The Conversation: The alarming question of e-cigarettes

01/19/2014 12:00 AM

10/08/2014 11:32 AM

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Anyone who’s ever wanted to look cool could see the attraction. The teenage boys slouched at a vape shop next door to a Sacramento tattoo parlor, sucking on pipes and blowing great, swirling, white nicotine vapor rings.

Ears pierced, hair cropped, laughing through a flavored haze that smelled like dirt-covered candy, they were so intent on what the devil was making them do that it was hard even to look without feeling a bit like the vice squad. A 19-year-old was boasting that he “used to have a silver and gold KTS but sold it.” His buddy, barely 18, quizzed a salesgirl about “moving up to a quad coil.”

“It’s like cars,” translated Andre Abille, a 27-year-old clerk at Vapor Parlor, adding that the lingo – references to supercharged pipes – reminded him of his own weakness for powerful engines. And it was like listening to drag race talk, or gun talk, or weed talk, or even artisan beer talk, in that, like all vice talk that’s not about your own vice, it was almost comically boring.

But it also was like seeing kids in a smoke-filled room, smoking. And that raised an alarming question, given the half-century we’ve spent prying tobacco companies away from the lungs of impressionable young people: Could a generation of public health work go up in a cloud of vaporized nicotine?

These are pivotal times in the war on smoking. Fifty years after the 1964 surgeon general’s report linking tobacco use with cancer, society has finally made some progress in drawing the line.

Armed with science showing the detrimental effects of secondhand smoke and smoking in general on children, cities and states have enacted smoking bans in bars, restaurants, parks, beaches, airlines, trains, college campuses and apartment buildings. While smokers may feel constrained, we are better off as a whole, not just because our air is cleaner but also because smoking-related diseases hurt everyone around the smoker, and make health care and health insurance more expensive for everyone.

Today the smoking rate among U.S. adults has fallen from 43 percent in 1964 to just 18 percent last year. Adolescent smoking rates, too, have been gradually improving. In 1975, 29 percent of high school seniors were smokers; in 2012, that figure was 10 percent.

Just as the anti-smoking message has begun to sink in, however, now comes vaping. Invented in China and introduced about five years ago into this country, the practice lets smokers inhale through battery-powered pipes that are as small as a conventional cigarette.

A nicotine solution is suspended in propylene glycol, the chemical compound used in stick deodorant, and released when the user sets off a small heating element and sucks on the “filter.” Because no tobacco is being set on fire, it isn’t technically smoking.

But something is getting inhaled and exhaled – something addictive, if the pipe holds a nicotine solution – and because vaping is so new, the jury is still out on the long-term health risks.

One of the handful of recent studies found metal and silicate particles in e-cigarette vapor at levels that could lead to respiratory problems and that were higher than conventional cigarette smoke. Another found that the secondhand “smoke” from e-cigarettes had fewer particulates and toxins than from regular tobacco.

Still other studies have found that the dosage of nicotine can vary wildly in e-cigarettes and vaping equipment, and though manufacturers claim that propylene glycol is safe, the risks of inhaling it over an extended period haven’t been studied in humans.

The most recent surgeon general’s report, released last week, calls for more research and regulation. When the U.S. Food and Drug Administration tried to regulate e-cigarettes the way it does, say, nicotine patches, it was beaten back in the courts because the manufacturers had stopped short of making overt health claims. The courts did leave open the door for regulation as a tobacco product, but the litigation-induced delay in new rules has created room for the industry to boom – and for plenty of smoke to rush into the vacuum.

The Big Three tobacco companies all have acquired or launched products for vapers, and last year, sales of e-cigarettes reached $1.7 billion. Vaping now occurs openly in many high-end bars and hotels, and pretty people brandish e-cigs at New York’s Fashion Week and Oscar parties. The packaging on some brands looks straight out of “Mad Men.” More troubling, after a 40-year ban on ads for tobacco, commercials for e-cigarettes are showing up on TV.

That’s why groups like the American Lung Association, American Heart Association, Campaign for Tobacco-Free Kids and World Health Organization have come out against vaping, and four states – Utah, North Dakota and New Jersey – have banned e-cigarettes indoors in the same way they ban conventional smoking. Nine other states regulate them like tobacco products.

Vaping proponents insist they have the right to their vice, which, they say, is a “cleaner” and potentially healthier alternative to tobacco. “Friends don’t let friends smoke – give them the only electronic cigarette worth switching to,” a new TV spot for NJOY Kings urges.

But let’s be clear: Investors aren’t rushing into this space because the market craves niche nicotine cessation products. From hipster bars to high school parties, vaping is a vice of impressionable adolescents, and adolescence is when most lifelong smokers become hooked.

The U.S. Centers for Disease Control and Prevention reported in September that about 1.78 million teenagers – about 10 percent of high school students and nearly 3 percent of middle schoolers – had used e-cigarettes in 2012, double the rate of the year prior. A fifth of the middle schoolers said they had never taken a puff before trying e-cigs.

And though about half of the states, including California, now restrict the sales of vaping equipment and e-cigarettes to minors, the products still are easily obtainable online with little or no proof-of-age requirement. In Utah, a state Department of Health survey found that even though kids there had no legal access, they were three times more likely than adults to have used e-cigarettes.

The marketing reflects the market. Two bros pull pranks on a football field in the NJOY commercial. A companion ad online features rock rebel Courtney Love dropping an F-bomb and blowing e-smoke in the face of an uptight society matron. Vape shops offer nicotine cartridges flavored to taste like fruit punch and chocolate, and pot dispensaries and head shops – because nicotine isn’t all you can inhale from a vape pipe – offer a cornucopia of cannabis vaping gear.

Indeed, when Senate Majority Leader Ellen Corbett, D-San Leandro, authored a bill last year that would have regulated e-cigarettes like a tobacco product in California, the marijuana lobby was among its most vehement opponents, arguing that cancer patients would suffer terribly if they couldn’t vape prescription weed in nonsmoking sections.

The charge in that fight was led by the Consumer Advocates for Smoke-free Alternatives Association, a group whose most visible founding member describes herself as a libertarian and whose scientific director has acknowledged that tobacco companies have given him funding. Though the measure passed in the Senate, it stalled in the Assembly and Corbett had to postpone the bill.

That bill should be resurrected and signed into law in California, along with a measure introduced last week by Assemblyman Roger Dickinson, D-Sacramento, that would limit the Internet sale of tobacco products – including e-cigarettes and vape pipes – to brick-and-mortar retailers. The FDA, too, should treat e-cigarettes like real ones, including banning their insidious ads.

Science may ultimately prove to be on the side of the vape lobby. If so, then the manufacturers can make their health claims and be regulated that way. But we’ve come too far to relax while an activity that looks suspiciously like smoking offers the real thing a shot at a comeback.

Millions of Americans have died long, slow, ugly deaths, lost loved ones or watched their health insurance soar sky high because questioning a popular bad habit felt like being the vice squad. Well, vices can seem cool – anyone who’s ever had one can see the attraction. But surely we don’t want a lethal addiction to start attracting kids again.

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