Despite their variety of fruity and sweet flavors, electronic cigarettes could pose similar dangers to users as traditional cigarettes, according to a panel of physicians and experts that met Tuesday — so much so that the devices should be banned indoors.
On Tuesday afternoon, Karen Hacker, director of Allegheny County Health Department, moderated a talk about e-cigs held by Pitt’s Health Policy Institute. The event featured a board of four speakers from Pittsburgh, including researchers and physicians, all with a perspective on e-cig and tobacco use.
Before the forum began, Hacker voiced her support for a March 2015 amendment to the June 2008 Pennsylvania Clean Indoor Air Act — which prohibits smoking in any public place or workplace — to include e-cigs.
The National Institute on Drug Abuse defines electronic cigarettes, commonly known as e-cigs, as battery-operated devices designed to deliver nicotine with flavorings and other chemicals in the form of vapor instead of smoke.
When the user takes a puff, liquid in a cartridge with anywhere from zero to 24 micrograms of nicotine combined with flavoring and other additives activates the battery-powered heat source. The end result is vapor that the user inhales.
“Our feeling is that if we make this regulation reality, it will just mean that no smoking means no smoking, regardless if it’s cigarettes, e-cigs or vaping,” Hacker said.
The law is currently only applicable to conventional cigarettes, but Hacker argues this law should extend to e-cigs as well, because she believes they should be categorized similarly.
As some of the leading experts on e-cigs, the speakers at the forum presented what is known about the devices so far, including risks similar to those of traditional cigarettes.
“[E-cig use] is certainly safer than tobacco, but it is not 100 percent safe,” Hacker said.
In addition to the proposal to ban e-cigs indoors, Pennsylvania is set to hike taxes on e-cigarettes on Oct. 1 of this year. The revenue bill passed in July by the Pennsylvania General Assembly will include a $1 increase in cigarette tax, which includes e-cigs.
Brian Primack, a professor at Pitt’s School of Medicine and a speaker at the forum, said that despite their risks, e-cigs can be a useful smoking cessation tool for people who have difficulty quitting smoking.
But for people who don’t smoke regular cigarettes already, e-cigs are hardly a cessation tool. Rather, Primack said, they’re “starter cigarettes” for non-smokers, often teens, who begin smoking e-cigs –– possibly due to the flavor variety –– and then move on to combustible cigarettes.
This, in addition to negative secondhand health effects of e-cig smoking, causes the risks of e-cig smoking to outweigh the benefits, according to Primack.
“The evidence right now is driving caution rather than enthusiasm,” Primack said.
Before the event, Hacker said the ACHD campaign to include e-cigs in the Pennsylvania Clean Indoor Air Act falls in line with policies that many other states have already adopted and modified to include vaping. Hacker said she supports this initiative because she believes e-cigs should be banned in the same places as combustible cigarettes.
“This is an issue that many states around the country have already been dealing with,” Hacker said. “I believe that there’s over 30 states that have decided to amend their indoor air acts to include e-cigs.”
Jonathan Spahr, from the Children’s Hospital of Pittsburgh, said at Tuesday’s forum he has concerns about the internal effects of e-cig toxins. He explained that there is no filtering system in the lungs, so any harmful molecule exposure potentially has a direct pathway to the brain and the heart.
According the Center for Disease Control and Prevention, combustible cigarettes — which could have risks similar to e-cigs — increase the risk of coronary heart disease and lung disease.
Spahr said e-cigs contain additives which can be harmful to the body, and there is extreme variability in the amount of nicotine or other compounds an individual inhales on each puff.
Spahr said increased e-cig use puts the youth population at risk not only because adolescents are uninformed about the dangers but also because it provides another avenue for childhood exposure to secondhand toxins. Because e-cig smoking is currently permitted in public, indoor places, there is a risk for secondhand effects.
“Having a smoking or vaping section of the room is like having a peeing section of the pool,” Spahr said.
Though the e-cig regulations may not be prohibited in public spaces statewide, UPMC has taken steps in that direction. Esa Davis, who works at UPMC Tobacco Treatment Service, said UPMC has been a tobacco-free campus, including e-cigs, since July 2014.
Though similar efforts were made at Pitt, the campus currently remains open to smokers. The Pitt News reported in 2014 that former Student Government Board President Graeme Meyer pushed to make campus tobacco-free in April 2014. In April 2016, former SGB member Jack Heidecker again pushed for a tobacco-free campus with a proposal to ban cigarettes, cigarillos, chewing tobacco and e-cigs. Heidecker released a survey through SGB’s Facebook page to gauge student opinion on the proposal, though he eventually abandoned the initiative due to lack of student support.
Clinical studies involving the safety of e-cigs are limited, but the FDA stresses that an e-cigarette user has no awareness of the nicotine concentration being inhaled while using the device.
Because of the potential risks of e-cig use, the FDA has taken an aggressive stance on selling and labeling the products, according to William Shadel, a representative from RAND, a company that works to improve policy based on data.
Prohibitions keep e-cig vendors from selling to minors and also require the packaging to state the product contains nicotine and that nicotine is potentially harmful. Despite the current limitations on e-cig vendors, the ACHD supports increased regulations to equal the regulations placed on combustible cigarettes.
The current e-cig regulations do not extend to flavorings or advertising. Therefore, vendors can display intriguing vape flavors, such as cookie dough or pina colada, in colorful magazine ads. Combustible cigarettes, on the other hand, as of 2009, no longer have any flavor other than menthol and have limited advertising avenues.
Although the research on e-cigarettes is still limited, Shadel said the risks of using them — or of exposing others to secondhand effects — are enough to call for a change in Pennsylvania’s Clean Indoor Air Act.
“We want to ensure that we are providing people with a fair and healthy environment to work in,” Shadel said.