How should policy makers react to the e-cigarette boom?
California was the state that, in 1998, pioneered a public smoking ban that caught on not only in other states across the US, but also around the world. Today, Californian policy makers have weighed in on what is rapidly becoming the next great controversy in the tobacco industry: electronic cigarettes.
A committee on the Los Angeles City Council today announced that they are preparing groundwork for legislation banning the use of electronic cigarettes (e-cigarettes) in public places, such as farmers markets, parks, recreational areas, beaches, bars, nightclubs and outdoor dining areas.
Though, in true Hollywood style, film production sets are exempt from the ban, as are dedicated "vaping lounges" - "vaping" being the colloquial term for smoking the vaporized nicotine and other chemicals provided by e-cigarettes.
Los Angeles is not the first major city to consider this course of action.
In January, the Chicago City Council approved a ban on e-cigarettes in indoor public areas, such as offices. A month before that, New York approved an amendment to the city's public smoking ban to include e-cigarettes.
But the fact that LA lawmakers are now taking this measure seriously will no doubt add further fuel to an already-heated debate on the health risks posed by e-cigarettes.
Nicotine but no tar
The main advantage offered by e-cigarettes is that they do not contain tar. However, they do contain nicotine.
E-cigarettes are battery-powered, portable devices that work by heating a liquid containing nicotine and a substance called propylene glycol into a vapor that is inhaled by the smoker.
The main advantage offered by e-cigarettes is that they do not contain tar - the fatal ingredient in conventional cigarettes that is at the root of most health problems associated with smoking. As such, e-cigarettes offer a healthier alternative to the kind of cigarettes that public health campaigns have spent decades targeting.
However, e-cigarettes do contain nicotine - the stimulant in tobacco that creates powerful cravings in smokers.
A 2012 study, published in the journal Nicotine & Tobacco Research, found that e-cigarettes deliver nicotine faster than other cigarette substitutes, such as gum or lozenges. But could e-cigarettes prove to be equally as addictive as conventional cigarettes?
There is not enough data to be sure right now, but that e-cigarettes profess to be a healthier alternative to conventional cigarettes, while still promoting the addictive qualities of tobacco, is one of the main dilemmas that has split a previously united front from tobacco researchers and public health groups.
Runaway popularity of e-cigarettes causes issues for regulation
The reason why pro- and anti-vaping factions have become so adversarial is because much of the medical research into the adverse effects and benefits presented by the new phenomenon of e-cigarettes is - at this early stage - contradictory or inconclusive.
This has presented a unique problem for scientists, lawmakers, tobacco companies, pressure groups and the public at large. The popularity of these new smoking devices is moving much faster than the medical knowledge required to make informed judgements about their safety or efficacy.
E-cigarettes are no fad. Unlike the relatively slow take-up of nicotine lozenges and gum, sales of e-cigarettes have skyrocketed, with no signs of slowing.
Sales of e-cigarettes in the US have doubled each year since 2008. In the last year, sales brought in an estimated total of $1.7 billion for e-cigarette manufacturers, and the number of vendors selling e-cigarettes quadrupled. Predictions suggest that sales of e-cigarettes will outstrip sales of traditional cigarettes by the next decade.
This puts pressure on policy makers and regulatory bodies to present solutions for public health issues that they may not necessarily have all the evidence for yet.
The US Food and Drug Administration (FDA), for example, have yet to take a position on the devices, which are unregulated with the exception of e-cigarettes that are marketed as a tool to help people quit smoking.
How should the FDA respond to e-cigarettes?
The FDA do not currently regulate e-cigarettes, with the exception of e-cigarettes that are marketed as a tool to help people quit smoking.
The effects of this lack of regulation, as explained on the FDA website, are that consumers do not know:
- The potential risks of e-cigarettes when used as intended
- How much nicotine or other potentially harmful chemicals are being inhaled during use
- If there are any benefits associated with using these products
- If e-cigarettes "may lead young people to try other tobacco products, including conventional cigarettes, which are known to cause disease and lead to premature death."
Some studies have raised concern over the way e-cigarettes are marketed and labeled.
Medical News Today recently reported on research conducted by the Roswell Cancer Park Institute (RCPI) in Buffalo, NY, which analyzed the chemical content of e-cigarette refill solutions and compared their findings with the product labeling.
The RCPI scientists found that the nicotine concentration of 1 in 4 products differed by more than 20% from the amounts advertised on their labels. Nicotine was also found in some refill solutions that were advertised as being nicotine-free.
The FDA are expected to announce new regulations for e-cigarettes soon. The RCPI recommend that four main criteria need to be given serious consideration by the FDA:
- Do low levels of contaminants in e-cigarette vapor pose a health risk?
- What are the thresholds for toxicity of contaminants in vapor?
- What should be the basis for product standards of e-cigarettes?
- Could the risks be ameliorated by changes in engineering?
Given the recent proposed bans on public vaping across US cities, the FDA are urgently required to address concerns over second- or thirdhand smoke risk.
A 2012 study, reported on by Medical News Today, analyzed potentially harmful emissions from e-cigarettes. The researchers behind the study acknowledged that although "passive vaping" is possible, they found no formaldehyde emissions and low emissions of volatile organic compounds.
RCPI's study, however, found that "significant" nicotine residues were left on the surfaces of a special chamber they used to measure thirdhand smoke risk from vaporized refill solutions.
"We need to better understand clinical implications of thirdhand exposure," RCPI's Dr. Maciej L. Goniewicz told Medical News Today.
"This is a new area of research and we simply do not have a comprehensive picture right now. We clearly showed that nicotine from e-cigarettes can be deposited on various surfaces. We also showed that e-cigarette users exhale some nicotine."
Dr. Goniewicz also points to a study in Proceedings of the National Academy of Sciences that showed "carcinogenic tobacco-specific nitrosamines" form in the residue produced during thirdhand exposure to vaping.
Will e-cigarettes increase or decrease the overall number of smokers?
Is it possible that e-cigarettes might act as a gateway drug to conventional tobacco use for new and younger smokers?
Some commentators have reported a trend in use of e-cigarettes where, rather than swapping traditional cigarettes for the tar-free electronic equivalents, smokers use the device to supplement their nicotine habit in locations where smoking is not permitted - such as in the workplace or in bars and restaurants.
Such behavior challenges the claim from groups resisting regulation of e-cigarettes that the devices are primarily a smoking cessation aid.
Is it possible that e-cigarettes instead might not only prolong smoking as a habit in existing smokers, but also act as a gateway drug to conventional tobacco use for new and younger smokers?
Dr. Goniewicz commented:
"Statistics provided by the Centers for Disease Control and Prevention showed slight decrease in smoking prevalence among US adults between 2008 and 2011. We do not know whether it can be attributed to increasing popularity of e-cigarettes. We need to closely monitor this trend over the next few years to understand effects of e-cigarettes on population level."
A recent, high-profile cover story from The New York Times quoted scientists who claim that e-cigarettes will only be effective at reducing the death toll from smoking with robust federal regulation.
For example, if ordinary cigarettes are made more expensive than e-cigarettes, or if the FDA gradually reduce the allowable levels of nicotine in traditional cigarettes - pushing smokers to e-cigarettes.
Cigarettes first went into broad use across the US in the 1920s. The ensuing popularity boom resulted in a lung cancer epidemic by the 1940s. Although smoking rates have declined since the 1960s - when about a half of all men and a third of all women smoked - the US is still home to 42 million smokers.
Though we may not have all the data yet, just how e-cigarettes - and the imminent regulation surrounding them - contribute to these figures will likely be a contentious area of debate for some time.
Written by David McNamee