E-cigarette etiquette: While regulations remain in flux, users recommend being mindful

By: Ryan Johnson, INFORUM
FARGO – When Kelsey Eaton tries to explain electronic cigarettes to new customers at Infinite Vapor, she first has to give a lesson in lingo.
“Vaping” is now a verb, referring to the act of inhaling from the battery-powered devices available in all shapes, styles and price ranges; “atomizers” heat the concentrated liquid, available in several flavors and with or without nicotine.
Meanwhile, public health officials are now beginning to wonder if “secondhand vapor” could pose health risks to others.
Even after mastering the vocabulary, e-cig users still need to settle one more issue – how to vape as desired without risking a breach of etiquette, especially as the social norms continue to evolve.
“Mostly, I just tell people to definitely look at the laws in their area and where the legislation’s at,” said Eaton, who has managed Infinite Vapor in downtown Fargo since the store opened last November.
But Bryce Brovitch and Jake Berg, 18-year-old high school seniors in Park Rapids, Minn., said the rules of using
e-cigs around others depends on more than the latest state and local laws.
Berg prefers to ask permission before using his e-cig in someone’s house or car.
Even though there’s nothing on the books in Minnesota that bans vaping indoors in public places, Brovitch said he usually goes outside so he won’t bother others – or make them think he’s breaking the smoking laws that do apply to regular cigarettes.
“You know that you can’t smoke inside, but it’s not smoking,” he said. “It still kind of looks like it.”
The law, for now
At the federal level, e-cigarettes aren’t classified as tobacco products, meaning the devices and liquid refills don’t have to comply with the same restrictions on advertising, manufacturing or age requirements for purchase or use.
But many states and communities in recent years have passed local laws to deal with the devices, which are growing in popularity and show no sign of slowing down.
A statewide smoke-free law approved by North Dakota voters in 2012 does include electronic cigarettes, Eaton said, which means they can’t be used indoors in public places and are banned from use outdoors within 20 feet of doors, operable windows and air intakes.
Minnesota’s smoke-free law doesn’t include e-cigarettes, and the devices remain legal to use indoors unless a city has passed rules outlawing it.
Keely Ihry, coordinator of the PartnerSHIP 4 Health that includes health officials from Becker, Clay, Otter Tail and Wilkin counties, said Minnesota requires purchasers of
e-cigs to be at least 18, but North Dakota doesn’t have that same statewide age requirement.
Fargo and West Fargo both have passed city-level laws that require e-cig purchasers to be 18 or older, and Dilworth and Moorhead have enacted policies that restrict the devices at public schools, she said.
But health officials such as Ihry have their work cut out for them, she said, because the rules are changing, and many are working for more comprehensive statewide and national policies and laws to address the rising influence of e-cigarettes.
“Some people don’t know that they’re not regulated,” she said. “There’s not a lot of information that’s out there at this point.”
Social norms
Even if e-cigs aren’t technically classified as cigarettes at the federal level, and sometimes don’t contain nicotine, Ihry said public health officials think of them as another regular tobacco product – and believe they should be used in the same manner.
“We would ask that since we don’t know a lot about the vapor that they would be used like a normal cigarette, so they would not be used in indoor public spaces like the bars and restaurants and other general workplaces,” she said.
Another issue, Ihry said, is that children who have grown up in the era of indoor smoking bans could see the act of smoking “renormalized” if they spot adults puffing e-cigs in restaurants and workplaces.
A lot of the rules regarding cigarettes, either formally in the law or the proper usage as agreed to by the broader society, have sprung up because of the secondhand smoke these products produce, Eaton said.
Electronic cigarettes don’t make that same “bad,” “raunchy” smoke, she said, instead emitting a vapor that may leave a light odor in the air.
“It’s just water vapor, and maybe some scent,” she said.
Still, Eaton said Infinite Vapor has tried to stay ahead of the curve by following its own rules that often are stricter than the laws of the communities in North Dakota and Minnesota where it operates its eight stores.
The stores only sell to customers 18 or older, for example, and support calls for the federal Food and Drug Administration to begin regulating the manufacturing of e-cig liquids for consistency and safety.
But the biggest etiquette advice, Eaton said, is to be mindful of others when vaping.
“If I am inside in a different state, and if someone tells me, ‘Hey, that’s bothering me,’ then I don’t do it,” she said. “If it makes people uncomfortable, or if I notice people are uncomfortable, and they’re like, ‘Hey, we don’t want that,’ I’m like, ‘Hey, that’s fine, just let me know.’ ”
http://www.inforum.com/event/article/id/432381/group/homepage/

Lawmakers say e-cigarette makers target kids

BY SEAN LENGELL, Washington Examiner
A group of congressional Democrats released a report Monday accusing the electronic cigarette industry of pushing their products on children and teens.
The report shows a significant increase in recent years in the marketing of e-cigarettes to minors through social media, radio and televisions advertisements, and sponsoring events with young audiences.
“From candy flavors to rock concert sponsorships, every single company surveyed in this report has employed a marketing strategy that appears to target youth,” said Senate Majority Whip Dick Durbin of Illinois, who helped spearhead the report.
“For years, federal regulations prohibiting tobacco companies from targeting young people have helped to protect a new generation of smokers from getting hooked on nicotine. Now, we must close this new gateway to addiction to protect our children.”

The lawmakers, who say their report is the first comprehensive investigation of e-cigarette marketing tactics, was compiled using responses from eight e-cigarette manufacturers and other publicly available information.
The report found that six of the companies that responded to the lawmakers’ survey market their products in flavors that can appeal to children, like cherry, chocolate, peach and grape mint.
It also showed that e-cigarette manufacturers have more than doubled spending on marketing between 2012 and 2013. Last year, six leading e-cigarette companies spent a total of $59.3 million on marketing alone.
“E-cigarette makers are starting to prey on kids, just like the big tobacco companies,” said Rep. Henry Waxman of California, a co-sponsor of the report. “With over a million youth now using e-cigarettes, [the Food and Drug Administration] needs to act without further delay to stop the companies from marketing their addictive products to children.”
Federal law prohibits the sale of tobacco cigarettes to anyone under 18, but there is no such restriction for e-cigarettes. The limited federal oversight has led to a boom in the e-cigarette industry, with sales doubling annually since 2008 and 2013 revenue expected to reach at least $1.5 billion.
The lawmakers called on e-cigarette companies to “take immediate action” to prevent the sale of their products to children and teenagers, including product promotion through social media and event sponsorships intended for youth audiences.
They also asked the companies to stop all radio and TV advertisements.
Six of the eight companies said they support some form of regulation, including restrictions on the marketing and sale of e-cigarettes to children and teens, the lawmakers said.
The legislators also have asked the FDA to ban the sale of e-cigarettes to minors and to implement rules to prohibit misleading product claims on e-cigarettes.
The other lawmakers who sponsored the report are Sens. Tom Harkin of Iowa, John Rockefeller of West Virginia, Richard Blumenthal of Connecticut, Edward Markey of Massachusetts, Sherrod Brown of Ohio, Jack Reed of Rhode Island, Barbara Boxer of California and Jeff Merkley of Oregon, as well as Rep. Frank Pallone Jr. of New Jersey.
http://washingtonexaminer.com/lawmakers-say-e-cigarette-makers-target-kids/article/2547210

E-cigarette firms targeting young people, lawmakers say

By: LALITA CLOZEL, Los Angeles Times
WASHINGTON — E-cigarette companies are preying on young consumers by using candy flavors, social media ads and free samples at rock concerts, according to a report released Monday by Democratic legislators.
A survey of nine electronic-cigarette companies found most were taking advantage of the lack of federal regulations to launch aggressive marketing campaigns targeting minors with tactics that would be illegal if used for traditional cigarettes, according to a report released by Sen. Richard J. Durbin (D-Ill.) and signed by 10 other Democratic lawmakers, including California Sen. Barbara Boxer and Rep. Henry A. Waxman of Beverly Hills.
According to the report, based on information from the eight companies that responded, five of the surveyed companies more than doubled their marketing expenditures between 2012 and 2013, regularly promoting e-cigarettes on Twitter, Facebook and Instagram.
Producers have come up with an array of creative flavors, a practice that was banned for traditional cigarettes by the Family Smoking Prevention and Tobacco Control Act of 2009. E-cigarette flavor names include pumpkin spice, chocolate treat, snap! and cherry crush.
E-cigarette companies have sponsored popular events and distributed free samples in shows, including the Coachella Valley Music and Arts Festival, as well as Mercedes-Benz Fashion Week. They have employed celebrities to promote their products, including Courtney Love, pop singer Sevyn Streeter and rapper Chris Brown. Streeter and Brown were featured in a music video that included an e-cigarette product placement.
“In the absence of federal regulation, some e-cigarette manufacturers appear to be using marketing tactics similar to those previously used by the tobacco industry to sell their products to minors,” the report said.
According to a September 2013 study by the Centers for Disease Control and Prevention, the percentage of high school students that had tried e-cigarettes doubled between 2011 and 2012 to 10%.
Because e-cigarettes, which produce a nicotine-laced vapor, have not yet been deemed a tobacco product by the Food and Drug Administration, they are not constrained by federal regulations that prohibit sales to minors, television and radio advertisements, and free sampling, according to the report.
The FDA is considering labeling e-cigarettes as tobacco products, which would place them under the agency’s authority.
“With over a million youth now using e-cigarettes, FDA needs to act without further delay to stop the companies from marketing their addictive products to children,” Waxman said.
Twenty-eight states have banned e-cigarette sales to minors, and most of the surveyed companies said they prohibited vendors from selling their products to children.
But the survey found that policies varied company to company, and only three out of eight had ever conducted compliance checks.
Several of the companies said they avoided running television advertisements specifically targeting young audiences, but they nevertheless aired commercials during prime-time shows that rated well among children and teenagers, including the 2013 Super Bowl and the TV show “Breaking Bad,” the report said.
Six out of eight companies surveyed said they favored more regulation, specifically regarding sales to minors. One company, Lead by Sales, which produces White Cloud Cigarettes, did not respond to any of the survey questions.
http://www.latimes.com/nation/la-na-congress-ecigarettes-study-20140415-story.html

Forum editorial: The ‘no’ applies to e-cigs

Forum editorials represent the opinion of Forum management and the newspaper’s Editorial Board.

Under the smoke-free law approved by North Dakota voters in 2012 the use of
so-called electronic cigarettes is prohibited in all places where smoking tobacco is not allowed. It’s that simple. The law, which won voter support in every county in the state, is unequivocal. No spinning by the tobacco lobby and its lackeys can make North Dakota’s e-cig prohibition less clear.
One argument for treating e-cigs differently than tobacco cigarettes is the devices do not generate secondhand smoke, and that they help smokers who want to quit tobacco. Therefore, e-cig advocates contend they should not be in the same banned-nearly-everywhere classification as other tobacco-based smoking products.
It’s all smoke and mirrors promulgated by Big Tobacco and others who know e-cigs can be (and early research shows they are) gateways for young people to start smoking tobacco.
First, the claim the vapors produced by e-cigs are harmless has no good science behind it. Rather, the substances generated include humectants used in fog and smoke machines, and vaporized nicotine and artificial flavors. Manufacturers have been cited for contaminants, including nickel, arsenic and chromium. There is no FDA oversight, no product-specific taxes and no restrictions on age of buyers.
No matter how dressed up they are, e-cigs are simply a nicotine-delivery device. The dangers of nicotine, a poisonous water-soluble alkaloid, are known. Furthermore, e-cigs are being marketed by emphasizing their candy-like flavors and seemingly benign brand names. Young people are responding as expected. A recent Youth Tobacco Survey showed a spike in e-cig use by youth, doubling to 10 percent in one year.
Also, the claim that e-cigs help cigarette smokers quit, and therefore should be unregulated, is a phony argument. There is nothing in law that prevents smokers from using e-cigs, as long as used in compliance with North Dakota’s smoke-free laws.
E-cigarettes represent the latest attempt by tobacco companies and their allies to hook more young smokers, and thus ensure a nicotine-addicted customer base into the future. The effort to characterize the devices as a way to help smokers quit is cynical and predicated on a falsehood. That effort has wormed its way into legislatures, including the North Dakota Legislature, where a handful of lawmakers have bought into the lie.
Voters overwhelming said “no” to cigarettes in 2012. That “no” included e-cigarettes. Legislators who don’t get it might want to find other work.
http://www.inforum.com/event/article/id/432045/group/Opinion/

Higher Cigarette Tax May Reduce Smoking Habit

By: Steve Urness (NewsDakota.com)
VALLEY CITY, N.D. (NewsDakota.com) At 44 cents per pack of cigarettes, North Dakota has one of the lowest cigarette taxes in the nation. Research has shown that cheap tobacco is a leading cause for tobacco use among our state’s youth, so the North Dakota Center for Tobacco Prevention and Control Policy and  City-County Health District in Barnes County and Valley City are advocating the health benefits of increasing that tax.
According to the Campaign for Tobacco-Free Kids and the American Cancer Society Action Network, increasing the cigarette tax from 44 cents to $2 could reduce youth smoking by 25 percent. Some 4,700 North Dakotans would be saved from premature smoking-related death and the state would save over $312 million in long-term health care costs.
Executive director for the Center, Jeanne Prom says the benefits of raising the tax are clear, “It’ll also make it more difficult for tobacco companies to hook our children on their lethal products.”
Prom adds, “It’s clear that between saving lives and decreasing health care costs by millions of dollars, increasing the cigarette tax is positive step for North Dakota.”
City County Health District Tobacco Free Coordinator Vicki Voldal Rosenau says “If we raise the price of tobacco, it becomes less affordable and chances for tobacco companies to hook our youth on nicotine are significantly reduced.”
For additional information about North Dakota’s tobacco tax, contact CCHD at 845-8518, or visit www.breathend.com.
http://www.newsdakota.com/2014/04/07/higher-cigarette-tax-may-reduce-smoking-habit/

Tobacco control group promoting smoke-free apartments

By Bismarck Tribune
BISMARCK, N.D. _ The North Dakota Center for Tobacco Prevention and Control Policy is promoting smoke-free apartments.
The center has launched an education campaign encouraging smoke-free housing policies.
“In North Dakota, 24 percent of residents live in apartments and many of these residents continue to be exposed to secondhand smoke,” Executive Director Jeanne Prom said in a statement.
The center cited a 2006 surgeon general’s report that said air-cleaning technologies and ventilating buildings do not eliminate smoke because conventional systems cannot remove all the toxins. Heating, ventilation and air conditioning systems also can distribute secondhand smoke throughout a building.
Prom said there are high costs to landlords associated with allowing smoking in apartments, like painting and replacing carpeting.
The center cited a Centers for Disease Control and Prevention report that estimated the annual cost savings of eliminating smoking in subsidized housing nationwide would be $108 million in annual renovation expenses and $72 million in annual smoking-related fire losses.
For more information go to www.smokefreehousingND.com.
http://bismarcktribune.com/news/state-and-regional/tobacco-control-group-promoting-smoke-free-apartments/article_a39a5b62-be9c-11e3-bd9c-0019bb2963f4.html

E-Cigarette Poisoning on the Rise, CDC Says

By Neha Sharma, DO, ABC News
They’re supposedly a safer alternative to conventional cigarettes. But electronic cigarettes may actually pose a serious danger to others in your home — particularly children.
The U.S. Centers for Disease Control and Prevention warned in report released today that the number of phone calls to U.S. poison control centers related to e-cigarette use has increased from just one call per month on average in 2010 to nearly 200 calls per month in early 2014.
“The rise in the numbers of e-cigs related calls to poison centers leads us to view this as a major public health concern,” said report author Dr. Kevin Chatham-Stephen, a pediatrician and an epidemiologist with the CDC.
He said that though e-cigs comprise less than 2 percent of all tobacco-related sales, they now account for more than 40 percent of poison center calls. More than half of the calls involved children younger than 5 years old.
“This is a very dramatic finding,” Chatham-Stephen said.
According to the report, most of these emergencies are linked to the liquid nicotine within the e-cigs. If the liquid is released from the cylinder that holds it, the result can be acute nicotine toxicity from direct skin or eye exposure, ingestion, or inhalation.
“Cigarettes are the most dangerous consumer product on the planet, and smokers need to treat e-cigs with considerable caution especially since the product is unregulated.” said Dr. Tim MacAfee, director of the Office on Smoking and Health at CDC and contributor to the report.
Those within the e-cigarette industry said concerns are overblown. Jason Healy, the president of e-cigarette manufacturer Blu-cigs, called the findings in the report “a weak argument” against the devices and is evidence of “an ongoing attack on the e-cigs industry by various anti-smoking groups.”
“The product is for adult smokers, and therefore the responsibility for children’s safety falls on the parents, just like bleaches and prescription medications,” Healy said. “The focus should be on parenting and education, and not regulation.”
Healy did say, however, that the findings should prompt the e-cig industry to formulate effective child safety measures.
Still, toxicology experts not involved in the study said the report reveals a concerning threat to kids.
“Nicotine is probably the most toxic plant chemical ever discovered,” said Dr. Richard Clark, medical director for the California Poison Control System and a professor of toxicology. Clark said poison centers like his are seeing a steady increase in calls related to e-cigs. Of particular concern, he said, is that unlike the conventional cigarette, which is usually very bitter, these devices are flavored and thus more attractive to children. The solution is also easily absorbed through the skin if spilled, unlike the contents of regular cigarettes.
Doctor’s Take
Despite decades of admonitions against smoking, an estimated 42 million people in the United States still smoke cigarettes. Cigarette smoking is the leading cause of preventable death in the United States, accounting for one of every five deaths each year. So for many, the electronic option may hold a certain appeal.
But though e-cigarette use is increasing among U.S. adolescents and adults, its overall impact on public health remains unclear. The dramatic rise in E-cigarette related calls to the country’s poison control centers is alarming. And the fact that the product is not childproof should alert parents to keep the product out of reach and in an enclosed container.
http://abcnews.go.com/blogs/health/2014/04/03/e-cigarette-poisoning-is-on-the-rise-cdc-says/

Study: Tobacco use declines on prime-time TV dramas

By Saba Hamedy, Los Angeles Times
Prime-time television dramas are less smoke friendly than they were in the 1950s.

According to a study published online in the journal Tobacco Control on Thursday, there has been a dramatic decline in visibility of tobacco products on prime-time U.S. broadcast television.
Researchers at the Annenberg Public Policy Center of the University of Pennsylvania determined this drop in portrayals of smoking and tobacco use in prime-time dramas mirrored the national decline in consumption.
The study examined 1,838 hours of popular U.S. prime-time dramas — everything from “Gunsmoke” (in the 1950s) to “House M.D.” (in the 2000s) — shown on television over 56 years.
Research suggested that from 1955 to 2010, tobacco use on television declined from a high of 4.96 instances per hour of programming in 1961 to 0.29 instances per hour in 2010.
The research also noted a decline in consumption and suggested that less prime-time smoking may have led to less smoking by the general population.
“TV characters who smoke are likely to trigger the urge to smoke in cigarette users, making it harder for them to quit,” said Patrick E. Jamieson, the study’s lead author, in a release.
“We now have further evidence that screen-based media are an important factor to consider in continued efforts to reduce the burden of smoking related illness in the U.S. and around the world,” said Dan Romer, the study co-author and APPC associate director.
However, the study, the largest ever of tobacco use on television, looked only at broadcast television shows. Cable programs, such as AMC’s “Mad Men” — where characters frequently smoke cigarettes on screen — were not part of the study.
“Despite the decline since 1961, tobacco use on TV remains a cause for concern,” Jamieson said. “The decline in prime-time TV tobacco use is welcome news, but we need to learn more about tobacco portrayal on cable TV, YouTube, and other popular Internet-based sources.”

http://www.latimes.com/entertainment/envelope/cotown/la-et-ct-tobacco-use-primetime-tv-dramas-20140403,0,5751556.story#ixzz2yJOrzdCI

Changes to tobacco ordinance passed

The West Fargo Pioneer
The Commission passed the second reading of changes to its tobacco ordinance to include electronic cigarettes at its Monday meeting.
The City’s ordinance now requires a tobacco license for anyone wishing to sell electronic cigarettes along with regular tobacco products and it prohibits the sale of electronic cigarettes to anyone under the age of 18. The City Commission is following precedence set by Fargo and Moorhead, which have passed similar laws.
North Dakota law already prohibits anyone from using electronic cigarettes in public buildings. Anyone smoking regular cigarettes or electronic versions must be at least 20 feet from public entrances.
http://www.westfargopioneer.com/content/changes-tobacco-ordinance-passed

Do e-cigarettes help smokers quit?

By Deborah Kotz  | THE BOSTON GLOBE STAFF

Electronic cigarettes are certainly trendy — look no further than the Vapefest in the nation’s capital last week — but whether inhaling nicotine vapors actually helps smokers quit traditional cigarettes remains a subject of fierce debate.
A new study is bound to add fuel to the fire. Researchers followed nearly 1,000 smokers for a year and found that those who used e-cigarettes were no more likely to quit smoking or reduce their dependence on tobacco cigarettes than those who weren’t using the products at the beginning of the study. About 14 percent of those who didn’t use e-cigarettes quit smoking compared to 10 percent of those used the products.
But the research, published last Monday in the journal JAMA Internal Medicine, raises more questions than it answers because only 88 of the 949 smokers in the study reported using e-cigarettes.
That small sample size makes it difficult to draw firm conclusions, admits study leader Dr. Pamela Ling, an associate professor of medicine at University of California, San Francisco. “We also looked at a broad population of smokers,” she said, “not just those who were specifically interested in quitting.”
In fact, only 8 percent of e-cigarette users reported that they were trying to quit when they were surveyed, and only 40 percent had any intention of quitting in the next six months.
“This means that we actually know for a fact that the majority of e-cigarette users in this study were not using these products as part of a quit attempt,” Dr. Michael Siegel, a tobacco control researcher at Boston University School of Public Health, wrote in a post on his blog. “Rather, it is a deliberate attempt on the part of the investigators to misuse data.”
Setting those fighting words aside, the study highlights the lack of evidence to determine whether e-cigarettes are a good smoking cessation aid — even though some smokers swear by them for helping them ease off their habit.
Only one clinical trial compared e-cigarettes with nicotine patches to help smokers quit, Ling said, and it found that both were about equally effective — or rather, equally ineffective since neither worked particularly well. Only 5 to 7 percent of the smokers in the study were able to completely stop lighting up regardless of which method they used.
“Although there are no data showing that e-cigarette use helps with cessation, there is potential harm,” wrote Dr. Mitchell Katz, the deputy editor of JAMA Internal Medicine in an editorial that accompanied the new study.
The products — which contain nicotine in liquid form mixed with flavorings, colorings, and various chemicals — remain unregulated, though the US Food and Drug Administration might move this year to put them under the same rules as other tobacco products. Even more concerning are recent modifications that have turned once disposable e-cigarettes into larger, reusable gadgets that users fill with highly potent liquid nicotine. Such handling can be very hazardous since liquid nicotine can be toxic if applied to the skin or ingested, according to an article in The New York Times.
Last year, the American Association of Poison Control Centers received 1,414 calls regarding accidental exposures and poisoning linked to liquid nicotine or e-cigarette devices — a 300 percent increase from 2012. Poison control centers have already received 651 calls through March 24 of this year and urged parents last week to keep the devices and liquid nicotine away from children. Whether vaping poses health risks remains unknown, though that hasn’t stopped e-cigarette makers from proclaiming that the product provides the “freedom to have a cigarette without the guilt,” as actress Jenny McCarthy states on the blu eCigs website.
In a study published earlier this month, Ling and her colleagues reviewed 59 websites selling e-cigarette products and found that 95 percent of them made health-related claims: more than half claimed the product helped with smoking cessation, and three-quarters claimed the product does not produce secondhand smoke. (It does, though, produce vapor that others can inhale and which may pose health risks to bystanders.)
Some manufacturers claimed on websites that their products were toxin free and didn’t contain the kinds of cancer-causing chemicals found in tar-ridden cigarettes. That’s something that requires more study to determine.
“Right now, we have an unusual situation with a product allowed on the market that’s making health and smoking cessation claims,” Ling said, “and manufacturers shouldn’t be allowed to make those claims without the science to support them.”
http://www.bostonglobe.com/lifestyle/health-wellness/2014/03/30/cigarettes-help-smokers-quit/yzMFrfhjw3ZqKbjHP2vMTL/story.html