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9.A. - Page 15 of 31 associated with increased risk of heart attack.10 The American Lung Association has reported that there is risk for irreversible lung damage and disease as a result of vaping.11 (h) The County of San Mateo (the "County") issues permits to tobacco retailers. (Chapter 4.98). In 2018, in order to reduce flavored tobacco product availability, the County adopted Ordinance No. 04799, prohibiting the sale of flavored tobacco products and pharmacy sales of all tobacco products. (i) In spite of these efforts, San Mateo County youth still have access to tobacco products and are using the products. According to the 2018 California Student Tobacco Survey, for Region 20 (San Francisco, San Mateo counties), the current e -cigarette use prevalence among high school students in 2017-2018 was 20.8%. This prevalence is much higher than the state-wide prevalence of 10.9%.12 (j) In June 2009, the Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act) was signed into law to give the U.S. Food & Drug Administration (FDA) authority to regulate the manufacture, distribution, and marketing of tobacco products. The Tobacco Control Act was enacted in order to protect the public and create a healthier future for all Americans.13 (k) A central requirement of the Tobacco Control Act is premarket review of all new tobacco products. Specifically, every "new tobacco product"—defined to include any tobacco product not on the market in the United States as of February 15, 2007—must be authorized by the FDA for sale in the United States before it may enter the marketplace. A new tobacco product may not be marketed until the FDA has found that the product is: (1) appropriate for the protection of the public health upon review of a premarket tobacco application; (2) substantially equivalent to a grandfathered product; or (3) exempt from substantial equivalence requirements. (1) In determining whether the marketing of a tobacco product is appropriate for the protection of the public health, the FDA must consider the risks and benefits of the product to the population as a whole, including users and nonusers of the product, and taking into account the increased or decreased likelihood that existing users of tobacco products will stop using tobacco products and the increased or decreased likelihood that those who do not use tobacco products will start using them. Where there is a lack of ° 5 Jun 2019 https://doi.org/10.1161/JAHA.119.012317 Journal of the American Heart Association. 2019;8:e012317 i Moritz, T. (2019, March 18). Vaping: It's All Smoke and Mirrors. Retrieved from https://www.lung.org/about- us/blog/2019/03/vap ing-smoke-and-mirrors.html 12 Zhu S -H, Zhuang YL, Braden K, Cole A, Gamst A, Wolfson T, Lee J, Ruiz CG, Cummins SE (2019). Results of the Statewide 2017-18 California Student Tobacco Survey. San Diego, California: Center for Research and Intervention in Tobacco Control (CRITC), University of California, San Diego. " FDA. (2018, January 17). Family Smoking Prevention and Tobacco Control Act — An Overview. Retrieved from https://www.fda.gov/tobacco-products/rules-regulations-and-guidance/family-smoking-prevention-and-tobacco-control-act- overview 292