Public Health

Posted on: December 23, 2013

E-cigarettes deliver public health concerns

By Pramod Dwivedi

It is very encouraging to see that some of our top elected officials in the state are interested in regulating electronic cigarettes, commonly known as e-cigarettes.

Last month, Iowa Attorney General Tom Miller declared his intention to ask the Legislature to ban the sale of e-cigarette to minors, and a week later, Gov. Terry Branstad, said he was “absolutely interested” in regulating e-cigarettes.

Linn County Public Health is thrilled that both of these announcements were made in Linn County, perhaps because Linn is the only county in Iowa to pass an ordinance that considers e-cigarettes the same as any tobacco product.

An electronic cigarette is a battery-operated device that delivers nicotine in a vapor form, not smoke. It looks like a conventional cigarette and simulates the act of tobacco smoking. Since e-cigarettes do not contain tobacco, they are not subject to U.S. or state tobacco laws, although some states do have regulations for e-cigarettes. The Iowa Smokefree Air Act does not regulate the sale or use of e-cigarettes.

Linn County is an exception and does place restrictions on retailers, including sales to minors. However, the lack of age restriction on e-cigarette sales in other parts of the state and country is a major public health concern because use of cigarettes at an early age is a strong predictor of a lifelong smoking habit, and experimentation with e-cigarettes may serve as a gateway to tobacco use.

The sale of e-cigarettes in the United States has doubled every year since 2008. Sales are estimated to continue to rise in the future thanks, in part, to aggressive marketing campaigns by manufacturers. According to a survey conducted by the federal Centers for Disease Control and Prevention, 1 in 10 high school students said they have tried an e-cigarette in 2012 compared to 1 in 20 in 2011. Among students in grades 6 to 12, experimentation with e-cigarettes has doubled to 6.8 percent from 3.3 percent. The survey also revealed that most students who had tried e-cigarettes had also smoked traditional cigarettes.

E-cigarettes come in many flavors intended to appeal to minors and youth. Some manufacturers use cartoons and popular video games in advertising (again to appeal to youth) even though conventional cigarette companies are banned from doing so.

Tobacco is a lethal but legal product. It kills more than 440,000 men and women in the United States annually (about one in five deaths). Iowa’s share of tobacco-related death is estimated to be 4,442 each year and tobacco use costs nearly $2 billion to the state’s economy.

Although smoking in Iowa and the rest of the U.S. has steadily decreased in the last 20 years, thanks to public health awareness and education, we still have a lot of work to do. We — as a county, state, and nation — have to ensure the progress the anti-tobacco group has made in the last two decades does not vaporize with the emergence of e-cigarettes.

It is true that e-cigarettes do not dispense hundreds of deadly, combustible carcinogens and toxins. What they deliver though, is nicotine, a tobacco-derived product that is extremely addictive. In some cases, toxic chemicals have been found in e-cigarettes.

Producers and users of e-cigarettes claim that e-cigarettes are a good alternative for people who are addicted to nicotine and help people quit tobacco smoking. However, a study published in The Lancet shows no statistical difference between the effectiveness of e-cigarettes (7.3 percent) and patches (5.8 percent) in quitting tobacco.

In a letter sent to the U.S. Food and Drug Administration in September, 40 of the nation’s attorneys general, including Iowa Attorney General Tom Miller, asked the FDA to regulate e-cigarettes under the Tobacco Control Act since they contain nicotine, a tobacco product.

In summary, we need to remember the following about e-cigarette:

- Youth using e-cigarettes without understanding the potential harms is concerning. It could be a gateway to tobacco use. An ordinance similar to Linn County will protect our youth from e-cigarettes.

- The health effects and potential risks of e-cigarettes are, at this time, unknown.

- The efficacy of e-cigarettes as a mechanism to quit smoking has not been fully studied.

- Finally, eight weeks of free smoking cessation is available through Quitline. Call 1-800-QUIT-NOW or visit www.quitlineiowa.gov.

Pramod Dwivedi is Health Director, Linn County Public Health. Comments: Pramod.Dwivedi@linncounty.org

* See more at: http://thegazette.com/2013/12/22/e-cigarettes-deliver-public-health-concerns/#sthash.5CDXl5tW.dpuf

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