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By Sarah Peters
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Electronic cigarette smokers will soon find themselves cast outside with the tobacco smokers when an ordinance approved by Los Angeles city council members goes into effect. Lawmakers voted February 4th to include e-cigarettes under the same set of restrictions that prohibit tobacco products from restaurants, workplaces, bars and other shared areas like parks and beaches. Vaping stores and lounges are exempt. The ordinance, which received Mayor Eric Garcetti's signature, will go into effect April 19th.
While the vote by councilmembers was unanimous, the arguments for and against the ban were less clear-cut.
Science has yet to endorse a definitive winner in the debate over whether or not vaping is a safe health practice—and has less information still on whether or not second-hand vaping poses significant health risks. Both sides agree that no one has all the information yet, not even the Federal Food and Drug Administration, which has been investigating e-cigarettes for about two years without issuing a set of regulations.
The right thing to do in the absence of certainty is to protect the public’s health, because many thousands of lives could be lost while you’re trying to figure something out.
“The problem with e-cigarettes is that the rise in these cigarettes has been so rapid and the popularity has spread like wildfire, that there has not been enough time for all the scientific evidence to be available at the level that usually, at a scientific perspective, is required,” said Lourdes Baezconde-Garbanati, an associate professor at the USC Keck School of Medicine.
Due to lack of regulation, there is no one set standard for e-cigarette production. As such, e-cigarettes vary widely in what ingredients they contain, the potency of those ingredients and their effectiveness. All this variation has lead to some scientific studies contradicting other scientific studies.
“It’s not that we don’t have scientific evidence, it’s that we don’t have the level of certainty that is usually required from a scientific perspective,” Baezconde-Garbanati continued. “However, we do have very sound scientific studies that are linking these cigarettes and the aerosol emissions, that contain a variety of harmful chemicals, to [health risks].”
The liquid cartridges and vapor contain chemicals that are shown to cause eye and throat irritation and damage to the respiratory track, among other potential issues, she said.
In the last few years, there have also been emergency room reports of nicotine poisoning in children as a result of contact with the e-liquid or vapor, she added.
“This is not the same vapor that comes from your teakettle,” Baezconde-Garbanati said.
NOT JUST WATER VAPOR
E-cigarettes have risen in popularity due much in part to the claims of manufacturers that they are a healthy alternative to combustible cigarettes, featuring no tar or tobacco, less nicotine and don’t emit smoke.
“Safer does not mean safe,” said Director of Los Angeles County Department of Public HealthJonathan Fielding at the council meeting. “Although they are less harmful than cigarettes, some e-cigarettes may present health risks.”
Studies of the e-liquid and the vapor produced through the atomizing process show that some e-cigarettes contain not just nicotine, but also chemicals, heavy metals and food additives, he said.
Toxins such as formaldehyde, acetaldehyde, and acrolein; metals such as tin, silver, iron, nickel aluminum, sodium, chromium, copper, magnesium, manganese, lead, potassium and silicate nanoparticles; and carcinogenic compounds found in tobacco and tobacco smoke have all been found in e-cigarettes, according to information provided by Baezconde-Garbanati.
The propylene glycol and glycerin found standard in e-cigarettes and used to create the vapor have both been approved by the FDA for ingestion, but little is known about the effects of repeat or long-term inhaling, Fielding said.
“Since many of these chemicals are efficiently absorbed into the bloodstream from the lungs, they present health risks to the users as well as the nonusers exposed to the vapor,” Fielding said. “Second-hand vapor contains particulate matter that may trigger asthma and make the eyes, nose and respiratory track irritated. People in enclosed spaces simply should not be subjected to these risks.”
VAPING'S POTENTIAL WIDESPREAD EFFECTS
The discussion around e-cigarettes and their impact on public health doesn’t revolve solely around their chemical composition. Proponents of the ban on e-cigarettes point to use among adolescents, which has risen significantly over the last several years.
In a survey of middle school and high school students, use of e-cigarettes doubled from 4.7 percent in 2011 to 10.0 percent in 2012, according to information collected by the National Youth and Tobacco Survey and published by the Centers for Disease Control and Prevention.
Additionally, the survey found that more than 75 percent of those who reported having used an e-cigarette had also smoked a traditional cigarette, prompting concern from health officials that e-cigarettes can act as an introduction to combustible cigarettes and result in dual use of both products.
“[Tobacco companies] glamorize the use of e-cigarettes with celebrity spokespeople and other marketing strategies,” Fielding said. “This enhances the use of these cigarettes as a gateway to traditional cigarette use, particularly among the most impressionable [populations] which are our youth.”
While marketed as a smoking cessation device, research shows that most people use e-cigarettes and combustible cigarettes in tandem, oft times leading to an even longer period of traditional cigarette use before the person quits, Fielding said.
E-cigarette manufacturers have marketed dual use of the products as an acceptable practice, he said.
“This threatens to undermine decades of work to protect the public by re-normalizing smoking,” Fielding said. “This societal norm has helped keep children from beginning smoking and helped adults make quit attempts.”
Opponents of restrictions on e-cigarettes reject the idea that the electronic devices will somehow revive combustible cigarette culture.
“E-cigarettes do not re-normalize smoking; they normalize not smoking,” said Jeff Stier, a senior fellow at the National Center for Public Policy Research, at the council meeting.
Many smokers have seen success quitting with help from e-cigarettes and putting vapers in with the smoking crowd could threaten those successes, he said.
“[As an example], you have a smoker who has quit smoking,” Stier said. “They’re at a bar and they want to use their vapor product and that is good news for public health. Without an amendment that would exempt bars, this law would require former smokers, which to me are champions, to go outside with the smokers—that’s nonsense.”
Stier asked that the city council move slowly in its actions because there may be unintended consequences of overly broad regulations.
“The precautionary principal applies to regulations as well,” Stier said. “Regulations should be narrowly tailored to achieve a public health goal and they shouldn’t do more harm than good.”
Former Surgeon General Richard Carmona is among those who are concerned that banning e-cigarettes could do more harm than good.
"A well-intentioned but scientifically unsupported effort like the current proposal could greatly impede the effort to defeat tobacco smoking," said Carmona in a letter he penned for the Los Angeles Daily News. "This regulation, if passed, would disincentivize smokers from switching to e-cigarettes, since many initially switch for reasons of convenience. It would also send the unintended message to smokers that e-cigarettes are as dangerous as tobacco smoking, with the result that many will simply continue to smoke their current toxic products."
Carmona disclosed that he recently joined the board of Scottsdale, Ariz.-based e-cigarette maker NJOY in the letter.
PRECAUTION IN THE ABSENCE OF CERTAINTY
More than 40 cities within California already have varying ordinances that prohibit vaping in places such as restaurants, bars, parks, and at public events, according to the American Lung Association.
Culver City, Hawthorne, Baldwin Park, South Pasadena and Inglewood are a just a few of the cities in addition to Los Angeles which already bar vaping from some indoor and outdoor areas, as shown in agraph created by the California chapter of the association.
Once the ordinance goes into effect, Los Angeles joins New York and Chicago as a growing group of major cities that are placing regulations on e-cigarettes, an industry with sales that exceeded $1.5 billion last year, according to Bloomberg Businessweek.
Those sales are only expected to grow as the continued popularity of e-cigarettes rise.
That rising popularity is the reason why lawmakers need to act now, even though the FDA has not yet issued a set of regulations, Baezconde-Garbanati said.
“The problem is that although there may be potential for harm reduction in the sense that many people may quit [smoking by] using an e-cigarette, at the same time, the potential exposure of the aerosol is harmful enough that it is a major concern to the public health community,” Baezconde-Garbanati said.
Although scientist have yet to conclusively determine just how dangerous e-cigarettes are, enough studies have shown that some level of danger does indeed exist and thus warrants caution on the side of health officials, she explained.
“Therefore, the right thing to do in the absence of certainty is to protect the public’s health, because many thousands of lives could be lost while you’re trying to figure something out,” Baezconde-Garbanati said.
While the long-term effects of e-cigarettes remain unknown, about 500,000 tobacco-related deaths occur in the U.S. each year, according to the American Lung Association.
Sarah Peters is a regular contributor to The Fix. She last wrote about apps for recovery.