ERIE COUNTY BOARD OF HEALTH MEETING
MAY 6, 2014
PRESENT: James Hoddick, D.D.S., Carolyn Montgomery, PhD, NP-C, Dennis Galluzzo, R.P.H, Jonathan Daniels, M.D., Robert Free, Director, Food Service Operations, Buffalo Bison’s Baseball, Matthew Dunaif, D.V.M. via telephone conferencing
EXCUSED: Maureen Montgomery, M.D.
ERIE COUNTY DEPARTMENT OF HEALTH
Gale Burstein, M.D., Commissioner of Health, Cheryll Moore, Medical Care Administrator, Gregory Jacobs, Environmental Health, Roseann Jordan, Environmental Health
REVIEW OF MINUTES FROM JANUARY 14, 2014 MEETING
Dr. Hoddick asked if anyone had any suggestions, additions, or deletions to the minutes, there were none. Carolyn Montgomery motioned to approve the minutes as written, there were no objections and the motion was carried.
FOOD POLICY COUNCIL
Robert Free told the group that the Food Policy Council continues to meet on a bi-weekly basis. The council is divided into sub-committees and they are in the process of assigning responsibilities for each of them. Cheryll Moore said there is one on government policy, education and advocacy. They have also been tasked with coming up with a 25 word sentence for each of those sub-committees to describe what their goal or vision is. A lot of brainstorming has been done over the last couple of months. They are now at a point of critical mass where a webpage that lists what the Food Policy Council is about; that being education, advocacy and best practice. By the next BOH meeting they are anticipating having the website up and running; as well as a document out. The BOH will then need to approve this information.
Dr. Hoddick asked if he could be included on the e-mails regarding these issues. To which Mr. Free and Ms. Moore agreed upon doing.
REGULATION OF SMOKING IN PUBLIC AND WORK PLACES AS PER NEW YORK STATE LEGISLATION
Greg Jacobs introduced himself to the group. He went on to say that Agenda item #4 Food Facility Inspections was not going to be addressed as there was a miscommunication in that there was no representative from the Environmental Food Inspection division at the meeting. Mr. Jacobs that he could give some information on the subject, but that it has been a number of years since he has personally done food inspection. Dr. Hoddick said that it was placed on the agenda for general information purposes. He said that there was no problem in tabling the item for the next meeting.
Mr. Jacobs runs the Tobacco Enforcement Program. His understanding was that the BOH had questions regarding Hookah bars and electronic cigarettes. Roseann Jordan was on hand also as she is extremely familiar with Hookah.
Dr. Hoddick said that the BOH had concerns with the direct effect on the smoker as well as the second hand affects. Mr. Jacobs gave the members informative handouts on electronic cigarettes. He said that there are some issues with them in that the device itself is very standard; the cartridges that contain nicotine and other chemicals are not regulated at all. There have been proposals from the FDA and a document out of the Federal Register. They are looking at attempting to prevent them from being smoked in public places, because of the unknown effect on others. There have been no studies done as to the second hand smoke effect because of the newness of the product.
Roseann Jordan went on to say that she had examples of the various establishments that are selling e-cigs in Buffalo. There is a concern regarding
the social aspect of kids wanting to smoke them because of the flavoring. There is no one regulating the flavoring at this time; and there are many fruity and alcohol flavors.
Ms. Jordan had a menu of a place that sells these products. Dr. Burstein said that NYS regulates that the product cannot be sold to minors. Carolyn Montgomery asked if the nicotine in the e-cigs was equivalent to cigarettes. Ms. Jordan said that it varies. The vapor lounges in Buffalo carry liquid that goes from 0 to 25 milligrams of nicotine in bottles from 5, 10, 15, 20 and 30 milliliters. People are able to customize; so that they are able to go from zero in having no nicotine in them to having 25 milligrams. Or more if they compound it.
Mr. Jacobs went on to say that there are no laws preventing e-cig usage inside enclosures. It is not a tobacco product. There is no burning of tobacco so there is no second hand smoke. Consequently this does not fall under the Clean Indoor
Air act. Dr. Burstein said that there are certain entities such as Rich Stadium that have instituted site policies, where you cannot smoke e-cigarettes.
Dr. Hoddick asked if the FDA or the NYS Health Dept. is looking at this issue? He said that the BOH could look into it, however if the state entity manages it we will go down the same path as the smoking ban in Erie County. Mr. Jacobs said that the Clean Indoor Act does give the controlling entity of a place to designate it as non-smoking and technically the e-cigs (because they are being inhaled) is considered to be smoking. As it is not a tobacco product there is a legal loophole the business (such as a restaurant) can say that they do not want them smoked inside the restaurant. Mr. Jacobs commented that the FDA proposed regulations on monitoring or having some kind of control over what is being put into the e-cigs; and possibly also designating them as a tobacco-like product so that it falls under the same jurisdiction as the Clean Indoor Air Act. Dr. Dunaif commented that since nicotine is classified as a drug, it should be regulated by the FDA. Dr. Daniels commented that it seems that there are two issues involved. One is the product of themselves, the individual who chooses to engage in e-cig smoking, and the secondary issue is the person not engaging in that activity. I.e. the bystander getting the second-hand smoke. The e-cig smoker is taking the risk of ingesting the vapor into their body, but just because they are doing it, doesn’t mean that they are informed about it. Dr. Daniels asked if the packaging of the e-cigs is giving all the information to the consumer; as there is no regulation for any warnings.
Dr. Hoddick commented that amending the Erie County Sanitary Code is a long, tedious process. He felt that an entity with more jurisdiction may get into it. However if an entity as the State does not get involved, the BOH could add it to the smoking ban in Erie County. Dr. Burstein said that the County Executive is looking into including prohibiting e-cigs in our County building policies. We are developing a new policy for County properties. She commented that looking into the whole county is something that we could also do. Dr. Hoddick said that policy could be put into the Sanitary Code. He suggested looking into this for the next BOH meeting and perhaps we could look into what NYS is doing. He also said that when the BOH started with the smoking ban it eventually got taken out of our hands by the EC Legislature. They wanted to write it into the County code as opposed to the Sanitary Code. Since the BOH has small jurisdiction, we could implement it to the Sanitary Code, if however another entity can accomplish this on a more widespread basis it would be worthwhile. Mr. Jacobs said that Suffolk County implemented a ban on e-cigs in 2009.
Ms. Jordan handed out information on Hookah bars. Mr. Jacobs went on to say that it involves big chunks of tobacco soaked in either molasses or honey. It is placed in a pipe and it is smoked. Mr. Jacobs said that it is legal to smoke there as the establishment is licensed to sell tobacco products. Hookah is a very sensitive cultural issue. It is set up the same way the cigar bars are. Food is customarily served in a hookah, but then it becomes a restaurant where there is no smoking. Ms. Jordan said that people are trying to skirt this issue. She said that it is a grey area. Dr. Hoddick had a question regarding employees in the second hand smoke. Mr. Jacobs said that the tobacco business comes into play, as it is designated as a tobacco business. Mr. Galluzzo questioned if second hand smoke is a problem. Ms. Jordan answered that it is very similar to cigarette smoke. She said that if you smoke a hookah for an hour it involves 200 puffs; while smoking
an average cigarette involves 20 puffs. The amount of smoke inhaled during a typical hookah session is about 90,000 milliliters compared with the 500 to 600 smoked with a cigarette. As you exhale you will have more carcinogens and contaminants. There are five hookah bars in the area, and another will be opening on Elmwood Avenue. Every one of them needs to have a tobacco license. Ms. Jordan went out to several hookah bars in the early evening, with a couple different agencies to observe. Mr. Jacobs said that they are also making sure that they are no minors on the premises. Sometimes a flavored alcohol is added to the base where the water is to enhance the flavor. However they have no solid evidence of this happening.
The sanitary aspect of what is being done, such as the counter tops being kept clean, and providing disposable mouth pieces can be addressed or regulated. Dennis Galluzzo indicated that instead of making a recommendation on e-cigs or hookah do a statement of what is found to be in the products and what to be aware of.
Handouts were distributed regarding how other states/municipalities were handling the smoking issue. Dr. Hoddick asked the members for suggestions on how to approach the issue. Dr. Burstein asked if an addition to the sanitary code could be done to outlaw hookah bars. Greg Jacobs did not think that hookah could be prohibited, but perhaps “sanitized” to some extent; or to make it more difficult for a hookah bar to be opened.
Dr. Hoddick suggested that we get legal on board, as well as Lynne Dixon to see if the EC Legislature could be involved. The BOH has limited power in these matters. Dr. Hoddick will contact Lynne Dixon regarding this matter.
PUBLIC HEALTH ACCREDITATION
Dr. Burstein said that we have completed our strategic plan. We are now working to implement it. Dr. Hoddick asked if there was anything the board could do to assist. Dr. Burstein answered that at this time there was not.
BOH’S MEMBERS’ STATUS
Dr. Daniels’s said that he had reached out to the City of Buffalo regarding their appointment, but had not heard anything back from them. He said that he would pursue the matter. We have information that Lynne Dixon would be selected to fill the E.C. Legislature’s slot, previously held by Lynn Marinelli.
The Memorandum of Support for Pharmacist-Administered Immunizations regarding Tdap will be posted on the ECDOH website under the ECDOH home page.
There was no other new business.
The next BOH meeting was scheduled for September 9 at 3:30 P.M. The meeting was then adjourned.