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It’s been more than 10 years since former New York City Mayor Michael Bloomberg pioneered the indoor smoking ban, but before leaving office in December he implemented a similar ban on electronic cigarettes. While the FDA has yet to regulate the sale and use of e-cigarettes, states including Utah, New Jersey and North Dakota have joined New York City in enforcing their own regulations with cities like Los Angeles and Chicago hoping to following suit. Little research has been conducted on the adverse health effects and possible benefits of e-cigarettes, and research efforts are further impeded by the wide variety of products available on the market and their lack of standardization.

This lack of e-cigarette regulation makes it difficult to study health effects due to differing amounts of nicotine and other chemicals delivered between brands and cartridge types. The American Association for Cancer Research (AARC) also found that e-cigarettes were used to supplement as opposed to substitute traditional cigarette smoking, making its effects difficult to isolate.

Few studies have been conducted regarding e-cigarette emissions, secondhand “smoke”, and air quality. One of the few studies found “no apparent risk to human health” from electronic cigarette emissions (linked below), while others offer conflicting information surrounding “passive vaping” (linked below). For anyone interested, I've linked to more resources below.

How can we learn from the regulation issues surrounding this new technology and apply it to the standardization and regulation of future healthcare innovations? Are there particular e-cigarette regulation initiatives with which you have experience, or current initiatives which you think could be applied to e-cigarette regulation?

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Marie Connelly
Replied at 2:22 PM, 23 Jan 2014

Very interesting resources, Isabelle - thanks for sharing!

E-cigarettes have been coming up a lot lately, and they clearly present an interesting challenge for those working at the intersection of politics, policy, and public health. There was a recent perspective piece in NEJM about e-cigarettes and the debate that's come up around their regulation - I've included a link below in case folks are interested in taking a look. The authors make the case for e-cigarettes as a harm reduction tool in supporting smoking cessation and decreasing tobacco-related deaths, but it does seem like the research here is in the very early stages still.

Curious to hear what others think - have colleagues here in the community been involved in the efforts to pass e-cigarette regulations in their communities? Are any providers having conversations about e-cigarettes with their patients?

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Janet Williams
Replied at 3:15 PM, 23 Jan 2014

There is no research on this. The e-cig manufacturers have no interest in submitting their product to FDA for consideration as an aid to quitting. There are 7 FDA recommended, evidence based aids to quitting. The secondhand vapor contains chemicals - and we need protect people from exposure. Chicago just added e-cigs to its smokefree law and others are considering this effort. The harm reduction theory is troublesome. Is it really harm reduction when a product contains only 5 chemicals that cause cancer instead of a larger number. E-cigs are being promoted by the manufacturers as a way to "smoke" where you are not allowed to. And relies on anecdotes about its ability to help people quit. The evidence shows that there are more dual users and the uptake in youth in the US is alarming. Big Tobacco is getting into the e-cig business and this means some heavy marketing to youth and young people in order to addict a new generation and promote dual use.

Amy Scheffler
Replied at 1:50 PM, 24 Jan 2014

Thanks all. To provide a bit of context: I currently work in health promotions and continuing care at Northeastern University, a campus that just went smoke-free in the fall of 2013. Implementation appears to be going relatively well thus far but there is now a larger question: how do e-cigarettes fit under the guise of "smoke-free"?

Recently, a student approached the health center with interest in advocating for the use of e-cigarettes as a tool to quit smoking tobacco. Given the lack of research on this pseudo-weaning method and the health impacts of e-cigarettes overall, we found it difficult to support advocacy of this students' chosen method to quit smoking tobacco. Given this encounter, I'm intrigued to hear any responses to Marie's questions above.

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Steven Rothschild
Replied at 7:08 PM, 24 Jan 2014

I sit on the Chicago Board of Health, and the City Council here recently passed an ordinance treating e-cigarettes like cigarettes. This came with the urging of the Board and strong leadership by Mayor Emanuel.

Several observations:
--Any time I tweet about this issue, I get several "hate tweets" back (One used the phrase "F**ing Nazi") from people whose accounts indicate that their sole function is to combat social media against e-cigarettes. This reeks of a tobacco industry PR strategy...

--There were several factors that led to the Chicago ordinance. First off was the hypocrisy of the industry (and several people have pointed out that Big Tobacco is buying up e-cigarette companies). On the one hand they imply that they are a smoking cessation tool, but on the other they don't want to test this as it would then become regulated by the FDA. They repeat that nothing more than water vapor is emitted, but block testing of the e-cigarettes (although data suggests numerous carcinogens are present in the vapor).

-- A second factor was the problem that Northeastern may come up against: Trying to figure out whether someone is smoking a regular cigarette or an e-cigarette in public. Several restaurant owners testified that they didn't want to be in the business of policing this issue, or addressing angry customers when someone is e-smoking at the adjoining table.

--The most compelling issue is the obvious one though: The tobacco industry is using e-cigarettes, just as with flavored tobaccos, just as with menthol, and just as with cartoon characters like Joe Camel before to target children and make sure that there is a replenishing customer base. Why else would we see products like bubblegum flavored e-cigarettes??? We argued that protection of the health of children -- and under 18 year-olds are a rapidly growing part of the e-cigarette market -- needed to be our first priority.

The EU and Canada are both cracking down on e-cigarettes for these reasons -- Chicago and other cities are now following suit in the US.

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