North Dakota No. 1 in protecting kids from tobacco

By: Helmut Schmidt, INFORUM
WASHINGTON – North Dakota is ranked first in the nation in funding programs to prevent kids from smoking and to help smokers quit, according to a report released Monday by a coalition of public health organizations.
The state will spend $9.5 million in fiscal year 2014 on tobacco prevention and cessation programs. That’s 102.3 percent of the amount recommended by the U.S. Centers for Disease Control and Prevention.
Alaska is ranked second, spending $10.1 million, or 94.8 percent of the CDC-recommended amount.
“I think this is something that our state should be hugely proud of,” said Holly Scott, tobacco prevention coordinator for Fargo Cass Public Health.
The high school smoking rate was in the 40 percent range in the late 1990s and early 2000s, Scott said.
By 2011, the percentage of high school students smoking had dropped to 19.4 percent. It was even lower in the Fargo area at 13.1 percent, Scott said.
“That’s enormous in terms of the amount of progress made,” she said.
Other states spending at least half of CDC’s recommended level are:

  • No. 3 Delaware, $8.3 million, 59.9 percent.
  • No. 4 Wyoming, $5.1 million, 56.7 percent.
  • No. 5 Hawaii, $7.9 million, 51.7 percent.
  • No. 6 Oklahoma, $22.7 million, 50.5 percent.

Minnesota is 12th in the nation, spending $21.3 million a year, or 36.4 percent of the funds recommended by CDC.
South Dakota follows at 13th, spending $4 million, or 35.4 percent of the CDC-recommended level.
“Right now we know that here in Minnesota, tobacco use is still a problem,” said Keely Ihry, the Partnership for Health tobacco coordinator for Clay County Public Health.
Ihry oversees the program for Clay, Wilkin, Becker and Otter Tail counties.
Ihry said among high school seniors in Clay County, 32 percent of males and 21 percent of females use tobacco.
In Becker County, 38 percent of males and 24 percent of females use tobacco.
In Wilkin County, 50 percent of males and 13 percent of females use tobacco. And in Otter Tail County, 46 percent of males and 26 percent of females use tobacco.
In North Dakota, a 2008 voter-approved initiative requires the state to fund its tobacco prevention and cessation program at the CDC-recommended level.
North Dakota’s program has seen success. From 2009 to 2011, the state reduced smoking among high school students from 22.4 percent to 19.4 percent.
In 2012, North Dakota voters also overwhelmingly approved a smoke-free law that applies to all workplaces, including restaurants and bars.
The annual report on states’ funding of tobacco prevention programs, titled “A Broken Promise to Our Children: The 1998 State Tobacco Settlement 15 Years Later,” was released by the Campaign for Tobacco-Free Kids, American Heart Association, American Cancer Society Cancer Action Network, American Lung Association, the Robert Wood Johnson Foundation and Americans for Nonsmokers’ Rights.
The states will collect $25 billion this year from the tobacco settlement and tobacco taxes, but will spend just 1.9 percent of it – $481.2 million – on tobacco prevention programs. This means the states are spending less than 2 cents of every dollar in tobacco revenue to fight tobacco use, the report said.
http://www.inforum.com/event/article/id/420703/group/News/

E-cigarettes cause alarming increase in calls to poison control center

Kentucky Regional Poison Control Center sees 333-percent increase

LOUISVILLE, Ky. — As the debate about electronic cigarette regulation continues with the U.S. Food and Drug Administration (FDA) and device manufacturers, data from one state poses concerns that should be part of the conversation.
E-cigarettes consist of a rechargeable lithium battery, a liquid cartridge and an LED light at one end that simulates the burning effect of a regular cigarette. When the user inhales, or “vapes,” a heating element converts the liquid in the cartridge into a vapor. Cartridges typically contain nicotine, propylene glycol or glycerol, flavoring and other additives.
E-cigarettes consist of a rechargeable lithium battery, a liquid cartridge and an LED light at one end that simulates the burning effect of a regular cigarette. When the user inhales, or “vapes,” a heating element converts the liquid in the cartridge into a vapor. Cartridges typically contain nicotine, propylene glycol or glycerol, flavoring and other additives.
The Kentucky Regional Poison Control Center of Kosair Children’s Hospital has received 39 calls about e-cigarettes so far this year, a 333-percent increase from nine calls received in 2012. Nationally, poison control centers have seen a 161 percent increase in calls from people with concerns about these devices. With sales of e-cigarettes doubling to $1.5 billion in the past year, the calls are likely to increase.
E-cigarettes consist of a rechargeable lithium battery, a liquid cartridge and an LED light at one end that simulates the burning effect of a regular cigarette. When the user inhales, or “vapes,” a heating element converts the liquid in the cartridge into a vapor. Cartridges typically contain nicotine, propylene glycol or glycerol, flavoring and other additives.
“More than half of the calls we have received were concerning children,” said Ashley Webb, Pharm.D., board-certified toxicologist and director of the Kentucky Regional Poison Control Center of Kosair Children’s Hospital.
“Kids are picking up the liquid cartridge when cartridges are left accessible or when an adult is changing the cartridge,” she said. “They’re also getting a hold of the e-cigarette and taking it apart to expose the liquid. They then either ingest the liquid or get it onto their skin. Even on the skin, the nicotine is absorbed and can create adverse side effects.”
These exposures raise a concern because of the concentrated nature of the cartridge fluid.
“The amount of nicotine in the cartridges is not regulated, but many contain more than 14 milligrams of nicotine,” said Dr. George Rodgers, associate medical director, Kentucky Regional Poison Control Center and professor and division chief of pediatric pharmacology and toxicology at the University of Louisville School of Medicine. “Severe cases of toxicity requiring hospitalization have been reported with children consuming 1.4 milligrams per kilogram of weight — equivalent to an average 2-year-old consuming the amount found in a cartridge,” he said. “And since children are not used to consuming nicotine, their symptoms may be more severe at lower levels.”
“Accidental exposure by children to e-cigarettes is a public health concern that we need to take seriously,” said Dr. LaQuandra Nesbitt, director of the Louisville Metro Department of Public Health and Wellness in Louisville, Ky. “Parents need to be aware of the potential dangers to their children.”
Symptoms of severe nicotine exposure include a pale appearance, flushing, sweating, headache, dizziness, hyperactivity or restlessness, vomiting, diarrhea, rapid heart rate, increased blood pressure, salivation and teary eyes. In very severe cases, the heart rate and blood pressure begin to drop to dangerously low levels and the patient can lapse into a coma, followed by difficulty breathing and even death.
When on the skin, nicotine in liquid form is easily absorbed. Even small amounts can cause irritation and a burning sensation.
“Only a few of the calls we have received have been from children inhaling nicotine from the e-cigarette,” Webb said. “And so far only two of the calls involved symptoms severe enough to require emergency care. But it’s only a matter of time before a child experiences a severe reaction.”
“Parents need to consider these devices as a potential harm to children and, like other poisons, keep them out of reach,” said Dr. Stephen P. Wright, pediatrician and medical director of Kosair Children’s Hospital. “Since e-cigarettes are also unregulated, we don’t know what other toxins may be in them.”
An analysis done by the FDA in 2009 showed that e-cigarettes contain carcinogens and other hazardous chemicals, including diethylene glycol, an ingredient used in antifreeze. Researchers from the University of Athens in Greece found that e-cigarettes, thought by some to be a safer alternative to tobacco smoking, do have a harmful effect on the lungs, as reported in Medical News Today.
“Since the industry is still so new, we don’t yet know all of the long-term health effects of e-cigarettes to the user, in addition to any effects of secondhand vapor,” said Wright, who is also a professor of pediatrics at the University of Louisville School of Medicine. “While they are touted as a healthier alternative to cigarettes, the jury is still out. We do know that not smoking anything — especially around children — is always the best bet.”
About the Kentucky Regional Poison Control Center of Kosair Children’s Hospital
The primary mission of the Kentucky Regional Poison Control Center is to reduce illness and death from poisoning in Kentucky. The center provides 24/7 free and confidential access to specially trained nurses, physicians and pharmacists who are certified in toxicology. They are specialists in communicating advice to health care professionals, first responders, patients, parents, family members, the general public and the media. Some of the more common calls received involve medications, household cleaning products, plants and personal care items.
Calls also are answered about work-related exposures in farming and industry, food poisoning, insect and snakebites and a variety of other potential hazards. On average, the poison control center’s hotline at (800) 222-1222 receives a call every 7 minutes, 24 hours a day, 365 days a year — more than 72,000 calls annually — from all of Kentucky’s 120 counties. Three of every four patients from those calls are successfully managed safely and inexpensively at home, reducing unnecessary emergency room visits and/or shortening hospital stays. For additional information, visit KosairChildrensHospital.com/PoisonControl.
http://www.lanereport.com/27431/2013/12/e-cigarettes-cause-increase-in-calls-to-poison-control-center/?fb_action_ids=10151744182160059&fb_action_types=og.likes&fb_source=other_multiline&action_object_map=%5B267785540038122%5D&action_type_map=%5B%22og.likes%22%5D&action_ref_map=%5B%5D

Bars one year into smoke-free

Tim Chapman – Tribune Editor , Pierce County Tribune
Rugby bars have been smoke free for just over one year now. Three of the city’s bar owners said business hasn’t been hurt because the state ban made for an even playing field.
Lee Ekren has owned Lee’s Bar for 47 years and said the ban didn’t especially bother him or affect his business. He said it wasn’t a bar of many regular smokers anyway, and people haven’t seemed to mind walking outside for a cigarette.
“Doesn’t make any difference to me,” Ekren said. “I’ve been here so long I figured if I’m gonna get (business), I’m gonna get it anyways.
Dan and Tracy Corum own Third Street Station and Tom Nowell owns I.C. Dubbles. Dan Corum and Nowell are opposed to the law, believing the decision should be up to each business, but neither has seen their profits affected much.
“It’s probably helped our food sales a bit, actually,” Dan Corum said. “Outside we have a lot of extra cigarettes to clean up. It’s kind of tough to stay on top of that.”
Said Nowell: “I don’t think it’s really hurt us much. Initially, there were people not happy about it.”
Dan Corum doesn’t mind going outside because he does the same when smoking at his residence. Tracy Corum, who also smokes, is pleased with the way their establishment feels and looks without cigarette smoke.
“It’s way nicer inside,” she said. “You don’t have all that smoke film.”
As of June, North Dakota was still the latest of 28 states to enact statewide bans in enclosed public places.
http://www.thepiercecountytribune.com/page/content.detail/id/508965/Bars-one-year-into-smoke-free.html?nav=5003#sthash.F2s1ZWEE.dpuf

Keep E-Cigarettes Away From Teens

Chicago Sun Times Editorial Board
Electronic cigarettes, those hip new cigarettes that blow a thick white vapor rather than smoke, are clearly less harmful than real cigarettes.
But that doesn’t mean e-cigarettes are harmless.
And until we know something different, that’s how we ought to treat them.
Folks who are wary of e-cigarettes — battery-operated nicotine inhalers that do not produce smoke — are going after them on two fronts. This group includes Mayor Rahm Emanuel, New York’s city council, other municipalities and states as well as the U.S. Food and Drug Administration.
The first is a no-brainer: keeping e-cigarettes out of the hands of teens and pre-teens. We cheer on efforts to do that in the city of Chicago and at the national level.
E-cigarettes don’t burn tar or tobacco, removing the risk of exposure to carcinogens in cigarette smoke. But they contain nicotine and the risks there, particularly to young people, are well documented. Nicotine is highly addictive, can impact the development of young brains, raises the heart rate and is one of the elements of smoking associated with heart disease.
E-cigarettes are being marketed aggressively to young people and come in flavors clearly meant to entice, such as bubble gum, pina colada and cherry. It appears to be working: between 2011 and 2012, use among middle and high school students more than doubled, according to the U.S. Centers for Disease Control. The risks of young people getting hooked on e-cigarettes and then switching to the more noxious traditional cigarettes are all too real.
Fortunately, Illinois already has joined about half the states in banning the sale of e-cigarettes to anyone under 18, effective Jan. 1. The FDA appears poised to take action across the country, with the agency noting with “great concern” the rise in youth e-cigarette usage. The wisest course is to ban the sale or marketing to anyone under 18.
The Chicago City Council could take that a step farther under an ordinance introduced last week. The mayor proposed prohibiting the sale of methol and flavored tobacco products, including e-cigarettes, within 500 feet of Chicago schools, up from 100 feet.
The mayor also wants to ban the smoke-less cigarettes anywhere that regular cigarettes are banned, including virtually all of indoor Chicago expect homes and cars, and at least 10 feet from business entrances. This is the second front that critics of e-cigarettes are pursuing. New York City will consider a similar ban this month.
This one is a little trickier but not by much. Without smoke, the risks to non-smokers nearby are clearly diminished. But the risks are not eliminated — there is concern that nicotine and chemicals such as formaldehyde and acetone are present in the e-cigarette vapor as well as other particles that can cause heart problems.
There is only limited and preliminary research on the potential hazards of e-cigarette vapors to others, leaving us in the do-no-harm category.
Until we know the full second hand effects of smoke-less cigarettes, it’s prudent to restrict them in the same way we do regular cigarettes. The City Council can and should be a forerunner in this area.
If and when the science on this questions is settled, a ban could be reconsidered.
Until then, do no harm.
http://www.suntimes.com/opinions/24065452-474/keep-e-cigarettes-away-from-teens.html

E-cig boom leads to taxation, regulation questions

WOODBURY, Minn. (AP) — Stores that sell increasingly popular e-cigarettes are popping up around the Twin Cities, highlighting the lack of regulation or taxation of the tobacco alternative.
E-cigarettes are battery powered and produce a nicotine vapor. Owners of stores that sell the devices told the St. Paul Pioneer Press that demand skyrocketed in July when a state tax increase sent cigarette prices up to about $7.50 a pack.
“Sales were insane,” said Angie Griffith, who owns several Smokeless Smoking stores and kiosks.
The surging sales have left regulators scrambling to react. The federal Food and Drug Administration is expected to release regulations on e-cigarettes soon, but for now there are very few state or federal rules applying to the devices.
That’s raised concern that some varieties could serve as an introduction to nicotine for youths. Some come in flavors including root beer, and cookies and cream.
But some former traditional smokers said e-cigarettes helped them kick a tobacco habit. A new Smokeless Smoking store in Woodbury, which opened Nov. 18, has already become a social hub for e-puffers, with its dimly lit lounge with sofas, TVs, games and books.
Griffith said the ability to form friendships and impromptu support groups with fellow e-cigarette smokers is important in helping customers kick tobacco.
“Smoking” an e-cigarette involves pushing a button on the small metal cylinder, examining its tiny computer screen, applying drops of flavoring and keeping an eye on the battery, then inhaling and exhaling the vapor. The vaporized liquids come in standard varieties but can be custom-made. Flavors mimic brands of cigarettes including Marlboro and Camel.
Gus Menth, a White Bear Lake truck driver, smoked cigarettes for 15 years. He tried to quit with nicotine patches but got so frustrated he once popped one in his mouth and chewed it. He can still remember the exact date he successfully switched to e-cigs: Jan. 15, 2011.
“I was tired of smelling bad,” Menth said. “And the cost savings is incredible.”
The metal e-cigarette costs from $30 to about $200, but is reusable. Menth and his wife, who also smokes e-cigs, estimate they are saving about $170 a month since their switch.
Menth said his breathing has improved. “I can run and play with my kid now,” he said.
___
Information from: St. Paul Pioneer Press
http://minnesota.publicradio.org/display/web/2013/11/30/health/ecigarettes-twin-cities

New E-cigarette shop opens in downtown Fargo

Fargo, ND (WDAY TV) – A new store opening to customers Friday on Broadway in Fargo hopes to tap into the growing business of electronic cigarettes.
E-cigarette sales hit the $500 million mark in 2012, and with that number expected to triple, Infinite Vapor hopes to get a piece of that $1.7 billion pie.
Kelsey Eaton- Manager, Infinite Vapor: “E-Cigarettes are a different way; an alternative to quitting smoking.
Cody Fruehling- First Infinite Vapor Customer: “Yeah, I’m addicted to the nicotine, but I’m also addicted to the feeling of smoking and that’s what the vapor offers.”
The E-cigarettes use flavored nicotine liquid to produce vapor that is then inhaled; therefore, no tobacco or tar is present.
Eaton: “A, they taste good, and B, they don’t smell, so you’re not smelly and it’s not all over your stuff and your hands don’t reek.”
With liquid flavors like banana and yummy gummy, public officials are concerned that E-cigarettes are catering to a younger crowd.
Robyn Litke Sall- Tobacco Prevention Coordinator, Fargo Public Health: “Sounds to me more like frozen yogurt flavor than it does E-cigarette flavor, so I really would strongly caution parents that this could be very attractive to their youth.”
With zero FDA regulation, E-cigarettes are allowed to be sold to minors, but Infinite Vapor manager Kelsey Eaton says they are taking the moral high ground.
Eaton: “We treat it just the same as any tobacco or nicotine product as in we take IDs. We don’t sell to anyone under 18.”
And just like traditional tobacco, E-cigarettes are banned in public places in North Dakota, while Minnesota still allows them.
The FDA is expected to place regulations on E-cigarettes in the near future.
http://www.wday.com/event/article/id/90738/

E-cigarette store to open in downtown Fargo

By: Dave Olson, INFORUM
FARGO – A chain of stores that began selling electronic cigarettes in the Twin Cities this past April is setting up a shop in downtown Fargo.
Bill Boldenow said he plans to open his Infinite Vapor store at 68 Broadway by Friday, but if that doesn’t happen, it’ll open “at the very latest the second week of December.”
Boldenow said the store will sell e-cigarettes and the e-juice that goes into them. E-cigarettes are pen-like devices that use a small battery and heating element to vaporize the e-juice, mimicking a cigarette.
While proponents such as Boldenow say e-cigarettes are safer than smoking, but some anti-smoking advocates are concerned the increasingly popular product isn’t regulated and has not been extensively tested.
Safe alternative?
E-juice typically contains nicotine along with some type of flavoring. When vaporized, e-juice is inhaled similar to the way smoke from a cigarette is inhaled, but without the carcinogens found in tobacco.
“We feel it’s a much safer alternative than tobacco, which we know is unsafe,” Boldenow said, adding that the e-juice Infinity Vapor sells is made in Minnesota and tested for consistency at a lab at St. Cloud State University.
“Infinity Vapor is a premium electronic cigarette shop that carries really high-quality products,” Boldenow said.
“A lot of the stuff you see out there these days – in gas stations and whatnot – are kind of a knockoff version,” he added.
Boldenow said e-juice nicotine levels can be adjusted to personal tastes, and he said many people who use e-cigarettes do so as a way to quit smoking.
“I want to promote people getting off of smoking,” he said. “I truly in my heart believe it is (a way to do that).”
Heather Nelson, part owner of the SnG Vapor store in Grand Forks, said more than a few of her customers kicked their smoking habit by turning to e-cigarettes.
“I’ve got a lot of people that (say), ‘I was smoking two packs a day for 30-plus years’ and in just a couple months they’ve gotten to a point where they are nicotine-free,” said Nelson, whose business has been operating in Grand Forks for about three years.
Nelson said the shop makes its own e-juice using a combination of four ingredients – nicotine; vegetable gelatin; coffee/tea flavorings; and pharmaceutical-grade propylene glycol.
Though propylene glycol is a chemical found in antifreeze, Nelson said it is a safe ingredient.
Regulation-free
But because e-juice is not regulated by the U.S. Food and Drug Administration, it is difficult to say just how safe or unsafe a particular batch may be, said Robyn Litke Sall, a tobacco prevention coordinator at Fargo Cass Public Health.
“We don’t yet know what all is contained in e-cigarettes. We don’t know if the vapor is harmful or not,” Sall said, adding that because of the lack of information, many health officials are concerned about statistics that indicate use of e-cigarettes among young people has doubled in recent years. In 2011, the market for e-cigs was $2 billion worldwide, according to an estimate by an industry group.
Because e-cigarettes look much like regular smokes, some wonder if they could be a gateway to smoking, said Sall, who added that scientific evidence is lacking when it comes to claims e-cigarettes help people stop smoking.
“Until there might be such evidence, we certainly can’t endorse it, or use it as a cessation device,” Sall said.
Both Boldenow and Nelson said they will not sell products to people under 18, assertions that don’t quell Sell’s concerns. She said a store may have a policy against selling to people under 18, but there is no law that prevents a business from doing so.
If a business decides to change their policy due to factors like competition, “there’s no penalty there,” Sall said.
Competitive advantage
E-cigarettes were included in North Dakota’s recently passed ban on indoor smoking in public places, meaning anyplace that is smoke-free by law must also be vapor-free.
Minnesota’s state law banning smoking in workplaces, bars and restaurants does not include e-cigarettes, but some communities in the state have their own ordinances regulating such products.
Moorhead is a city with no e-cigarette regulations, and that might give businesses an edge over their competition on the North Dakota side of the Red River, said Jake Bruns, owner of Mick’s Office, a downtown Moorhead bar.
Bruns said few of his customers use e-cigarettes, which are already widely available at convenience stores in the area. But he said that might change with a store opening that is devoted to the devices.
“There could be some marketing opportunities there,” he said.
http://www.inforum.com/event/article/id/419678/group/homepage/

Letter to the Editor: E-cigarettes aren’t a solution for those addicted to nicotine

By: Jim Tennant, Napa
After reading the story about a new e-cigarette store in Napa, I was disappointed that your reporter uncritically repeated the propaganda that the e-cigarette industry (which is being taken over by the traditional tobacco industry) has been feeding the public (“E-cig entrepreneur hopes to blow away tobacco cigarettes,” Nov. 20).
In fact, there is no evidence that e-cigarettes are any safer than the deadly, traditional tobacco products. E-cigarettes are not useful as a way to quit or cut down smoking. Nicotine is one of the most addictive drugs known to man and e-cigarettes are another way of delivering this terrible drug to your body. E-cigarettes seem to me to be like washing your glass before drinking poison.
Flavored e-cigarettes are a blatant attempt to market to children — adult smokers would not buy them. Napa County has regular, free, effective quit-smoking classes available to the public and I hope that anyone who wants to quit smoking will use this service and not switch to another form of this deadly drug.
 http://napavalleyregister.com/news/opinion/mailbag/e-cigarettes-aren-t-a-solution-for-those-addicted-to/article_a25bbf74-5705-11e3-9c78-001a4bcf887a.html

Study: Teens' E-Cigarette Use Promotes Heavy Tobacco Use

By: Jessica Berman
WASHINGTON — According to the first-ever study on the use of electronic cigarettes, or e-cigarettes, by young people, researchers have found that the devices, marketed as an alternative to real cigarettes, appear to fuel heavy smoking among youth.
E-cigarettes are battery-powered devices that look like cigarettes and deliver a smokeless aerosol of nicotine, flavorings and other chemicals. They are promoted as a safer alternative to cigarettes and an aid to stopping smoking.
However, a new study looking at the use of electronic cigarettes in nearly 76,000 Korean teenagers found they are less likely to have succeeded in kicking the habit and that electronic cigarettes made them heavier smokers.
Stan Glantz directs the Center for Tobacco Control Research and Education at the University of California, San Francisco.  He is also the senior author of the study.
Glantz said that while there is evidence electronic cigarettes help a small percentage of adult smokers stop, the same is not true for adolescents, who he says are being bombarded with appealing ads.
“They are being marketed with flavors, with images of sex and independence, and also marketed with the claim they will help you quit smoking and, in fact, the kids who are trying to quit smoking were more likely to be using e-cigarettes. But, as I said before, [they are] much less likely to actually quit,” said Glantz.
Glantz said that the nicotine in e-cigarettes makes them addictive even though users do not inhale as many toxic chemicals. He also claimed that tobacco companies, which manufacture the devices, take advantage of the lack of regulation of e-cigarettes to try to hook new smokers.
“We have the kind of Wild West marketing that we did in the bad old days for cigarettes. And the kids are clearly responding to that, and youth use of e-cigarettes in Korea is going up very rapidly just as it did here in the United States,” said Glantz.
U.S. regulators report the number of middle and high school students who use e-cigarettes doubled from 2011 to 2012, to a total of 1.7 million students.
Regulations to ban the smokeless devices are being proposed in Chicago, which may become the first U.S. city to restrict the sale of electronic cigarettes.
The article on e-cigarette use among Korean teens is published in the Journal of Adolescent Health.
http://www.voanews.com/content/study-teens-e-cigarette-promotes-heavy-tobacco-use/1798525.html

E-cigarettes sprouting promise and questions

With a preoccupied gaze into the distance, Matt Tlougan inhales from the mouthpiece of a device held in his hand. A battery in its base powers a heating unit that vaporizes a concoction of confectioners’ flavors and nicotine, “juice,” as it’s known.
A few moments later, a gray-white cloud rolls out of his nostrils and mouth.
Is he smoking?
The answer, so far, is as nebulous as the cloud around him. Electronic cigarettes, or e-cigarettes, began appearing in the U.S. as something more than a curiosity around 2005. The market for them is growing at such a rate that Tlougan has opened three Vape It Zone stores since he first tried an e-cigarette himself seven months ago. At his sites in Rochester and St. Cloud, Minn., he said, sales average 20 to 25 units a day. He has similar hopes for the kiosk in The Empire Mall that opened about a month ago, and he is considering opening a fourth Vape It Zone in Brandon.
Articles from Time and the New York Timesthis year note e-cigarette sales have doubled annually since 2008 and are expected to reach $1.7 billion this year.
E-cigarette proponents say the product simulates smoking, and Tlougan said within a day of using one he was able to stop a pack-and-a-half-a-day habit of the real thing. He also gave up chewing a can of smokeless tobacco a day.
Because e-cigarettes don’t incinerate tobacco, they don’t produce the toxic chemicals associated with smoking.
However, “we don’t know what the potential health effects are from vapor, nicotine and other compounds. It kind of goes back to the early days of cigarettes,” said Dr. Daniel Heinemann of Canton, president of the South Dakota State Medical Association.
Vapor could be as bad as smoke.
“Any time you heat chemicals, they change their properties … you get chemical reactions that take place. We don’t know if other chemicals are formed in that process. That could be a problem. It could cause health effects,” Heinemann said. At the very least, e-cigarettes are a potent device for delivering addictive nicotine to the body, he said.
Doctors and public officials are looking to the Food and Drug Administration for guidance on regulating e-cigarettes.
“All of us are waiting to see what happens at the federal level,” Mary Michaels said. She is a healthy community specialist with the Sioux Falls Health Department. Depending on how the FDA approaches e-cigarettes, they might fall under the South Dakota ban on smoking in public places.

Attorneys general press for FDA study

Marty Jackley already has joined 40 other state attorneys general in urging the FDA to move quickly to study and regulate e-cigarettes.
“The nicotine found in e-cigarettes is highly addictive, has immediate biochemical effects on the brain and body at any dosage and is toxic in high doses,” the attorneys general wrote FDA Commissioner Margaret Hamburg on Oct. 23.
“Consumers are led to believe that e-cigarettes are a safe alternative to cigarettes, despite the fact that they are addictive, and there is no regulatory oversight ensuring the safety of the ingredients in e-cigarettes.”
The latter assertion is a fair point. The e-cigarettes Tlougan sells already are manufactured. However, family members, including his mother, a chemist at the Mayo Clinic, make the juice he sells.
“We make each bottle, one by one.” Quality control can be readily achieved, though “you’ve got to be on your toes,” he said. The flavorings come from candy manufacturers, and the nicotine is from an FDA-approved lab. He offers juice with nicotine concentrations ranging from 18 percent to zero, and if you have to take his word for that, well, he points out competitors are selling juice they readily acknowledge was made in China.
FDA scrutiny ultimately could help his business, Tlougan said. He would like to be able to prove he’s selling a product using certified ingredients that is as safe as the nicotine inhalers Mayo Clinic physicians give to patients who are trying to quit smoking. The only substantive difference between those and e-cigarettes, Tlougan said, is that e-cigarettes transport nicotine in vapor and inhalers don’t.
Tlougan won’t sell to minors, and he has no problem with e-cigarettes being included in smoking bans.
“It would not hurt our business if they are banned in bars and public areas. If you ask me, I think it’s a great thing. Nonsmokers shouldn’t have to be around smokers,” he said.
Sioux Falls Mayor Mike Huether is a big supporter of the smoking ban. So far, though, he isn’t making e-cigarettes a priority for inclusion under the ban. They’re flying under his radar.
“I know nothing about those,” Huether said. “I couldn’t even pick one out.”
If his position mirrors many officials’ who have yet to learn about e-cigarettes, it is not universal. Rochester moved pre-emptively as a municipality to ban e-cigarettes everywhere smoking is banned. The City Council a week ago gave final approval to an ordinance, according to Stevan Kvenvold, city administrator.
“It wasn’t subject to much debate,” Kvenvold said. “The council pretty much agreed that e-cigarettes were smoking. There was not too much back and forth about it.”
While the attorneys general want the FDA to extend to e-cigarettes the existing rules prohibiting marketing tobacco to minors, Jackley said state and local governments should decide other issues associated with them, such as taxing them and determining whether they fall under the umbrella of smoking bans.
Heinemann of the state medical association said e-cigarettes should not be sold to minors. However, his group has not yet taken a position on whether they should fall under the smoking ban.

New thing for some, quitting for others

Tlougan said his customers fall into two camps: Those who are eager to try a new experience and those who hope to use e-cigarettes to wean themselves off smoking, and he cites his own spectacular success in being able to quit a savage tobacco habit using e-cigarettes.
But Heinemann said e-cigarettes are not an ideal tool to quit smoking.
If a patient came to him asking about using an e-cigarette to quit smoking, “I would tell them there are other things we can use over time to taper you off nicotine,” such as nicotine gum and patches. He said e-cigarettes re-enforce the ritual and oral fixation that is a part of smoking. For someone trying to give up smoking, “in my mind, replacing one oral device with another, I’m not sure that gets them headed in the right direction.”
For Tlougan, though, the fact he can hold it and it has a mouthpiece hardly are coincidental. They are attractive aspects of his e-cigarette.
While he still needs nicotine, he said almost half his customers buy juice without it. “They just want the flavor.” It begs the question: How dangerous is it to inhale vaporized cinnamon, blueberry or chocolate flavoring?
“We need to study them,” Heinemann said. “For anybody to say they’re not harmful, we don’t know that yet.
“In terms of what it means to the body to inhale this, we don’t know. We need more research.
“Until we have that, the minimum should be to keep these out of the hands of children.”
http://www.argusleader.com/article/DF/20131125/NEWS/311250014/E-cigarettes-sprouting-promise-questions?nclick_check=1