hello oh I was just going to get you [Music] some so I'm seeing people um Hello everybody we're we've started the recording of some people showed up in the waiting room that need to be panelists who are board of health
members so we're getting people into the right places so just give us a moment um Maheen if you can promote board members from the waiting room and then everyone else can just hang out there for now and yeah there's Risha we have Jack
okay okay we have everybody we're missing Betsy but we knew she wouldn't attend so um so we have all our board members we have lots of folks in the waiting room who appear to want to make public comment we'll get to that in a minute i'm going to turn it to you Risha to open the meeting
great nice to see everyone uh so I will officially open the meeting of April 3rd at 5:02 p.m um I just have to say everyone who's in attendance so myself Risha Jack Dia and Premla are all here
as board members and joined by Kiko and Mahin and as we said Betsy is not joining us tonight so with that uh we can move into the agenda um the first order of
business is to review the minutes from the last meeting um did anyone have any concerns or suggestions to improve those and if not does someone want to move to uh
approve March's minutes i'll move Jack so moved a second seconded Dia and all those in favor i i see everyone's hands so that's
everyone is uh Maheen are are you the one that does does the minutes they're very good they're not they're not you know verbatim which is great but they're very they're very well done so
we're lucky to have you well we it is good to have Mahen and I do want to give credit where credit is due it's Nancy Schroeder who does the minutes okay she was she was at the meeting with us in person in March and so she took notes and did the minutes she also does a great job you know working the the
recorded meeting as this one will be um and then Maheen does editing and puts it all together so we we have a good team but thank you for that feedback um Kiko did you want to talk about the agenda change yeah so we do have a slight uh change to the agenda um we have a um a subject matter expert that
we've invited to talk with the board about some questions that folks had regarding nicotine pouches and she needs to leave as soon as possible so we're going to take some time for public comment and then we will move into the tobacco regulations uh portion of the old business and do the body art second
um so that's the slight agenda change um so I'll turn it so I think we can start then with public comment we do have a fair number of people in the waiting room if you want to make comment please do raise your virtual hand i see a couple of hands going up okay um and
then I'm going to call on people in order of the hands that are going up and we really do need to limit people to maximum of three minutes i am going to cut you off at three minutes um so if you can be shorter than that great if not three minutes is the max um so I'm
going to go ahead and start with Ken who has raised his hand first ken I'm going to allow you to talk hello there yep go ahead don't have the video but anyway um so I'm back again um I I spoke
um extensively a couple of times to the board in support of nicotine free generation so I just uh not going to bore you with repeating that but I do want to say that um it's really um exciting considering that um our
national economy is tanking and the virtual destruction of public health at a national level that we can here in Massachusetts as we did with the Belchtown Board of Health and the Pelum Board of Health and a dozen more than a
dozen other communities um to bring uh to show the public that we are effectively doing something in support of public health uh there are now uh over half a million residents of
Massachusetts who live in nicotine free generation uh municipalities and it shows that it's really a growing movement and I'm really optimistic it's going to go forward and it's a very easy thing um for any board
to do we just go ahead and vote it doesn't cost any money and um so thank you once again uh Ken I forgot to ask you to say your name and where you're from okay it's Kenstein uh Belchtown Board of Health
thank you thank you okay um next up is Mark Gotautle hi good evening uh it's nice to join you again i'll be very brief and in fact um Ken um made some of the points I was going to make i was here uh back in
January when we first discussed the nicotine-free generation uh policy and you know I the major thing that happened since then is that the city of Somerville adopted it um city of 80,000 um and we're very optimistic that a
number of other communities will also go that direction and take this on i just wanted to um uh um remind everyone that I did send some copies of the uh nicotine free generation policy guide uh
to Kiko back in I think early February and um some markups of uh of the reggg section 5C1 and 5C4 that just need a few little tweaks in order to implement this it's easy peasy um and uh did I say I'm
Mark Gotautle from the Public Health Advocacy Institute in Boston i I certainly meant to and yeah with the absolute devastation in terms of our federal public health infrastructure particularly around tobacco policy with the elimination of all the staff from
the CDC's office on smoking and health and the center for the FDA center for tobacco products um you know local and state action are absolutely necessary to save lives and make for healthier healthier communities particularly when
we have so many young people in these in a a a a a area that's rich with young college students as Amherst is so I I hope you will consider uh moving forward with this initiative thank you
thank you Mark and thank you also for identifying yourself um and then I'm going to allow Peter Brennan to talk and Peter if you would please identify yourself before you begin speaking thank you you should hey good evening my name is
Peter Brennan i am the executive director in New England Convenience Store and Energy Marketers Association represent the interests of uh 8,800 convenience stores throughout New England 4,421 right here in Massachusetts plenty
in beautiful Amherst Massachusetts um I believe the topic tonight was uh nicotine pouch restrictions so I'm going to focus on that but since the previous two speakers uh who I'm well acquainted with they travel from town to town pushing this policy that's um at
best ineffective at worst uh enormous uh harm to our retailers in an uncertain economic climate when we already have u inflation tariffs everything else that we've discussed coming down from the federal government no our retailers don't need you to ban a perfectly legal
product that adults enjoy and that's why we keep behind the shelves and we check IDs um but on to pouches pouches are misunderstood and I'm eager to hear what this expert has to say but um the general consensus is that nicotine
pouches and they're many forms there's many brands uh various strengths um are useful to get people u you know provide people with a safer alternative to smoking those that smoke um so I don't know why you'd want to
take a safer alternative to smoking and put it in an adult-only store when it would be better served in the interest of public health to have it right at the point of sale where somebody's used to purchasing their combustible nicotine products i think that in the interest of
public health these products should be widely available um they should come in various strengths because if somebody's looking if somebody say has a um severe smoking habit they're used to a lot of nicotine they might want a higher milligram than the average casual user
will uh in terms of pouch strength so we do caution against limiting um the strength of pouches that people might want and restricting these to adult only facilities which are um cloally known as I guess vape shops you know I I don't
know what public health benefit what argument you can make that putting nicotine pouches in vape shops and restricting them there is good for public policy uh we've seen many missteps in nicotine policy over the last few years uh we've seen the flavor
ban which has been totally ineffective at reducing smoking rates um even in even for say menthol cigarettes rates have actually gone up uh you can trace every pack that hasn't been sold in Massachusetts to primarily New Hampshire
occasionally Rhode Island Connecticut but the state has lost an enormous amount of tax money by banning flavored products and they're still on the streets because we've created a thriving illicit market you have a thriving illicit market for flavored vapes that now come from China and that's a huge
problem that we want to stop um we think the best place for these products is behind the counter at our retailers we check IDs we scan IDs i know my time's up i'm happy to take questions thank you thanks Peter um next up we have Heather Warner
and Heather please identify yourself before you begin speaking um good evening everybody um Heather Warner um I am with the Collaborative for Educational Services the Hampshire Franklin Tobaccofree
Community Partnership i live in Florence i grew up in Ammerst i spoke at the last meeting and I mentioned that at age 14 I bought my first tobacco products at Auggie's um smoke shop in in Ammerst and
um you know by the time I quit I was a two pack a day smoker and um when I look at both the initiatives um tonight you know first of all I just want to commend the board of health on looking at tobacco regulations on understanding the
role as public health um policy makers that you know we have done so much good by regulating nicotine products per our last speaker um in response to the idea that uh flavored bans have not improved
smoking rates they absolutely have the among young people the smoking rates with the nicotine ban I mean with flavor bans have exponentially decreased um so I also just wanted to
say um I am in support of the nicotine-free generation i I feel that this is actually a way that reduces nicotine in a community alongside other initiatives like having a cap on the number of retailers and have that cap be
declining like you have but the nicotine-free generation just simply does not initiate another new generation so each year it goes up by only one year this is a way to actually decrease the hardship on um retailers and not you
know produce a new generation of um you know users so if I mean I think that's we don't necessarily want to initiate new new users as a way to keep businesses in you know going so um that would be my
argument there i think with the Zen pouches um you know I think what we see is that the left unchecked the tobacco and nicotine industry will brazenly target disadvantaged and vulnerable communities including teens and bipok
and LGBTQI communities and um you know we've worked hard to um you know look at new evolving products such as the Zen pouches and um it's like whack-a-ole you
know it's like that we do have to keep revisiting these regulations because the industry keeps getting creative with loopholes around you know having concept flavors that are sold through Zen you know something like chill which is a really a flavor um and 20 seconds left
Heather okay with synthetic nicotine what we are seeing with young people just like with Jewel is that they are initiating and becoming addicted quickly and um they are initiating with these products they are not a step down
product for young people and instead they're they cause a very fast you know rate of addiction just by the you know trying them and using them a number of times so these high products are problematic thank you Heather um okay let's see um next we
have Moren Busby again please identify yourself and where you're from hi U my name is Moren Busby i live in Melrose Massachusetts and um like Heather today I spent the day at the state house um it was enough day uh end
nicotine use uh for the future it's a a youthled event in fact um there were 240 chairs set up in the room where we had uh a program and award ceremony and I had to stand because there were 300 attendees very important topic for our
youth um I got to go around and visit some legislators with youth and listen to them tell about what's going on in their schools and like Heather just said um nicotine pouches are an initiation um product for our youth they're cheap
they're high in nicotine content and they're very discreet youth are using them and they're not using them as a a way to cut down on their smoking um I wish I could show these to you but uh yesterday in preparation for the meeting at the state house I went to a local
shop and I picked up a vape that is looks just like a guitar vape device another vape device that looks just like a a a rubber teddy bear and I also picked up a vape device that um says vape and play music wireless wirelessly
from your phone so you can vape and play music um from the same device and this is the tobacco industry playbook come up with new devices target youth find cute funky also cheap and discreet in some cases products that that youth will be attracted to and because their brains
are so susceptible to addiction um youth addiction of nicotine is um as Heather said happens very rapidly thank you once again for um taking up this topic and I do hope that the um board considers very seriously adopting the nicotine-free
generation which is now in 14 communities and covers 500,000 people in this in the state of Massachusetts thank you thank you Moren um next up we have Jenny
Chadwick again Jenny please identify yourself and where you're from before you begin speaking yeah thank you um my name is Jenny Chadwick and I am in Somerville Massachusetts i'm going to Brandeise University getting my PhD but I always call Missouri home i was one of
the first sponsors of Tobacco 21 bill and um from a college town and so I I want to just um talk to you about what we know i spent three years on college campuses across the state of Missouri um right before coming here to Massachusetts working with youth right
as Zen was hitting the market um within college students and Peter's not wrong we are a group of people that come to every meeting just like Peter does and the one thing I can tell you about testifying across the country is the petroleum and convenience store associations come and
testify at all of these meetings when we think about tobacco control and oftentimes the information that they produce and provide to us is inaccurate and so I just want to share that the truth initiative emailed yet again today just um with a report saying the Massachusetts policy was the first to
remove all flavored tobacco products leading to an 86% decrease in overall ecigarette sales and a 9 um8% decrease in flavored ecigarette sales in the state between September 2019 and December um 2023 we know these policies
are effective i also want to just highlight um and reiterate the importance of local communities stepping up um I helped co-author the CDC's tobacco 21 evaluation guide it is now taken off the CDC's website um my work
is cited in the eliminate tobacco related disparities and death addressing disparities surgeon general's report that no longer exists on the HHS website it is up to local governments and state governments right now to really address
this tobacco control issue as we hear of the sad news of Brian King the FDA um center for tobacco products director um being reallocated to a different unit so um as far as pouches nicotine pouches
and why adult only stores I have students college students often tell me that they are so addicted to nicotine that they are sleeping with pouches in their mouth um we see uh party favor bowls of nicotine pouches at um college
parties we have stacks or towers within dorm rooms of nicotine pouches they are products that are attracting kids and and and their increases over 100% in the last year so it is a product that we definitely want to regulate as we think
about nicotine free generation and nicotine pouches and I want to thank you for taking up and considering all tobacco control and especially these two issues thank you thank you very much Janine i don't see any other hands raised i did see one other hand before
but it's no longer raised is there anybody else in the waiting room who would like to make public comment this is the last call for public comment if I don't see your hand raised I'm not going to call on you okay Josh I'm going to allow you to talk just a
moment josh please identify yourself and where you're from my name is Josh Bro i'm with the National Association of Tobacco Outlets we're a retail trade association um didn't plan on speaking tonight but wanted to just make a couple of comments um previous speakers have mentioned um
youth uh a lot tonight and I understand we don't want to see youth using these products either but the legal use uh the legal age of purchase is 21 years old um Massachusetts has already banned flavored tobacco products as was
mentioned by a previous speaker nicotine-free generation is targeting legalaged adults and their right to choose what legal products they would like to put inside their body as an adult I have the right to choose what
products I want to use that is my god-given right as a legal-aged adult nicotine-free generation is not targeting the youth it is targeting legalaged adults in these communities in
Massachusetts i strongly urge you to consider that the legal age of purchase is 21 years old already they are not allowed the youth are not allowed to use these products until they are 21 years old adding
nicotine-free generation to your local regulations will not change the use rates it will change the point of purchase they will find the products either online or in a neighboring community that does not have NFG on the
books thank you for your time i really appreciate it thank you Josh and then um we have one more speaker um atif Taznim i'm going to allow you to talk go ahead and identify yourself and
where you're from yes yes my name is Atik Das and I'm owner of the Amoris market in Amoris and I see before me and our guy told me same thing you know and we we have 50 state in America and that's the only one
state have 21 age already you know and all other states have 18 year old to buy tobacco or nicotine products and we already ban the flavor tobacos too is heard lot of local businesses around here you know the kids still buying flavored tobacco going in the other
states like Connecticut New Hampshire Vermont and other states and if we ban just in a in a like nicotine purchase people cannot go to Hadley people cannot go the South Hy people can go to other town they still kind of buy you know it's going to affect only local
businesses lot of you know and my request is we are very very strict with the ID 21 year old people can buy and we check ID everyone you know and We are we're requesting to just don't make any
local laws it can affect local business and that's it thank you okay once again I'm going to ask any other folks want to make public comment last call can we also move Jenny
back to the attendance sorry i don't know why that didn't happen sorry thanks yep okay um so public comment is now closed i'm turning it back to you Risha great and thank you everyone um I I suspect everyone knows our um how we
operate but we don't respond to public comments um but we really appreciate everyone's feedback we are going to move into uh our discussion on tobacco regulations today's discussion as as some of you indicated is focused on oral
nicotine pouches um that is the one remaining element of the uh the regulations that we hadn't made a decision on and we'd like to get those regulations approved and out um tobaccof
free generation is something that at our last meeting we agreed to hold a public discussion on and we will do that in the future separate from these regul after these regulations go out so um I don't know maybe the be I'm not
sure how to I'd like to hear from everyone and I'm wondering if maybe I should read Bets's comment um into the record uh that because she couldn't join us um Pico does that seem like one way to
start yeah I think it would be good to read and they're just brief um Betsy's comments and then we only have Cheryl for a short amount of time probably about I would say maybe 15 minutes so I think if we can read Bets's comments and then maybe have just a few minutes of
discussion i think there were some particular questions that we wanted to ask Cheryl um while she's with us great and thank you Cheryl um so yeah the Betsy I'm just going to read from from a an email that Betsy sent on this
topic i'm convinced that oral pouches are a useful harm reduction tool in the treatment of cigarette and tobacco addiction i'm also convinced that the pouches as with ecigarettes are an attractive gateway delivery system for nicotine that poses a special risk to youth i think that balancing the harm
reduction benefits for established users with risks of recruitment of new nicotine users is the important issue in deciding whether to restrict pouches to adult-only establishments or just require that their sale be restricted as other tobacco products perhaps the compromise might be that the higher dose
products would be restricted to adult-only establishments i see benefits and disadvantages to restricting access to lower dose pouches but probably ultimately favor allowing lowd dose pouches to be treated as tobacco products remaining more widely available rather than limiting to adult only
stores um and I will just take one step back which is the original draft of our regulations had oral nicotine pouches as uh regulated to adult only stores and it was brought up in our first public hearing and we uh several of us felt
like we didn't quite know enough to feel like we were making an educated decision uh did some research um I suspect several of us have and maybe um I'll just open it up maybe we start with questions rather than our our first
opinion since we have Cheryl for such a limited amount of time um did anyone come up with questions that they didn't feel like they had answered or uh from today's public comments at all and I also just wanted to say in case people don't remember Cheryl Sabara is
with the Massachusetts Association of Health Boards and has done a lot of advising of boards of health on the issue of tobacco regulations and thank you for joining us Cheryl sure well this may be easier than I thought well I mean maybe I can just get the
conversation started because I think one one question that has come up I mean we we I think we have three options before us which is don't restrict nicotine pouches restrict them only to adult stores or restrict them to the low dosage uh the 3 milligram and 6
milligram pouches if I I think that's the question those are the three options and so Cheryl I know maybe you can sort of weigh in on what you think other boards of health are doing or particular on that issue of choosing the lower doses versus restricting to adult only stores well it's it's um mixed um
Somerville just restricted them to adult retail tobacco stores their um theory was that they also they Somerville also restricts electronic cigarettes all electronic cigarettes to adult only
retail tobacco stores they can't be sold in convenience stores and they used the the the rationale that that's what they do with vaping products so that's what they feel they should do um with nicotine pouches they did not address
the various strengths of the nicotine if you do a little bit of research on um the varying strengths there are lots of varying strengths and you can just do your own lit review um
googling and find out what is considered a low strength a medium strength a high strength an extra high strength and then we have ones that are 28 milligrams and then even some that are even more and um
my understanding is that low strength is considered between 2 and 4 mg and um one website that I found which is allpouch.com um quotes that this strength is good for
beginners particularly beneficial for those who are experimenting with nicotine for the first time medium strength is 6 to8 mg um high strength is they consider 10 to 14 um extra high is
20 to 16 to 20 and then um the product that they are um that's advertised on this website is bad bull which is 28 milligrams and we have seen some that have been higher so some municipalities
are restricting them to adult only others are um restricting them to no more than six milligrams because that's what the FDA when they approved Zin
products they approved a 3 mgram and a six mgram product but in that authorization they did not approve them as a cessation device and they stated that the authorization does not allow
the company to make reduced risk claims about the products but they did approve them and I think since the FDA took that action we've seen um more interest in some cities and towns to restrict them
to either three or six and I know anecdotally in some towns um the reason they chose those numbers before the FDA um decided what it decided and authorized those two Zen products um
some of the retailers said those are the ones that they sell mainly is the six millgram one so yeah those are the options you know do nothing restrict them
or restrict the am the con the amount i I guess I have a question on they're not flavored um because you can't sell flavored tobacco products but um but if you if
you go into stores we have been told by health inspectors that when they do a taste test some of these products that say they're not flavored like chill um are in fact flavored when they go in and
do a test but you're right if they're if they're explicitly labeled as a flavored product um they should not be sold in Massachusetts well I guess my my question is um you know it does feel like the brands
are trying to get around this and they're calling them scents or you know some other thing that isn't a flavor but it's still the same appeal um from a marketing sense and I'm wondering if you've seen any towns look
at restricting that i'm not sure what you mean restricting restricting restricting the you know the the the fake flavors the the because you know I'm looking at Zen right now and it's cool blueberry it's not cool
blueberry flavor it's just cool blueberry that would indicate there would be an a presumption in that case that that is a flavored product pursuant to the Department of Public Health regulations but almost all of them have
a a something you know I don't know any I haven't seen any that are just like here's your nicotine flavored nicotine it's mint or you know something um and so I guess what I'm trying to understand is is there a way to regulate the the
concern with flavors as I've understood it in in all nicotine or tobacco products is that it makes it much more appealing for young people um and so to my mind a scent or however you're calling it is the same appeal and I'm
wondering if if anyone has tried to to work around you know to to that what what we're seeing now is we are seeing boards of health um actually challenge some of these um distributors
and manufacturers who submit letters that say because they have to pursuant to state law saying this product is not flavored um and they are testing them because they've heard from students in
schools that they are in fact flavored and some of them you just open up the pack and you can just smell it i mean it's you don't have to be a rocket scientist so they're testing these products and they're finding on them for being flavored zenchill is one right now
conquered and needed are have fined on the products um claiming that they opened them up and they tasted them and they're flavored products they taste like menthol um so what's going to
happen with that we we don't know um whether um Philip Morris is going to sue these towns claiming that they are not flavored products we've heard rumors that Zen Chill will not be sold in
Massachusetts anymore we don't know whether that's an accurate but we've heard that from some retailers um but they're very popular products they're extremely popular products and they're so popular that they're they don't they
fly off the shelves and that's so so I guess what I'm saying is you we are seeing boards now challenge the manufacturer letters that are saying these aren't flavored products because so rather than trying
to form a regulation that says it can't be flavored or colored or smelling or blah blah blah well that that's what the regulation does say it can't have a taste or smell other than the taste smell of tobacco so that's what the regulation does say and the courts in
Massachusetts have upheld that um that you can smell it or taste it and if it smells or tastes like something other than tobacco then it's flavored regardless of what the manufacturer letter says and I know a previous
speaker said they're illegal in Massachusetts yeah they are but unfortunately we're seeing them on the shelves cheryl I have a question i'm wondering if the FDA only approved the three and
the six migrams in strengths where are the higher strengths available and I mean your tobacco inspectors could tell you better than I can but they're in convenience stores they're in adult stores they're in vaping stores they're
in they're everywhere regardless of the fact that regardless of the of the amount yeah but they weren't approved they have a marketing they aren't authorized but but there's a but they're they're on the shelves legally um right i I guess I just want
to correct Premmo that it's not that those two were FDA approved and the others weren't those two were given marketing authorization right which means they can be marketed it didn't say that that those were the only ones that could be sold i see thank you for clarifying yep
so I um I wanted to say that I appreciate the um level of rigor and uh discussing whether the FDA approved these specifically not as a cessation device um I and to to Bets's
previous point that these might have potential benefits for individuals who are trying to quit smoking i I guess I wonder if other towns have taken that into consideration that this is
potentially uh beneficial to the sessation of smoking even though these are low dose yeah I I think that they have um and and that's why no one's looking at banning these products um the qu the the
challenge becomes that balancing test that we always have um and and and we also don't have the evidence that these are actually helping people quit smoking we have evidence that they're being used
in addition to combustible products there's there are a lot of dual users out there who may very well be adults um but you know my husband smokes cigarettes he's addicted to nicotine and
I would prefer that he use a 3 mgram nicotine pouch instead of a combustible malber um but that doesn't we still have that balancing test with youth attraction to these products
because they can be used so discreetly and adults being able to get these products if they do help them quit more power to them i mean no one's suggesting banning him we're just trying to balance the threat of harm versus the
potential benefit thank you i think that uh considering that uh the average cigarette has about 10 milligrams of of nicotine and that the fact that no nicotine is safe and that any nicotine poses a risk for
addiction it seems appropriate to suggest a cap or uh the nicotine pouches if you were to to keep them around and I think perhaps that cap would be around the six milligram line but
uh my intuition I'm not sure if other folks um sort of agree here i I guess I would just ask a qu a clarifying question on that which is by keep them around do you mean keep them
uh available in all outlets that sell nicot sell have a a tobacco license or are you suggesting actually saying no outlet would be able to um sell something above six milligram even a 21
plus outlet fair question i think um I think if we are considering restricting tobacco to um adult only establishments then having I think no in
I think in the 21 and over or in the general like a convenience store for example I think it would be appropriate to to curb the higher dose um across the board just my opinion does anyone have any further questions
for Cheryl um Risha okay um what what sort of volume are we looking at here for for the sale of this of of the the pouches because I'm I'm not uh familiar with them to tell you the truth
[Music] um and I don't you know and I'm I'm seeing numbers that there's very you know low low numbers um in terms of teen use of it obviously they can't purchase it anyway but
um are we looking at high volume yeah I can I can I I did some research of this on this because I'm putting together a presentation for a certificate program that our association is doing um this on Saturday and um according to the CDC
sales of these products these pouches from 19 from 2016 to 2023 sales increased from 6 million to 334 million
um use current use um from 2019 to 2023 um it tripled it's it's low i mean it's it's low it's one it went from 1% to
3.2% um but it is the second most popular nicotine tobacco or nicotine product used by youth in 2024 second only to vaping products um the
EPS have determined that it's approximately 480,000 middle and high school students use them nationwide um the majority are flavored and we hear from schools that kids are
using them more and more frequently even in middle schools and I was at the state house today as was one of the previous speakers and we heard high school kids talking to legislators and their staff
about not being able to go into bathrooms without seeing the pouches being used and the vaping products being used and the pouches are are can be used right in class you don't even have to go
into a a a a stall to use them you can just put them they just you know they dissolve and they're flavored and these students talked about their friends who can't stop using them and I believe a previous speaker mentioned that some you
know college age people are going to sleep with them in their mouths so you know it's it's so the the desire and the sales are going up um Philip Morris International you know
bought Swedish Match and which is the company that that created Zenchill and they bought the company I believe it was in 2020 um for I think let's see I think it
was 16 billion that they bought it for just looking at my um slides to see when when they bought it philip Morris bought it for 16 billion they bought Swedish Match in 2022 their sales are at
record highs um they in 2024 the shipments of Zen rose they shipped 644 million cans which was up by more than half from
2023 they can't keep up with the demand they expanded their factory in Kentucky and they're building a new factory in Colorado for $600 million and they've pledged PMI has pledged to make twothirds of its income from
products like Zin by 2030 so whether they're I mean they claim that they're making these products for adults as a harm reduction tool but what we're seeing is an an increase in use by youth so
again what we always have to do in public health is do that balancing test the right to engage in business the right to privacy versus the need to protect especially to protect those people that are unable to protect
themselves which we frequently see as youth as the elderly those with special needs those populations that have that are targeted quite frankly and that don't have the ability to protect themselves
thank you appreciate that sure um I just want to say thank you Cheryl yeah thank you Cheryl i wanted to ask um I know in Belchuretown they um restricted them the sale of them to adult only establishments but there is no adult only establishment in
Beluretown so they're effectively not available for sale in Belchuretown in Somerville I imagine there are more there's more than one adult only right absolutely in Ammerst we have just one so by restricting it so I'm just wondering if there's anything problematic about essentially creating a monopoly by restricting it to just one
store restricting the sale to just one store yeah i mean I I I think that I mean that we run into this a lot and I I we've got a case going on now in Barnstable County where you know there's one alleged smoking bar in the entire
town of Barnstable which is huge made up of several different villages and retailers complain and you know you know it it puts the that one retailer um in uh benefit beneficial situation
now if if the retailer is acting the way the retailer should be acting because of the regulation in the state law no child should be able to enter there um but you also I mean I don't know if this would hurt adult users i don't know where the
stores you know the geography of Amherst i'm not as familiar with it as you are obviously but I don't know whether that's a venue that's easy i don't know what the hours of the venue are um these are all part of that balancing test which
the board has the legal authority to exercise their judgment and just to add on to that um Kiko the monopoly situation creates sort of an additional concerted effort to um make that pledge i mean uh to sell additional
uh tobacco products and to um meet the overall the P the the Philip Morris sort of pledge to to have more tobacco sale it seems like this just furthers the point that we should have a cap of of um tobacco sale
a cap of tobacco amount milligrams is that what you're talking about yeah thank you okay cool just wanted to make sure yep um I think you need to leave in a minute so I want I do i was just going to quick
procedural question so at this point the regulations read um restricting to adult only establishments if we change it if the board decides to change it does that have to go back out for a public hearing because it's a is that a significant enough change in the regulations to require that we do another public
hearing we've heard a lot from people today that is a question I would defer to town council on that there is not a legal requirement that you hold a public hearing number one there is no legal requirement that you hold a public
hearing pursuant to chapter 111 section 30 the only legal requirement for holding a public hearing is if you're addressing a regulation that um concerns title 5 septic or sewer so there is no
legal requirement that you do this that you hold another hearing so it would be a judgment call basically that you would make um my understanding having been at several of these meetings is that you
have received a lot of testimony on both of these issues so the concern that the public would not be aware of this in addition to the fact that you are not legally required to hold a hearing would
lead me to be comfortable in you amending the regulation to change that but that's I can't give you legal advice i can't understood understood it would really that would be a question I would ask temple very helpful background thank you so much Cheryl really appreciate you
joining us sure and I'm sorry I need to go but it's okay i was just asked yesterday so yes I know it's completely last minute you're amazing thank you so much all right good luck um if you have any other questions
Kiko or anyone just feel free to give me a call okay thanks so maybe I'll just state my my own uh I I feel like I've never been more ambivalent about of how to move forward with this i I feel like every argument
has another side um the ones that I am weighing in my head are we could restrict to lower amounts people could just buy five of them um what what h does that actually you know offer any
benefit um the we could keep it to adult only the monopoly situation you know I can understand that that would cause tension amongst retailers um does it also by restricting it to one place
only push people to buy online where we have no restrictions um so I I I yeah I don't know if anyone else feels like a clarity has come out and it's really obvious but I am not feeling that
way i'm not saying not to make a decision we have to make a decision but yeah Jack so the the adult only retail tobacco store and the normal unrestricted retail store the
the only difference in these regulations is is the pouches being available no there there's several things that are restricted uh only to the um to only the 21 plus uh I don't off the top of my head know what
they are kiko do or does anyone have that in their head i just I was just scanning it i I couldn't pick it up okay readily okay so it's worth reviewing yeah so there are um strengths of vapes that are only
allowed for sale in adult only stores if a vape has over a certain percentage of a certain milligrams of nicotine you can only buy in adult only i can't remember i think it's 35 over 35 milligrams i could be wrong don't quote me on that that's a difference between tobacco products that can be sold in adult only
versus convenience stores um other than that I don't know that there's anything that's different okay yeah i didn't think there was um too much i guess that's an interesting insight yeah
so I you know I I did I liked Bets's um um input did we read that into the record yes okay yeah um so yeah I I I I really don't want to hurt business and in Ammerst
um and it's it is available um and and so I don't really think it needs to be treated you know differently where it's only adult only that's my my feeling and it is you know subject to
the to the uh tobaccof free generation rules correct it would be yeah yeah so all right yeah so that that's that's where I lie on it so I'd like to open it up to the retail stores it's my feeling
others Just a point of clarification uh Kiko um absolutely it was over 35 milligrams per mill millimeter thank you Dia for checking that um and Jack just to clarify so are did you have any viewpoint about the dosage amount restricting to smaller dosages well it
sounds like that 35 for the vape that the pouches would have difficulty but I guess in the spirit of that I guess some some cap would be appropriate i I don't know what that that would be but um cigarette being
10 um but I just think people will take more pouches to get around that if it's uh I'm not so hung up about it I guess um yeah I was trying to figure out there's a price difference i'm trying to do a search but I'm also trying to focus on
the meeting if there's a price difference between the lower dosage um pouches and the higher do yeah i mean if I wanted 30 milligrams I'd just stick as many pouches as I wanted probably and at a certain point it might become logistically difficult to have a whole
pouch yeah but and presumably the larger pouches would be less cost per milligram although that doesn't always happen but presumably that would be the obvious pricing strategy but you know I am sympathetic to the the
people that are suffering from addiction and making it harder for them to purchase this you know maybe rare that it actually serves in terms of addict addiction recovery but I wouldn't want to make it more
difficult for those people um do you know how late the adult only store is open i can check it's lazy long we're talking about right okay it closes at 8 this evening okay so
it's basically 11 to 8 are its hours except Sunday 12:00 to 5:00 um you know like Risha I'm ambivalent as well um although I do think that if it's going to be available
then there is some rationale for making it available at um other locations other than adult only stores again with the three and six milligram cap
Um you know a lot of a lot of this may be um a a push from PMI you know in terms of marketing the the issue of uh assisting with
cessation but I think it makes sense to give the benefit of the doubt in this case um so I'm inclined to agree to uh not restrict the sale but and but all
do restrict the dose in the other in the convenience stores and so on and so allow any dose at adult only but only certain doses outside of adult only is that have I understood correctly or what
you're suggesting yeah uh we reg we can regulate um the strength available in adult only stores this just our power is so immense this just gets more complicated as we go
along um I think Dia you had said that you felt for simplicity's sake it would be best to just to keep only the two dosages available it doesn't matter where which store yeah is that is that right that's right and I think it's a good compromise between what's perceived
as you know really lowering any dosage anywhere or uh restricting access um and not and and then take and being mindful of businesses and and the impact yeah that makes sense to me okay so we
have a proposal which is uh allow oral nicotine patches at and I think I've heard up to six milligrams um in all tobacco retail licensed
outlets um and I guess there I think I'm hearing the same for adult only so that there wouldn't be a place in town that you could get the the twelves or the tens or whatever is that That's right
i I'm I'm on board with that um again I think that these are really difficult you know tradeoffs that we're trying to balance um I think the and and I'm saying I I mean I'm just one vote but uh I I would support that i guess I would
also like to maybe work with our inspectors and think about this flavor issue because I do think they're being marketed as flavored whether they're actually saying they're flavored or not
that is the branding is such that they are they've got a wintergreen mint mango whatever um on all of them so that bothers me but that as I understand it from Cheryl is something we do in
enforcement not in the regulations jack is isn't that a state issue though doesn't It's a state regulation yeah but we we would enforce it yeah yeah oh okay so that but that comes down to the local enforcement of of the state
regulation okay a and local discretion about whether a product is flavored or not because every product has to have a letter that says this is not a flavored product and this is why and blah blah blah because flavored products are banned in Massachusetts but so every product has a letter attached to it but
boards can test the product and say you're saying it's not flavored but it smells like mango to me we're going to say you can't sell these but then you're entering I mean it's you're taking a step into a territory where people might get Yeah i mean she said maybe Philip Morris is going to sue folks who knows
it remains to be seen but that is something that boards of health can do challenge whether something is unflavored as they're saying it is at the local level yeah so if we if we want to put in that you know somehow to give the code
enforcement or not the code enforce the inspector uh more teeth on the matter then that's that's fine by me and it it has nothing to do with this regulation it would be a thing we do just separately from that okay well I think we've got a proposal on the table which
is exciting um so I'll just restate it which is to um to allow oral nicotine patches to be sold in any outlet that has a tobacco license up to six milligrams
i think pouches but yes I did you keep saying pouches i think that I think that's my accent because my head is saying pouches oh okay um okay so uh anyone want to Well why
don't I said it so why don't I motion uh to put that forward as our regulation anyone want a second i'll second okay Kremla yes ka yes
and I I know I'm supposed to ask Jack and myself but that's just silly we we already said yes um All right well that's what we're putting in and I I don't think we need to go back to public hearing cheryl's comment aside around um it it this was something that could have been commented on and has been and we
have now come to a conclusion on it all right so we have to take a vote to put these regulations with that change out is that correct Kiko or is that was that vote all we needed to do
i think that you voted on the piece that is up for debate and so that's now we just add that to the regulations and I think that's it i don't think we have to revote on the actual regulations am I missing something just in case let's just do it okay okay with that change um
I submit I I I put forward a a vote to pass these regulations okay uh Premala yes jack yes all right we did it i just I thank you everybody i also just wanted to clarify for people who are in
the waiting room that we're no longer taking public comment i see someone has a raised hand so we we we're not taking comment at that point at this point and we don't engage in dialogue at with folks who are with the public at this stage but thank you for being here yeah
and sorry that always feels very weird because it does it's nice to have dialogue but that is just not how our our meetings are set up all right so the next agenda item uh no rest for the weary is on body art
um I think we have recommendations uh so this is Betsy Kiko and I have met and discussed this um and so I think we have recommendations on all the pending questions uh for your comment and thoughts uh we are certainly not saying
this is the only or best way to do this um so let me just I had them up and now they seem okay here they are so um we had previously uh talked about and the board had agreed it can it can it has not been voted on
so it can still be uh discussed if anyone would like uh that we will remove the requirement for a social security number to be part of any application for a body art license um because those applications become
public record um and it felt like a breach of privacy the second um thing that we already talked about was apprenticeships and so we are um
recommending that the uh that there is a number of procedures and it differs whether you're a um a tattoo artist or a piercer but a number of procedures that they observe them the trainer doing a number that they are
observed to be doing by the trainer and then at that point um after those are done on they can be uh proceeding without that supervision
um that we we put in a sample and it's at the it's an appendex on this document called body art regulations March 28th 2025 body art regulation issues sorry March 28th
um so we have put in a sample form that would show how many have been observed each it's a it's a daily form so how many have been observed how many have been supervised is um and uh and we expect that some you don't
have to use that form but it has to have the elements that that form has on it um and so when an inspector comes that's what they would look at to see if these things are being met uh the hours required for for tattoo artists has been and again this is what we talked about
last time so I'm just trying to summarize um from 4,040 hours on the tattoo artist to 24,400 and piercers oh I I didn't finish that thought i uh
1,200 I think it was it was 2020 yeah it was 2020 and now we're recommending it may reduce reduced to,200 and that is in line with um professional piercer association recommendations and then the standards in several other localities
ours were a bit of an outlier and and we couldn't really come up with the math that justified having different numbers and that the licenses will specifically say apprentice on them um
so those are I I put in track changes on the regulations that you can look at but I those are the main the meaty things uh I realized when I was putting those into track changes that we are also getting rid of um the probationary
period um so there was sort of a two-year apprenticeship plus a year of probation um and while we didn't explicitly discuss that by reducing it to these you know supervised uh you watch you watch me and then you
can go on your own um it it got rid of the probationary period as well so I just wanted to make sure that people understood that that was part of the change i'm just going to keep going and then we can talk about all of the things actually I feel like that that
was that's sort of meaty and so we talked about the apprenticeship last time any questions as I said at this time did it feel different did it feel like that's not what folks had agreed with last time no
okay uh guest artists um again I think we talked about this last time so we were okay that the requirements for guest artists are not exactly the same as being a licensed resident artist um so for instance they
don't have to have the skin or anatomy courses that a licensed practitioner does when they're a guest artist we were okay with that so no changes uh we recommend further specifying that the owner of the establishment is liable if there is a
breach by the guest artist right in the previous version it just said the establishment was was liable but not the the who the person associated with that and that's what something the inspectors had asked us and then um we would like the own we would like to require the
owner of the establishment be on the premise while the guest artist is touching clients um but they don't necessarily need to be supervising and that was really the rationale there was if something happens and they need to call for local help a guest artist wouldn't have contacts in the community
uh to to know where to call so I think those are the things that we had previously discussed we have two more new recommendations that I assume we'll have discussion today the first one is that that that anatomy
course where all of this started so to re refresh people's memories who haven't thought about this as much as maybe I have over the last several months we require a skin course for tattoo artists there's no
uh there there's no difficulty there skin courses are available they are clear no one's had a problem taking one we require um a anatomy course for piercers and that one became a problem because it wasn't clear what sufficed uh
what would meet our criteria and there were none none immediately available so we did our research we found several um we have also come to understand that this one course save each life is indeed
accepted by many other municipalities um and so it may become difficult to say that doesn't work for us because it means that if they were just okay in Northampton then they come over here and suddenly that course is is
no longer accepted we uh had looked into the uh the the curricula of Primal Instincts uh and wisdom learnings that's the online UK version the Primal Instinct is
the in-person in New Hampshire one and those two felt really valuable um they are very different right one's in person several hundred the other is online by the UK by a UK group and about
$25 um but they both were very very specific in the kinds of things that they were teaching around piercing and anatomy um and so it both of those felt good and so what we are suggesting um is that we list those three primal
instinct save each life and wisdom learning as things that we have vetted and are approved would would accept and we would accept any other course that has the following uh topics covered in it and that's re we we've
really taken this from both primal instinct and wisdom learning so we're looking for the overlap there so it's that it would cover skin and tissue including healing would cover the nervous system with an emphasis on facial nerves it would uh cover
complications for example skin healing response to injury inflammation allergies hypertropic scarring or trophic scarring um follicular cysts contact dermatitis we're not saying it has to cover all of
those but for instance um it would need to cover the anatomy of male and female genitalia the lymphatic system why piercing openings cannot be restricted and afterare and then some variations and special cases that piercers should be aware of so if a
course had that basic content the inspectors would not have to come back to us and ask they could use their judgment to say that was acceptable so that's where we landed that took months and months and months to get to that it feels very simple in
the end but um any any thoughts or questions what was the issue with save each life i mean I know that other municipalities but clearly we have had some issue with it so I I think this was really a me
issue i looked at all of the available course because you can you can freely get the coursework you have to pay to take the test and so I downloaded all the coursework and it felt like it took the first two pages of an anatomy um textbook's chapters and it was like
here's the human body with all of the muscles and you're like well how does that it has nothing to do with piercing specifically it didn't talk about the implications of piercing on any anatomy um it really felt like a very high level
anatomy 101 um so if it weren't accepted by other municipalities I would not vote for it to be accepted here but what was the cost for that uh I can pull it up remember the the draft with me no no and it's not on the
latest draft i I took it out i think I took it out i could scan down first yeah I did um I think it's about $125 if I'm remembering correctly um certainly less
than the north the New Hampshire course you're you're correct it's $125 uh the New Hampshire one is $300 no I'm sorry the New Hampshire one is $600 and the UK one is $20
you know I I'm inclined to to go with that me issue that you had Risha it's just you know yes other municipalities have accepted it but if you
feel as I do that there needs to be solid education in anatomy and healing and and and all of the things you mentioned i I don't think it's unreasonable to have
um just two choices as long as one of them is very affordable and is in fact costs less than save each life and I think the danger of going down the road of well as long as these are available as that that these could
become not available at any point right so the the Wisdom UK one who knows why they have it and what the regulations in the UK are that require it uh the the New Hampshire one is because Massachusetts requires it and
the Save Each Life one is because Massachusetts requires it so we don't know what you know we we don't want to be in I didn't want to put us in a situation where every year we had to look and see what was available and and Fair enough but but my feeling is um you
know if if we want them to have a certain amount of education then then that stands regardless um you know I I I'm already conflicted about the fact that individual boards of health decide these things because I
really think it needs to be governed by the state but in the absence of that I I I strongly feel that a certain amount of knowledge is required to embark on this and if it's available what I'm trying to say is if the save
each life course doesn't pass muster then it doesn't pass muster and yeah and you know and if um the UK course goes away then we'll have to reconsider but if if
the Save each life course just really is very elementary um in in what it teaches then it sort of defeats the purpose it seems to me um go ahead Dia i have a question but go ahead
okay uh I just wanted to say um I think this was also I don't want to speak for Betsy but I think this was also Bets's concern that the Sage Life was sort of a tattoo um centric system curriculum that was sort of vaguely manipulated for the
piercers as well i think it's especially I appreciate that there is a clear list and I think it sort of sets a standard across um I think is the first time a town has sort of specifically laid out the uh topics that would be acceptable
in lie of these courses so that uh to address your point um oh hello cat to address your point um uh that this would be um not specific to these courses but more of a general understanding of the anatomy that's required to study um and Kiko I'm going
to let you go i just want to clarify i believe that was me that thought that it not Betsy so I don't want to add Bets's uh um yeah conference without her actually saying that
thank you yeah so my question is whether the Save each life course has those six components that you're proposing go in the regulations does it meet those requirements or are we not able to tell that from looking at it online
i could give it your That's such an obvious question i can give it another look i also wonder if this isn't something at some point maybe we we should just take the test i I had asked for a copy of the test and they wouldn't give it to me so I need I would need to
pay for it to take it um but there is also the question of if the if the actual questions are applied piercing questions related to anatomy that's you know that's different than if
it was just like name five muscles you know I I have no idea what that test is at the end um that's only looked at the reading yeah and maybe there was a cost associated with taking the test right you have to pay the $125 to do the
course right yeah um which is why they haven't done it yet right and so I the so the piercer that I spoke to who works at Wanderlust who took that course it wasn't so much that it wasn't appropriate to piercing or that it was you know superficial or not rigorous it was more that it had more information
about anatomy and physiology than he felt like he needed for his piercing job like information about lung function he was like I don't know i don't need to know that but he didn't say to me I mean I could ask him again he didn't say that I didn't have pieces that were relevant and that you know what we could do
actually reisha we could ask him whether it covers those six things if he remembers if those six things were covered in that course which he took recently there's also an online outline of the course at the on the website that might
this might so we can do a little research on that but I think to your point Dia what this is a good solution which is instead of saying you must take one of these three courses you're saying your course must meet these things and they seem reasonable and it seems like there are some courses out there hopefully Save each life is one of them
who basically meet those requirements that the board could live with and inspectors can feel comfortable approving well and I think that's how I tried to word it in the regulations which is these three have been vetted
against this and we will accept them and and I should actually vet save each life against this um but that's not saying that these are the only three or if one of them stops existing that doesn't you know the regulations still stand it it
has the outline of what any course needs to apply so my suggestion on this one is that I go back take a look and see if I would you know using the curriculum and the outline say that these things are met um and if that is true maybe we do a
bit of a conditional vote on this one so we don't delay a lot but saying if I you know if we deem that Save each life does meet these indeed um then we would we would be happy with this this wording or this recommendation
yeah I'm comfortable with that okay um and then the last section uh that we have a recommendation on is around genital piercing um yeah I'm really interested for someone else to take up some of these uh
regulations and and dive into things that they know nothing about because it's a fascinating world um so the issues were that we had two sections one that talked about not allowing any genital mutilation and the other that
talked about a bunch of very specific not necessarily anatomically correct restrictions um and so the inspectors came back and said "What is allowed is everything not allowed is it it's not
clear and these things are not the right words for thing you know not anatomically correct but also like not qu like it's a a bunch of deep piercings what that that doesn't have a actual meaning in in the the trade as it
were so what we are recommending is that um we take away the whole section that says you can't do A B CDE E like the very specific so it used to say you couldn't do any neck piercings you
couldn't do any u uvula piercings you couldn't do any triangle piercings of the genitals um and so we're going to we're going to say our recommendation is to get rid of all of those um genital piercing and as a bit of
background has be so these regulations date back at least to pre200 none of this is in the state model rags and genital piercings more broadly have become much more widely accepted and available
um both in the state and nationally and so it feels like we are over sort of nitpicking on what can and cannot be and that rather our broad safety regulations should apply we will keep
that there's no mutilation allowed that um we shouldn't be removing parts of the body as it were but in terms of piercing that is going to be something that we don't get that specific about um Kiko do you want to add anything to
any of the like the rationale there um I I can talk about Northampton yeah I mean I think as you were reading the list I was remembering about what you said about Northampton so that would good to share but I just wanted to let folks know that I did run that whole list of piercings by the piercer at
Wanderlust and he essentially said that a lot of those genital pierces that are banned in that list are things that are happening um they are things have changed in the last 15 years or so um but that in Ammerst they don't generally get much request for those types of
pierces he does a lot of you know belly buttons you know noses it's just not the kind of thing so much in Ammeris in Northampton where he used to work there was more genital piercing requested but not so much in Amoris so it just again speaks to probably not the need to have
a whole exhaustive list it it also there were things on there like an ankle pierce and he said there's no way anybody would do an ankle pierce like from a function functional standpoint that's not something you would do like you learn that in your anatomy you don't want to put a pierce where the Achilles is so um you know he was very clear that
a lot of the things that are restricted are not things that a piercer would do so that just kind of made the group Risha and Betsy and I think that it doesn't make sense to have this list especially as things change um in terms of what is sort of acceptable and they
have very conscient I mean at least this pier piercer I spoke to is very conscientious about not doing something if somebody asked him to do something that is not anything he's learned or not anything that is in sync with his training he would not do
it so just sharing that feedback and so I'll just give the Northampton example that I referenced and Kiko referenced so I look Northampton has the same regulations that we do with all of those listed again their last regulations were passed in 2010 so they're quite old um
and uh I went on to the piercing stores websites to see what they offer and they offer some of the things that are technically banned um and so it feels like the regulations haven't caught up to what's you know they're they're
publicly advertising that they do it so they clearly think it's okay they're not doing this under the table um and so it feels like an issue of that that both Northampton and ours uh regulations are just sort of behind the times from what's
actually safe and acceptable did you speak to anyone on the Northampton Board of Health about that discrepancy no and now it goes into public record seems like an excellent opportunity to
um reach out to also set some some clarity around um just sort of conciseness and and um yeah yeah I mean it's a good point I had spoken with folks in Northampton beforehand not about this particular
issue which Risha Risha just brought to light in the last month but about how the body art regulations Hi I'm in a meeting sorry see you later um how the body art regulations ations um are in sort there's no good state template there's no good state guidance
there used to be a working group but that's been disbanded and so the locals are really kind of just doing it on their own and I think that one thing I requested when I was at the public health excellence meeting which is the regional capacity building group was to establish a body art working group for pe for boards boards of health to come
together in the absence of really good state guidance to share ideas and figure out how to proceed with some of these more difficult you know questions So but they're not mentioned in the state model regulations nope it does not restrict
specific types of piercing it so all genital piercing is restricted for anyone under the age of 18 cannot happen um and that is true in ours and that is true in the state but they don't add you know ours say ours used to say or
currently says so-called deep piercing of the penis so-called deep piercing of the scrotum um those things are not listed as specifically banned for folks over the age of 18 sorry just a point of clarification Risha i just wanted to um when I said
this would opportunity to to um I didn't mean opportunity to reach out to the Northampton board an opportunity to take leadership um and and um and and move forward these these proposals thanks i you know again I don't have the
regulations in front of me so I can't I I I don't remember what what was other than what you've just mentioned Gisha i don't know what else the um the regulations as they stand prohibit
yeah I can um I can pull it up i I have in my notes just the genital ones but they're beyond genital and we're we're recommending we get rid of all of the So there are 17 listed
um anyone who's looking at the regulations it's on page nine or the old regulations not the ones I redid page nine section D the bottom so it's piercing of the uvula piercing of the tracheal area piercing of the neck piercing of the ankle piercing between
ribs or vertebrae piercing of the web area of the hand or foot piercing of the lingual frenum tongue web piercing of the clitoris any form of chest or deep muscle piercings excluding piercing of nipple piercing of the anus piercing of an eyelid whether top or bottom piercing
of the gums piercing or skewing of a testicle so-called deep piercing of the penis and then there's more words so-c calledled Deep piercing of the scrotum more words so-called deep piercing of the vagina more words such other areas of the body as the amorous board of hell shall
determine so they're not all genital sites no no and Risha you said that there are no restrictions at all in the state model not none about where Pier can happen these sections don't exist right okay
and just another point I appreciate that um as Kiko was mentioning these other piercings that are labeled don't often occur um so it seems really um unnecessary to go in or to retain them
i mean I think it Betsy said the same thing that um I forget if Preml or Kiko said it earlier which is the anatomy courses become more important um and so we really are saying you need to know what's safe and what could go
wrong if you're piercing different parts of the body um and we're going to assume that our regulations are putting you in a place that you will know that between the anatomy course and the mentorship and apprenticeship which is where most things are learned
if I could ask when were the state model rags um so they are recent more recent certainly um and I should say so Hadley we spoke to Hadley they have the state model rags so they have no restrictions um e
everything I have seen that's been passed in the past five years has no restrictions and and that's the the state is not regulating body piercing
but came up with these model regulations to assist municipalities in terms of regulating that is my understanding yes I don't have a date that I can see on
these state model reds so I would have to go online and look but um my understanding is they are the last few years well um you know it's it's hard for me to separate myself as a healthc care provider from
um and you know certainly um I have opinions about genital piercing but I you know if the if the state regulations don't um address them and there are other
um uh you know the anatomy course and so on i I think that that is um valuable in terms of mitigating any any harm um potential harm caused you know the issue of we're not doing that
much of those things you know that could change if the population changes so um you know that that's less of an issue for me but um uh you know
it even though I feel strongly about this I think I can live with given you know with uh removing them given that the state ranks don't deem it important enough to address
yeah I'm with you Carmela on the I don't think our I don't think we should write regulations because we have a very good piercer in town who's acting ethically and uh and is not you know going out there and really trying to get more clients in for
these kinds of piercings um we don't know what happens and these our experiences these will last you know 10 years without getting another review so we want to be open but yep i also Great d you you went off mic i don't
know if you were going to add something just to say I appreciate your point Prem and also appreciate that the guardrails are in place in terms of safety jack do you want to add anything uh no not not my my topic of expertise at all
so I'm sorry just be thankful you didn't have to go down the rabbit hole I did of learning all about the genital piercing i shouldn't be laughing i'm sorry um no I don't have anything to add um I did just want to add that I looked
on the website and um there's a memo to local boards of health from the state with the model regulations for body art it's from 2001 so I don't think that there's something more i mean the regulations themselves don't have a date on it but there's a there's a memo and then the
regulations are underneath it and the memo is dated 2001 referencing the regulations so I suppose it's possible they could have been updated but I doubt it um and they they really say that there's no direct statutory authority for the promugation of body art regulations on a statewide basis so it's
incumbent upon boards of health who wish to regulate this practice to adopt local regulations so again it's one of these things that's not required but we're doing it because it's been done and it seems like the right thing to do to have some regulations in place and I think it's worth pointing out that
many states don't regulate it at all correct um okay well those are the suggestions that our little group made um I would love to be in a situation where we take a vote i don't know if um
people felt like they had enough time to read through those uh changes I made um to the regulations i think the one outstanding piece that we we I feel like we could take a vote pending this um is
whether we recommend save each life or not as a as a preapproved but we can always add you know approved courses at any point um and can I just clarify on that i think the approved courses are not in
the regulations okay they're not listed right i don't like them i I think I put them in an annex is that how I did it i think you did put them in an annex yeah I I think it's actually better i mean here's how they do it in Northampton is that they have the regulations and I
think our regulations as are proposed yours are more um stringent in terms of specifying what content the board hopes to see in anatomy class northampton doesn't have that but they have sort of a procedural document that the inspectors use that has the list of
approved courses that has the forms and all those things that you would require to show that people are following through on their apprenticeship and it's not part of the regulations per se it's more of the practical application of those regulations it seems a little bit cleaner to me to have an operations side
versus a regulatory side but I don't know what you all think so the the reason I'm hesitating on that is that I hate to put uh someone who's looking to to take a job here as a piercer or a body artist in a position where it just says you
know you need an anatomy course and like the guy did who came in was like well save each life counts um and so I feel like if it's if it's out there in the public document because the inspector's documents aren't public they someone has to call them and ask um but if it's out
there in that document that says these are will for sure count um that makes me feel like we've we haven't set someone up to take a course that then doesn't count it's a good point and I understand where you're coming from the other option would be to
some put something in the regulations that says you know aspiring practitioners must reach out to inspectors to confirm that their piercing anatomy course meets specifications before enrolling in it something like that you know it's up it's up to you all it's just another
just another option or presumably a a vow that we would keep a a list on our website that would have the courses that we've looked at in a separate document that's a good idea yeah it's more that to me that I would really like
it to be public facing and you know they know what counts um it's a good point yeah so in terms of taking a vote you're saying that it will be a conditional based on this last piece that you want to figure out with respect to Well I
mean I'm I'm happy with that that um compromise at the end which is to say please check the town website for a list of pre-approved courses um and then say whether save each life is on that or not
we can figure out sign um but do do people feel like they've had a chance to read the edits and the revisions to this policy and and are you know capable of making a vote or do they need do you guys need more time
i feel like voting okay yeah I'm good with voting for all of the all of the changes okay so the I will put it forward since I have to get the wording right um so we are proposing um to
finalize our I should get the name right body art regulations um with the current changes with the one exception that we will change um it will not be an appendex of the approved courses but
rather on a uh public health website and tell people to look for approved courses there um and so yes that is my I am putting that forward and if someone would like to second
second dia seconds uh Jack uh approve premla yes okay i approve dia approves okay that's really exciting uh Kiko you will let us know if we have to do a public hearing on this um it sounds
like maybe from Cheryl we don't um but you'll you'll get back to us on what what what happens next i mean Cher I know Cheryl was very clear that I should check with town council and I will do so and at the same time I want to say that again we've gotten feedback from the
constituents extensive feedback from the constituents in town about this so I feel like that's the purpose of a public hearing and that we've achieved that through our efforts so anyway but yes I will let you all know do you know if the inspectors had a chance to look at these
Um not since we made the most recent revisions no but I definitely will pass it on to them um okay so maybe before we sort of put it into the files make sure there's not something that they catch yet for sure yep before it's signed
sealed and delivered yep okay so um that is the old business is there any There is no new business nothing listed anyway so we're on to director's update
yes okay um so briefly um COVID levels have remained low flu is finally tapering off i think we're emerging from the winter respiratory season although if my husband is any indication people are still getting sick he's sick today so it's still around but it's better um
we are offering uh COVID and flu vaccine dropin hours in April so Wednesdays every Wednesday in the month of April from 11 to 1 public health nurse has her door open for people to drop in if folks haven't had a flu shot it's still not too late um COVID shot especially for
people over 65 even if they had a shot in November they are el can be eligible for a second booster a spring booster if it's been six months since their last shot or people who are imuno compromised can also get a second COVID booster two months after an initial one so we're offering this last sort of harrah for
vaccine on this sort of drop-in basis for the month of April um and then starting in May public health is going to be offering public health nursing dropin hours um on every Wednesday of the month from 1 to 3 Olivia again will have her door open for people to drop in
for blood pressure checks just to chat with the public health nurse about health concerns they might have um get pro health promotion materials and referrals so we're really wanting to as I've said so many times to this group really wanting to engage with the community have an open door policy have let people know that we're here to help
and here to provide information and connections that folks might need to be healthy um excited that we will hopefully have an Ammerst College intern this summer have offered the position to someone who's accepted she's applying for a scholarship which is critical because we don't have funds for this job
and I strongly believe that interns should be paid so it's a partnership between us and Amoris College um so hopefully that will work out and she'll be working on a vaccine our vaccine education campaign that's beginning to take shape so that's we might even have
a UMass Ammeris uh intern as well not sure about that the Amoris College one looks very promising so that will be great um just briefly there was an article in the Gazette about this last week and I might have mentioned it to this group before i'm not sure that we do have these opioid settlement funds
that we're beginning to spend um we decided to make a So we have almost $400,000 in these funds already in the coffers and with more coming in every year from various lawsuits and there are still others out there that are being settled so this is like a continuous
steady stream of moderate income that can support efforts to mitigate the impact of the opioid crisis in the region and in our town so we because it is really a regional issue and people sort of go from place to place and because um people with lived or living
experience of using drugs sometimes struggle with housing issues this is a grant with Tapestry and um Craig Stores from the state it's a matching grant so two three cities Ammeris Northampton East Hampton contributed $50,000 each from their opioid settlement funds to
get an additional 150 from the state which is now given to Tapestry and Craig Stores the shelter here in Ammerst that also does a lot of regional work sees people who are from around the county um they do outreach as well as providing shelter for folks who are unhoused those two groups are going to work together to
do some intensive harm reduction efforts and efforts to house people who um are you are people who are in recovery or who are using actively using drugs so that's really exciting way to use our opioid settlement money in collaboration with other towns and in a regional way
um so that will just be beginning um I think the public health excellence grant I mentioned earlier is a great resource hope that we can sort of use it to come together to solve some of these you know thorny problems like what do we do about body body art
regulations and we've been reassured by the folks at um the state that the public health excellence grant is not going to be jeopardized by any cuts to federal funding we had a call just this week and the leaders uh Dr goldstein and Sam Wong who's the director of the
office of local and regional health we're clear that there have been some cuts to federal funds that will have an impact on the work that we do in Massachusetts there were some COVID grants that have been cut that were funding some local health departments not Ammerst um but you know we're it's
been a bad week from a health standpoint in terms of what's happening at the federal level i think you all heard about tens of thousands of DHS folks being laid off so it's it's feels very shaky but fortunately we here in Ammerst our funding is secure you know we're
going to continue to do what we continue to do and we're thankful that that public health excellence work is intact and won't be threatened by anything happening at the federal level um some news on my end is that I've been asked to serve in a temporary
role as the senior center director because the senior center director uh resigned her last day was last Friday and so I've stepped in to wear an additional hat so I'll be managing the senior service senior services senior center until um a replacement is found
so I'm doing that it's great there's a lot of synergy between our departments we see a lot of seniors in the health department and I'm just down the hall so but it is today was actually a heavy week i felt a little bit like oh this might be some some work so So have patience with me if I'm not as
responsive as you would like and feel free to nudge me if you need something from me and I'm not getting back to you um but I'm excited about that opportunity um I I did want to mention that speaking of the public health excellence grant we
had talked about this um MAHB training for boards of health and Cheryl actually referenced that she was preparing a presentation for one of these trainings that's happening on Saturday and I had hoped that we could get funding for interested board members to pay the $100 registration fee through the public
health excellence grant but it turns out that that's not an available resource so last time we talked about this a few people were interested the Northampton training is on the 26th of April and then there's one in Marlboro on May 10th um I think if folks are interested I'm
I'm going to look at my budget i mean if you can pay for it yourself fabulous if not I'm going to look at our budget and see if we might be able to you know sponsor maybe two board members to go i'd like to go i mean Cheryl's a great presenter i think she has so much expertise and so many things and there
are many topics on the agenda that are of interest I think to all of us so I just wanted to ask what folks thought about that are people interested in going and should I see if we can find funding how important is that for people i already registered oh you did okay
yeah and uh you know from what I understand they're going to send the bill for registration to you which is that what it said in the registration was that clearly worded uh yeah yeah interesting okay okay okay
that's good i'm I'm very excited that you registered i I think we can manage it um I think I I don't know if any of the others of you would want to go you don't have to tell me now but I'm unfortunately out of town so out of town okay okay anyway what's the date uh it's
April 26th for the Northampton training and then the May May 10th one's in Marlboro which is a drive from here so think about it and then Premla don't don't worry i think we can handle that don't we'll cover it it'll be fine thank you it might be worth reaching out
to Betsy though just to see if she registered yep and speaking of which I did want to make a rather unfortunate but bittersweet announcement which is that Dia is going to be stepping down from the board because she's moving to Northampton and
will no longer be an Ammeris resident so very happy for her but sad that to see her go so Dia I don't know if you want to say a few words thank you thank you Kiko um I want to express my gratitude um for the opportunity to learn about how to be a
dedicated board member um and to think collaboratively uh and address issues that that matter uh deeply to us um on the on the board of health while I'll be relocating uh and must resign um I'll still be studying in the town of Ammerst
um and and watching the YouTube videos of the board of health um and hopefully have an opportunity in the future to um use some of the the valuable um tools I've learned um in my short tenure and so thank you very much for the warm
welcome um and sorry to go so soon you will be missed you will definitely be missed you've been a great and wonderfully engaged participant in these meetings and we'll definitely miss your contribution to the conversations so but wish you all the
best and do keep in touch both thank you very much thanks Diane thank you so that does mean that we'll have a vacancy then um so I'll be talking with
Paul about um the process for filling that vacancy i'll keep you posted on how that goes i think that's it for my update i think there are two items that I'm thinking we should talk about unanticipated 48 hours before the
meeting before we um adjourn which is that what what does the what is the board's preference in terms of virtual versus in-person meetings so I think we want I think we would be good if we could kind of have an understanding about how we want to move forward we had in person last time it was lovely to
have everyone together do we want to switch back and forth is one question and then and I'll and I'll punt it to you Risha to to handle to facilitate these two questions but the other question that I had is about the regulations the tobacco regulations when the effective date would be i forgot to
bring this up earlier when it was the agenda item because um there will be sort of a transition time needed since we're making a change to what products are able to be sold in places and you can't just sort of say effective tomorrow because it get need people need
some time to kind of plan so I think that's something the board needs to decide too is the effective date of the regulations is there any precedence on how long would be reasonable
um I think I've seen I think I've seen anywhere between sort of three and six months depending on the sort of you know significance or depth of the changes um so three months would be somewhere in
July how do people feel about August 1 sort of just making it around you know at least three months the next the next slot that is over three months
works for me yeah i defer to whatever Kiko thinks the biggest change is probably the pouches yeah that they have to take off the larger amounts from the shelves right i think that's
the biggest change yes so three months seems reasonable to I think so work through that stock i mean you you could say July 1st which is the beginning of the fiscal year not that people who aren't in government care about that so much um but August 1
is fine if that seems like a little bit more time yeah i I wouldn't want to make it less than three months i you know they they have stock they have stock in orders they um I don't want to put them in a jam
um so uh do we have to vote on that i think I think it would be good to take on that yeah does anyone want to make a motion to start the regulations on on August 1st i'll make a motion that the tobacco
regulations should go into effect August 1st 2024 five five sorry uh oh great all those in [Music]
favor myself Jack and Premalai okay great um and before we and I've already forgotten your other thing that I'm supposed to facilitate but before we go I also I mean it feels like we should announce that Premla while Dia is leaving that Premla has agreed to stay on for another term yes and we're really
grateful for that uh thank you Premala we're really excited to have you for the next year thank you Risha sorry Premal i neglected to mention that but yes we're so grateful to have you so grateful thank you um the other thing we do
virtual or in person how do we want to manage it how do you want to manage it so I I see the options as um we could go every other we could do a quarterly inperson um or we could just do as needed so sort
of you know having some of the public comments or you know certain types of uh um of meetings does anyone have a I know it's much easier for all of us to stay in our homes and be able to to join that way but there is absolute value both in
terms of meeting each other and and building that that trust and relationship and also um you know the the contrast in who shows up we get more local people showing up and commenting uh when we do
it in person versus the um the folks from out of town that come when it's virtual i think quarterly seems reasonable um that seems like a good compromise to
me because that would be more than as needed so I guess we could say at least quarterly if it should come up that we need to meet in person more often than that for a given situation then we do
that make sense Jack yeah I agree i u I you know go either way but uh yeah I think we should be meeting occasionally you know in person i I
don't know if it's confusing uh to you know the announcements or whatever but probably not and and Kiko and Mahen you you both have to join so it matters what your preferences are for these two
yeah I mean I like the inperson meetings you know I think more than once a year in person would be great so um and and I more governor Healey did just authorize the ongoing um you know permissibility of virtual meetings for
these kinds of open meetings because that expired at the end of March um I was just going to ask yeah it was an artifact of co but it's been successful i think it really has helped with engagement so it's going to still be allowed but I think the value of being able to alternate is good
it so it's quarterly quarterly sounds good to me i mean I think I guess then my question would be is it something that you schedule ahead of time or do we sort of just agree oh then it's been in two months since we've met in person let's meet in person next time or certain things like public hearings to
your point Premla we would maybe prefer to do in person and we adjust that way or so set schedule or kind of adjusting as people feel the need i prefer a set schedule uh because I
will make different arrange you know I have childcare arrangements but also just you know I will make sure I don't have meetings up until 4:30 if I have to actually physically go somewhere um so I would prefer a little bit more like you know that we plan it out maybe not now
because I actually have to go uh at the hour but um that you know we set up the schedule in advance of which ones will be in person and then obviously ly if if changes are needed then changes are needed but that sounds good and dia doesn't give a
say on this one anymore okay thanks for raising that Kiko I think that's really useful yep I think it's a good plan I know you have to go but uh Kiko how' the uh cup of Joe go oh it was great it was great was there for a little while
which was nice and I met a lot of Great people got some good questions felt like it was really good PR for public health yeah thank you i really wanted to go but sorry I missed it but no worries yeah moral support thank you i I felt the support so and a good we had a good turnout and people were really engaged
and asked good questions so I was really pleased nice yeah thank you yeah so sorry I have to run it's my mom's birthday and I missed dinner and I want to get there for cake so Oh all right well happy birthday to your mom thank you Risha all right so I will
motion to end adjourn the meeting at 7:01 uh all those in favor i don't think we're going to do a All right bye everyone thank you everybody good luck [Music] D thank you