There is a growing trend of businesses, schools, cities, and states banning electronic cigarettes (e-cigarettes) in public places. North Dakota, New Jersey, and Utah have banned the use of e-cigarettes in workplaces, bars, and restaurants. Other states are currently in the process of passing similar legislation. In addition, cities such as Chicago, New York, and recently Overland Park, Kansas have also enacted bans. Upset that the FDA has not set any standards for regulating e-cigarettes and e-liquid, politicians and business owners have decided to label them as tobacco products in order to apply the same rules and regulations to their use. They are not tobacco products and should not be treated as such. They are predominately used to quit smoking, which is one of the goals behind the tobacco bans in the first place.
Starting in 1995 with California, states have banned smoking in public places. Although Missouri has yet to follow suit, the city of Kansas City joined the smoke-free ranks in 2008. For six long years, Kansas City smokers have remained outside in freezing snowstorms, hail, and 110 degree heat. Huddled together in doorways, sidewalks, and tiny patches of roped off pig-pen style farms of shame, our numbers dwindled. Those who remained persevered through tax hikes and cultural demoralization, through nicotine gum, lozenges, and skin patches. Then, new products emerged that could save us from the cancerous tar pits of our own lungs and self-images: the e-cigarette and the e-liquid vaporizer. According to Dr. Robert West, University College of London’s director of tobacco studies, for every million people who switch to e-cigarettes, 6,000 lives can be saved (ABC News). Instead of praising this new product as a way for smokers to finally quit, it’s being banned alongside the product it’s meant to combat. Why is something so good at helping people quit smoking shunned and ostracized by the very people who want us to quit? Personally, I never cared until August 1, 2014, when my college, University of Missouri – Kansas City, banned tobacco products.
College is difficult and stressful. As a result, each semester I find myself chain smoking cigarettes trying to maintain grades and academic productivity. “Fine,” I thought, resigned to defeat after the ban took effect, “I’ll just take up vaping instead.” But the campus-wide ban included e-cigarettes and vaporizers. Having very little knowledge of vaping, the science, benefits, culture, and legal opposition, I decided to find out why this product was being spurned by policy-makers who probably knew as much about it as I did.
I started by comparing e-cigarettes with vaping pens. They both operate essentially the same way. A rechargeable battery heats a conductive coil around a wick soaked with e-liquid. The heat vaporizes the liquid and the vapor is inhaled by the user. In an e-cigarette the liquid is housed in little cartridges sold individually, and usually resemble an actual cigarette. The popular brands include Blu E-cigs by Lorillard, Vuse by R.J Reynolds, and soon to be on the market, HeatSticks by Philip Morris. A vaporizer differs by utilizing an “open tank system” that holds various amounts of e-liquid which can be purchased individually in vials. This system is more popular with vaping enthusiasts for its versatility and ability to be modified by the user to their specifications. The open tank system allows battery upgrades for large plumes of vapor and any flavor or nicotine dosage can be used. It is worth noting that Lorillard and R.J. Reynolds are currently trying to get the open tank system banned by the FDA as it cuts deeply into their nicotine markets (Gawker Media).
The e-liquids consist of five main ingredients and are sold in thousands of varieties and flavors. Many vape stores mix their own in-house blends according to the customer’s tastes and preferred nicotine level. Premium e-liquids are sold by manufacturers who use labs to mix and test the safety of their products. The base of the liquid is usually pharmaceutical grade, or food grade, propylene glycol (PG) and/or vegetable glycerin (VG). These suspend the nicotine and flavors in the vapor for consumption and give the vapor the visual cloud that looks like smoke. They make up around 80 percent of the liquid. Some, but not all, of the e-liquids contain nicotine in doses of 3mg, 6mg, 12mg, 18mg, and 24mg per ml. Most smokers who want to quit start out with higher dosages of nicotine and slowly lower them as they vape, eventually getting down to nicotine-free e-liquid. The nicotine is sold in pharmaceutical-grade, concentrated doses and therefore must be diluted with distilled water. The final ingredient in e-liquid is the flavor. The flavorings are the same used in food production across the country, and are part of almost every food we buy in our grocery stores.
That seems pretty simple and innocuous. Why all the controversy? Why all the fear and safety apprehensions? Concerns brought up by Terry Goodman, the city councilman in Overland Park, Kansas, who pushed for the recent city regulations on e-cigarettes consisted of the following taken from the staff comments of the May 7th, 2014 Community Development Committee:
Critics claim that e-cigarettes: have health consequences and may contain ingredients known to be toxic to humans; are being marketed to youths (through both advertisement campaigns and through the inclusion of flavors appealing to youths); are a gateway to conventional cigarettes; make it difficult to enforce current regulations on conventional cigarettes due to the difficulty in distinguishing between the two; and can potentially result in misunderstandings or confrontations between members of the public. Some critics also claim that e-cigarettes can be used to ingest illegal substances, such as liquid marijuana. There has also been recent media coverage regarding poisonings – some leading to death – by ingestion of the cartridge liquids or through absorption through the skin.
These concerns echo the greater public’s worries about vaping and are the most frequent arguments made by the opposition and fear-mongering media.
The first item is vague but includes an important sentiment: “E-cigarettes have health consequences.” Yes, everything we do has some sort of health consequences. After two weeks of vaping, my health consequences were a reduced desire to smoke, an extreme coughing fit when I did, an increase in taste and smell, more energy, and much less stink on my clothes. Because there is no harm in secondhand vapor, any nicotine issues reside entirely within the user.
In continuing with the list of concerns, we come to the idea that e-cigs are being marketed to kids and the candy-like flavors entice kids to try them. These are different topics and it’s important to draw the distinction. Let’s begin with e-cigarette marketing.
ABC News reported that TV ads for e-cigs reached children by an increase of 256 percent between 2011 and 2013, which makes sense given that the market was still emerging in 2011 and 2012 and advertising was still catching up. They also said 80 percent of the ads were for the same company, Blu e-Cigs. These ads featured a trendy man in his early 30s with a slightly raspy voice speaking directly to smokers while inhaling deeply on his Blu e-Cig. The commercials followed him throughout his day, preaching that smokers possess a “desire to explore” while cutting to a background of mountains in an exotic locale. He used patriotism like “after all, this country was founded on free will.” It was full of cheap rhetoric and corny model footage, but had nothing for kids. There were no cartoon characters, bright colors, or kids in the advertisement. This ad, as cliché as it might have been, was marketed to adults. Just because an ad is seen by a child does not mean that the ad is designed to be marketed to kids.
The flavors exist because that is what demand dictates, not because they are trying to market to children. Users like a wide range of flavors. According to a recent study Kanstantinos Farsalinos published in the International Journal of Environmental Research and Public Health, in which 4,618 e-cig users were surveyed:
The results of this survey of dedicated users indicate that flavours are marketed in order to satisfy vapers’ demand. They appear to contribute to both perceived pleasure and the effort to reduce cigarette consumption or quit smoking. Due to the fact that adoption of ECs by youngsters is currently minimal, it seems that implementing regulatory restrictions to flavours could cause harm to current vapers while no public health benefits would be observed in youngsters.
While the state of Kansas already prohibits the sale of e-cigs and e-liquid to minors, Missouri does not. Of the 16 shops I visited, 11 were in Missouri and voluntarily enacted self-regulation against selling to minors. Vape shop owners aren’t against all regulation; they just want to be regulated differently from tobacco and given a fair chance to sell their products. I asked Jon Brower, owner of Waldo Vapes in Missouri, if he ever sold to minors and he responded, “God no! None of the reputable shops in town would. It’s entirely self-regulated; this is not for kids.” If the community and politicians are concerned that e-liquid flavors will entice minors to try vaping, simply prohibit selling to them. The vaping community agrees, and willingly supports that idea already. But, to ban the sale entirely, for all ages, is one vape over the line.
The last item on Goodman’s list is probably the most contentious between the vaping community and its opponents. These are the stories of potential harm from vaping that have been sensationalized and used by the opposition to elevate the fear and risk of using vaping products. Notice that Goodman didn’t say there have been poisonings, only that there “has been recent media coverage” of alleged poisonings. These incidents seem to constantly re-emerge like urban legends. I couldn’t possibly say that they are all untrue or that if someone drank an entire vial of e-liquid that they wouldn’t get a little sick. But it’s important to consider the source of what information is getting reported and how it’s being worded. One of the most referenced and highly sensationalized reports of poisoning came from Consumer Reports.
The article, from September 22, 2014, is titled “Lock up your e-cigarettes if you have kids in the house. More evidence of nicotine poisonings in toddlers.” The article, meant to elicit fear in parents and politicians about e-cigs and vaping, points out that due to a rise in reports of children being poisoned there is a Child Nicotine Poison Prevention Act of 2014 being introduced to Congress. This Act is sponsored by Consumer’s Union, which is owned and operated by Consumer Reports. What we really need to need know is how many kids are being injured from these products, and the severity of their injuries. While Consumer Reports may not want to report on those statistics, the Centers for Disease and Prevention have. There were 1,226 calls to poison control centers over the last four years for children under 5 years old due to e-liquid exposure. That’s about 306 calls per year in a nation of 322 million. The adverse health effects reported were vomiting, nausea, and eye irritation. That is unfortunate, but hardly death through skin exposure as Councilman Goodman suggests. It’s also worth noting that calls to poison control centers for regular cigarettes over the same period of time were 16,248, with the same adverse reactions.
The most important section of this article focuses on a 30-month-old who was taken to the hospital after putting an e-liquid vial in her mouth. The article doesn’t say what happened to the child, so I traced it to its source in the Archives of Disease in Childhood, where Dr. Sanjay Gupta gave the rest of the story. The girl had vomited and was otherwise asymptomatic after the incident. “The child was systemically well and all clinical observations were normal.” Just because there is a report of a child being rushed to the hospital because of e-liquid ingestion, doesn’t mean there was anything wrong with the child. This example shows how well the media can twist the truth and influence policy-makers who use fear and paranoia to control their citizens.
While this concludes the list of concerns by Councilman Goodman and the similar worries by lawmakers, consumer advocates, and policy makers, it doesn’t alleviate the threat to vapers in this country. It’s important for regulators to have concerns about the safety of their constituents, but it’s equally important to base those concerns on facts and common sense, not on fear mongering news stories, or paranoid hypothetical delusions.