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The Wild West of nicotine
Are e-cigarettes a better alternative to tobacco?

05/15/14
By Rebecca Fishow rfishow@hippopress.com



 There’s not enough scientific evidence to prove that electronic cigarettes are a healthier alternative to tobacco cigarettes — yet — but, despite that, 90 percent of the customers who come into GP Vapors for the first time are looking to quit smoking, says owner Michael Boutin.

What’s more, Boutin says that since he’s opened the Salem store in 2010, he’s helped more than 100 people quit smoking tobacco cigarettes.
“Some comments [e-cigarette critics] make is that there’s no proof it helps people quit smoking, but in fact it does,” he said.
While Boutin’s sells a variety of reusable e-cigarette products including  premium “e-juice” that’s blended on site,  in downtown Manchester, Nirmal Singh sells disposable varieties at his convenience store, North End Superette — and he’s had a very different experience.
He says the product hardly sells. 
“We don’t get that many customers,” Singh said. But the customers he has gotten  “say they want to try them so they can quit smoking, but they come back in a few days to get regular cigarettes. And some people even use both. They like to be able to smoke inside.”
As Singh spoke, he stood outside his store, smoking a cigarette. He said he tried the e-cigarettes he sells but didn’t like them. 
“It didn’t feel like it had the of kick you get from real cigarettes,” he said. “I  tried one, but it didn’t feel like I was smoking so I went back to cigarettes.”
Whether or not people are making the switch, the health effects of “vaping” are under hot debate. It has been touted as a safe replacement for cigarettes and criticized for its potential to hook more people, especially youth, on nicotine. 
But experts say it could be years before the medical community, and the public, know the true health effects of e-cigarettes. 
“It is unregulated, so we don’t know much about them,” said Kate McNally, tobacco cessation specialist for the Cheshire Coalition for Tobacco Free Communities. “I don’t want to be the one that stands in the way of progress if it turns out it is totally safe. I don’t want to be an alarmist. ... I want to make sure we are doing what we need to do to not increase the smoking rate.”
As the Food and Drug Administration considers its first set of regulations, New Hampshire researchers and specialists are turning to education, rather than making premature judgment calls. In late April the New Hampshire Comprehensive Cancer Coalition released an emerging issues brief that explains what e-cigarettes are, how they differ from tobacco cigarettes and the challenges of dealing with an unregulated product.
The unknown
In a nutshell, an electronic cigarette is a battery-powered device that simulates a burning cigarette by producing a vapor that resembles smoke. There’s a heating element that vaporizes liquid containing nicotine and flavoring.
The brief’s co-author, Dr. Susanne E. Tanski, who has been researching e-cigarettes for years, said she has seen a boom of “vapers” — people who use e-cigarettes. There’s a whole culture developing around it, and innovative vapers are even personalizing and customizing their e-cigarettes.
That makes studying health effects even more crucial, experts say. Tanski said that while it’s 100 percent true that there’s no smoke, it’s unclear what’s in the vapor or whether it’s harmful. McNally agreed that it’s too soon to take a hard stance one way or another.
“It is true they are not combustible tobacco products, which has some people feeling that is a benefit to them, but we just don’t really have hard evidence they are actually safer,” McNally said. “So whether you are an opponent or proponent, nobody has any evidence that in time they will have no consequences for their use.”
But acquiring that knowledge can’t be rushed — just look at tobacco’s lengthy history and how long it took to understand its effects on health, McNally said. While she hopes e-cigarette research won’t take quite as long, the product has been too much of a “fast-moving train,” and for now people should be patient and cautious.
Breathe New Hampshire President and CEO Daniel Fortin said it’s possible serious consequences could crop up.
“I just lost a father-in-law to lung cancer … the first question they gave him is, ‘Were you ever a smoker?’” he said. “Twenty or 30 years down road, they could be asking, ‘Did you ever use e-cigarettes?’”
 
FDA proposes regulations
The proposed FDA regulations would ban the sale of e-cigarettes to minors (New Hampshire has had its own law in place since 2010), ban selling them in vending machines unless they are in venues that don’t allow minors, and require that e-cigarette manufacturers disclose the ingredients of their products. Vendors would also be barred from touting health benefits of vaping. The individual regulations would go into effect within 6 to 36 months.
State smoking cessation experts and some local e-cigarette vendors welcome the newly proposed FDA regulations.
“I am totally for it,” said Boutin. “The liquids we sell already have that disclaimer on the labels. We don’t do any online sales. We don’t do vending machines, and we already have warnings to keep away from children and pets. Everybody should have that.”
Disclosing ingredients is essential, Tanski said, because currently there’s no way to know what’s in the nicotine liquids or how much nicotine people get when they puff.
“That’s a huge, huge issue because there’s no quality control,” she said.
What smoking cessation advocates and Boutin disagree is on points related to flavoring. The FDA proposal doesn’t mention restricting companies from offering piña colada, cotton candy and a variety of other sweet flavors.
“You’ve got to wonder what these companies are intending when you see marketing for gummi bear flavor. Let’s face it — it’s not the old guys like me,” Fortin said. “Most people start smoking between the ages of 18 and 26, so you’ve got to assume that’s the target audience as well.”
But imposing regulations on flavors could be detrimental to those who are looking to replace cigarettes with vaping, Boutin said. It gives his customers (the vast majority of whom have been cigarette smokers) the option to get off the nicotine taste. 
“Who wants to go from cigarettes to a tobacco-flavored thing? They want to get away from that tobacco. Flavors are a must,” he said. “If you are over 18, you should have the choice, I believe.”
Marketing for e-cigarette products is common now, too. Ads ran during the Superbowl, and samples were given out in party favor packets at the Oscars. While advertisements for cigarette and smokeless tobacco products have been banned from television and radio since 1971, the FDA has been silent about doing the same e-cigarettes.
 
A means to an end?
People in New Hampshire are turning to vaping to get off smoking, Boutin said. And while long-term effects remain unknown, he says people like the option because they still get the feel of smoking and the visual of the vapor, but it does away with the “other 4,000 chemicals” found in cigarettes.
“They are not hacking up a lung every morning,” he said. “They have more energy. They are able to breathe, smell and taste better, and one of the big things is they are saving money.”
But more often than not, the cessation technique falls short of helping people get off nicotine altogether, which is the ultimate goal for cessation specialists.
“When you speak with users they will tell you how well they’ve done in reducing cigarette use … ,” Tanski said. “But I have not yet met a person who completely quit. Most were dual using — they were still smoking the occasional cigarette.”
Additionally, the majority of vaping devices don’t regulate how much nicotine people are getting — how big a drag is, how much is in each drag, or the frequency of use — which makes it difficult for cessation specialists to do their job. Most quitting techniques, like the patch or the gum, involve gradually ratcheting down the amount of nicotine people get.
“I’m at a loss as a provider,” McNally said. “I can’t really help them to make sure they are getting the doses they need.”
Vaping technology is changing fast, Tanski said, and it seems there could be ways to design devices that control a person’s intake of nicotine in order to truly help people kick nicotine addictions.
Until that happens, cessation specialists agree that speaking with a doctor and using research-based quitting methods are still the best ways to quit. 
 
As seen in the May 15, 2014 issue of the Hippo.





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