11.b.

1
  

PUBLIC HEALTH ISSUES

x Tobacco Usage
1. Tompkins County Adult smoking rate (age-adj), 14.0%. (NYS eBRFSS, 2014)
2. Tompkins County Youth: Student Survey [Communities That Care] 2014
Grades 9-12, Lifetime use of cigarettes, 18.1% (NYS=22.4%)

Attachment: Tobacco-21 Findings and Options for BOH meeting (6928 : T21 background information)
Grades 9-12, 30-day use of cigarettes, 6.1% (NYS=7.3%)
30-day use of smokeless, 4.7%
Grade 12 alone, 30-day use, 10.3%,

Ease of access: Cigarettes are Very easy or Sort of easy to get

Grade 10, 26.6%
Grade 11, 40.2%.
Grade 12, 51.4%
Grades 9 to 12, 34.6%.
How wrong would most adults in your neighborhood think it was for kids
your age to smoke cigarettes? A little wrong + Not wrong at all
grade 10, 10.4%
grade 11, 15.4%
grade 12, 18.2%
Grades 9-12, 13.0%
How wrong do your parents feel it would be for you to smoke tobacco?
A little wrong + Not wrong at all


grade 10, 3.4%

grade 11, 4.0%
grade 12, 6.3%
Grades 9-12, 4.0%
Use of electronic nicotine delivery systems (ENDS or e-cigs) was not part of
this survey, though numerous studies show that ENDS use among high
schoolers is growing rapidly nationwide. (See below)

Ted Schiele (11/29/16) T-21 FINDINGS & OPTIONS 1

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3. Disparate populations:
Adults, Tompkins County: Low SES and Poor mental health
Percent of adults with household income less than $25,000 who are
current smokers

Attachment: Tobacco-21 Findings and Options for BOH meeting (6928 : T21 background information)
Percentage of cigarette smoking among adults who report poor
mental health

Ted Schiele (11/29/16) T-21 FINDINGS & OPTIONS 2

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Youth, national: Education and Employment (Report of the USSG, 2012)

Attachment: Tobacco-21 Findings and Options for BOH meeting (6928 : T21 background information)
4. E-Cigarette use nationally has increased in lockstep with increased e-cig advertising

NYS, e-cig use, grade 9-12, 10.5% (2014)

NYS, e-cig use, ages 18-25, 12.7%

Ted Schiele (11/29/16) T-21 FINDINGS & OPTIONS 3

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5. Youth exposure to tobacco marketing in the retail environment,

85% HS students (NYS) report being aware of tobacco marketing
Exposure to retail cigarette advertising is a risk factor for smoking
initiation. Policies and parenting practices that limit adolescents exposure
to retail cigarette advertising could improve smoking prevention efforts
[Henriksen et al. Pediatrics. 2010 August ; 126(2): 232238. doi:10.1542/peds.2009-3021]

Attachment: Tobacco-21 Findings and Options for BOH meeting (6928 : T21 background information)
x Raising the age

1. Institute Of Medicine Report 2015: Public Health Implications of Raising the

Minimum Age of Legal Access to Tobacco Products (http://www.nap.edu/18997)
If the minimum legal age is raised to 21 (projections for nationwide
impacts):
The tobacco use initiation rate would decrease as follows:
by about 15% for youth under age 15
by 25% for ages 15-17
by a little over 15% for ages 18-20
The study model projects that if the minimum age were raised
today, by the time todays teenagers were adults, there would be a
12% decrease in the prevalence of tobacco use among those adults.
The model projects that, looking 30 years out, raising the age now
would result in approximately 223,000 fewer premature deaths, and
4.2 million fewer years of life lost among those born in the first 20
years of this century.
Selected Findings excerpted from the IOM study
Finding 3-5: While the development of some cognitive abilities is
achieved by age 16, the parts of the brain most responsible for
decision making, impulse control, sensation seeking, future
perspective taking, and peer susceptibility and conformity continue
to develop and change through young adulthood [Ages 18-25].
Finding 3-6: Animal studies suggest that adolescent brains, because
of their level of development, are uniquely vulnerable to the effects
of nicotine and nicotine addiction.
Selected Conclusions excerpted from the IOM study Summary chapter
Conclusion 7-1: Increasing the minimum age of legal access to
tobacco products will likely prevent or delay initiation of tobacco use
by adolescents and young adults. ["Initiation" = having smoked 100
cigarettes]

Ted Schiele (11/29/16) T-21 FINDINGS & OPTIONS 4

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Conclusion 7-2: Although changes in the minimum age of legal

access to tobacco products will directly pertain to individuals who
are age 18 or older, the largest proportionate reduction in the
initiation of tobacco use will likely occur among adolescents 15 to 17
years old.
Conclusion 7-4: Based on the modeling, raising the minimum age of

Attachment: Tobacco-21 Findings and Options for BOH meeting (6928 : T21 background information)
legal access to tobacco products, particularly to age 21 or 25, will
likely lead to substantial reductions in smoking prevalence.
Conclusion 8-1: Based on the modeling, raising the minimum age of
legal access to tobacco products will likely lead to substantial
reductions in smoking-related mortality.
Conclusion 8-2: Based on a review of the literature, raising the
minimum age of legal access to tobacco products (MLA) will likely
immediately improve the health of adolescents and young adults by
reducing the number of those with smoking-caused diminished
health status. ... Raising the MLA will also likely reduce the
prevalence of other tobacco products and exposure to secondhand
smoke, further reducing tobacco-caused adverse health effects,
both immediately and over time.
Conclusion 8-3: Based on a review of the literature and on the
modeling, an increase in the minimum age of legal access to
tobacco products will likely improve maternal, fetal, and infant
outcomes by reducing the likelihood of maternal and paternal
smoking.

2. Role of brain development

Exposing the undeveloped adolescent brain to nicotine increases the
chance that the brain will become essentially hardwired for nicotine. That
is largely why about 90% of adult smokers started before age 18. Those
who wait until the brain is fully developed, about age 25, are unlikely to
become lifetime users. The longer use is delayed, the lower is the
likelihood of lifetime addiction.
No one starts smoking for the nicotine, yet it is the nicotine that turns that
so-called responsible decision into a long term addiction.

Ted Schiele (11/29/16) T-21 FINDINGS & OPTIONS 5

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GENERAL REQUIREMENTS/APPROACH FOR THE LAW

x Tompkins Law
1. See "Draft for discussion".

x Chautauqua law, (differences from Tompkins draft)

Attachment: Tobacco-21 Findings and Options for BOH meeting (6928 : T21 background information)
1. 2. Definitions.
Defines "Prohibited Products" in a single list, and links the definition of all
the products to NYS Public Health Law Article 13-F
adds in a second paragraph, "all other products which are prohibited from
being sold to minors by NYS PH Law Art. 13-F, as the same may be
amended from time to time." For example, ENDS were just added in 2015,
and smoking paraphernalia was just added in 2013.
Defines "Enforcement Officer" as the County Board of Health
2. 3. Policy.
ID requirements for proof of age is referenced back to 13-F
Prohibits vending machine sales of any prohibited products
Prohibits self-service access to prohibited products.
Tompkins County Ch. 155 (1998) prohibits self service of tobacco
products, but does not restrict self service of newer products such
as e-cigs and paraphernalia (as is covered by Item 1, above).
Tompkins Ch. 155 does not restrict vending machine sales ("This
section shall not apply to the sale of tobacco products in vending
machines located in a bar or in vending machines in the bar area of
a food service establishment with a valid on-premises full liquor
license or in a tobacco business." Ch. 155 3)
3. 4. Posting of Signs.
Includes a more comprehensive list of prohibited products and a reference
to 13-F for adding items to the sign if the state adds them to their sign.
Thus, as the state may add products to ATUPA (see Item 1, above), the
county sign will change in step with the state sign.
4. 5. Enforcement.
Separates violation of the state ATUPA law from a violation of their county
Age 21 law in 5(c) i-vi, "For a violation of this Law which does not
consititute a violation of NYS PH Law"
Includes details of serving a hearing notice, reference to the
Sanitary Code, proposed stipulation, civil penalty.

Ted Schiele (11/29/16) T-21 FINDINGS & OPTIONS 6

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Includes "Any person who desires to register a complaint under this

Local Law may do so through the Enforcement Officer
5. 6. Violations and Penalties
References penalty amounts to the min/max as set by 13-F 1399-ee(2).

x Albany Law, (differences from Tompkins draft)

Attachment: Tobacco-21 Findings and Options for BOH meeting (6928 : T21 background information)
1. 1, 2, 4: Only sell to someone who has demonstrated they are 21 with a photo
ID, unless they reaonably look 30 years old, though that can't be a defense if you
get caught.
2. Law written as effective immediately upon filing with secretary of state

OPTIONS FOR IMPLEMENTATION

x Annual Costs (from the 2015 EH Annual Report)

1. Staff time for tobacco control: 2% of EH total (Based on 3,400 total staff days =
approx. 68 days = approx. $14,300 for PHS wage rate)
2. Activity for Tobacco Control:
ATUPA Activity 2015 2014 2013 2012 2011
Active Operations 68 68 66 66 66
ATUPA Compliance Checks 93 135 153 129 133
Violations 0 1 6 3 1
(6 months)
NYSDOH Grant $33,710 $32,395 $34,059 $35,004 $16,421

x Options for Retailer and consumer education outreach

1. Health Promotion Program (HPP) proposes to be responsible for educational
outreach in first 1 year subsequent to passage of a local law
New mandatory signs specified in the law would be distributed to all
retailers by HPP staff
Education materials would be distributed to all retailers by HPP staff and
may include copy of the law, FAQs, door stickers intended to notify the
public.
2. OTPS Funding for the Year-1 outreach proposed to come from the education line
of the 2016-17 ATUPA grant.

x Options for Checking Compliance for ages 18-20 years

1. Complaint based only. No additional staffing for proactive, ATUPA-style
compliance checks for age 18-20.

Ted Schiele (11/29/16) T-21 FINDINGS & OPTIONS 7

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Response to a complaint
Field education by EH staff, similar to initial CIAA complaint
Compliance check by EH staff working with an individual age 18-20
2. Phased-in inspections by EH staff
No age 18-20 compliance checks for the first xx months after
implementation, then carry out compliance checks for approximately one

Attachment: Tobacco-21 Findings and Options for BOH meeting (6928 : T21 background information)
quarter to one third of the licensed retailers per year, such that within 3-4
years after age 18-20 checks have started, all retailers will have been visited.
Complaints will be responded to by EH staff (see Options 1 above).
3. All operations inspected annually
Requires one compliance check for under age 18, and one compliance
check for age 18-20, each year

x Fines
1. Albany County: assesses fine for violation of the county law for sale to age 18-20,
and in addition assesses ATUPA fine for sale to under age 18 (see
correspondence, below).

2. Correspondence from Albany County Dir. EH, via Director of Advancing Tobacco
Free Communities of Albany County
From:Lenehan,Marcia[mailto:Marcia.Lenehan@albanycountyny.gov] 
Sent: Friday,September16,201611:20AM
To: JudyA.Rightmyer;LisaAyers
Subject: RE:T21
Hi Judy,
We will be doing separate stings for Tobacco 21, but not on every establishment. We have hired a 18 year
old to work for two weeks(combined approximately 70 hours) to go out with the ATUPA inspector to get
into as many places as they can. We are hoping that they should be able to make it to at least 1//4-1/3 of
the total ATUPA list each year and we will track it to make sure that we covering the entire county and
hitting them all eventually. That individual will also be called upon should we receive a Tobacco 21
complaint. We (required by NYSDOH) continue to do the ATUPA program as usual . When we have had
a sale involving our 16-17 year olds with the ATUPA program, we also fine them for violating the county
law, so instead of a $350.00 fine for the first violation under ATUPA alone, the fine is $650.00. There are
no extra points assessed however.
I hope that this is clear and not confusing for youfeel free to contact me if there are any questions.

Marcia
Marcia M. Lenehan, M.S.
Director of Environmental Health
Albany County Department of Health
tel 518.447.4620; fax 518.447.4513
Marcia.Lenehan@albanycounty.com

Ted Schiele (11/29/16) T-21 FINDINGS & OPTIONS 8

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Tobacco 21 DRAFT for discussion. 11.b.1
Prepared by: Public Health & Tobacco Policy Center, Boston. Kerry Snyder, JD (ksnyder@tobaccopolicycenter.org)

Section 1: Findings
[ The majority of his Section removed for this BOH meeting for the purpose of brevity ]

Tompkins County has a substantial interest in reducing the number of individuals of all ages who use
cigarettes and other tobacco products, and a particular interest in protecting adolescents from tobacco
dependence and the illnesses and premature death associated with tobacco use;1

Attachment: Tobacco-21 Findings and Options for BOH meeting (6928 : T21 background information)
It is the intent of Tompkins County to implement effective measures through this Chapter to reduce
youth access to tobacco products, e-cigarettes and similar aerosol devices, smoking paraphernalia and
shisha.

Section 2: Definitions

DEPARTMENT means Tompkins County Health Department.

ELECTRONIC NICOTINE DELIVERY SYSTEMS (ENDS) has the same meaning as in 72-6.

LEGAL AGE means age 21 years.

SHISHA means any product made primarily of tobacco or other leaf or herbs, or any combination
thereof, smoked or intended to be smoked in a hookah or water pipe.

SMOKING PARAPHERNALIA means any pipe, water pipe, hookah, rolling papers, or any other device,
equipment or apparatus designed for the inhalation of tobacco or Shisha.

TOBACCO PRODUCT means any product made or derived from tobacco or which contains nicotine
marketed or sold for human consumption, whether consumption occurs through inhalation, or oral or
dermal absorption. Tobacco product does not include drugs, devices, or combination products
authorized for sale by the state or U.S. Food and Drug Administration, as those terms are defined in the
Federal Food, Drug and Cosmetic Act.

TOBACCO RETAILER has the same meaning as in 155-2.

Section 3: Minimum Sales Age Restriction

No person shall sell any Tobacco Product, Electronic Nicotine Delivery System, Shisha or Smoking
Paraphernalia to persons under the Legal Age.

Section 4: Signage

Any person selling tobacco products, liquid nicotine, shisha or electronic cigarettes are sold or offered
for sale shall post in a conspicuous place a sign upon which there shall be imprinted the following
statement, SALE OF CIGARETTES, CIGARS, CHEWING TOBACCO, POWDERED TOBACCO, SHISHA
OR OTHER TOBACCO PRODUCTS, HERBAL CIGARETTES, LIQUID NICOTINE, ELECTRONIC
CIGARETTES, ROLLING PAPERS OR SMOKING PARAPHERNALIA, TO PERSONS UNDER TWENTY-
ONE YEARS OF AGE IS PROHIBITED BY LAW. Such sign shall be printed on a white card in red letters
at least one-half inch in height.

T-21 TOMPKINS COUNTY 1

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Tobacco 21 DRAFT for discussion. 11.b.1
Prepared by: Public Health & Tobacco Policy Center, Boston. Kerry Snyder, JD (ksnyder@tobaccopolicycenter.org)

Section 5: Violations and Enforcement

(A) The Department or its authorized designee(s) shall enforce the provisions of this Chapter. The
Department may conduct periodic inspections in order to ensure compliance with this Chapter.

(B) Any person found to be in violation of this Chapter shall be liable for a civil penalty of no less than
$300 but no more than $1,000 for a first violation, and no less than $500 but no more than $1,500 for
each subsequent violation.

Attachment: Tobacco-21 Findings and Options for BOH meeting (6928 : T21 background information)
x In the alternative, this subsection could simply state Any person found to be in violation
of this Chapter shall be subject to a civil penalty in the amounts imposed by N.Y. Public
Health Law 1399-ee(2).

(C) Any peace officer or police officer within the County of Tompkins is authorized to enforce this
chapter. The Department is authorized to enforce this chapter in the same manner as a violation of the
County Sanitary Code.

Section 6: Rules and Regulations

The Department may issue and amend rules, regulations, standards, guidelines, or conditions to
implement and enforce this Chapter.

Section 7: Severability

The provisions of this Chapter are declared to be severable, and if any section of this Chapter is held to
be invalid, such invalidity shall not affect the other provisions of this Chapter that can be given effect
without the invalidated provision.

Section 8: Effective Date

The effective date of this ordinance shall be sixty (60) days from the date of its enactment.

1
Lorillard Tobacco Co. v. Reilly, 533 U.S. 525, 555 (2001); see also Cf. Ian McLaughlin, Tobacco Control Legal Consortium,
License to Kill?: Tobacco Retailer Licensing as an Effective Enforcement Tool 1 (2010), available at
http://publichealthlawcenter.org/sites/default/files/resources/tclc-syn-retailer-2010.pdf.

T-21 TOMPKINS COUNTY 2

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LOCAL LAW
INTRODUCTORY NO. 2 - 16
CHAUTAUQUA COUNTY

A LOCAL LAW TO RAISE THE LEGAL AGE FOR PURCHASE OF

TOBACCO PRODUCTS IN CHAUTAUQUA COUNTY TO 21

Attachment: Tobacco-21 Findings and Options for BOH meeting (6928 : T21 background information)
BE IT ENACTED, by the County Legislature of the County of Chautauqua, New York,
as follows:

Section 1. Legislative Findings and Intent.

The sale in Chautauqua County of tobacco and related products to individuals under twenty-one
years of age should be prohibited in order to:

a) further the goals of New York States tobacco use prevention and control
program, as identified in New York State Public Health Law 1399-ii;
b) respond to the fact that tobacco is the leading cause of preventable death and
disease in New York State;
c) respond to findings made by the Institute of Medicine, which prepared a report at
the request of the U.S. Food and Drug Administration entitled Public Health
Implications of Raising the Minimum Age of Legal Access to Tobacco Products,
concluding and suggesting that:

i. adolescent brains are uniquely vulnerable to the effects of nicotine;

ii. a younger age of initiation is strongly associated with greater nicotine
dependence and is also associated with greater intensity and persistence of
smoking beyond adolescence and into adulthood;
iii. almost one in five high school seniors is a current cigarette smoker;
iv. underage users rely primarily on social sources, such as friends and
family, to acquire tobacco, and most of these sources are likely to be
between eighteen and twenty years old;
v. raising the minimum legal age to twenty-one will mean that those who can
legally obtain tobacco are less likely to be in the same social networks as
high school students;
vi. delaying initiation rates will likely decrease the prevalence of tobacco
users in the U.S. population; and
vii. raising the minimum legal age will likely immediately improve the health
of adolescents and young adults by reducing the number of those with
adverse physiological effects;

d) address the fact that, when adjusted for age, 27.8 percent of adults in Chautauqua
County smoke, which is the ninth highest county smoking rate in the State;
e) respond to findings that most (nearly 90%) of those addicted to tobacco, start using
tobacco before twenty-one years of age;
f) respond to the growing rates of electronic cigarette use among youth, which expose

T-21 CHAUTAUQUA COUNTY LEGISLATURE Page 1

Packet Pg. 146
 11.b.1

users to unhealthy levels of nicotine and other unknown harmful chemicals;

g) reduce the exposure of our youth to disease-causing toxins in secondhand smoke and
in chemicals emitted from electronic cigarettes, liquid nicotine, shisha, herbal
cigarettes, and other Prohibited Products as defined herein;
h) apply evidence-based strategies to address the public health issues that result from
tobacco use including but not limited to cancer, heart disease, and lung disease;
i) prevent exposure of youth, who are particularly susceptible to addiction, to the

Attachment: Tobacco-21 Findings and Options for BOH meeting (6928 : T21 background information)
chemically addictive effects of tobacco and related products, in an effort to improve
public wellness and reduce health insurance expenditures; and
j) protect young County residents from the unregulated and unknown effects of
electronic cigarettes, herbal cigarettes, and other Prohibited Products.

Section 2. Definitions.

a) Prohibited Products means:

i. cigarettes, cigars, chewing tobacco, powdered tobacco, shisha, bidis, gutka,

other tobacco products, nicotine water, herbal cigarettes, electronic cigarettes,
liquid nicotine, snuff, rolling papers, and smoking paraphernalia, as those
terms are defined in New York State Public Health Law Article 13-F and,
when not so defined, as commonly understood to be defined; and
ii. all other products which are prohibited from being sold to minors by New
York State Public Health Law Article 13-F, as the same may be amended
from time to time.

b) Enforcement Officer means the County of Chautauqua Board of Health.

Section 3. Policy.

a) The sale of Prohibited Products to those under the age of twenty-one is prohibited in
Chautauqua County to the same extent that sale of such products to those under
eighteen years of age is prohibited by New York State Public Health Law Article
13-F, as the same may be amended from time to time.
b) The identification requirements contained in New York State Public Health Law
Article 13-F Section 1399-cc(3), as the same may be amended from time to time, are
hereby incorporated into this law by reference, except that the age to be proven by
such identification shall be twenty-one.
c) Prohibited Products may not be sold in vending machines located in the County.
d) No person operating a place of business wherein Prohibited Products are sold or
offered for sale shall sell, permit to be sold, offer for sale or display for sale any
Prohibited Product in any manner, unless such Product is stored for sale (a) behind a
counter in an area accessible only to the personnel of such business, or (b) in a locked
container; provided, however, such restriction shall not apply to tobacco businesses as
defined in subdivision eight of 1399-aa of New York State Public Health Law
Article 13-F, as the same may be amended from time to time, and to places to which
admission is restricted to persons twenty-one years of age or older.

T-21 CHAUTAUQUA COUNTY LEGISLATURE Page 2

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Section 4. Posting of Signs.

Vendors of Prohibited Products shall post a sign in a conspicuous place imprinted with the
statement SALE OF CIGARETTES, CIGARS, CHEWING TOBACCO, POWDERED
TOBACCO, SHISHA, BIDIS, GUTKA OR OTHER TOBACCO PRODUCTS, HERBAL
CIGARETTES, LIQUID NICOTINE, ELECTRONIC CIGARETTES, ROLLING PAPERS, OR

Attachment: Tobacco-21 Findings and Options for BOH meeting (6928 : T21 background information)
SMOKING PARAPHERNALIA, TO PERSONS UNDER TWENTY-ONE YEARS OF AGE,
IS PROHIBITED BY LOCAL LAW. Such sign shall be printed on a white card in red letters at
least one-half inch in height. Signs shall be protected from tampering, damage, removal, or
concealment. In the event additional sign language is required due to changes to New York State
Public Health Law Article 13-F, vendors shall add such additional language to their signs,
including, but not limited to, reference to additional products which may become prohibited for
sale to minors.

Section 5. Enforcement.

a) The Enforcement Officer is charged with ensuring compliance with this Local Law.
b) In the event a violation of this Law also constitutes a violation of New York State
Public Health Law, as the same may be amended from time to time, the Enforcement
Officer shall take enforcement action pursuant to and in accordance with New York
State Public Health Law Article 13-F 1399-ee, as the same may be amended from
time to time.
c) For a violation of this Law which does not constitute a violation of New York State
Public Health Law:

i. the Enforcement Officer may issue and serve upon the person complained
against a written hearing notice, in accordance with the provisions of the
Chautauqua County Sanitary Code, together with the complaint made against
him or her. The Complaint shall specify the provision(s) of this Local Law of
which such person is alleged to be in violation, accompanied by a statement of
the manner in which that person is alleged to have violated it, and shall require
the person so complained against to answer the charges of such complaint at a
public hearing before the Board of Health or its designated hearing officer, at a
specified location, date, and time, not fewer than fifteen (15) days after the
date of service of the notice;
ii. notwithstanding the above, the Board of Health or its designee may, in its
discretion, offer a proposed stipulation to the person complained against, in
which case the person complained against will have the option of executing the
proposed stipulation within any time frame specified, or proceeding with a
formal hearing;
iii. when the Enforcement Officer determines after a hearing that a violation of
this Local Law has occurred, a civil penalty may be imposed by the
Enforcement Officer pursuant to Section 6 of this Local Law. Nothing herein
shall be construed as prohibiting an Enforcement Officer from commencing a
proceeding for injunctive relief to compel compliance with this Local Law;

T-21 CHAUTAUQUA COUNTY LEGISLATURE Page 3

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iv. any person who desires to register a complaint under this Local Law may do so
through the Enforcement Officer;
v. the decision of the Enforcement Officer shall be reviewable pursuant to Article
78 of the Civil Practice Law and Rules; and
vi. the Enforcement Officer, subsequent to any appeal having been finally
determined, may bring an action in a court of proper jurisdiction to recover the
civil penalty assessed in accordance with Section 6 of this Local Law.

Attachment: Tobacco-21 Findings and Options for BOH meeting (6928 : T21 background information)
Section 6. Violations and Penalties.

Violation of any provision of this Local Law shall be punishable by a civil penalty in an amount
determined by the Chautauqua County Board of Health, within the parameters of the minimum
and maximum penalties set forth in New York State Public Health Law 1399-ee(2), as the same
may be amended from time to time.

Section 7. Severability.

If any clause, sentence, paragraph, subdivision, section, or part of this law or the application
thereof to any person, individual, corporation, firm, partnership, or business shall be adjudged by
any court of competent jurisdiction to be invalid or unconstitutional, such order or judgment
shall not affect, impair, or invalidate the remainder thereof but shall be confined in its operation
to the clause, sentence, paragraph, subdivision, section, or part of this law, or in its specific
application.

Section 8. Effective Date.

This local law shall become effective October 1, 2016.

T-21 CHAUTAUQUA COUNTY LEGISLATURE Page 4

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LOCAL LAW NO. C FOR 2016

A LOCAL LAW OF THE COUNTY OF ALBANY, NEW YORK PROHIBITING

THE SALE OF CIGARETTES, TOBACCO PRODUCTS, LIQUID NICOTINE OR
ELECTRONIC CIGARETTES TO MINORS AND YOUNG ADULTS

Attachment: Tobacco-21 Findings and Options for BOH meeting (6928 : T21 background information)
Introduced: 2/9/16
By Messrs. Miller, Commisso, Mss. Lekakis, McKnight, Willingham, Chapman,
Cunningham, Messrs. A. Joyce, Clay, Touchette, Fein, Reinhardt, Simpson,
Beston, Domalewicz, Higgins and R. Joyce:

BE IT ENACTED, by the Legislature of the County of Albany as follows:

SECTION 1.
Any person operating a place of business wherein cigarettes, tobacco products,
liquid nicotine, or electronic cigarettes are sold or offered for sale is prohibited from
selling such cigarettes, tobacco products, liquid nicotine, or electronic cigarettes to
individuals under twenty-one years of age. Sale of cigarettes, tobacco products, liquid
nicotine, or electronic cigarettes in such places shall be made only to an individual who
demonstrates, through a driver's license or other photographic identification card
issued by a government entity or educational institution, that the individual is at least
twenty-one years of age. Such identification need not be required of any individual who
reasonably appears to be at least thirty years of age, provided, however, that such
appearance shall not constitute a defense in any proceeding alleging the sale of
cigarettes, tobacco products, liquid nicotine, or electronic cigarettes to an individual
under twenty-one years of age.

SECTION 2.
Any person operating a place of business wherein non-tobacco shisha, pipes, or
rolling papers are sold or offered for sale is prohibited from selling such non-tobacco
shisha, pipes, or rolling papers to individuals under twenty-one years of age. Sale of
non-tobacco shisha, pipes, or rolling papers in such places shall be made only to an
individual who demonstrates, through a driver's license or other photographic
identification card issued by a government entity or educational institution, that the
individual is at least twenty-one years of age. Such identification need not be required
of any individual who reasonably appears to be at least thirty years of age, provided,
however, that such appearance shall not constitute a defense in any proceeding alleging
the sale of non-tobacco shisha, pipes, or rolling papers to an individual under twenty-
one years of age.

SECTION 3.
Any person operating a place of business wherein cigarettes, tobacco products,
liquid nicotine, electronic cigarettes, herbal cigarettes, nontobacco shisha, pipes, or
rolling papers are sold or offered for sale shall post in a conspicuous place a sign, in
accordance with the rules of the department, advising persons about the minimum age
requirements for the purchase of such items.

T-21 ALBANY COUNTY Page 1 Pg. 150

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 11.b.1

SECTION 4.
Any person who violates any provision of this article shall be subject to the
imposition of a civil penalty by the Commissioner of the Albany County Department of
Health of a minimum of $300.00, but not to exceed $1,000.00 for a first violation, and a
minimum of $500.00, but not to exceed $1,500.00 for each subsequent violation.

For purposes of enforcing the ban on the sale of tobacco products and or herbal
cigarettes to minors, other than by a vending machine, a sale shall be made only to an

Attachment: Tobacco-21 Findings and Options for BOH meeting (6928 : T21 background information)
individual who demonstrates that he/she is at least 21 years of age and has
demonstrated such in accordance with the guidelines set forth hereinabove. Such
identification shall not be required of any individual who reasonably appears to be at
least 30 years of age; provided however that such appearance shall not be a defense in
any action alleging the sale to an individual under 21 years of age.

SECTION 5.
If any clause, sentence, paragraph, section, subdivision or other part of this Local
Law or its applications shall be adjudged by a court of competent jurisdiction to be
invalid or unconstitutional, such order or judgment shall not affect, impair, or
otherwise invalidate the remainder of this Local Law which shall remain in full force
and effect except as limited by such order or judgment.

SECTION 6.
This law shall be null and void on the day that Statewide or Federal legislation
goes into effect, incorporating either the same or substantially similar provisions as are
contained in this law, or in the event that a pertinent State or Federal Administrative
Agency issues and promulgates regulations preempting such action by the County of
Albany. The County Legislature may determine via mere resolution whether or not
identical or substantially similar statewide legislation has been enacted for the
purposes of triggering the provisions in this section.

SECTION 7.
This Local Law shall be effective immediately upon filing with the Office of the
Secretary of State.

Referred to Health and Audit and Finance Committees. 2/9/16

Favorable Recommendation Health and Audit and Finance Committees.
4/27/16
On roll call vote the following voted in favor: Messrs. Beston, Bullock, Ms.
Chapman, Messrs. Clay, Clenahan, Commisso, Ms. Cunningham, Messrs. Domalewicz,
Feeney, Fein, Higgins, A. Joyce, R. Joyce, Ms. Lekakis, Messrs. Mackey, Mayo, Mss.
McKnight, McLean Lane, Messrs. Miller, Reinhardt, Simpson, Touchette, Ward and Ms.
Willingham 24.
Those opposed: Messrs. Burgdorf, Dawson, Drake, Ethier, Grimm, Hogan,
Mauriello, Mendick, OBrien, Signoracci, Smith, Stevens and Tunny 13.
Abstained: Mr. Crouse
Local Law was adopted. 5/9/16

T-21 ALBANY COUNTY Page 2 Pg. 151

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 11.b.2

REPORT BRIEFMARCH 2015

For more information visit www.iom.edu/TobaccoMinimumAge

Public Health
Implications of

Attachment: IOM Report on Tobacco use 2015 (6928 : T21 background information)
Raising the Minimum
Age of Legal Access to
Tobacco Products

Over the past 50 years, tobacco control in the United States has led to an esti-
mated 8 million fewer premature deaths. However, tobacco use continues to
signicantly affect public health, and more than 40 million Americans still
smoke.
In 2009, the Family Smoking Prevention and Tobacco Control Act granted
the U.S. Food and Drug Administration (FDA) broad authorities over tobacco
products, though it prohibited FDA from establishing a nationwide minimum
age of legal accessan MLA for tobacco productsabove 18 years of age. It
...tobacco use continues to
also directed FDA to convene a panel of experts to conduct a study on the signicantly affect public health,
public health implications of raising the minimum age to purchase tobacco and more than 40 million Americans
products. At FDAs request, the Institute of Medicine (IOM) convened a com- still smoke.
mittee in 2013 for this purpose.
In the resulting report, Public Health Implications of Raising the Minimum
Age of Legal Access to Tobacco Products, the committee of experts reviews
existing literature on tobacco use initiation, developmental biology and psy-
chology, and tobacco policy and predicts the likely public health outcomes of
raising the MLA for tobacco products to 19 years, 21 years, and 25 years. The
committee also uses mathematical modeling to quantify these predictions.
Of note, the report contains only conclusions regarding raising the MLA;
as requested by FDA, the committee does not offer recommendations as to
whether the MLA should be raised.

IUUQXXXOBQFEVPQFOCPPLQIQ SFDPSE@JE
IUUQXXXOBUJPOBMBDBEFNJFTPSHINE_NFEJB'JMFT3FQPSU'JMFT5PCBDDP.JO"HFUPCBDDP@NJOJNVN@BHF@SFQPSU@CSJFGQEG
Packet Pg. 152
 11.b.2

Lowering Initiation Rates decision making, impulse control, sensation seek-

ing, and susceptibility to peer pressure continue
The initiation age of tobacco use is critical. Among
to develop and change through young adulthood,
adults who become daily smokers, approximately
and adolescent brains are uniquely vulnerable to
90 percent report rst use of cigarettes before
the effects of nicotine. In addition, the majority
reaching 19 years of age, and almost 100 percent
of underage users rely on social sourceslike
report rst use before age 26. As mentioned above,
family and friendsto get tobacco.
FDA cannot raise the MLA nationwide. However,
Raising the MLA to 19 will therefore not have
states and localities can set a higher minimum age
much of an effect on reducing the social sources
for their communities. Most states currently set
of those in high school. Raising the MLA to 21 will

Attachment: IOM Report on Tobacco use 2015 (6928 : T21 background information)
the MLA at 18 years. Four states set it at 19 years,
mean that those who can legally obtain tobacco
and several localities around the country have
are less likely to be in the same social networks
raised the minimum age to 21 years.
as high school students. In the same vein, increas-
Based on its review of the literature, the
ing the MLA from 21 to 25 is not likely to achieve
committee concludes that overall, increasing the
additional notable reductions in social sources for
MLA for tobacco products will likely prevent or
those under age 15.
delay initiation of tobacco use by adolescents and
young adults. The age group most impacted will
be those age 15 to 17 years. The committee also
concludes that the impact of raising the MLA to Reducing Prevalence, Decreasing
21 will likely be substantially higher than raising Disease
it to 19. However, the added effect of raising the Delaying initiation rates will likely decrease the
MLA from 21 to 25 will likely be considerably prevalence of tobacco users in the U.S. popula-
less. tion. To quantify this decrease in both prevalence
The parts of the brain most responsible for of tobacco users and in related health concerns

FIGURE: Committee Estimates Regarding Effects on Initiation Rates

100%
Decrease in Initiation Rate

30%
MLA 25

25%
MLA 21

20% MLA 19

15%

10%

5%

under 15 yrs 15-17 yrs 18 yrs 19-20 yrs 21-24 yrs

Age Group

NOTE: This gure was created using data from Table 7-2 in the report.

2 Packet Pg. 153


that could be a result of raising the MLA, the com-
mittee commissioned the use of two established
and complementary tobacco simulation models,
SimSmoke and the Cancer Intervention and Sur-
veillance Modeling Network smoking population
model (CISNET).
In using the models, the committee employed
all available evidence and expert judgment to
project outcomes. The committee also had to
make assumptions with important implications.
The models only address cigarette smoking, but
the committee expects the MLA and relative
effects on initiation to apply to all tobacco prod-
ucts. In addition, the models project the effects of
raising the MLA on the United States as a whole
and do not take into account existing variations
in tobacco usesuch as by race or socioeconomic
statusinitiation rates, and tobacco control activ-
ities. In addition, the rapidly changing landscape
of tobacco productsfor example, e-cigarettes
provides unknowns and could affect the future of
tobacco product use in ways that the committee
was unable to anticipate due to lack of evidence.
Based on the modeling and backed up by the
literature review, the committee concludes that
raising the minimum age of legal access to tobacco
products in the United States, particularly to ages
21 and 25, will likely lead to a substantial reduc-
tion in smoking prevalence. If the MLA were
raised now, the models projected that by the time
todays teenagers were adults, there would be a
3 percent decrease in prevalence of tobacco use
among those adults if the MLA were raised to 19,
a 12 percent decrease if raised to 21, and a 16 per-
3 Packet Pg. 154
11.b.2
The parts of the brain most
responsible for decision making,
impulse control, sensation seeking,
and susceptibility to peer pressure
continue to develop and change
through young adulthood, and
adolescent brains are uniquely
vulnerable to the effects of nicotine
and nicotine addiction.
Attachment: IOM Report on Tobacco use 2015 (6928 : T21 background information)
cent decrease if raised to 25.
Given a decline in the initiation rates of
tobacco use by adolescents and lower prevalence
in the population, it follows that tobacco-related
disease would also decrease in proportion to the
reduction in tobacco use. It is generally known
that smoking-related diseases like cancer and
heart disease develop over decades, and there-
fore, it could take many years to lower rates of
these diseases; however, there could be imme-
diate decreases in other tobacco-related health
effects.
The committee concludes that raising the
MLA will likely immediately improve the health
of adolescents and young adults by reducing the
number of those with adverse physiological effects
such as increased inammation and impaired
immune functioning caused by smoking, as these
could potentially lead to negative health conse-
quences, including increased hospitalizations
and lessened capacity to heal wounds. Adverse
maternal, fetal, and infant outcomesinclud-
ing preterm births, low birth weight, and sudden
infant deathwill also probably decrease due to
reduced tobacco exposure in mothers and infants.
Raising the MLA will also lessen the populations
exposure to secondhand smoke and its associated
health effects, both now and in the future.
Over time, the committee concludes that rais-
ing the MLA will likely lead to substantial reduc-
tions in smoking-related mortality, though results
from the models suggest that these results will not
be observed for at least 30 years, assuming that the
MLA increase occurs now. The CISNET model

Committee on the Public Health Implications of Raising the
Minimum Age for Purchasing Tobacco Products
Richard J. Bonnie (Chair)
Harrison Foundation Professor
of Medicine and Law,
Professor of Psychiatry and
Neurobehavioral Sciences,
Director of the Institute of Law,
Psychiatry, and Public Policy,
University of Virginia
Anthony J. Alberg
Blatt Ness Distinguished
Endowed Chair in Oncology,
Professor, Public Health
Sciences, Interim Director of
Hollings Cancer Center, Medical
University of South Carolina
Regina Benjamin
NOLA.com/Times Picayune
Endowed Chair in Public Health
Sciences, Xavier University,
New Orleans
Jonathan Caulkins
Professor, Operations Research
and Public Health Policy, Heinz
College of Public Policy and
Management, Operations
Research Department,
Carnegie Mellon University
Bonnie Halpern-Felsher
Professor, Department
of Pediatrics, Director of
Research, Associate Director
of Adolescent Medicine
Fellowship Program, Division of
Adolescent Medicine, Stanford
University
Swannie Jett
Executive Director, Florida
Department of Health in
Seminole County
Harlan Juster
Director, Bureau of Tobacco
Control, New York State
Department of Health
Consultants
Theodore R. Holford
Susan Dwight Bliss Professor
of Public Health (Biostatistics)
and Professor of Statistics,
Yale School of Medicine, Yale
University
David T. Levy
Professor, Lombardi
Comprehensive Cancer Center,
Georgetown University Medical
Center
Study Staff
Kathleen Stratton
Study Director
Leslie Y. Kwan
Research Associate
Bettina Ritter
Research Assistant
Anna Martin
Senior Program Assistant
Study Sponsor
U.S. Food and Drug Administration
11.b.2
projected that if the MLA were raised now to 21
Jonathan D. Klein
nationwide, there would be approximately 223,000
Associate Executive Director,
Julius B. Richmond Center of
fewer premature deaths, 50,000 fewer deaths from
Excellence for Children and lung cancer, and 4.2 million fewer years of life lost
Secondhand Smoke, American
Academy of Pediatrics for those born between 2000 and 2019.
Paula M. Lantz
Professor and Chair,
Department of Health
Policy and Management,
Milken Institute School of
Public Health, The George Conclusion
Washington University
Robin Mermelstein The public health impact of raising the MLA for
Director of the Institute for
Attachment: IOM Report on Tobacco use 2015 (6928 : T21 background information)
Health Research and Policy, tobacco products depends on the degree to which
Professor of Psychology,
Clinical Professor of local and state governments change their poli-
Community Health Sciences,
School of Public Health, cies. These decisions will depend on each states
Institute for Health Research
and Policy, University of Illinois,
or localitys balance between personal interests
Chicago
and the privacy of young adults to make their own
Rafael Meza
Assistant Professor, choices versus societys legitimate concerns about
Department of Epidemiology,
University of Michigan protecting public health.
Patrick OMalley
Research Professor, Institute
The IOM committee makes conclusions about
for Social Research, University
of Michigan
likely public health outcomes of raising the MLA
Kimberly Thompson for tobacco products. Overall, in the absence of
Professor of Preventive
Medicine and Global Health, transformative changes in the tobacco market,
University of Central Florida
College of Medicine, President, social norms and attitudes, or in the knowledge of
Kid Risk, Inc.
patterns and causes of tobacco use, the committee
is reasonably condent that raising the MLA will
reduce tobacco use initiation, particularly among
adolescents 15 to 17 years of age; improve the health
of Americans across the lifespan; and save lives. F
Maria Roditis
Postdoctoral Research Fellow,
Adolescent Medicine, Division
of Adolescent Medicine,
Department of Pediatrics,
Stanford University
Doris Romero
Financial Associate
Rose Marie Martinez
Senior Board Director, Board
on Population Health and
Public Health Practice
500 Fifth Street, NW
Washington, DC 20001
TEL 202.334.2352
FAX 202.334.1412
www.iom.edu
The Institute of Medicine serves as adviser to the nation to improve health.
Established in 1970 under the charter of the National Academy of Sciences,
the Institute of Medicine provides independent, objective, evidence-based advice
to policy makers, health professionals, the private sector, and the public.
Copyright 2015 by the National Academy of Sciences. All Packet Pg. 155
rights reserved.
 11.c
Tompkins County Legislature Meeting: 03/20/17 04:30 PM
Governor Daniel D. Tompkins Building Department: Health Department
Ithaca, NY 14850 Category: Public Health
Functional Category: Health Related, Local Law
WITHDRAWN

RESOLUTION NO. DOC ID: 6763

1 Authorizing a Public Hearing on Proposed Local Law No. __ of 2017

2 Tobacco 21
3 WHEREAS, Tompkins County has a substantial interest in reducing the number of individuals of all ages who
4 use cigarettes and other tobacco products, and a particular interest in protecting adolescents from tobacco dependence
5 and the illnesses and premature death associated with tobacco use, now therefore be it
6
7 RESOLVED, on recommendation of the Tompkins County Board of Health and the Health and Human
8 Services Committee, That a public hearing be held before the Tompkins County Legislature in Legislative Chambers
9 of the Governor Daniel D. Tompkins Building, 121 East Court Street, Ithaca, New York, on Tuesday, April 18, 2017,
10 at 5:30 oclock in the evening thereof concerning proposed Local Law No. __ of 2017 - Tobacco 21. At such time and
11 place all persons interested in the subject matter will be heard concerning the same,
12
13 RESOLVED, further, That the Clerk of the Board is hereby authorized and directed to place proper notice of
14 such public hearing in the official newspaper of the County.
15 SEQR ACTION: TYPE II-20

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Prepared by: Public Health & Tobacco Policy Center, Boston, Kerry Snyder, ksnyder@tobaccopolicycenter.org

Section 1: Findings

Tompkins County has a substantial interest in reducing the number of individuals of all ages who use
cigarettes and other tobacco products, and a particular interest in protecting adolescents from tobacco
dependence and the illnesses and premature death associated with tobacco use;1

It is the intent of Tompkins County to implement effective measures through this Chapter to reduce
youth access to tobacco products, e-cigarettes and similar aerosol devices, smoking paraphernalia and
shisha.

Section 2: Definitions

Attachment: Tompkins County DRAFT T21 (2) without Findings (6763 : Tobacco 21)
DEPARTMENT means Tompkins County Health Department.

ELECTRONIC NICOTINE DELIVERY SYSTEMS (ENDS) has the same meaning as in 72-6.

LEGAL AGE means age 21 years.

SHISHA means any product made primarily of tobacco or other leaf or herbs, or any combination
thereof, smoked or intended to be smoked in a hookah or water pipe.

SMOKING PARAPHERNALIA means any pipe, water pipe, hookah, rolling papers, or any other device,
equipment or apparatus designed for the inhalation of tobacco or Shisha.

TOBACCO PRODUCT means any product made or derived from tobacco or which contains nicotine
marketed or sold for human consumption, whether consumption occurs through inhalation, or oral or
dermal absorption. Tobacco product does not include drugs, devices, or combination products
authorized for sale by the state or U.S. Food and Drug Administration, as those terms are defined in the
Federal Food, Drug and Cosmetic Act.

TOBACCO RETAILER has the same meaning as in 155-2.

Section 3: Minimum Sales Age Restriction

No person shall sell any Tobacco Product, Electronic Nicotine Delivery System, Shisha or Smoking
Paraphernalia to persons under the Legal Age.

Section 4: Signage

Any person selling tobacco products, liquid nicotine, shisha or electronic cigarettes are sold or offered
for sale shall post in a conspicuous place a sign upon which there shall be imprinted the following
statement, SALE OF CIGARETTES, CIGARS, CHEWING TOBACCO, POWDERED TOBACCO, SHISHA
OR OTHER TOBACCO PRODUCTS, HERBAL CIGARETTES, LIQUID NICOTINE, ELECTRONIC
CIGARETTES, ROLLING PAPERS OR SMOKING PARAPHERNALIA, TO PERSONS UNDER TWENTY-
ONE YEARS OF AGE IS PROHIBITED BY LAW . Such sign shall be printed on a white card in red letters
at least one-half inch in height.

1
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Section 5: Violations and Enforcement

(A) The Department or its authorized designee(s) shall enforce the provisions of this Chapter. The
Department may conduct periodic inspections in order to ensure compliance with this Chapter.

(B) Any person found to be in violation of this Chapter shall be liable for a civil penalty of no less than
$300 but no more than $1,000 for a first violation, and no less than $500 but no more than $1,500 for
each subsequent violation.

(C) Any peace officer or police officer within the County of Tompkins is authorized to enforce this
chapter. The Department is authorized to enforce this chapter in the same manner as a violation of the

Attachment: Tompkins County DRAFT T21 (2) without Findings (6763 : Tobacco 21)
County Sanitary Code.

Section 6: Rules and Regulations

The Department may issue and amend rules, regulations, standards, guidelines, or conditions to
implement and enforce this Chapter.

Section 7: Severability

The provisions of this Chapter are declared to be severable, and if any section of this Chapter is held to
be invalid, such invalidity shall not affect the other provisions of this Chapter that can be given effect
without the invalidated provision.

Section 8: Effective Date

The effective date of this ordinance shall be sixty (60) days from the date of its enactment.

1
Lorillard Tobacco Co. v. Reilly, 533 U.S. 525, 555 (2001); see also Cf. Ian McLaughlin, Tobacco Control Legal Consortium,
License to Kill?: Tobacco Retailer Licensing as an Effective Enforcement Tool 1 (2010), available at
http://publichealthlawcenter.org/sites/default/files/resources/tclc-syn-retailer-2010.pdf.

2
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