ECigs: ETech Meets Public Health Again (Part Two)


[For information on why I’ve been missing-in-action here, please see this post at my personal blog: http://mhistoire.wordpress.com/2013/05/25/breathing-in-memory-of-rose-ann-broussard-cooper-anderson/ I expect to be back in business next week.]


So, in Part One, the eCig conversation was largely framed through health and legislative perspectives, with concerns hooked substantially on potential use by minors and young adults. In part two, I want to dig a little deeper into some of these issues, and spin off in new directions, mostly workplace use, more about minors, and issues of DIY and unintended uses of e-cigs.

I keep saying how complicated is the issue of electronic cigarettes. This tweet illustrates part of that.

The American Cancer Society (ACS) is one of the organizations most strongly advising caution with respect to e-cigs, and perceived as “the opposition” by the e-cig and vaping communities. Obviously, given that at least one person at their event was using an e-cig, this is not a topic with complete consensus, but it is also close enough to consensus to raise eyebrows and warrant comment. The issues are further complicated by the ACS accepting donations from e-cig manufacturers.

Similarly, despite the prolific and prominent vitriol from the vaping community regarding any suggestion that e-cigs warrant further research or concern or caution, there are elements of that community willing to work with the government and professional medical organizations on exactly those areas.

Growing Electronic Cigarette Manufacturer “Welcomes” FDA’s “Reasonable Regulation” Of Category:
http://www.prnewswire.com/news-releases/growing-electronic-cigarette-manufacturer-welcomes-fdas-reasonable-regulation-of-category-204121851.html

Given that e-cigs are an emerging technological alternative to the issue of smoking and that smoking in public spaces and the workplace has been a major issue over the past few decades, it’s no real surprise that there are guidelines and suggestions being created to advise employers about best practices for managing e-cigs in the workplace. Given that my own campus, University of Michigan, only recently went smoke-free (July 1, 2011), and that several of my friends are still struggling to make the switch, I expect that this is an issue worthy of local attention.

What employers need to know about electronic cigarettes? Fact Sheet, September 2011. (pdf)
http://www.businessgrouphealth.org/pub/f311fb03-2354-d714-51a9-0b67bb588666
Main points:
Quick Facts About E-Cigarettes
• Not an FDA-approved tobacco cessation device.
• Contain nicotine and detectable levels of known carcinogens and toxic chemicals.
• Look very similar to regular cigarettes (especially from a distance).
• Manufactured using inconsistent or non-existent quality control processes.
Actions for Employers
• Determine whether the use of e-cigarettes is allowed in their jurisdictions, including in the workplace.
• Understand whether unions, works councils, or other laws can raise barriers to implementing workplace
policies regulating e-cigarettes.
• Stay informed on any new laws and emerging scientific evidence regarding e-cigarettes.

Please note the date on those tips, and that they haven’t been updated, although the conversation is far from over!

Sullum, Jacob. Boston Bans E-Cigarettes in Workplaces, Just Because. Dec. 2, 2011 http://reason.com/blog/2011/12/02/boston-bans-e-cigarettes-in-workplaces-f

American Society for Quality: Should e-Cigarettes Be Allowed in the Workplace? April 15, 2013 http://asq.org/qualitynews/qnt/execute/displaySetup?newsID=15801

One marketing firm addressed a sort of a case study of why one life insurance firm in Britain banned e-cigs at work, arguing against each of the points.


Should electric cigarettes be allowed in the workplace http://www.slideshare.net/jackwillis2005/ppt-should-e-cigarettes-be-allowed-in-the-workplace

Here are a couple links with pro and con information about the Standard Life policy decision. A major point seems to be the psychology of e-cig use, that because of their resemblance to real cigarettes they give the message that smoking is a good thing or at least permissible. I am not aware of any research into this assumption, although there is substantial evidence on the related concept of candy cigarettes.

The Scotsman: Standard Life bans employees from smoking electronic cigarettes at work (2012): http://www.scotsman.com/the-scotsman/health/standard-life-bans-employees-from-smoking-electronic-cigarettes-at-work-1-2124568

Daily Mail: Safety fears over electronic cigarettes because they are ‘unclean’ and unregulated: http://www.dailymail.co.uk/health/article-2129550/Safety-fears-electronic-cigarettes-unclean-unregulated.html

And a couple pieces about the psychological impact candy cigarettes. Consider, though, that the research on candy cigarettes is looking explicitly at the impact on children, not adults.

Klein JD, Forehand B, Oliveri J, Patterson CJ, Kupersmidt JB, Strecher V. Candy cigarettes: do they encourage children’s smoking? Pediatrics. 1992 Jan;89(1):27-31. http://www.ncbi.nlm.nih.gov/pubmed/1728016

Klein JD, Clair SS. Do candy cigarettes encourage young people to smoke? BMJ. 2000 Aug 5;321(7257):362-5. http://www.ncbi.nlm.nih.gov/pubmed/10926600

Klein JD, Thomas RK, Sutter EJ. History of childhood candy cigarette use is associated with tobacco smoking by adults. Prev Med. 2007 Jul;45(1):26-30. Epub 2007 Apr 24. http://www.ncbi.nlm.nih.gov/pubmed/17532370

Back to the American Cancer Society, and the issue of minors having access to e-cigs.

Anti-THR Lies and related topics: Who leads the fight against banning e-cigarette sales to minors? Guess again: it is the American Cancer Society: http://antithrlies.com/2013/04/25/who-leads-the-fight-against-banning-e-cigarette-sales-to-minors/

As with everything surrounding the e-cig controversies, it’s never straightforward, and there are always multiple views with value. This tweet was in response to my Part One blogpost on e-cigs.

The links highlight the work of Dr. Michael Siegel, Professor, Department of Community Health Sciences, Boston University School of Public Health.

Dr. Siegel:
“I do not question the need to balance the benefits of enhancing smoking cessation among adult smokers with the costs of youth beginning to use this nicotine-containing product. But show me at least one youth using the product before you call for a ban. This recommendation makes a mockery out of the idea of science-based or evidence-based policy making in tobacco control.”
The Rest of the Story: Tobacco News Analysis and Commentary: American Legacy Foundation Sounds Alarm About Electronic Cigarette Use Among Young People, Calling for a Ban on Flavored E-Cigarettes, But Fails to Document a Single Youth Using These Products http://tobaccoanalysis.blogspot.com/2013/04/american-legacy-foundation-sounds-alarm.html

In response to:

““While most candy-flavors – such as chocolate, vanilla and peach – were banned in 2009 from cigarettes, flavored tobacco products like cigars, hookah, snus and e-cigarettes persist in more than 45 flavors and are still legally on the market,” said Andrea Villanti, PhD, MPH, CHES, Research Investigator for Legacy. “These products can be just as appealing to young people as flavored cigarettes, offering a product appearing to be more like candy to those most at-risk of becoming lifelong tobacco users,” she added.”
FDA Should Extend Ban on Flavors to Other Products to Protect Young People, April 3, 2013 http://legacyforhealth.org/newsroom/press-releases/flavored-tobacco-continues-to-play-a-role-in-tobacco-use-among-young-adults

“Overall, 18.5% of tobacco users report using flavored products, and dual use of menthol and flavored product use ranged from 1% (nicotine products) to 72% (chewing tobacco). In a multivariable model controlling for menthol use, younger adults were more likely to use flavored tobacco products (OR=1.89, 95% CI=1.14, 3.11), and those with a high school education had decreased use of flavored products (OR=0.56; 95% CI=0.32, 0.97). Differences in use may be due to the continued targeted advertising of flavored products to young adults and minorities. Those most likely to use flavored products are also those most at risk of developing established tobacco-use patterns that persist through their lifetime.”
Villanti AC, Richardson A, Vallone DM, Rath JM. Flavored Tobacco Product Use Among U.S. Young Adults. American Journal of Preventive Medicine 44(4):388-391, April 2013 http://www.ajpmonline.org/article/S0749-3797(12)00939-7/abstract

Dr. Siegel:
“But I don’t think most anti-smoking groups or advocates care about the actual evidence. They’ve already made up their minds. Vaping looks too much like smoking. So forget about the fact that not a single nonsmoking youth could be found who has even tried the product. The advocates must continue to follow the party line and warn about the danger of electronic cigarettes as a gateway to nicotine addiction. Never mind that the gateway just doesn’t exist.”
The Rest of the Story: Tobacco News Analysis and Commentary: New Study on Electronic Cigarette Use Among Youth Fails to Find a Single Nonsmoking Youth Who Has Even Tried an Electronic Cigarette: http://tobaccoanalysis.blogspot.com/2013/01/new-study-on-electronic-cigarette-use.html

In response to:

“E-cigarettes are battery-powered devices that look like cigarettes and deliver a nicotine vapor to the user. They are widely advertised as technologically advanced and healthier alternatives to tobacco cigarettes using youth-relevant appeals such as celebrity endorsements, trendy/fashionable imagery, and fruit, candy, and alcohol flavors [2], [3]. E-cigarettes are widely available online and in shopping mall kiosks, which may result in a disproportionate reach to teens, who spend much of their free time online and in shopping malls.”
Grana, Rachel A. Electronic Cigarettes: A New Nicotine Gateway? Journal of Adolescent Health 52(2):135-136, February 2013.
http://www.jahonline.org/article/S1054-139X(12)00736-7/fulltext
[NOTE: Check out the bibliography]

“Only two participants (< 1%) had previously tried e-cigarettes. Among those who had not tried e-cigarettes, most (67%) had heard of them. Awareness was higher among older and non-Hispanic adolescents. Nearly 1 in 5 (18%) participants were willing to try either a plain or flavored e-cigarette, but willingness to try plain versus flavored varieties did not differ. Smokers were more willing to try any e-cigarette than nonsmokers (74% vs. 13%; OR 10.25, 95% CI 2.88, 36.46). Nonsmokers who had more negative beliefs about the typical smoker were less willing to try e-cigarettes (OR .58, 95% CI .43, .79)."
Pepper JK , Reiter PL , McRee A-L , Cameron LD , Gilkey MB , Brewer NT . Adolescent males' awareness of and willingness to try electronic cigarettes. J Adolesc Health . 2013;52:144–150. http://www.jahonline.org/article/S1054-139X(12)00409-0/abstract

Wow. All smart people, working in or from the peer-reviewed literature, but with varying interpretations. For more information about flavors in e-cigs, check out these e-cig review and information sites.

Vapor Rater: http://www.vaporrater.com
Vapour Trails: http://www.vapourtrails.tv

The first thing I saw that actually sparked a moment of interest in e-cigs for me personally was the idea that you can make your own at home. I’m not a smoker, but I’m also not much of a drinker. I am, however, addicted to canning, pickling, and otherwise preserving produce and home goods. I go so far as to even make my own fruit shrubs as beverage mixes for my friends who do drink, even though I don’t partake. If you could convince me that e-cigs were safe and healthy and all that, you could tempt me to want to learn how to mix the vaping liquid for my friends, even if I don’t use it myself.

RTS Vapes: Lab Safety when Mixing Liquid Nicotine: http://rtsvapes.blogspot.com/2012/09/lab-safety-when-mixing-liquid-nicotine.html

A brief detour down memory lane. When I was in high school I remember vividly a change in what and who was “cool” between sophomore and junior years. During freshman and sophomore years, the cool kids, the influencers, were those who snuck off into corners to make out and have sex. In junior and senior years it was no longer sex but drugs that was cool, and a lot of the smartest kids in school adopted drugs, creating and using intellect, technology, and creativity to explore this “counter-culture” area. In chemistry class, one of the top students used the chem lab to gold-plate a baby marijuana leaf into a pickle fork. A pair of National Merit Scholars broke into the high school academic system to do a statistical analysis comparing the IQs of known street drug users compared to street drug ‘virgins’ among the student population, with the drug users ‘proven’ to have the highest IQs. There was a perception that drugs weren’t just cool, but smart. I don’t know, but it would not surprise me to find that high school students today are also inquisitive and creative with exploring new technologies that allow them to buck the status quo. It is with that in mind that I read these next tweets.


Portable Vaporizer – Marijuana Pot Herbal Portable Vaporizers http://www.youtube.com/watch?v=vs6AjEXcOok

For the record, I am a supporter of the legalization of marijuana, and it makes sense that if e-cigs are safer to want to extend those health benefits to persons who smoke anything recreationally. I’m not opposed to e-cigs, either, but do think there are benefits to information, education, and appropriate legislation. There are really two main questions. One, this is a new technology, and we don’t know that much about it. E-cigs were invented in 2004, and there simply hasn’t been time to fully research the technical, physical, and psychological health impacts of use. That is a problem for most new and emerging technologies, and we don’t have a solution for that at this point. The other main question is really about minors. So, the argument from Dr. Siegel is that youth don’t use e-cigs. Are you sure?

One response to “ECigs: ETech Meets Public Health Again (Part Two)

  1. Pingback: At the Movies: Public Health Aspects of E-Cigarettes, 10 (Or So) Thought-Provoking Videos | Emerging Technologies Librarian

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