER MA-01845 79 CHICKERING NO SUPER RD PETROLEUM NORTH YES NO N/A N/A AVAILABLE NOT 12/19l2017 OBSERVED VIOLATIONS N/A ANDOVER MA-01845 79 CHICKERING INO SUPER RD PETROLEUM NORTH YES NO N/A N/A NOT 02/13/2019 VIOLATIONS N/A AVAILABLE ANDOVER OBSERVED MA-01845 800 WAVERLY RD NO WALGREENS NORTH yS NO N/A JN/ANOT AILABLE 12/19/2017 VIOLATIONS N/A PHARMACY ANDOVER OBSERVED MA-01845 Page 2 of 3 Compliance Check Inspections of Tobacco Product Retailers Through 08/31/2019-Search Results 533 CHICKERING ROAD NOT NO QUIC PIC NORTH YES NO N/A N/A AVAILABLE 12/19/2017 VIOLATIONS N/A ANDOVER OBSERVED MA-01845 533 CHICKERING ROAD OT NO QUIC PIC NORTH YES NO N/A N/A AVAILABLE 02/13/2019 VIOLATIONS N/A ANDOVER OBSERVED MA-01845 75 CHICKERING RD NOT NO RICHDALE NORTH YES NO N/A N/A AVAILABLE 12/19/2017 VIOLATIONS N/A ANDOVER OBSERVED MA-01845 75 CHICKERING RD NO RICHDALE NORTH YES NO N/A N/A AVAILABLE 0211 3/2 0 1 9 VIOLATIONS N/A ANDOVER OBSERVED MA-01845 757 TURNPIKE ST NO STOP AND NORTH YES NO N/A N/A NOT 12/19/2017 VIOLATIONS N/A SHOP ANDOVER AVAILABLE OBSERVED MA-01845 701 SALEM 1140.14(b)(l)-Saletoa J AND M I I WARNING CONVENIENCE NORTH YES YES ENDS/ JUUL 02/13/2019 04/11/2019 LETTER Minor, STORE AND ANDOVER E liquid ISSUED to verify age ( )(i}Failure DELI MA-01845 Page 3 of 3 i . .0 F&I R mm 11 MR MIMI American Journal of Preventive Medicine � RESEARCH ARTICLE Short-Term Impact of a Flavored Tobacco Restriction: Changes in Youth Tobacco Use in a Massachusetts Community Melody Kingsley, MPH,'Claude M. Setodji, PhD Joseph D. Pane, MSP,2 William G. Shadel, PhD Glory Song, MPH,'Jennifer Robertson,JD,1 Lindsay Kephart, MPH,' Patricia Henley, MEd,1 W. W. Sanouri Ursprung, PhD' Introduction: To counter the high prevalence of flavored tobacco use among youth, many U.S. localities have passed policies that restrict youth access to these products.This study aims to evalu- ate the short-term impact of a flavored tobacco restriction policy on youth access to,and use of,fla- vored tobacco products in a Massachusetts community. Methods:A community with the policy(Lowell)was matched to a community without the policy (Malden) with similar demographics, retailer characteristics, and point-of-sale tobacco policies. Product inventories were assessed in tobacco retailers in the 2 communities, and surveys were administered to high school—aged youth in those communities.Inventories and surveys were con- ducted around the time the policy took effect in October 2016 (baseline) and approximately 6 months later(follow-up);all data were analyzed in 2017.Chi-squared tests and difference-in-differ- ence models were used to estimate the impact of the policy on flavored tobacco availability and youth perceptions and behaviors related to flavored tobacco use. Results: Flavored tobacco availability decreased significantly in Lowell from baseline to follow-up periods by 70 percentage points (p<0.001), whereas no significant changes in flavored tobacco availability were seen in Malden. In addition, current use of both flavored and non-flavored tobacco decreased in Lowell, but increased in Malden from baseline to follow-up; these changes were significantly different between communities (flavored tobacco: —5.7%,p=0.03; non-flavored tobacco: —6.2%,p=0.01). Conclusions: Policies that restrict the sale of flavored tobacco have the potential to curb youth tobacco use in as few as 6 months. Am J Prev Med 2019;000(000):1-8.@ 2019 American Journal of Preventive Medicine.Published by Elsevier Inc. All rights reserved. INTRODUCTION may be more likely to continue to use tobacco in the long term compared with youth who do not use flavored n 2009,the Family Smoking Prevention and Tobacco products.5,6 Control Act banned sales of flavored cigarettes but Flavored tobacco products are widely sold and pro- not flavored cigars/cigarillos, smokeless tobacco, or moted in stores, including convenience stores, which e-cigarettes. Since this time,sales of flavored non-cigarette tobacco products have risen,which are available in thou- sands of distinct flavors (including fruit, candy,and men- From the 'Massachusetts Department of Public Health, Boston,Massa- chusetts;andd 2IRA LAND Corporation, poration,Pittsburgh,Pennsylvania thol)2,3 Flavored tobacco use among youth has also risen: Address correspondence to: Melody Kingsley, MPH, Massachusetts From 2016 to 2017,flavored tobacco use increased signifl- Department of Public Health,250 Washington Street,Boston MA 02108. cantly among high school—aged tobacco users nationwide E-mail:melody.kingsley@state.ma.us. (from 57.7%to 63.6%)4 Youth who use flavored tobacco 0749-3797/$36.00 https://doi.org/10.1016/j.amepre.2019.07.024 ©2019 American Journal of Preventive Medicine.Published by Elsevier Inc.All rights Am l Prev Med 2019;000(000):1-8 1 reserved. ARTICLE IN PRESS 2 Kingsley et al/Am J Prev Med 2019;000(000):1-8 youth frequently visit.'''The saturation of flavored tobacco flavored product and tobacco use overall were products in retail stores increases availability of these prod- expected than in a community without the policy. ucts,which results in increased youth exposure to flavored tobacco.Previous research has found that increased access and exposure to tobacco products increases youth suscep- METHODS tibility to and experimentation with tobacco.For example, Study Sample higher retail density near schools has been associated with In 2014, the Massachusetts Tobacco Control Program (MTCP) higher youth ever-smoking rates.9 received funding from the Centers for Disease Control and Preven- Results from the 2017 Massachusetts Youth Health tion to evaluate the impact of municipal flavored tobacco restriction Survey revealed that 79.8%of current(past 30-day)high policies on the point-of-sale retail environment and youth tobacco school—aged tobacco users used a flavored tobacco use.At the time,only 9 communities in Massachusetts had passed a product in the past 30 days. Students frequently obtain Policy. In June 2016, the city of Lowell passed a flavored tobacco products from tobacco retailers, with 32.9% of current restriction policy (which took effect in October 2016) and was high school—aged tobacco users in Massachusetts selected for evaluation as a case community. Lowell was selected from a pool of communities with a population of at least 15,000 that reporting getting tobacco products from a retail store.10 passed the policy because of its high adult smoking rate and high A policy that removes flavored tobacco from the retail tobacco retail density compared with other communities.In addi- environment can address both availability and youth lion.Lowell was already funded by MTCP to conduct enforcement exposure to these products. In 2014, municipal Boards activities related to the policy,thus increasing the feasibility of con- of Health in Massachusetts began passing regulations ducting surveys in tobacco retailers and schools. restricting the sale of flavored tobacco products (exclud- In Lowell,the period between policy passage and implementa- tion was approximately 3.5 months. During this time, retailers ing menthol but including e-cigarettes) to adult-only were expected to sell down or otherwise remove their flavored (ages >21 years) establishments, such as smoking bars, tobacco stock.To aid local Board of Health staff in enforcement, vape shops,and tobacconists.As of April 2019,this pol- the Massachusetts Association of Health Boards,an MTCP tech- icy has been passed by 147 municipalities in Massachu- nical assistance provider,developed tools,including enforcement setts,covering 63%of the state's total population." trainings, an enforcement protocol, and a flavored product list, Previous research has focused on the impact of with information on all known products with a characterizing fla- these policies on the sale and availability of flavored vor(type,brand name,and flavor name).In Lowell,enforcement products. A recent study evaluating flavored tobacco agents were required to complete educational visits in retailers both before and after policy implementation to disseminate edu- restrictions across Massachusetts found drastic reduc- cational materials (such as the flavored product list) and answer tions in flavored tobacco availability in tobacco policy-related questions. retailers following policy implementation!2 However, To evaluate the impact of the policy(independent of commu- limited research exists on the impact of reduced nity-level and retail-level characteristics),a comparison commu- access to flavored tobacco on youth tobacco use. An nity was selected and matched to Lowell on the following evaluation of New York City's flavored tobacco variables: community demographics, retailer characteristics, and restriction found significant declines in overall sales Presence of other point-of-sale policies (Table 1 provides a com- plete list and description of variables). Using direct matching of flavored tobacco products included in the restric- methods, Malden (a Massachusetts community about 30 miles tion (cigars, smokeless, pipe/roll your own) post- from Lowell)was selected as a comparison community because it implementation, and that the odds of both flavored was most like Lowell—both in similarity of matching variables tobacco ever use and any tobacco ever use (not (greatest number of variables with<20%differences)and similar- including e-cigarettes) among youth decreased 3 years ity of other passed point-of-sale policies. after policy implementation (based on data from the Retailer inventories were conducted during education visits by New York City Youth Risk Behavior Survey).13 This MTCP-funded Board of Health regional staff in a census of all tailers in Lowell and Malden at baseline (September 2016) paper aims to add to this evidence base by evaluating re before Lowell's flavored restriction policy took effect on October the short-term (6-month) impact of the flavored 1, 2016 and 6 months later (March 2017). Data collection was restriction policy in 1 Massachusetts community on conducted using an online platform that was developed in collab- youth access and use of all types of tobacco products, oration with Counter Tools."These surveys captured store infor- compared with a matched community without this mation, presence of flavored product advertisements, a full policy. The study hypothesis was that the policy inventory of flavored tobacco products available(cigars/cigarillos, would result in greater reductions in retail availability hookah/shisha,smokeless/dissolvable,e-cigarette/nicotine liquid), and (in Lowell only) enforcement activities conducted during of flavored tobacco than in a community without the each visit.In Lowell, inventories were conducted at 118 retailers policy. In addition, a greater increase in reported dif- at baseline and 113 retailers at follow-up(of 125 total retailers).In ficulty to obtain flavored tobacco and a greater Malden,inventories were conducted at 51 retailers at baseline and decrease in youth initiation of tobacco use with a 48 retailers at follow-up (of 52 total retailers). Inventories were www.ajpmonline.org r,. .. ATM .1 ' Kingsley et al/Am J Prev Med 2019;000(000):1-8 3 Table 1. Community Matching Characteristics and Availabil- instructed to return to the same classrooms at follow-up;however, ity of Flavored Products at Baseline and 6-Month Follow-up students who took the survey may not be the same at both time points (surveys were cross-sectional). In Lowell, 593 surveys were Lowell Malden completed at baseline, and 524 surveys were completed at follow- Variable (case) (comparison) up.In Malden,636 surveys were completed at baseline,and 646 sur- Demographic characteristicsa veys were completed at follow-up. Total population 106,519 59,450 Male,% 49.6 48.4" Measures White,% 60.3 56.7' Stores were classified as having flavored tobacco products if they Youth(underage 18 years),% 23.7 19.7b sold 1 or more flavored products at time of inventory;the number Median income,$ 50,192 56,347b of unique flavored products in each store was summed.Availabil- Below poverty level,% 17.5 12.8 ity of flavored products was assessed at baseline and follow-up. Smoking rate,% 21.6 18.9`' Student demographics (age,grade in school,gender,and race/ Retail characteristics° ethnicity) and tobacco-related outcomes were also assessed at Independent stores,% 79.8 85.9`' baseline and follow-up. Students were provided with a list of Retail density 1.2 10b tobacco products and asked whether they had ever used the prod- Illegal sales to minors,% 2.3 8.0 uct. Students were asked about both non-flavored (e.g., plain, tobacco,regular,menthol,and mint) and flavored products (e.g., Selling flavored tobacco 77.3 76.6" grape,cherry,watermelon,berry,vanilla,rum,red,tropical crush, Si baseline,% b caramel,honey,and banana).Students who indicated any past use Single cigar price,$ 2.54 2.50 were classified as ever users. Students who indicated use within Point-of-sale policies° the past 30 days were classified as current users.These classifica- Flavored tobacco restriction Yes No tions are aligned with those used by many national and global Cigar packaging restriction Yes Yes youth tobacco surveys.16 Retail capping No No Students responded to the question:How easy do you think it is to Pharmacy ban Yes Yes get flavored tobacco products?With very easy,somewhat easy,some- aSmoking rates are small area estimates based on data from 2011 to what difficult, or very difficult These response options were col- 2015 Massachusetts Behavioral Risk Factor Surveillance System. lapsed into 2 categories:easy and difficult. b<20%different than case community. Students responded to the question: Was the first tobacco prod- °Retail density is calculated as the number of retailers per 1,000 adults uct(including e-cigarettes)you tried flavored?with yes,no,or I've (ages >18 years). The rate of illegal sales to minors (under age 18 never tried a tobacco product. years)is calculated as the number of sales made to minors during retail P compliance checks in fiscal year 2015(190 and 105 total checks con- ducted in Lowell and Malden,respectively). SIS Statistical Anal The flavored tobacco restriction restricts the sale of flavored tobacco Y products to adult-only retailers.The cigar packaging restriction sets a Data were analyzed in September 2017.Descriptive statistics were minimum price for single ($2.50) and multi-pack ($5.00) cigars.The calculated for flavored product availability and demographic char- retail capping policy sets a limit on the number of tobacco sales permits acteristics of students in Lowell and Malden at baseline and fol- allowed in a community.The pharmacy ban policy prohibits the sale of tobacco products in pharmacies and all other healthcare institutions. low-up. Chi-squared tests were used to test for differences on these characteristics between Lowell and Malden and within com- munities between baseline and follow-up. not conducted at all retailers at baseline and follow-up for the fol- A difference-in-difference multivariate linear probability model lowing reasons:retailer closed at time of survey,retailer went out was used to assess the impact of the restriction on 4 outcomes:(1) of business, retailer not youth accessible (e.g., vape shops), or perception of ease of access to flavored tobacco, (2) initiation of retailer opened after baseline data collection. The final analytical tobacco use with a flavored product, (3) ever and current use of sample included only retailers with inventories conducted at both flavored and non-flavored tobacco products, and (4) perceived baseline and follow-up(I I I in Lowell and 47 in Malden). likelihood of using tobacco if flavored products were not available. Youth surveys were conducted in both communities around the These models controlled for age,gender,race/ethnicity,and base- same time as retailer inventories and were administered to students line differences (and any unmeasured time confounder) between in all grades (9th-12th) in public high schools, by local youth Lowell and Malden on the outcomes of interest. involved in MTCP's youth engagement program.A power analysis All analyses were conducted using R,version 3.4.4. based on statewide average smoking rates for each grade was used to estimate the target sample sizes.'5 Surveys were administered at RESULTS baseline(November 2016 to January 2017 in Lowell and September 2016 in Malden)and follow-up(May 2017 in Lowell and April 2017 In Lowell, the number of flavored products sold per in Malden)on paper in randomly selected classrooms,and adminis- retailer decreased significantly from baseline to follow- tration and data confidentiality procedures were overseen by Health Resources in Action, Inc. These surveys captured youth demo- up (Table 2):There was a 70—percentage point decrease graphics, tobacco products used, and perceptions and behaviors the number of stores where flavored products were related to flavored tobacco use(Appendix Figure 1 shows the com- available(from 77.3%to 7.3%,p<0.001).By comparison, plete survey instrument, available online). Data collectors were in Malden, no significant change was observed in the 12019 4 Kingsley et al/Am J Prev Med 2019,000(000):1-8 Table 2. Impact of Flavored Tobacco Restriction on Flavored Tobacco Availability Lowell(case) Malden(comparison) Baseline,% Follow-up,% Baseline,% Follow-up,% Variable (n=111) (n=111) p-valuea (n=47) (n=47) p-value' How many flavored products does your store sell? 0 22.7 92.7 <0.01 23.4 21.3 0.54 1-5 26.4 5.5 27.7 21.3 6-20 40.9 1.8 38.3 34.0 21-30 5.4 0 8.5 21.3 31-50+ 4.6 0 2.1 2.1 Note:Boldface indicates statistical significance(p<0.05). 'Chi-squared tests used to test for significance between baseline and follow-up. number of flavored products sold per retailer over the both communities, students were similar between base- same time frame (from 76.6%to 78.7%,p=0.537). line and follow-up, with the exception of age. At follow- Some differences were detected between students sur- up, students in Lowell were slightly younger, whereas veyed in Lowell and Malden, including differences in students in Malden were slightly older. To control for age, gender, and race/ethnicity (Table 3). However, in residual demographic differences between and within Table 3. Demographic Characteristics of Participants With Comparisons Between Baseline and 6-Month Follow-up Overall Lowell(case) Malden(comparison) Lowell, Malden, Baseline, Follow-up, Baseline, Follow-up, Variable % % p-valuea %(n=593) %(n=524) p-valuea %(n=636) %(n=646) p-value' Age,years <13 0.1 0.1 <0.01 0.2 0.0 <0.01 0.2 0.0 <0.01 14 11.8 10.2 14.2 9.0 14.5 5.9 15 17.8 20.7 13.0 23.3 23.6 17.9 16 22.3 25.4 20.1 24.8 25.1 25.7 17 24.4 27.5 31.5 16.4 28.2 26.8 18 21.1 13.6 17.9 24.6 6.8 20.3 >19 2.5 2.5 3.1 1.9 1.6 3.4 Grade 9 21.1 17.3 <0.01 18.1 24.6 <0.01 16.7 17.8 0.92 10 22.0 26.4 16.1 28.6 26.1 26.8 11 17.5 26.4 20.0 14.7 26.7 26.2 12 39.4 29.9 45.8 32.1 30.5 29.2 Gender Female 53.5 52.5 0.03 52.6 54.5 0.35 52.1 52.9 0.68 Male 46.3 46.5 47.0 45.5 47.1 45.9 Other 0.2 1.0 0.4 0.0 0.8 1.2 Transgender Yes 1.2 1.4 0.57 1.6 0.8 0.47 1.3 1.6 No 95.7 96.1 95.5 95.9 95.6 96.5 Do not know 3.1 2.5 2.9 3.3 3.1 1.9 Race Asian 30.6 27.0 <0.01 30.6 30.7 0.73 27.8 26.1 0.49 Black 11.1 17.1 10.8 11.5 18.1 16.2 Hispanic 23.8 21.3 22.8 25.0 20.6 21.9 Other 10.7 11.0 10.5 10.9 11.6 10.4 White 23.8 23.6 25.3 21.9 21.9 25.4 Note:Boldface indicates statistical significance(p<0.05). 'Chi-squared tests used to test for significance between groups. www.ajpmonline.org ARTICLE PRESS Kingsley et al/Am J Prev Med 2019;000(000):1-8 5 Table 4. Impact of Flavored Tobacco Restriction on Flavored Tobacco Access and Use,and Non-flavored Tobacco Use Lowell(case) Malden(comparison) Difference Variable Estimate%(95%CI)a Estimate%(95%CI)a Estimate%(95%CI) Difficult to access flavor productb -3.8(-15.1,7.4) -13.1(-25.7,-0.5) 9.3(-7.1,25.7) First use tobacco product was flavored 4.6(-7.3,16.6) 4.3(-9.8,18.4) 0.3(-17.7,18.3) Still use tobacco if not available in flavors` 2.9(-17.9,23.8) 30.0(4.6,55.4) -27.1(-60.7,6.6) Ever use(flavored products) Any tobacco use -4.0(-8.8,0.9) 2.1(-2.6,6.7) -6.1(-12.5,0.4) Cigarette -1.0(-3.2,1.2) 1.1(-1.0,3.2) -2.0(-5.0,0.9) Cigar -2.0(-4.8,0.8) 0.7(-2.0,3.4) -2.7(-6.5,1.0) Blunt -2.1(-6.2,2.1) 2.5(-1.5,6.5) -4.6(-10.1,1.0) Smokeless -0.9(-2.8,1.0) 0.8(-1.0,2.6) -1.7(-4.3,0.8) E-cigarette -1.7(-6.2,2.7) 1.9(-2.4,6.2) -3.6(-9.6,2.4) Current use(flavored products) Any tobacco use -2.4(-6.2,1.3) 3.3(-0.3,6.9) -5.7(-10.7,-0.7) Cigarette -0.5(-1.8,0.8) 0.7(-0.6,1.9) -1.2(-2.9,0.6) Cigar -1.0(-3.0,0.9) 0.2(-1.6,2.1) -1.2(-3.8,1.4) Blunt -1.8(-5.0,1.4) 2.2(-0.9,5.3) -4.0(-8.3,0.3) Smokeless -0.8(-2.2,0.7) 0.4(-0.9,1.8) -1.2(-3.1,0.7) E-cigarette -1.3(-4.2,1.6) 1.8(-0.9,4.6) -3.1(-6.9,0.7) Ever use(non-flavored products) Any tobacco use -5.0(-9.8,-0.2) 3.6(-1.0,8.2) -8.6(-15.0,-2.2) Cigarette -2.4(-5.5,0.8) -1.0(-4.1,2.0) -1.3(-5.5,2.9) Cigar 0.7(-2.1,3.4) 0.9(-1.7,3.5) -0.2(-3.9,3.4) Blunt -3.5(-7.7,0.6) 4.5(0.6,8.5) -8.1(-13.6,-2.5) Smokeless 0.3(-1.7,2.2) 1.0(-0.9,2.9) -0.8(-3.4,1.9) E-cigarette -0.6(-4.8,3.5) 2.5(-1.5,6.4) -3.1(-8.6,2.5) Current use(non flavored products) Any tobacco use -1.9(-5.5,1.7) 4.3(0.9,7.8) -6.2(-11.0,-1.4) Cigarette -1.5(-3.2,0.3) -0.2(-1.9,1.5) -1.3(-3.7,1.0) Cigar -0.9(-2.7,0.9) 0.8(-0.9,2.6) -1.7(-4.1,0.7) Blunt 2.1(-5.3,1.0) 3.5(0.5,6.6) -5.7(-9.9,-1.5) Smokeless 0.0(-1.4,1.5) 0.9(-0.5,2.3) -0.9(-2.9,1.1) E-cigarette 1.4(-1.1,4.0) 2.5(0.1,5.0) -1.1(-4.5,2.3) Note:Boldface indicates statistical significance(p<0.05). aPercent change from baseline to follow-up,estimated from difference-in-difference models adjusting for age,gender,and race/ethnicity. bRestricted to students who reported ever trying a tobacco product. °Restricted to students who currently use(use in the past 30 days)flavored tobacco products. communities, all multivariate models controlled for age, ever and current use of flavored tobacco from baseline gender,and race. to follow-up were in opposite directions in Lowell and Among tobacco ever users, after controlling for cova- Malden: Use of any flavored tobacco product riates,there were no significant differences in the change decreased from baseline to follow-up in Lowell, in the percentage of students reporting that it was diffi- whereas use of any flavored tobacco product increased cult to obtain flavored products in their town from base- in Malden (Figure 1). Difference-in-difference models line to follow-up between Lowell and Malden (Table 4; found a marginally significant difference between the 2 unadjusted baseline and follow-up estimates are in communities in change in ever use of any flavored Appendix Table 1,available online). tobacco product (-6.1%,p=0.07) and a significant dif- There were no significant differences in change in ference in change in current use of any flavored likelihood that a student initiated on flavored tobacco tobacco product (-5.7%, p=0.03) (Table 4). When from baseline to follow-up between Lowell and Malden looking at flavored tobacco products individually, the (Table 4). However, significant differences between greatest differences between Lowell and Malden were Lowell and Malden were found in changes in flavored seen in changes in ever use (-4.6%,p=0.10) and cur- tobacco use from baseline to follow-up. Changes in rent use (-4.0%,p=0.07) of blunt wraps. 12019 ARTICLE IN PRESS 6 Kingsley et al/Am J Prev Med 2019;000(000):1-8 -+- Lowell(Current Use) Lowell(Ever Use) .A- Maden(Current Use) •A- Malden(Ever Use) 30- _m 0 20 $D 10 J l0 .O H 30 T m zv T_ 10 Basehnc Follow-up Figure 1. Changes in any flavored and non-flavored tobacco use between baseline and 6-month follow-up: Lowell and Malden, 2016 and 2017. Note:Any tobacco use includes use of the following products:cigarettes,cigars/cigarillos,e-cigarettes,blunts/blunt wraps,and smokeless tobacco. Significant differences between Lowell and Malden were rigorous enforcement infrastructure, which included also found in changes in non-flavored tobacco use from multiple education visits and education materials, such baseline to follow-up. Use of any non-flavored tobacco as the flavored product list. product decreased in Lowell from baseline to follow-up, Second, this study expands on the findings of the New whereas use of any non-flavored tobacco product York City flavored product restriction evaluation to show increased in Malden (Figure 1). Difference-in-difference that flavored tobacco restrictions begin to have an impact models found significant differences between the 2 com- on youth tobacco use shortly after policy implementation, munities in changes in ever use(-8.6%,p=0.01) and cur- not only in the long term.The policy was found to be asso- rent use (-6.2%, p=0.01) of any non-flavored tobacco ciated with reduced tobacco use 6 months after implemen- product(Table 4).The greatest differences between Lowell tation and was associated with greater reductions in ever and Malden were again seen in changes in the use of blunt and current use of both flavored and non-flavored tobacco wraps: Significant differences were found in changes in than in a community without the policy. In fact, in Mal- ever use (-8.1%, p<0.01) and current use (-5.7%, den,increases (though not all statistically significant)were p=0.01)of non-flavored blunt wraps(Table 4). seen in ever and current use of flavored and non-flavored tobacco. These differences between Lowell and Malden DISCUSSION were even seen in blunt wraps,which had the highest cur- rent use rates in both communities at baseline. This sug- This study is one of the first to assess the impact of a fla- gests the policy helps curb use of tobacco products popular vored tobacco restriction on both the retail environment among youth and does not necessarily drive youth to and youth tobacco use. It builds on previous research to switch to non-flavored tobacco,even for flavored tobacco include a comprehensive assessment of all tobacco prod- products with high baseline use. The decreases seen in ucts in retailers and is the first study to look at the short- non-flavored tobacco use in Lowell may have been due in term impact of the restriction on youth tobacco use. part to changes in social norms,which have been found to This study has 2 main findings with public health sig- impact youth smoking rates.18 Prior research in Massachu- nificance. First, consistent with previous research, there setts found that youth residing in communities with strong are greater reductions in availability of flavored products regulations addressing both clean air and youth tobacco in a community with a flavored product restriction ver- access perceived their communities to be significantly sus one without.12,13,17 Retailer compliance with the more "anti-smoking" compared with youth in communi- restriction in Lowell was likely aided by MTCP's ties without strong regulations in these areas.19 www.ajpmonline.org ARTICLE IN PRESS Kingsley et al/Am J Prev Med 2019,000(000):1-8 7 Even so,the greater reductions in tobacco use in Low- of the policy on tobacco use,these additional outcomes are ell than Malden may have been aided, in addition to areas that future studies could consider assessing. decreased availability of flavored products, by the geo- graphic layout of Lowell.Lowell has a high Walk Score,20 CONCLUSIONS suggesting that students may have limited access to cars, and in turn, limited access to neighboring communities With rigorous enforcement,the flavored restriction pol- without a policy. Unfortunately, sample sizes were too icy has promising potential to curb youth tobacco use, small to assess whether Lowell students are more likely even within 6 months after implementation.With a Ton- to obtain flavored products in communities other than ger follow-up time, the authors expect these trends will their own compared with Malden students. continue,and the policy may begin to impact and reduce Significant differences between communities in flavored tobacco initiation, as exposure to flavored change in perceived ease of access to flavored products tobacco among younger students continues to decline. or initiation with a flavored product, were not found. Future considerations for improving policy impact This could be attributed partially to the short follow-up include encouraging surrounding communities to adopt time, as reducing exposure to flavored tobacco may take this policy and adding menthol flavoring into the restric- more time than reducing retail availability (e.g., owing tion because tobacco companies have historically tar- to remaining advertising,non-compliant retailers, other geted menthol cigarettes to youth.21 sources of access). This study has many strengths.Both retailer and youth ACKNOWLEDGMENTS data were collected in a community in which the policy was passed with large sample sizes (almost 100% of The authors would like to thank the following Board of Health retailers, and close to 600 students, were surveyed in staff from the Massachusetts Tobacco Cessation and Preven- tion program for conducting retailer inventories: Cesar Pungi- Lowell). Data were collected both before and after policy rum and Maureen Buzby.The authors would like to thank the implementation. Finally, a rigorous matching method following staff from Health Resources in Action, Inc. for their was used to select Malden as the comparison community. assistance in conducting youth surveys: Carly Caminiti, Lisa Aslan, and Arielle Levy. The authors would also like to thank Limitations Hannah Liu for her assistance with study design. Student data collected at baseline and follow-up were This study was supported by funding from the Centers for cross-sectional, so the authors cannot assess whether Disease Control and Prevention cooperative agreement CDC- tobacco-related behaviors of individuals changed over RFA-DP15-1509. MK led manuscript development and writing.CMS and WGS time. However, as surveys were conducted in the same assisted in study design and manuscript development and writ- school and classrooms at both time points, the survey ing. LK and MK assisted with preliminary data cleaning, and cohort likely remained relatively stable.Regarding match- JDP conducted all data analyses. GS, JR, and LK assisted in ing, Lowell was only matched to 1 community,and some study design, creation of data collection tools,and manuscript differences existed between the 2 communities.Differences development. All authors contributed ideas and helped to in tobacco-related characteristics most likely to impact review and revise the manuscript. youth tobacco rates(e.g.,smoking rate,retail density,base- The authors of this paper have no financial disclosures to line availability of flavored tobacco) were all < 20%, and report. difference-in-difference models controlled for time-invari- ant characteristics with baseline differences between com- SUPPLEMENTAL MATERIAL munities (however, these models cannot control for any Supplemental materials associated with this article can be time-varying change in youth tobacco use that might found in the online version at https://doi.org/10.1016/j. occur). Additional methodologic limitations include that amepre.2019.07.024. baseline youth surveys were conducted in Lowell 1-3 months after policy implementation, at which point REFERENCES retailers may have started to remove flavored tobacco from shelves,so the actual impact of the policy could have 1. 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OTP-Restriction-C754e.pdf.Published 2019.Accessed June 26,2019. 2011;20(suppl 2):iil-ii7.https://doi.org/10.1136/tc.2011.043604. www.ajpmonline.org 130 �ON1Plr`4hre ���ri� s -( 7 4G Srl1E'S = 1 ! 0/0 a rl- COrf)PI `i2ncp- rq{-2 Jj�c 11 ION - Sep4eati5ec 30, 201q Agency Date Retailer Name Retailer Address Retailer City Sold To Minor Cost of Product BOH 12-21-2015 a I prime energy 1725 Turnpike St North Andover No BOH 09-23-2016 a I prime energy 1725 Turnpike St North Andover No BOH 12-04-2014,a I prime energy 1725 Turnpike St North Andover Yes 1.37 BOH 08-08-2018 a I prime energy 1725 Turnpike St North Andover Yes 6.58 BOH 12-20-2018 a I prime energy 1725 Turnpike St North Andover No BOH 08-13-2019 a I prime energy 1725 Turnpike St North Andover No BOH 12-15-2014 den rock wine and spirits 54 Peters St North Andover No BOH 12-21-2015 den rock wine and spirits 54 Peters St North Andover No BOH 09-23-2016•den rock wine and spirits 54 Peters St North Andover No BOH 08-08-2018 den rock wine and spirits 54 Peters St North Andover No BOH 08-13-2019 den rock wine and spirits 54 Peters St North Andover No BOH 12-30-2015 j and m convenience store 701 Salem St North Andover No BOH 09-30-2016 j and m convenience store 701 Salem St North Andover No BOH 12-15-2014 j and m convenience store 701 Salem St North Andover No BOH 08-08-2018 j and m convenience store 701 Salem St North Andover No BOH 08-13-2019 j and m convenience store 701 Salem St North Andover No BOH 12-30-2015 main street liquors 64 Main St North Andover No BOH 09-30-2016 main street liquors 64 Main St North Andover No BOH 12-15-2014 main street liquors 64 Main St North Andover No BOH 08-08-2018 main street liquors 64 Main St North Andover No BOH 08-13-2019 main street liquors 64 Main St North Andover No BOH 12-21-2015 market basket 350 Winthrop Ave North Andover No BOH 09-23-2016 market basket 350 Winthrop Ave North Andover No BOH 12-04-2014 market basket 350 Winthrop Ave North Andover No BOH 08-08-2018 market basket 350 Winthrop Ave North Andover No BOH 08-13-2019 market basket 350 Winthrop Ave North Andover No BOH 12-17-2015 mcaloons liquors 531 Chickering Rd North Andover No BOH 09-30-2016 mcaloons liquors 531 Chickering Rd North Andover No BOH 12-15-2014 mcaloons liquors 531 Chickering Rd North Andover No BOH 08-08-2018 mcaloons liquors 531 Chickering Rd North Andover No SOH 08-13-2019 mcaloons liquors 531 Chickering Rd North Andover No BOH 12-30-2015 mikes market 220 Middlesex St North Andover No BOH 09-23-2016-mikes market 220 Middlesex St North Andover Yes 10.65 BOH 12-04-2014 mikes market 220 Middlesex St North Andover No BOH 08-08-2018 mikes market 220 Middlesex St North Andover No BOH 08-13-2019 mikes market 220 Middlesex St North Andover No BOH 05-28-2015 mobil 350 Winthrop Ave Ste 15 North Andover No BOH 12-21-2015 mobil 350 Winthrop Ave Ste 15 North Andover No BOH 09-23-2016 mobil 350 Winthrop Ave Ste 15 North Andover BOH 12-04-2014 mobil 350 Winthrop Ave Ste 15 North Andover Yes 1.8 BOH 12-30-2015 mobil-north andover automotive 980 Osgood St North Andover No BOH 09-30-2016 mobil-north andover automotive 980 Osgood St North Andover BOH 12-15-2014 mobil-north andover automotive 980 Osgood St North Andover No BOH 08-08-2018 mobil- north andover automotive 980 Osgood St North Andover BOH 08-13-2019 mobil-town mart 260 winthrop ave North Andover Lawrence No BOH 12-30-2015 mobil mart-sj enterprises 12 Massachusetts Ave North Andover Yes 10.25 BOH 09-23-2016 mobil mart-sj enterprises 12 Massachusetts Ave North Andover Yes 10.25 BOH 12-04-2014,mobil mart-sj enterprises 12 Massachusetts Ave North Andover No BOH 08-08-2018 mobil mart-sj enterprises 12 Massachusetts Ave North Andover No BOH 08-13-2019 mobil mart-sj enterprises 12 Massachusetts Ave North Andover No BOH 12-17-2015 quic pic 535 Chickering Rd North Andover No BOH 09-30-2016 quic pic 535 Chickering Rd North Andover No BOH 12-15-2014 quic pic 535 Chickering Rd North Andover No BOH 08-08-2018 quic pic 535 Chickering Rd North Andover No BOH 08-13-2019 quic pic 535 Chickering Rd North Andover No BOH 12-17-2015 race way convenience store 1503 Osgood St North Andover No BOH 09-30-2016 race way convenience store 1503 Osgood St North Andover No BOH 12-15-2014 race way convenience store 1503 Osgood St North Andover No BOH 08-08-Z018,race way convenience store ✓ 1503 Osgood St North Andover Yes 2.65 BOH 12-20-2018 race way convenience store 1503 Osgood St North Andover No BOH 08-13-2019 race way convenience store 1503 Osgood St North Andover No BOH 12-17-2015,richdale 4 Main St North Andover Yes 6.35 BOH 12-21-2015 richdale 75 Chickering Rd North Andover No BOH 09-30-2016 richdale 4 Main St North Andover No BOH 09-30-2016 richdale 75 Chickering Rd North Andover No BOH 12-15-2014 richdale 4 Main St North Andover No BOH 12-15-2014 richdale 75 Chickering Rd North Andover No BOH 08-08-2018 richdale 4 Main St North Andover No BOH 08-08-2018 richdale 75 Chickering Rd North Andover No BOH 08-13-2019 richdale 75 Chickering Rd North Andover No BOH 08-13-2019 richdale 4 Main St North Andover No BOH 12-21-2015 rite aid 525 Turnpike St North Andover No BOH 09-23-2016 rite aid 525 Turnpike St North Andover No BOH 12-04-2014 rite aid 525 Turnpike St North Andover No BOH 08-08-2018 rite aid 525 Turnpike St North Andover No BOH 12-04-2014 stop and shop 757 Turnpike St North Andover No BOH 12-21-2015,stop and shop 757 Turnpike St North Andover Yes 10.59 BOH 09-23-2016,stop and shop 757 Turnpike St North Andover No BOH 08-08-2018 stop and shop 757 Turnpike St North Andover No BOH 12-21-2015 super petroleum 79 Chickering Rd North Andover Yes 10.5 BOH 09-30-2016-super petroleum 79 Chickering Rd North Andover No BOH 12-15-2014-super petroleum 79 Chickering Rd North Andover No BOH 08-08-2018 super petroleum 79 Chickering Rd North Andover No BOH 08-13-2019 super petroleum 79 Chickering Rd North Andover No BOH 12-21-2015-the vineyard 554 Turnpike St North Andover No BOH 09-23-2016 the vineyard 554 Turnpike St North Andover No BOH 12-04-2014 the vineyard 554 Turnpike St North Andover No BOH 12-21-2015 walgreens 800 Waverley Rd North Andover No BOH 09-23-2016 walgreens 800 Waverley Rd North Andover No BOH 12-04-2014 walgreens 800 Waverley Rd North Andover No BOH 08-08-2018 walgreens 800 Waverley Rd North Andover No BOH 12-21-2015 wine and beer at the andovers 350 Winthrop Ave North Andover No BOH 05-28-2015 wine and beer at the andovers 350 Winthrop Ave North Andover No BOH 09-23-2016 wine and beer at the andovers 350 Winthrop Ave North Andover No BOH 12-04-2014,wine and beer at the andovers 350 Winthrop Ave North Andover Yes 10.57 BOH 08-08-2018 wine and beer at the andovers 350 Winthrop Ave North Andover No BOH 08-13-2019 wine and beer at the andovers 350 Winthrop Ave North Andover No d Ci�ecic5 - 10g Cf�e��5 3 Su�PS " 3 I� non--cpMp (Cgnce r4Qf 3 v1 I 2l�1y SAP Jr, 30, 2-0f � Agency Date Retailer Name y Retailer Address Retailer City Sold To Minor FDA: Decisi FDA: Letter FDA OS-29-2015 :a I prime energy 1725 Turnpike St North Andover No No Violation Observed FDA 11-13-2015 :a I prime energy 1725 Turnpike St North Andover No No Violation Observed FDA 06-08-2016 'a I prime energy 1725 Turnpike St North Andover No No Violation Observed FDA 10-25-2016 :a I prime energy 1725 Turnpike St North Andover No No Violation Observed FDA 12-19-2017 :a I prime energy 1725 Turnpike St North Andover No No Violation Observed FDA 02-13-2019 :a I prime energy 1725 Turnpike St North Andover No No Violation Observed FDA 11-03-2016-,den rock wine and spirits 54 Peters St North Andover No No Violation Observed FDA 12-19-2017 :den rock wine and spirits 54 Peters St North Andover No No Violation Observed FDA 02-13-2019 :den rock wine and spirits 54 Peters St North Andover No No Violation Observed FDA 05-29-2015 :j and m convenience store 701 Salem St North Andover No No Violation Observed FDA 11-03-2015 :j and m convenience store 701 Salem St North Andover No No Violation Observed FDA 06-08-2016 :j and m convenience store 701 Salem St North Andover No No Violation Observed FDA 10-25-2016 :j and m convenience store 701 Salem St North Andover No No Violation Observed FDA 12-19-2017 :j and m convenience store 701 Salem St North Andover No No Violation Observed FDA 05-08-2019 :j and m convenience store 701 Salem St North Andover No No Violation Observed FDA 04-11-2019:j and rn convenience store 701 Salem St North Andover Yes Warning Letter Issued FDA 05-29-2015 :main street liquors 64 Main St North Andover No No Violation Observed FDA 11-03-2015 :main street liquors 64 Main St North Andover No No Violation Observed FDA 06-08-2016 :main street liquors 64 Main St North Andover No No Violation Observed FDA 10-25-2016 :main street liquors 64 Main St North Andover No No Violation Observed FDA 12-19-2017 :main street liquors 64 Main St North Andover No No Violation Observed FDA 02-13-2019 :main street liquors 64 Main St North Andover No No Violation Observed FDA 05-29-2015 :market basket 350 Winthrop Ave North Andover No No Violation Observed FDA 11-13-2015 :market basket 350 Winthrop Ave North Andover No No Violation Observed FDA 06-08-2016 :market basket 350 Winthrop Ave North Andover No No Violation Observed FDA 10-25-2016 :market basket 350 Winthrop Ave North Andover No No Violation Observed FDA 12-19-2017 :market basket 350 Winthrop Ave North Andover No No Violation Observed FDA 02-13-2019 :market basket 350 Winthrop Ave North Andover No No Violation Observed FDA 05-29-2015 :mcaloons liquors 531 Chickering Rd North Andover No No Violation Observed FDA 11-13-2015 :mcaloons liquors 531 Chickering Rd North Andover No No Violation Observed FDA 06-07-2016:mcaloons liquors 531 Chickering Rd North Andover No No Violation Observed FDA 10-25-2016:mcaloons liquors 531 Chickering Rd North Andover No No Violation Observed FDA 12-19-2017 :mcaloons liquors 531 Chickering Rd North Andover No No Violation Observed FDA 02-13-2019 :mcaloons liquors 531 Chickering Rd North Andover No No Violation Observed FDA 05-29-2015 :mikes market 220 Middlesex St North Andover No No Violation Observed FDA 11-13-2015 :mikes market 220 Middlesex St North Andover No No Violation Observed FDA 06-08-2016 :mikes market 220 Middlesex St North Andover No No Violation Observed FDA 10-25-2016 :mikes market 220 Middlesex St North Andover No No Violation Observed FDA 12-19-2017 :mikes market 220 Middlesex St North Andover No No Violation Observed FDA 02-13-2019 :mikes market 220 Middlesex St North Andover No No Violation Observed FDA 08-11-2014 :mobil 350 Winthrop Ave Ste 15 North Andover No No Violation Observed FDA 05-29-2015 :mobil 350 Winthrop Ave Ste 15 North Andover No No Violation Observed FDA 11-13-2015 'mobil 350 Winthrop Ave Ste 15 North Andover No No Violation Observed FDA 06-08-2016 :mobil 350 Winthrop Ave Ste 15 North Andover No No Violation Observed FDA 10-25-2016 :mobil 350 Winthrop Ave Ste 15 North Andover No No Violation Observed FDA 05-29-2015 :mobil-north andover automotive 980 Osgood St North Andover No No Violation Observed FDA 11-13-2015 :mobil-north andover automotive 980 Osgood St North Andover No No Violation Observed FDA 06-09-2016:mobil- north andover automotive 980 Osgood St North Andover No No Violation Observed FDA 10-26-2016 :mobil- north andover automotive 980 Osgood St North Andover No No Violation Observed FDA 12-19-2017 'mobil - north andover automotive 980 Osgood St North Andover No No Violation Observed FDA 07-02-2015:mobil mart-sj enterprises 12 Massachusetts Ave North Andover Yes Warning It http://w%m FDA 09-12-2015 :mobil mart-sj enterprises 12 Massachusetts Ave North Andover No No Violation Observed FDA 02-09-2016:mobil mart-sj enterprises 12 Massachusetts Ave North Andover No No Violation Observed FDA 06-08-2016'mobil mart-sj enterprises 12 Massachusetts Ave North Andover No No Violation Observed FDA 10-25-2016'mobil mart-sj enterprises 12 Massachusetts Ave North Andover No No Violation Observed FDA 12-19-2017 'mobil mart-sj enterprises 12 Massachusetts Ave North Andover No No Violation Observed FDA 02-13-2019 :mobil mart-sj enterprises 12 Massachusetts Ave North Andover No No Violation Observed FDA 07-18-2014 :quic pic 535 Chickering Rd North Andover No No Violation Observed FDA OS-29-2015 :quic pic 535 Chickering Rd North Andover No No Violation Observed FDA 11-13-2015 :quic pic 535 Chickering Rd North Andover No No Violation Observed FDA 06-07-2016:quic pic 535 Chickering Rd North Andover No No Violation Observed FDA 10-25-2016 :quic pic 535 Chickering Rd North Andover No No Violation Observed FDA 12-19-2017:quic pic 535 Chickering Rd North Andover No No Violation Observed FDA 02-13-2019 :quic pic 535 Chickering Rd North Andover No No Violation Observed FDA 05-29-2015 :race way convenience store 1503 Osgood St North Andover No No Violation Observed FDA 11-13-2015 :race way convenience store 1503 Osgood St North Andover No No Violation Observed FDA 06-23-2016:race way convenience store 1503 Osgood St North Andover Yes Warning U http://wun FDA 09-03-2016 :race way convenience store 1503 Osgood St North Andover No No Violation Observed FDA 01-26-2017 :race way convenience store 1503 Osgood St North Andover No No Violation Observed FDA 12-19-2017 :race way convenience store 1503 Osgood St North Andover No No Violation Observed FDA 02-13-2019 :race way convenience store 1503 Osgood St North Andover No No Violation Observed FDA 05-29-2015 :richdale 75 Chickering Rd North Andover No No Violation Observed FDA 11-13-2015 :richdale 75 Chickering Rd North Andover No No Violation Observed FDA 06-07-2016 :richdale 75 Chickering Rd North Andover No No Violation Observed FDA 10-25-2016 :richdale 75 Chickering Rd North Andover No No Violation Observed FDA 05-29-2015 :richdale 4 Main St North Andover No No Violation Observed FDA 11-03-2015 :richdale 4 Main St North Andover No No Violation Observed FDA 06-08-2016 :richdale 4 Main St North Andover No No Violation Observed FDA 10-25-2016 :richdale 4 Main St North Andover No No Violation Observed FDA 12-19-2017 :richdale 75 Chickering Rd North Andover No No Violation Observed FDA 12-19-2017 :richdale 4 Main St North Andover No No Violation Observed FDA 02-13-2019 :richdale 75 Chickering Rd North Andover No No Violation Observed FDA 02-13-2019 :richdale 4 Main St North Andover No No Violation Observed FDA 05-29-2015 :rite aid 525 Turnpike St North Andover No No Violation Observed FDA 11-03-2015 :rite aid 525 Turnpike St North Andover No No Violation Observed FDA 06-08-2016 :rite aid 525 Turnpike St North Andover No No Violation Observed FDA 10-25-2016 :rite aid 525 Turnpike St North Andover No No Violation Observed FDA 12-19-2017 :rite aid 525 Turnpike St North Andover No No Violation Observed FDA 05-29-2015 :stop and shop 757 Turnpike St North Andover No No Violation Observed FDA 11-03-2015 :stop and shop 757 Turnpike St North Andover No No Violation Observed FDA 06-08-2016 -stop and shop 757 Turnpike St North Andover No No Violation Observed FDA 10-25-2016 '.stop and shop 757 Turnpike St North Andover No No Violation Observed FDA 12-19-2017 :stop and shop 757 Turnpike St North Andover No No Violation Observed FDA OS-29-2015 :super petroleum 79 Chickering Rd North Andover No No Violation Observed FDA 11-13-2015 :super petroleum 79 Chickering Rd North Andover No No Violation Observed FDA 06-07-2016 :super petroleum 79 Chickering Rd North Andover No No Violation Observed FDA 10-25-2016 :super petroleum 79 Chickering Rd North Andover No No Violation Observed FDA 12-19-2017 :super petroleum 79 Chickering Rd North Andover No No Violation Observed FDA 02-13-2019 :super petroleum 79 Chickering Rd North Andover No No Violation Observed FDA 05-29-2015 :the vineyard 554 Turnpike St North Andover No No Violation Observed FDA 11-13-2015 :the vineyard 554 Turnpike St North Andover No No Violation Observed I FDA 06-08-2016'the vineyard No Violation Observed FDA 554 Turnpike St North Andover No 10-25-2016 :the vineyard 554 Turnpike St North Andover No No Violation Observed FDA 05-29-2015-'walgreens No Violation Observed 11-03-2015 FDA 800 Waverley Rd North Andover No:walgreens 800 Waverley Rd North Andover No No Violation Observed FDA 06-09-2016:walgreens No Violation Observed 10-25-2016 : FDA 800 Waverley Rd North Andover No walgreens 800 Waverley Rd North Andover No Na Violation Observed FDA 12-19-2017:walgreens No Violation Observed 800 Waverley Rd North Andover No I i I I I I I I I I 141?-111)111 k" E, Board Of Health Update 10/22/19 Re: Mosquito Control Happy Halloween and Remember to Trick-or-Treat (and put on DEET) & North Andover Public Schools Outdoor Activities and Athletics. The Board of Health has not recommended any restrictions on outdoor activities after 6:30pm because of cooler temperatures and reduced mosquito activity at night as of October 26, 2019. The Board of Selectmen has set Trick-or-Treating Hours for October 31, from 5:30-7:30 p.m. North Andover High School will be releasing information about changes to sports, programming or other activities. Please see the NAHS Athletic Schedule site for additional information. Mosquito activity has been declining with the cooler temperatures at dusk and mosquitoes are completely inactive when it is 50 degrees or below. There may still be some limited mosquito activity and residents should still take precautions as necessary. North Andover is still listed at a moderate risk(not high or critical) because we have not had a hard frost,but the cooler temperatures during peak mosquito hours have reduced mosquito activity and the threat of mosquito borne diseases. Mosquito borne diseases are completely preventable and awareness and personal protection are always essential. The Board of Health still recommends that residents be aware and to continue using bug spray,wear appropriate clothing to cover exposed skin and to always be aware of any mosquito activity when outdoors. Mosquitoes may still be active during the warmer daytime hours in certain areas such as in the woods, along trails and in shaded areas so please be aware and take all necessary precautions to avoid mosquito bites. Have a happy,mosquito free Halloween and remember to Trick-or-Treat and put on some DEET! Please go to northandoverma.gov/health for more information. If you have any questions or concerns please feel free to call the North Andover Public Health Department at 978-688-9540.