They look like cigarettes. They include nicotine like cigarettes. And they are puffed on like cigarettes.
But instead of smoke, they emit vapor. Instead of using a lighter, they use batteries. And instead of being prohibited for people younger than 18, they have no regulations.
They are electronic cigarettes or e-cigarettes. And they’re popping up in Clark County.
Officials with Clark County Public Health gave a presentation on e-cigarettes to the Clark County Board of Health, which is composed of the county commissioners. The board asked the staff to prepare an ordinance that would restrict the sale of electronic cigarettes to only those legally able to purchase tobacco products.
The board will hold a workshop on the proposed ordinance, which will also go through the public hearing process before commissioners vote.
Electronic cigarettes are battery-operated devices that look like cigarettes. An LED light inside the device warms a replaceable cartridge that is soaked with nicotine. The light vaporizes the nicotine, which is then inhaled by the user.
Flavors such as chocolate, vanilla, strawberry, cherry, mint and tobacco can be added to the cartridge.
The lack of smoke means the e-cigarettes are not subject to the state’s indoor smoking ban. Some local businesses, however, have decided to prohibit them because it’s tough at first glance to distinguish between the devices and the real thing, said Theresa Cross, health educator for the county’s chronic disease prevention program.
The U.S. Food and Drug Administration is investigating e-cigarettes and conducted a limited study in 2009. The study found that the cartridges contained detectable levels of known carcinogens and toxic chemicals, including ingredients in antifreeze.
The study also found some of the cartridges labeled as “non-nicotine” did in fact include low levels of nicotine.
The nonprofit group Consumer Advocates for Smoke-free Alternatives Association claims e-cigarettes are a safer way of delivering nicotine because they eliminate the harmful elements in smoke, such as carbon monoxide.
But because electronic cigarettes are unregulated, there is no consistency between different brands of flavors and cartridges, Cross said. The lack of regulation also means manufactures’ ingredient lists, nicotine levels and safety claims go unchecked, she said.
In addition, long-term health effects of using e-cigarettes are unknown, Cross said.
“We are concerned about people using a product that is completely unregulated,” she said.
Cross purchased an e-cigarette starter kit and “juicy peach” flavoring, which also contains nicotine, at a kiosk at the Westfield Vancouver mall. The kit included the device, five nicotine cartridges — each cartridge was the equivalent to one pack of cigarettes — a power cord and two batteries, and cost $150. The flavoring was an additional $20. Cartridges are also sold individually.
In addition to the kiosk at the mall, e-cigarettes are sold at convenience stores. Health officials worry the availability of the devices and the marketing of the flavored nicotine are aimed at kids — a concern echoed by county Commissioners Steve Stuart and Marc Boldt.
“The only thing you don’t have is a carton Camel,” Stuart said.
Stuart said he was only interested in an ordinance to prohibit people younger than 18 from purchasing the devices. He does not want to regulate what businesses can sell or adults can purchase.
Commissioner Tom Mielke said he was opposed to the commissioners taking action. Any regulation of the devices should be left to the FDA, he said.
“I personally don’t think it’s the role of the board of commissioners,” he said.
As the board of health, however, the commissioners do have the authority to enact an ordinance.
Other Washington counties, such as King and Spokane, have enacted similar ordinances to what Clark County is considering. In addition, some states have implemented statewide restrictions on the sale and advertisement of e-cigarettes.
By Marissa Harshman: 360-735-4546 or [email protected]
E-cigarettes growing in popularity
Late Wednesday morning, Rob Steele strolled through the Valley Sports Bar with a cigarette tucked behind his ear.
Stopping at a table, he pulls out the cigarette, takes one or two puffs before sliding it back into place. There is no smoke, no smell and no ashes. No one in the bar even seems to notice.
Steele has joined the growing number of South Dakota smokers who have turned to electronic cigarettes or e-cigarettes in order to abide by the new smoking ban.
“It’s a good substitute, but it’s not quite the same,” said Steele, kitchen manager at Valley Sports Bar in Rapid Valley.
E-cigarettes are essentially small, battery-operated heating elements combined with a nicotine cartridge and an atomizer. When the person draws on the e-cigarette, the atomizer converts the nicotine in the cartridge into vapor. The nicotine-laced vapor is then inhaled into the lungs. When the person exhales, only odorless vapor is expelled.
The cigarettes are advertised as a way to get a nicotine fix without the smoke, smell and mess. Steele said the brand Valley Sports Bar sells, Green Smart Living, costs $10 a box for five nicotine cartridges. Each cartridge is the equivalent of one pack of cigarettes or 300 puffs, according to the Green Smart website.
Most e-cigarettes are designed to look like an actual cigarette, complete with a LED light that lights up whenever the smoker inhales. Some, however, are designed to look like pens or other objects.
E-cigarettes have been on the market for several years but have really taken off as more states have gone smoke-free. Last year, South Dakota did just that, outlawing smoking in all public places.
Since then, local bar owners have seen more people utilizing the smokeless product.
Pat Larsen, manager of Valley Sports Bar, said he has sold quite a few of the e-cigarettes and sees a fair number of people using them in his bar.
“We’ve had good response to them,” he said.
Larsen has also noticed employees from such businesses as Rapid City Regional Hospital purchasing the e-cigarettes in order to comply with no-smoking policies at the work place.
Tracy Island of Deadwood Gulch Resort is surprised she hasn’t sold more of the e-cigarettes but sees patrons on occasion using them.
Eric Brekke, sales coordinator at Deadwood Gulch, is a smoker and has begun to regularly use e-cigarettes while at work or in public places. Although he isn’t trying to quit, he thinks the e-cigarettes are a great alternative.
“It will get me 8 to 10 hours stuck in an airport without wanting to hurt anybody,” he said with a laugh.
Supporters of the e-cigarettes argue that they contain fewer chemicals than a tobacco cigarette, especially carcinogens. Tobacco cigarettes contain 4,000 chemicals, 69 of which are known carcinogens, according to Dr. Allen Nord, a Rapid City physician and an outspoken proponent of the smoking ban.
But the U.S. Food and Drug Administration reported in 2009 that tests showed that e-cigarettes do more than deliver nicotine to consumers. The FDA alleges they also deliver plenty of chemicals, including an ingredient used in antifreeze.
In September 2010, the FDA also announced it had taken action against five e-cigarette companies for poor manufacturing practices and unsubstantiated claims. The agency argued that the e-cigarettes can increase nicotine addiction and more studies are needed to prove safety.
Nord said e-cigarettes may be safer than tobacco cigarettes due to the decrease of many of the carcinogens, but they won’t help with nicotine addiction issues.
“Nicotine is so outrageously addictive. It’s not a bad habit, it’s a drug addiction,” he said.
Nicotine affects the human brain in the same way methamphetamine does, Nord said.
For that reason, it would be a terrible idea for a nonsmoker to take up e-smoking, he said. They could still become addicted. But a smoker who uses the e-cigarette to reduce their own smoking habits could benefit in the same way they would benefit from nicotine gum or a nicotine patch.
“I would say it’s a step toward total abstinence from nicotine,” Nord said.
While the e-cigarette doesn’t have the same carcinogens as regular cigarettes, thus reducing lung cancer risks, nicotine carries its own risks. Nicotine is a vaso-constrictor, which means it narrows the opening of blood vessels. Such constriction can negatively affect the heart, he said.
“For smokers, especially heavy smokers, this represents an escape route,” Nord said. “For people are who not smokers, it’s a terrible idea.”
Steele, who has smoked for 15 years, isn’t interested in quitting, but the e-cigarette option has changed his smoking habits. He went from a two-pack-a-day habit to half a pack a day.
It also made life easier at home. Father to a two-week-old baby boy, Steele doesn’t smoke regular cigarettes around his son.
“I don’t smoke regular cigarettes in the house anymore,” he said.
He said the e-cigarette actually helped his son’s mother while she was in the hospital having the baby. She was able to smoke the e-cigarette in her room and avoid nicotine cravings.
He thinks the e-cigarette also makes him more productive at work. Instead of going outside for his smoke break and leaving the kitchen, he can stay busy at work with the e-cigarette. “I can smoke and still supervise the casino at the same time I take my smoke break,” he said.
That said, Steele admits that there’s still something about smoking a tobacco cigarette. The routine of pulling the cigarette from the pack and lighting it remains a habit that’s hard to break.
“When it’s nice outside, I still like to step outside and have a regular cigarette,” he said.
By Lynn Taylor Rick: 394-8414, [email protected].
Use of e-cigarettes not allowed on US flights
The U.S. Department of Transportation says the use of smokeless electronic cigarettes on airplanes is prohibited and plans to issue 
an official ban this spring, according to a letter from Transportation Secretary Ray LaHood obtained by The Associated Press.
In the letter to Sen. Frank Lautenberg of New Jersey, LaHood said the department has been informing airlines and the public that it interprets smoking regulations to include e-cigarettes. Lautenberg, who wrote the 1987 law that banned smoking on airplanes, had asked transportation officials to clarify the rule.
E-cigarettes are plastic and metal devices that heat a liquid nicotine solution in a disposable cartridge, creating vapor that the “smoker” inhales. A tiny light on the tip even glows like a real cigarette. They have prompted debate over how risky they are and whether they’re even legal.
Numerous videos on YouTube show passengers using the devices on airplanes. Lautenberg even said some passengers have interpreted flight attendant instructions to mean that the devices were only prohibited when other electronic devices were not allowed during takeoff and landing.
Many airlines already have begun informing passengers that the devices are not allowed on flights, but Lautenberg said there had been confusion over their use and wanted to make sure officials were solidly opposed to opening the door to e-smoking on planes. Some e-cigarette distributors have touted their convenience because they can be “smoked” anywhere traditional cigarettes are not allowed.
“We still don’t know the health effects of e-cigarettes, and we don’t want to turn airline passengers into laboratory mice,” Lautenberg said in an e-mailed statement.
Jason Healy, president of e-cigarette maker Blu Cigs, called the move somewhat disappointing, but said it isn’t the end of the world. Healy said he hopes that once more people understand e-cigarettes and more testing is done, that airlines could choose whether to allow them.
“I understand from an airline’s point of view the hassles it could create,” said Healy, whose company has partnered with a luxury charter jet company to provide free e-cigs on private flights. “It’s not the actual product, it’s the disruption and explaining to everyone else that it’s not smoke.”
Users and distributors say e-cigarettes address both the nicotine addiction and the behavioral aspects of smoking _ the holding of the cigarette, the puffing, seeing the smoke come out and the hand motion _ without the more than 4,000 chemicals found in cigarettes.
Nearly 46 million Americans smoke cigarettes. About 40 percent try to quit each year, according to the Centers for Disease Control and Prevention. But unlike nicotine patches or gums, e-smokes have operated in a legal gray area.
First marketed overseas in 2002, e-cigarettes didn’t become easily available in the U.S. until late 2006. Now, the industry has grown from the thousands of users in 2006 to several million worldwide, with tens of thousands new e-smokers every week.
The future of e-cigarettes is likely to be decided by the Food and Drug Administration. The FDA lost a court case last year after trying to treat e-cigarettes as drug-delivery devices, rather than tobacco products, because e-cigarettes heat nicotine extracted from tobacco.
New study try to clear the air around e-cigarettes
Two studies published online Tuesday by the American Journal of Preventive Medicine tell consumers more — a little bit more, anyway — about 
electronic cigarettes and their potential to help smokers cut back or quit the habit.
Electronic cigarettes are built to look like real cigarettes. They’re made of plastic, run on batteries and allow users to inhale nicotine in a vapor form. Unlike nicotine delivery products such as gum, lozenges or patches, or smoking cessation medications like Chantix, they allow users to hold something that feels like a cigarette and mimic the behavior of smoking.
Some think this might make them a more effective smoking cessation tool, but their effectiveness is not yet known.
For the first paper, Johns Hopkins public health doctoral candidate John Ayers and co-authors used a free and publicly available tool called Google Insights for Search to monitor English-language Web searches for e-cigarettes. The team noted how many times people searched for e-cigarettes in the U.S., Britain, Canada and Australia from January 2008 to September 2010, and also monitored online shopping searches.
They compared searches for e-cigarettes with searches for nicotine gum and other cessation products. Searches for e-cigarettes increased sharply between July 2008 and February 2010, the team reported. Online shopping searches followed a similar pattern. E-cigarettes “are by far the most popular smoking alternatives and cessation products on the market,” said Ayers in a press release.
The problem is, no one knows if they’re effective. In another study release by the journal, Boston University public health professor Michael Siegel and colleagues sent out online surveys to 5,000 people who had made a first-time purchase of Blu e-cigarettes during a two-week period in 2009.
They asked respondents about their smoking habits and nicotine use after buying the e-cigarettes. Most of the respondents were men. More than 80% had smoked for six or more years. Nearly two-thirds had tried to quit three or more times.
Sixty-seven percent said they had reduced the number of cigarettes they smoked six months after trying e-cigarettes; 49% said they had quit for an unspecified amount of time and 31% were not smoking at all at the six-month point.
The authors wrote that the results suggested that “if proven safe, e-cigarettes may be a potentially important tool for harm reduction” and that they’re “worthy of further investigation.”
But the findings weren’t definitive, they cautioned. All of the data were self-reported, and they had only a 4.5% response rate.
The Food and Drug Administration announced last September that it would regulate e-cigarettes as drugs.
By Eryn Brown, Los Angeles Times
Interest in E-cigarettes Is High, but Safety and Effectiveness Unknown
Electronic cigarettes are drawing heavy media and marketing attention, and while a new study finds that consumer interest also runs high, a 
companion study underscores that e-cigarettes’ ability to help smokers cut down or quit is unknown.
E-cigarettes run on batteries and look like real cigarettes, cigars or even ballpoint pens. Users inhale doses of nicotine or other toxins found in tobacco in vapor form. Because e-cigarettes do not contain tobacco or create smoke, manufacturers are marketing them both as a safer alternative to smoking and as a cessation aid.
Of the two studies appearing online and in the April issue American Journal of Preventive Medicine, one shows that consumer interest in e-cigarettes currently is much higher than interest in more traditional products.
“Although we don’t know much about the health effects of e-cigarettes, they are by far the most popular smoking alternatives and cessation products on the market,” said lead author John Ayers, a doctoral candidate at Johns Hopkins Bloomberg School of Public Health.
His group monitored English-language Google searches in the USA, Canada, the UK and Australia from January 2008 until September 2010. They compared searches for e-cigarettes with searches for a nicotine lozenge and for cessation products like nicotine patches, nicotine gum and the drug Chantix (varenicline).
Between July 2008 and February 2010, searches about e-cigarettes increased sharply in all nations, especially in the United States. “We found that e-cigarettes were more popular in U.S. states with stronger tobacco control,” Ayers said. This, he said, suggests that consumers are using e-cigarettes to either bypass smoking restrictions or to quit when faced with restrictions.
To see if searches on e-cigarettes led to sales, his group monitored online shopping searches. Shopping search trends mirrored informational search trends, they found.
In the second study, Michael Siegel, M.D., looked at e-cigarettes’ effectiveness as smoking cessation aids using an online survey. Siegel, a professor at the Boston University School of Public Health, obtained 5,000 email addresses of people who had made a first-time purchase in 2009 from an e-cigarette distributor.
Of the 222 consumers replied to the survey, 216 were qualified to participate. Nearly 67 percent of these respondents said they reduced the number of cigarettes they smoked since using e-cigarettes and 49 percent reported that they had quit smoking for an unspecified time after trying e-cigarettes.
Siegel acknowledged and other smoking cessation experts have said that it is possible that smokers who had greater success cutting down or quitting were more likely to respond. This would bias the results, which already relied on a small fraction of those contacted.
“We don’t know anything about the 95 percent of the people who deleted the email,” said Jennifer Unger, Ph.D. “Maybe they’re still smoking the same number of cigarettes. Maybe they are using even more nicotine than before because they’re smoking ordinary cigarettes and e-cigarettes.” Unger, with the Institute for Health Promotion and Disease Prevention Research at the University of Southern California, has no affiliation with either study.
“Neither of these two studies provides scientific evidence that e-cigarettes are effective in helping people to quit,” said John Pierce, Ph.D., a professor of cancer prevention at the Moores Cancer Center at the University of California at San Diego. “It’s not clear to me that e-cigarettes aren’t harmful in some way. It’s not clear to the FDA, either.”
In Sept. 2010, the Food and Drug Administration cited five e-cigarette distributors for “unsubstantiated claims and poor manufacturing practices,” according to an agency release. In January 2011, the FDA moved unsuccessfully to block e-cigarette importation.
Source: Health Behavior News Service, part of the Center for Advancing Health, at (202) 387-2829 or [email protected].
American Journal of Preventive Medicine: Contact the editorial office at (858) 534-9340 or [email protected].
Ayers JW, Ribisl KM, Brownstein JS. Tracking the rise in popularity of electronic nicotine delivery systems (“electronic cigarettes”) using search query surveillance. Am J Prev Med 40(4), 2011.
Siegel MB, Tanwar KL, Wood KS. Electronic cigarettes as a smoking-cessation tool: results from an online survey. Am J Prev Med 40(4), 2011.
E-cigarette faces ban as safety debate rages over unregulated quit-smoking device
Advocates believe e-cigarettes provide a stepping-stone to quitting, but opponents say their health impact is unknown. Now New York is considering a state-wide ban…
What are e-cigarettes?
Electronic cigarettes have three integrated parts: the nicotine cartridge, the vaporiser and a lithium ion battery.
The battery powers the cartridge and releases the nicotine by heating, rather than burning like a conventional cigarette.
There are dozens of brands including Sky Cigs, Joye 510 and Green Smoke.
An e-cigarette starter kit can range from £30 to £100 with extra refill cartridges sold separately.
A smoker on 10 cigarettes a day would save around £700 if they switched.
But while e cigarettes are marketed as a safer device to tobacco there has been little independent research into the health impact.
Hundreds of thousands of smokers who try to quit the habit fail every year despite trying exercise, nicotine patches and good old-fashioned will-power.
Now electronic cigarettes are being touted as the latest ‘stop smoking’ device. These battery-powered sticks are filled with a nicotine or non-nicotine solution that is heated and inhaled as a vapour.
Most are refillable devices with solutions offered in different nicotine concentrations and in hundreds of different flavours.
Advocates say they provide a stepping-stone to quitting and give the sensation of smoking without taking in the carcinogens and 1,000 chemicals found in tobacco.
Scientists at the University of California, Berkeley, who studied the device said the device had great potential in reducing the harm of smoking.
Writing in the Journal of Public Health Policy, they said: ‘We conclude that electronic cigarettes show tremendous promise in the fight against tobacco-related morbidity and mortality.’
However, an argument is brewing in the U.S about whether they represent a new miracle cure or menace to public safety.
Some health officials say e-cigarettes are just another addictive habit, one that can hook kids early and legally on smoking.
Last year, Dr Edward Langston, of the American Medical Association said: ‘Very little data exists on the safety of e-cigarettes, and the FDA has warned that they are potentially addicting and contain harmful toxins.’
He added: ‘The fact that they come in fruit and candy flavors gives them the potential to entice new nicotine users, especially teens.’
Meanwhile New York lawmakers are considering introducing the first state ban on the device.
Democrat Linda Rosenthal, or the New York Assembly, said: ‘I got interested in this because I saw all these ads for e-cigarettes, so I did some research.
‘I found what is in the e-cigarettes is a mystery.’
The former smoker wants to ban e-cigarettes in New York until they are more thoroughly investigated and regulated.
It has prompted indignation from former smokers who say they have been helped by the device.
Elaine Keller, vice president of the Consumer Advocates for Smoke-Free Alternatives Association, said: ‘I would still be smoking if not for this product.’
Ms Keller said she has been tobacco-free since March 2009 after 45 years of smoking.
She added: ‘I can’t point to anything to say it’s 100 percent safe,’ she said.
‘The thing is, it only needs to be safer. The only standard is that it’s safer than smoking.’
E-cigarettes have prompted debate nationwide since they became widely available in the United States in 2006.
But as either a tobacco cigarette substitute or a much more extensively tested and restricted drug-delivery device, the future of e-cigarettes will likely be decided by the Food and Drug Administration.
However, this has not proven a simple task. The FDA tried to class e-cigarettes as drug-delivery devices as these require research and trials that tobacco products do not need.
However, a federal judge overturned this decision because e-cigarettes heat nicotine extracted from tobacco.
It is likely the argument will run for some time yet as powerful lobbies are involved.
If treated as a tobacco product, e-cigarettes would avoid the research and trials required of competitors in the pharmaceutical industry, including anti-smoking patches and inhalers.
However, as a medical device, e-cigarettes could draw opposition from that powerful lobby as a fresh and less expensive competitor.
By Claire Bates
Dailymail.co.uk
Are e-cigarettes too good to be true?
Some of us smokers received, over the holidays, the well-intended gift of e-cigarettes to save us from the deadly carcinogens of real
cigarettes. But not so fast; this supposedly ingenious solution to the most addictive substance ever known to man may actually give us more problems than its promised cure.
Electronically-fired cigarettes look, taste and sometimes smell like real cigarettes but do not have the same amount of cancer-causing chemicals, it is believed. What makes them even better is that they don’t release residual or second-hand smoke that can be inhaled by others (second hand-smoke is believed to be more toxic than the actual smoke).
Staunch anti-smoking advocate groups in the country— New Vois Association of the Phils. Inc. and the Philippine Laryngectomee Club Inc.—say e-cigarettes are a probable solution in their fight against cancer and tobacco addiction.
Association president and larynx cancer survivor Emer Rojas says that “based on initial market response, it is the most effective smoking cessation tool developed…compared to nicotine replacement therapy (NRT) and other methods,”
E-cigarettes may be regarded as one of the most promising smoking cessation tools in the world. Aside from containing less harmful chemicals, they effectively curb the use of cigarettes.
The world wide web has enough entries on the history of e-cigarettes. The registered e-juice or the liquid cartridge containing the tobacco alternative being exported out of China, for instance, is supposed to contain: propylene glycol, an oil based medium that dissolves nicotine, glycerol, tobacco essence, organic acid, an anti-oxidant of sort, butyl valerate, isopentyl hexonate, lauryl laurate, benzyl benzoate, methyl octynicate, ethyl heptylate, hexyl hexanoate, geranyl butyrate, menthol, citric acid, water, alcohol, trimethylpyrazine, tetramethypyrazine, dimethylpyrazine, acetypyrazine, terpineol, ethyl maltol, guaiacol, acetylypyridine and octalactone.
Combinations and derivatives of these compounds are supposed to give different flavors to the e-cigarette cartridges life the traditional regular tobacco flavor and menthol to imitate actual cigarette brands like Marlboro or other menthol brands as well as other flavors like mocha, vanilla, caramel, chocolate and coffee.
Cartridges also come in varying nicotine concentrations. Users have the choice from zero nicotine; low which is supposed to have nicotine at around 6 to 8 mg/ml; and medium at 10 to 14 mg/ml; to high and extra strength having 16 to 35 mg/ml doses.
But not everybody is enthusiastic about e-cigarettes. Rojas says that those opposing them are players in the tobacco industry themselves. It makes perfect sense.
Other contention against the e-cigarette, Rojas says, is that they are easily bought by minors and are used in areas where “No Smoking” signs are present.
“Yes there are many ‘underground’ importerhttps://www.tobacco-facts.net/files/category/electronic-cigarettes/page/s trying to test the market. most are coming from china but some are manufactured in the usa. some may contain certain levels of nicotine just like nicotine patches… which aims to reduce the nicotine craving,” Rojas adds.
But from the land where regulation on counterfeits is next to nothing, cheaper substitutes in the molecular cocktail of the e-cigarette as well as quality consistency can’t be as far fetched. And probability is high that nicotine is the least of the users’ problem.
At this point, no one really knows.
In the Philippines, e-cigarettes have been in the local market for years and have made a craze among Makati’s chic young urban professionals. The prohibitive price added a touch of exclusivity. In the past year, though, several generic models from China have surfaced in bazaars and tiangge all over the country at affordable prices. Now it can be had for as low as P500.
This is not bad at all, of course, although like everything else that doesn’t come with any indications and is to be ingested; e-cigarettes deserve a second look.
Science has proven the menace of tobacco addiction and the myriad of medical conditions that follow its wake. True, but only few really know what goes in these hi-tech, smokeless, electronic contraptions, much less the health complications that can possibly arise from their use.
What is astounding is that e-cigarettes are being sold in the open for some time now and yet our government remains clueless about what it really is.
To no surprise, e-cigarettes sold in the Philippines do not come with a warning label or a list of cigarettes ingredients. The Food and Drugs Administration, too, has yet to issue an approval.
By Rey T. Salita
E-cigarettes safer than cigarettes, researcher claims
In a new report that bucks the concerns raised by the Food and Drug Administration, a Boston University School of Public 
Health (BUSPH) (sph.bu.edu) researcher concludes that electronic cigarettes are much safer than real cigarettes and show promise in the fight against tobacco-related diseases and death.
The review, which will be published online ahead of print this month in the Journal of Public Health Policy, is the first to comprehensively examine scientific evidence about the safety and effectiveness of electronic cigarettes, also known as e-cigarettes, said Michael Siegel, professor of community health sciences at BUSPH. The battery-powered devices provide tobacco-less doses of nicotine in a vaporized solution.
“Few, if any, chemicals at levels detected in electronic cigarettes raise serious health concerns,” the authors said. “Although the existing research does not warrant a conclusion that electronic cigarettes are safe in absolute terms and further clinical studies are needed to comprehensively assess the safety of electronic cigarettes, a preponderance of the available evidence shows them to be much safer than tobacco cigarettes and comparable in toxicity to conventional nicotine replacement products.”
The report reviewed 16 laboratory studies that identified the components in electronic cigarette liquid and vapor. The authors found that carcinogen levels in electronic cigarettes are up to 1,000 times lower than in tobacco cigarettes.
“The FDA and major anti-smoking groups keep saying that we don’t know anything about what is in electronic cigarettes,” Siegel said. “The truth is, we know a lot more about what is in electronic cigarettes than regular cigarettes.”
Since coming onto the market in the United States more than three years ago, electronic cigarettes have proven to be controversial. The FDA has threatened to ban the sell of e-cigarettes and six national anti-smoking groups – the American Cancer Society, American Heart Association, American Lung Association, Campaign for Tobacco-Free Kids, American Legacy Foundation, and Action on Smoking and Health – have also called for the removal of electronic cigarettes from the market.
Their concerns are that the FDA has not evaluated any e-cigarettes for safety or effectiveness, that the devices contain dangerous chemicals, and that they are marketed toward children. In December, however, a federal appeals court ruled that the FDA should regulate e-cigarettes as tobacco products rather than as drug-delivery devices, such as nicotine-replacement patches or gum. The latter undergo much more stringent FDA regulations.
“Taking these products off the market would force thousands of users to return to cigarette smoking,” Siegel said. “Why would the FDA and the anti-smoking groups want to take an action that is going to seriously harm the public’s health? The only ones who would be protected by a ban on e-cigarettes are the tobacco companies, as these new products represent the first real threat to their profits in decades.”
The report also reviews preliminary evidence that electronic cigarettes can be effective in suppressing the urge to smoke, largely because they simulate the act of smoking a real cigarette. E-cigarettes might also offer an advantage over traditional nicotine delivery devices, the authors argue, because smoking-related stimuli alone have been found capable of suppressing tobacco abstinence symptoms for long periods of time.
Provided by Boston University Medical Center
King County wants to ban public e-cigarette smoking
Five years after Washington residents voted to ban smoking cigarettes, cigars and pipes in public places, King County wants to add one more 
thing to the list: Electronic cigarettes.
The 2006 state law banned smoking in bars and restaurants on the basis that second-hand smoke causes cancer and other diseases. But King County’s rationale for adding e-cigarettes – also known as battery-powered nicotine-delivery devices – to the list of forbidden acts is a little different.
The fake cigs, from which users inhale vaporized nicotine, don’t emit smoke. Rather, they produce a less-smelly, combustion-free mist.
But public health officials say they’re so similar to the real thing that they make tobacco enforcement difficult and often prompt smokers to think it’s OK to light up in public. And that leads to second-hand smoke, health officials reason.
“The idea is that even though they’re not exactly identical to cigarettes, people see folks using e-cigarettes, and they think somebody else is smoking,” said Bud Nicola, a King County Board of Health member and affiliate professor with the University of Washington School of Public Health.
“It makes it very difficult for inspectors.”
The Board of Health is scheduled to discuss and vote on the proposed regulation (PDF) Thursday. The proposal also includes restricting the sales of e-cigarettes and similar devices to people 18 and over, and a ban on free giveaways and heavily discounted sales of the products.
Often marketed as “healthier smoking” or a way to quit smoking, e-cigarettes have become a controversial issue in public health circles. Earlier this month, the federal Food and Drug Administration lost its court fight to ban or regulate e-cigarettes as unapproved drug delivery devices.
According to a Public Health Seattle-King County report, the FDA had found known toxins in a sampling of e-cigarettes, including carcinogenic nitrosamines and diethylene glycol, an anti-freeze ingredient. The FDA also found the devices delivered a strikingly wide range of nicotine. The amount of the toxins was not included in the local health report.
Although some e-cigarette makers say their products don’t contain nicotine, the FDA says there is no way of knowing that for sure.
Despite that, the products are widely available in convenience stores and malls and increasingly popular, making health experts worry that they can be a youth “gateway” for smoking. A recent operation by the Spokane public health district found that most retailers sold e-cigarettes to teens who tried to buy them.
“These are something that can potentially get kids hooked on nicotine,” Nicola said. “E-cigarettes have a high appeal to youth. They come in candy flavors.”
While the feds study their e-cigarette options, Nicola said its important for local health officials to protect the public from potential harm. King County’s proposal would also restrict sales and giveaways of other “unapproved nicotine delivery devices,” such as nicotine lollipops, wafers and water.
None of those products have undergone FDA review. Nicotine gum and patches would not be a part of the restrictions, because they are regulated by the FDA as smoking-cessation products.
If King County’s proposal is passed, it’s believed it would be the strictest in the country. A handful of states and other jurisdictions have some e-cigarette rules, but none as comprehensive as the one proposed here.
By Vanessa Ho: 206-448-8003, [email protected].
E-cigarettes – To Smoke Or Not To Smoke?
Electronic cigarettes, or smokeless cigarettes that promise to recreate a smoking experience for those who are huffing and puffing for that ‘drag’ 
have been in the news for quite a while trying to establish their credibility. The latest is a US Court of Appeals ruling that FDA cannot ban e-cigarettes.
Telephone landlines have been replaced by mobiles and public phone booths are fading into obscurity, gramophone players, transistors, tape recorders and even compact discs have been compressed into all in one light weight portable mp3 players, but what of traditionally ‘injurious to health’ cigarettes? Well, cigarettes have also gotten a technological makeover and let’s see how.
Mr. Sunil Kumar of Steamz, the E-Cigarette Company in India, explains to Medindia, his reasons for promoting e-cigarettes as opposed to conventional cigarettes with tobacco.
Q. What are the components of an e-cigarette?
Response: The e-cigarette resembles a conventional cigarette in terms of visual appeal. The battery in the e-cigarette resembles the tobacco rod; the cartridge resembles the filter and the tip of the battery glows when a person inhales from the cartridge. This gives the impression and satisfaction of smoking to a smoker.
Q. But the smoker is not smoking? How?
Response: A non-nicotine cartridge contains water, food safe flavouring agents, and glycol, again a food safe agent. The glycol is added to emit steam instead of smoke. Since there is no smoke emission, it’s pollution free thus preventing secondary smoking or passive smoking.
Q. If there is no nicotine, how do you appeal to smokers who are addicted to nicotine? What of chain smokers?
Response: We introduced the product in the market to discourage people from smoking. We sell nicotine cartridges only on insistence. There are four kinds of cartridges: high nicotine, medium nicotine, low nicotine and non-nicotine. These cartridges are to encourage smokers to gradually reduce and eventually quit smoking.
Q. Sounds too good to be true, so why has the WHO not approved the product as nicotine replacement therapy?
Response: Initially when the product was introduced in the US, the FDA did not approve it. But, later seeing the impact it has come to be accepted and become widely popular in the US and other Western countries. It’s a new product and it will take time to see itsutility. If the government cannot ban cigarettes, which are hazardous to health, they cannot ban e-cigarettes for obvious reasons.
Q. What reasons?
Response:
1. No nicotine, no smoke, but gives the satisfaction of smoking. So it is a safe option as opposed to smoking cigarettes with tobacco.
2. It can be used on board because according to law only lit tobacco is smoking. Since there is no tobacco lit and no smoke emission, it is not unlawful.
3. You can try placing a handkerchief and smoke a tobacco cigarette and you will find that it leaves a stain. But, even with a cartridge with nicotine fluid, there’s no stain.
Q. In your opinion, how are e-cigarettes more effective than patches and chewing gums?
Response: When a smoker smokes a cigarette, the nicotine takes 6 to 8 seconds to reach the brain and release dopamine; this makes nicotine an addictive drug. So psychologically a smoker needs the same sensation of using a cigarette, a desire to quench oral fixation. Patches don’t give that satisfaction and chewing gums will be effective on tobacco chewers, not smokers. One week of using an e-cigarette can make a lot of difference. If a smoker returns to regular cigarettes, the nicotine impact from a regular cigarette is unpleasant.
Q. Who is the target buyer for e-cigarettes?
Response: People from all strata of the society. Initially it was highly priced, we were selling it for Rs. 4000/- with 15 cartridges but a taxi-driver was willing to buy and use the product. Now the price is slashed to make it affordable. We do not want e-cigarettes to be a fashion statement, people are getting health conscious and we want to promote good health, but one cannot expect smokers to quit smoking through lip service. If that is possible, then the consumption and the revenue from the tobacco industry should have decreased. It’s only been on the rise in spite of the mandatory health hazard warning on the cigarette packs.
Q. How much do e-cigarettes cost now?
Response: It’sbetter priced than before. The first kit contains a battery, a charger and a cartridge and priced at Rs. 700/-. After that a person needs to buy only the cartridge (refills) each priced at Rs. 100/-. Each cartridge is equal to 30 cigarettes. So for someone who smokes 10 cigarettes a day, it should last for three days.
Q. How do you dispose the cartridges?
Response: Not anywhere near combustible material. You dispose like other electrical items and batteries.
Q. How is the reception for the product in India?
Response: We’ve made many families smile. Homemakers are grateful and promote the product seeing family members who’ve quit smoking. Even doctors who have quit recommend e-cigarettes. It’s the social cause that appeals the most with e-cigarettes. Also, e-cigarette (nicotine) consumers are not posing a threat to another human being.
Rechargeable e-cigarettes are drawing favourable attention because the claims are reasonable and practical. The product is a novel invention and the intention behind promoting e-cigarettes is undeniably noble. The market for e-cigarettes is by and large massive given the percentage of smokers. Since e-cigarettes are new in the Indian scenario, the demand is gradually growing. However good health is a personal choice and for smokers, e-cigarettes pose a healthy option to oneself and companions.
Medindia Exclusive