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Where there's no smoke, there's fire

BY BRENT GRIFFITHS | MAY 07, 2014 5:00 AM

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Right above the door a small, square sign warns minors they are barred from entering. Those old enough to be welcomed into the newly opened Iowa City establishment, Black and Gold Vapors, will see a small, black binder displaying tantalizing flavors such as Galapagos, Pegasus, and Smurfette.

While this local business, located at 440 Kirkwood Ave., is voluntarily supporting a no-minors policy, Gov.  Terry Branstad will ultimately decide whether to make it law to ban sales of electronic cigarettes to minors across the state. A spokesman for the governor said he would not indicate a position until reviewing the final text. He has 30 days to make a decision.

The bill, House File 2109, marks Iowa’s foray into the national and even international debate surrounding the subject.

Beneath the fruity flavors, salacious advertising, small amount of initial research and even the legislation itself is the battle over the safety of the increasingly popular devices.

Advocates of the electronic versions point to a panacea for those who want to quit smoking, since many of the 250 known harmful chemicals  — such as ammonia — in the traditional tobacco cigarette has been removed. But medical experts view these promises of e-cigarettes with a healthy dose of skepticism, particularly because many of the devices still contain the addictive stimulant nicotine.

One such expert, Sue Curry, the dean of the University of Iowa College of Public Health, said eliminating many of the harmful substances found in cigarettes is helpful, but the remaining nicotine can go “systemic” through the user’s body, affecting the brain and heart.

Usually derived from a tobacco plant, nicotine has been linked as the hook for traditional cigarettes.
Research about electronic cigarettes, however, has yet to be confirmed through numerous studies. Scientists and lawmakers continue to debate the addictiveness of e-cigarettes. They disagree on whether the device is “safe” and whether they can wean smokers away from their traditional products or whether users will instead move from the practice of so called vaping to smoking cigarettes.

Business owners and others involved in the industry in Iowa say they have seen the impact e-cigarettes can have on traditional smokers.

“I’ve helped more people quit smoking in the last two months then Nicorette has in the past five years,” said Black and Gold Vapor Sales Associate Travis Schaapveld.

At Black and Gold Vapors, customers are challenged to use an e-cigarette for a day and refrain from the temptation of regular cigarettes. Store manager Bekka Hayslett said this practice has helped customers quit smoking at a rapid rate.

Aaron Swartzentruber walked into the store recently to see if e-cigarettes could help him. The stench and smell of cigarettes was bothering his family, and a few of his friends tried the new devices. After testing out a couple of flavors, he paused and a small grin spread across his face. “Wow,” he told Hayslett and Schaapveld — clearly satisfied with the product.

Users like Swartzentruber say the “throat hit,” the feeling of nicotine coursing down the body, is a sensation that e-cigarettes possess but other products like nicotine gum or patch can’t replicate.

Nicotine still an issue

While the tar and other chemicals may be absent from the e-cigarette, one common denominator between the traditional smoke and vaping is nicotine. And that’s still a problem, according to some specialists.

A major concern about nicotine is its effect on development throughout the body. In particular, the chemical has been found to affect brain development, particularly among adolescents who begin smoking before they are 18 years old.

Edythe London, a professor of medical pharmacology at UCLA, has studied the effects nicotine has on brain development. Her latest research on young adult smokers suggests the insula, an island-shaped area of brain cortex that controls cravings, was thinner among those who smoked less.

The study was unable to show whether this difference is linked to smoking or genetic differences, but it illustrates the potential impact the habit can have on brain development.

Researchers agree e-cigarettes pose less risk when it comes to the cocktail of chemicals found in traditional cigarettes, but the new technology has lead to some concerns. The Centers for Disease Control and Prevention has documented that calls to poison-control centers involving nicotine liquid, which is added to some e-cigarettes, are “dramatically increasing” among both young children and adults. According to the study, calls increased from one per month in September 2010 to 215 per month in February 2014.  Fifty-one percent of the calls involved children 5 years old and younger, and 42 percent were for adults 20 years old or older.

The spike is linked to a liquid, which is poured into tanks for midsize e-cigarettes. Children are at risk for consuming the liquids, because they bottles they come in may not be child-proof.

But the rise of calls among adults is particularly interesting, because calls for help among those more than 20 years old also involve nicotine poisoning; just as alcohol, too much of the drug can wreak havoc on the body, leading to vomiting and in some cases death. Nicotine poisoning does not mean the chemical has to be inhaled as it can also be absorbed through the skin or eyes, possibly through a spill, or ingested.

To what extent this new twist on an old habit has either hurt or helped the general public is, according to one expert, basically unknown.  

“I would say there is not a consensus yet,” said Richard O’Connor, associate professor of oncology at the Roswell Park Cancer Institute in Buffalo, who has studied the spread of e-cigarettes across the country.

O’Connor, as do many of his colleagues, prefers not to guess on how long it will take scientists to have any definitive findings about the benefits or hazards about this trend.

But in Washington, D.C., and in states across the country, lawmakers are trying to make the call.

Iowa legislators passed a bill during the final days of the legislative session last month that bans both nicotine and non-nicotine e-cigarettes for minors. The debate in Des Moines, though, centered on what was left out of the final text of the bill — such as banning non-nicotine devices and restricting local control.

Democrats seized on those who were pushing for the bill’s passage and made not so subtle hints about tobacco companies who pushed for it.

Rep. Dave Jacoby, D-Coralville, said the bill was one of the worst written pieces of legislation he has ever seen in Iowa.

According to lobbying records, which are required by the Legislature, RAI Services, an offshoot of Reynolds America, hired two lobbyists to push the bill through. Altria, the new name for Phillip Morris, hired five and Iowans For Alternatives To Smoking And Tobacco, a collection of Iowa’s e-cigarette businesses, hired a lobbyist who was previously employed by Phillip Morris.

On the opposite side of the bill, well-known health”groups, including the lobbying wing of the American Cancer Society, the American Heart and Lung Associations, were opposed to the bill, House File 2109.

Senate Democrats, who control the chamber, were able to include a ban on non-nicotine e-cigarettes after Rep. Chip Baltimore, R-Boone, and Republicans in control of the Iowa House fought off amendments containing the provision.

Baltimore was responsible for moving the bill through the House and securing its passage there on Feb. 11. While he remains opposed to the idea of banning non-nicotine devices, it was a small, acceptable change.

The owner of one of Iowa’s largest e-cigarette stores said reaching the compromise was an easy decision.

“[Including non-nicotine e-cigarettes] was something we could easily give up if it might cause people to sway one way or another,” said Corey Halfhill, the owner of Central Iowa E-Cigarettes in Des Moines. “We felt it was better to just roll with it, and not fight that issue by any means and just support it.”

Halfhill said he was “absolutely ecstatic” when he heard how the bill turned out last week. He owns three stores and runs Iowans for Alternatives to Smoking Tobacco. He said he hopes proponents can prepare for the next session to “keep things rolling pretty much the same.”

Nationally

A host of states and cities have decided to act on issues concerning e-cigarettes. Many have considered, or passed, bans on selling to minors. Minnesota has more regulations on the product, having decided to classify it under other tobacco products since 2010 and more recently increasing taxes on e-liquid and disposable e-cigarettes.

An expert who tracks the topic across the country said states were leaving themselves an out before the federal government took action.

An expert who tracks the topic across the country said states were leaving themselves an out before the federal government took action.

Karmen Hanson, a researcher with the National Conference of State Legislatures, said in regards to the spread of e-cigarette-related laws, many states are beginning to go beyond their initial questions and exploring how to tax the products, if they apply to current clean-air  laws, and regulating online sales.

The federal government released long-awaited regulations for e-cigarettes and a host of other products on April 25.

The Food and Drug Administration, in turn, used powers granted to it under previous federal law to “deem” electronic cigarettes under its jurisdiction, allowing regulation of the devices.

Included in the FDA’s 200-page proposal is a federal rule banning minors from obtaining e-cigarettes containing nicotine. Further, health warnings will be required on products and manufactures would face new requirements.

Those requirements include:
• only making direct or indirect claims about e-cigarettes reducing risks if the FDA finds research to back up the assertions and the “marketing of the product would benefit public health as a whole”;
• mandating manufacturers to register with the FDA and report product and ingredient lists.

A 75-day public comment period is ongoing. After the period ends, the FDA is required to view all submitted comments and make any necessary changes to its proposal. There is no set time for how long the process could take.

“The FDA process is arduous and time consuming … and we want to avoid renormalizing smoking, making it culturally acceptable once again,” said Robert Jackler, a principal investigator at Stanford Research into the Impact of Tobacco Advertising.

Beneath the metal: History and Explanation

Hon Lik created the electronic cigarette in China in 2003. According to an LA Times story, the pharmacist was trying to stop smoking, his own father had died from cancer after years of smoking, and he hoped he could create a product that would help him kick the habit. Eventually, the idea crossed the Pacific and began with small-scale companies. The so-called Big Tobacco companies, such as R.J. Reynolds, maker of Camel and Kool,  Altria, better known as Phillip Morris, maker of Marlboro, Lorillard, and the maker of Newport, were initially absent from the market.

The small cylinders, typically constructed using either plastic or aluminum, began to gain traction. The premise was simple: Cut out the chemicals, replicate the experience, and, in some cases, add in the nicotine. Models without nicotine are readily available on the market. A tiny battery heats either a liquid mixture of nicotine or a cartridge vaporizing the contents until they could be inhaled.

At first cig-likes e-cigarettes modeled to look exactly like the traditional product, were the most prominent. Companies such as Blu E-Cigarettes became massively popular. But advances in technology pushed the cylinders to carry more features. Now, users can customize what they inhale, or vape, to fit their palate with traditional tobacco or sweet candy flavors as two of the options.
This juice, a mixture of propylene glycol, vegetable glycerin, food-grade flavorings, and nicotine, fills a small tank that attaches to the battery.

Although the world’s largest tobacco companies were not originally a part of the e-cigarette boom, in recent years, their investments have shifted to the e-cigarette market. The third-largest tobacco company in the United States, Lorillard, acquired Blu e-cigarettes in 2012. And R.J. Reynolds hawks its Vuse e-cigarettes.

The chemical is at the center of both the selling point and controversy over nicotine-delivery systems, the official term for e-cigarettes.


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