[Unidentified]: This meeting is being recorded.
[MaryAnn O'Connor]: OK. Hello, everyone, and welcome to the January Board of Health meeting of the City of Medford. We have members Dr. Platterwoods and Kathy Chabonier joining us today. I hope you all receive the agenda minutes. Yep, good to go. All right. Dr. Platterwoods, would you like to open the meeting?
[Adam Hurtubise]: Sure, I'll officially open the meeting. First is the approval of the minutes from December 20th, 2022. Anybody oppose? Kathy?
[Unidentified]: No. They look good.
[Adam Hurtubise]: OK. Minutes are accepted.
[MaryAnn O'Connor]: All right.
[Adam Hurtubise]: Update on Meffert's tobacco regulations.
[MaryAnn O'Connor]: Can I get an official vote? Be back in just one second for the record. Official vote to approve the minutes, Dr. Plattowitz?
[Adam Hurtubise]: Yes.
[MaryAnn O'Connor]: Yes. Thank you. It's all right. Sorry, keep going.
[Adam Hurtubise]: Next is the tobacco regulation.
[MaryAnn O'Connor]: So I did send out the updated version that shall did so nicely. And Maureen sent to me so that you could review. I don't know if you have them in front of you. Yeah. So typically, like most all of our regulations, we have our statement of the purpose and all of our definitions are included. So the real regulation after the definitions are listed. Well, it doesn't start till page seven. And a lot of these are what we currently have in our med for tobacco regulations. But now we're trying we're incorporating the state's level violations and suspensions and some other additional updates that were put into effect by the state July 2019, 2021. Right. 2020, Marianne. It was all over. Okay. So, all right. And I think some of that one page seven, the signage is a little bit of an update. Is that correct, was we want to ask. So the right signage. I mean it's not like we could vote on that boat because that's what's in the state right now so we're just incorporating into to operate. So updated signage, the identification of every single purchaser of tobacco products now, regardless of how old they may appear, need to show ID, right? That's new within the state. Nothing for us to really vote on there. Tobacco sales permit is on page eight. That's already currently the way our regs are written. We could update if you wanted on page nine sales. We have the limited minimum pricing. Right now we have a single cigar for $2.50 pack of two more than five. I don't know what is interested in changing that at all just keeping it as is.
[Maureen Busby]: So Cheryl would know better across the state how many municipalities have updated that. I think three of my communities did update and went from $250 to $290 for a single and $5 up to $580 for a multi-pack. But a community I was working with the other night elected not to increase the minimum price. So it's really up to the board if you, the idea of increasing the minimum price is kind of to keep up with inflation. This was set several years ago when we were attempting to limit access, youth access to those pink and purple foil wrap cigars that were selling for 69 cents, 79 cents. And we figured that if, you know, if kids walking into a school, you know, middle school kids walking into a school after, in a store after school might have a dollar or $2 And we were just trying to limit their access by increasing the price. And so you have the minimum price already of $2.50 for singles, $5 for multipacks. So the question is, do you want to increase that minimum price?
[MCM00001745_SPEAKER_04]: Correct me if I'm mistaken, but I thought that a decision was made that they did not want to increase the price. Maybe I'm wrong.
[Maureen Busby]: Yeah.
[MCM00001745_SPEAKER_04]: Yeah.
[Maureen Busby]: I think it was right Miriam. The idea was to get a draft of what the board was thinking about at that time and then vote on everything in this meeting.
[MaryAnn O'Connor]: Right. Correct. Correct. I mean, we don't have to increase if you don't want to so.
[Unidentified]: You still on mute.
[Adam Hurtubise]: I would just I would just leave it. The next one is 255.
[Unidentified]: What are the other municipalities doing that most have increased?
[MCM00001745_SPEAKER_04]: The increase was proposed because Boston increased it based on the consumer price index. The difference now is that many of the products that were captured with this cigar packaging section in the regulation are now illegal, because they were flavored tobacco products mainly, and now state law prohibits them. So I would say it's 50-50 for municipalities that are just leaving the price as is, and half of them are increasing the price based upon what Boston did.
[Unidentified]: I mean, I'd go with Dr. Plotowicz on that, say in the 50-50.
[MaryAnn O'Connor]: Okay, sounds good. The next section on page 10-H, again, the sale of flavored tobacco product, that's state law now, so that's in our regulation. It's written the same with the nicotine content, no greater than 35 milligrams. And the documentation, that's state law now. So we've added that to our regulation. We've always had the prohibition of blood maps and the coupons and out-of-package sales. So the next, everything else is currently in our way. There's no change. There's no change for health care institutions. educational institutions. So the next change would be section s on page 12. And that is the incorporation of state laws and state. And again, nothing we can do that. But under violation section T, we had a discussion at our last meeting on this. After the first sale to a minor, the state fine is now $1,000. But what we need to vote on today is they allow us to set a suspension time period. And it's what no less than one no higher than 30 right. Correct. So in this regulation we propose three consecutive business days after the sale to a minor and $1,000 fine. That's something that the board would need to decide that that's what they want to do. So again, it's no less than one day no greater than 30. We proposed in this regulation, three consecutive. Just as an FYI, we did have two stores on Martin's most recent compliance checks. We did have two stores that sold to a minor. So they are receiving their $1,000 fines, but we haven't let them know what the suspension will be at this point, because we're waiting for the board to decide. Dr. Clatterman, did you want to jump in?
[Adam Hurtubise]: Oh, the were the minors. I'm just curious.
[Maureen Busby]: 717 female, a 17 year old female.
[Adam Hurtubise]: Okay.
[MaryAnn O'Connor]: All right. And she asked for a pack of mothers. Correct.
[Maureen Busby]: Right. That's right. And I sold both in both stores. Yep.
[Unidentified]: Sounds like a problem to me and that we should go higher on the suspension.
[Adam Hurtubise]: Yeah, I'm all concerned about that in that, whereas the first violation one and two, these are a lot of mom and pop shops and cigarette revenue, tobacco product revenue is a big part of their substance. So as a first violation, I'm a little inclined to be a little lenient. mindful of the small business owner, which I believe a lot of these stores are in the city of Medford. I'm also coming down hard on the second time, and that's already built in. But I'm a little bit inclined to be somewhat more lenient on the first offense, because it is the first offense, and because of who we're talking about. you know, mom and pop five and tens type corner shops.
[Unidentified]: Don't they have to show identification anyway?
[Adam Hurtubise]: Yeah, they should have been carded. But if you have a part-time worker, you know, another kid that may slip by that's happened before. It was a new helper, you know, and the guy was contrived. The owner was contrived and never happened again. He trained everybody and you know, that stuff might happen. So I just don't want to. come down with a 30 day suspension on a mom and pop shop. That depends on those sales. It's not a big chain store, you know?
[MaryAnn O'Connor]: How do you feel about the three day suspension?
[Adam Hurtubise]: Yeah, that's okay. That's okay.
[MaryAnn O'Connor]: It's more than one in front of us today. Is that okay?
[Adam Hurtubise]: It's kind of up there, but it sends the message. I think that's a good compromise. More than one, but certainly not 30. for a first time offense. Yeah, you do it again, then it's different.
[Unidentified]: Okay, so can I get a motion to have the first fine of $1,000 be given with a three day suspension.
[MaryAnn O'Connor]: for sale to my first offense.
[Adam Hurtubise]: I want you to approve what you just said.
[Unidentified]: OK.
[MaryAnn O'Connor]: I would vote yes on that. OK. Second by Kathy. All right. So can I get a formal vote, Dr. Plattowitz?
[Adam Hurtubise]: Yes.
[MaryAnn O'Connor]: Kathy Shabaniya? Yes. OK. Motion to set three days is approved. Thank you. And I believe if you see. Oh, great job on page 13. It's pretty clear outlines a list of state versus local fine. So, the violation for the state first offensive thousand second offense. 2000 and the third offense is 5000 for sale to a minor. However, for the policy subject to our local regulations in Medford. We are confined to first defense of $100 second 200 and third 300. So I think I really appreciate the way that the. finds the state versus the local or were listed out makes it much more clear, I think, for folks to, to understand that. And I believe that's all that we needed to really go to change or incorporate. Everything else looks like it stayed pretty close. I think we're good. I think we're done on that. And I'll have to go back to those two stores. What do you mean? Yeah, just one last thing. So effective date for these changes? I believe the effective date could be today. Correct, Cheryl?
[MCM00001745_SPEAKER_04]: Yes, because you're not changing anything retailers know are already subject to these laws.
[MaryAnn O'Connor]: Okay, so let's take a formal vote to approve the regulations as written with incorporated in the states and the three-day suspension and the effective date being today, July 17th. Oh, would I say July? I want it to be July, January 17th, 2023. All right, can I get a motion to approve regulation, Dr. Plattowitz?
[Adam Hurtubise]: Yeah, motion to approve. What you just said.
[MaryAnn O'Connor]: OK. Take a formal vote, Dr. Plattowitz. Yes?
[Adam Hurtubise]: Yes.
[MaryAnn O'Connor]: Shabana, yes?
[Unidentified]: Yes. Yes. Can you hear me? Yes.
[MaryAnn O'Connor]: Yeah. Thank you. Okay, perfect. We're good to go. Thank you very much. Thank you very much. Thanks for your help.
[Unidentified]: Thank you.
[MaryAnn O'Connor]: Okay, next on the agenda so I'm going to let Sophie Greenbaum do a better summary, because I'm choking at this point. But Sophie's going to present some data that her grant has been working on. It's a regional grant, but she also has great metadata, youth focus, prevention focus issues. And I'm going to let you explain that while I cough.
[MCM00001230_SPEAKER_01]: Sure. Thanks, Marianne. So my name is Sophie Greenbaum. I am the Mystic Valley prevention coordinator on this specific grant that's called Mass Call 3B. So I'll tell you a little bit about the grant and then I'll walk us through the assessment. I'll try to keep it as entertaining as possible. I know data presentations are not always the most fun, but I think it's really helpful. There's some great quotes in here and we can learn a lot about what's happening in the region. So I'm going to share my screen and okay. All right, so we have the mystic Valley Public Health Coalition, as our overarching organization, and then mass call three be which is within a grant that is funding mystic Valley. So this is our central coalition, but then we're working across Malden, Medford, Melrose, Reading, Stoneham, Wakefield, and Winchester. So they have their individual organizations that are doing the work within their own towns that are collaborations across A couple of different sectors trying to think about youth prevention efforts. For the most part, some of them have a little bit of flexibility in what they do. And then representatives from each of those coalitions come together and join us as a part of the Mystic Valley Public Health Coalition. Right now we are working on a grant that is looking at primary prevention for substance misuse among our youth and young adults. Some of the main goals for this are making sure that what we actually implement is evidence-based or at least evidenced informed. We have this period of data collection that happened over this past summer, so summer 2021, And then we're making sure that we apply a racial equity framework to every stage of our grant, as well as a couple of guiding principles that are from BSAS, from actual funder. So they're just highlighted out here. We're using this as our framework as we think about our capacity building, as we think about our strategic planning. This is also a big part of what was infused into our actual data collection period. So, if we're going to just take a look at the Mystic Valley Public Health assessment, there are a couple of key areas that I'm going to go over. There's the assessment information itself, the demographics of who we talked to, what did that look like, some of the key findings, and then where we're going with this grant. Where is this supposed to be taking us? So our assessment information, we had qualitative and quantitative data. Our qualitative data were key stakeholder interviews, focus groups, and then we had our quantitative scores, which came from primarily our school surveys. So it was the YRBS, the communities that care data that happens here in Medford, and then just a smattering of other data about suicide and overdose. our court data, and a variety of other things that were available that everyone was able to then collectively pull together and give us a better picture of what's actually happening across this region. I am going to spend some time focusing on the qualitative data today because I think that that gives this really nice picture of what's going on, and then I'll complement it with a little bit of the quantitative findings. A lot of this probably will already be familiar to many of the folks here. I'm sure that many of these findings you've heard in other presentations that might be specifically towards Medford or, you know, just in general kind of makes sense. But it's important to see what's happening as a region so that when we do start to make actual implementation strategies, we have something that we can cohesively say works across the entire network. Some of our limitations with qualitative data is just, it's subjective. It's one of the things that makes qualitative data really wonderful but it also makes it challenging in that we can't take a single quote or a single theme and say that this applies to every single person in the region. These are just experiences that are sort of coloring in what we see in our quantitative data. There is also a decent amount of representation that came from Melrose and lesser from some of our other towns and communities. So it is a little bit skewed in that way. And then we recruited on social media, I believe actually primarily through Facebook. That also skews a little bit of who actually responded to the call for stakeholder interviews and things like that. We're going to go over the demographics for qualitative data. I won't take too much time here, but just give you the highlights. We have primarily cis women and girls, primarily people who identify as heterosexual or straight, Primarily black or African American respondents, followed closely by white. We have a lot of youth who were interviewed, which is awesome because that's giving us a really good idea of what's actually happening, what are they seeing, what are they talking about, and then a solid representation between 25 to 44. about half and half almost for people who have parents who are immigrants to the United States. And then representation of languages spoken at home. This asterisk over here is just saying that people were allowed to respond to more than one language. So if these percentages are not making sense to you over here, it's because people could endorse multiple. And I'll also say that all of the interviews were done in English. take that as we're going through this. Some of our key findings. So we had a consultant conduct the actual analysis. She took our qualitative and quantitative, put it together and gave this really pretty thorough report. I can actually distribute that to you all if that's something of interest that you'd like to see. There's a lot of detail. Anything that you might be interested in here is certainly covered from that report. This presentation is built based on her report and based on the highlights. Those are a lot of data that she combed through. She had a couple of key areas that she uses these big buckets to separate out the qualitative data. I'll go over the risk factors, protective factors, and the needs because those are some of the key areas. The substance use, I'll also cover lightly, but you'll see it all works together. So as far as our protective factors, there are four main themes that popped out pretty quickly. So people are endorsing supportive communities. There were a lot of conversations about our schools, having trusted adults in the schools, feeling like there are environments where people can be supported based on their identity and their authentic self, whether that's within the community or within their home or within the schools. There were also some great comments about prevention education and feeling like there were opportunities for professional development or opportunities to have students learn in their health classes. Positive youth development, which is really awesome that that is something that even came up in these conversations. but just the idea that students feel like they have these opportunities to be autonomous and take control over their own health and choices. And then adult relationships. So people endorsed having trusted adults across a couple of different spaces, including their coaches, guidance Councilors, parents, siblings, family members, and neighbors. So, I won't read you every single quote that is on the next couple of slides but I do think that they're really helpful way to think about the way that some of our students and community members are thinking about what a supportive community means. So in these quotes here, there are a couple of comments about being able to feel like as you're walking home. There are people who are waving at you who recognize you you have the sense of belonging, and a sense of, you know, other people are here to support you even from a distance. There are some comments about having supportive teachers for LGBTQ students and teachers who are openly supportive of that and may even identify as a part of the LGBTQ community. And then talking about the connections with faculty members that feel really supportive and engaging. The prevention and education piece, I think, is a little bit more straightforward. It's kind of what I just said about having these overarching programs that are available for students and community members that are really focused on prevention and a little bit more proactive. The comments about positive youth development is saying that there are a couple of locations where it feels like you can just go and you can enjoy being a student or enjoy being a young community member and that there are people, adults specifically, who are going to uplift your voice and have you as a part of the decision-making process. I like this like bottom piece down here with the high school Councilors. Let's help them be responsible as community citizens and take charge of who your community is and you're a part of that community, which I think is one of those big takeaway messages that's so important to have our students feeling like they're empowered and they have the ability to shift change and shift culture within the school or within the community. Adult relationships, again, very straightforward. People feel like they have them. They're available across a couple of different areas in the community. We also have our risk factors. So mental health was a big one. And that really spanned across a couple of different ideas. So we had the issue of treatment options, the issue of being a young adult who may have to get their parents involved if they want mental health services and maybe not feeling comfortable doing that. So some of the stigma components, community norms. So again, this survey really is in the context of substance use. So there were some people who endorsed just confusion around what is normal substance use. Some of this was about alcohol use in the way that adults consume in social function. Some of it was about marijuana, conflicting messages, the impacts of COVID. I don't think anyone here is surprised to see that that came up in the survey. and then using substances to cope or self-medicate with issues like bullying or trauma or family stress, things like that. Mental health, this is exactly what you would think about where there are people who are really struggling and end up using substances in the context of mental health struggles like anxiety. There's also a piece where there's the disconnection from normalcy with school and kind of that structure that happened during COVID and also concerns about when people are isolated and those mental health issues just increasing, especially for young adults and students. Community norms. So I think that the second quote here is really important to think about. This is taking the context of adults and what they're doing and thinking about the way that people are using substances in the community. And it's just very normalized. And so then it becomes pretty quickly confusing for our students. impacts of COVID. People got to hide behind their screen for a year and they lost some of their confidence and motivation. I think being kept inside for a year or two years and then being like let loose, spike substance use in a lot of teenagers. So again, these are perceptions and things that students feel like they are seeing in their school community and among their friends. And then the coping and self-medicating piece. I think that also is a little bit more straightforward. So, when we're thinking overall about substance use across our qualitative and quantitative data, you'll see here that this maps very, very closely to what we're seeing here. So, in this past 30-day use with our quantitative data, people are talking about alcohol, marijuana, and vapes. This is how our qualitative data ended up laying out. So the first discussion point was vapes, then marijuana, then alcohol. But again, these are the top three pretty consistently. In most places, you know, most of the coalition meetings that I've been a part of, vaping comes up. almost every single time. Marijuana is also a major point of discussion and it seems like as far as vaping goes, it doesn't seem like there are a lot of solutions that are readily available and that's going to be something that I'm pretty certain we'll end up focusing on through this grant. And then the major areas for improvement in needs, this goes back to our mental health issue. So there need to be more treatment options. There are issues of expense, issues of people wanting in-person services rather than something that's online. Schools, people were talking about needing more prevention education and having some of these things be proactive rather than a reactive response to something that's happening in the community or already happened. And then more youth activities. So there's this gap between our elementary schools and high schools where it doesn't feel like there's a lot, or in our high schools, a lot of things being focused around sports and competitive activities, after school activities, rather than things like the arts or other spaces. Here, I know I'm kind of coming close on some of the time I don't want to take up too much time here but I'm happy to share these slides if you want to take a look through some of the quotes. I think it's especially helpful to see with our students. I think this was also an interesting quote having the Winchester parent who's talking about just trying to look for someone to see their daughter to help with some pretty basic issues as far as stress and anxiety, and then just not being able to find anyone. We've heard that very consistently I know that there is the change. to the community health behavioral clinics, but we'll kind of see how that rolls out and if maybe that alleviates some of the burden that people are feeling right now. Our schools, so this is the first quote talking about vaping in bathrooms that comes up all the time. And then just a way to get information into the schools and have that communication back and forth between what we're doing, what other community organizations are doing and what our schools are doing. And then youth activities, which I pretty much already outlined. And then this contributes a piece about youth action teams. So in Wakefield, they have a youth action team. A couple of our other communities have these teams where they bring together the students and they are running some of their initiatives. We also have a regional group that is run through this grant as well. So the next steps for this grant really look like a couple of things. So we'll have data share back events, so we're going to take all the information, not all of it, actually let me rephrase that, the highlights of the information that we got in this assessment and share them back with the community to get feedback. We really want to know some of these qualitative pieces of information here. Does that ring true for a lot of our community members? Does it vary by population? What are we missing? What did we not get here? That's really important to think about when we're starting to consider strategic planning. Capacity building is another piece and another component of this grant. So We had a meeting in actually about a month ago as part of the prevention professionals, which is a part of the Mystic Valley Public Health Coalition, to think about what tools do we need to make sure that what we actually come up with is sustainable. And then our strategic planning. So we have all this information, we have feedback, hopefully in a couple, you know, like in a month. What are we going to do with this, how are we going to best make use of these funds and make sure that we're coming up with things that feel. like they resonate with the community and they're actually changeable. So that's gonna be probably our biggest upcoming challenge as we try to make something work across seven communities that all are pretty different, but also a really exciting part of the grant where we can get to the action and get to the pieces where we're actually doing something with our individual communities. And that is all. Thank you so much.
[Adam Hurtubise]: A quick question. Any data to correlate the students' responses to their families, i.e., what's the prevalence of marijuana use in their own family from the adults in vaping and alcohol? Because if their own families are doing it, I don't think they get a chance of now of not doing it.
[MCM00001230_SPEAKER_01]: Yeah, that's a really good question. And not something that I necessarily feel like I have the numbers to support I can take a look at what we have, but that is one of the big things that we are probably going to have to think about so I just shared a couple of quotes that talk about adult use and then what children are saying, but there were definitely like more a good handful of qualitative quotes where people are talking about well my parents say I'm not supposed to drink and I shouldn't do this but then they say well you can have um you know a beer at home or a glass of wine at home and then they have a holiday party where everyone's drunk and you know it's getting very confusing and students don't necessarily know what is appropriate so that's another thing that we want to think about how do we message that to our parents in the community so that they're able to provide more consistent messaging to their own children.
[Unidentified]: Any other questions or comments?
[MaryAnn O'Connor]: Great point, Dr. Platowicz. I think, you know, I've seen this presentation a couple of times now, but I think, you know, it rings so true. And it's things that we've known and we've heard for a while, you know, with the protective factors and the risk factors and lack of youth activities and sense of belonging and that such. So, you know, nothing, I shouldn't say really nothing surprised me all that much. I mean, it was really, I thought the quotes though really kind of, when you look at the data all the time, but hearing the words out of the youth's mouth really drives it home that that's not just day to one abuse day, but this is real, and it really affected these kids. continued good work and good luck with that grant and keep us posted and we'll have you back in this. I hope you consider some of your community feedback and there will be more of that happening within the community as well.
[MCM00001230_SPEAKER_01]: Yes, definitely. And I will say also just one last note about having those quotes and the youth voices. When we do the data share backs, we are hoping to have our public health youth leadership group have some representatives at our share back events so that they can actually read out some of the quotes to the community and give a little bit more life to what we're seeing even just written on a slide. And then if they're not available, also having some pre-recorded quotes from our students so that people, we can play it and have people understand that we are talking about actual, you know, kids who are like your neighbors and just, you know, trying to do their best through high school or middle school or whatever it is. So, yes, I look forward to coming back and sharing more once we keep going. So thank you so much. Thank you.
[MaryAnn O'Connor]: It's great. Okay, I think that's all we have on the agenda at this time. Any other questions or thoughts? I don't have anything else for other business at this moment. So we have a motion to adjourn?
[Adam Hurtubise]: Motion to adjourn.
[MaryAnn O'Connor]: Second. Okay, Dr. Kladowicz, yes? Yes. Kathy Chabonet, yes?
[Unidentified]: Yes.
[MaryAnn O'Connor]: OK, motion to adjourn is accepted. Thank you all.
[Unidentified]: Take care. Thank you, Sophie. That was great.
[MaryAnn O'Connor]: See you next month.