Reversing the Youth Tobacco Epidemic Act of 2019

Floor Speech

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Mr. PALLONE. 2339, the Protecting American Lungs and Reversing the Youth Tobacco Epidemic Act of 2019.

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Mr. PALLONE. Madam Speaker, pursuant to House Resolution 866, I call up the bill (H.R. 2339) to amend the Federal Food, Drug, and Cosmetic Act with respect to the sale and marketing of tobacco products, and for other purposes, and ask for its immediate consideration.

The Clerk read the title of the bill.

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Mr. PALLONE. Madam Speaker, I yield myself such time as I may consume.

Madam Speaker, I am pleased to speak in support of H.R. 2339. This bill provides a comprehensive approach to address the youth tobacco epidemic that has unfolded before our eyes in recent years.

The numbers are disturbing. About 6.2 million American middle and high school students used some type of tobacco product last year, and one in every three high school students have used a tobacco product in the last 30 days. These numbers should alarm us all, especially as we have worked so hard and invested so much to ensure the next generation doesn't face the same type of tobacco-related disease and death as those that have preceded them.

It is clear the tobacco industry has employed the same tactics that they have used for decades to hook young people on new versions of their products in order to generate new customers that will be addicted for life. E-cigarette manufacturers like Juul have used slick product designs, glossy advisements, and sweet flavors to appeal to kids. The rapid rise of products like these have reversed the progress we have made in slowing youth tobacco use.

In fact, the Centers for Disease Control and Prevention found that e- cigarette use by high school students has increased by 78 percent between 2017 and 2018. Young people have said that kid-friendly flavors like bubble gum, chocolate, cotton candy, and mango are the driving force behind why they say they began using e-cigarettes in the first place.

There is also evidence that kids perceive flavored tobacco products to be less harmful than nonflavored alternatives. And flavors mask the harshness and flavor of the tobacco, causing young and adult smokers to smoke more, not less.

But e-cigarettes are not the only contributor to the youth tobacco epidemic. Research has shown that menthol-flavored cigarettes have contributed to the increased number of young people smoking. In 2019, nearly half of middle and high school students who were currently smoking used menthol cigarettes.

Congressional action is necessary today because President Trump broke his promise to clear the market of flavored e-cigarettes. The administration's proposal created giant loopholes, leaving a myriad of disposable and open tank e-cigarette systems on the market that continue to attract kids, as well as menthol-flavored products.

While it is important for us to increase the minimum age to purchase tobacco products from age 18 to 21, which we did, the surge in youth tobacco usage cannot be reversed just by increasing the age alone. In order to fully combat this crisis, we need a multipronged approach that tackles all of the reasons and ways that kids are using these products, and H.R. 2339 is the solution that we need.

This bill prohibits all flavors that are so popular among kids. It updates and extends existing marketing and advertising restrictions for combustible tobacco products to all tobacco products, including e- cigarettes. It restricts the purchase of most tobacco products to only face-to-face settings and makes it explicitly unlawful to market, advertise, or promote any e-cigarette product to individuals under the age of 21. It also invests $2 billion in Federal resources in cessation support prevention in medically underserved populations, including racial and ethnic minorities, supplying tobacco cessation therapies and counseling in community health centers, and funding new strategies for cessation of menthol tobacco products.

We are proud to have the support of more than 100 organizations, including the Campaign for Tobacco-Free Kids, the American Lung Association, the American Academy of Pediatrics, the American Heart Association, the American Cancer Society, the NAACP, and the National Medical Association.

Madam Speaker, we have to take decisive action in order to prevent losing the next generation of our kids to a lifetime of nicotine addiction. We have to pass this bill, and I urge all of my colleagues to join us in supporting the legislation.

Madam Speaker, I yield 1 minute to the gentlewoman from New York (Ms. Clarke), the vice chair of our committee.

Ms. CLARKE of New York. Madam Speaker, I thank the gentleman for yielding me time to address this very important issue.

I rise today in the best interests of the American people, the African American community, and my constituents.

I include in the Record this letter from the ACLU about the concerns of H.R. 2339, Reversing the Youth and Tobacco Epidemic Act. February 27, 2020. Re Coalition Concerns with Blanket Prohibition on Menthol and Other Flavored Tobacco within H.R. 2339, Reversing the Youth Tobacco Epidemic Act. Hon. Frank Pallone, Chairman, House Committee on Energy and Commerce, Washington, DC.

The undersigned civil rights and civil liberties organizations write to express concerns with a broad prohibition on menthol and other flavored tobacco products within H.R. 2339, the Reversing the Youth Tobacco Epidemic Act of 2019. While this legislation is a well-intended effort to address health issues associated with tobacco use among youth, we have concerns that a blanket prohibition on menthol and other flavored tobacco products, which will apply to adults, will (1) disproportionately impact people and communities of color; (2) trigger criminal penalties, prioritizing criminalization over public health and harm reduction; and (3) instigate unconstitutional policing and other negative interactions with local law enforcement. I. H.R. 2339 Disproportionately Impacts People and Communities of Color

Of adults, approximately 80 percent of Blacks and 35 percent of Latinx who choose to smoke prefer menthol cigarettes. Thus, any ban on menthol cigarettes will disproportionately affect people of color. While H.R. 2339 and similar legislation are often motivated by the desire to decrease and eliminate smoking among certain populations, Blacks and other people of color should not disproportionately bear the brunt of enforcement of such prohibitions, which a menthol ban would ensure.

Similarly, enforcement of a ban on flavored cigars will also disproportionally impact people of color given cigar preferences. Black adults are 60% of cigarillo and nonpremium cigar smokers, with these products often flavored. Additionally, at Committee markup, H.R. 2339 was amended to exempt certain traditional, expensive cigars from a prohibition of online tobacco sales. There is no justification for differentiating a La Palina from a Black and Mild. Making this distinction undermines the public health arguments made for this bill and suggests that some tobacco preferences, within certain communities, will be prioritized and protected over others. II. H.R. 2339 Increases Criminal Penalties Over Public Health

H.R. 2339 prohibits menthol and other flavored tobacco products under the Food, Drug, and Cosmetic Act (FD&C Act). This prohibition criminalizes the manufacturing, importing, distributing, or selling of menthol and other flavored tobacco products under the FD&C Act, imposing up to three years of imprisonment. Violating a menthol and flavored tobacco ban would implicate other federal criminal penalties as well. For example, the Federal Cigarette Contraband Trafficking Act would be implicated, allowing up to five years of imprisonment.

With a criminal legal system that incarcerates Blacks at nearly six times the rate of white Americans and a prison population that is 67 percent Black and Latinx, any prohibition on menthol and flavored tobacco products promises continued overcriminalization and mass incarceration of people of color. A ban on menthol and flavored tobacco products could reintroduce many of the harms imposed by the failed war on drugs as lawmakers work to legalize cannabis and take a public health approach to opioids. A bill criminalizing tobacco is contrary to those efforts. Righting the wrongs of earlier failed drug policy requires consideration of the unintended consequences of well- intentioned policies, especially on the most vulnerable communities. It also requires us to remember that harm reduction, including education and counseling, are what work to reduce usage and harm in our society, not prohibition. III. H.R. 2339 Encourages Harmful Police Practices

Recent history shows us that drug prohibitions and bans increase negative interactions between law enforcement and people of color. The New York Police Department's (NYPD) stop and frisk program resulted in nearly 700,000 stops in 2011, with drugs serving as the alleged pretext for most of those stops. Ninety percent of those stops were of Black and Latinx people. We are concerned that law enforcement's attempts to enforce a menthol and flavored tobacco ban will undoubtedly lead to fines, arrests, and eventual incarceration for those who continue to use and sell menthol and flavored tobacco products. While the legislation was amended at Committee to try to minimize law enforcement practices here, it only applies in the context of federal enforcement of the FD&C Act; it does not govern local enforcement around any state and city prohibition policies that will follow.

The death of Eric Garner in 2014 generated national attention not only for the brutality he experienced at the hands of NYPD police, but for the reason that led to the encounter with law enforcement. Mr. Garner died from an illegal chokehold having been stopped by police for selling single cigarettes in violation of state law. Gwendolyn Carr, Eric Garner's mother, cautions: ``When you ban a product sold mostly in Black communities, you must consider the reality of what will happen to that very same overrepresented community in the criminal justice system.'' With a federal prohibition on menthol and flavored tobacco products, states will develop their own prohibition and enforcement policies that could result in harmful police practices like that witnessed with Mr. Garner.

Based on our concerns, we urge you to not impose a blanket ban on menthol and related tobacco products. A prohibition on all menthol and flavored tobacco products will not achieve a public heath goal of reducing smoking among Black people, young people, or others. We hope we can work together to avoid repetitions of policies that are intended to protect youth and communities of color, but instead only further engrain systemic criminalization and racism. Sincerely,

American Civil Liberties Union, Center for Popular Democracy, Drug Policy Alliance, Friends Committee on National Legislation, Law Enforcement Action Partnership, National Action Network, National Association of Criminal Defense Lawyers.

Ms. CLARKE of New York. While it is indeed a health imperative to reduce and eliminate the use of tobacco products in our society, I would like to recognize the inequity, potential harm, and unintended consequences of a ban on menthol combustible products within the Reversing the Youth Tobacco Epidemic Act.

This bill's purpose is to curb youth tobacco usage by banning flavored tobacco products, more specifically ending the scourge of youth vaping in our Nation and the flavored products used to attract young people to its use.

However, this legislation has dire, unintended consequences for African American users, the overwhelming majority of which are over the age of 21.

It does not treat all flavored tobacco products equally, exempting premium cigars preferred by White smokers, yet banning menthol cigarettes. Menthol is the preferred flavor of African American tobacco users, used by 90 percent of Black tobacco users.

While I would love to assume the best intentions of all parties of this legislation and hope for the best in regard to law enforcement, lived experiences demand caution.

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Mr. PALLONE. Madam Speaker, I yield an additional 30 seconds to the gentlewoman.

Ms. CLARKE of New York. Madam Speaker, as a result of this asymmetric ban, law enforcement would have an additional reason to stop and frisk menthol tobacco users because menthol would be considered illegal under this ban.

Having said that, I cannot support H.R. 2339 due to the potentially dire consequences that would create additional stop and frisk opportunities of African Americans and the constituents I took an oath to protect.

I really believe that this is a health imperative, and if that is the case, the ban should be on all tobacco products and would be the best answer. Unfortunately, this bill does not do that.

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Mr. PALLONE. Madam Speaker, I yield 1 minute to the gentlewoman from Minnesota (Ms. Craig).

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Mr. PALLONE. Madam Speaker, I yield 2 minutes to the gentlewoman from Illinois (Ms. Schakowsky), who chairs our Consumer Protection and Commerce Subcommittee.

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Mr. PALLONE. Madam Speaker, I want to say that Ms. Pelosi has been so much out front on trying to move this bill and always thinks of herself as a mom or, as she says, a grandmother first, and that is why she so cares about the children.

Madam Speaker, I yield 1 minute to the gentlewoman from California (Ms. Pelosi), our Speaker.

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Mr. PALLONE. Madam Speaker, I yield 2 minutes to the gentleman from California (Mr. Ruiz), a member of our committee.

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Mr. PALLONE. Madam Speaker, I yield the gentleman from California an additional 1 minute.

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Mr. PALLONE. Madam Speaker, I yield 2\1/2\ minutes to the gentlewoman from California (Ms. Eshoo), who chairs our Health Subcommittee.

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Mr. PALLONE. Madam Speaker, I yield the gentlewoman from California an additional 30 seconds.

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Mr. PALLONE. Madam Speaker, I yield 2 minutes to the gentleman from Illinois (Mr. Rush), who is the chairman of our Energy Subcommittee.

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Mr. PALLONE. Madam Speaker, I yield 1 minute to the gentlewoman from Illinois (Ms. Kelly), who is a member of our committee.

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Mr. PALLONE. Madam Speaker, I yield 1 minute to the gentlewoman from Florida (Ms. Wasserman Schultz).

Ms. WASSERMAN SCHULTZ. Madam Speaker, today we finally comprehensively address America's resurgent youth nicotine epidemic.

In 2019 more than 5.3 million middle and high school students used e- cigarettes, double the number who reported vaping just 2 years before. It is no surprise when flavors like gummy bear and cotton candy are used to lure children to e-cigarettes. And the aggressive digital marketing aimed at minors, like the campaigns Juul admitted to running, obviously work.

But this Republican administration failed to holistically address this issue. Worse, they caved to Big Tobacco by embracing a woefully inadequate flavor ban. So this bill does just what this administration refused to; it bans flavors and proactively combats this epidemic.

I am grateful to Chairman Pallone for including language from my legislation, the PROTECT Act, that directs the CDC to implement a successful--like the anti-tobacco youth campaign was--youth anti-vaping education and prevention campaign. That is vital because if a child never starts vaping, we keep them off this perilous path to nicotine addiction.

Madam Speaker, I urge a ``yes'' vote on this bill to stand up to Big Tobacco and to protect the health of young people.

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Mr. PALLONE. Madam Speaker, may I inquire about the amount of time remaining on both sides.

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Mr. PALLONE. Madam Speaker, I yield 1 minute to the gentlewoman from Texas (Ms. Jackson Lee).

Ms. JACKSON LEE. Madam Speaker, I am not here to target people of color. I am here to save lives.

I support this legislation because it closes an effective tax loophole for e-cigarettes and taxes them just accordingly as tobacco.

It prohibits the manufacture of flavored tobacco and, more importantly, actually prohibits companies from marketing or promoting e-cigarettes to youth under the age of 21. That is an important element.

It makes sure that the grants that are gotten from those dollars are utilized for outreach and education, for evidence-based smoking- cessation programs. It awards grants to make tobacco-cessation therapies and counseling available to community health centers.

We have to save lives. People of color die disproportionately through tobacco products, including these flavored cigarettes.

The NAACP says flavored cigarettes, e-cigarettes, have driven the youth epidemic and more than half of youth smokers. Organizations like the National Black Nurses Association, African American Tobacco Control Leadership Council, Black Women's Health Imperative, and National Hispanic Medical Association all support this.

Madam Speaker, I am here to save lives. That is why I am supporting this legislation.

Madam Speaker, I rise in support of H.R. 2339, the ``Protecting American Lungs and Reversing Youth Tobacco Epidemic Act.''

I support this important lifesaving and life-extending legislation because it:

1. Closes a tax loophole for e-cigarettes by establishing tax parity with current tobacco taxes, which is a highly effective way to reduce youth smoking.

2. Prohibits the manufacture and sale of all flavored tobacco products, including menthol cigarettes, within one year, and removes all flavored e-cigarettes from the market within 30 days.

3. Prohibits companies from marketing or promoting e-cigarettes to youth under age 21.

4. Directs the Food and Drug Administration (FDA) to prohibit non- face-to-face (online) sales of most tobacco products, including e- cigarettes, thereby blocking a key path for high schoolers to obtain tobacco products, many of which are sold online with limited or no age verification requirements.

5. Provides FDA with the authority to collect user fees from all classes of tobacco products, including e-cigarettes, and increases the annual user fees collected for tobacco products by $100 million.

6. Requires the Federal Trade Commission to issue an annual report to Congress on the domestic sales, advertising, and promotional activities of cigarette, cigar, smokeless tobacco, and e-cigarette manufacturers.

7. Invests in grants for outreach and education for evidence-based smoking cessation programs for individuals in medically underserved communities, including racial and ethnic minorities.

8. Awards grants to make tobacco cessation therapies and counseling available at Community Health Centers.

This critical legislation provides a comprehensive approach to address the youth tobacco epidemic, which has surged in recent years with the introduction of such new tobacco products as e-cigarettes.

I support H.R. 2339 because it will help prevent the loss of an entirely new generation to a lifetime of nicotine addiction.

Madam Speaker, one of the most effective ways to reduce youth use of a tobacco product is to increase taxes on that product.

This legislation closes the tax loophole for e-cigarettes by establishing tax parity with current tobacco taxes--significantly increasing the cost of e-cigarettes.

Currently, there is no federal excise tax on the nicotine contained in e-cigarettes, which could result, for example, in up to a 75 percent increase in the cost of some brands of e-cigarettes.

As the Campaign for Tobacco-Free Kids points out, ``The Surgeon General has called raising prices on cigarettes `one of the most effective tobacco control interventions.'

The tobacco industry has targeted kids through social media advertisements, glossy marketing campaigns, and other kid-friendly platforms.

Banning the marketing and promotion of e-cigarettes to young people will have a salutary effect because about 95 percent of adult smokers start before age 21 and young people who do not begin smoking by their early 20s are unlikely to ever start.

The legislation also includes numerous other provisions to address the youth tobacco epidemic, including prohibiting the manufacturer and sale of all flavored tobacco products, prohibiting companies from marketing or promoting e-cigarettes to youth under age 21, and directing the FDA to prohibit non-face-to-face (online) sales of most tobacco products, including e-cigarettes.

Madam Speaker, it is gratifying to know that this legislation is supported by nearly 100 groups, including the Campaign for Tobacco-Free Kids, American Lung Association, American Heart Association, American Cancer Society Cancer Action Network, American Academy of Pediatrics, African American Tobacco Control Leadership Council, Black Women's Health Imperative, National Black Nurses Association, National Hispanic Medical Association, Catholic Health Association of the United States, American Public Health Association, National Education Association, Parents Against Vaping e-cigarettes (PAVe), First Focus, Children's Defense Fund, and American College of Physicians.

In support this legislation, the NAACP, the nation's oldest civil rights organization, has stated that: ``Flavored e-cigarettes have driven the youth epidemic, and more than half of youth smokers-- including seven out of ten African American youth smokers--smoke menthol cigarettes, so it's time to take these products off the market once and for all.''

Madam Speaker, over the last few years, the use of e-cigarettes has skyrocketed among American middle school and high school students.

More than 5.3 million middle school and high school students used e- cigarettes in 2019, an alarming increase of more than 3 million in two years.

The recent dramatic rise in the number of middle and high school students using e-cigarettes has reversed the progress that had been made in previous years in the use of tobacco by kids and teenagers.

The U.S. Surgeon General has labeled the skyrocketing growth in youth use of e-cigarettes an ``epidemic.''

The Surgeon General has also concluded that youth use of nicotine in any form, including e-cigarettes, is unsafe, causes addiction, and can harm brain development, which impacts attention, memory, and learning.

The Surgeon General also found that using nicotine in adolescence increases the risk of future addiction to other drugs.

E-cigarettes have very high levels of nicotine, placing young people at significant risk for developing nicotine addiction.

Studies have shown that one brand of e-cigarette cartridge can contain as much nicotine as a full pack of traditional cigarettes.

In 2009, Congress enacted a federal law prohibiting the manufacture and sale of traditional cigarettes that had flavors (other than the flavors of menthol or tobacco), since the tobacco industry had begun targeting young people by offering flavored cigarettes, including candy and fruit flavors.

However, that 2009 flavor prohibition has not applied to tobacco products other than traditional cigarettes.

Now, the legislation being considered this week would broaden that 2009 prohibition--blocking the manufacture and sale of all flavored tobacco products, including e-cigarettes and menthol cigarettes.

In recent years, tobacco companies have significantly stepped up the introduction and marketing of flavored tobacco products, especially e- cigarettes, with more than 15,000 flavors now available on the market.

The widespread availability and appeal of kid-friendly flavors has significantly contributed to the rapid rise in e-cigarette use by young people--with the tobacco industry targeting and addicting kids with enticing flavors such as gummy bear and cotton candy.

Flavors mask the harsh taste of tobacco and make it easier for kids to start to use a tobacco product and to become addicted.

More than 9 out 10 young persons using e-cigarettes use flavored the e-cigarettes, with 7 out of 10 current youth e-cigarette users saying they used them ``because they come in flavors I like.''

The bill's prohibition on menthol cigarettes will also help protect kids.

More than half of youth smokers--and seven in ten African American youth smokers--smoke menthol cigarettes.

A 2013 FDA analysis concluded that menthol cigarettes soothe the harshness of tobacco, increase youth initiation, increase nicotine addiction, and make it harder for smokers to quit.

Madam Speaker, the National Medical Association, the voice of America's African American physicians, supports this legislation, stating:

As the collective voice of African American physicians, we know that banning menthol cigarettes will save lives in our community. Smoking-related illnesses are the number one cause of death in the African American community and approximately 45,000 African Americans die each year from smoking-related diseases. Further, more than 85 percent of African American smokers use menthols cigarettes. . . . For years, the tobacco industry has aggressively promoted menthol cigarettes and other flavored tobacco products in African American communities. Taking action to ban menthol cigarettes is long overdue and the NMA requests that Congress move swiftly to take up this bill and save lives.

Madam Speaker, I do not agree with opponents of the legislation who assert that because 85% of African American smokers use menthol products, that it would disproportionally harm communities of color.

H.R. 2339 is not intended to disproportionately impact people and communities of color; instead it treats all tobacco products the same by prohibiting flavoring in all tobacco products.

Further, the legislation prohibits the sale, but not the possession, of the banned products and expressly prohibits law enforcement from using abusive practices, such as stop and frisk, to enforce the ban.

In 2009, President Obama signed into law the Family Smoking Prevention and Tobacco Control Act which prohibited all flavored cigarettes, other than menthol, after the tobacco industry used these products to target kids.

H.R. 2339 merely extends the same enforcement authorities enacted under the Tobacco Control Act to prohibit all flavored tobacco products and ensure that the tobacco industry is no longer manufacturing or importing any flavored products.

Finally, instead of imposing criminal penalties, should the U.S. Food and Drug Administration find a manufacturer or retailer in violation of the law, the FDA most commonly utilizes warning letters, no-tobacco sale orders, and civil monetary penalties.

Thus, it is simply untrue that H.R. 2339 increases criminal penalties or ``criminalizes tobacco.''

Before concluding, it is noteworthy that H.R. 2339 makes critical investments to medically underserved communities to enhance smoking cessation, particularly among racial and ethnic minority populations.

In order to ensure there are necessary resources for current smokers to quit and transition off flavored tobacco products, the bill provides significant resources to Community Health Centers to provide for the availability of counseling and tobacco cessation therapies, as well as other grant programs to enhance the availability of smoking cessation, in particular for menthol products, in medically underserved communities.

In sum, H.R. 2339 will help ensure the tobacco industry can no longer target minority communities to the detriment of public health.

I strongly support this legislation and urge all Members to join me in voting for its passage.
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Mr. PALLONE. Madam Speaker, I yield myself the balance of my time.

Madam Speaker, I respect the ranking member, but I have to say this: The notion that somehow the Trump administration is doing anything significant to deal with this youth vaping epidemic or tobacco epidemic is simply not the case. They are weak-kneed proposals that are not going to do anything significant.

The problem that we have and what this bill is trying to address is this: The tobacco companies know that vaping or e-cigarettes are basically exempted from most of the restrictions that exist now for regular cigarettes. So what do they do? They go and advertise these products on TV. They try to convince young people and adults that vaping and e-cigarettes are a cessation device, which is simply not true.

The CDC says they are not cessation devices. They hook people; they addict people; they contain large amounts of nicotine.

The flavors that they promote--whether it be menthol, mango, whatever it is--make the kids and adults think that these are not tobacco products or that these are not products that contain nicotine.

Then what do the kids do? Sure, we have legislation now, a statute that says you can't sell these products to kids under 21, but they go online. They buy them online. They don't need an ID for that. Or they get some adult to go to the store and buy the e-cigarettes or cigarettes for them.

So, we need this legislation. We need to say that e-cigarettes are deemed a tobacco product. They come under the same restrictions for advertising and warnings as regular cigarettes. We need to ban online sales so that kids cannot go online and buy these things without having an ID. We need to ban flavors across-the-board because that is what masks the nicotine and makes people think it is okay, that somehow these are cessation devices, or even that if you smoke a menthol or mango cigarette, somehow that does not contain nicotine and does not become addictive.

Madam Speaker, I urge my colleagues to please vote for this legislation. Vote for the kids. It is that important.

Madam Speaker, I yield back the balance of my time. Request to Add Cosponsors to H.R. 2339
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Mr. PALLONE. Madam Speaker, I want to thank my colleague from New York for yielding me this time.

Madam Speaker, I include in the Record the following letters of support for H.R. 2339:

First, a letter from 76 leading public health organizations; second, a letter from the NAACP; third, a letter from the National Medical Association; and fourth, a letter from public health organizations specifically supporting the menthol prohibition. February 4, 2020. House of Representatives, Washington, DC.

Dear Representative: We are writing to express our strong support for H.R. 2339, the Reversing the Youth Tobacco Epidemic Act of 2019. This legislation will address the current youth e-cigarette epidemic that is undermining the progress made in reducing youth tobacco use.

Use of e-cigarettes by youth has escalated rapidly in recent years, placing a new generation at risk of nicotine addiction and tobacco use. Between 2017 and 2019, e-cigarette use more than doubled among high school students (from 11.7% to 27.5%) and tripled among middle school students (from 3.3% to 10.5%). More than 5.3 million middle and high school students used e-cigarettes in 2019, an alarming increase of more than 3 million in two years. Use of other tobacco products, including cigarettes, cigars and hookah, is also a serious problem. Tobacco use remains the leading preventable cause of death in the United States and is responsible for approximately $170 billion in health care costs each year.

The Reversing the Youth Tobacco Epidemic Act provides a much-needed response to this serious public health problem. Its prohibition on flavored tobacco products, including flavored e-cigarettes, flavored cigars, and menthol cigarettes, is needed to stop tobacco companies from targeting and addicting kids with enticing flavors, such as gummy bear and cotton candy. Flavors mask the harsh taste of tobacco and make it easier for kids to start to use a tobacco product and to become addicted.

The bill's prohibition on flavored e-cigarettes is all the more important because the Administration's recently released policy on flavored e-cigarettes will leave thousands of flavored e-liquids and devices on the market. Flavors are a key reason for widespread youth use of e-cigarettes. Ninety- seven percent of current youth e-cigarette users have used a flavored e-cigarette in the past month, and seven out of ten said they used e-cigarettes ``because they come in flavors I like.''

The bill's prohibition on menthol cigarettes, flavored cigars, and other flavored tobacco products will also help protect kids and public health. More than half of youth smokers--and seven in ten African American youth smokers-- smoke menthol cigarettes. As a result of decades of pervasive tobacco industry marketing, 85 percent of African-American smokers smoke menthol cigarettes, and menthol is a likely contributor to the higher rates of tobacco-caused death and disease experienced by African Americans. A 2013 Food and Drug Administration (FDA) analysis concluded that menthol cigarettes increase youth initiation, increase nicotine addiction, and make it harder for smokers to quit. Cigars are also available in a wide variety of flavors that make them more attractive to kids. More than one million high school students smoke cigars.

In addition to its prohibition on flavored tobacco products, the Reversing the Youth Tobacco Epidemic Act includes a number of other provisions that will help to reduce youth use of e-cigarettes and use of other tobacco products, including prohibiting online sales of most tobacco products, addressing inappropriate marketing and advertising, and ensuring that FDA will promptly implement the graphic health warnings on cigarette packs and advertising that are required under the 2009 Tobacco Control Act.

Youth use of e-cigarettes and other tobacco products is a problem that will not resolve itself. It will require action by Congress. The Reversing the Youth Tobacco Epidemic Act provides the comprehensive response that is needed. We urge you to support this important legislation when it comes to the House floor. Sincerely,

AASA, The School Superintendents Association; Academy of General Dentistry; Action on Smoking & Health; African American Tobacco Control Leadership Council; American Academy of Oral and Maxillofacial Pathology; American Academy of Oral and Maxillofacial Radiology; American Academy of Otolaryngology-Head and Neck Surgery; American Academy of Pediatrics; American Association for Cancer Research.

American Association for Dental Research; American Association for Respiratory Care; American Cancer Society Cancer Action Network; American College Health Association; American College of Cardiology; American College of Occupational and Environmental Medicine; American Dental Association; American Federation of School Administrators; American Federation of Teachers; American Heart Association.

American Lung Association; American Medical Association; American Public Health Association; American School Counselor Association; American School Health Association (ASHA); American Society of Addiction Medicine; American Thoracic Society; Americans for Nonsmokers' Rights; Association of Educational Service Agencies; Association of Maternal & Child Health Programs.

Association of School Business Officials International; Association of Schools and Programs of Public Health; Association of State and Territorial Health Officials (ASTHO); Association of Women's Health, Obstetric and Neonatal Nurses; Asthma and Allergy Foundation of America; Big Cities Health Coalition; Campaign for Tobacco-Free Kids; Catholic Health Association of the United States; Children's Wisconsin; ClearWay Minnesota.

Common Sense Media; Community Anti-Drug Coalitions of America's (CADCA); Eta Sigma Gamma--National Health Education Honorary; First Focus Campaign for Children; International Association for the Study of Lung Cancer; March of Dimes; Mesothelioma Applied Research Foundation; NAACP; National African American Tobacco Prevention Network; National Association of County and City Health Officials.

National Association of Elementary School Principals; National Association of Pediatric Nurse Practitioners; National Association of School Nurses; National Association of Secondary School Principals; National Association of Social Workers; National Black Nurses Association; National Center for Health Research; National Coalition for Cancer Survivorship; National Education Association; National Hispanic Medical Association.

National Medical Association; National Network of Public Health Institutes; National Rural Education Advocacy Collaborative; National Rural Education Association; Oncology Nursing Society; Parents Against Vaping e-cigarettes (PAVe); Prevent Cancer Foundation.

Public Health Solutions; SHAPE America; Society for Cardiovascular Angiography and Interventions; Society for Public Health Education; Students Against Destructive Decisions; The Society of State Leaders of Health and Physical Education; The Society of Thoracic Surgeons; Trinity Health; Trust for America's Health; U.S. PIRG. ____ NAACP, Washington Bureau, Washington, DC, October 16, 2019. Re NAACP Support for H.R. 2339, the ``Reversing the Youth Tobacco Epidemic Act of 2019''. Hon. Frank Pallone, Chairman, Committee on Energy and Commerce, House of Representatives, Washington, DC.

Dear Chairman Pallone: On behalf of the NAACP, our nation's oldest, largest and most widely-recognized grassroots-based civil rights organization, I would like to thank you for your leadership in introducing H.R. 2339, the ``Reversing the Youth Tobacco Epidemic Act of 2019.'' Nearly all tobacco use begins during youth and young adulthood--which is a crucial period for the development of the human brain. Your legislation would help put a stop to tobacco use by including a ban on all characterizing flavors of tobacco products, which are often created to appeal to the younger market.

As was noted in our 2016 NAACP resolution, ``Support State and Local Restrictions on the Sale of Flavored Tobacco Products,'' ``the tobacco industry has a well-documented history of developing and marketing brands targeted to African Americans and their youth'' and further that ``the tobacco industry manipulated the manufacturing of cigarettes to ensure the uptake and continued use of tobacco, especially by AfricanAmerican young people and other vulnerable populations for many years.'' Your legislation makes clear that the proliferation of slick new products purposefully designed to appeal to young people to get them addicted to nicotine and tobacco should not, and will not, be tolerated.

The use of tobacco and nicotine has evolved since that first Surgeon General's report. A quick Google search will lead you to an array of products online, including cigarettes, cigars, smoking pipes, and the most recent addition--e-cigarettes. These e-cigarettes are now available in many flavors and studies show that flavor choices like mint, candy, fruit, or chocolate draw the interest of teens in middle school and high school. Unfortunately, while combustible cigarette use among teens has declined over the past two decades, there is a widespread--and false-- perception that e-cigarettes are safe.

This false belief threatens any progress we have made in combatting this controllable public health threat. Recent data shows that over 3.6 million youth used e-cigarettes in 2018, making this product the most commonly used tobacco product on the market.

Flavored e-cigarettes have driven the youth epidemic, and more than half of youth smokers--including seven out of ten African-American youth smokers--smoke menthol cigarettes, so it's time to take these products off the market once and for all. States and cities are standing up and taking action, and we believe our federal government should do the same.

Thank you again for your leadership on this important issue, and for your concern for the health and well-being of future generations. Sincerely, Hilary O. Shelton,

Director, NAACP Washington Bureau & Senior Vice President for Policy and Advocacy. ____ National Medical Association, Silver Spring, MD, April 16, 2019.

NMA Applauds the Introduction of Legislation to Ban the Sale of All Flavored Tobacco Products, including Menthol Cigarettes and Flavored Cigars

The National Medical Association strongly supports the Reversing the Youth Tobacco Epidemic Act of 2019 legislation introduced today. This would prohibit the sale of all flavored tobacco products, including menthol cigarettes and flavored cigars. We applaud Representative Frank Pallone (D- NJ) for introducing the bill and taking this important step forward.

As the collective voice of African-American physicians, we know that banning menthol cigarettes will save lives in our community. Smoking-related illnesses are the number one cause of death in the African-American community and approximately 45,000 African Americans die each year from smoking-related diseases. Further, more than 85 percent of African-American smokers use menthol cigarettes. According to a 2013 report by the U.S. Food and Drug Administration (FDA), when compared to non-mentholated cigarette use, the ``cooling and anesthetic properties'' of mentholated cigarette use increases smoking initiation and the likelihood of becoming addicted in children and adults and decreases success in quitting smoking.

As reported by the Surgeon General in a 1994 report by the U.S. Department of Health and Human Services, 90 percent of smokers first started smoking by age 18. Also, as reported by B. K. Ambrose in a 2015 article of The Journal of the American Medical Association (JAMA), a majority of the youth ages 12-17 first tried flavored tobacco products and that flavoring was the leading reason for their tobacco use.

For years the tobacco industry has aggressively promoted menthol cigarettes and other flavored tobacco products in African-American communities. Taking action to ban menthol cigarettes is long overdue and the NMA requests that Congress move swiftly to take up this bill and save lives. To that end, increased funding should be earmarked to increase smoking-cessation initiatives and increased promotion of same in African American communities. Our support of this legislation is for the betterment of the public health.

The National Medical Association is the collective voice of African American physicians and the leading force for parity and justice in medicine. The NMA is the oldest organization of African American professionals in America representing the over 50,000 African American physicians and the patients we serve in the United States and its territories. Niva Lubin-Johnson, M.D., FACP, President. ____ October 16, 2019. Hon. Frank Pallone, Chairman, Committee on Energy & Commerce, House of Representatives, Washington, DC. Hon. Greg Walden, Ranking Member, Committee on Energy & Commerce, House of Representatives, Washington, DC.

Dear Chairman Pallone and Ranking Member Walden: We write in support of prohibiting menthol cigarettes, which is a key part of the Reversing the Youth Tobacco Epidemic Act (H.R. 2339). There is overwhelming scientific evidence that menthol cigarettes have had a profound adverse effect on public health. Removing them from the market would drive down tobacco use and the death and disease it causes, particularly among youth and African Americans.

Menthol cigarettes are popular with youth. Over half of youth smokers--and seven in ten African American youth smokers--smoke menthol cigarettes. Menthol cools and numbs the throat and reduces the harshness of tobacco, making it easier and more appealing for youth to start smoking. In 2013, the U.S. Food and Drug Administration (FDA) released a report finding that menthol cigarettes lead to increased smoking initiation among youth and young adults, greater addiction, and decreased success in quitting smoking. An FDA scientific advisory committee concluded, ``Removal of menthol cigarettes from the marketplace would benefit public health in the United States.''

Smoking-related illnesses are the number-one cause of death in the African American community and claim the lives of approximately 45,000 African Americans each year. Menthol cigarettes are a major reason why. Eighty-five percent of all African American smokers smoke menthol cigarettes, which is a direct result of a decades-long marketing campaign by the tobacco industry aimed at the African American community. African Americans generally have higher levels of nicotine dependence as a consequence of their preference for mentholated cigarettes.

Estimates of the harm menthol cigarettes cause to African Americans are alarming. The FDA advisory committee found that the marketing and availability of menthol cigarettes increases the overall prevalence of smoking and reduces smoking cessation among African Americans. In 2011, it estimated that by 2020, 4,700 excess deaths in the African- American community will be attributable to menthol cigarettes, and over 460,000 African Americans will have started smoking because of menthol cigarettes.

Our organizations fully support the menthol prohibition in the Reversing the Youth Tobacco Epidemic Act. It will protect public health and save lives. We look forward to working with you to advance this bill. Sincerely,

Action on Smoking & Health, African American Tobacco Control Leadership Council, American Academy of Oral and Maxillofacial Pathology, American Academy of Pediatrics, American Association for Dental Research, American Association for Respiratory Care, American Cancer Society Cancer Action Network, American College of Physicians, American College of Preventive Medicine, American Dental Education Association, American Heart Association.

American Lung Association, American Medical Association, American Public Health Association, American Society of Addiction Medicine, American Society of Clinical Oncology, American Thoracic Society, Americans for Nonsmokers' Rights, Association of Schools and Programs of Public Health, Association of Women's Health, Obstetric and Neonatal Nurses, Big Cities Health Coalition, Black Lives/ Black Lungs, Campaign for Tobacco-Free Kids, CATCH Global Foundation, Inc.

Catholic Health Association of the United States, Clearway Minnesota, Community Anti-Drug Coalitions of America, Counter Tools, Eta Sigma Gamma--National Health Education Honorary, LUNGevity Foundation, March of Dimes, National African American Tobacco Prevention Network, National Association of County & City Health Officials.

National Association of Pediatric Nurse, Practitioners, National Association of School Nurses, National Center for Health Research, National Medical Association, National Network of Public Health Institutes, Oncology Nursing Society, Prevent Cancer Foundation, Respiratory Health Association, Society for Public Health Education, Society for Research on Nicotine & Tobacco, Students Against Destructive Decisions.

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Mr. PALLONE. Madam Speaker, supporters have emphasized that this bill is urgently needed to combat the youth e-cigarette epidemic that is getting worse every day and is being driven by flavored products. I am proud of the broad coalition of support that this legislation has engendered, and I agree with these organizations that the time is now to ensure we protect our kids and the next generation.

Madam Speaker, if we don't pass this bill today, all of the gains we have made in the past to prevent tobacco use and nicotine addiction will simply be wiped out--will be wiped out.

I urge my colleagues, support this legislation. This is the best thing we can do to prevent this youth epidemic.

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